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Pennsylvania Code



Subchapter A. GENERAL PROVISIONS


Sec.


1021.1.    Purpose.
1021.2.    Definitions.
1021.3.    Applicability.
1021.4.    Exceptions.
1021.5.    Investigations.
1021.6.    Comprehensive EMS system plan.
1021.7.    Comprehensive regional EMS system plan.
1021.8.    EMS data collection.

§ 1021.1. Purpose.

 The purpose of this subpart is to facilitate improvement of the Statewide EMS system into a comprehensive and flexible system through coordination of the regional EMS systems, to synchronize the Statewide and regional systems with EMS systems in neighboring states and to otherwise implement the Department’s responsibilities under the act consistent with the Department’s rulemaking authority.

§ 1021.2. Definitions.

 The following words and terms, when used in this subpart, have the following meanings, unless the context clearly indicates otherwise:

   ACLS courseAdvanced cardiac life support course—A course in advanced cardiac life support sanctioned by the American Heart Association.

   AEMT—Advanced emergency medical technician—An individual who is certified by the Department as an advanced EMT.

   ALS—Advanced life support.

   ALS ambulance—Advanced life support ambulance—An ambulance that is staffed and equipped to provide EMS above the AEMT level and used in the transport of patients.

   ALS squad vehicle—Advanced life support squad vehicle

     (i)   A vehicle that is maintained or operated to transport EMS providers above the AEMT level, and equipment and supplies, to rendezvous with the crew of an ambulance for the purpose of providing advanced EMS to patients.

     (ii)   The vehicle is not used in the transport of patients.

   APLS course—Advanced pediatric life support course—A course in advanced pediatric life support sanctioned by the American Academy of Pediatrics and the American College of Emergency Physicians.

   ATLS course—Advanced trauma life support course—A course in advanced trauma life support sanctioned by the American College of Surgeons Committee on Trauma.

   Act—35 Pa.C.S. § §  8101—8157 (relating to Emergency Medical Services System Act).

   Advanced EMS—Advanced emergency medical services—EMS exceeding the scope of practice of an EMT, as authorized by the Department.

   Advisory Board—The State Advisory Board, which is the Board of Directors of the Pennsylvania Emergency Health Services Council.

   Air ambulance—A rotorcraft specifically designed, constructed or modified and equipped, used or intended to be used and maintained or operated for the purpose of providing emergency medical care to and air transportation of patients.

   Ambulance—A ground, water or air vehicle which is maintained or operated for the purpose of providing EMS to and transportation of patients.

   Ambulance crew—EMS providers that staff an ambulance to provide emergency medical services.

   BLS—Basic life support.

   BLS ambulance—Basic life support ambulance—An ambulance that is equipped to provide EMS at or below the AEMT level and used in the transport of patients.

   BLS squad vehicle—Basic life support squad vehicle

     (i)   A vehicle that is maintained or operated to transport EMS providers, and equipment and supplies, to rendezvous with the crew of an ambulance for the purpose of providing to patients EMS at or below the AEMT level.

     (ii)   The vehicle is not used in the transport of patients.

   Basic EMS—Basic emergency medical services—EMS included within, but not exceeding, the scope of practice of an EMT.

   Bureau

     (i)   The Bureau of Emergency Medical Services of the Department.

     (ii)   If the Department is reorganized, the office within the Department assigned primary responsibility for administering the act.

   CPR—Cardiopulmonary resuscitation—Artificial circulation which is performed as a procedure when cardiac arrest occurs.

   CPR course—Cardiopulmonary resuscitation course—A course of instruction in CPR meeting the Emergency Cardiac Care Committee National Conference on CPR and Emergency Cardiac Care standards. The course shall encompass one- and two-rescuer adult, infant and child CPR, and obstructed airway methods.

   Call-taker—An EMS agency dispatch center employee who is responsible for taking calls from callers seeking EMS and gathering the essential information from callers to determine whether EMS is needed and, if required, the location to which EMS resources need to be sent.

