§ 1003.1. Commonwealth Emergency Medical Director.

 (a)  Roles and responsibilities. The Commonwealth Emergency Medical Director is responsible for the following:

   (1)  Providing medical advice and recommendations to the Department regarding the EMS system.

   (2)  Assisting in the development and implementation of a Statewide EMS quality improvement program.

   (3)  Assisting the Department in revising or modifying the scope of practice of ALS and BLS prehospital personnel.

   (4)  Providing advice and guidance to the Department on investigations and the pursuit of disciplinary actions against prehospital personnel and providers of EMS.

   (5)  Reviewing, evaluating and making recommendations regarding regional transfer and medical treatment protocols.

   (6)  Reviewing, evaluating and making recommendations for the Statewide BLS medical treatment protocols.

   (7)  Reviewing, evaluating and making recommendations for protocols to get acutely ill and injured patients to the most appropriate facility, including criteria for the evaluation, triage, treatment, transport and referral, as well as bypass protocols.

   (8)  Evaluating regional EMS quality improvement programs.

   (9)  Providing direction and guidance to the regional EMS medical directors for training and quality improvement monitoring and assistance.

   (10)  Meeting with representatives and committees of regional EMS councils and the Council as necessary and as directed by the Department to provide guidance and direction.

   (11)  Reviewing, evaluating and making recommendations to the Department on clinical research proposals.

   (12)  Providing other services relating to the Department’s administration of the act as assigned by the Department.

 (b)  Equivalent qualifications. If the Commonwealth Emergency Medical Director is not a medical command physician, the Commonwealth Emergency Medical Director shall possess the following qualifications:

   (1)  The minimum qualifications for a medical command physician in §  1003.4(b)(1)—(3) and (5) (relating to medical command physician).

   (2)  Experience in the prehospital and emergency department care of the acutely ill and injured patient.

   (3)  Knowledge regarding the medical command direction of prehospital personnel and the operation of emergency dispatch.

   (4)  Knowledge of the capabilities and limitations of ambulances, including air ambulances and prehospital personnel.

   (5)  Knowledge of potential medical complications which may arise during transport of a patient by an ambulance service.

 (c)  Disclosure. The Commonwealth Emergency Medical Director shall disclose to the Department all financial or other interest in providers of EMS and in other matters which present a potential conflict of interest.

   The provisions of this §  1003.1 amended September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256611) to (256612).

 (a)  Roles and responsibilities. Each regional EMS council shall have a regional EMS medical director who shall carry out the following duties:

   (1)  Assist the regional EMS council to approve or reject applications for medical command physicians received from medical command facility medical directors.

   (2)  Maintain liaison with the Commonwealth Emergency Medical Director.

   (3)  Assist the regional EMS council, after consultation with the regional medical advisory committee, to establish and revise transfer and medical treatment protocols for the regional EMS system.

   (4)  Assist the regional EMS council to establish field treatment protocols for determining when a patient will not be transported to a treatment facility and establish procedures for documenting the reasons for a nontransport decision.

   (5)  Assist the regional EMS council to establish field protocols to govern situations in which a patient may be transported without consent, in accordance with Pennsylvania law. The protocols shall cover appropriate documentation and review procedures.

   (6)  Assist the regional EMS council to establish criteria for level of care and type of transportation to be provided in various medical emergencies, such as ALS versus BLS, and ground versus air ambulance, and distribute approved criteria to PSAPs.

   (7)  Conduct quality improvement audits of the regional EMS system including reviewing the quality improvement activities conducted by the ALS service medical directors within the region.

   (8)  Serve on the State EMS Quality Improvement Committee.

   (9)  Serve as chairperson of the regional EMS council medical advisory committee.

   (10)  Facilitate continuity of patient care during inter-regional transport.

   (11)  Recommend to the Department suspension, revocation or restriction of prehospital personnel certifications and recognitions.

   (12)  Conduct hearings in accordance with §  1003.28 (relating to medical command authorization) upon appeal of an individual whose medical command authorization is denied or restricted by the ALS service medical director and issue written decisions.

   (13)  Review regional plans, procedures and processes for compliance with State standards of emergency medical care.

 (b)  Minimum qualifications. A regional EMS council medical director shall have the following qualifications:

   (1)  Licensure as a physician.

   (2)  Experience in prehospital and emergency department care of the acutely ill or injured patient.

   (3)  Experience in medical command direction of prehospital personnel.

   (4)  Experience in emergency department management of the acutely ill or injured patient.

   (5)  Have completed 3 years in a residency program in emergency medicine or have served as a medical command physician in this Commonwealth prior to October 14, 2000.

   (6)  Experience in the training of basic and advanced prehospital personnel.

   (7)  Experience in the medical audit, review and critique of BLS and ALS prehospital personnel.

 (c)  Disclosure. A regional EMS medical director shall disclose to a regional EMS council all financial or other interest in providers of EMS and in other matters which present a potential conflict of interest.

   The provisions of this §  1003.2 amended September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256612) to (256614).

 (a)  Roles and responsibilities. A medical command facility shall have a medical command facility medical director. A medical command facility medical director is responsible for the following:

   (1)  Medical command.

   (2)  Quality improvement.

   (3)  Liaison with regional EMS council medical director.

   (4)  Participation in prehospital training activities.

   (5)  Clinical and continuing education training of prehospital personnel.

   (6)  Recommendations to the regional EMS medical director regarding medical command physician applications from the medical command facility.

 (b)  Minimum qualifications. To qualify and continue to function as a medical command facility medical director, an individual shall have the following qualifications:

   (1)  Be currently serving as a medical command physician.

   (2)  Satisfy one of the following:

     (i)   Have completed 3 years in a residency program in emergency medicine.

     (ii)   Have served as a medical command physician in this Commonwealth prior to October 14, 2000.

     (iii)   Have secured board certification in surgery, internal medicine, family medicine, pediatrics or anesthesiology. If the physician has board certification in one of these medical specialties, the physician shall also have successfully completed or taught the ACLS course within the preceding 2 years and have completed, at least once, the ATLS course, and either an APLS or PALS course, or other programs determined by the Department to meet or exceed the standards of theses programs.

   (3)  Experience in prehospital and emergency department care of the acutely ill or injured patient.

   (4)  Experience in providing medical command direction to prehospital personnel.

   (5)  Experience in the training of BLS and ALS prehospital personnel.

   (6)  Experience in the medical audit, review and critique of BLS and ALS prehospital personnel.

   The provisions of this §  1003.3 amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256614) to (256615).

 (a)  Roles and responsibilities. A medical command physician shall provide medical command to prehospital personnel. This includes providing online medical command to prehospital personnel whenever they seek direction.

 (b)  Minimum qualifications. To qualify and continue to function as a medical command physician, an individual shall:

   (1)  Be a physician.

   (2)  Satisfy one of the following:

     (i)   Have completed 3 years in a residency program in emergency medicine.

     (ii)   Have served as a medical command physician in this Commonwealth prior to October 14, 2000.

     (iii)   Have successfully completed or taught the ACLS course within the preceding 2 years and have completed, at least once, the ATLS course, and either an APLS or PALS course, or other programs determined by the Department to meet or exceed the standards of these programs.

   (3)  Have completed the continuing medical education credits required for membership in the American Medical Association, or its equivalent, or be serving a graduate year III in a residency program in emergency medicine or a graduate year II in a residency program in emergency medicine, with concurrent online supervision by an approved medical command physician.

   (4)  Be a full-time emergency physician or practice emergency medicine for at least half-time of a full-time medical practice.

   (5)  Possess a valid Drug Enforcement Agency (DEA) number.

   (6)  Have completed the Medical Command Course.

 (c)  Approval of medical command physician.

