(A) To be licensed
to provide ALS services, each ambulance or EFR service must have a current
written contract, called an affiliation agreement, with one or more hospitals
licensed by the Department to provide medical control, in accordance with
105
CMR 170.300(D). This
agreement shall contain a reasonable and effective plan for medical control and
include the following features:
(1) Treatment
protocols and point-of-entry plans using regional guidelines that are in
conformance with the Statewide Treatment Protocols, and other relevant
regulations, policies and administrative requirements of the
Department;
(2) Designation of an
affiliate hospital medical director, who shall have authority over the clinical
and patient care aspects of the affiliated EMS service including, but not
limited to, the authorization to practice of its EMS personnel;
(3) Provision of on-line medical direction in
accordance with the Statewide Treatment Protocols 24 hours per day, seven days
per week, by a hospital-based physician;
(4) Operation of an effective quality
assurance/quality improvement (QA/QI) program coordinated by the affiliate
hospital medical director and with participation of on-line medical direction
physician(s) and service medical director, if different from the affiliate
hospital medical director, that includes, but is not limited to, regular review
of patient care reports and other statistical data pertinent to the EMS
service's operation, in accordance with the hospital's QA/QI standards and
protocols;
(5) Operation of a
program for skill maintenance and review for EMS personnel;
(6) Ensuring EMS personnel have access to
remediation, training and retraining, as necessary, under the oversight of the
affiliate hospital medical director or his or her designee;
(7) Regular consultation between medical and
nursing staffs and EMS personnel providing ALS services including, but not
limited to, attendance at morbidity and mortality rounds and chart
reviews;
(8) A procedure by which a
physician can maintain recorded direct verbal contact with the EMS personnel
regarding a particular patient's condition and order, when appropriate, the
administration of a medication or treatment for a patient, to which such
physician or his or her designee shall sign the patient care report documenting
the patient's care and transport by the EMS personnel;
(9) Policies and procedures for obtaining
medications, in accordance with the level of licensure of the EMS service, from
the hospital's pharmacy;
(10) A
procedure by which the service shall notify its affiliate hospital medical
director within 72 hours of Department action against any EMT's or EFR's
certification (denial, suspension, revocation or refusal to renew
certification), or other Department disciplinary action (letter of censure,
letter of clinical deficiency, advisory letter) against any EMS personnel
employed by the service; and
(11)
If the service has more than one affiliation agreement, in accordance with
105
CMR 170.300(D), the identity
of all hospitals with which the service has affiliation agreements and policies
and procedures that set forth the duties and responsibilities of each affiliate
hospital.
(B) To be
licensed to provide BLS services, each ambulance or EFR service must have a
current written contract, called an affiliation agreement, with one hospital
licensed by the Department to provide medical control; except that more than
one ambulance or EFR service at the BLS level that each averages less than 200
calls per year may be covered by the same written contract for medical control.
BLS affiliation agreements shall meet all the requirements of
105
CMR 170.300(A), in
accordance with these services' licensure level.
(C) An affiliation agreement, shall be kept
current, be reviewed and updated or renewed at intervals of no more than every
four years.
(D) A service that has
bases of operation in more than one EMS region shall maintain an affiliation
agreement in each of the EMS regions in which it operates. A service that
maintains more than one place of business within a single EMS region may
maintain more than one affiliation agreement, provided that the Department
approves the additional agreement. No service that maintains a single place of
business may enter into more than one affiliation agreement.
(E) On-line medical direction may be
delegated by the affiliate hospital to physicians at another hospital licensed
by the Department to provide medical control. If on-line medical direction is
routinely delegated to physicians at another hospital, then such hospital may
be a party to the affiliation agreement between the service and the affiliate
hospital.