   Call-taking—The act of answering emergency calls from the public and obtaining the information necessary to dispatch EMS resources to the reported location of the emergency.

   Commonwealth EMS Medical Director—Commonwealth Emergency Medical Services Medical Director—A physician who is approved by the Department to advise and formulate policy on matters pertaining to EMS.

   Continuing education—Learning activities intended to build upon the education and experience of EMS providers and EMSVOs to enhance and strengthen the quality of services provided.

   Continuing education course—A unit of continuing education for which the Department will grant an EMS provider or EMSVO continuing education credit.

   Continuing education sponsor—An entity or institution that is accredited by the Department as a sponsor of continuing education courses.

   Conviction—A judgment of guilt, a plea of guilty or a plea of nolo contendere.

   Department—The Department of Health of the Commonwealth.

   Dispatcher—An EMS agency dispatch center employee who is responsible for taking the information gathered by the call-taker and determining the appropriate EMS response and dispatching the EMS resources needed to respond to the EMS needs of the patient.

   Dispatching—The act of alerting and directing the response of EMS resources to the desired locations.

   EMR—Emergency medical responder—An individual who is certified by the Department as an emergency medical responder.

   EMS—Emergency medical services—Either of the following:

     (i)   The medical care, including medical assessment, monitoring, treatment, transportation and observation, which may be provided to a person in responding to an actual or reported emergency to either of the following:

       (A)   Prevent or protect against loss of life or a deterioration in physiological or psychological condition.

       (B)   Address pain or morbidity associated with the person’s condition.

     (ii)   The transportation of an individual with medical assessment, monitoring, treatment or observation of the individual who, due to the individual’s condition, requires medical assessment, monitoring, treatment or observation during the transport.

   EMS agency—Emergency medical services agency—An entity that engages in the business or service of providing EMS to patients within this Commonwealth by operating one or more of the following:

     (i)   An ambulance service.

     (ii)   An air ambulance.

     (iii)   An ALS ambulance.

     (iv)   An ALS squad vehicle.

     (v)   An intermediate ALS ambulance.

     (vi)   An intermediate ALS squad vehicle.

     (vii)   A BLS ambulance.

     (viii)   A BLS squad vehicle.

     (ix)   A QRS.

     (x)   An ALS water ambulance.

     (xi)   An intermediate ALS water ambulance.

     (xii)   A BLS water ambulance.

     (xiii)   An EMS agency dispatch center.

     (xiv)   A special operations EMS service, which includes a tactical EMS service, a wilderness EMS service, an urban search and rescue service, and a mass-gathering EMS service.

     (xv)   Another vehicle or service that provides EMS outside of a health care facility as prescribed by the Department by regulation.

   EMS agency dispatch center—Emergency medical services agency dispatch center

     (i)   A communications center owned, operated or controlled by an EMS agency that dispatches EMS resources due to a PSAP routing emergency callers to it for that purpose or due to the EMS agency receiving calls through an EMS agency provided telephone number through which the EMS agency invites persons to request the EMS agency’s response to an emergency.

     (ii)   This term does not include a communications center licensed by the Pennsylvania Emergency Management Agency under 35 Pa.C.S. Chapter 53 (relating to emergency telephone service).

   EMS agency medical director—Emergency medical services agency medical director—A physician who is employed by, contracts with or volunteers with an EMS agency either directly or through an intermediary to evaluate the quality of patient care provided by the EMS providers utilized by the EMS agency and to provide medical guidance and advice to the EMS agency.

   EMS agency medical director course—Emergency medical services agency medical director course—A course adopted by the Department for EMS agency medical directors which provides education in EMS medical direction.

   EMS educational institute—Emergency medical services educational institute—An institute accredited by the Department to provide education required for the certification of an EMS provider by the Department.

   EMS PCR—Emergency medical services patient care report—A report that provides standardized data and information relating to patient assessment and care.

