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Code of Maryland Regulations Title 30 Maryland Institute for Emergency Medical Services Systems.

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Presentation on theme: "Code of Maryland Regulations Title 30 Maryland Institute for Emergency Medical Services Systems."— Presentation transcript:

1 Code of Maryland Regulations Title 30 Maryland Institute for Emergency Medical Services Systems

2 Objectives Following the completion of this presentation the participant will be able to: Following the completion of this presentation the participant will be able to: Locate and reference the Code of Maryland Regulations (COMAR), Title 30 Locate and reference the Code of Maryland Regulations (COMAR), Title 30 Describe the impact of Title 30 on the daily operations of emergency services Describe the impact of Title 30 on the daily operations of emergency services Recognize the Provider Review Process (PRP) Recognize the Provider Review Process (PRP) Recognize the role of Quality Review as outlined in Title 30 Recognize the role of Quality Review as outlined in Title 30

3 Why Regulate? Why Regulate? Why Regulate? In its infancy MIEMSS established guidelines based on an informal process. In its infancy MIEMSS established guidelines based on an informal process. The result was inconsistency, and the lack of coordination often caused confusion among providers. The result was inconsistency, and the lack of coordination often caused confusion among providers. There were no formal policies or procedures. There were no formal policies or procedures.

4 Maryland Regulations Maryland Regulations Regulations are the generally applicable rules under which a state agency operates. The legislature must authorize an agency to promulgate regulations. The agency then must follow detailed rules in drafting and enacting the regulations.

5 What is COMAR? The Regulations of all Maryland Agencies are collected in the Code of Maryland Regulations known as “COMAR”. The Regulations of all Maryland Agencies are collected in the Code of Maryland Regulations known as “COMAR”.

6 COMAR Description COMAR is divided into “Titles”. Each title is numbered and generally represents the rules for a separate state agency. COMAR is divided into “Titles”. Each title is numbered and generally represents the rules for a separate state agency. Examples: Examples: MIEMSS -Title 30 MIEMSS -Title 30 Department of Health -Title 10 Department of Health -Title 10

7 COMAR Description Titles are then broken down into “Subtitles” or “Chapters”. Titles are then broken down into “Subtitles” or “Chapters”. Examples from MIEMSS Title 30: Examples from MIEMSS Title 30: Subtitle 02: Emergency Medical Services Providers Subtitle 02: Emergency Medical Services Providers Chapter 03: Scope of Practice and Duties Chapter 03: Scope of Practice and Duties

8 COMAR Description The information in each chapter defines the regulations relating to that title. The information in each chapter defines the regulations relating to that title. The chapter is written in outline format (much like the Maryland Medical Protocols) for ease of reference. The chapter is written in outline format (much like the Maryland Medical Protocols) for ease of reference. Each Subtitle contains a list of definitions for terms used in the chapter. Each Subtitle contains a list of definitions for terms used in the chapter.

9 Where Can I Locate a Copy? A copy is located in the reference section of each public library. A copy is located in the reference section of each public library. COMAR can also be located on-line at https://constmail.gov.state.md.us/comar/dsd_w eb/default.htm COMAR can also be located on-line at https://constmail.gov.state.md.us/comar/dsd_w eb/default.htm

10 Who Does it Impact? TITLE 30 effects: TITLE 30 effects:...“any EMS service or provider who operates in the State of Maryland”...