   (1)  A physician may function as a medical command physician if approved to do so by a regional EMS council.

   (2)  A regional EMS council shall approve a physician as a medical command physician if the physician demonstrates that the physician will function under the auspices of a medical command facility and establishes one of the following:

     (i)   That the physician satisfies the qualifications for a medical command physician in subsection (b).

     (ii)   That the physician has received certification as a medical command physician from the Department upon successfully completing the voluntary medical command physician certification program administered by the Department.

   (3)  A regional EMS council shall conclude that the physician will be operating under the auspices of a medical command facility if the physician establishes that the physician has an arrangement with the medical command facility to provide medical command on its behalf while on duty for the medical command facility, under the direction of the medical command facility medical director and under the policies and procedures of the medical command facility, and further establishes one of the following:

     (i)   That the facility meets the requirements for a medical command facility prescribed in §  1009.1 (relating to operational criteria).

     (ii)   That the facility has received recognition as a medical command facility from the Department under §  1009.2 (relating to recognition process).

 (d)  Notice requirements for medical command facility and regional EMS council.

   (1)  A medical command facility shall give notice to each regional EMS council having responsibility for an EMS region in which the medical command facility anticipates medical command physicians functioning under its auspices will be providing medical command, and shall explain the circumstances under which medical command will be given in that region.

   (2)  A regional EMS council that has approved a physician as a medical command physician shall give notice of the approval to the Department.

 (e)  Transfer and medical treatment protocols. A medical command physician shall provide medical command to prehospital personnel in ground ambulances and QRSs consistent with the transfer and medical treatment protocols which are in effect in either the region in which treatment originates or the region in which the prehospital personnel begin receiving online medical command from the medical command physician.

   The provisions of this §  1003.4 amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial page (256615).

 (a)  Roles and responsibilities. An ALS service medical director is responsible for the following:

   (1)  Providing medical guidance and advice to the ALS ambulance service, including:

     (i)   Reviewing the Statewide BLS medical treatment protocols and the regional transfer and medical treatment protocols, and ensuring that the ALS ambulance service’s prehospital personnel are familiar with them, and amendments and revisions thereto.

     (ii)   Providing guidance to the ALS ambulance service with respect to the ordering, stocking and replacement of drugs, and compliance with laws and regulations impacting upon the ALS ambulance service’s acquisition, storage and use of those drugs.

     (iii)   Participating in the regional and Statewide quality improvement plans, including continuous quality improvement reviews of patient care and its interaction with the regional EMS system.

     (iv)   Recommending to the relevant regional EMS council, when appropriate, specific transfer and medical treatment protocols for inclusion in the regional transfer and medical treatment protocols.

   (2)  Granting, denying or restricting medical command authorization to members of the ALS ambulance service’s prehospital personnel who require this authorization, and participating in appeals from decisions to deny or restrict medical command authorization in accordance with §  1003.28 (relating to medical command authorization).

   (3)  Performing medical audits of patient care provided by the ALS ambulance service’s prehospital personnel.

 (b)  Equivalent qualifications. If the ALS service medical director is not a medical command physician, the ALS service medical director shall:

   (1)  Possess the minimum qualifications for a medical command physician in §  1003.4(b)(1)—(5) (relating to medical command physician).

   (2)  Have experience in the medical command direction of prehospital personnel.

   (3)  Have knowledge of the capabilities and limitations of ambulances, including air ambulances, and prehospital personnel.

   (4)  Have knowledge of potential medical complications which may arise during transport of the patient by an ambulance service.

   (5)  Successfully complete the Medical Command Course.

   The provisions of this §  1003.5 amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256615) to (256616).

   This section cited in 28 Pa. Code §  1001.2 (relating to definitions); 28 Pa. Code §  1007.7 (relating to licensure and general operating requirements); and 28 Pa. Code §  1007.8 (relating to disciplinary and corrective actions).

Subchapter B. PREHOSPITAL EMS PERSONNEL

Sec.

§ 1003.21. Ambulance attendant.

 (a)  Roles and responsibilities. An ambulance attendant, as part of the crew of an ambulance or a QRS, may perform BLS activities within the ambulance attendant’s scope of practice, as set forth in subsection (c), at the scene of an emergency or enroute to a facility. This section does not prohibit an ambulance attendant from providing BLS services as a good Samaritan.

 (b)  Qualifications. To qualify as an ambulance attendant an individual shall satisfy the age requirement under the Child Labor Law (43 P. S. § §  41—71) and one of the following:

   (1)  Possess a current certificate evidencing successful completion of an advanced first aid course sponsored by the American Red Cross and a certificate issued within the last 2 years evidencing successful completion of a CPR course.

   (2)  Possess a current certificate evidencing successful completion of a course determined by the Department to be equivalent to the requirements in paragraph (1).

 (c)  Scope of practice. An ambulance attendant shall have the authority to provide the following BLS services if trained to do so:

   (1)  Patient assessment—including vital signs—and ongoing evaluation.

   (2)  Pulmonary or cardiopulmonary resuscitation and foreign body airway obstruction management.

   (3)  Administration of oxygen.

   (4)  Insertion of oropharyngeal or nasopharyngeal airways.

   (5)  Oropharyngeal suctioning.

   (6)  Assessment and management of cardiac, respiratory, diabetic shock, behavioral and heat/cold emergencies, as prescribed within an advanced first aid course meeting the requirements in subsection (b)(1) or (2).

   (7)  Emergency treatment for bleeding, burns, poisoning, seizures, soft tissue injuries, chest-abdominal-pelvic injuries, muscle and bone injuries, eye injuries and childbirth (including care of the newborn), as prescribed within an advanced first aid course meeting the requirements in subsection (b)(1) or (2).

   (8)  Application of spinal immobilization devices and splinting materials, including traction splints.

   (9)  Basic triage and basic maneuvers to gain access to the patient.

   (10)  Patient lifting and moving techniques.

   (11)  Use of an automated external defibrillator when approved by a physician who serves as the medical director of the ambulance service with respect to its use of automated external defibrillators.

   (12)  Assist a prehospital practitioner who is above the level of first responder in the use of Department-approved automatic ventilators and pulse oximetry when approved by the medical director of the ambulance service.

   (13)  Other BLS skills taught in a course in advanced first aid sponsored by the American Red Cross, provided the ambulance attendant has received training to perform those skills in a course or in an equivalent training program approved by the Department, and is able to document having received the training. The Department will identify these skills as follows:

     (i)   The Department will publish in the Pennsylvania Bulletin, at least annually, a list of the skills taught in the most recent course in advanced first aid sponsored by the American Red Cross.

     (ii)   If the course sponsored by the American Red Cross teaches skills in addition to advanced first aid, the Department will exclude those skills from the published list. An ambulance attendant may not perform a skill taught in a course approved under this paragraph if the Department does not include the skill in the list it publishes under subparagraph (i).

   The provisions of this §  1003.21 amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial page (256616).

 (a)  Roles and responsibilities. A first responder may perform, at the scene of an emergency, enroute to a facility, or in an emergency setting in a facility, the BLS services in subsection (e) to stabilize and improve a patient’s condition until more highly trained personnel arrive. Following the arrival of more highly trained personnel, a first responder may continue to perform the BLS services within a first responder’s scope of practice as set forth in subsection (e) under the direction of more highly trained personnel. This section does not prohibit a first responder from providing BLS services as a good Samaritan.

 (b)  Certification.

   (1)  The Department will certify as a first responder an individual who meets the following qualifications:

     (i)   Completes an application on a form prescribed by the Department.

     (ii)   Is 16 years of age or older.

     (iii)   Has successfully completed a first responder training course approved by the Department. The Department will publish annually in the Pennsylvania Bulletin a list of courses leading to first responder certification.

