R426-2. Emergency Medical Services Provider Designations for Pre-Hospital Providers, Critical Incident Stress Management and Quality Assurance Reviews, R426. Health, Family Health and Preparedness, Emergency Medical Services, Utah Administrative Code

Utah Administrative Code (Current through November 1, 2019)

R426. Health, Family Health and Preparedness, Emergency Medical Services

R426-2. Emergency Medical Services Provider Designations for Pre-Hospital Providers, Critical Incident Stress Management and Quality Assurance Reviews

R426-2-100. Authority and Purpose

Latest version.

(1) This rule establishes types of providers that require a designation, the application process for a obtaining a designation and minimum designation requirements.

(2) The rule also establishes criteria for critical incident stress management and the process for quality assurance reviews.

R426-2-200. EMS Provider Designation Types

Latest version.

(1) The following type of provider shall obtain a designation from the Department:

(a) Quick Response Unit;

(b) Emergency Medical Service Dispatch Center; or

R426-2-300. Quick Response Unit Minimum Designation Requirements

Latest version.

(1) A quick response unit shall meet the following minimum designation requirements:

(a) vehicle(s), equipment, and supplies that meet Department requirements;

(b) describe location(s) for stationing its vehicle(s), equipment and supplies;

(d) a Department-endorsed training officer;

(e) a current plan of operations, which shall include:

(i) the names, EMS ID Number, and license level of all personnel;

(ii) operational procedures; and

(iii) a description of how the designated provider proposes to interface with other licensed and designated EMS providers.

(f) A current agreement with a Department-certified off-line medical director who will perform the following:

(i) develop and implement patient care standards which include written standing orders and triage, treatment, pre-hospital protocols, and/or pre-arrival instructions to be given by designated emergency medical dispatch centers;

(ii) ensure the qualification of field licensed EMS personnel involved in patient care and dispatch through the provision of ongoing continuing medical education programs and appropriate review and evaluation;

(iii) develop and implement an effective quality improvement program, including medical audit, review, and critique of patient care;

(iv) annually review triage, treatment, and transport protocols and update them as necessary;

(v) suspend from patient care, pending Department review, a field EMS personnel or dispatcher who does not comply with local medical triage, treatment and transport protocols, pre-arrival instruction protocols, or who violates any of the EMS rules, or who the medical director determines is providing emergency medical service in a careless or unsafe manner.

(vi) notify the Department within one business day of any imposed suspensions; and

(vii) attend meetings of the local EMS Council, if one exists, to participate in the coordination and operations of local EMS providers.

(g) Have current treatment protocols approved by the certified off-line medical director for the designated service level;

(h) provide the Department with a copy of its certificate of insurance;

(i) provide the Department with a letter of support from the licensed ambulance provider(s) in the geographical service area; and

(j) not be disqualified for reasons including:

(i) violation of Subsection 26-8a-504; or

(ii) a history of disciplinary action relating to an EMS license, permit, designation or certification in this or any other state.

R426-2-400. Emergency Medical Service Dispatch Center Minimum Designation Requirements

Latest version.

(1) Have in effect a selective medical dispatch system approved by the off-line medical director which includes:

(a) systemized caller interrogation questions;

(b) systemized pre-arrival instructions;

(c) protocols matching the dispatcher's evaluation of injury or illness severity with vehicle response mode and configuration;

(d) use protocols matching the dispatcher's evaluation of injury or illness severity with vehicle response mode and configuration;

(e) provide pre-hospital arrival instructions by a licensed Emergency Medical Dispatcher;

(f) have a current updated plan of operations including:

(i) plan of operations to be used in a disaster or emergency;

(ii) communication systems; and

(iii) aid agreements with other designated medical service dispatch centers;

(g) a current agreement with a Department-certified off-line medical director;

(h) an ongoing medical call review quality assurance program; and

(i) a licensed emergency medical dispatcher roster including licensed staff names, Department license numbers and expiration dates, and dispatch system training certification number and expiration dates.

