§ 1003.28. Medical command authorization.

 (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).

   This section cited in 28 Pa. Code §  1003.2 (relating to regional EMS medical director); 28 Pa. Code §  1003.5 (relating to ALS service medical director); 28 Pa. Code §  1003.23 (relating to EMT); 28 Pa. Code §  1003.24 (relating to EMT-paramedic); 28 Pa. Code §  1003.25b (relating to prehospital registered nurse); 28 Pa. Code §  1003.29 (relating to continuing education requirements); 28 Pa. Code §  1003.41 (relating to air ambulance medical director); and 28 Pa. Code §  1005.10 (relating to licensure and general operating standards).