     (iv)   Has passed a written examination for first responder certification prescribed by the Department, or has passed an examination which the Department has determined to be equivalent in both content and manner of administration.

     (v)   Has passed a practical test of first responder skills prescribed by the Department, or has passed an examination which the Department has determined to be equivalent in both content and manner of administration.

   (2)  A first responder’s certification is valid for 3 years, subject to disciplinary action under section 11(j.1) of the act (35 P. S. §  6931(j.1)) and §  1003.27 (relating to disciplinary and corrective action).

 (c)  Recertification. A first responder shall apply for recertification between 1 year and 60 days prior to expiration of the first responder’s certification from the Department. Failure to apply for recertification in a timely manner may result in the individual not being recertified before the prior certification expires. The Department will recertify as a first responder an individual who meets the following qualifications:

   (1)  Completes an application on a form prescribed by the Department.

   (2)  Is or was previously certified as a first responder.

   (3)  Has successfully completed one of the following:

     (i)   The first responder practical skills and written knowledge examination prescribed by the Department.

     (ii)   The continuing education requirements applicable to first responders in §  1003.29(a) (relating to continuing education requirements).

 (d)  Certification by endorsement.

   (1)  For an individual who is 16 years of age or older and who is currently certified in another state as a first responder or as a person with similar responsibilities, the Department will endorse the following qualifications as equivalent to those in subsection (b):

     (i)   Successful completion of training curriculum which meets or exceeds the standards for the training course prescribed by the Department in subsection (b)(1)(iii).

     (ii)   Successful completion of a written examination for first responder certification, or an equivalent certification, which is determined by the Department to meet or exceed the standards of the written examination prescribed by the Department under subsection (b)(1)(iv).

     (iii)   Successful completion of a practical skills examination for first responder certification, or an equivalent certification, which is determined by the Department to meet or exceed the standards of the practical skills examination prescribed by the Department under subsection (b)(1)(v).

   (2)  An individual whose first responder certification or equivalent certification in another state is expired at the time of application may seek to have the satisfaction of paragraph (1)(i) endorsed as equivalent to the satisfaction of subsection (b)(1)(iii), but will not be considered by the Department for endorsement of qualifications under paragraph (1)(ii) or (iii), and shall successfully complete the first responder practical skills and written knowledge examinations prescribed by the Department after applying for certification through examination.

   (3)  Certification under this subsection is valid for 3 years. Upon expiration of that certification, the individual shall meet the requirements for recertification in subsection (c).

 (e)  Scope of practice.

   (1)  A first responder’s scope of practice includes the BLS services which may be performed by an ambulance attendant as set forth in §  1003.21(c) (relating to ambulance attendant), if the first responder has been trained to perform those services.

   (2)  A first responder’s scope of practice also includes other BLS services taught in a first responder training course approved by the Department, if the first responder has received training to perform those services, and is able to document having received the training, in one of the following:

     (i)   A first responder training course approved by the Department.

     (ii)   A course which is determined by the Department to meet or exceed the standards of a first responder training course preapproved by the Department.

     (iii)   A course for which the first responder may receive continuing education credit towards recertification.

   (3)  The Department will publish in the Pennsylvania Bulletin, at least annually, a list of the skills taught in first responder training courses most recently approved by the Department.

   (4)  If the approved course is not offered by the Department, the Department may exclude from the published list, skills taught which the Department determines are not appropriate services to be performed by a first responder. A first responder may not perform a skill taught in a course under paragraph (2)(ii) or (iii) if the Department does not include the skill in the list it publishes under paragraph (3).

   The provisions of this §  1003.22 amended September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256617) to (256618).

 (a)  Roles and responsibilities. An EMT may perform, in a prehospital, interhospital or emergency care setting in a hospital, or during the transfer of convalescent or other nonemergency cases, the BLS services set forth in subsection (e), to prevent loss of life or aggravation of physiological or psychological illness or injury. This section does not prohibit an EMT from providing BLS services as a good Samaritan.

 (b)  Certification.

   (1)  The Department will certify as an EMT an individual who meets the following qualifications:

     (i)   Completes an application on a form prescribed by the Department.

     (ii)   Is 16 years of age or older.

     (iii)   Has successfully completed an EMT training course approved by the Department.

     (iv)   Has successfully completed a written EMT examination prescribed by the Department.

     (v)   Has successfully completed an EMT practical skills examination prescribed by the Department.

   (2)  The Department will also certify as an EMT an individual who completes an application on a form prescribed by the Department and who has one of the following:

     (i)   Permanent certification as an EMT-paramedic under §  1003.24(b) (relating to EMT-paramedic) but without medical command authorization under §  1003.28 (relating to medical command authorization).

     (ii)   Permanent recognition as a prehospital registered nurse under §  1003.25b (relating to prehospital registered nurse) but without medical command authorization under §  1003.28.

   (3)  Certification granted under paragraph (1) or (2) is valid for 3 years, subject to disciplinary action under section 11(j.1) of the act (35 P. S. §  6931(j.1)) and §  1003.27 (relating to disciplinary and corrective action).

 (c)  Certification by endorsement.

   (1)  For an individual who is 16 years of age or older and currently certified as an EMT in another state, the Department will endorse the following qualifications as equivalent to those in subsection (b):

     (i)   Successful completion of EMT training curriculum that meets or exceeds the standards of the training course prescribed by the Department under subsection (b)(1)(iii).

     (ii)   Successful completion of a written examination for EMT certification which is determined by the Department to meet or exceed the standards of the written examination prescribed by the Department under subsection (b)(1)(iv).

     (iii)   Successful completion of a practical skills examination for EMT certification which is determined by the Department to meet or exceed the standards of the practical skills examination prescribed by the Department under subsection (b)(1)(v).

   (2)  An individual whose EMT certification in another state is expired at the time of application may seek to have the satisfaction of paragraph (1)(i) endorsed as equivalent to the satisfaction of subsection (b)(1)(iii), but will not be considered by the Department for endorsement of qualifications under paragraph (1)(ii) or (iii), and shall successfully complete the EMT practical skills and written examinations prescribed by the Department after applying for certification through examination.

   (3)  Certification under this subsection is valid for 3 years. Upon expiration of that certification the individual shall meet the requirements for recertification in subsection (d).

 (d)  Recertification. An EMT shall apply for recertification between 1 year and 60 days prior to expiration of the EMT’s certification from the Department. Failure to apply for recertification in a timely manner may result in the individual not being recertified before the prior certification expires. The Department will recertify as an EMT an individual who meets the following qualifications:

   (1)  Completes an application on a form prescribed by the Department.

   (2)  Is or was previously certified as an EMT.

   (3)  Has successfully completed one of the following:

     (i)   The written and practical EMT recertification examinations prescribed by the Department.

     (ii)   The continuing education requirements for EMTs in §  1003.29(b) (relating to continuing education requirements).

 (e)  Scope of practice. An EMT’s scope of practice, under medical command direction or utilization of the Statewide BLS medical treatment protocols, includes the BLS services which may be performed by a first responder as set forth in §  1003.22(e) (relating to first responder) and the following:

   (1)  Administration to a patient or assisting a patient to administer drugs previously prescribed for that patient, as specified in the Statewide BLS medical treatment protocols.

   (2)  Transportation of a patient with an indwelling intravenous catheter without medication running, unless the medication is part of the patient’s normal treatment plan and the transport of the patient with medication running is consistent with the Statewide BLS medical treatment protocols.

   (3)  Other BLS services taught in a basic training program for EMTs approved by the Department, if the EMT has received training to perform those services, and is able to document having received the training, in one of the following:

     (i)   A basic training course for EMTs approved by the Department.

