Administrative Rules of the State of Montana

BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

In the matter of the adoption of New Rules I, II, and III, amendment of ARM 37.104.101, 37.104.105, 37.104.109, 37.104.203, 37.104.213, 37.104.218, and 37.104.316, and repeal of ARM 37.104.221 pertaining to emergency medical services (EMS)

)

NOTICE OF ADOPTION, AMENDMENT, AND REPEAL

TO: All Concerned Persons

1. On December 24, 2009, the Department of Public Health and Human Services published MAR Notice No. 37-496 pertaining to the public hearing on the proposed adoption, amendment, and repeal of the above-stated rules at page 2446 of the 2009 Montana Administrative Register, Issue Number 24.

2. The department has adopted New Rule I (37.104.102), II (37.104.321), and III (37.104.405) as proposed.

3. The department has amended ARM 37.104.101, 37.104.105, 37.104.203, 37.104.213, 37.104.218, and 37.104.316 and repealed ARM 37.104.221 rules as proposed.

4. The department has amended the following rule as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:

37.104.109 BASIC LIFE SUPPORT SERVICE LICENSING (1) An ambulance service or nontransporting medical unit (NTU) capable of providing service only at the basic life support level will be licensed at the basic life support level.

(a) An ambulance service or NTU that provides advanced life support with EMT-intermediates or EMT-paramedics, but cannot reasonably provide it 24 hours per day, seven days per week due to limited personnel, will receive a basic life support license with authorization for limited ALS.

(b) An ambulance service or NTU that provides advanced life support with EMT-basics with endorsements will receive a basic life support license with authorization for limited ALS.

(2) through (2)(b) remain as proposed.

AUTH: 50-6-323, MCA

IMP: 50-6-323, MCA

5. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:

COMMENT #1: One commentor questioned in Rule I (37.104.102) how the "one EMT and a driver" works and requested information about whether the driver should have some EMS skills. The commentor thought that the driver should know how to do more than just drive and should be able to help the EMT if needed.

RESPONSE #1: Senate Bill 79, passed by the 2009 Legislature, allows a qualified volunteer EMS service to respond with one EMT-basic and one trained driver. In order to meet legislative intent, these proposed rules clarify that the driver only needs to obtain emergency vehicle driving education. However, this does not restrict services with adequate staffing and training resources from providing additional education to allow a driver to provide more services or assistance to the EMT.

COMMENT #2: One commentor noted that "service plan" is deleted in ARM 307.104.101(31) of these proposed rules, but is not similarly deleted in ARM 37.104.109(2)(a) without the definition to clarify the meaning of this.

RESPONSE #2: ARM 37.104.109(2)(a) does not reference a "service plan" and is not in error.

COMMENT #3: In ARM 37.104.316(3) commentor stated that the proposed new language identifies "training equivalent to the emergency vehicle operation objectives…" but it does not identify who will determine equivalency. The commenter suggests that this section be modified to clarify that the department will determine equivalency.

RESPONSE #3: The emergency driving learning objectives of an EMT-basic course are very minimal and can be met by many courses provided for EMS, law enforcement, fire, and other emergency responders. The department does not feel that it is necessary to review and determine equivalency of each of these courses and that the EMS services can adequately determine equivalency which meets the intent of statute.

COMMENT #4: We oppose the deletion of the definition for a grandfathered advanced first aid person under ARM 37.104.101(22) and other related deletions which allow a grandfathered first aid person to act as one of the required personnel on an ambulance.

RESPONSE #4: The department was not aware that there is still one person in the state that qualifies as a grandfathered advanced first aid responder and it is not the intention of the department to eliminate the contribution this provider makes to their local community. Even so, the department does not feel that it is necessary to continue to have this paragraph in rule. To the extent that there are any services with grandfathered first aid providers, they may contact the department to obtain a personnel waiver through authority allowed under 50-6-325, MCA and ARM 37.104.107.

COMMENT #5: One commentor stated that ARM 37.104.101(22), "intermediate life support service", defines a service that provides care at the "EMT-intermediate equivalent" level, but that equivalency is not defined.

RESPONSE #5: The complimentary rule which defines an "EMT-intermediate equivalent" is already in ARM 37.104.101(17).

COMMENT #6: One commentor suggested the language "cannot provide it 24 hours a days, seven days per week" in ARM 37.104.109(1)(a) should be deleted and instead proposed providing language that states "an ambulance service or NTU that provides advanced life support with EMT-basics with endorsement will receive a basic life support license with authorization for limited ALS".

RESPONSE #6: ARM 37.104.109(1)(a) effects not only EMS services which provide advanced life support with EMT-basics with endorsements, but also services that utilized limited EMT-intermediate or EMT-paramedic staff. The department feels it can revise ARM 37.104.109(1) with two modifications which clarify, but do not change the intent of the proposed rule:

(b) An ambulance service or NTU that provides advanced life support with EMT-basics with endorsements will receive a basic life support license with authorization for limited ALS.

COMMENT #7: One commentor stated that ARM 37.104.109(2)(a) and (2)(b) is a Board of Medical Examiners (BOME) or local medical director issue and should be deleted from these rules. Additionally, the commentor questioned why any rules for medical direction are in service licensing rules as medical direction is a BOME issue.

RESPONSE #7: Under 50-6-323, MCA, the department has general authority to supervise and regulate emergency medical services. Additionally, 50-6-323(5)(c), MCA states that the department may prescribe and enforce rules for offline and online medical direction. The department and the Board of Medical Examiners work closely to ensure that the BOME authority for EMTS and the department authority for EMS services are coordinated.

COMMENT #8: One commenter stated that ARM 37.104.213(2) should be stricken or clarified as it appears to require the highest qualified person on an ambulance to always be in the back with the patient.

RESPONSE #8: The department disagrees that ARM 37.104.213(2) needs to be stricken or clarified. The first part of the sentence describes that an EMT (or their equivalent) must be attending the patient. The second part of the sentence requires that an EMT licensed at the corresponding level must attend the patient. For example, it requires the paramedic of an EMT-basic/EMT-paramedic team attend to the patient if any advanced life support monitoring or care is necessary. However, this does not restrict an EMT-basic on team to provide care to the patient that only requires basic life support.

COMMENT #9: One commentor stated that language in ARM 37.104.218(3) relative to "two-way communication, approved by the department" is too vague and should not be left that open.

RESPONSE #9: The department feels that ARM 37.104.218(3) should remain open and flexible as there are a variety of methods that EMS services operate and utilize communications technologies and all of them cannot be described in rules. Additionally, there are continually new technologies emerging to facilitate communications with hospitals and medical control and a detailed rule would not enable the department to easily approve these technologies as they become available.

COMMENT #10: One commentor suggested that language from 50-6-322, MCA be added to ARM 37.104.316.

RESPONSE #10: The department disagrees. It is not common practice to publish language from a statute into rules. Upon adoption of these rules, the department will provide a complete overview of the new statute and rule language to all services.

/s/ Shannon McDonald /s/ Anna Whiting Sorrell

Rule Reviewer Anna Whiting Sorrell, Director

Public Health and Human Services

Certified to the Secretary of State February 16, 2010.