4309339 New Chapter 5 of Title 29, establishing regulations on the provision of ambulance and emergency medical services

DEPARTMENT OF HEALTH

 

NOTICE OF PROPOSED RULEMAKING

 

The Director of the Department of Health, pursuant to the authority set forth in Section 24 of the Emergency Medical Services Act of 2008 (Act), effective March 25, 2009 (D.C. Law 17-357; D.C. Official Code § 7-2341.23 (2012 Supp.)); and Mayor’s Order 2009-89, dated June 1, 2009, hereby gives notice of his intent to take final action to adopt in not less than thirty (30) days after the date of publication in the D.C. Register, the following rules to amend Chapter 5 (Ambulance Service) of Title 29 (Public Welfare) of the District of Columbia Municipal Regulations (DCMR).

 

This rulemaking will establish regulations regarding the provision of emergency medical services, including: the provision of ambulance services; emergency medical service provider certifications; approval of emergency medical service educational institutions and courses; and penalties for violations of the regulations.  The regulations will also incorporate certain national standards for the provision of emergency medical services.  Incorporation of recognized national standards for the establishment and oversight of the District’s pre-hospital care will ensure that persons and entities providing emergency medical services and education in the District of Columbia are properly qualified and supervised.

 

Title 29, PUBLIC WELFARE, of the DCMR is amended as follows:

 

Chapter 5, AMBULANCE SERVICE, is repealed and replaced in its entirety to read as follows:

 

CHAPTER 5             EMERGENCY MEDICAL SERVICES

 

500                  GENERAL PROVISIONS

 

500.1               The purpose of this chapter shall be to ensure high quality pre-hospital care for children and adults in the District of Columbia.

 

500.2               The provisions of this chapter shall apply to every one of the following:

 

(a)        Persons performing the duties of emergency services personnel, compensated or uncompensated, within the District of Columbia;

 

(b)        Entities providing emergency medical services within the District of Columbia, public or private, for-profit or not-for-profit, including owners or operators of emergency medical services agencies and owners or operators of emergency medical response vehicles; and

 

(c)        Persons and entities providing emergency medical services training and instruction, public or private, for-profit or not-for-profit, within the District of Columbia.

 

 

500.3               The provisions of this chapter shall not apply to the following:

 

(a)        The unexpected rendering of immediate care by a private citizen, or the unexpected use of a privately owned vehicle which is not ordinarily used in the business of transporting persons who are sick, injured, wounded, or otherwise incapacitated or helpless, in the performance of a lifesaving act;

 

(b)        Agencies, vehicles, or training facilities owned or operated by the United States government and operating on federal property;

 

(c)        Agencies operating within the District of Columbia pursuant to mutual aid agreements;

 

(d)       Validly licensed or certified emergency medical response vehicles based outside the District which do not otherwise constitute public vehicles for hire; and

 

(e)        Validly licensed vehicles operated solely for the transportation of non-emergency patients to and from treatment facilities as outpatients; provided, that this exemption shall not apply to any vehicle which is in any way held out as an emergency medical response vehicle.

 

 

501                  AMBULANCE SERVICES

 

501.1               No person shall operate or hold itself out as operating an ambulance in the District unless the operator holds a currently valid certificate issued pursuant to this chapter for that ambulance.

 

501.2               No person shall advertise or disseminate information to the public that emergency medical technician ambulance service is offered unless that service is:

 

(a)        Provided by District-certified emergency medical technicians;

 

(b)        Operating District-certified basic life support ambulances, as defined by the Director pursuant to § 510 of this chapter; and

 

(c)        Operating on a continuous twenty-four (24) hour per day basis except for those agencies providing special event coverage.

 

501.3               No person shall advertise or disseminate information to the public that paramedic ambulance services are offered unless that service is:

 

(a)        Provided by District-certified paramedics;

 

(b)        Operating District-certified advanced life support ambulances, as defined by the Director pursuant to § 510; and

 

(c)        Operating on a continuous twenty-four (24) hour per day basis.

 

501.4               Advertising or information regarding ambulance services may only appear on emergency medical response vehicles, as defined in to § 510, used on a continuous twenty-four (24) hour per day basis to provide service.

 

 

502                  CERTIFICATION AS AN EMERGENCY MEDICAL SERVICES AGENCY

 

502.1               No person, including volunteer groups and government entities  shall operate an Emergency Medical Services Agency in the District without holding a valid certification issued pursuant to this chapter, except as provided in § 500.3.

 

502.2               An Emergency Medical Services Agency that provides EMS services during a special event must be certified as a District EMS Agency, whether or not it operates an ambulance or response vehicle.

 

502.3               Application for certification as an Emergency Medical Services Agency shall be submitted to the Director of the District of Columbia Department of Health (Director) in accordance with this chapter.

 

502.4               Before applying for certification as a District of Columbia Emergency Medical Services Agency that intends to operate an ambulance service, one shall first obtain a Certificate of Need in accordance with the Health Services Planning Program Reestablishment Act of 1996 (D.C. Law 11-191; D.C. Official Code §§ 44-401, et seq. (2005 Repl. & 2012 Supp.)), and the Certificate of Need Regulations (22-B DCMR § 4000, et seq.).

 

502.5               A person operating an Emergency Medical Services Agency under an authorization of the Director issued before the effective date of this chapter shall be considered certified under this chapter for a period of two (2) years from the effective date of this chapter, after which the agency shall apply for renewal of its certification in accordance with this chapter.

 

502.6               An application for certification as an Emergency Medical Services Agency shall be made in a manner established by the Director and shall contain the following:

 

(a)                The name and address of the applicant;

 

(b)               The name under which the applicant is doing business or proposes to do business;

 

(c)                A description of each vehicle, including the make, model number, year of manufacture, and any distinguishing characteristics to be used to designate the applicant’s vehicle (if applicable);

 

(d)       The location and description of the place or places from which the applicant intends to operate;

 

(e)                The geographic boundaries of the applicant’s proposed response area;

 

(f)                Category of certification the applicant is applying for (basic or advanced life support, first responder, ground transport, or air medical);

 

(g)               The patient care reporting system that the applicant intends to use, which shall be compliant with the current United States National Highway Transportation Safety Administration (NHTSA) or National Emergency Medical Services Information System (NEMSIS) standard;

 

(h)               The name, address, phone number, e-mail address, and District medical license number, and DEA certificate of the physician medical director;

 

(i)                 The name, address, phone number, fax number (if available), and e-mail address of the person in charge of day-to-day operations;

 

(j)                 Insurance information, to include the name of the insurance company, agent, phone number, e-mail address, and type of coverage;

 

(k)        Proof of meeting the following minimum insurance limits; provided that this requirement shall not apply to ambulances owned and operated by an agency of the District government:

 

(1)        Commercial general liability:

 

(A)       Per occurrence: one million dollars ($1,000,000);

 

(B)       Aggregate: two million dollars ($2,000,000);

 

(C)       Products and completed operations: two million dollars ($2,000,000); and

(D)       Personal/advertising injury: one million dollars ($1,000,000);

(2)        Vehicle liability: one million dollars ($1,000,000) per occurrence;

(3)        Worker’s compensation, employers’ liability:

(A)       Each accident: five hundred thousand dollars ($500,000);

 

(B)       Employee disease: five hundred thousand dollars ($500,000); and

 

(C)       Disease policy limit: five hundred thousand dollars ($500,000);

(4)        Umbrella or excess liability: two million dollars ($2,000,000);

(5)        Professional liability:

 

(A)       Per occurrence: one million dollars ($1,000,000); and

 

(B)       Aggregate: three million dollars ($3,000,000);

 

(l)         A copy of the applicant’s Drug Enforcement Agency license, where applicable;

 

(m)       A copy of the applicant’s protocols and authorized drug list (as applicable), signed and dated by the medical director;

 

(n)        A written agreement with the applicant’s medical director that specifies:

 

(1)               The duties of the medical director;

 

(2)               The responsibilities of the medical director;

 

(3)               The  authority of the medical director;

 

(4)               The specific responsibilities of each EMS physician if the agency has multiple assistant medical directors; and

 

(5)               That adequate indemnification exists for:

 

(A)       Medical malpractice; and

 

(B)       Civil liability;

 

(o)        A written agreement with the applicant’s operational director that specifies:

 

(1)               The duties of the operational director;

 

(2)               The responsibilities of the operational director; and

 

(3)               The authority of the operational director;

 

(p)        A written agreement with the applicant’s quality improvement officer that specifies:

 

(1)               The duties of the quality improvement officer;

 

(2)               The responsibilities of the quality improvement officer; and

 

(3)               The authority of the quality improvement officer;

 

(q)        A written quality improvement plan, approved by the applicant’s medical director, in accordance with Section 555 of this chapter; and

 

(r)        A written emergency response plan that includes the following:

 

(1)               How the applicant will receive calls for assistance;

 

(2)               How the applicant will respond to calls for assistance; and

 

(3)               How the non-transport applicant will summon transport services.

