Current through Register Vol. 35, No. 6, March 26, 2024
A. General: These guidelines provide overall
guidance for the performance of medical direction in New Mexico. The guidelines
set forth the qualifications, responsibilities and activities of a system's
designated medical director. The guidelines will also define a process for
notifying the EMS bureau of the withdrawal of medical control by a physician
from a provider, and specifying requirements for medical direction of
intermediate and advanced life support personnel and basic life support
personnel with special skills approval. Finally, the guidelines with set forth
the legal requirements for an EMS system to maintain "jumpkits" under the
authorization of the EMS medical director. Each guideline in Paragraphs 9 and
10 are prefaced by either the word "mandatory" or the word "recommended".
Mandatory items are required, while recommended items are highly
recommended.
B. Medical director
oversight:
(1)
(Mandatory) A designated medical director shall be required
for all the situations outlined below:
(a) a certified ambulance carrier as defined
in state corporation commission (SCC) Regulation 18 NMAC 4.2 [now 18.4.2 NMAC],
or such other rules as may be promulgated by the SCC or its successor
agency;
(b) all advanced life
support and intermediate life support EMTs;
(c) all basic life support EMTs who provide
advanced life support skills, medications, and/or techniques authorized under
the scope of practice or special skills authorizations; and
(d) all EMTs or first responders who provide
semi-automatic defibrillation services.
(2)
(Recommended) All other services operating on a basic life
support (BLS) level are urged to have a local or system-wide medical director
as feasible by local situations and availabilities.
C. Medical director
qualifications: The qualifications for an EMS medical director are provided
below. A medical director:
(1)
(Mandatory) shall be an M.D. or D.O. licensed or otherwise
authorized to practice medicine in New Mexico;
(2)
(Mandatory) shall, if a new medical director, complete one of
the below listed medical direction education/training methods within one year
of assuming the responsibilities of a medical director; current medical
directors shall complete one of the below listed methods of medical direction
education/training within two years of the effective date of this
regulation:
(a) a
nationally-recognized EMS medical director's course; or
(b) a bureau-recognized orientation course;
or
(c) a local orientation provided
by a regional or state EMS medical director.
(3)
(Mandatory) The bureau shall be notified within thirty (30)
days when a new EMS medical director assumes responsibilities or when a medical
director is no longer providing those duties for a service.
(4)
(Recommended) may be familiar with the design and operation
of EMS systems;
(5)
(Recommended) may be experienced in, and possess current
knowledge of, emergency care of patients who are acutely ill or traumatized
(emergency medicine board-certification and/or certification in recognized
training such as advanced cardiac life support (ACLS), advanced trauma life
support (ATLS), or pediatric advanced life support (PALS) are
recommended);
(6)
(Recommended) may be actively involved and knowledgeable
in:
(a) the emergency management of
acutely ill or injured patients;
(b) the training and continuing education of
EMS personnel under the medical director's supervision at their level of
certification;
(c) the quality
assurance program of a service including, but not limited to, medical audit,
review and critique of basic and advanced level EMS personnel;
(d) the administrative and legislative
processes affecting regional and/or state pre-hospital EMS organizations;
and
(e) the laws and regulations
affecting local, regional and state EMS services and personnel.
D. Administrative and
system oversight responsibilities: The EMS medical director, in conjunction
with the local EMS service director and other local advisory boards or
committees shall provide the responsibilities outlined below (any element of
these responsibilities may be delegated as appropriate to other qualified
individuals within the EMS system):
(1)
advise the program administrator on all elements of the EMS program as to their
medical appropriateness and to assure the quality medical services are being
provided;
(2) approve the level of
pre-hospital care which may be rendered locally by each of the EMS personnel
employed by and/or volunteering with the services under the medical director's
supervision;
(3) regardless of an
EMS provider's level of state certification or licensure, approve the level
that each EMS provider may function at locally, before the provider is
permitted to perform pre-hospital care to the public;
(4) establish and monitor field performance
standards for EMS personnel in the service;
(5) assist in development of local disaster
and mass casualty plans;
(6)
develop and sign a contract or letter of agreement between the medical director
and the EMS service outlining the specific responsibilities, authorities and,
if appropriate, compensation of the EMS medical director;
(7) develop procedures with the service on a
method by which the medical director may withdraw medical control for an EMS
provider who is non-compliant with these guidelines, other relevant laws and
regulations and accepted medical standards. The procedure shall be outlined in
the contract or letter of agreement between the medical director and the
service; shall reflect any internal procedures of that EMS service and due
process afforded individual providers, if any, as outlined by the service;
and
(8) establish local medical
standards for dispatch procedures to assure the appropriate EMS response units
are dispatched to the medical emergency scene. This should include development
of a relevant emergency medical dispatch system with the local agency providing
dispatch for the EMS service.