     (ii)   A course which is determined by the Department to meet or exceed the standards of a basic training course for EMTs preapproved by the Department.

     (iii)   A course for which the EMT may receive continuing education credit towards recertification.

 (f)  Publication of approved skills.

   (1)  The Department will publish in the Pennsylvania Bulletin, at least annually, a list of the skills taught in the EMT basic training course most recently approved by the Department.

   (2)  If the course is not offered by the Department, the Department may exclude, from the published list, skills taught which the Department determines are not appropriate skills to be performed by an EMT. An EMT may not perform a skill taught in a course under subsection (e)(3)(ii) or (iii) if the Department does not include the skill in the list it publishes under paragraph (1).

   The provisions of this §  1003.23 amended September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256619) to (256622).

 (a)  Qualifications for certification. The Department will issue an EMS instructor certification to an individual who meets all of the following requirements:

   (1)  Has completed an application for EMS instructor certification on a form prescribed by the Department.

   (2)  Is 18 years of age or older.

   (3)  Has successfully completed an EMS instructor course approved by the Department, or possesses a bachelor’s degree in education or a teacher’s certification in education.

   (4)  Has successfully completed an EMT-Basic transition program or update, or has completed an EMT-Basic course.

   (5)  Possesses current certification as an EMT or EMT-paramedic, or recognition as a health professional.

   (6)  Possesses current certification in CPR or current certification as a CPR instructor.

   (7)  Possesses at least 1 year experience functioning at the EMT, EMT-paramedic or health professional level providing prehospital care.

 (b)  Renewal of instructor certification. An EMS instructor certification is valid for 3 years. The Department will renew an EMS instructor certification for an individual who meets the following requirements:

   (1)  Has completed an application for renewal of an EMS instructor certification on a form prescribed by the Department.

   (2)  Has demonstrated competence in teaching the didactic and practical skills portions of the curriculum.

   (3)  Has provided documentation to the Department to establish that the individual conducted at least 60 hours of teaching EMS or rescue courses during the previous 3 years.

   (4)  Possesses current certification as an EMT, certification as an EMT-paramedic or recognition as a health professional.

   (5)  Possess current certification in CPR.

   (6)  Effective October 14, 2003, has completed an EMS instructor update program within 3 years prior to applying for renewal of certification.

 (a)  Roles and responsibilities.

   (1)  An EMT-paramedic who has been granted medical command authorization under §  1003.28 (relating to medical command authorization), or an individual who is a student in an approved EMT-paramedic training program under the supervision of an approved preceptor, may provide in a prehospital, interhospital or in an emergency care setting in a facility, or during the transfer of convalescent or other nonemergency cases, BLS services which may be performed by an EMT as set forth in §  1003.23(a) and (e) (relating to EMT), as well as the ALS services in subsection (d) to prevent loss of life or aggravation of physiological or psychological illness or injury. This section does not prohibit an EMT-paramedic from providing EMS as a good Samaritan.

   (2)  An EMT-paramedic who does not have or chooses not to maintain medical command authorization under §  1003.28 may apply to the Department for certification as an EMT. The rules applicable to certification of an EMT-paramedic as an EMT are in §  1003.23(b)(2). An EMT-paramedic without medical command authorization who is certified as an EMT may provide only the BLS services within an EMT’s scope of practice as set forth in §  1003.23(a) and (e) until the EMT-paramedic has regained medical command authorization in accordance with §  1003.28. Following loss of medical command authorization, an EMT-paramedic may function as an EMT for the ALS ambulance service under which the EMT-paramedic has lost medical command authorization, for 30 days without securing EMT certification, if approval to do so is granted by the ALS service medical director for that ALS ambulance service.

 (b)  Certification.

   (1)  The Department will certify as an EMT-paramedic an individual who meets the following qualifications:

     (i)   Completes an application on a form prescribed by the Department.

     (ii)   Possesses current certification as an EMT.

     (iii)   Is 18 years of age or older.

     (iv)   Has successfully completed a training course for EMT-paramedics approved by the Department.

     (v)   Has successfully completed a practical examination of EMT-paramedic skills.

     (vi)   Has successfully completed a written examination for EMT-paramedics administered by the Department.

   (2)  An individual certified as an EMT-paramedic is permanently certified as an EMT-paramedic, subject to disciplinary action under section 11(j.1) of the act (35 P. S. §  6931(j.1)) and §  1003.27 (relating to disciplinary and corrective action).

   (3)  An EMT-paramedic shall register biennially with the Department on forms supplied by the Department prior to the biennial anniversary date of the EMT-paramedic’s certification and shall supply information requested by the Department on the registration form.

 (c)  Certification by endorsement.

   (1)  For an individual who is 18 years of age or older and who is currently certified in another state as an EMT-paramedic, the Department will endorse the following qualifications as equivalent to those in subsection (b).

     (i)   Certification as an EMT-paramedic in the other state instead of current certification as an EMT in this Commonwealth.

     (ii)   Successful completion of EMT-paramedic training curriculum that meets or exceeds the standards of the training course prescribed by the Department under subsection (b)(1)(iv).

     (iii)   Successful completion of a written examination for EMT-paramedic certification which is determined by the Department to meet or exceed the standards of the written examination prescribed by the Department under subsection (b)(1)(vi).

     (iv)   Successful completion of a practical skills examination for EMT-paramedic certification which is determined by the Department to meet or exceed the standards of the practical skills examination prescribed by the Department under subsection (b)(1)(v).

   (2)  An individual whose EMT-paramedic certification in another state is expired at the time of application may seek to have the satisfaction of paragraph (1)(ii) endorsed as equivalent to the satisfaction of subsection (b)(1)(iv), but will not be considered by the Department for endorsement of qualifications under paragraph (1)(i), (iii) or (iv), and shall successfully complete the EMT-paramedic practical skills and written examinations prescribed by the Department after making application for certification through examination.

 (d)  Scope of practice. An EMT-paramedic’s scope of practice includes the BLS services which may be performed by an EMT in §  1003.23(a) and (e) and the ALS services set forth in this subsection. An EMT-paramedic, with medical command authorization, following the order of a medical command physician, or use of Department approved transfer and medical treatment protocols as authorized by the ALS service medical director, may:

   (1)  Perform pulmonary ventilation by the use of oral, nasal, endotracheal or tracheostomy intubation.

   (2)  Insert, in peripheral veins, intravenous catheters, needles or other cannulae-IV lines.

   (3)  Obtain venous blood samples for analysis, but only for diagnostic and treatment purposes.

   (4)  Prepare and administer approved medication and solutions by intravenous, intramuscular, subcutaneous, intraosseous, oral, sublingual, topical, inhalation, rectal or endotracheal routes.

   (5)  Perform defibrillation and synchronized cardioversion.

   (6)  Perform gastric suction by nasogastric or orogastric intubation.

   (7)  Insert nasogastric or orogastric tubes.

   (8)  Visualize the airway by use of the laryngoscope and remove foreign bodies with forceps.

   (9)  Apply electrodes and monitor cardiac electrical activity including electrocardiograms.

   (10)  Perform Valsalva maneuvers.

   (11)  Use mechanical cardiopulmonary resuscitation devices.

   (12)  Assess and manage patients in accordance with the EMT-paramedic training curriculum approved by the Department.

   (13)  Perform thoracic decompression.

   (14)  Perform cricothyrotomy and pulmonary ventilation.

   (15)  Perform central venous and intraosseous cannulation.

   (16)  Perform external transcutaneous pacing.

   (17)  Perform urinary catheterization.

   (18)  Access central venous lines and subcutaneous indwelling catheters.