 

 

502.7               The Director shall evaluate each applicant before issuing a certificate. The evaluation may include the inspection of:

 

(a)        Vehicles;

 

(b)        Equipment;

 

(c)        Staffing capability;

 

(d)       Records;

 

(e)        Premises; and

 

(f)        Operational procedures.

 

502.8               If the Director determines that an applicant has met the requirements of this chapter, the Director shall issue a certificate to the applicant.  The certificate shall be valid for not more than two (2) years.

 

502.9               A certified Emergency Medical Services Agency shall notify the Director no later than five (5) business days after the expansion of any service provided by the agency or any change in headquarters or substation location.

 

502.10             An applicant or Emergency Medical Services Agency shall furnish to the Director, upon his or her request, a copy of any insurance policy required by § 502.5.

 

502.11             Each Emergency Medical Services Agency shall provide for twenty-four (24) hour physician supervision by a physician licensed in the District of Columbia and shall report to the Director the means of this supervision at the time of application for certification and upon renewing the certification.

 

502.12             After the Director issues a certificate, the Director may inspect an agency on a scheduled or random basis.  An inspection may include inspection of the items listed in § 502.6.

 

502.13             If the Director denies an application for certification, the applicant may appeal the denial pursuant to the rules of the District of Columbia Office of Administrative Hearings .

 

502.14             The Director may suspend or revoke an agency’s certificate at any time the Director determines that the agency no longer meets the requirements for operating as a certified Emergency Medical Services Agency.

 

502.15             An Emergency Medical Services Agency certification shall not be transferable.

 

502.16             An Emergency Medical Services Agency certificate shall be displayed in the principal place of business of the agency, with a copy in each place of operation.

 

 

503                  CHANGE IN INFORMATION

 

503.1               An Emergency Medical Services Agency shall notify the Director, in a manner that the Director prescribes, of any change in the protocols or authorized drug list of the agency no fewer than thirty (30) days prior to the change.

 

503.2               An Emergency Medical Services Agency shall notify the Director, in a manner that the Director describes, of any change in the medical director of the agency, as required by Subsection 504.6.

 

 

504                  EMERGENCY MEDICAL SERVICES AGENCIES: MEDICAL DIRECTORS

 

504.1               The medical director of a certified Emergency Medical Services Agency shall be responsible for maintaining the quality of the patient care provided by the Emergency Medical Services Agency and of ensuring that the Emergency Medical Services Agency engages in adequate quality assurance activities, including:

 

(a)        Initial and continuing education training;

 

(b)        The establishment and maintenance of policies and procedures covering the operations, training, and quality oversight of the agency;

 

(c)        A requirement that the medical director or his or her designee review patient care reports in accordance with their quality assurance and improvement plan as outlined in § 555 of this chapter;  

 

(d)       A requirement that the medical director or his or her designee review field communications recordings in accordance with their quality assurance and improvement plan as outlined in § 555;

 

(e)        A requirement that the medical director or his or her designee perform post-run interviews and case conferences in accordance with their quality assurance and improvement plan as outlined in § 555;

 

(f)        Investigations of all complaints; and

 

(g)        The establishment and enforcement of pre-hospital medical care and treatment protocols to be used by EMS providers working under their supervision as members of the Emergency Medical Services Agency.

 

504.2               The medical director shall serve as the medical authority for the certified Emergency Medical Services Agency and shall serve as the liaison of the Emergency Medical Services Agency with the medical community, medical facilities, and governmental entities.

 

504.3               The medical director shall have authority sufficient to oversee the quality of patient care for all EMS providers within the agency.  The medical director:

 

(a)        May withdraw, at his or her discretion, the authorization for personnel to perform any or all patient care procedures;

 

(b)        Shall notify the District EMS Officer using the appropriate form of any provider whose authorization to render care has been withdrawn within seventy-two (72) hours of the withdrawal; and

 

(c)        Shall also notify any other known EMS agency that sponsors the provider within seventy-two (72) hours of the withdrawal of authorization.

 

504.4               The medical director shall establish and maintain the agency’s protocols and authorized drug list.  The medical director shall sign and date the protocols and the authorized drug list.

 

504.5               An Emergency Medical Services Agency shall notify the Director of any change in the medical director of the agency no fewer than thirty (30) days prior to the change and no later than fifteen (15) days after naming a replacement.

 

504.6               An emergency or temporary change of the medical director shall be reported as follows:

 

(a)                When an agency’s medical director is unable to serve because of emergency circumstances, such as death or critical illness, the agency shall notify the Director within two (2) business days and shall further notify the Director upon naming a replacement; and

 

(b)               When there is a temporary change of less than one (1) year, such as for a military commitment, the agency shall notify the Director no later than fifteen (15) days after naming a replacement.

 

 

505                  EMERGENCY MEDICAL SERVICES AGENCIES: LOCATION

 

505.1               An Emergency Medical Services Agency shall maintain a fixed physical location. The agency shall notify the Director no fewer than thirty (30) days prior to any change in the location before the agency moves to the new location.

 

 

506                  EMERGENCY MEDICAL SERVICES AGENCIES: STORAGE OF LINENS, EQUIPMENT, AND SUPPLIES

 

506.1               An Emergency Medical Services Agency shall supply adequate, clean, and enclosed storage space for linens, equipment, and supplies at each place of operation. The storage shall be maintained as follows:

 

(a)        An area used for storing equipment or supplies shall be kept neat, clean, and sanitary;

 

(b)        When the Emergency Medical Services Agency is operating an ambulance, an area used for storing linens shall be kept neat, clean, and sanitary;

 

(c)                Soiled supplies and used disposable items shall be stored or disposed of in plastic bags, covered containers, or compartments provided for this purpose; and

 

(d)       Regulated waste shall be stored in a red or orange bag or container clearly marked with a biohazard label.

 

506.2               An area used for storing medications and administration devices shall comply with the applicable drug or device manufacturer’s recommendations for climate-controlled storage.

 

506.3               Narcotics and other controlled substances shall be stored and maintained in accordance with District and federal laws and regulations.

 

506.4               Medications and medication kits shall not be maintained past their expiration date.

 

506.5               Medications and medication kits shall be removed from vehicles and stored in a properly maintained and locked secure area when the vehicle is not in use, unless the ambient temperature of the vehicle’s medication storage compartment is maintained in accordance with the Department of Health’s (DOH) climate requirements.

 

506.6               Medication and medication kits shall be stored in the vehicle in accordance with § 511 of this chapter.

 

506.7               An Emergency Medical Services Agency, in addition to other applicable regulatory reporting requirements, shall notify the Director in writing of any diversion, loss, theft, or tampering with any controlled substance, medication delivery system, or other regulated medical device from the agency’s facility or vehicle. Notification shall be made no later than seventy-two (72) hours after the discovery of the occurrence.