R426-2-500. Nonemergency Secured Behavioral Health Transport Minimum Designation Requirements

Latest version.

(1) Vehicle(s), equipment, and supplies that meet the current requirements of the Department for designated nonemergency secured behavioral health transport providers as found on the Bureau of EMS and Preparedness' website.

(2) Meet staffing requirements as set forth by the EMS Committee. During transport each designated nonemergency secured behavioral health transport vehicle shall be staffed with two personnel, with at least one who has obtained required training as approved by Department policy for mental health patient de-escalation and American Heart Association cardiopulmonary resuscitation or equivalent.

R426-2-600. Designation Applications

Latest version.

(1) Any person applying for designation shall submit to the Department:

(a) Applications fees.

(b) Complete application on Department approved forms.

(2) The Department may determine if clarifying information is needed for approval or processing. The Department will provide needed requirements to the applicant.

(3) A provider applying for re-designation should submit an application as described above 90 days prior to the expiration of its designation in order to avoid a lapsed period of time.

(4) A designation may be issued for up to a four-year period.

R426-2-700. Quick Response Unit Designation Applications

Latest version.

(1) A Quick Response Unit shall provide:

(a) name of the organization and its principles;

(b) name of the person or organization financially responsible for the service and documentation from that entity accepting responsibility;

(d) a description of the geographical area of service; and

(e) a demonstrated need for the service.

R426-2-710. Stroke Treatment and Stroke Receiving Center Designation Requirements

Latest version.

A hospital desiring to be a Stroke Treatment Center (Primary or Comprehensive) must be accredited as such by the Joint Commission on Accreditation of healthcare Organizations (JACHO) or other nationally recognized accrediting body. A hospital desiring to be designated as a Stroke Receiving Center for receiving stroke patients via Emergency Medical Services shall meet the following requirements:

(1) Be licensed as an acute care hospital in Utah.

(2) Have an emergency department staffed by a Registered Nurse at all time.

(3) Require physician response to the emergency department in less that thirty (30) minutes for treatment of stroke patients.

(4) Maintain the ability of physician and nursing staff to utilize a standardized assessment tool for ischemic stroke patients.

(5) Maintain, have readily available and utilize approved thrombolytic medications for treatment of patients meeting criteria for administration of thrombolytic therapy.

(6) Have a standardized acute stroke protocol in place and provide authority of appropriate emergency department staff to implement the protocol when appropriate.

(7) Maintain availability of ancillary equipment and personnel to diagnose and treat acute stroke patients in a timely manner.

(8) Have in place patient transport protocols with designated stroke treatment centers.

(9) Have an active and functioning performance improvement program for acute stroke care and report required data to the Utah Department of Health as required by the Department.

(10) Submit to a formal survey by representatives of the Department

(11) Upon successful designation, the Department may, in consultation with off line EMS medical direction and protocol, recommend direct transport of stroke patients to a Stroke Receiving Center or a Stroke Treatment Center by an EMS agency.

R426-2-720. Percutaneous Coronary Intervention (PCI) Center Requirements

Latest version.

A hospital desiring to be designated as a Percutaneous Coronary Intervention (PCI) Center for the purpose of receiving acute ST-elevation myocardial infarction (STEMI) patients via EMS shall meet to following requirements:

(1) Be licensed as an acute care hospital in Utah.

(2) Have an emergency department staffed by at least one (1) Physician and one (1) Registered Nurse at all times.

(3) Have the ability to receive 12 lead EKG data from EMS agencies transporting patients to the hospital for treatment of ST Segment Elevation Myocardial Infarction (STEMI).

(4) Have and maintain the ability to provide cardiac catheterization and PCI of STEMI patients within ninety (90) minutes of patient arrival in the emergency department 24/7.

(5) Have an active and functioning performance improvement program for STEMI care and report required data to the Utah Department of Health as required by the Department.

(6) Submit to a forma survey by representatives of the Department.

(7) Upon successful designation, the Department may, in consultation with offline EMS medical direction and protocol, recommend direct transport of STEMI patients to a STEMI Treatment Center by an EMS agency.