   (19)  Perform other ALS skills taught in a training course for EMT-paramedics approved by the Department, if the EMT-paramedic has received training to perform those services and is able to document having received the training, in one of the following:

     (i)   A training course for EMT-paramedics approved by the Department.

     (ii)   A course which is determined by the Department to meet or exceed the standards of a training course for EMT-paramedics preapproved by the Department.

     (iii)   A course for which the EMT-paramedic may receive continuing education credit towards qualifying for medical command authorization.

 (e)  Publication of approved skills.

   (1)  The Department will publish in the Pennsylvania Bulletin, at least annually, a list of the skills taught in the EMT-paramedic training course most recently approved by the Department.

   (2)  If the approved course is not offered by the Department, the Department may exclude, from the published list, skills taught which the Department determines are not appropriate skills to be performed by an EMT-paramedic. An EMT-paramedic may not perform a skill taught in a course under subsection (d)(19)(ii) or (iii) if the Department does not include the skill in the list it publishes under paragraph (1).

   The provisions of this §  1003.24 amended September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256622) to (256624).

 Physicians who have education and continuing education in ALS services and prehospital care may function as a member of the crew on an ambulance as a health professional. This section does not prohibit a health professional physician from providing EMS as permitted under 42 Pa.C.S. §  8331 (relating to medical good Samaritan civil immunity).

 (a)  Roles and responsibilities.

   (1)  A prehospital registered nurse who has medical command authorization under §  1003.28 (relating to medical command authorization) may provide the ALS services in §  1003.24(d) (relating to EMT-paramedic) and those listed in subsection (c) in addition to the BLS services in §  1003.23(a) and (e) (relating to EMT) to respond to the perceived needs of an individual for immediate medical care in an emergency. This section does not prohibit a prehospital registered nurse from providing EMS as permitted under 42 Pa.C.S. §  8331 (relating to medical good Samaritan civil immunity).

   (2)  A prehospital registered nurse who does not have or chooses not to maintain medical command authorization may apply to the Department for recognition as an EMT. The rules applicable to certification of a prehospital registered nurse as an EMT are set forth in §  1003.23(b)(2). Following loss of medical command authorization, a prehospital registered nurse may function as an EMT for the ALS ambulance service under which the prehospital registered nurse has lost medical command authorization, for 30 days without securing EMT certification, if approval to do so is granted by the ALS service medical director for that ALS ambulance service.

 (b)  Recognition of a prehospital registered nurse.

   (1)  The Department will recognize as a prehospital registered nurse a registered nurse who meets the following qualifications:

     (i)   Completes an application on a form prescribed by the Department.

     (ii)   Is 18 years of age or older.

     (iii)   Has successfully completed the American Heart Association or American Red Cross basic cardiac life support training program and the ACLS course, or other programs determined by the Department to meet or exceed the standards of the specified programs.

     (iv)   Has successfully completed one of the following:

       (A)   The Pennsylvania prehospital registered nurse curriculum adopted by the Department.

       (B)   A knowledge and skills assessment process adopted by the Department.

     (v)   Has successfully completed the written ALS examination for prehospital registered nurses approved by the Department.

     (vi)   Has successfully completed the EMT practical skills examination.

   (2)  A registered nurse who received recognition as a health professional registered nurse under the voluntary health professional registered nurse recognition program conducted by the Department prior to September 2, 1995, will be deemed to have Department recognition as a prehospital registered nurse.

   (3)  Department recognition of a prehospital registered nurse under this section is permanent subject to disciplinary action under section 11(j.1) of the act (35 P. S. §  6931(j.1)) and §  1003.27 (relating to disciplinary and corrective action).

   (4)  A prehospital registered nurse shall register biennially with the Department on forms supplied by the Department prior to the biennial anniversary date of the prehospital registered nurse’s recognition and shall supply information requested on the registration form.

 (c)  Scope of practice. A prehospital registered nurse with medical command authorization may perform, in addition to those services within an EMT-paramedic’s scope of practice, other services authorized by The Professional Nursing Law (63 P. S. § §  221—225.5), when authorized by a medical command physician through either on line medical command or standing medical treatment protocols.

 (d)  Recognition by endorsement. The Department will grant recognition as a prehospital registered nurse to an individual who has served in a similar capacity in another state and who meets the following qualifications:

   (1)  Completes an application on a form prescribed by the Department.

   (2)  Is 18 years of age or older.

   (3)  Has successfully completed the American Heart Association or the American Red Cross basic life support training program and the ACLS course, or other programs determined by the Department to meet or exceed the standards of the specified programs.

   (4)  Is licensed as a registered nurse in both this Commonwealth and another state.

   (5)  Has successfully completed one of the following:

     (i)   The written ALS examination for prehospital registered nurses approved by the Department and the EMT practical skills examination.

     (ii)   Written and practical skills examinations determined by the Department to meet or exceed the examinations approved by the Department.

   (6)  Has successfully completed one of the following:

     (i)   The Pennsylvania prehospital registered nurse curriculum adopted by the Department.

     (ii)   A knowledge and skills assessment process adopted by the Department.

     (iii)   Curriculum or a knowledge and skills assessment process, which is determined by the Department to meet or exceed the standards adopted by the Department.

   The provisions of this §  1003.25b adopted September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256625) to (256627).

 (a)  Basic rescue practices technician.

   (1)  Roles and responsibilities. A basic rescue practices technician is an individual certified by the Department as possessing the training and skills to perform rescue skills in accordance with the basic rescue practices course approved by the Department. A basic rescue practices technician utilizes basic tools and equipment of the rescue service to perform a safe and efficient rescue operation.

   (2)  Training programs. Basic rescue practices technician training programs will be approved by the Department.

   (3)  Minimum qualifications. A basic rescue practices technician shall successfully complete a training program for basic rescue practices approved by the Department and shall successfully complete a written basic rescue practices test administered by the Department.

 (b)  Basic vehicle rescue technician.

   (1)  Roles and responsibilities. A basic vehicle rescue technician is an individual certified by the Department as possessing the training and skills to perform rescue skills in accordance with the basic vehicle rescue course approved by the Department. That program provides the student with the knowledge and skills necessary to achieve the rescue of persons involved in automobile accidents.

   (2)  Training programs. Basic vehicle rescue technician training programs will be approved by the Department.

   (3)  Minimum qualifications. A basic vehicle rescue technician shall complete a training program for basic vehicle rescue approved by the Department, and shall successfully complete a written examination for basic vehicle rescue developed by the Department and administered by the Department.

 (c)  Special vehicle rescue technician.

   (1)  Roles and responsibilities. A special vehicle rescue technician is an individual certified by the Department as possessing the training and skills to perform rescues in accordance with the specialized rescue training course approved by the Department.

   (2)  Training programs. Specialized rescue training programs will be approved by the Department.

   (3)  Minimum qualifications. An individual shall complete a training program approved by the Department for a specific level of specialized vehicle rescue performance, and also shall successfully complete a written examination developed by the Department and administered by the Department.

 (d)  Rescue instructor. The Department will develop a program providing for the certification of rescue instructors. Courses that seek Department approval as a rescue training course shall be taught by certified rescue instructors.

 (e)  Certificates. The rescue technician certifications issued by the Department under this section do not constitute a legal prerequisite to performing rescues. The rescue instructor certifications issued by the Department under this section do not constitute a legal prerequisite to serving as a rescue instructor in programs other than rescue training courses approved by the Department. The Department approves the rescue programs and issues the certifications referenced within this section to promote the Statewide EMS system having an adequate number of personnel with sufficient training and skills to perform rescues.

 (a)  The Department may, upon investigation, hearing and disposition, impose upon prehospital personnel who are certified or recognized by the Department one or more of the disciplinary or corrective measures in subsection (c) for one or more of the following reasons:

   (1)  Demonstrated incompetence to provide adequate emergency medical services.