 

 

507                  EMERGENCY MEDICAL SERVICES AGENCIES: RECORDS

 

507.1               An Emergency Medical Services Agency shall maintain records that include:

 

(a)        Approved patient care report forms;

 

(b)        Employee or member rosters;

 

(c)        Time sheets;

 

(d)       Call rosters;

 

(e)        Training records;

 

(f)        Dispatch logs, which shall include:

 

(1)        The type of call;

 

(2)               The time the call was received;

 

(3)               The time the call was dispatched;

 

(4)               The time that personnel responded;

 

(5)               The time that personnel arrived on the scene;

 

(6)               The time that transport service was requested (for non-transport response agencies);

 

(7)               The time that transport of the patient to the hospital began (if applicable);

 

(8)               The time the patient arrived at the hospital (if applicable);

 

(9)               The time that personnel returned to service; and

 

(10)           The disposition of the call.

 

507.2               An Emergency Medical Services Agency shall prepare and securely maintain records at its principal place of operations or a secured storage facility for not less than six (6) years and shall make the records available for inspection by the Director.

 

507.3               Records shall be stored in a manner that ensures reasonable safety from water and fire damage and from unauthorized disclosure.

 

507.4               An Emergency Medical Services Agency shall supply copies of records to the Director upon request.

 

507.5               An Emergency Medical Services Agency that fails to make its records available for inspection by the DOH, or fails to provide copies of records to the Director upon request, may be subject to fines, suspension, or termination of certification to operate an Emergency Medical Services Agency.

 

507.6               An Emergency Medical Services Agency shall maintain a current personnel record for each individual provider affiliated with the agency.  The personnel record shall include:

 

(a)                A copy of the provider’s current National Registry of Emergency Medical Technicians (NREMT) certification;

 

(b)               A copy of the provider’s current DOH certification;

 

(c)                A copy of the provider’s current cardiopulmonary resuscitation (CPR) card;

 

(d)               A copy of the provider’s current Advanced Cardiac Life Support (ACLS) card (if applicable); and

 

(e)                A copy of training records and qualifications for the positions held.

 

507.7               An Emergency Medical Services Agency shall provide a roster showing each provider’s name, address, e-mail address, NREMT certification number, and DOH certification number to the Director annually, as part of the agency’s annual report, due no earlier than January 1 and not later than March 1 of each year.

 

507.8               If an Emergency Medical Services Agency operates an emergency response vehicle, the agency shall maintain each vehicle currently in use in accordance with the manufacturer’s recommendations for preventative maintenance.

 

507.9               If an Emergency Medical Services Agency operates an emergency response vehicle, the agency shall maintain records on each vehicle currently in use.  The vehicle records shall include:

 

(a)                Maintenance records demonstrating adherence to the manufacturer’s recommendations for preventative maintenance;

 

(b)               A valid vehicle registration;

 

(c)        A vehicle inspection certificate;

 

(d)       Proof of vehicle insurance coverage; and

 

(e)        Reports of any collision involving the vehicle.

 

 

508                  EMERGENCY MEDICAL SERVICES AGENCIES:  LONG-TERM RESPONSES TO MUTUAL AID REQUESTS

 

508.1               If an emergency response vehicle of an Emergency Medical Services Agency responds on a mutual aid request that is located outside of the District of Columbia for a period that exceeds forty-eight (48) hours, the agency shall notify the District EMS Officer no later than twenty-four (24) hours after responding.

 

 

509                  EMERGENCY MEDICAL SERVICES AGENCIES: PATIENT CARE REPORTS

 

509.1               An Emergency Medical Services Agency shall complete a Patient Care Report (PCR) for each patient that the EMS provider sees.  Each PCR shall include the name and the DOH certification number of all EMS providers who attended to the patient and shall include the signature of the EMS provider in charge of the patient’s care.

 

509.2               The PCR shall be completed according to the current NHTSA or NEMSIS standard as published in DOH policy.

 

509.3               The Emergency Medical Services Agency shall maintain each PCR in compliance with Health Insurance Portability and Accountability Act (HIPAA) and other applicable District or federal laws or regulations.

 

 

510                  EMERGENCY MEDICAL SERVICES AGENCY VEHICLES: CERTIFICATIONS

 

510.1               No ground ambulance or emergency medical response vehicle shall be operated in the District of Columbia (except in response to a mutual aid agreement or as otherwise authorized by the Mayor or Director) unless it has a valid certification issued pursuant to this chapter and is operated by a certified Emergency Medical Services Agency.

 

510.2               Before receiving a certification for an ambulance or emergency medical response vehicle, an applicant shall submit to the Director the following information for each vehicle:

 

(a)                The name and address of the applicant and the owner of the vehicle;

 

(b)               A description of the vehicle, including the make; model number; year of manufacture; vehicle identification number; vehicle license tag number; length of time the vehicle has been in use; and the color scheme, insignia, name, monogram, or other distinguishing characteristics to be used to designate the vehicle;

 

(c)                The address of the location from which the vehicle will operate; and

 

(d)               Other information that the Director deems reasonably necessary to determine compliance with this chapter.

 

510.3               Before receiving a certification for a ground ambulance, an applicant shall submit the following additional information to the Director for each ground ambulance:

 

(a)                The location of the Certificate of Star–of-Life Ambulance, identifying compliance with Federal Specification for the Star-of-Life Ambulance KKK-A-1822 at the time the ambulance was manufactured; or

 

(b)               The location of the certificate attesting that the ambulance was in compliance with NFPA 1917 “Standard for Automotive Ambulances” at the time the ambulance was manufactured.

 

510.4               No certification for a ground ambulance shall be issued unless the Director finds that the ambulance is, and will be at all times when in use as an ambulance:

 

(a)                Built and equipped in accordance with the certification specified in § 510.3 above at the time the ambulance was manufactured;

 

(b)               Equipped with the mandatory items specified in the Equipment for Ambulances joint document published by the American College of Surgeons (ACS), the American College of Emergency Physicians (ACEP), and the National Association of Emergency Medical Services Physicians (NAEMSP); or DOH required equipment list.

 

(c)                Covered by insurance of a kind and in amounts conforming to the standards set forth by the Director pursuant to § 502 of this chapter; provided that this requirement shall not apply to ambulances owned and operated by an agency of the District government; and

 

(d)               Equipped in compliance with these regulations at all times unless the ambulance is out of service.

 

510.5               Each ambulance shall be equipped with not less than twenty (20) triage tags.

 

510.6               The District EMS Officer or designee shall inspect all ground ambulances for compliance with the vehicle requirements for the class in which a certification is sought.

                       

510.7               A ground ambulance vehicle certificate shall be issued if all of the following conditions are met:

 

(a)        All information contained in the application is complete;

 

(b)        The applicant is a certified District Emergency Medical Services Agency;

 

(c)        The ambulance is registered by the motor vehicle agency for the jurisdiction from which the vehicle will operate; and

 

(d)               The ambulance meets the minimum requirements as provided in this chapter.

 

510.8               The Director shall issue two (2) decals with each ambulance certificate.

 

510.9               The decals, which indicate that the ambulance has been certified by the Director and the date on which the certification expires, shall be affixed in prominent places on the front and rear of the ambulance.

 

510.10             The certificate shall be kept on file either at the place from which the ambulance operates or other designated place of the Emergency Medical Services Agency.

 

 

 

511                  EMERGENCY MEDICAL SERVICES AGENCY VEHICLES:  NON-TRANSPORT VEHICLES

 

511.1               An emergency medical response vehicle maintained and operated for response to the location of a medical emergency to provide immediate medical care at the basic or advanced life support level, but not to provide patient transport, shall be certified as a non-transport emergency medical response vehicle. Such vehicles would include fire apparatus, response cars, and other non-transport vehicles, but does not include air or watercraft.

 

511.2               A non-transport EMS vehicle shall be certified pursuant to § 510 of this chapter.

 

511.3               A non-transport EMS vehicle shall not be used for the transportation of patients except in the case of unstable or potentially unstable patients when there is no transport unit immediately available. In such an event, the circumstances of the call shall be documented by the Emergency Medical Services Agency and reported to the Director within seventy-two (72) hours.