   EMS provider—Emergency medical services provider—The term includes the following:

     (i)   An EMR.

     (ii)   An EMT.

     (iii)   An AEMT.

     (iv)   A paramedic.

     (v)   A PHRN.

     (vi)   A PHPE.

     (vii)   A PHP.

     (viii)   An individual prescribed by regulation of the Department to provide specialized EMS.

   EMS provider educational course—An educational course approved by the Department, other than a CPR course, the successful completion of which is a requirement for securing an EMS provider certification.

   EMS system—Emergency medical services system—The arrangement of personnel, facilities and equipment for the delivery of EMS in a geographic area to prevent and manage emergencies.

   EMS vehicle—Emergency medical services vehicle—A ground EMS vehicle, a water ambulance or an air ambulance.

   EMS vehicle crew—Emergency medical services vehicle crew—EMS providers that staff an EMS vehicle to provide emergency medical services.

   EMSOF—Emergency Medical Services Operating Fund—Moneys appropriated to the Department under section 8153(a) of the act (relating to support of emergency medical services) and which are not assigned to the Catastrophic Medical and Rehabilitation Fund.

   EMSVO—Emergency medical services vehicle operator—An individual who is certified by the Department to operate a ground EMS vehicle.

   EMT—Emergency medical technician—An individual who is certified by the Department as an emergency medical technician.

   EVOC—Emergency vehicle operator’s course.

   Emergency—A physiological or psychological illness or injury of an individual so that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate EMS to result in one of the following:

     (i)   Placing the health of the individual or, with respect to a pregnant woman, the health of the woman or her unborn child in serious jeopardy.

     (ii)   Serious impairment of a bodily function.

     (iii)   Serious dysfunction of a bodily organ or part.

   Emergency department—An area of the hospital dedicated to offering emergency medical evaluation and initial treatment to individuals in need of emergency care.

   Emergency dispatch calls—Emergency incidents to which an EMS agency dispatch center dispatches EMS resources.

   Emergency medical dispatch—The dispatching of emergency medical services agencies.

   Emergency medical dispatch protocols—A system or program that enables patients to be assessed and treated by telephone by utilizing currently accepted emergency medical dispatch standards.

   Facility—A physical location at which an entity operates a health care facility licensed under Federal or State law.

   First responder—An individual who is certified by the Department as a first responder.

   Ground EMS vehicle—Ground emergency medical services vehicle—The term includes the following:

     (i)   A BLS ambulance.

     (ii)   A BLS squad vehicle.

     (iii)   An intermediate ALS ambulance.

     (iv)   An intermediate ALS squad vehicle.

     (v)   An ALS ambulance.

     (vi)   An ALS squad vehicle.

   Hospital—An institution having an organized medical staff which is primarily engaged in providing to inpatients by or under the supervision of physicians, diagnostic and therapeutic services or rehabilitation services for the care or rehabilitation of injured, disabled, pregnant, diseased, sick or mentally ill persons. The term includes a facility for the diagnosis and treatment of disorders within the scope of specific medical specialties, but not a facility caring exclusively for the mentally ill.

   Intermediate ALS ambulance—Intermediate advanced life support ambulance—An ambulance that is staffed and equipped to provide EMS at the AEMT level and used in the transport of patients.

   Intermediate ALS squad vehicleIntermediate advanced life support squad vehicle

     (i)   A vehicle that is maintained or operated to transport EMS providers at the AEMT level, and equipment and supplies, to rendezvous with the crew of an ambulance for the purpose of providing advanced EMS to patients.

     (ii)   The vehicle is not used in the transport of patients.

   Medical advisory committee—An advisory body formed to advise a regional EMS council or the Advisory Board on issues that have potential impact on the delivery of emergency medical care.

   Medical audit—A mechanism to evaluate patient care.

