Jurisprudence. Documentation must be kept for 5 years

1 2 3 4 5 6 7 8 Jurisprudence What is a Jurisprudence Exam? Purpose A jurisprudence exam determines the of the Health and Safety Code Chapter 773, DSHS rules, and other applicable laws affecting the activities regulated by DSHS Enacted by the 84 th Legislature Effective September 1, 2017 Who Needs the Jurisprudence Training and Exam? An applicant for an EMS provider license or EMS personnel certification All certified personnel must take it prior to certification renewal if expires after September of 2017 Will have to be taken for renewal (every 4 years) All provider renewals must assure all certified personnel has completed if provider renewal occurs after September of 2017 Who can Provide Jurisprudence Training? All DSHS approved programs All education programs, beginning after September 1, 2017 at any level must provide the course to the students before issuing a course completion certificate Documentation of Completion of Jurisprudence Training A CE will suffice for proof of completion Proof of completion must be submitted to DSHS only if CE is Documentation must be kept for 5 years Two Sources of Regulations Texas Health and Safety Code (HSC) Consists of statutes and (overall) Texas Code (TAC) Consists of the rules and regulations (specifics) HSC 773.050 (Jurisprudence) Sets forth the for the jurisprudence exams Allows DSHS to develop to administer jurisprudence courses and exams and to stipulate who must take them HSC 773.0612 (Access to Records) (1 of 2) Allows the department (DSHS) or its representative to have access to records/documents that are directly related to care or to EMS personnel to enforce adopted rules is considered to have been given by all persons who holds a certification or license 1

9 10 11 12 13 14 15 16 HSC 773.0612 (Access to Records) (2 of 2) This includes PCRs, EMS units, vehicles, and places of Documents obtained during an investigation will be considered and are only used for purposes consistent with department rules No court order, release or subpoena is required HSC 773.064 (Criminal Penalties) (1 of 4) Defines the following acts which as criminal offenses: Knowingly practices or attempts to practice, or impersonates a Paramedic, Intermediate,, or ECA without being appropriately certified by the department Class misdemeanor HSC 773.064 (Criminal Penalties) (2 of 4) An EMS provider commits on offense if they knowingly advertise a false, misleading, or deceptive statement or misrepresentation of staffing, equipment, and Class misdemeanor HSC 773.064 (Criminal Penalties) (3 of 4) Knowingly uses or permits to be used a vehicle that the person owns, operates, or controls to transport a sick or injured person unless the person is as an EMS service Class misdemeanor Exceptions: If transported as a not ordinarily engaged in EMS A MCI where casualties exceed vehicle capacity A variance has been granted HSC 773.064 (Criminal Penalties) (4 of 4) All offenses under this section will be prosecuted in the in which the offense is alleged to have occurred TAC 157.2 Definitions Selected Definitions (1 of 27) - Leaving a patient without appropriate medical care once patient contact has been established, unless emergency medical services personnel are following medical director's protocols, a physician directive or the patient signs a release; turning the care of a patient over to an individual of lesser education when advanced treatment modalities have been initiated Selected Definitions (2 of 27) Accreditation - Formal recognition by a national association of a provider's service or an education program based on standards established by that association Administrator of Record (AOR) - The for an EMS provider who meets the requirements of Health and Safety Code 2

Advanced life support (ALS) - Emergency prehospital or interfacility care that uses invasive medical acts and which would include ALS assessment. The provision of advanced life support shall be under the medical supervision and control of a licensed 17 18 19 20 21 Selected Definitions (3 of 27) Advanced life support (ALS) vehicle - A vehicle that is designed for transporting the sick and injured and that meets the requirements of an advanced life support vehicle and has sufficient equipment and supplies for providing level of care based on national standards and the EMS provider's medical director approved treatment protocols Ambulance - A for transportation of sick or injured person to, from or between places of treatment for an illness or injury, and provide out of hospital medical care to the patien Selected Definitions (4 of 27) Advanced Emergency Medical Technician (AEMT) - An individual who is certified by the department and is minimally proficient in performing the basic life support skills required to provide emergency prehospital or interfacility care and initiating and maintaining under medical supervision certain advanced life support procedures, including therapy and endotracheal or esophageal intubation Authorized ambulance vehicle - A vehicle authorized to be by the licensed provider and that meets all criteria for approval by the department Selected Definitions (5 of 27) Basic life support (BLS) - Emergency prehospital or interfacility care that uses medical acts. The provision of basic life support will have sufficient equipment and supplies for providing basic level care based on national standards and the EMS provider's medical director approved treatment protocols Basic life support (BLS) vehicle - A vehicle that is designed for transporting the sick or injured and that has sufficient equipment and supplies for providing basic life support based on national standards and the EMS provider's medical director approved treatment Selected Definitions (6 of 27) - Direction given to a prehospital emergency medical services unit, by direct/on-line medical control or predetermined triage criteria, to pass the nearest hospital for the most appropriate hospital/trauma facility - An individual who is requesting emergency medical services personnel certification or licensure, recertification or relicensure from the Texas Department of State Health Services. Selected Definitions (7 of 27) - Emergency medical services personnel with current certification from the Texas Department of State Health Services Credit hour - Continuing education credit unit awarded for successful completion of a unit of learning activity Designated infection control officer - A designated officer who serves as a 3

