Current through Register Vol. 35, No. 6, March 26, 2024
A.
Purpose: Special skills are
those skills, procedures, and medications that are requested by an EMS service
to enhance emergency treatment capabilities beyond the normal scope of
practice, as defined in the Emergency Medical Services Act. Use the enclosed
procedures for application, reporting and renewal for special skills.
Applications are reviewed and approved or disapproved by the medical direction
committee, and once approved, become a legally recognized addition to the
service capabilities.
B.
General: All levels of EMS personnel, including licensed EMS first
responders and all levels of licensed EMTs are eligible for special skills
consideration for any procedure, skill or medication.
C.
Application procedure: The
EMS service medical director, or his designee, shall coordinate with the EMS
service director, and shall apply for special skills to the EMS medical
direction committee.
D.
Application document: The application document for a special skill
must be tailored to the level of the request. While the degree of detail in
each section may vary to match the nature of the skill requested, all
applications should include the following elements, in order:
(1) application cover page: titled to state
the requested special skill, date of application, name of service, service
director name and medical director name;
(2) contact information page: must include
address and contact information for the service, service director and medical
director;
(3) letters of support:
must include individual letters of support from the service director and
medical director; additional letters of support from the local medical
community or evidence of notification of the local medical community may be
required; the need for letters of notification and support from the local
medical community and who provides the letters must be adjusted to match the
nature of the special skill requested;
(4) service description: provide a concise
description of the EMS service; this includes such items as basic call
demographics relevant to the applicant, level of licensure of providers and
names and locations of the primary receiving medical facilities;
(5) description of the special skill: provide
a description of the procedure, medication or requested skill; include
information on risks, benefits, indications and contraindications;
(6) justification and statement of need:
provide a statement explaining why the special skill is needed; this should
include a description of the current medical intervention or alternative
practice to the special skill and a risk or benefit analysis that supports the
special skill requested; the estimated number of potential interventions per
year, other relevant statistical data and a statement indicating the level of
current scientific information/studies to support the requested special skill;
the level of scientific justification can be adjusted to match the level of the
special skill requested;
(7)
protocol: provide a copy of the treatment protocol; include other operational
protocols relevant to the special skill, if applicable;
(8) training: provide a training syllabus;
this must include learning objectives and the training hours for initial and
continuing education; this section should also include a description of the
instructors, how training will be completed, and a description of the method
used to initially evaluate the skill; once initial training is completed, a
list of trained and approved personnel shall be provided to the medical
direction committee; these special skill authorized licensed EMS personnel must
appear on the service's personnel list on the New Mexico EMS tracking
and reporting system database.
(9) QA/QI program: provide a description of
the QA/QI process for the special skill, including frequency of evaluation,
names and qualifications of the personnel involved in the process; include a
copy of the evaluation tool or forms that will be used, if applicable;
and
(10) the application and all
supporting documentation shall be submitted to the EMS bureau, attn: EMS
program manager.
E.
Applicants may involve the EMS regional offices when preparing a special skill
request and include a letter evidencing regional review. Applicants shall
forward a copy of their application to their EMS regional office when
completed.
F. Upon receipt, the
state EMS medical director and state EMS program manager will review the
application. The service will be notified if the application is found to be
incomplete or to contain significant errors.
G. Applications must be received at the
bureau at least 30 days prior to the next regularly scheduled medical direction
committee meeting to be placed on the agenda of that meeting for consideration
by the medical direction committee.
H. The medical direction committee shall take
action on all special skills applications on the agenda at their regularly
scheduled meeting. The medical direction committee may take the following
actions on the application: approved with limitations or restrictions, denied
or tabled with a request for a formal presentation or additional information by
the requesting service medical director or their designee.
I. The medical direction committee may give
an approval subject to specific conditions, limitations or restrictions. This
may include a written and practical examination.
J. Within 10 working days following the
decision of the medical direction committee, the state EMS program manager
shall provide a written or email response to the applicant regarding the action
of the medical direction committee.