 

511.4               A non-transport emergency medical response vehicle shall be constructed to provide sufficient space for the safe storage of the equipment and supplies required by this chapter.

 

511.5               A non-transport emergency medical response vehicle used for advanced life support shall have a locking storage compartment or approved locking bracket for the security of medications and medication kits within the vehicle interior, locked compartment, or trunk, which shall be inaccessible to the public.  When not in use, medications and medication kits shall be kept locked in the required storage compartment or approved bracket at all times.

 

511.6               A non-transport emergency medical response vehicle shall have a motor vehicle safety inspection performed by the District of Columbia Department of Motor Vehicles after the completion of its conversion to a non-transport emergency medical response vehicle and before an application for a non-transport emergency medical response vehicle certificate is submitted.

 

511.7               Each non-transport emergency medical response vehicle shall be equipped with not less than twenty (20) triage tags.

 

511.8               A non-transport emergency medical response vehicle certificate shall be issued if all of the following conditions are met:

 

(a)        All information contained in the application is complete;

 

(b)        The applicant is a certified District Emergency Medical Services Agency;

 

(c)        The vehicle is registered by the motor vehicle agency for the jurisdiction from which the vehicle will operate; and

 

(d)       The vehicle meets the minimum requirements as provided in this chapter.

 

511.9               The Director shall issue two (2) decals with each non-transport emergency medical response vehicle certificate.

 

511.10             The decals, which indicate when the certificate expires, shall be affixed in prominent places on the front and rear of the vehicle.

 

511.11             The certificate shall be kept on file either at the place from which the non-transport emergency medical response vehicle operates or other designated place of the Emergency Medical Services Agency.

 

 

512                  EMERGENCY MEDICAL SERVICES AGENCY VEHICLES:  AIR AMBULANCES

 

512.1               An aircraft maintained and operated for response to the location of a medical emergency to provide immediate medical care at the basic or advanced life support level and for the transportation of patients shall be certified as an emergency medical response vehicle, operating as an air ambulance, pursuant to § 510.

 

512.2               An air ambulance shall be commercially constructed and certified to comply with the U.S. Federal Aviation Administration standards in effect on the date of its construction.

 

512.3               An air ambulance shall be constructed to provide sufficient space for safe storage of the equipment and supplies required by this chapter.

 

512.4               Equipment and supplies as specified in the Emergency Medical Services Agency’s protocols shall be available for access and use from inside the patient compartment of the air ambulance.

 

512.5               An air medical certificate shall be issued if all of the following conditions are met:

 

(a)        All information contained in the application is complete;

 

(b)        The applicant is a certified District Emergency Medical Services Agency;

 

(c)        The aircraft is registered with the Federal Aviation Administration; and

 

(d)       The aircraft meets the minimum requirements as provided in this chapter.

 

512.6               An air ambulance certificate shall not be sold, transferred, or assigned without the approval of the Director.

 

 

513                  EMERGENCY MEDICAL SERVICES AGENCY VEHICLES:  INSPECTIONS

 

513.1               Each Emergency Medical Services Agency’s vehicle, its equipment, all associated records, and the premises designated in its application, shall be available for inspection by the District EMS Officer or his or her designee during the usual hours of operation.

 

513.2               The Director may subject any emergency medical response vehicle certified under this chapter to an unscheduled inspection to determine compliance with certification standards.

 

513.3               An emergency medical response vehicle certification issued under this chapter shall be valid for one (1) year; provided that the Emergency Medical Services Agency maintains a valid District certification.

 

513.4               The Director shall renew an emergency medical response vehicle certification upon submission of an application demonstrating compliance with all certification requirements, as though the vehicle were the subject of an application for an original certification.

 

 

514                  EMERGENCY MEDICAL SERVICES AGENCY VEHICLES:  OPERATING STANDARDS

 

514.1               The owner of an emergency medical response vehicle shall maintain the vehicle in good repair and safe operating condition and shall meet the same motor vehicle, vessel, or aircraft safety requirements as apply to all vehicles, vessels, or aircraft in the District of Columbia.

 

514.2               The owner of an emergency medical response vehicle shall maintain current District of Columbia motor vehicle safety inspection, Federal Aviation Administration (FAA) Airworthiness Permit, or Coast Guard Safety Inspection or approved equivalent.

 

514.3               The owner of an emergency medical response vehicle shall keep exterior surfaces of the vehicle, including windows, mirrors, warning devices, and lights free of dirt and debris.

 

514.4               The operator of any ground emergency medical response vehicle shall exercise emergency operating privileges, including the use of audible and visible emergency warning devices, in compliance with the laws and regulations of the District of Columbia.

 

514.5               No person shall smoke at any time in an emergency medical response vehicle.

 

514.6               Except as follows, no person shall possess a firearm, weapon, explosive, or incendiary device on an emergency medical response vehicle:

 

(a)        A sworn law-enforcement officer is authorized to carry a weapon; or

 

(b)        A rescue line gun or other rescue device powered by an explosive charge may be carried on a non-transport response vehicle.

 

514.7               An emergency medical response vehicle shall only be operated by an individual who is properly trained and licensed.

 

514.8               Each occupant of a ground emergency response vehicle shall use mechanical restraints as required by the Mandatory Use of Seat Belts Act of 1985, effective December 12, 1985 (D.C. Law 6-73; D.C. Official Code §§ 50-1801, et seq. (2009 Repl.)).

 

514.9               Equipment and supplies in the patient compartment of an emergency response vehicle shall be stored within a closed and latched compartment or fixed securely in place while not in use.           

                                               

514.10             While the vehicle is in motion, equipment and supplies at or above the level of the patient's head while supine on the primary ambulance stretcher shall be secured in place to prevent movement.           

 

514.11             An emergency response vehicle shall adhere to the requirements for sanitary conditions and supplies that apply to an emergency medical response vehicle in accordance with standards established and published by the Centers for Disease Control and Prevention.

                                               

514.12             The interior of an emergency medical response vehicle, including storage areas, linens, equipment, and supplies shall be kept clean and sanitary.

                                               

514.13             Linen or disposable sheets and pillowcases or their equivalent used in the transport of patients shall be changed after each use.         

                                               

514.14             Blankets, pillows, and mattresses used in a ground or air ambulance vehicle shall be kept clean and in good repair.

                                               

514.15             A device inserted into the patient's nose or mouth that is single-use shall be disposed of after use. A reusable item shall be sterilized or high-level disinfected according to current guidelines of the Centers for Disease Control and Prevention (CDC) before reuse. Each reusable item, if not individually wrapped, shall be stored in a separate closed container or bag.

                                               

514.16             A used sharp item shall be disposed of in a leak-proof, puncture-resistant, and appropriately marked biohazard container (needle-safe device/sharps box) that is securely mounted.

                                               

514.17             The operator and staff of an emergency response vehicle shall ensure that after a patient is treated or transported within the vehicle and before the vehicle is occupied by another patient:     

                                               

(a)                Contaminated surfaces shall be cleaned and disinfected using a method recommended by the CDC;

 

(b)             Soiled supplies and used disposable items shall be stored or disposed of in plastic bags, covered containers, or compartments provided for this purpose; and

 

(c)                Regulated waste shall be stored in a red or orange bag or container clearly marked with a biohazard label.

514.18             The EMS agency shall maintain a written policy detailing the procedures to be followed:

(a)        If a mechanical failure occurs with an emergency medical response vehicle when responding to an incident;

 

(b)        If a mechanical failure occurs with an emergency medical transport vehicle when transporting a patient;

 

(c)                For completing and filing dated inventory sheets daily to ensure each ambulance is clean, has adequate supplies, and is safe to operate;

 

(d)               For keeping records of all maintenance performed on the vehicle during its service life;

 

(e)                For reporting to DOH any accident with an emergency medical transport vehicle when transporting a patient that results in injury to the patient; and

 

(f)                For reporting to DOH the number of accidents per year involving emergency medical response vehicles, as part of the agency’s annual report, due no earlier than January 1 and not later than March 1 of each year.