E. Protocol development: The medical director
shall:
(1) develop, implement, and revise
written treatment protocols and standing orders governing pre-hospital care and
medical aspects of patient triage, transport, transfer, dispatch, extrication,
rescue and radio telephone communication by the EMS service; and
(2) establish written protocols under which
circumstances the EMS service may:
(a) not
transport a patient when there has been an initial call for services;
(b) transport a patient against his/her will,
in accordance with state law including procedure, appropriate forms and review
process;
(c) handle emergency
treatment of a minor, especially in cases where that patient refuses treatment
and transport;
(d) interaction with
an intervening health care provider at the scene of an emergency;
(e) not begin or terminate life support
measures in patients with EMS do not resuscitate (DNR) orders, hospice
protocols and other legally recognized advanced directives; and
(f) triage and transport trauma patients
consistent with state patient triage criteria and transport
protocols.
F.
Training responsibilities: The medical director shall:
(1) establish and monitor the training
standards of a service for initial and continuing medical education;
and
(2) provide, as appropriate,
educational sessions for EMS personnel within the service.
G. Quality assurance/improvement
responsibilities: The medical director shall plan, develop and implement a
system for ongoing medical audit of pre-hospital patient care rendered by the
EMS service and its personnel. This auditing system shall provide for, but not
be limited to:
(1) an organized method for
internal collection of operational and patient care data, including access to
both pre-hospital and outcome records to permit identification and resolution
of problems impacting the quality of patient care;
(2) a comprehensive mechanism for receipt,
investigation and resolution of medically-related complaints about the EMS
service;
(3) regular review and
on-site evaluation of EMS personnel operating within the service; and
(4) regular review of the overall system to
assure compliance with state corporation commission Regulation 18 NMAC 4.2 [now
18.4.2 NMAC], or such other rules as may be adopted by the SCC or its successor
agency.
H. Medical
liaison responsibilities: The medical director shall:
(1) function as the liaison between the EMS
system and the local medical community, medical facilities and regional/state
EMS medical directors; and
(2) as
needed, be available to represent the medical aspects of an EMS service to
local, regional or state boards/committees, as well as political subdivisions
such as municipal governing bodies or legislatures.
I. Notification of withdrawal or restriction
of medical support: An EMS medical director may withdraw or restrict all or any
of the medical control authorized to a provider under his/her medical direction
in the following manner:
(1) the withdrawal or
restriction shall be made in writing and sent to the EMS provider, EMS service
director and operations section of the bureau within five (5) working days of
the action; and
(2) the bureau
shall perform a preliminary investigation and decide, after consultation with
the EMS medical director and service director, whether or not the matter shall
be referred to the commission for investigation with potential impact on
licensure or be handled locally within the service.
J. Medication control and storage: The EMS
medical director shall: if appropriate for the local service, develop a program
whereby reasonable quantities of dangerous drugs may be possessed and
transported to other locations by authorized personnel in "jumpkits". These
"jumpkits" will be kept at the authorized personnel's residence(s) or
vehicle(s) and will be stored according to the New Mexico board of pharmacy
regulations (i.e., temperature control and security).
(1) The specific dangerous drugs and the
quantities allowed in "jumpkits" will be determined and approved by the EMS
medical director and made available to the New Mexico board of pharmacy or its
staff, as requested.
(2) A list of
authorized personnel who maintain "jumpkits" shall be made available at the
request of the New Mexico board of pharmacy or its staff.
(3) An inventory of all dangerous drugs,
including controlled substances, issued to authorized personnel for "jumpkits"
will be kept for a period of three (3) years and will include the following:
(a) date issued;
(b) name of authorized personnel;
(c) name and strength of dangerous drugs or
controlled substances issued.
(4) The "jumpkits" will be made available
during consulting pharmacist inspections, as requested, and with advance
notice, to the New Mexico board of pharmacy inspectors.
(5) "Jumpkits" which are authorized by the
EMS medical director, to including [sic] specifically approved quantities of
controlled substances, shall be on the EMT's person or double-locked and
secure. Controlled substances shall not be stored in unattended
vehicles.