between the employer's employees who have been or believe they have been exposed to a potentially life-threatening infectious disease, through a person who was treated and/or transported, by the EMS provider 22 23 24 25 26 27 Selected Definitions (8 of 27) - The Texas Department of State Health Services - A procedure put into effect by a trauma facility to ensure appropriate patient care when that facility is unable to provide the level of care demanded by a trauma patient's injuries or when the facility has temporarily exhausted its resources Emergency care attendant (ECA) - An individual who is certified by the department as minimally proficient to provide emergency prehospital care by providing initial aid that promotes comfort and avoids aggravation of an injury or illness Selected Definitions (9 of 27) Emergency medical services (EMS) - Services used to respond to an individual's need for medical care and to prevent death or aggravation of physiological or psychological illness or injury. Emergency medical services (EMS) operator - A who, as an employee of a public agency, as that term is defined by Health and Safety Code that receives emergency calls Selected Definitions (10 of 27) Emergency medical services (EMS) personnel Consist of all personnel at the ECA, EMT, AEMT, EMT-I, EMT-P or licensed paramedic level Emergency medical services (EMS) provider - A who uses, operates or maintains EMS vehicles and EMS personnel to provide EMS. Emergency medical technician (EMT) - An individual who is certified by the department as minimally proficient to perform emergency prehospital care that is necessary for basic life support and that includes the control of hemorrhaging and cardiopulmonary resuscitation Selected Definitions (11 of 27) Emergency medical services (EMS) volunteer provider - An EMS provider that has at least % of the total personnel as volunteers and is a nonprofit organization. Emergency medical services (EMS) volunteer - EMS personnel who provide emergency prehospital or interfacility care in affiliation with a licensed EMS provider or a registered First Responder organization without, except for reimbursement for expenses Selected Definitions (12 of 27) Emergency medical technician-paramedic (EMT-P) - An individual who is by the department as minimally proficient to provide emergency prehospital or interfacility care in health care facility's emergency or urgent care clinical setting, including a hospital emergency room and a freestanding emergency medical care facility by providing advanced life support that includes initiation and maintenance under medical supervision of certain procedures, including intravenous therapy, endotracheal or esophageal intubation or both, electrical defibrillation or cardioversion, and drug therapy Selected Definitions (13 of 27) 4

Emergency medical services vehicle - consists of: Basic life support (BLS) vehicle; Advanced life support (ALS) vehicle; Mobile intensive care unit (MICU); MICU wing and MICU fixed wing air medical vehicles; or emergency medical service vehicle Emergency Medical Task Force (EMTF) - A unit specially organized to provide coordinated emergency medical response operation systems during large scale EMS incidents 28 29 30 31 32 Selected Definitions (14 of 27) General trauma facility - A hospital designated by the department as having met the criteria for a Level and Level trauma facility. General trauma facilities provide resuscitation, stabilization, and assessment of injury victims and either provide treatment or arrange for appropriate transfer to a higher level trauma facility, provide ongoing educational opportunities in trauma related topics for health care professionals and the public, and implement targeted injury programs Selected Definitions (15 of 27) Governmental entity - A county, a city or town, a school district, or a special district or authority created in accordance with the Texas Constitution, including a rural fire prevention district, an emergency services district, a water district, a municipal utility district, and a hospital district Inactive EMS provider status - The period when a licensed EMS provider is able to respond or response ready to an emergency or non-emergency medical dispatch Interfacility care - Care provided while transporting a patient between facilities Selected Definitions (16 of 27) - A person who holds a current paramedic license from the Texas Department of State Health Services (department) or a person who uses, maintains or operates EMS vehicles and EMS personnel to provide EMS and who holds an EMS provider license from the department Medical control - The supervision of prehospital emergency medical service providers by a licensed. This encompasses on-line (direct voice contact) and off-line (written protocol and procedural review). Selected Definitions (17 of 27) Major trauma facility - A hospital designated by the department as having met the criteria for a Level trauma facility as described in 157.125 of this title. Major trauma facilities provide similar services to the Level I trauma facility although research and some medical specialty areas are not required for Level II facilities, provide ongoing educational opportunities in trauma related topics for health care professionals and the public, and implement targeted injury prevention programs Selected Definitions (18 of 27) Medical Director - The licensed who provides medical supervision to the EMS personnel of a licensed EMS provider or a recognized First Responder Organization under the terms of the Medical Practices Act and rules promulgated by the Texas Medical Board. Also may be referred to as off-line medical control 5