 

 

515                  EMERGENCY MEDICAL SERVICES PROVIDERS

 

515.1               No person shall hold himself or herself out as being an emergency medical services provider in the District without holding a valid certification issued pursuant to this chapter.

 

515.2               An applicant for certification as an emergency medical services provider shall be at least eighteen (18) years old.

 

515.3               An applicant for certification as an emergency medical service provider shall be sponsored by a District certified EMS agency.

 

515.4               The applicant shall have the endorsement of the sponsoring agency’s medical director.

 

515.5               Each applicant for certification as an emergency medical service provider must pass the NREMT written and practical examination following successful completion of a course of study no less stringent than the National Emergency Medical Services Education Standards published by the National Highway Traffic Safety Administration of the United States Department of Transportation for the certification level desired.

 

515.6               The applicant shall affirm that he or she possesses the requisite physical and mental health and is free from addiction to narcotics or alcoholic beverages or from physical or mental impairments or diseases that would impair the applicant's ability to provide emergency care for persons transported by ambulance.

 

515.7               The applicant shall have no physical or mental impairment that would render him or her unable to perform all practical skills required for that level of training and certification. Physical and mental performance skills include the ability of the individual to function as an EMS provider under dangerous conditions, including exposure to communicable disease, hazardous chemicals, or other risk of serious injury.

 

515.8               An applicant for certification or renewal of certification as an emergency medical services provider shall undergo a criminal background check, including the fingerprinting of the applicant, in accordance with Federal Bureau of Investigation policies and procedures and in a Federal Bureau of Investigation environment.

 

515.9               The criminal background check shall be performed no more than six (6) months prior to the submission of the application.

 

515.10             The Director shall deny an application for certification by an individual convicted of any of the following crimes:

 

(a)        A felony involving sexual misconduct in which the victim’s failure to affirmatively consent is an element of the crime, such as forcible rape;

 

(b)        A felony involving the sexual or physical abuse of children, the elderly, or the infirm, such as sexual misconduct with a child, making or distributing child pornography or using a child in a sexual display, incest involving a child, or assault on an elderly or infirm person;

 

(c)        A crime in which the victim is an out-of-hospital patient or a patient or resident of a health care facility including abuse of, neglect of, theft from, or financial exploitation of a person entrusted to the care or protection of the applicant.

 

515.11             A sponsoring EMS agency shall not employ an applicant as an EMS provider who has been convicted of, has pleaded nolo contendere to, is on probation before judgment or placement on a stet docket because of, or has been found not guilty by reason of insanity for any item listed in § 515.10 of this chapter or has been found to have engaged in prohibited conduct as listed in § 563.17.

 

515.12             If the Director denies an application because the Director determined that the applicant presents a present danger to children or youth, the sponsoring EMS agency shall notify the applicant of the determination and inform the applicant in writing that he or she may appeal the denial to the Office of Administrative Hearings within thirty (30) days after the determination.

 

515.13             The emergency medical service provider certificate shall be valid for no greater than two (2) years, expiring on June 30.

 

515.14             The Emergency Medical Responder provider certificate shall be valid for no greater than two (2) years, expiring on December 31.

 

515.15             An emergency medical services provider certificate shall not be assigned or transferred.

 

515.16             An EMS provider in the District of Columbia shall maintain a valid NREMT certification card at the same or greater provider level as his or her DC certification.

 

515.17             An EMS provider in the District of Columbia shall maintain a valid American Heart Association Health Care Provider or equivalent CPR card during his or her certification period.

 

515.18             An Advanced Life Support Provider shall maintain a valid American Heart Association Advanced Cardiac Life Support (ACLS) card during his or her certification period.          

 

 

516                  EMS PROVIDERS - EMERGENCY MEDICAL RESPONDER

 

516.1               Each applicant for certification as an Emergency Medical Responder (EMR) shall submit an application to the Director.  The application shall include:

 

(a)        A copy of a valid NREMT-First Responder (or greater) certification card;

 

(b)        A copy of a valid American Heart Association (AHA) Health Care Provider (or equivalent) CPR card;

 

(c)        A completed application signed by the sponsoring EMS agency’s medical director; and

 

(d)       A check or money order made out in the appropriate fee made payable to the D.C. Treasurer (if applicable).

 

516.2               Upon receipt of a complete application, the Director shall review the application and, if approved, shall issue a D.C. EMR certification card.

 

 

517                  EMS PROVIDERS - EMERGENCY MEDICAL TECHNICIAN

 

517.1               Each applicant for certification as an Emergency Medical Technician (EMT) shall submit an application to the Director.  The application shall include:

 

(a)                A copy of a valid NREMT-EMT (or greater) certification card;

 

(b)        A copy of a valid AHA Health Care Provider (or equivalent) CPR card;

 

(c)        A completed application signed by the sponsoring EMS agency’s medical director; and

 

(d)       A check or money order made out in the appropriate fee made payable to the D.C. Treasurer (if applicable).

 

517.2               Upon receipt of a complete application, the Director shall review the application and, if approved, shall issue a D.C. EMT certification card.

 

 

518                  EMS PROVIDERS – ADVANCED EMERGENCY MEDICAL TECHNICIAN

 

518.1               Each applicant for certification as an Advanced Emergency Medical Technician (AEMT) shall submit an application to the Director to be considered for a District of Columbia AEMT certification.  The application shall include:

 

(a)                A copy of a valid NREMT-AEMT (or greater) certification card;

 

(b)               A copy of a valid AHA Health Care Provider (or equivalent) CPR card;

 

(c)                A completed application signed by the sponsoring EMS agency’s medical director; and

 

(d)               A check or money order made out in the appropriate fee made payable to the D.C. Treasurer (if applicable).

 

518.2               Upon receipt of a complete application, the Director shall review the application and, if approved, shall issue a D.C. AEMT certification card.

 

 

519                  EMS PROVIDERS – EMERGENCY MEDICAL TECHNICIAN-INTERMEDIATE

 

519.1               Each applicant for certification as an Emergency Medical Technician-Intermediate (EMT-I) shall submit an application to the Director.  The application shall include:

 

(a)                A copy of a valid NREMT EMT-I99 (or greater) certification card;

 

(b)        A copy of a valid AHA Health Care Provider (or equivalent) CPR card;

 

(c)        A copy of a valid AHA Advanced Cardiac Life Support (ACLS) card;

 

(d)       A completed application signed by the sponsoring EMS agency’s medical director; and

 

(e)        A check or money order made out in the appropriate fee made payable to the D.C. Treasurer (if applicable).

 

519.2               Upon receipt of a complete application, the Director shall review the application and, if approved, shall issue a D.C. EMT-I certification card.

 

 

520                  EMS PROVIDERS – PARAMEDIC

 

520.1               Each applicant for certification as a Paramedic shall submit an application to the Director.   The application shall include:

 

(a)                A copy of a valid NREMT Paramedic certification card;

 

(b)        A copy of a valid AHA Health Care Provider (or equivalent) CPR card;

 

(c)        A copy of a valid AHA ACLS card;

 

(d)               A completed application signed by the sponsoring EMS agency’s medical director; and

 

(e)        A check or money order made out in the appropriate fee made payable to the D.C. Treasurer (if applicable).

 

520.2               Upon receipt of a complete application, the Director shall review the application and, if approved, shall issue a D.C. Paramedic certification card.

 

 

521                  EMS PROVIDERS: RECERTIFICATION, REINSTATEMENT, AND OUT OF STATE APPLICATIONS

 

521.1               Each applicant for renewal shall submit the items required for the certification level requested to the Director no later than May 31 of the year in which his or her certification expires.

 

521.2               If an applicant has previously held a District EMS provider certification that has lapsed, he or she may apply for reinstatement of his or her previous District certification by submitting the items required for the certification level requested and indicating his or her former status on the application.

