No. 28813 (Amendment): R426-100. Emergency Medical Services Do Not Resuscitate

DAR File No.: 28813
Filed: 06/15/2006, 04:27
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment provides for the use of medic alert type-bracelet in addition to the Department of Health-issued bracelet for use with an Emergency Medical Services (EMS) "Do Not Resuscitate" declaration.

 

Summary of the rule or change:

The rule change clarifies and adds language to allow the use of metal medic alert type-bracelets and necklaces. This will allow patients who choose to declare a "Do Not Resuscitate" order, the option of wearing a metal bracelet or necklace, rather than the plastic hospital type bracelet provided and currently required by the Department of Health, Bureau of EMS.

 

State statutory or constitutional authorization for this rule:

Title 26, Chapter 8a; and Section 75-2-1105

 

Anticipated cost or savings to:

the state budget:

There is no anticipated cost or savings to state budget because this option is entirely voluntary to the individual.

 

local governments:

There is no anticipated cost or saving to local government because this option is entirely voluntary to the individual.

 

other persons:

Assuming that 10 individuals annually opt to use the alternative bracelets, the cost will be approximately $300 annually.

 

Compliance costs for affected persons:

Each person who chooses to participate in this option will pay approximately $30 for the alternate bracelet. However, participation is completely voluntary.

 

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

This rule change will improve use of medical alert bracelets and should have no negative fiscal impact on regulated businesses. A. Richard Melton, Acting 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:

07/31/2006

 

This rule may become effective on:

08/07/2006

 

Authorized by:

Richard Melton, Deputy Director

 

 

RULE TEXT

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

R426-100. Emergency Medical Services Do Not Resuscitate.

R426-100-2. EMS/DNR Forms, Directives, [and ]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.

(4) [Only the Department may create an]An EMS/DNR bracelet or necklace[which] may be issued only to individuals whose physician has determined that the declarant is in a terminal condition and who submits an EMS/DNR directive to the Department.[ The bracelet shall clearly display the declarant's name, the name of the proxy if the EMS/DNR directive was made by a proxy, attending physician's name and telephone number, and the unique identifying number from the EMS/DNR form.]

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

(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 has submitted 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 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;

(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, 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 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 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 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 sufficient to notify EMS personnel of the existence of the EMS/DNR directive.

(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.

 

R426-100-6. 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 [standing]written orders. 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, do not resuscitate

Date of Enactment or Last Substantive Amendment: [March 14, 2003]2006

Notice of Continuation: October 1, 2004

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