11 Operational Impact Day-to-day influence of Title 30 Day-to-day influence of Title 30 Licensure / Certification / Credential Licensure / Certification / Credential Scope of Practice and Duties Scope of Practice and Duties Prohibited Conduct Prohibited Conduct Disciplinary Procedures Disciplinary Procedures Operational Suspensions Operational Suspensions Hearings Hearings Summary Suspension of License or Certification Summary Suspension of License or Certification

12 Maryland Title 30 Overview Subtitle 01: General Subtitle 01: General Subtitle 02: Emergency Medical Services Providers Subtitle 02: Emergency Medical Services Providers Subtitle 03: EMS Operational Programs Subtitle 03: EMS Operational Programs Subtitle 04: Emergency Medical Services Education Programs and Courses Subtitle 04: Emergency Medical Services Education Programs and Courses Subtitle 06: Automated External Defibrillation Program Subtitle 06: Automated External Defibrillation Program

13 Maryland Title 30 Subtitle 07: Emergency Medical Communications System Subtitle 07: Emergency Medical Communications System Subtitle 08: Designation of Trauma and Specialty Referral Centers Subtitle 08: Designation of Trauma and Specialty Referral Centers Subtitle 09: Commercial Ambulances Services Subtitle 09: Commercial Ambulances Services Subtitle 05 will cover EMS Regional Councils tentatively beginning July 1, Subtitle 05 will cover EMS Regional Councils tentatively beginning July 1, 2002.

14 Subtitle 01 General Explains “Incorporation by Reference” Explains “Incorporation by Reference” The mechanism for including the Maryland Medical Protocols into COMAR. The mechanism for including the Maryland Medical Protocols into COMAR. Designates the MIEMSS “Open Meeting” policy. Designates the MIEMSS “Open Meeting” policy. Outlines the process for the access and/or correction of public records. Outlines the process for the access and/or correction of public records. Governs the procedures for obtaining a declaratory ruling from the EMS Board. Governs the procedures for obtaining a declaratory ruling from the EMS Board.

15 Subtitle 02 Emergency Medical Services Providers Defines the Licensure and Certification Process Defines the Licensure and Certification Process Including: Including: Establishing fees for testing Establishing fees for testing Requirements for providers Requirements for providers Reciprocity Reciprocity Examination and reexamination Examination and reexamination Issuance of a license or certificate Issuance of a license or certificate Renewal, surrender and/or reinstatement of a license or certificate Renewal, surrender and/or reinstatement of a license or certificate Criteria for denial of a license or certificate Criteria for denial of a license or certificate

16 Subtitle 02 Emergency Medical Services Providers Chapter 3 of this subtitle establishes the “Scope of Practice” (based on the Maryland Medical Protocols) and duties for all levels of EMS providers including: Chapter 3 of this subtitle establishes the “Scope of Practice” (based on the Maryland Medical Protocols) and duties for all levels of EMS providers including: Emergency Medical Dispatchers Emergency Medical Dispatchers First Responders First Responders The chapter also contains the requirement that an EMS provider must function under an EMS Operational Program. The chapter also contains the requirement that an EMS provider must function under an EMS Operational Program.

17 Subtitle 02 Emergency Medical Services Providers Chapter 4 defines “Prohibited Conduct” Chapter 4 defines “Prohibited Conduct” Outlines the actions that can be taken as a result of prohibited conduct Outlines the actions that can be taken as a result of prohibited conduct Reprimand or probation Reprimand or probation Suspend or revoke a license or certificate Suspend or revoke a license or certificate Deny a license or certificate Deny a license or certificate Refuse to renew a license or certificate Refuse to renew a license or certificate

18 Subtitle 02 Emergency Medical Services Providers Chapter 05 specifies the disciplinary procedures including: Chapter 05 specifies the disciplinary procedures including: Investigation of incident reports Investigation of incident reports Review by the Provider Review Panel Review by the Provider Review Panel Action by the EMS Board Action by the EMS Board Case resolution conference Case resolution conference Hearings Hearings EMS Board action EMS Board action

19 Subtitle 02 Emergency Medical Services Providers Chapter 5 continued: Designates the composition of the Provider Review Panel Designates the composition of the Provider Review Panel Establishes the process for summary suspension of a license or certification Establishes the process for summary suspension of a license or certification Provides confidentiality and admissibility of proceedings, records, and files used throughout the provider review process. Provides confidentiality and admissibility of proceedings, records, and files used throughout the provider review process.

