N.M. Admin. Code § 7.27.3.9

Current through Register Vol. 35, No. 23, December 10, 2024

Section 7.27.3.9 - MEDICAL DIRECTION GUIDELINES

A. General: These guidelines provide overall guidance for the performance of medical direction in New Mexico. The guidelines set forth the qualifications, responsibilities and activities of a system's designated medical director. The guidelines will also define a process for notifying the EMS bureau of the withdrawal of medical control by a physician from a provider, and specifying requirements for medical direction of intermediate and advanced life support personnel and basic life support personnel with special skills approval. Finally, the guidelines with set forth the legal requirements for an EMS system to maintain "jumpkits" under the authorization of the EMS medical director. Each guideline in Paragraphs 9 and 10 are prefaced by either the word "mandatory" or the word "recommended". Mandatory items are required, while recommended items are highly recommended.

B. Medical director oversight:

(1)

(Mandatory) A designated medical director shall be required for all the situations outlined below:

(a) a certified ambulance carrier as defined in state corporation commission (SCC) Regulation 18 NMAC 4.2 [now 18.4.2 NMAC], or such other rules as may be promulgated by the SCC or its successor agency;

(b) all advanced life support and intermediate life support EMTs;

(c) all basic life support EMTs who provide advanced life support skills, medications, and/or techniques authorized under the scope of practice or special skills authorizations; and

(d) all EMTs or first responders who provide semi-automatic defibrillation services.

(2)

(Recommended) All other services operating on a basic life support (BLS) level are urged to have a local or system-wide medical director as feasible by local situations and availabilities.

C. Medical director qualifications: The qualifications for an EMS medical director are provided below. A medical director:

(1)

(Mandatory) shall be an M.D. or D.O. licensed or otherwise authorized to practice medicine in New Mexico;

(2)

(Mandatory) shall, if a new medical director, complete one of the below listed medical direction education/training methods within one year of assuming the responsibilities of a medical director; current medical directors shall complete one of the below listed methods of medical direction education/training within two years of the effective date of this regulation:

(a) a nationally-recognized EMS medical director's course; or

(b) a bureau-recognized orientation course; or

(c) a local orientation provided by a regional or state EMS medical director.

(3)

(Mandatory) The bureau shall be notified within thirty (30) days when a new EMS medical director assumes responsibilities or when a medical director is no longer providing those duties for a service.

(4)

(Recommended) may be familiar with the design and operation of EMS systems;

(5)

(Recommended) may be experienced in, and possess current knowledge of, emergency care of patients who are acutely ill or traumatized (emergency medicine board-certification and/or certification in recognized training such as advanced cardiac life support (ACLS), advanced trauma life support (ATLS), or pediatric advanced life support (PALS) are recommended);

(6)

(Recommended) may be actively involved and knowledgeable in:

(a) the emergency management of acutely ill or injured patients;

(b) the training and continuing education of EMS personnel under the medical director's supervision at their level of certification;

(c) the quality assurance program of a service including, but not limited to, medical audit, review and critique of basic and advanced level EMS personnel;

(d) the administrative and legislative processes affecting regional and/or state pre-hospital EMS organizations; and

(e) the laws and regulations affecting local, regional and state EMS services and personnel.

D. Administrative and system oversight responsibilities: The EMS medical director, in conjunction with the local EMS service director and other local advisory boards or committees shall provide the responsibilities outlined below (any element of these responsibilities may be delegated as appropriate to other qualified individuals within the EMS system):

(1) advise the program administrator on all elements of the EMS program as to their medical appropriateness and to assure the quality medical services are being provided;

(2) approve the level of pre-hospital care which may be rendered locally by each of the EMS personnel employed by and/or volunteering with the services under the medical director's supervision;

(3) regardless of an EMS provider's level of state certification or licensure, approve the level that each EMS provider may function at locally, before the provider is permitted to perform pre-hospital care to the public;

(4) establish and monitor field performance standards for EMS personnel in the service;

(5) assist in development of local disaster and mass casualty plans;

(6) develop and sign a contract or letter of agreement between the medical director and the EMS service outlining the specific responsibilities, authorities and, if appropriate, compensation of the EMS medical director;

(7) develop procedures with the service on a method by which the medical director may withdraw medical control for an EMS provider who is non-compliant with these guidelines, other relevant laws and regulations and accepted medical standards. The procedure shall be outlined in the contract or letter of agreement between the medical director and the service; shall reflect any internal procedures of that EMS service and due process afforded individual providers, if any, as outlined by the service; and

(8) establish local medical standards for dispatch procedures to assure the appropriate EMS response units are dispatched to the medical emergency scene. This should include development of a relevant emergency medical dispatch system with the local agency providing dispatch for the EMS service.