Medical - The assistance and management given to health care providers and/or entities involved in regional EMS/trauma systems planning by a physician or group of physicians designated to provide technical assistance 33 34 35 36 37 38 Selected Definitions (19 of 27) Medical - Direction given to emergency medical services personnel by a licensed physician under the terms of the Medical Practice Act and rules promulgated by the Texas Medical Board pursuant to the terms of the Medical Practice Act Off-line medical direction - The licensed physician who provides approved and medical supervision to the EMS personnel of a licensed EMS provider under the terms of the Medical Practices Act and rules promulgated by the Texas Medical Board Selected Definitions (20 of 27) Operational policies - Policies and which are the basis for the provision of EMS and which include, but are not limited to such areas as vehicle maintenance, proper maintenance and storage of supplies, equipment, medications, and patient care devices; complaint investigation, multi-casualty incidents, and hazardous materials; but do not include personnel or financial policies. Out of service vehicle - The period when a licensed EMS Provider vehicle is to respond or be response ready for an emergency or non-emergency response. Selected Definitions (21 of 27) Mobile intensive care unit (MICU) - A vehicle that is designed for transporting the sick or injured and that meets the requirements of the advanced life support vehicle and which has sufficient equipment and supplies to provide cardiac monitoring, defibrillation, cardioversion, drug therapy, and two-way communication with at least one on the vehicle when providing EMS - A detailed, written set of instructions by the EMS Provider medical director, which may include delegated standing medical orders, to guide patient care or the performance of medical procedures as approved Selected Definitions (22 of 27) Quality management - Quality assurance, quality, and/or performance improvement activities Regional Advisory Council (RAC) - An organization serving as the Department of State Health Services recognized health care coalition responsible for the development, implementation and maintenance of the trauma and emergency health care system within the geographic jurisdiction of the Trauma Service Area. A Regional Advisory Council must maintain 501(c)(3) (non-profit)status Selected Definitions (23 of 27) - The procedure for renewal of emergency medical services certification Reciprocity - The recognition of certification or privileges granted to an individual from another state or recognized EMS system Relicensure - The procedure for renewal of a license; the procedure for renewal of an EMS provider license Selected Definitions (24 of 27) 6

Response ready - When an EMS vehicle is equipped and staffed in accordance with 157.11 of this title (relating to Requirements for a Provider License) and is immediately available to respond to any emergency call hours per day, seven days per week (24/7). Scope of practice - The procedures, actions and processes that an EMS personnel are permitted to undertake in keeping with the terms of their professional license or certification and approved by their EMS provider's medical director Shall - requirements 39 40 41 42 43 44 Selected Definitions (25 of 27) Specialized emergency medical services vehicle - A vehicle that is designed for responding to and transporting sick or injured persons by any means of transportation than by standard automotive ground ambulance or rotor or fixed wing air craft and that has sufficient staffing, equipment and supplies to provide for the specialized needs of the patient transported. This category includes, but is not limited to, water craft, off-road vehicles, and specially designed, configured or equipped vehicles used for transporting special care patients such as critical neonatal or patients Selected Definitions (26 of 27) Standard of care - Care equivalent to what any, prudent person of like certification level would have given in a similar situation, based on locally, regionally and nationally adopted standard emergency medical services curricula as adopted by reference relating to Emergency Medical Services Training and Course Approval Trauma facility - A that has successfully completed the designation process, is capable of stabilization and/or definitive treatment of critically injured persons and actively participates in a regional EMS/trauma system Selected Definitions (27 of 27) Trauma Service Area - An organized geographical area of at least three counties administered by a advisory council for the purpose of providing prompt and efficient transportation and/or treatment of sick and injured patients When in service - The period of time when an EMS vehicle is at the scene or when to a facility with a patient TAC 157.11Requirements for an EMS Provider License EMS Authorization The department will issue an authorization for vehicle to be operated by the applicant A vehicle authorization shall be issued for the following levels of service Vehicle Authorizations are not required to be to particular vehicles and may be interchangeably placed in other vehicles as necessary (as long as with the same provider) Vehicle Authorizations are not between providers EMS Vehicles (1 of 2) All EMS vehicles must be adequately constructed,, maintained and operated to render patient care, comfort and transportation of adult, pediatric, and neonatal patients safely and efficiently 7