 

521.3               If an applicant is currently certified as an EMS provider in another state, the applicant may apply to the Director to be considered for a District of Columbia certification.  The application shall include all required items for the certification level requested plus verification of status from the State where the applicant is currently certified.

 

 

522                  EMS PROVIDERS: INACTIVE STATUS

 

522.1               Inactive certification may be granted to EMS providers certified as an Emergency Medical Responder, Emergency Medical Technician, Advanced Emergency Medical Technician, Emergency Medical Technician-Intermediate, and Paramedic who are not actively providing patient care and are:

 

(a)                Educators, administrators, or regulators who are not actively involved in patient care;

 

(b)               Students who have completed their initial certification training but are not affiliated with an Emergency Medical Services Agency; or

 

(c)                Not actively providing patient care because of relocation, illness, pursuit of education, family responsibilities, military duty, or another reason that the Director determines.

 

522.2               To be eligible for inactive status, a provider shall meet all certification requirements except skills verification.

 

522.3               A provider may only request inactive status during his or her first recertification cycle if he or she has performed the duties of an EMS provider for at least six (6) months.

 

522.4               A provider shall reapply for inactive status biennially, prior to the expiration of his or her current inactive certification, if he or she wishes to continue his or her District certification.

 

522.5               A provider who has an inactive National Registry certification shall only qualify for an inactive District certification.

 

522.6               A provider who has an active National Registry certification may request an inactive District certification.

 

522.7               An inactive provider who seeks to return to active status shall submit a complete application package to the Director and shall demonstrate skills competency in accordance with current NREMT policy and affiliation with an EMS agency that shall be verified in writing.

 

522.8               The fee for an inactive certification shall be the same as for its equivalent active level.

 

 

523                  EMS PROVIDERS: PROVISIONAL CERTIFICATION

 

523.1               The Director may issue a provisional certification to an applicant for certification as an EMS provider emergency medical services personnel who does not fully meet the requirements specified in this chapter if the Director finds that the public interest would be served by issuing the provisional certification.

 

523.2               A provisional certification issued pursuant to this section may be granted for a period of up to one hundred eighty (180) days and may be renewed no more than once.

 

 

524                  LIMITED RECIPROCITY CERTIFICATIONS

 

524.1               The Director may grant limited reciprocity certifications of up to ninety (90) days to applicants for certification as Emergency Medical Services Agencies, emergency medical response vehicles, or emergency medical service providers if the applicant is certified in another jurisdiction and the Director determines that a limited reciprocity certification by the District is necessary to respond and protect the public health interest.

 

524.2               An Emergency Medical Services Agency seeking a limited reciprocity certification shall file a written application for a limited reciprocity Emergency Medical Services Agency certification in a manner specified by the Director. The Emergency Medical Services Agency shall attest that the agency complies with this chapter unless the Director waives the requirement in whole or in part.  The Director shall verify the attestation.          

                                               

524.3               A limited reciprocity Emergency Medical Services Agency certification shall be valid for a time period determined by the Director based on the need; provided, the time period shall not be greater than ninety (90) days.

 

524.4               A limited reciprocity Emergency Medical Services Agency certification shall not be transferable.

 

524.5               An Emergency Medical Services Agency shall file a written application for a limited reciprocity emergency medical response vehicle certification in a manner that the Director specifies. The emergency medical services agency shall attest that the vehicle complies with this chapter unless the Director waives the requirement in whole or in part.  The Director shall verify the attestation.           

                       

524.6               The Director may inspect any Emergency Medical Services Agency vehicle issued a limited reciprocity certification at any time for compliance with this chapter.          

                                               

524.7               A limited reciprocity Emergency Medical Services Agency vehicle certification shall be valid for a time period that the Director determines based on the need; provided, the time period shall not be greater than ninety (90) days.

 

524.8               A limited reciprocity Emergency Medical Services Agency vehicle certification shall not be transferable.

 

524.9               A limited reciprocity Emergency Medical Services Agency vehicle certification shall not be renewable.

 

524.10             A limited reciprocity Emergency Medical Services Agency vehicle certification shall be affixed on the vehicle to be readily visible and in a location and manner that the Director specifies.

 

524.11             An Emergency Medical Services Agency vehicle for which a limited reciprocity certification has been granted shall not be operated without a properly displayed certification.

 

524.12             An Emergency Medical Services Agency shall file a written application for a limited reciprocity emergency medical service provider certification in a manner that the Director specifies. The Emergency Medical Services Agency shall attest that the provider complies with this chapter unless the Director waives the requirement in whole or in part.  The Director shall verify the attestation.

 

524.13             The Director may inspect the credentials of an EMS provider who has been issued a limited reciprocity certification at any time for compliance with this chapter.          

                                               

524.14             A limited reciprocity EMS provider certification shall be valid for a time period that the Director establishes based on the need; provided, the time period shall not be greater than ninety (90) days.

 

524.15             A limited reciprocity EMS provider certification shall not be transferable.

 

524.16             A limited reciprocity EMS provider certification shall not be renewable.

 

524.17             An EMS provider shall maintain copies of his home-state certification and District limited reciprocity certification at all times while performing patient care in the District.

 

524.18             An EMS provider licensed or certified in another jurisdiction shall not practice without an DOH-issued certification.

 

524.19             In limited circumstances, when it is necessary to respond and protect the public safety or health, the Director may issue limited reciprocity certifications in groups.

 

 

525                  EMS PROVIDERS:  CERTIFICATION CARDS

 

525.1               An EMS provider shall carry his or her current certification card on his or her person any time he or she is working as a care provider.

 

525.2               Upon request of a DOH inspector, the District EMS Officer or other designated official, an EMS provider shall present his or her certification card for inspection.

 

525.3               Failure of an EMS provider to present valid credentials shall result in the immediate suspension of the provider’s District certification.

 

 

526                  EMS PROVIDERS:  SCOPE OF PRACTICE

 

526.1               The Director shall develop a scope of practice policy in accordance with the Department of Transportation and the National Highway Traffic Safety Administration’s current national standard guidelines.

 

526.2               The medical directors of each  EMS agency shall develop a scope of practice that meets or exceeds the Director’s scope of practice model.

 

526.3               An EMS provider shall adhere to the scope of practice approved and in effect for his or her respective EMS agency.

 

526.4               EMS personnel shall only provide emergency medical care while acting under the authority of the medical director for the EMS agency for which he or she is affiliated and within the scope of the EMS agency certification.

 

526.5               The Director may authorize providers to exceed the current scope of practice.

 

(a)        The EMS Agency’s medical director shall submit a request to expand the scope of practice for the EMS agency to the District’s EMS Officer.

 

(b)        The State EMS Officer shall review the request and make a recommendation to the Director to approve or deny the request.

 

 

527                  EMERGENCY MEDICAL SERVICE EDUCATIONAL INSTITUTION STANDARDS

 

527.1               No person shall provide EMS certification education, continuing education, or refresher education in the District without being certified as an EMS educational institution pursuant to this chapter.

 

527.2               Each EMS educational institution shall obtain approval from the Director prior to offering a course of study.

 

527.3               In order to be state approved for purposes of the NREMT, an educational institution shall obtain approval under this chapter.

 

527.4               Paramedic educational institutions shall be accredited through the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) after January 1, 2013.

 

527.5               In order to receive certification as an EMS educational institution, an applicant shall submit to the Director an application indicating compliance with §§ 527 through 531.

 

527.6               Each education program shall have adequate space at facilities to accommodate the program.

 

527.7               Each education program shall have sufficient financial resources to ensure complete course delivery for all enrolled students.

 

527.8               An EMS educational institution that is not part of the District of Columbia government or a component of an accredited institution of higher learning shall be licensed through the District of Columbia Education Licensure Commission (ELC) in addition to being certified by the Director.

 

527.9               After review of the application, the EMS educational institution shall be subject to a site visit as part of the certification process. The site visit is to verify the information contained in the application.

 

527.10             Each EMS educational institution, its equipment, all associated records, and the premises designated in its application shall be available for inspection by the District EMS Officer or designee during the usual hours of operation.