20 Subtitle 02 Emergency Medical Services Providers Chapter 6 : Contains the procedures for administrative hearings regarding: Contains the procedures for administrative hearings regarding: Licensure Licensure Certification Certification Disciplinary action of an EMS provider Disciplinary action of an EMS provider

21 Subtitle 02 Emergency Medical Services Providers Chapter 7 : Governs summary procedures for suspending an EMS providers license or certificate based on the protection of public health, safety or welfare. Governs summary procedures for suspending an EMS providers license or certificate based on the protection of public health, safety or welfare.

22 Subtitle 03 EMS Operational Programs Defines the criteria for approval of an EMS Operational Program Defines the criteria for approval of an EMS Operational Program Establishes the policy for Medical Direction including the appointment of the EMS Medical Directors. Establishes the policy for Medical Direction including the appointment of the EMS Medical Directors. Provides the guidelines for quality assurance, protocol development and designation of Base stations. Provides the guidelines for quality assurance, protocol development and designation of Base stations.

23 Subtitle 03 EMS Operational Programs Quality Assurance (QA) Each EMS Operational Program must have: Each EMS Operational Program must have: A written QA plan approved by the medical director A written QA plan approved by the medical director A medical Review Committee A medical Review Committee

24 Quality Assurance Quality assurance plan components Quality assurance plan components Data review Data review Identification and analysis of trends Identification and analysis of trends Positive Positive Negative Negative Identification of protocol violations Identification of protocol violations Remediation for patient care issues at the jurisdictional level. Remediation for patient care issues at the jurisdictional level.

25 Quality Assurance Quality assurance plan requirements Quality assurance plan requirements Notify MIEMSS within 30 days of incidents that may have resulted in patient harm, require disciplinary actions from MIEMSS, or require a change in state protocol. Notify MIEMSS within 30 days of incidents that may have resulted in patient harm, require disciplinary actions from MIEMSS, or require a change in state protocol. Review written and oral allegations that an EMS provider failed to act in accordance with applicable law or protocol. Review written and oral allegations that an EMS provider failed to act in accordance with applicable law or protocol.

26 Medical Review Committee Medical Review Committee (MRC) responsibilities: Every operational program must designate a MRC. Every operational program must designate a MRC. The committee is selected by the operational program and its medical director. The committee is selected by the operational program and its medical director. It shall be the duty of the MRC with the participation of the medical director to carry out the quality assurance plan. It shall be the duty of the MRC with the participation of the medical director to carry out the quality assurance plan.

27 Medical Review Committee Medical Review Committee (MRC) responsibilities: The MRC is subject to the confidentiality and immunity provisions as provided by COMAR. The MRC is subject to the confidentiality and immunity provisions as provided by COMAR. Each member must sign a confidentiality agreement. Each member must sign a confidentiality agreement.

28 Subtitle 03 EMS Operational Programs Protocol development is also covered under this subtitle. Protocol development is also covered under this subtitle. Chapter 05 section.02 defines the composition of the Protocol Review Committee. Chapter 05 section.02 defines the composition of the Protocol Review Committee. This section also established the process for protocol development and approval including: This section also established the process for protocol development and approval including: Pilot Protocols Pilot Protocols Research Protocols Research Protocols Optional Protocols Optional Protocols Emergency Protocols Emergency Protocols

29 Subtitle 03 EMS Operational Programs Chapter 06 governs the approval and operation of an EMS Base Station. Chapter 06 governs the approval and operation of an EMS Base Station. Specific requirements are outlined for: Specific requirements are outlined for: Approval and renewal Approval and renewal Specialty centers and consultation centers Specialty centers and consultation centers Out-of-state centers Out-of-state centers Denial or rescission of approval Denial or rescission of approval Appeal process Appeal process

