Subchapter A. ADMINISTRATIVE AND SUPERVISORY
EMS PERSONNEL

§ 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).