All vehicles shall have an environmental system capable of heating or cooling the patient(s) and staff, in accordance with the manufacturer specifications, within the patient compartment at all times when in service and which allows for protection of, according to manufacturer specifications, from extreme temperatures if it becomes environmentally necessary 45 46 47 48 49 50 EMS Vehicles (1 of 2) When operational, each EMS vehicle must have communication with appropriate medical resources All EMS vehicles shall have the of the provider and a current department issued EMS provider license prominently displayed on both sides of the vehicle in at least inch lettering and in contrasting color. The license number shall have the letters TX prior to the license number. This requirement does not apply to fixed or rotor wing aircraft Administrator of Record EMS services have an Administrator or Record (AOR) The department must be notified whenever there is a change in the AOR Requirements for AOR (1 of 2) Declaration of the administrator of record and any subsequently filed declaration of a new administrator shall declare the following: The AOR is not employed or otherwise compensated by another, for-profit EMS provider Must meet the requirements for an or other healthcare professional license or certification issued by the State Subject to criminal history check Requirements for AOR (1 of 2) Required to complete a department approved course that covers: Chapter 773 of the Health and Safety Code Chapter 157 of the Texas Administrative Code EMS processes EMS billing processes Medical control accountability improvement processes for EMS Requirements for AOR (2 of 2) Completion of hours of CE related to Texas and federal laws and rules related to EMS An EMS provider that is directly operated by a governmental entity is exempted from the education requirements An EMS provider that held a license on 9/1/2013 and has an AOR who has at least years of experience providing EMT the AOR is exempt from the education and EMT or other healthcare provider certification requirement Minimum Staffing Requirements (1 of 5) BLS Units: must be staffed at a minimum with Emergency Care Attendants (ECAs) 8

BLS with ALS Capability: when in service below ALS it must be staffed at a minimum of 2 ECAs. Full ALS status requires at least an EMT-Intermediate ( ) and at least an EMT 51 52 53 54 55 56 57 Minimum Staffing Requirements (2 of 5) BLS with MICU Capability: When in-service below MICU it must be staffed at a minimum of 2. Full MICU status becomes active when staffed by at least a certified or licensed and at least an EMT ALS: When in service, it must be staffed at a minimum with one EMT Basic and one EMT- Intermediate (AEMT) Minimum Staffing Requirements (3 of 5) ALS with MICU Capability: when in service below MICU it must be staffed at a minimum with EMT-Intermediate (AEMT) and one EMT. Full MICU status becomes active when staffed by at least a certified or licensed paramedic and at least an EMT MICU: when in service it must be staffed at a minimum with one EMT and one certified or licensed EMT-Paramedic Minimum Staffing Requirements (4 of 5) : When response-ready or in-service, EMS vehicles authorized to operate for a specialized purpose shall be staffed with a minimum of two personnel appropriately licensed and/or certified as determined by the type and application of the specialized purpose and as approved by the medical director and the department. Minimum Staffing Requirements (5 of 5) When response-ready or in-service, authorized EMS vehicles may operate at a lower level than licensed by the department. When operating at the BLS level with an ALS/MICU ambulance, the EMS provider must have an approved plan for the ALS/MICU medication as approved by the EMS provider medical director's protocol and/or policy Treatment/Transport Protocols (1 of 2) All providers must submit a copy of written delegated standing orders to the department must be signed by the medical director Protocols must have an effective date Must address the use of certified or licensed medical personnel, in addition to EMS staff, may provide patient care on behalf of the provider and/or in the provider s vehicle Treatment/Transport Protocols (2 of 2) Protocols must address the use of all required, supplies, and drugs carried on each EMS vehicle Must identify procedures for each EMS certification or license level utilized Must indicate specific applications, including geographical area and duty status of personnel EMS Equipment (1 of 2) The EMS provider shall submit a list, approved and signed by the medical director and fully supportive of and consistent with the protocols, of all medical equipment, supplies, medical 9

devices, parenteral solutions and pharmaceuticals to be carried The list shall specify the of each item to be carried and shall specify the sizes and types of each item necessary to provide appropriate care for all age ranges appropriate to the needs of their patients The list shall include equipment for treatment and transport of adult, pediatric, and neonatal patients 58 59 60 61 62 EMS Equipment (2 of 2) All patient care equipment, and medical devices must be, appropriately secured in the vehicle at the time of providing patient care and response ready, and supplies shall be clean and fully operational. All patient care powered equipment shall have manual mechanical, spare batteries or an power source, if applicable All solutions and pharmaceuticals shall be up to date and shall be stored and maintained in accordance with the manufacturer's and/or U.S. Federal Drug Administration (FDA) recommendations Minimum Equipment Requirements: BLS Units (1 of 6) All BLS units must have equipment required to administer BLS scope of practice and incorporate the knowledge, competencies and basic skills of an EMT/ECA and skills as authorized by the EMS provider medical director Minimum Equipment Requirements: BLS Units (2 of 6) All BLS units shall be able to perform treatment and transport patients receiving the following skills: Airway/ventilation/ Cardiovascular circulation Medication administration - routes Single and multi-system trauma patients Minimum Equipment Requirements: BLS Units (3 of 6) All BLS units must have: Oropharyngeal airways Portable and vehicle mounted Bag-valve-mask units; oxygen capable Portable and vehicle mounted oxygen Oxygen delivery devices Dressing and bandaging materials Commercial Minimum Equipment Requirements: BLS Units (4 of 6) All BLS units must have (Continued): Rigid immobilization devices Spinal immobilization devices Extremity Equipment to meet special patient needs Equipment for determining and monitoring patient vital signs, condition or response to equipment 10