30 Subtitle 04 Emergency Medical Services Education Programs and Courses Governs the Educational Programs for: Governs the Educational Programs for: Emergency Medical Dispatchers Emergency Medical Dispatchers Basic Life Support Providers Basic Life Support Providers Advanced Life Support Providers Advanced Life Support Providers

31 Subtitle 04 Emergency Medical Services Education Programs and Courses Governs the Educational Programs for: Governs the Educational Programs for: Emergency Medical Dispatchers Emergency Medical Dispatchers Basic Life Support Providers Basic Life Support Providers Advanced Life Support Providers Advanced Life Support Providers Requirements for continuing education programs are also contained within this subtitle. Requirements for continuing education programs are also contained within this subtitle.

32 Subtitle 06 Automated External Defibrillation Program Establishes the criteria for the authorization of “Public Access” AED Programs Establishes the criteria for the authorization of “Public Access” AED Programs Specific requirements for PAD programs include: Specific requirements for PAD programs include: Medical direction Medical direction Protocols Protocols Quality assurance and maintenance Quality assurance and maintenance Training Training

33 Subtitle 07 Emergency Medical Services Communications System Establishes the system Establishes the system for helicopter communication to SYSCOM.

34 Subtitle 08 Designation of Trauma and Specialty Referral Centers Provides the criteria for the designation of trauma and specialty referral centers. Provides the criteria for the designation of trauma and specialty referral centers. In addition it outlines the following standards for the trauma and specialty referral centers In addition it outlines the following standards for the trauma and specialty referral centers Data Collection and Quality Management Data Collection and Quality Management Designation and verification criteria Designation and verification criteria Disciplinary Action for subtitle violation Disciplinary Action for subtitle violation

35 Subtitle 08 Designation of Trauma and Specialty Referral Centers This subtitle establishes the standards for the following: This subtitle establishes the standards for the following: Trauma Centers Trauma Centers Burn Centers Burn Centers Specialty Referral Centers Specialty Referral Centers Pediatric Trauma Centers Pediatric Trauma Centers Eye Trauma Centers Eye Trauma Centers Perinatal and Neonatal Referral Centers Perinatal and Neonatal Referral Centers

36 Subtitle 09 Commercial Ambulance Services This subtitle provides the standards for Commercial Ambulance Services in the State of Maryland. This subtitle provides the standards for Commercial Ambulance Services in the State of Maryland. Licensing process is defined Licensing process is defined Operational requirements are established Operational requirements are established Eligibility, application and renewal procedures are included Eligibility, application and renewal procedures are included Record keeping and MIEMSS record submission are outlined Record keeping and MIEMSS record submission are outlined

37 Subtitle 09 Commercial Ambulance Services Commercial Ambulance Services continued Chapter 09 governs the enforcement of commercial ambulance statutes and regulations. Chapter 09 governs the enforcement of commercial ambulance statutes and regulations. A standard commercial ambulance service equipment list (for ALS and BLS) is located in Chapters 10 & 11. A standard commercial ambulance service equipment list (for ALS and BLS) is located in Chapters 10 & 11. The last chapter of the commercial ambulance service subtitle governs the operation of neonatal ambulance services. The last chapter of the commercial ambulance service subtitle governs the operation of neonatal ambulance services.

38 Maryland Title 30 Maryland Information System Maryland Information System Each operational Each operational program shall provide to MIEMSS on a monthly basis a report of patient encounters.

39 Maryland Title 30 How do we get to compliance? How do we get to compliance? Education Education Communications Communications Cooperation Cooperation Consensus Consensus

40 Summary COMAR provides the framework for the Maryland EMS System. COMAR provides the framework for the Maryland EMS System.

41 More Information If you need additional information please contact the MIEMSS, Office of the Assistant Attorney General If you need additional information please contact the MIEMSS, Office of the Assistant Attorney General Monty Magee (410) Monty Magee (410) Sarah Sette(410) Sarah Sette(410)

42 Maryland Title 30 Questions ??? Comments ???


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