E. Protocol development: The medical director shall:

(1) develop, implement, and revise written treatment protocols and standing orders governing pre-hospital care and medical aspects of patient triage, transport, transfer, dispatch, extrication, rescue and radio telephone communication by the EMS service; and

(2) establish written protocols under which circumstances the EMS service may:

(a) not transport a patient when there has been an initial call for services;

(b) transport a patient against his/her will, in accordance with state law including procedure, appropriate forms and review process;

(c) handle emergency treatment of a minor, especially in cases where that patient refuses treatment and transport;

(d) interaction with an intervening health care provider at the scene of an emergency;

(e) not begin or terminate life support measures in patients with EMS do not resuscitate (DNR) orders, hospice protocols and other legally recognized advanced directives; and

(f) triage and transport trauma patients consistent with state patient triage criteria and transport protocols.

F. Training responsibilities: The medical director shall:

(1) establish and monitor the training standards of a service for initial and continuing medical education; and

(2) provide, as appropriate, educational sessions for EMS personnel within the service.

G. Quality assurance/improvement responsibilities: The medical director shall plan, develop and implement a system for ongoing medical audit of pre-hospital patient care rendered by the EMS service and its personnel. This auditing system shall provide for, but not be limited to:

(1) an organized method for internal collection of operational and patient care data, including access to both pre-hospital and outcome records to permit identification and resolution of problems impacting the quality of patient care;

(2) a comprehensive mechanism for receipt, investigation and resolution of medically-related complaints about the EMS service;

(3) regular review and on-site evaluation of EMS personnel operating within the service; and

(4) regular review of the overall system to assure compliance with state corporation commission Regulation 18 NMAC 4.2 [now 18.4.2 NMAC], or such other rules as may be adopted by the SCC or its successor agency.

H. Medical liaison responsibilities: The medical director shall:

(1) function as the liaison between the EMS system and the local medical community, medical facilities and regional/state EMS medical directors; and

(2) as needed, be available to represent the medical aspects of an EMS service to local, regional or state boards/committees, as well as political subdivisions such as municipal governing bodies or legislatures.

I. Notification of withdrawal or restriction of medical support: An EMS medical director may withdraw or restrict all or any of the medical control authorized to a provider under his/her medical direction in the following manner:

(1) the withdrawal or restriction shall be made in writing and sent to the EMS provider, EMS service director and operations section of the bureau within five (5) working days of the action; and

(2) the bureau shall perform a preliminary investigation and decide, after consultation with the EMS medical director and service director, whether or not the matter shall be referred to the commission for investigation with potential impact on licensure or be handled locally within the service.

J. Medication control and storage: The EMS medical director shall: if appropriate for the local service, develop a program whereby reasonable quantities of dangerous drugs may be possessed and transported to other locations by authorized personnel in "jumpkits". These "jumpkits" will be kept at the authorized personnel's residence(s) or vehicle(s) and will be stored according to the New Mexico board of pharmacy regulations (i.e., temperature control and security).

(1) The specific dangerous drugs and the quantities allowed in "jumpkits" will be determined and approved by the EMS medical director and made available to the New Mexico board of pharmacy or its staff, as requested.

(2) A list of authorized personnel who maintain "jumpkits" shall be made available at the request of the New Mexico board of pharmacy or its staff.

(3) An inventory of all dangerous drugs, including controlled substances, issued to authorized personnel for "jumpkits" will be kept for a period of three (3) years and will include the following:

(a) date issued;

(b) name of authorized personnel;

(c) name and strength of dangerous drugs or controlled substances issued.

(4) The "jumpkits" will be made available during consulting pharmacist inspections, as requested, and with advance notice, to the New Mexico board of pharmacy inspectors.

(5) "Jumpkits" which are authorized by the EMS medical director, to including [sic] specifically approved quantities of controlled substances, shall be on the EMT's person or double-locked and secure. Controlled substances shall not be stored in unattended vehicles.

N.M. Admin. Code § 7.27.3.9

3/16/95, 1/1/97, 4/1/98; Recompiled 10/31/01