R426-2-800. Emergency Medical Service Dispatch Center Designation Applications

Latest version.

(1) An Emergency Medical Service Dispatch Center shall provide:

(a) name of the organization and its principles;

(b) name of the person or organization financially responsible for the service provided by the designee and documentation from that entity accepting responsibility;

(d) a description of the geographical area of service; and

(e) a demonstrated need for the service.

R426-2-810. Stroke Designation Application

Latest version.

A hospital desiring to be designated as a Stroke Receiving Center shall submit the applicable fees and an application on Department-approved forms to the Department. As part of the application, the applicant shall provide:

(1) The name of the hospital to be designated.

(2) The hospital address

(3) The name and phone number of the person responsible for supervision of the hospital's stroke care.

(4) Other information that the department deems necessary for processing of the application and oversight of the designated entity.

(5) Hospitals desiring designation must be verified by hosting a site visit by the Department.

(6) The Department and its consultants my conduct observation, review and monitor activities with any designated stroke center to verify ongoing compliance with designation requirements.

(7) Submit performance improvement data to the Department as required.

R426-2-820. Percutaneous Coronary Intervention (PCI) Center Application

Latest version.

A hospital desiring to be designated as a ST Segment Elevation Myocardial Infarction (STEMI) Treatment Center shall submit the applicable fees and an application on Department-approved forms to the Department. As part of the application, the applicant shall provide:

(1) The name of the hospital to be designated.

(2) The hospital address

(3) The name and phone number of the person responsible for supervision of the hospital's STEMI care.

(4) Other information that the department deems necessary for processing of the application and oversight of the designated entity.

(5) Hospitals desiring designation must be verified by hosting a site visit by the Department.

(6) The Department and its consultants my conduct observation, review and monitor activities with any designated stroke center to verify ongoing compliance with designation requirements.

(7) Submit performance improvement data to the Department as required.

R426-2-900. Nonemergency Secured Behavioral Health Transport Designation Applications

Latest version.

(1) A designated nonemergency secured behavioral health transport provider shall provide to the Department:

(a) name of the organization and its principles;

(b) name of the person or organization financially responsible for the service and documentation from that entity accepting responsibility; and

(2) Provide a current plan of operations, which shall include:

(a) a description of operational procedures;

(b) description(s) of how the designated non-emergency secured behavioral health transport will interface with hospitals, emergency receiving facilities, licensed mental health facilities, and EMS providers;

(d) written policies that address under what circumstances a transport will be declined for medical or payment purposes;

(e) a written protocol to activate 911 if an emergency medical situation arises; and

(f) procedures for patient care.

(3) Provide a written policy of how the designated nonemergency secured behavioral health transport will report patient care data to the Department.

(4) Provide a copy of its certificate of insurance or if seeking application, provide proof of the ability to obtain insurance to respond to damages due to operation of a vehicle in the and following minimum amounts:

(a) liability insurance in the amount of $1,000,000 for each individual claim; and

(b) liability insurance in the amount of $1,000,000 for property damage from any one occurrence.

(5) A designated nonemergency secured behavioral health transport provider shall obtain the insurance from an insurance company authorized to write liability coverage in Utah or through a self-insurance program and shall:

(a) provide the Department with a copy of its certificate of insurance demonstrating compliance with this section;

(b) direct the insurance carrier or self-insurance program to notify the Department of all changes in insurance coverage within 60 days; and

(c) provide the Department with a copy of its certificate of insurance indicating coverage at or above $1,000,000 for liability.

(6) Prior to approval of the designation, all vehicles will be inspected and permitted by the Department and shall meet the requirements in R426-4-300(5).

(7) Not be disqualified for any of the following reasons:

(a) violation of Subsection 26-8a-504; or

(b) a history of disciplinary action relating to an EMS license, permit, designation or certification in this or any other state.

R426-2-1000. Denial or Revocation of Designation

Latest version.