   (2)  Deceptive or fraudulent procurement or misrepresentation of certification or recognition credentials.

   (3)  Willful or negligent practice beyond the scope of certification or recognition authorization.

   (4)  Abuse or abandonment of a patient.

   (5)  The rendering of services while under the influence of alcohol or illegal drugs.

   (6)  The operation of an emergency vehicle in a reckless manner or while under the influence of illegal drugs or alcohol.

   (7)  Disclosure of medical or other information if prohibited by Federal or State law.

   (8)  Willful preparation or filing of false medical reports or records, or the inducement of others to do so.

   (9)  Destruction of medical records required to be maintained.

   (10)  Refusal to render emergency medical care because of a patient’s race, sex, creed, national origin, sexual preference, age, handicap, medical problem or financial inability to pay.

   (11)  Failure to comply with Department-approved regional EMS council transfer and medical treatment protocols.

   (12)  Failure to comply with ambulance response reporting requirements as established by the Department.

   (13)  Failure to meet recertification requirements.

   (14)  Conviction of a felony or crime involving moral turpitude. Conviction includes a judgment of guilt, a plea of guilty or a plea of nolo contendere.

   (15)  Conviction of a misdemeanor which relates to the practice or the profession of the prehospital practitioner. Conviction is a judgment of guilt.

   (16)  A willful or consistent pattern of failure to complete details on a patient’s medical record.

   (17)  Misuse or misappropriation of drugs or medication.

   (18)  Having a certification or other authorization to practice a health care profession or occupation revoked, suspended or subjected to disciplinary sanction.

   (19)  Failure to comply with skill maintenance requirements established by the Department.

   (20)  Violating a duty imposed by the act, this subpart or an order of the Department previously entered in a disciplinary proceeding.

   (21)  Other reasons as determined by the Department which pose a threat to the health and safety of the public.

 (b)  It is the duty of all prehospital personnel to report to the Department, within 30 days, a misdemeanor or felony conviction, or a revocation, suspension or other disciplinary sanction of a certificate or other authorization to practice a health care profession or occupation.

 (c)  If disciplinary action is appropriate for one of the reasons listed in subsection (a), the Department may:

   (1)  Deny an application for certification or recognition.

   (2)  Administer a written reprimand with or without probation.

   (3)  Revoke, suspend, limit or otherwise restrict the certification or recognition.

   (4)  Require the person to take refresher educational courses.

   (5)  Stay enforcement of a suspension and place the individual on probation with the right to vacate the probationary order for noncompliance.

 (d)  The Department will conduct all aspects of the disciplinary process and any hearing that may be held in accordance with 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure). A revocation or suspension of certification or recognition may be appealed to the Commonwealth Court under 2 Pa.C.S. § §  501—508 and 701—704 (relating to Administrative Agency Law).

   The provisions of this §  1003.27 amended under the Do-Not Resuscitate Act, 20 Pa.C.S. Chapter 54.

   The provisions of this §  1003.27 amended September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363; amended December 13, 2002, effective March 1, 2003, 32 Pa.B. 6117; amended February 6, 2004, effective February 7, 2004, 34 Pa.B. 677. Immediately preceding text appears at serial pages (293998) to (294000).

 (a)  Authority to grant medical command. The ALS service medical director has the authority to grant, deny, or restrict as provided in subsection (c)(3), medical command authorization to an EMT-paramedic or prehospital registered nurse who seeks to provide EMS on behalf of the ALS ambulance service. The ALS service medical director shall document the medical command authorization decision and how that decision was made. The decision of the ALS service medical director shall affect the medical command authorization status of the EMT-paramedic or prehospital registered nurse for that ALS ambulance service only.

 (b)  Prerequisites to initial determination regarding medical command authorization.

   (1)  Prior to making the initial determination whether to grant or deny medical command authorization, the ALS service medical director shall:

     (i)   Require the individual seeking medical command authorization to complete an application for medical command authorization on a form prescribed by the Department.

     (ii)   Verify with the Department the individual’s certification or recognition status.

     (iii)   Inquire of the Department whether disciplinary action under section 11(j.1) of the act (35 P. S. §  6931(j.1)) and §  1003.27 (relating to disciplinary and corrective action) has been or is currently being imposed against the individual.

   (2)  The ALS service medical director shall deny medical command authorization to an individual who is not certified or recognized by the Department, who is currently subject to a disciplinary or corrective measure imposed by the Department which prevents the individual from having medical command authorization, or who has not complied with the applicable continuing education in §  1003.29 (relating to continuing education requirements).

   (3)  Before the ALS service medical director may grant medical command authorization to an individual, the ALS service medical director shall verify that the individual can competently perform each of the services set forth within the scope of practice authorized by the individual’s certification or recognition. The ALS service medical director may only grant medical command authorization to permit practice in accordance with the medical treatment protocols in the region or regions in which ambulances of the ALS ambulance service, out of which the individual will function, are stationed. If the individual had not previously been granted medical command authorization for any ALS ambulance service in this Commonwealth, the ALS service medical director shall determine the individual’s competence to perform those services by direct observation. Alternatively, the ALS service medical director may determine the individual’s competence by consulting with a physician, EMT-paramedic or prehospital registered nurse who has directly observed the individual’s performance of those services, and who the ALS service medical director has determined to be qualified to make the assessment. If the individual had previously been granted medical command authorization, the ALS service medical director shall verify that the individual can competently perform each of those services by either directly observing the individual’s performance of those services; or by consulting with a physician, EMT-paramedic or prehospital registered nurse who has directly observed the individual’s performance of those services, and who the ALS service medical director has determined to be qualified to make the assessment; or doing the following for services not directly observed:

     (i)   Consulting with one or more medical command physicians who have given the individual medical command.

     (ii)   Consulting with emergency department physicians who have received patients to whom the individual has provided prehospital emergency care.

     (iii)   Performing a medical audit of records of services provided by the individual seeking medical command authorization, for patients attended to by that individual for the ALS ambulance for which the ALS service medical director is making the medical command authorization decision.

     (iv)   Consulting with one or more ALS service medical directors who has granted, denied or restricted the individual’s medical command status.

   (4)  If the ALS service medical director determines that the individual applying for medical command authorization cannot competently perform one or more of those services, the ALS service medical director shall either deny, or restrict as provided in subsection (c)(3), the individual’s medical command authorization in a written document provided to the individual.

 (c)  Review of medical command authorization. At least annually, and more often as circumstances warrant, the ALS service medical director shall review the medical command authorization status of each EMT-paramedic and prehospital registered nurse providing services on behalf of the ALS ambulance service. In reviewing medical command authorization, the ALS service medical director shall ensure that the individual has completed or is completing the applicable continuing education requirements in §  1003.29 and has demonstrated competence, as verified by the ALS service medical director, in performing each of the services that fall within the scope of the individual’s medical command authorization. The ALS service medical director, upon review of medical command authorization, may:

   (1)  Renew medical command authorization.

   (2)  Renew medical command authorization and require continuing education courses in any field the ALS service medical director deems appropriate. The ALS service medical director may require an individual to secure more continuing education credit than generally required for personnel operating under medical command authorization for the ALS ambulance service, only if the ALS service medical director determines that the following conditions are satisfied:

     (i)   The individual does not demonstrate sufficient competence in performing a service.

     (ii)   The continuing education is prescribed to address that deficiency.

     (iii)   The number of continuing education hours generally required are not sufficient to provide the education the individual needs to remedy the problem.

