N.J. Admin. Code § 8:41-9.6

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:41-9.6 - Medical command

(a) The provision of advanced life support care by ALS crewmembers staffing a MICU is deemed a delegated medical practice. The medical command physician provides the authority for the ALS crewmembers to act.

(b) The medical command physician shall provide medical command to ALS crewmembers in a timely fashion and without undue delay.

1. All orders shall be prefaced with the name of the physician ordering the treatment.

(c) In the event that a MICU not affiliated with the mobile intensive care program seeks medical command from the medical command physician, the physician shall provide medical command as if the MICU was one of the program's own.

(d) In the instance where a physician arrives on the scene prior to the arrival of the crewmembers, the on-scene physician is deemed to have assumed medical command and shall remain in charge of the care of the patient until such time as he or she decides to relinquish control. The crewmembers shall inform the on-scene physician as to the policy for contact with the medical command physician and request that the on-scene physician initiate contact so as to coordinate patient care. If it is appropriate that the on-scene physician remain in charge, he or she must be physically present with the crewmembers through transport to the receiving health care facility and shall sign off on the patient care report.

(e) In the instance where a physician arrives on the scene after the arrival of the crewmembers, the crewmembers shall advise the physician that they are operating under the direct supervision of a medical command physician. If the on-scene physician feels that he or she may be helpful in the patient's medical treatment, he or she should speak to the medical command physician to relay information and discuss care. The medical command physician may then, as he or she deems appropriate, either retain medical command or turn over medical command to the on-scene physician. If the on-scene physician assumes medical command, he or she must be physically present with the crewmembers throughout the transport to the receiving health care facility and shall sign off on the patient care report.

(f) Except as provided for in the event of communications failure or standing orders authorized by this chapter, no ALS crewmember shall perform any skill or procedure, administer any pharmaceutical agent or engage in any other activity within his or her approved scope of practice unless the crewmember has first received the direct and specific order of the medical command physician or physician directed registered nurse.

(g) All orders given to ALS crewmembers shall be specific with regard to treatments ordered or medications and dosages to be given and the sequence in which the treatment is to be performed.

(h) ALS crewmembers shall provide the medical command physician or physician directed registered nurse with an appropriate report of patient assessment, patient condition, patient updates after treatment has been rendered and any other information required by the physician.

(i) Communications with the ALS crewmembers shall be performed directly by the medical command physician unless prevented by emergent patient care duties. In that case, a physician directed registered professional nurse may relay the report and orders if the registered nurse:

1. Possesses CPR and ACLS certifications;

2. Possesses PALS certification or has successfully completed the Emergency Pediatric Nurse Course to the standards of the Emergency Nurses Association;

3. Has been trained in the proper use of the base station; and

4. Personally relays the report to the medical command physician and any orders or direction to the ALS crewmembers. All orders shall be prefaced with the name of the medical command physician ordering the treatment.

(j) No medical command physician or physician directed registered nurse shall order any crewmember to perform any treatment or administer any medication outside of the crewmember's approved scope of practice.

(k) The medical command physician shall review the patient care report and affix his or her original signature to it, in accordance with established institutional policies, but not later than 30 calendar days after providing the medical direction. The medical command physician shall inform the medical director of any discrepancies in the patient care report.

(l) In an instance where patient care is provided in accordance with approved communications failure protocols, the authority for such treatment shall be deemed to emanate from the medical director.

(m) In every instance where an ALS crewmember has treated a patient, the medical command physician who provided the medical direction to the ALS crewmember shall ensure that the receiving health care facility is notified as soon as possible after providing medical command. The report shall be relayed to either a physician or registered nurse at the receiving health care facility, and shall contain:

1. The patient's chief complaint and presenting signs and symptoms;

2. Treatment ordered for the patient; and

3. The estimated time of arrival of the patient.

N.J. Admin. Code § 8:41-9.6