63 64 65 66 67 68 69 70 Minimum Equipment Requirements: BLS Units (5 of 6) All BLS units must have (Continued): Pharmaceuticals, as required by the medical director s An external cardiac appropriate to the staffing level (AED) with two sets of adult and two sets of pediatric pads Minimum Equipment Requirements: BLS Units (6 of 6) All BLS units must have (Continued): Patient device capable of being secured to the vehicle, and the patient must be fully restrained per manufacturer recommendations auto injector or similar device capable of treating anaphylaxis Minimum Equipment Requirements: ALS Units (1 of 4) All ALS units must have equipment to administer the ALS scope of practice and incorporate the knowledge, competencies, and basic and skills of an AEMT (EMT-I) and additional skills as authorized by the EMS provider medical director Minimum Equipment Requirements: ALS Units (2 of 4) All ALS units shall be able to perform treatment and transport patients receiving the following skills, including all required BLS skills: Airway/ventilation/oxygenation Cardiovascular circulation Immobilization administration - routes Intravenous (IV) initiation/maintenance Minimum Equipment Requirements: ALS Units (3 of 4) All ALS units must have: All required BLS equipment Advanced equipment equipment and supplies Pharmaceuticals as required by the medical director protocols Minimum Equipment Requirements: ALS Units (4 of 4) All ALS units must have (Continued): Wave-form or state approved carbon dioxide detection equipment must be used after January 1,, when performing or monitoring endotracheal intubation Minimum Equipment Requirements:MICU Units (1 of 3) All MICU units must have equipment to administer the ALS scope of practice and incorporate the knowledge, competencies, and advanced skills of and additional skills as authorized by the EMS provider medical director Minimum Equipment Requirements: MICU Units (2 of 3) 11

All MICU units shall be able to perform treatment and transport patients receiving the following skills: Airway/ventilation/oxygenation circulation Immobilization Medication administration - routes (IV) initiation/maintenance fluids 71 72 73 74 75 76 Minimum Equipment Requirements: MICU Units (3 of 3) All MICU units must have: All required BLS and ALS equipment 12-Lead capability cardiac monitor/defibrillator by January 1, Pharmaceuticals as required by the medical director protocols Minimum Equipment Requirements: BLS with ALS Capability Units All BLS with ALS Capability units must have: All required equipment even when in service or response ready at the ALS level All required equipment, when in service or response ready at the ALS level Minimum Equipment Requirements: BLS with MICU Capability Units All BLS with MICU Capability units must have: All required BLS equipment even when in service or response ready at the level All required MICU equipment, when in service or response ready at the level Minimum Equipment Requirements: ALS with MICU Capability Units All ALS with MICU Capability units must have: All required equipment even when in service or response ready at the MICU level All required equipment, when in service or response ready at the ALS level Additional Requirements: All Levels (1 of 4) In addition to medical supplies and equipment, all EMS vehicles must have: A complete and current copy of written or electronic approved and signed by the medical director; with a current and completed equipment, supply and medication list available to crew Additional Requirements: All Levels (2 of 4) Operable emergency devices Personal protective equipment for staff, including at least: Protective non-porous gloves Medical protection Medical respiratory protection meeting NIOSH approved N95 or greater standards Medical protective gowns or equivalent 12

Personal supplies 77 78 79 80 81 82 83 Additional Requirements: All Levels (3 of 4) container Biohazard bags Portable battery-powered flashlight (not a pen light) A mounted, currently inspected, pound ABC fire extinguisher (not applicable to air ambulances) No Smoking signs in the patient compartment and the cab Additional Requirements: All Levels (4 of 4) A current emergency response guide or an electronic version that is available to the crew (for hazardous materials) triage tags in coordination with the Regional Advisory Council (RAC) Additional Requirements: Specialized Equipment As justified by specific patient needs, and when qualified personnel are available, EMS providers may appropriately utilize equipment in to that which is required by their authorization levels. Such equipment must be consistent with and/or patient- specific orders and must correspond to personnel qualifications. Responsibilities of the EMS Provider (1 of 27) Provider license are effective for a year period Assure that all response ready vehicles are available, maintained, operated, equipped, insured and staffed according with the license and as required by the medical director Develop, implement, maintain, and evaluate an effective, ongoing, system-wide, data-driven, interdisciplinary quality assessment and performance improvement program. Responsibilities of the EMS Provider (2 of 27) The quality assessment and performance improvement program shall be individualized to the provider and shall, at a minimum, include: The of patient care as directed by the medical director's protocols and medical director input into the provider's policies and standard operating procedures A management system Responsibilities of the EMS Provider (3 of 27) Performance improvement program must include (continued): Monitoring the of patient care provided by the personnel and taking appropriate and immediate corrective action to insure that quality of care is maintained in accordance with the existing standards of care and the provider medical director's signed, approved Responsibilities of the EMS Provider (4 of 27) Performance improvement program must include (continued): The program shall include, but not be limited to, an program that achieves measurable improvement in patient care outcomes and reduction of medical errors 13

