BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES OF THE

STATE OF MONTANA

 

In the matter of the amendment of ARM 37.104.101, 37.104.102, 37.104.105, 37.104.109, 37.104.316, 37.104.319, 37.104.321, 37.104.329, 37.104.330, 37.104.401, 37.104.404, and 37.104.405 pertaining to emergency medical services (EMS)

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NOTICE OF AMENDMENT

 

           TO: All Concerned Persons

 

1. On November 14, 2013, the Department of Public Health and Human Services published MAR Notice No. 37-655 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 2039 of the 2013 Montana Administrative Register, Issue Number 21.

 

2. The department has amended ARM 37.104.102, 37.104.105, 37.104.109, 37.104.319, 37.104.321, 37.104.329, 37.104.330, 37.104.401, 37.104.404, and 37.104.405 as proposed.

 

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

 

            37.104.101 DEFINITIONS The following definitions apply in subchapters 1 through 4:

            (1) through (29) remain as proposed.

            (30) "Service medical director" means a person who meets the requirements of a service medical director as provided in ARM 24.156.2701 and provides offline medical director direction for an emergency medical services as defined in 50-6-302, MCA.

            (31) through (36) remain as proposed.

 

AUTH: 50-6-323, MCA

IMP:     50-6-323, MCA

 

            37.104.316 PERSONNEL REQUIREMENTS: BASIC LIFE SUPPORT GROUND AMBULANCE SERVICE (1) Except as provided for in 50-6-322, MCA, a basic life support ground ambulance service must ensure that at least two of the following individuals are on board the ambulance when a patient is loaded or transported, with the proviso that having only two ECP-EMR personnel on a call is not allowed:

            (a)  an ECP-EMR equivalent with the proviso that having only two EMP-EMR personnel on a call is not allowed; or

            (b) an EMT-basic equivalent; or

            (b) remains as proposed, but is renumbered (c).

            (2) and (3) remain as proposed.

 

AUTH: 50-6-323, MCA

IMP:     50-6-323, MCA

 

4. 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 commenter stated that the proposed personnel requirements under ARM 37.104.316 allow an ambulance to be staffed by only one ECP-EMR.

 

RESPONSE #1: While it is not the intent of the department to allow only one ECP-EMR to staff an ambulance, we can see how the current paragraph may be confusing to interpret. The department proposes adding language to ARM 37.104.316, which does not change the intent of proposed rules but may be clearer to understand.

 

COMMENT #2: Two commenters state that allowing ECP-EMRs to function on an ambulance is beyond the intent of the NHTSA National Scope of Practice Model document.

 

RESPONSE #2: The department disagrees. The NHTSA Scope of Practice document states: "This individual (EMR) possesses the basic knowledge and skills necessary to provide lifesaving interventions while awaiting additional EMS response and to assist higher level personnel at the scene and during transport." It further states, "In some systems, Emergency Medical Responders serve as a part of the crew on transporting EMS units…" The department's rules model the use of an EMR as described in this national document.

 

COMMENT #3: Two commenters noted that the definition in ARM 37.104.101(30) refers to ARM 24.156.2701, but does so incorrectly.

 

RESPONSE #3: The purpose of these rules is to assure that the department's service licensing rules and the board of medical examiner's ECP licensing rules are consistent. We appreciate the commenters noting this inconsistency and we accept their proposed solution.

 

COMMENT #4: One commenter suggested that ARM 37.104.109(2)(b) should be edited to read "…ECP is authorized by the service medical director to provide" and further justifies that only a medical director recognized by the Board of Medical Directors may authorize an ECP's practice.

 

RESPONSE #4: The department disagrees. ARM 37.104.101(30) clarifies that the service medical director is a physician or physician assistant recognized as a medical director by the Board of Medical Examiners and provides offline medical direction for an emergency medical service as defined in 50-6-302, MCA.  ARM 37.104.109 clarifies that the service medical director recognized by the department is responsible for the medical oversight and supervision of the service, including the ECPs working for the service.

 

            5. The department intends to apply these rules retroactively to January 1, 2014. A retroactive application of the proposed rules does not result in a negative impact to any affected party.

 

 

/s/ Shannon L. McDonald                          /s/ Marie Matthews for                                

Shannon L. McDonald                               Richard H. Opper, Director

Rule Reviewer                                           Public Health and Human Services

           

Certified to the Secretary of State January 6, 2014