Current through Register Vol. 48, No. 12, March 22, 2024
a)
Critical care transport may be provided by:
1)
Department-approved critical care
transport providers, not owned or operated by a hospital, utilizing
EMT-Paramedics with additional training, nurses, or other qualified health
professionals; or
2)
Hospitals, when utilizing any vehicle service provider or any
hospital-owned or operated vehicle service provider. Nothing in the
Act requires a hospital to use, or to be, a Department-approved
critical care transport provider when transporting patients, including those
critically injured or ill. Nothing in the Act shall restrict
or prohibit a hospital from providing, or arranging for, the medically
appropriate transport of any patient, as determined by a physician licensed to
practice medicine in all of its branches, an APRN, or a
PA. (Section 3.10(f-5) of the Act)
b)
All critical care transport
providers must function within a Department-approved EMS System. Nothing
in this Part shall restrict a hospital's ability to furnish
personnel, equipment, and medical supplies to any vehicle service provider,
including a critical care transport provider. (Section 3.10(g-5) of
the Act)
c) For the purposes of
this Section, "expanded scope of practice" includes the accepted national
curriculum plus additional education, experience and equipment (see Section
515.360
) as approved by the Department pursuant to Section 3.55 of the Act. Tier I
transports are considered "expanded scope of practice".
d) For the purposes of this Section, CCT
plans are defined in three tiers of care. Tier II and Tier III are considered
Critical Care Transports.
e) Tier I
Tier I provides a level of care for patients who require care
beyond the Department-approved Paramedic scope of practice, up to but not
including the requirements of Tiers II and III. Tier I transport includes the
use of a ventilator, the use of infusion pumps with administration of
medication drips, and maintenance of chest tubes.
1) Personnel Staffing and Licensure
A) Licensure
i) Licensed Illinois Paramedic, PHRN, PHPA or
PHAPN;
ii) Scope of practice more
comprehensive than the national EMS scope of practice model approved by the
Department in accordance with the EMS System plan (see Sections
515.310
and
515.330);
and
iii) Approved to practice by
the Department in accordance with the EMS System plan.
B) Minimum Staffing
i) System authorized EMT, A-EMT, EMT-I,
Paramedic, PHRN, PHPA or PHAPN as driver; and
ii) System authorized expanded scope of
practice Paramedic, PHRN, PHPA, PHAPN or physician who shall remain with the
patient at all times.
2) Education, Certification and Experience
A) Initial Education. Documentation of
initial education and demonstrated competencies of expanded scope of practice
knowledge and skills as required by Tier I Level of Care and approved by the
Department in accordance with the EMS System plan.
B) CE Requirements
i) Annual competencies of expanded scope of
practice knowledge, equipment and procedures shall be completed; and
ii) The EMS vehicle service provider shall
maintain documentation of competencies and provide documentation to the EMS
Resource Hospital upon request.
C) Certifications. Tier I personnel shall
maintain all of the following renewable certifications and credentials in
active status:
i) Advanced Cardiac Life
Support (ACLS);
ii) Pediatric
Education for Pre-Hospital Professionals (PEPP) or Pediatric Advance Life
Support (PALS);
iii) International
Trauma Life Support (ITLS) or Pre-Hospital Trauma Life Support (PHTLS);
and
iv) Any additional educational
course work or certifications required by the EMS MD.
D) Experience
i) Minimum of one year of experience
functioning in the field at an ALS level or as a physician in an emergency
department; and
ii) Documentation
of education and demonstrated competencies of expanded scope of practice
knowledge and skills required for Tier I Level of Care, approved by the
Department and included in the EMS System plan.
3) Medical Equipment and Supplies
A) Ventilator; and
B) Infusion pumps.
4) Vehicle Standards
Any vehicle used for providing expanded scope of practice
care shall comply at a minimum with Section
515.830
(Ambulance Licensing Requirements) or Sections
515.900
(Licensure of SEMSV Programs -General) and
515.920
(SEMSV Program Licensure Requirements for All Vehicles) regarding licensure of
SEMSV Programs and SEMSV vehicle requirements, including additional medical
equipment and ambulance equipment as defined in this Section. Any vehicle used
for expanded scope of practice transport shall be equipped with an onboard
alternating current (AC) supply capable of operating and maintaining the AC
current needs of the required medical devices used in providing care during the
transport of a patient.
5)
Treatment and Transport Protocols shall address the following:
A) EMS MD or designee present at established
Medical Control;
B) Communication
points for contacting System authorized Medical Control and a written Expanded
Scope of Practice Standard;
C)
Written operating procedures and protocols signed by the EMS MD and approved
for use by the Department in accordance with the System plan; and
D) Use of a ventilator, infusion pumps with
administration of medication drips, and maintenance of chest tubes.