 

527.11             The Director may subject any EMS educational institution certified under this chapter to an unscheduled inspection to determine compliance with certification standards.

 

527.12             Each education program shall have written criteria for:

 

(a)                Admission;

 

(b)               Multiple evaluations of each student during the course of study including evaluation of competency in providing patient care;

 

(c)                Student requirements for:

 

(1)               Attendance;  and

 

(2)               Educational performance, including:

 

(A)       Attitudes;

 

(B)       Knowledge; and

 

(C)       Behavior;

 

(d)               Student access to program information including:

 

(1)               Fees;

 

(2)   Requirements;

 

(3)               Policies and procedures;

 

(4)               The student handbook; and

 

(5)               Support services;

 

(e)                Selection of:

 

(1)               A medical director;

 

(2)               A program director;

 

(3)               Faculty; and

 

(4)               Other necessary personnel;

 

(f)                Nondiscrimination and fair practices with regard to students, faculty, and program personnel;

 

(g)               Review and improvement of the effectiveness of student evaluation techniques; and

 

(h)               HIPAA privacy training.

 

527.13             Each education program shall require that each student wear some type of distinctive identification during his or her field and clinical internship.  The identification shall clearly identify the:

 

(a)                Student’s name;

 

(b)               Student’s status; and

 

(c)                Education program.

 

527.14             Each education program shall maintain an organizational chart that shows the relationships among students, the program director, the medical director, and the instructors for each course.

 

527.15             Each education program shall maintain accurate and appropriate records of:

 

(a)                Students;

 

(b)        Faculty;

 

(c)        Courses, including:

 

(1)        Course statistics as specified in DOH policy; and

 

(2)        Demographics of students; and

 

(d)       Written agreements with facilities and agencies that provide clinical and field experience, which shall include:

 

(1)        Liability policies;

 

(2)        Scope of practice for the student;

 

(3)        Evaluation criteria; and

 

(4)        The responsibility for and level of supervision of students.

 

527.16             The education program shall maintain records at least five (5) years following course completion in a manner to prevent loss, destruction, or unauthorized use.

 

527.17             Each education program shall teach the appropriate curriculum which shall include:

 

(a)                Didactic instruction which shall impart fundamental knowledge, skills, and attitudes which contribute to the delivery of state-of-the-art pre-hospital emergency medical care; and

 

(b)               Supervised field internships that include practice of skills while functioning in a pre-hospital environment.

 

527.18             Training programs may utilize distance education for cognitive components of initial training leading to EMS provider certification if the program:

 

(a)                Demonstrates the methods of distance education utilized are educationally and technically appropriate for the content and audience; and

 

(b)               Ensures the quality of the distance education method, including:

 

(1)        Stating the educational objectives clearly; and

 

(2)        Offer sufficiently comprehensive, accurate, up-to-date, educationally sound instructional materials.

 

527.19             Each EMS educational institution shall maintain written agreements and position descriptions stating the roles and responsibilities of the following program positions:

(a)        Medical director;

(b)        Program director; and

(c)        EMS instructors.

 

528                  EDUCATIONAL INSTITUTIONS: MEDICAL DIRECTOR

 

528.1               Each EMS educational institution offering certification courses shall have a medical director who:

 

(a)        Is a physician licensed to practice medicine in the District of Columbia;

 

(b)               Has current working knowledge and experience in emergency medical care of acutely ill or injured patients;

 

(c)        Has working knowledge of the District EMS system; and

 

(d)               Has knowledge of the District of Columbia scope of practice for Emergency Medical Services Providers and the National Educational Standards.

 

528.2               If the educational institution is a part of an Emergency Medical Services Agency, the same person may serve as the medical director of both.

 

528.3               The medical director shall be responsible for the oversight of the medical educational content of the curriculum.

 

 

529                  EDUCATIONAL INSTITUTIONS: PROGRAM DIRECTOR

 

529.1               Each EMS educational institution shall have a program director who:

 

(a)                Has at least two (2) years of experience instructing and evaluating EMS students;

 

(b)               Has experience with administration of educational programs;

 

(c)                Has an instructor certification equivalent to the course level being instructed; and

 

(d)               Has knowledge of the District scope of practice for Emergency Medical Services Providers and the National Educational Standards.

 

529.2               The program director shall:

 

(a)                Have overall responsibility for the success of the education program, including continuous quality review and improvement of the education program;

 

(b)               Serve as the education program student and faculty liaison;

 

(c)                Identify sites where students can fulfill field internship requirements; and

 

(d)               Keep the medical director informed of the program schedule, progress of individual student performance, student or instructor complaints, and the status of other program activities.

 

529.3               The medical director may also act as the program director.

 

 

530                  EDUCATIONAL INSTITUTIONS: PROGRAM INTERNSHIPS

 

530.1               Each EMS education program, with the exception of Emergency Medical Responder education programs, provided by an EMS educational institution shall provide students with access to field internships with appropriate medical oversight and supervision within any District-approved Emergency Medical Services Agency. Each internship shall include:

 

(a)                Patient assessments;

 

(b)               EMS orientation;

 

(c)                Additional components as required by the National Education Standards; and

 

(d)               Additional components as may be required by DOH.

 

530.2               If the field internship is located outside the District of Columbia, the educational institution offering the education program of which the internship is a part shall:

 

(a)                Comply with the laws of the state where the field internships are located; and

 

(b)               Notify the appropriate EMS officials in the state where the field internships are located of the presence of program students in those internships.

 

 

531                  EDUCATIONAL INSTITUTIONS: EVALUATIONS

 

531.1               Each educational institution shall have a written policy and procedure for evaluation of each of its education programs.

 

531.2               Each program shall conduct a self-evaluation at least annually and shall provide written evidence that the program is meeting its objectives and the changing needs of EMS care to DOH as part of the institution’s annual report.

 

531.3               An evaluation plan shall include methods for gathering and analyzing data on the effectiveness of the following:

 

(a)        Instruction;

 

(b)        Resources;

 

(c)        Responsiveness to recommendations for change;

 

(d)       Instructors; and

 

(e)        Students’ ability to function as entry-level providers upon successful completion of the program.

 

531.4               The results of the evaluations shall provide the basis for continuous quality improvement and future direction of the educational courses.

 

 

532                  EDUCATIONAL INSTITUTIONS: ANNUAL REPORTS

 

532.1               Each education program shall submit an annual report to the Director, due no earlier than January 1 and not later than March 1 of each year, in an approved format which shall:

 

(a)        Update program information;

 

(b)        Identify any major changes in the program during the year; and

 

(c)        Include the annual self evaluation described in § 531 of this chapter.

 

533                  EDUCATIONAL INSTITUTIONS: CERTIFICATION RENEWAL

533.1               An educational institution shall apply for renewal of its certification at least six (6) months before the expiration of its current certification.

 

533.2               If the Director determines that the applicant meets the requirements of this chapter, the Director shall grant the applicant a two (2) year approval as an EMS educational institution.

 

533.3               In order to maintain its certification, an education institution shall:

 

(a)                Comply with the regulations set forth in this chapter;

 

(b)               Advise the Director in writing no later than thirty (30) days after any changes in:

 

(1)        Program personnel other than instructional faculty;

 

(2)        Changes to the educational institution’s organization; or

 

(3)        Changes to the educational programs offered by the institution; and

 

(c)                Conduct at least one (1) full length certification course every two (2) years.

 

533.4               An EMS educational institution that is required to be licensed through ELC shall maintain its license in order to maintain its certification as an EMS educational institution.

 

 

534                  EDUCATIONAL INSTITUTIONS: PROVISIONAL CERTIFICATIONS

 

534.1               The Director may grant an educational institution a provisional certification for one (1) year if, after review of the application and site visit, he or she has determined that:

 

(a)        Standards for certification are not fully met;

 

(b)        Non-compliance is not substantial or will not negatively impact quality of educational offerings;

 

(c)        All requirements for full approval can be resolved within one (1) year; and

 

(d)       Provisional certification is in the public interest.