84 85 86 87 88 89 90 Responsibilities of the EMS Provider (5 of 27) Provide attestation of providers participation in the local Regional Council (RAC) When an air ambulance is initiated through any other method than the local 911 system the air service providing the air ambulance is required to notify the local 911 center or the appropriate local response system for the of the response at time of launch. This would not include interfacility transports or schedule transports Responsibilities of the EMS Provider (6 of 27) Ensuring that all personnel are currently or licensed by the department Assuring that all personnel, when on an in-service vehicle or when on the scene of an emergency, are prominently by, at least, the last name and the first initial of the first name, the or license level and the EMS provider's name. A provider may utilize an alternative identification system in incident specific situations that pose a potential for danger if the individuals are identified by name Responsibilities of the EMS Provider (7 of 27) Assuring the of all patient information is in compliance with all federal and state laws Assuring that Informed Treatment/ Transport forms are signed by all persons refusing service, or documenting incidents when a signed Informed Treatment/Transport Refusal form cannot be obtained Responsibilities of the EMS Provider (8 of 27) Assuring that patient care reports are completed for all patients and meet standards as outlined Full report within hours If full report is not possible at patient delivery, an abbreviated document shall be provided at the time of patient delivery containing care provided, patient s condition on scene and during transport, patient s response to treatments, and all times Responsibilities of the EMS Provider (9 of 27) Assuring that all are stored according to conditions specified in the pharmaceutical storage policy approved by the EMS provider's medical director Assuring that staff completes a readiness as written by the EMS provider's policy Responsibilities of the EMS Provider (10 of 27) Assuring that there is a maintenance plan for vehicles and equipment Assuring that staff has reviewed policies and as approved by the EMS Provider and the EMS Provider Medical Director Responsibilities of the EMS Provider (11 of 27) Maintenance of medical reports Maintain for at least years from the anniversary date of last treatment by the EMS provider; even if the business is sold or closed 14

If a patient was younger than 18, the records must be maintained until the patient reaches 21 or for 7 years; whichever is longer Medical records that relate to any civil,, or administrative proceeding may not be destroyed until the proceeding is resolved 91 92 93 94 95 96 Responsibilities of the EMS Provider (12 of 27) Maintenance of medical reports (continued) Records must be maintained for a longer length of time than when by other federal or state statute or regulation Records may be transferred to another licensed EMS provider only if the EMS provider, in, assumes ownership of the records and maintains the records consistent with this chapter Responsibilities of the EMS Provider (13 of 27) Maintenance of medical reports (continued) Destruction of medical records shall be done in a manner that assures continued Records must be maintained in the location that is the primary place of business, unless department approves another location Assuring that all requested patient records are made promptly available to the medical director, hospital or department when requested Responsibilities of the EMS Provider (14 of 27) Assuring that current protocols, equipment, supply and medication lists, and the correct original Vehicle Authorization at the appropriate level are maintained on each response-ready vehicle Monitoring and enforcing with all policies and protocols Assuring provisions for the appropriate of medical and/or biohazardous waste materials Responsibilities of the EMS Provider (15 of 27) Assuring ongoing compliance with the terms of first responder agreements Assuring that all, reports or information provided to the department and hospital are current, accurate and complete assuring compliance with all federal and state laws and regulations and all local ordinances, policies and codes at all times Responsibilities of the EMS Provider (16 of 27) Assuring that all response required by the department is submitted in accordance relating to Reporting Requirements for EMS Providers Assuring that, whenever there is a in the EMS provider's name or the service's operational assumed name, the printed name on the vehicles are changed accordingly within days of the change Responsibilities of the EMS Provider (17 of 27) Assuring that the department is notified within days whenever: A is sold, substituted, or replaced There is a change is level of service There is a change in the service area Change in mailing address 15

Change in physical Change of location for storage of records Change in the administrator of record 97 98 99 100 101 102 103 Responsibilities of the EMS Provider (18 of 27) Notifying the department within business day if there is a change in medical director Develop, implement and enforce required policies/procedures and assure that all employees/volunteers is provided a upon employment and when changes are made Responsibilities of the EMS Provider (19 of 27) Required policies must address: PPE to staff Infection control procedures Management of possible exposures to disease Emergency vehicle operations Responsibilities of the EMS Provider (20 of 27) Required policies must address (Continued): information for the designated infection control officer for whom education based on US Code, Title 42, Chapter 6A, Subchapter XXIV, Part G, 300ff- 136 has been documented Appropriate documentation of patient care Vehicle, equipment, and readiness inspections Responsibilities of the EMS Provider (21 of 27) Credentialing of new response personnel before being assigned primary care responsibilities. This process should include as a minimum: A comprehensive session of services, policies, procedures, protocols, safety precautions, and the quality management process An period in which all new personnel practice under the supervision of and are evaluated by a more experienced person Responsibilities of the EMS Provider (22 of 27) Assuring the of medications, fluids and controlled substances in compliance with local, state and federal laws Assuring the manufacturer s operating instructions for all critical patient care and/or technical equipment utilized are available Maintaining vehicle liability insurance as required by the Texas Traffic Code Responsibilities of the EMS Provider (23 of 27) Assuring that the department is notified, within business days, of a collision involving an in-service or response ready EMS vehicle that results in vehicle damage whenever: The vehicle is rendered disabled and inoperable at the scene of occurrence; or There is a on board Responsibilities of the EMS Provider (24 of 27) 16