6) Quality Assurance Program
A) The Tier I transport provider shall
develop a written Quality Assurance (QA) plan approved by the EMS System and
the Department in accordance with subsection (e)(6)(D). The provider shall
provide quarterly QA reports to the assigned EMS Resource Hospitals for the
first 12 months of operation.
B)
The EMS System shall establish the frequency of quality reports after the first
year if the System has not identified any deficiencies or adverse
outcomes.
C) An EMS MD or a SEMSV
shall oversee the QA program.
D)
The QA plan shall evaluate all expanded scope of practice activity for medical
appropriateness and thoroughness of documentation. The review shall include:
i) Review of transferring physician orders
and evidence of compliance with those orders;
ii) Documentation of vital signs and
frequency and evidence that abnormal vital signs or trends suggesting an
unstable patient were appropriately detected and managed;
iii) Documentation of any side
effects/complications, including hypotension, extreme bradycardia or
tachycardia, increasing chest pain, dysrhythmia, altered mental status and/or
changes in neurological examination, and evidence that interventions were
appropriate for those events;
iv)
Documentation of any unanticipated discontinuation of a catheter or rate
adjustments of infusions, along with rationale and outcome;
v) Review of any Medical Control contact for
further direction;
vi)
Documentation that any unusual occurrences were promptly communicated to the
EMS System; and
vii) A root cause
analysis of any event or care inconsistent with standards. The EMS System
educator shall assess and carry out a corrective action
plan.
E) The QA plan
shall be subject to review as part of an EMS System site survey and as deemed
necessary by the Department (e.g., in response to a complaint).
f) Tier II
Tier II provides a level of care for patients who require
care beyond the Department-approved national EMS scope of practice model and
expanded scope of practice ALS (Paramedic) transport program, and who require
formal advanced education for ALS Paramedic staff. Tier II transport includes
the use of a ventilator, infusion pumps with administration of medication
drips, maintenance of chest tubes, and other equipment and treatment, such as,
but not limited to: arterial lines; accessing central lines;
medication-assisted intubation; patient assessment and titration of IV pump
medications, including additional active interventions necessary in providing
care to the patient receiving treatment with advanced equipment and
medications.
1) Personnel Staffing and
Licensure
A) Licensure - Licensed Illinois
Paramedic, PHRN, PHPA or PHAPN:
i) Expanded
scope of practice more comprehensive than the national EMS scope of practice
model and Tier I Level as approved by the Department; and
ii) Approved to practice by the EMS System
and the Department in accordance with the EMS System plan.
B) Minimum Staffing:
i) System authorized Paramedic, PHRN, PHPA or
PHAPN; and
ii) System authorized
Paramedic, PHRN, PHPA, PHAPN or physician who is critical care prepared and who
shall remain with the patient at all times.
2) Education, Certification and Experience
A) Initial Advanced Formal Education.
i) At a minimum, 80 didactic hours of
established higher collegiate education or equivalent critical care education
based on nationally recognized program models; and
ii) Demonstrated competencies, as documented
by the EMS MD or SEMSV MD and approved by the Department.
B) CE Requirements
i) The EMS System shall document and maintain
annual competencies of expanded scope of practice knowledge, equipment and
procedures;
ii) The following
current credentials, as a minimum, shall be maintained: ACLS, PEPP or PALS,
ITLS or PHTLS;
iii) A minimum of 40
hours of critical care level education shall be completed every four
years;
iv) The EMS provider shall
maintain documentation of compliance with subsections (f)(2)(B)(i) through
(iii) and shall provide documentation to the EMS Resource Hospital upon
request; and
v) Nationally
recognized critical care certifications shall be maintained and renewed based
on national recertification criteria.
C) Experience. Minimum of two years
experience functioning in the field at an ALS level for Paramedics and PHRNs
and one year experience in an emergency department for physicians.
3) Medical Equipment and Supplies
A) Ventilator; and
B) Infusion pumps.
4) Vehicle Standards
Any vehicle used for providing critical care transport shall
comply at a minimum with Section
515.830
(Ambulance Licensing Requirements) or Sections
515.900
(Licensure of SEMSV Programs - General) and
515.920
(SEMSV Program Licensure Requirements for All Vehicles) regarding licensure of
SEMSV Programs and SEMSV vehicle requirements, including additional medical
equipment and ambulance equipment as defined in this Section. Any vehicle used
for CCT shall be equipped with an onboard AC supply capable of operating and
maintaining the AC current needs of the required medical devices used in
providing care during the transport of a patient.