   Medical command

     (i)   Medical oversight, including orders, given by a medical command physician to an EMS provider to do either of the following:

       (A)   Provide immediate medical care or transportation to prevent loss of life or aggravation of physiological or psychological illness or injury.

       (B)   Withdraw or withhold treatment.

     (ii)   Medical command is given in a prehospital setting, interfacility transport setting or emergency care setting in a hospital.

   Medical command course—The course adopted by the Department for medical command physicians which provides an overview of the EMS system and process of medical command.

   Medical command facility—A distinct unit which contains the necessary equipment and personnel for providing medical command to and control over EMS providers.

   Medical command facility medical director—A medical command physician who meets the criteria established by the Department to assume responsibility for the direction and control of the equipment and personnel at a medical command facility.

   Medical command physician—A physician who is certified by the Department to give medical command to EMS providers.

   Medical coordination—A system which involves the medical community in all phases of the regional EMS system and consists of the following elements:

     (i)   Designation of a regional EMS medical director.

     (ii)   Oversight to ensure implementation of all medical requirements, with special emphasis on patient triage and medical treatment protocol.

     (iii)   Effective emergency medical planning and recommendation for Department recognition of online command facilities with medical command physicians who give medical command to EMS providers.

     (iv)   Transfer and medical treatment protocols.

     (v)   Technologic innovations that support the training and operations of the physicians giving orders to EMS providers.

     (vi)   Technologic innovations that support the training and operations of the EMS program and an effective process for accountability-for example, records, case review and audits.

   Medical monitoring—Performing continuous or periodic observations of an individual’s condition or continuation of an ordered treatment plan for an individual to prevent pain, suffering or the exacerbation of a preexisting condition.

   Medical observation—Performing continuous or periodic observations of an individual’s stable condition to determine whether there is a change in that condition.

   Medical record—Documentation of the course of a patient’s condition and treatment, maintained to provide communication among health care providers for current and future patient care.

   PALS coursePediatric advanced life support course—A course in advanced pediatric life support sanctioned by the American Heart Association and the American Academy of Pediatrics.

   PHP—Prehospital emergency medical services physician—A physician who is certified by the Department as a prehospital EMS physician.

   PHPE—Prehospital physician extender—A physician assistant who is certified by the Department as a prehospital physician extender.

   PHRN—Prehospital registered nurse—A registered nurse who is certified by the Department as a prehospital registered nurse.

   PSAP—Public safety answering point

     (i)   The Pennsylvania Emergency Management Agency-approved first point at which calls for emergency assistance from individuals are answered.

     (ii)   A PSAP is operated 24 hours a day.

   Paramedic—An individual who is certified by the Department as a paramedic.

   Patient—An individual for whom an EMS provider is responsible for one of the following:

     (i)   Providing EMS on behalf of an EMS agency.

     (ii)   Required to provide EMS on behalf of an EMS agency because the individual’s condition requires or may require medical observation, monitoring, assessment or treatment for an illness, disease, injury or other disability.

   Peer review—The evaluation by health care providers of the quality and efficiency of services ordered or performed by EMS providers and physicians who direct or supervise EMS providers under the act and the regulations of the Department.

   Peer review committee—A committee of health care providers who engage in peer review under the act.

   Performance appraisal—A yearly written evaluation of a call-taker’s or dispatcher’s job performance measured against established EMS agency dispatch center expectations, policies and standards.

   Physician—An individual who has a currently registered license to practice medicine or osteopathic medicine in this Commonwealth.

   QRS—Quick response service—An operation in which EMS providers of an EMS agency:

     (i)   Respond to an actual, reported or perceived emergency.

     (ii)   Provide EMS to patients pending the arrival of other EMS providers and resources that have been dispatched to the scene.

   Quality assurance action—An action taken by a quality assurance reviewer or EMS agency dispatch center supervisor after a quality assurance review to correct or improve call-taking or dispatching deficiencies identified by the quality assurance review.

   Quality assurance review—A quality assurance process that is used to assess the job performance of a call-taker or dispatcher.