(1) The Department may deny an application for a designation for any of the following reasons:

(a) failure to meet requirements as specified in the rules governing the service;

(b) failure to meet vehicle, equipment, or staffing requirements;

(d) conduct during the performance of duties relating to its responsibilities as an EMS provider that is contrary to accepted standards of conduct for EMS personnel described in Sections 26-8a-502 and 26-8a-504;

(e) failure to meet agreements covering training standards or testing standards;

(f) a history of disciplinary action relating to a license, permit, designation, or certification in this or any other state.

(g) a history of criminal activity by the licensed or designated provider or its principals while licensed or designated as an EMS provider or while operating as an EMS service with permitted vehicles;

(h) falsifying or misrepresenting any information required for licensure or designation or by the application for either;

(i) failure to pay the required designation or permitting fees or failure to pay outstanding balances owed to the Department;

(j) failure to submit records and other data to the Department as required by statute or rule;

(k) misuse of grant funds received under Section 26-8a-207; and

(l) violation of OSHA or other federal standards that it is required to meet in the provision of the EMS service.

(2) An applicant who has been denied a designation may request a Department review by filing a written request for reconsideration within thirty calendar days of the issuance of the Department's denial.

R426-2-1100. Application Review and Approval

Latest version.

(1) If the Department finds that an application for designation is complete and that the applicant meets all requirements, it may approve the designation.

R426-2-1200. Change in Designated Level of Service

Latest version.

(1) A quick response unit may apply to provide a higher designated level of service by:

(a) submitting the applicable fees; and

(b) submitting an application on Department-approved forms to the Department.

(2) As part of the application, the applicant shall provide:

(a) a copy of the new treatment protocols for the higher level of service approved by the off-line medical director;

(b) an updated plan of operations demonstrating the applicant's ability to provide the higher level of service;

(c) a written assessment of the performance of the applicant's field performance by the applicant's off-line medical director; and

(d) provide the Department with a letter of support from the licensed provider(s) in the geographical service area.

(3) If the Department finds that the applicant has demonstrated the ability to provide the upgraded service, it shall issue a new designation reflecting the higher level of service.

R426-2-1300. Critical Incident Stress Management and Peer Support Training

Latest version.

(1) The Department may establish a critical incident stress management (CISM) team to meet its public health responsibilities.

(2) The Department's CISM team may conduct stress debriefings, defusings, demobilizations, education, and other critical incident stress interventions upon request for persons who have been exposed to one or more stressful incidents in the course of providing emergency services.

(3) The Department's CISM team may assist the Department in approving peer support training for licensed EMS personnel.

(4) Individuals who serve on the CISM team shall complete Department approved initial and ongoing training.

(5) While serving as a CISM team member, the individual is acting on behalf of the Department. All records collected by the CISM team are Department records. CISM team members shall maintain all information in strict confidence.

(6) The Department may reimburse a CISM team member for travel expenses incurred in performing his or her duties in accordance with state finance mileage reimbursement policy.

(7) The Department will maintain a list of individuals who have successfully completed an approved peer support training program.

(8) Individuals who perform peer support functions may receive legal protections to not be compelled to disclose information as described in Utah Code Section 78B-5 Part 9.

(9) Individuals who perform peer support functions for a licensed or designated EMS provider should be familiar with peer support policies for the licensed or designated EMS provider with whom they are employed or otherwise serving.

R426-2-1400. Quality Assurance Reviews

Latest version.

(1) The Department may conduct quality assurance reviews of licensed and designated providers and training programs on an annual basis or more frequently as necessary to enforce this rule.

(2) The Department shall conduct a quality assurance review prior to issuing a new license or designation.

(3) The Department may conduct quality assurance reviews on all personnel, vehicles, facilities, communications, equipment, documents, records, methods, procedures, materials and all other attributes or characteristics of the designated provider.

(a) The Department will provide a written copy to the designated provider.

(b) The designated provider shall correct deficiencies within 30 days unless otherwise directed by the Department.

(c) The designated provider shall immediately notify the Department on a Department-approved form when the deficiencies have been corrected.