Code of Maryland Regulations Title 30 Maryland Institute

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More Information n If you need additional information please contact the MIEMSS, Office of the Assistant Attorney General Monty Magee n Sarah Sette n (410) 706 -8531 (410) 706 -8514

Maryland Title 30 Questions ? ? ? Comments ? ? ?