   Quality assurance reviewer—An EMS agency employee who conducts quality assurance reviews of the EMS agency dispatch center’s radio activity to determine adherence to the EMS agency dispatch center’s standards.

   Radio activity—Call-taking, dispatching and communicating on a public safety radio frequency.

   Receiving facility—A facility to which an ambulance may transport a patient who requires prompt medical care in addition to that provided by EMS providers who respond to an emergency.

   Regional EMS council—Regional emergency medical services council—A nonprofit incorporated entity or appropriate equivalent that is assigned by the Department to:

     (i)   Plan, develop, maintain, expand and improve EMS systems within a specific geographical area of this Commonwealth.

     (ii)   Coordinate those systems into a regional EMS system.

   Regional EMS medical director—Regional emergency medical services medical director—The medical director of a regional EMS council.

   Registered nurse—An individual who has a current original or renewed license to practice nursing in this Commonwealth as a registered nurse.

   Residency program—Training approved or recognized by the State Board of Medicine or the State Board of Osteopathic Medicine as a program of graduate medical training for physicians.

   Rural area—An area outside urbanized areas as defined by the United States Bureau of the Census.

   Scope of practice—The EMS that an individual who is certified by the Department as an EMS provider is permitted to perform under the certification.

   Service area—The geographic area in which an EMS agency routinely provides EMS.

   Special event—A planned and organized activity or contest, which places participants or attendees, or both, in a defined geographic area in which the potential need for EMS exceeds local EMS capabilities or where access by emergency vehicles might be delayed due to crowd or traffic congestion at or near the event.

   Special vehicle rescue technician—An individual who is certified by the Department as possessing the training and skills to perform special rescue operations as taught in the special vehicle rescue training program approved by the Department.

   Standard operating procedures—A set of policies and procedures developed and adopted by an EMS agency dispatch center to aid in directing the daily operations of the telecommunications staff.

   Statewide EMS protocolsStatewide emergency medical services protocols—Written EMS protocols adopted by the Department that have Statewide application to the delivery of EMS by EMS providers.

   Trauma center—A facility accredited as a trauma center by the Trauma Foundation.

   Trauma Foundation—The Pennsylvania Trauma Systems Foundation, a nonprofit Pennsylvania corporation whose function is to accredit trauma centers.

   Vehicle rescue technician—An individual who is certified by the Department as possessing the training and skills to perform a rescue from a vehicle as taught in a vehicle rescue technician program approved by the Department.

   Water ambulance—A watercraft specifically designed, constructed or modified and equipped, used or intended to be used and maintained or operated for the purpose of providing emergency medical care to, and water transportation of, patients.

§ 1021.3. Applicability.

 This subpart affects persons and activities regulated by the Department under the act.

§ 1021.4. Exceptions.

 (a)  The Department may grant exceptions to, and departures from, this subpart when the policy objectives and intentions of the Department as reflected in this subpart are otherwise met or when compliance would create an unreasonable hardship, but would not impair the health, safety or welfare of the public. Exceptions or departures from this subpart will not be granted if compliance with the standard is required by statute.

 (b)  Requests for exceptions to this subpart shall be made in writing to the Department. The requests, whether approved or not approved, will be documented and retained on file by the Department in accordance with its document retention schedule. Approved requests shall be retained on file by the applicant during the period the exception remains in effect.

 (c)  A granted request will specify, if relevant, the period during which the exception is operative. The duration of an exception may be extended if the reasons for the original exception continue. Requests for an exception extension shall be made in writing to the Department.

 (d)  An exception granted may be revoked by the Department for just cause. Just cause includes, for example, failure to meet the conditions for the exception. Notice of the revocation will be in writing and include the reason for the action of the Department and a specific date upon which the exception will be terminated.

 (e)  In revoking an exception, the Department will provide for a reasonable time between the date of the written notice or revocation and the date of termination of an exception for the holder of the exception to come into compliance with this subpart. Failure to comply after the specified date may result in enforcement or disciplinary proceedings.