5) Treatment and Transport Protocols shall
address the following:
A) EMS MD or designee
present at established Medical Control communication points and a written
Expanded Scope of Practice Standard Operating Procedure signed by the EMS MD
and approved for use by the Department in accordance with the System
plan;
B) The use of a ventilator,
infusion pumps with administration of medication drips, maintenance of chest
tubes, and other equipment and treatment, such as, but not limited to: arterial
lines, accessing central lines, and medication-assisted intubation;
and
C) Patient assessment and
titration of IV pump medications, including additional active interventions
necessary in providing care to the patient receiving treatment with advanced
equipment and medications.
6) Quality Assurance Program
A) The Tier II transport provider shall
develop a written QA plan approved by the EMS System and the Department in
accordance with subsection (f)(6)(D). The participating provider shall provide
quarterly reports to the assigned EMS Resource Hospitals for the first 12
months of operation.
B) The EMS
System shall establish the frequency of quality reports after the first year if
the System has not identified any deficiencies or adverse outcomes.
C) An EMS MD or SEMSV MD shall oversee the QA
program.
D) The QA plan shall
evaluate all expanded scope of practice activity for medical appropriateness
and thoroughness of documentation. The review shall include:
i) Review of transferring physician orders
and evidence of compliance with those orders;
ii) Documentation of vital signs and
frequency, and evidence that abnormal vital signs or trends suggesting an
unstable patient were appropriately detected and managed;
iii) Documentation of any side effects or
complications, including, but not limited to, hypotension, extreme bradycardia
or tachycardia, increasing chest pain, dysrhythmia, altered mental status
and/or changes in neurological examination, and evidence that interventions
were appropriate for those events;
iv) Documentation of any unanticipated
discontinuation of a catheter or rate adjustments of infusions, along with
rationale and outcome;
v) Review
of any Medical Control contact for further direction;
vi) Documentation that unusual occurrences
were promptly communicated to the EMS System; and
vii) A root cause analysis shall be completed
for any event or care inconsistent with standards. The EMS MD or the SEMSV MD
shall recommend and implement a corrective action plan.
E) The QA plan shall be subject to review as
part of an EMS System site survey and as deemed necessary by the Department
(e.g., in response to a complaint).
g) Tier III
Tier III provides the highest level of ground transport care
for patients who require nursing level treatment modalities and
interventions.
1) Minimum Personnel
Staffing and Licensure
A) EMT, A-EMT, EMT-I or
Paramedic (as driver); and
B) Two
critical care prepared providers, who shall remain with the patient at all
times:
i) Paramedic, PHRN, PHPA or PHAPN;
and
ii) RN, PHRN, PHPA or
PHAPN.
2)
Education, Certification, and Experience: Paramedic, PHRN, PHPA or PHAPN
A) Initial Advanced Formal Education
i) Approval to practice by EMS System and the
Department in accordance with the EMS program plan;
ii) At a minimum, 80 didactic hours of
established higher collegiate education or equivalent critical care education
nationally recognized program models;
iii) Demonstrated competencies, as documented
by EMS MD and SEMSV MD and approved by the Department; and
iv) Expanded scope of practice more
comprehensive than the national EMS scope of practice model and Tier II level
as approved by the Department.
B) CE Requirements
i) The EMS System shall document and maintain
annual competencies of expanded scope of practice knowledge, equipment and
procedures;
ii) The following valid
credentials, at a minimum, shall be maintained: ACLS, PEPP or PALS, ITLS or
PHTLS;
iii) A minimum of 40 hours
of critical care level CE shall be completed every four years;
iv) The EMS provider shall maintain
documentation of compliance with subsection (g)(2)(B)(i) and shall provide
documentation to the EMS Resource Hospital upon request; and
v) Nationally recognized critical
certifications shall be maintained and renewed based on national
recertification criteria.
C) Experience
i) Minimum of two years experience
functioning in the field at an ALS Level;
ii) Documented demonstrated competencies;
and
iii) Completion of annual
competencies of expanded scope knowledge, equipment and procedures.
3) Education,
Certification and Experience - Registered Professional Nurse
A) CE Requirements
i) A minimum of 48 hours of critical care
level education shall be completed every four years;
ii) The EMS provider shall maintain
documentation of compliance with subsection (g)(3)(A)(i) and shall provide
documentation to the EMS Resource Hospital upon request; and
iii) Annual competencies of expanded scope of
practice knowledge, equipment and procedures shall be completed.
B) Certifications
Tier III personnel shall maintain the following valid
critical care certifications and credentials:
i) ACLS;
ii) PALS, PEPP or ENPC;
iii) ITLS, PHTLS, TNCC or TNS; and
iv) ECRN or equivalent.