K. Special skills may not be utilized until
receipt of the special skill approval letter from the bureau any specific
conditions or limitations will be evidenced in the approval letter from the
bureau.
L.
Monitoring:It is expected that EMS services with approved special
skills will continuously comply with the requirements of their application and
approval letter. This includes, but is not limited to, such items as training
curricula, approved instructors, quality assurance, protocols and data
collection. Any changes to the approved application shall be sent to the state
EMS program manager for concurrence/coordination with the medical direction
committee.
M. The medical direction
committee may immediately suspend or revoke special skill privileges for an
individual or service that loses medical direction, or fails to comply with the
stated requirements, or for any other reason to protect the health and welfare
of the people of New Mexico.
N. If
a new medical director assumes control of a service with an active special
skill program, the bureau shall receive a letter of support from the new
medical director within 30 days or the special skill approval may be
withdrawn.
O. The service shall
maintain a current list of all providers trained and approved to utilize the
special skill. This list must be provided to the bureau upon request.
P.
Reporting: The service shall
provide to the EMS program manager periodic written special skill reports.
During the first year, the EMS bureau or medical direction committee may
request a semi-annual report; subsequent reports shall be due one year from
date of initial approval, and annually on the approval anniversary date
thereafter. The EMS bureau or medical direction committee may request a report
at any time. The medical direction committee may excuse an agency from the
yearly report based on adequate surveillance being available from the state
patient care report database.
Q.
Report document: The written special skill report shall include
the following minimum elements:
(1) report
cover page: titled to state the special skill reported, date, name of service,
service director and medical director;
(2) contact information page: shall include
address and contact information for the service, service director and medical
director;
(3) letters of support:
must include individual letters of continued support from the service director
and service medical director;
(4)
statistics and outcome data: provide data on the utilization and patient
outcomes involving the special skill; do not include patient identifiers; all
adverse outcomes related to the special skill must be reported;
(5) continuing education: provide evidence of
the continuing education program and refresher program;
(6) personnel list: provide a list of all
personnel authorized to perform the special skill; these special skill
authorized licensed EMS personnel must appear on the service's personnel list
required for the New Mexico EMS tracking and reporting system
database.
(7) QA/QI
program: provide evidence of the ongoing QA/QI program;
(8) renewal: during a regularly scheduled
meeting, the medical direction committee shall review all ongoing individual
special skills programs on their three year anniversary and make a
determination on renewal;
(9) if
the medical direction committee determines not to provide automatic renewal on
an ongoing special skill program, the state EMS program manager shall provide a
written notification to the service director and the service medical director
within 10 working days; and
(10)
the special skills program will be placed on the agenda of the next, or
subsequent, regularly scheduled meeting of the medical direction committee and
final determination regarding renewal will be made.
R. Special skills programs will remain active
until a final determination regarding renewal has been made.
S.
Special skills application:
(1) general section;
(2) EMS service name;
(3) address;
(4) service chief/director;
(5) contact phone number;
(6) physician medical director;
(7) physician/medical director contact phone
number;
(8) special skill
proposed;
(9) level of licensure
necessary for special skill;
(10)
estimated number of personnel to be trained;
(11) estimated date of initial
training;
(12) training/quality
assurance;
(13) describe or
identify the curriculum, including learning objectives, training hours,
etc.;
(14) please identify the lead
instructor and provide a brief summary of their qualifications or attach a
resume;
(15) resumes required for
new instructors;
(16) if
training/experience is required, provide a letter of commitment from the
supporting institution;
(17)
describe or attach a proposed continuing education plan;
(18) attach a description of quality
assurance plan, including periodic case reviews and ongoing problems;
(19) identification and steps for remedial
action if necessary;
(20)
signatures; person completing the application, service chief/service director
and medical director;
(21) submit
digital copies of the application in its entirety to: EMS bureau, state EMS
program manager, (1301 Siler Rd., Building F, Santa Fe, NM 87507) or as
directed by the EMS bureau;
(22)
submit one copy to the regional office.