 (f)  The Department may, on its own initiative, grant an exception to this subpart if the requirements in subsection (a) are satisfied.

Cross References

   This section cited in 28 Pa. Code §  1021.141 (relating to research).

§ 1021.5. Investigations.

 The Department may investigate any person, entity or activity for compliance with the act and this subpart.

§ 1021.6. Comprehensive EMS system plan.

 (a)  The Department, with the advice of the Advisory Board, will develop and annually update a Statewide EMS System Plan, which will include both short-range and long-range goals and objectives for the coordinated delivery of EMS in this Commonwealth.

 (b)  The plan will contain:

   (1)  An inventory of EMS resources available in this Commonwealth.

   (2)  An assessment of the effectiveness of the existing Statewide EMS system and a determination of the need for changes to the Statewide EMS system.

   (3)  Performance measures for delivery of EMS to persons in this Commonwealth.

   (4)  Methods to be used in achieving stated performance measures.

   (5)  A schedule for achievement of the stated performance measures.

   (6)  A method for monitoring and evaluating whether the stated Statewide performance measures are being achieved.

   (7)  Estimated costs for achieving the stated performance measures.

 (c)  The Department will incorporate regional EMS system plans into the Statewide EMS System Plan.

 (d)  The Department will adopt a Statewide EMS System Plan, updates to the plan after public notice, an opportunity for comment and its consideration of comments received. The Department will make the plan available to the General Assembly and concerned agencies, entities and individuals who request a copy.

§ 1021.7. Comprehensive regional EMS system plan.

 (a)  A regional EMS council shall develop and annually update a regional EMS system plan for coordinating and improving the delivery of EMS in the region for which it has been assigned responsibility.

 (b)  The plan must contain:

   (1)  An inventory of EMS resources available in the region.

   (2)  An assessment of the effectiveness of the existing regional EMS system and a determination of the need for enhancement of the regional EMS system.

   (3)  A statement of goals and specific measurable objectives for delivery of EMS to persons in the region.

   (4)  Identification of interregional problems and recommended measures to resolve those problems.

   (5)  Methods to be used in achieving stated performance measures.

   (6)  A schedule for achievement of the stated performance measures.

   (7)  A method for evaluating whether the stated performance measures have been achieved.

   (8)  Estimated costs for achieving the stated performance measures.

   (9)  Other information as requested by the Department.

 (c)  A regional EMS council shall, in the course of preparing a regional EMS system plan and updates to the plan, provide public notice and an opportunity for comment. It shall consider the comments before submitting a proposed plan to the Department.

 (d)  A regional EMS system plan will become final after it is approved by the Department. The regional EMS council shall make the plan available to concerned agencies, entities and individuals who request a copy.

§ 1021.8. EMS data collection.

 (a)  Reasons for EMS data collection. The Department, either directly or through regional EMS councils or the Advisory Board, may collect EMS data for the purpose of evaluating the effectiveness of the Statewide and regional EMS system plans and the need to revise those plans and pursue future EMS system initiatives. This will include collecting EMS data to determine the status of the Statewide and regional EMS systems, the degree of compliance with the requirements in the act and this subpart, and the effectiveness of the Statewide and regional EMS systems in reducing morbidity and mortality when the EMS systems are involved.

 (b)  Duty to provide EMS data and records. Persons regulated by the Department under the act, as well as PSAPs and others dispatchers of EMS resources, shall provide data and access to records, including audio records, without charge, as reasonably requested by the Department, the regional EMS councils or the Advisory Board when they are acting for and on behalf of the Department, to aid the Department, the regional EMS councils and the Advisory Board in conducting the activities referenced in subsection (a) and engaging in an investigation authorized under the act and this subpart.

Cross References

   This section cited in 28 Pa. Code §  1027.3 (relating to licensure and general operating standards).



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