C) Advanced Certifications Preferred but not
Required
i) Certified Emergency Nurse
(CEN);
ii) Critical Care Registered
Nurse (CCRN);
iii) Critical Care
Emergency Medical Technician-Paramedic (CCEMT-P);
iv) Certified Registered Flight Nurse (CFRN);
and
v) Certified Transport
Registered Nurse (CTRN).
D) Experience
i) Two years of experience with demonstrated
competency in a critical care setting; and
ii) Documented demonstrated EMT System
competencies.
4) Medical Equipment and Supplies
Tier III transport requires nursing level treatment
modalities and interventions as agreed upon by the sending physician and the
accepting physician at the receiving facility. If either physician is not
available for consult, the EMS MD or SEMSV MD or designee shall direct
care.
5) Vehicular
Standards
Any vehicle used for providing CCT shall comply, at a
minimum, with Section
515.830
(Ambulance Licensing Requirements) or Sections
515.900
(Licensure of SEMSV Programs - General) and
515.920
(SEMSV Program Licensure Requirements for All Vehicles) regarding licensure of
SEMSV Programs and SEMSV vehicle requirements, including additional medical
equipment and ambulance equipment as defined in this Section. Any vehicle used
for CCT shall be equipped with an onboard AC supply capable of operating and
maintaining the AC current needs of the required medical devices used in
providing care during the transport of a patient.
6) Treatment and Transport Protocols shall
address the following:
A) Paramedic, PHRN,
PHPA or PHAPN: EMS MD or designee present at established Medical Control
communication points and written Critical Care Standard Operating procedure
signed by the EMS MD and approved for use by the Department in accordance with
the System plan;
B) Registered
Professional Nurse: The provider's EMS MD or SEMSV Critical Care MD may
establish standing medical orders for nursing personnel, or the RN may be
approved to accept orders from the sending physician or receiving
physician.
7) Quality
Assurance Program
A) The Tier III transport
provider shall have a written QA plan approved by the EMS System and the
Department, in accordance with subsection (g)(7)(D). The provider shall provide
quarterly reports to the assigned EMS Resource Hospitals for the first 12
months of operation.
B) The EMS
System shall establish the frequency of quality reports after the first year if
the System has not identified any deficiencies or adverse outcomes.
C) An EMS MD or SEMSV MD shall oversee the QA
program.
D) The QA plan shall
evaluate all expanded scope of practice activity for medical appropriateness
and thoroughness of documentation. The review shall include:
i) Review of transferring physician orders
and evidence of compliance with those orders;
ii) Documentation of vital signs and
frequency and evidence that abnormal vital signs or trends suggesting an
unstable patient were appropriately detected and managed;
iii) Documentation of any side effects or
complications, including, but not limited to, hypotension, extreme bradycardia
or tachycardia, increasing chest pain, dysrhythmia, altered mental status or
changes in neurological examination, and evidence that interventions were
appropriate for those events;
iv)
Documentation of any unanticipated discontinuation of a catheter or rate
adjustments of infusions, along with rationale and outcome;
v) Review of any medical control contact for
further direction;
vi) Prompt
communication of unusual occurrences to the EMS System;
vii) A root cause analysis shall be completed
for any event or care inconsistent with standards. The EMS MD or the SEMSV MD
shall recommend and implement a corrective action plan.
E) The QA plan will be subject to review as
part of an EMS System site survey and as deemed necessary by the Department
(e.g., in response to a complaint).
h) The Department will approve vehicle
service providers for CCT when the provider demonstrates compliance with an
approved EMS System's CCT program plan for Tier II or Tier III transports. Only
Department-approved agencies may advertise as CCT providers.
i) The Department will suspend a vehicle
service provider's approval for critical care transport if any part of the
provider's QA plan is not followed or if a situation exists that poses a threat
to the public health and safety. The Department will provide a notice of
suspension of CCT approval and an opportunity for hearing. If the vehicle
service provider does not respond to the notice within 10 days after receipt,
approval will be revoked.
j) The
Director may summarily suspend any licensed provider's authorization to perform
CCT under this Part if the Director or designee determines that continued CCT
by the provider poses an imminent threat to the health or safety of the public.
Any order for suspension will be in writing and effective immediately upon
service of the provider or its lawful agent. Any provider served with an order
of suspension shall immediately cease accepting all CCT cases and shall have
the right to request a hearing if a written request is delivered to the
Department within 15 days after receipt of the order of suspension. If a timely
request is delivered to the Department, then the Department will endeavor to
schedule a hearing in an expedited manor, taking into account equity and the
need for evidence and live witnesses at the hearing. The Department is
authorized to seek injunctive relief in the circuit court if the Director's
order is violated.