   (3)  Restrict medical command authorization, if the restriction does not preclude the individual from performing the services specified within the scope of the individual’s certification or recognition as permitted by the medical treatment protocols for the region. This permits imposing a restriction such as requiring on scene supervision when the individual performs a specified service or services, or permitting a specified service or services to be performed only when the individual is receiving online medical command.

   (4)  Withdraw medical command authorization.

 (d)  Appeals to the regional EMS medical director. An individual whose medical command authorization has been denied by the ALS service medical director may appeal the decision within 14 days to the regional EMS medical director. The individual’s appeal shall be in writing and shall specify the reasons the individual disagrees with the decision of the ALS service medical director. The regional EMS medical director shall conduct a hearing. If the regional EMS medical director is unable to conduct a fair hearing due to receiving prejudicial information prior to the hearing, or for any other reason, the regional EMS council shall arrange for the regional EMS medical director of another region to conduct the hearing. At the hearing, the ALS service medical director shall have the burden to proceed and offer testimony and other evidence in support of the ALS service medical director’s decision. The individual shall also have an opportunity to present testimony and other evidence in support of the individual’s position. Both parties shall have an opportunity to cross-examine opposing witnesses and to submit oral and written position statements. The regional EMS medical director may give the parties up to 5 additional days following the hearing to submit written position statements. The regional EMS medical director will issue a written decision affirming, reversing or modifying the ALS service medical director’s decision within 14 days after the hearing or within 14 days after the submission of post hearing position statements, if they are filed. The regional EMS medical director’s written decision shall contain the regional EMS medical director’s findings and conclusions. If the ALS service medical director fails to appear at the hearing, the regional EMS medical director shall reverse the ALS service medical director’s decision. If the individual fails to appear at the hearing, the regional EMS medical director shall make a determination upon the evidence presented and either affirm, reverse or modify the decision of the ALS service medical director. The burden of proof is a preponderance of the evidence.

 (e)  Appeals to the Department. If either party is dissatisfied with the decision of the regional EMS medical director with regard to medical command authorization, that party shall have the right of immediate appeal to the Department. The party appealing the regional EMS medical director’s decision shall submit a written statement to the Department specifying the reasons for the party’s objections to the regional EMS medical director’s decision within 14 days after that decision. The other party shall have 14 days to respond. The Department will review the record before the regional EMS medical director, and if deemed advisable by the Department will hear argument and additional evidence. As soon as practicable, the Department, will issue a final decision containing findings of fact and conclusions of law which affirms, reverses or modifies the regional EMS medical director’s decision.

 (f)  Scope of appeals. Appeals under this section shall be confined to a review and determination of whether, at the time of the assessment conducted by the ALS service medical director, the individual possessed the competence to perform all services within the scope of the individual’s medical command authorization for the ambulance service.

 (g)  Service; determination of time period. Each party shall serve the other with any document the party files with a regional EMS medical director or the Department. In determining the time in which a document is to be filed under this section, time begins to run for the parties when the document is mailed, and time begins to run for a regional EMS medical director when the document is received by the regional EMS medical director.

   The provisions of this §  1003.28 adopted September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256630) to (256633).

 (a)  First responders. A first responder who elects to qualify for recertification by fulfilling continuing education requirements shall, prior to the expiration of the 3-year certification period, successfully complete the following:

   (1)  Sixteen hours of instruction in subjects related to the scope of practice of a first responder as set forth in §  1003.22(a) and (e) (relating to first responder) and which have been approved by the Department for continuing education credit. At least eight of those credits shall be in medical and trauma education, commencing with the first full certification period the first responder begins following October 14, 2000:

   (2)  A CPR course completed or taught biennially.

 (b)  EMTs. An EMT who elects to qualify for recertification by fulfilling continuing education requirements shall, prior to the expiration of the 3-year certification period, successfully complete the following:

   (1)  Twenty-four hours of instruction in subjects related to the scope of practice of an EMT as set forth in §  1003.23(a) and (e) (relating to EMT) and which have been approved by the Department for continuing education credit. At least 12 of those credits shall be in medical and trauma education, commencing with the first full certification period the EMT begins following October 14, 2000.

   (2)  A CPR course completed or taught biennially.

 (c)  EMT-paramedics. To be eligible to receive and retain medical command authorization, an EMT-paramedic shall successfully complete in each calendar year, 18 hours of instruction in subjects related to the scope of practice of an EMT-paramedic as set forth in §  1003.24(a) and (d) (relating to EMT-paramedic) and which have been approved by the Department for continuing education credit, and shall biennially attend or teach a CPR course. Beginning in 2002, at least 9 of the 18 hours of instruction shall be in medical and trauma education. In the initial year of certification, the EMT-paramedic’s continuing education requirements, to secure renewal of medical command authorization for the following year, shall be prorated based upon the month the certification was secured.

 (d)  Prehospital registered nurses. To be eligible to receive and retain medical command authorization, a prehospital registered nurse shall successfully complete in each calendar year, 18 hours of instruction in subjects related to the scope of practice of a prehospital registered nurse as set forth in §  1003.25b(a) and (c) (relating to prehospital registered nurse) and which have been approved by the Department for continuing education credit, and shall attend or teach biennially a CPR course. Beginning in 2002, at least 9 of the 18 hours of instruction shall be in medical and trauma education. In the initial year of recognition, the prehospital registered nurse’s continuing education requirements, to secure renewal of medical command authorization for the following year, shall be prorated based upon the month the recognition was secured.

 (e)  This section does not prohibit an ambulance service from requiring prehospital personnel to satisfy continuing education requirements it may choose to impose as a condition of employment, provided that the ambulance service may not do the following:

   (1)  Excuse a prehospital practitioner from meeting continuing education requirements imposed by this section.

   (2)  Establish individual continuing education requirements for the EMT-paramedics or prehospital registered nurses staffing the ambulance service, except as authorized by §  1003.28(c)(2) (relating to medical command authorization).

   The provisions of this §  1003.29 adopted September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256633) to (256634).

 (a)  Entities and institutions may apply for accreditation as a continuing education sponsor by submitting to the Department an application in a format prescribed by the Department. The applicant shall supply all information requested in the application. The Department will grant accreditation to an applicant for accreditation as a continuing education sponsor if the applicant satisfies the Department that the courses the applicant will offer will meet the following minimum standards:

   (1)  The courses shall be of intellectual and practical content.

   (2)  The courses shall contribute directly to the professional competence, skills and education of prehospital personnel.

   (3)  The course instructors shall possess the necessary practical and academic skills to conduct the course effectively.

   (4)  Course materials shall be well written, carefully prepared, readable and distributed to attendees at or before the time the course is offered whenever practical.

   (5)  The courses shall be presented by a qualified responsible instructor in a suitable setting devoted to the educational purpose of the course.

 (b)  Accreditation of the continuing education sponsor shall be effective for 3 calendar years.

 (c)  At least 90 days prior to expiration of the 3-year accreditation period, a continuing education sponsor shall apply to the Department for renewal of the sponsor’s accreditation. The Department will renew the sponsor’s accreditation if the sponsor meets all of the following requirements:

   (1)  The sponsor has presented, within the preceding 3 years, at least five separate continuing education courses which met the minimum standards in subsection (a).

   (2)  The sponsor establishes to the Department’s satisfaction that future courses to be offered by the sponsor will meet the minimum standards in subsection (a).

   (3)  The sponsor has satisfied its responsibilities under §  1003.32 (relating to responsibilities of continuing education sponsors).

 (d)  If the Department deems that the continuing education sponsor has demonstrated a history of understanding and compliance with the regulatory standards for providing continuing education to prehospital personnel, the Department may apprise the continuing education sponsor that its accreditation constitutes prior approval of continuing education courses offered under this chapter which are presented in a classroom setting, and permit the continuing education sponsor to assign the number of credit hours for such a course, based upon the criteria in §  1003.31(a) (relating to credit for continuing education).