Assuring that the department is notified, within business day, of a collision involving an in-service or response ready EMS vehicle that results in vehicle damage whenever there is personal injury or death to any person Maintaining professional liability insurance in the minimum amount of $, with a company licensed to do business in Texas in order to secure payment for any loss or damage resulting from any occurrence arising out of, or caused by the care, or lack of care, of a patient 104 105 106 107 108 109 Responsibilities of the EMS Provider (25 of 27) Insuring continuous for the service area defined in documents submitted to the department Responding to requests for assistance from the highest elected official of a political subdivision or from the department during a declared emergency or mass casualty situation according to national, state, regional and/or local plans, when authorized Immediately notify the department in writing when operations in any service area Responsibilities of the EMS Provider (26 of 27) Providing written notice to the department, RAC and Emergency Medical Task Force, if the EMS provider will make staff and equipment during a declared emergency or mass casualty situation, for a state or national mission, when authorized Develop or adopt and then implement policies, procedures and protocols necessary for its operations as an EMS provider, and enforce all such policies, procedures and protocols Responsibilities of the EMS Provider (27 of 27) Assuring all EMS personnel receive continuing education on the provider's treatment protocols. The provider shall maintain education and training records to include date, time, and location of such education or training for all its EMS personnel Assure that all patients transported by must be in a department authorized EMS vehicle TAC 157.16 EMS Provider Disciplinary Actions Reasons for Disciplinary Action (1 of 8) An EMS provider retains ultimate for the operation of the service. A licensed EMS provider may not claim a defense when one or more staff members, acting with or without the consent and knowledge of the license holder, commit(s) multiple violations in this section, or perform(s) contrary to EMS standards while on EMS business for the provider DSHS may issue an emergency suspension order to any EMS provider if there is reasonable cause to believe that the conduct of any licensed provider creates an imminent to public health or safety Reasons for Disciplinary Action (2 of 8) An EMS provider may be suspended or revoked for, but not limited to, the following reasons: Failing to comply with any requirement of provider licensure as defined in 157.11 of this title (relating to Requirements for an EMS Provider License) Operating the service while the is under suspension 17

Failing to correct deficiencies as instructed by the department or altering a license issued by the department 110 111 112 113 114 Reasons for Disciplinary Action (3 of 8) An EMS provider may be suspended or revoked for, but not limited to, the following reasons (Continued): Obtaining or attempting to obtain or assisting another to obtain a provider license or personnel certification by, forgery, deception, or misrepresentation Providing false or misleading and/or making false or misleading claims to clients or the public about the service Failing to operate a subscription service/membership program according to applicable provisions Reasons for Disciplinary Action (4 of 8) An EMS provider may be suspended or revoked for, but not limited to, the following reasons (Continued): Failing to maintain patient according to standards and department regulations in the provision of services based on national origin, race, color, creed, religion, gender, sexual orientation, age, physical or mental disability Reasons for Disciplinary Action (5 of 8) An EMS provider may be suspended or revoked for, but not limited to, the following reasons (Continued): Falsifying a patient care or any other document or record resulting from or pertaining to EMS Provider responsibilities Obtaining any or benefit by fraud, coercion, theft, deception, or misrepresentation Failing to pay an administrative penalty in full within established time frames Reasons for Disciplinary Action (6 of 8) An EMS provider may be suspended or revoked for, but not limited to, the following reasons (Continued): Failing to give the department true and complete information when asked, regarding any alleged or actual violation of the Health and Safety Code, Chapter 773 Failing to each vehicle deemed to be in service or response ready with appropriately and currently certified personnel Operating, directing, or allowing staff to operate vehicle devices unnecessarily or inappropriately Reasons for Disciplinary Action (7 of 8) An EMS provider may be suspended or revoked for, but not limited to, the following reasons (Continued): Operating, directing, or allowing any person to operate any vehicle on EMS business while under the of any substance that inhibits the mental or physical capacities of that person Having been found to have operated, directed, or allowed staff to operate any vehicle while on EMS business in a reckless or manner and/or in a manner that is dangerous to the health or safety of any person 18