   The provisions of this §  1003.30 adopted September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial page (256635).

 (a)  Credit hour. A prehospital practitioner shall receive 1 hour credit for each 60 minutes of instruction presented in a classroom setting by a continuing education sponsor. Credit may not be received if attendance or other participation in the course is not adequate to meet the educational objectives of the course as determined by the course sponsor. Credit may not be received for other than 30 or 60-minute units of instruction, however the course shall be at least 60 minutes. For completing a continuing education course that is not presented in a classroom setting, or that is not presented by a continuing education sponsor, the prehospital practitioner shall receive the number of credit hours assigned by the Department to the course.

 (b)  Course completion. A prehospital practitioner may not receive credit for a continuing education course not completed, as evidenced by satisfaction of the check-in/check-out process for a course presented in a classroom setting by a continuing education sponsor, which reflects that the prehospital practitioner met the continuing education attendance requirement for receiving credit, and the continuing education sponsor’s report to the Department verifying that the prehospital practitioner has completed the course. The course will also not be considered completed if the prehospital practitioner does not satisfy other course completion requirements imposed by this chapter and the continuing education sponsor.

 (c)  Continuing education credit for instruction. A prehospital practitioner shall receive credit equal to the number of hours served as an instructor in a continuing education course offered by a continuing education sponsor, or in a course that satisfies requirements for initial certification or recognition of a prehospital practitioner conducted by an EMS training institute.

 (d)  Continuing education credit through endorsement. A prehospital practitioner who attends or teaches a course offered by an organization with National or state accreditation to provide education may apply to the Department to receive credit for the course. The prehospital practitioner shall have the burden of demonstrating to the Department that the course meets standards substantially equivalent to the standards imposed in this chapter.

 (e)  Continuing education credit assigned to courses not conducted by a continuing education sponsor. If a course is offered by an organization with National or state accreditation to provide education, which is not a continuing education sponsor, the Department will assign credit to the course, including the possibility of no credit or partial credit, based upon considerations of whether the course bears entirely upon appropriate subject matter and whether the method of presenting the course meets standards substantially equivalent to those prescribed in this chapter.

 (f)  Continuing education credit assigned to self-study courses. Credit may be sought from the Department for a self-study continuing education course. The prehospital practitioner shall submit an application to the Department to approve the self-study course for credit prior to commencing the course and shall supply the Department with the materials the Department requests to conduct the evaluation. The Department will assign credit to the course based upon considerations of whether the course addresses appropriate subject matter and whether the method of completing the course meets standards substantially equivalent to those prescribed in this chapter. The Department may require modifications to the proposed self-study as a precondition to approving it for credit.

 (g)  Continuing education credit assigned to courses not presented in a classroom setting. A prehospital practitioner shall be awarded credit for completing a course without the prehospital practitioner physically attending the course in a classroom setting, provided the course has been approved by the Department for credit when presented in that manner.

 (h)  Reporting continuing education credits to prehospital personnel. A record of the continuing education credits received by prehospital personnel shall be maintained in a Statewide registry. A report of the continuing education accumulated shall be provided annually to first responders and EMTs, and semiannually to EMT-paramedics and prehospital registered nurses at the mailing address on record with the Department.

 (i)  Resolution of discrepancies. It is the responsibility of the prehospital practitioner to review the report of continuing education credits and to notify the appropriate regional EMS council of any discrepancy within 30 days after the report is mailed. The Department will resolve all discrepancies between the number of continuing education credits reported and the number of continuing education credits a prehospital practitioner alleges to have earned, which are not resolved by the regional EMS council.

   The provisions of this §  1003.31 adopted October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363.

 (a)  Course approval. A continuing education sponsor shall submit, to the regional EMS council that exercises responsibility for the EMS region in which the continuing education sponsor intends to conduct a new continuing education course, an application for approval of that continuing education course. The continuing education sponsor shall submit that application at least 30 days prior to the date the continuing education sponsor expects to conduct the course.

 (b)  Record of attendance. A continuing education sponsor shall maintain a record of attendance for a course presented in a classroom setting by maintaining a check-in/check-out process approved by the Department, and shall assign at least one person to ensure that all individuals attending the course check in when entering and check out when leaving. If an individual enters a course after the starting time, or leaves a course before the finishing time, the assigned person shall ensure that the time of arrival or departure is recorded for the individual.

 (c)  Reporting attendance. A continuing education sponsor shall report to the Department, in the manner and format prescribed by the Department, attendance at each continuing education course presented in a classroom setting within 10 days after the course has been presented.

 (d)  Course evaluation. A continuing education sponsor shall develop and implement methods to evaluate its course offerings to determine their effectiveness. The methods of evaluation shall include providing a course evaluation form to each person who attends a course.

 (e)  Record retention. The continuing education sponsor shall retain for each course it presents, the completed course evaluation forms and the check-in/check-out record for a course presented in a classroom setting. If the continuing education sponsor has received Department approval to assign credit to a course under §  1003.30(d) (relating to accreditation of sponsors of continuing education), the retained records shall also include course materials used, a record of the course instructor’s qualifications, the course instructor’s lesson plans and examinations if applicable. These records shall be retained for at least 4 years from the presentation of the course.

 (f)  Providing records. A continuing education sponsor shall promptly provide the Department with complete and accurate records relating to the course as requested by the Department.

 (g)  Course not presented in a classroom setting. A continuing education sponsor shall be exempt from the requirements of subsections (a) and (b) for a course which is not presented in a classroom setting, if the course is approved by the Department for credit when presented in that manner. When presenting the course to the Department for approval for credit, the continuing education sponsor shall present a procedure for monitoring, confirming and reporting prehospital practitioner participation in a manner that achieves the purposes of subsections (a) and (b).

 (h)  Monitoring responsibilities. A continuing education sponsor shall ensure that a course was presented in a manner that met all of the educational objectives for the course, and shall determine whether each prehospital practitioner who enrolled in the course met the requirements of this chapter and the continuing education sponsor to receive credit for completing the course.

 (i)  Course completion. A continuing education sponsor shall report to the Department, in a manner and format prescribed by the Department, completion of a course by a prehospital practitioner who completes the course, and shall identify to the Department a prehospital practitioner who seeks credit for a course but who did not meet the requirements of the continuing education sponsor or this chapter to receive continuing education credit. The continuing education sponsor shall also provide a prehospital practitioner who completes a course with a document certifying completion of the course.

 (a)  A continuing education sponsor may advertise a course as a continuing education course in a manner that states or suggests that the course meets the requirements of this chapter only if the course has been approved by the Department or is deemed approved under §  1003.30(d) (relating to accreditation of sponsors of continuing education).

 (b)  When a course has been approved for continuing education credit, the continuing education sponsor shall announce, in its brochures or registration materials: this course has been approved by the Pennsylvania Department of Health for

 (c)  If a continuing education sponsor advertises that it has applied to the Department to secure continuing education credit for a course, prior to presenting the course it shall disclose to all enrollees whether the course has been approved or disapproved for credit.

 If the continuing education sponsor fails to satisfy the requirements of this chapter, the Department may:

   (1)  Withdraw its accreditation.

   (2)  Downgrade its accreditation status to provisional accreditation, subject to withdrawal if deficiencies are not resolved within a time period prescribed by the Department.

   (3)  Withdraw approval of a continuing education course applicable to any future presentation of the course.

   The provisions of this §  1003.34 adopted October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363.

Subchapter C. [Reserved]

§ 1003.41. [Reserved].

   The provisions of this §  1003.44 reserved October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial page (256638).