115 116 117 118 119 Reasons for Disciplinary Action (8 of 8) An EMS provider may be suspended or revoked for, but not limited to, the following reasons (Continued): Operating, directing, or allowing staff to operate any vehicle that is not mechanically safe, and in good operating condition Having been found in violation of any local, state, or national code or regulation pertaining to EMS operations or business practices; and/or violating any rule or standard that could the health or safety of any person Types of Disciplinary Actions (1 of 4) Emergency Suspension If reasonable cause exits of an danger to public health or safety Becomes effective immediately without a hearing or notice to the license holder Penalty An administrative penalty may be assessed when an EMS provider is in violation of the Health and Safety Code, Chapter 773, 25 Texas Administrative Code, Chapter 157, or the reasons outlined previously Types of Disciplinary Actions (2 of 4) Non-Emergency Suspension or Revocation As listed previously of License: A license may be denied for, but not limited to, the following reasons: Failure to meet licensing requirements Owner(s) having a history of a misdemeanor or which the department has determined may put the safety of any person at risk Types of Disciplinary Actions (3 of 4) Denial of License: A license may be denied for, but not limited to, the following reasons (Continued): conduct while holding an EMS provider license which could put any person at risk The EMS provider has received disciplinary action in another state or by a federal agency or misrepresenting any fact or requirement on or for an application or related document for a provider license or EMS personnel license/certificate Issuing a check for application for a provider license which is to the department unpaid Types of Disciplinary Actions (4 of 4) Probation The department may any penalty assessed under this section and may specify terms and conditions of any probation issues Surrender of License A provider who wishes to his or her license prior to the expiration date may do so by completing a Surrender of License Statement. A 19

provider that has pending or imminent disciplinary action must acknowledge that the surrender is a no contest plea 120 121 122 123 124 125 126 127 Notification of Disciplinary Action If the department proposes to deny, suspend, revoke, or probate a license, the EMS provider license holder and the administrator of record shall be notified at the address shown in the current records of the department. The notice shall state the facts or conduct to warrant the proposed action and state that the license holder may request a hearing Hearing Request A request for a hearing shall be in writing and submitted to the department and postmarked no later than days after the date of the notice. The hearing shall be conducted pursuant to the Administrative Procedure Act, Government Code, Chapter 2001 If the candidate, applicant or licensee does not request a hearing in writing within 30 days after proper notice, the individual is deemed to have the opportunity for a hearing as outlined in the notice Notification of Disposition An order of final disposition of any disciplinary action shall be sent to the license. A copy of the order shall also be sent to the provider's medical director and to any government entity, institution or facility with which the license holder is known to be associated TAC 157.33 Certification Initial Certification Requirements (1 of 3) Must be at least years of age Have a high school diploma or GED An who provides care exclusively as a volunteer is exempt from this requirement Must have successfully completed a DSHS approved course Must have completed an approved examination Initial Certification Requirements (2 of 3) Submit an application and pay the non-refundable may be exempt. However, if such an individual receives compensation during the certification period, the exemption ceases and the individual shall pay a prorated fee to the department based on the number of years remaining in the certification period when employment begins. Initial Certification Requirements (3 of 3) Provide evidence of current active National Registry at the appropriate level The NR First Responder certification is considered the appropriate level for and ECA Submit through the state approved service to undergo FBI criminal history check Length of Certification A candidate who meets all requirements shall be certified for years beginning on the date of issuance of a 20

certificate and wallet-size certificate. A candidate must verify current certification before staffing an EMS vehicle. Certification may be verified by the applicant s receipt of the official department identification card or by using the department s certification 128 129 130 131 132 133 Inactive Certification A certified EMT, AEMT, or EMT-P may make application to the department for certification at any time during the certification period or within one year after the certificate expiration date While on inactive certification, a person shall not practice other than to act as a bystander rendering first aid or cardiopulmonary resuscitation (CPR) or the use of an Automated External Defibrillator in the capacity of a layperson. An individual shall not simultaneously hold inactive and certification Time Limit for Completing Requirements (1 of 2) An initial candidate for certification shall complete all requirements for certification no later than years after the candidate's course completion date. The application will expire two years from the date the mailed application is postmarked, or the date a faxed, online submission or hand-delivered application is received at the department Time Limit for Completing Requirements (2 of 2) NR certification must current until final requirement for state certification is met A candidate who does not complete all requirements for certification within two years of the candidate's initial course completion date would have to all requirements; including the completion of another initial course Reciprocity Through NR Certification (1 of 2) A person who is currently certified by the National Registry but did not complete a departmentapproved course may apply for the equal or level Texas certification by submitting a reciprocity application and a nonrefundable fee of $120 Applicants holding National Registry AEMT certification may be required to submit written verification of proficiency of AEMT from an approved education program Reciprocity Through NR Certification (2 of 2) National Registry first responder certification is not eligible for reciprocity at the ECA level A candidate will not be eligible for reciprocity if the National Registry certification prior to the completion of all requirements for certification as listed in this section A candidate who meets the requirements shall be certified for four years beginning on the date of issuance of a certificate and wallet-size certificate The candidate has completed a state approved jurisprudence Reciprocity of Those Certified by Another State (1 of 3) A person currently certified by another state may apply for equal or lower level Texas certification by submitting a reciprocity application and a nonrefundable fee of $120 21