 

534.2               The Director may impose conditions on certifications and restrictions on program or course offerings.

 

534.3               An EMS educational institution that receives a one (1) year provisional status by ELC shall be placed in a one (1) year provisional status by the Director.

 

534.4               An EMS educational institution that has been granted a one (1) year provisional certification shall submit written progress reports to the Director semiannually, at dates set by the Director, covering the six (6) months prior to the month in which each report is submitted.

 

534.5               Upon satisfactory resolution of limitations, or at the end of the one (1) year provisional period, the Director shall:

 

(a)                Confer approval for the remainder of the two (2) year period; or

 

(b)               Revoke or deny approval.

 

 

535                  EDUCATIONAL INSTITUTIONS: REVOCATION OF CERTIFICATION

 

535.1               The Director may revoke program approval if an educational institution is not in compliance with the provisions of this chapter. Notification of revocation shall:

 

(a)                State the reasons for revocation; and

 

(b)               Advise the education institution of its appeal rights.

 

 

 

536                  EDUCATIONAL INSTITUTIONS: DENIAL OF CERTIFICATION

 

536.1               The Director may deny program approval if an educational institution is not in compliance with the provisions of this chapter. Notification of denial shall:

 

(a)                State the reasons for denial; and

 

(b)               Advise the education institution of its appeal rights.

 

 

537                  EMERGENCY MEDICAL SERVICE INSTRUCTOR STANDARDS

 

537.1               Each educational institution shall maintain the following records for every instructor:

 

(a)                Copies of documents verifying the instructor’s past educational experience, including:

 

(1)        Education;

 

(2)        Publications; and

 

(3)        Previous instruction experience and credentials;

 

(b)               A copy of the instructor’s certification in a related discipline;

 

(c)                A copy of the current District Instructor certification;

 

(d)               Documentation used by the agency to assess and authorize the Continuing Education instructors to teach each category (if applicable); and

 

(e)                Copies of the instructor’s evaluations.

 

537.2               An instructor shall be evaluated in the classroom environment during his or her didactic evaluations.

 

537.3               An instructor may be evaluated in the classroom or field environment during his or her practical teaching evaluations.

 

537.4               The Director may conduct an audit or evaluation of an instructor’s records at any time, with or without prior notice.

 

537.5               An instructor certification shall be concurrent with the sponsoring EMS educational institution’s or the Emergency Medical Services Agency’s certification period.

 

 

538                  EMERGENCY MEDICAL RESPONDER INSTRUCTOR STANDARDS

 

538.1               Emergency Medical Responder (EMR) courses shall be taught by:

 

(a)        District-certified EMR instructors;

 

(b)        EMR instructor trainees under the supervision of a District-certified EMR instructor; or

 

(c)        EMT or Advanced Emergency Medical Services instructors.

 

538.2               In order to be certified as an EMR instructor, an individual shall:  

 

(a)        Hold and maintain a valid District EMR or greater provider certificate or license, to include but not limited to Emergency Medical Technician, Advanced Emergency Medical Technician, Emergency Medical Technician-Intermediate, Paramedic, Nurse, or Physician;

 

(b)        Hold and maintain a valid instructor certification in a related discipline, such as CPR;

 

(c)        Successfully complete a competency-based evaluation based on current District policy; and

 

(d)       Submit to the Director a completed EMR instructor application signed by the medical director of the EMS educational institution at which the applicant will teach, verifying competency evaluations and practice teaching dates.

                

538.3               Certification as an EMR instructor shall be concurrent with the sponsoring EMS educational institution’s certification period.

 

538.4               In order to remain in good standing during his or her certification period, an EMR instructor shall:

 

(a)                Maintain a current District EMS provider certification or license at the EMR level or greater, to include but not limited to Emergency Medical Technician, Advanced Emergency Medical Technician, Emergency Medical Technician-Intermediate, Paramedic, Nurse, or Physician;

 

(b)               Successfully complete a competency-based evaluation based on current District policy;

 

(c)        Attend EMR instructor workshops as required; and

 

(d)       Submit to the Director a completed EMR instructor application signed by the medical director verifying competency evaluations and teaching dates.

 

538.5               An EMR instructor may also function as the EMR program director if approved by the educational institution’s medical director.

 

538.6               An EMR instructor whose certification has expired may apply to the Director for reinstatement within two (2) years of expiration.

 

538.7               An EMR instructor reinstatement applicant shall:

 

(a)        Hold a District EMR or greater provider certificate, to include but not limited to Emergency Medical Technician, Advanced Emergency Medical Technician, Emergency Medical Technician-Intermediate, Paramedic, Nurse, or Physician;

 

(b)        Successfully complete a competency-based evaluation based on current District policy; and

 

(c)        Submit to the Director a completed EMR instructor application signed by the medical director verifying successful evaluations from practice teaching.

 

538.8               An EMR instructor whose certification has lapsed for more than two (2) years shall be required to meet initial EMR instructor requirements.

 

 

539                  EMERGENCY MEDICAL TECHNICIAN INSTRUCTOR STANDARDS

 

539.1               Emergency Medical Technician (EMT) courses shall be taught by:

 

(a)        District-certified EMT instructors;

 

(b)        EMT instructor trainees under the supervision of a District-certified EMT instructor; or

 

(c)        District-certified Advanced Emergency Medical Services (AEMS) instructors.

 

539.2               An EMT instructor who is not an AEMS instructor shall:

 

(a)        Maintain a valid District EMT or greater provider certification or license, to include but not limited to Advanced Emergency Medical Technician, Emergency Medical Technician-Intermediate, Paramedic, Nurse, or Physician;

 

(b)               Maintain a valid instructor certification in a related discipline, such as CPR;

 

(c)        Successfully complete a competency-based evaluation based on current District policy; and

 

(d)       Submit a completed EMT instructor application signed by the medical director verifying successful evaluations and practice teaching dates to the Director.

                

539.3               EMT instructor certification shall not exceed two (2) years and shall be concurrent with the sponsoring EMS educational institution’s certification period.

 

539.4               In order to remain in good standing during the two (2) year certification period, an EMT Instructor shall:

 

(a)        Successfully complete a competency-based evaluation based on current District policy;

 

(b)        Maintain a current District EMS provider certification or license at the EMT level or greater, to include but not limited to Advanced Emergency Medical Technician, Emergency Medical Technician-Intermediate, Paramedic, Nurse, or Physician;

 

(c)        Attend EMT instructor workshops as required; and

 

(d)       Submit to the Director a completed EMT instructor application signed by the medical director verifying competency evaluations and teaching dates.

 

539.5               If the educational institution’s medical director approves, the EMT may also function as the EMT Program director.

 

539.6               An EMT instructor whose certification has expired may apply to the Director for reinstatement within two (2) years of expiration.

 

539.7               An EMT instructor reinstatement candidate shall:

 

(a)        Maintain a valid District EMT or greater provider certification or license, to include but not limited to Advanced Emergency Medical Technician, Emergency Medical Technician-Intermediate, Paramedic, Nurse, or Physician;

 

(b)        Successfully complete a competency-based evaluation based on current District policy; and

 

(c)        Submit a completed EMT instructor application signed by the medical director verifying successful evaluations and teaching dates to the Director at the end of the interim teaching period.

 

539.8               EMT instructor certification shall not exceed two (2) years and shall be concurrent with the sponsoring EMS educational institution’s certification period.

 

539.9               An EMT instructor whose certification has lapsed for more than two (2) years shall be required to meet initial EMT instructor requirements.

 

 

 

540                  ADVANCED EMERGENCY MEDICAL SERVICES  INSTRUCTOR STANDARDS

 

540.1               Advanced Emergency Medical Technician (AEMT) courses, Emergency Medical Technician-Intermediate (EMT-I) courses, and Paramedic courses shall be taught by:

 

(a)        District-certified Advanced Emergency Medical Services (AEMS) instructors; or

 

(b)        AEMS instructor trainees under the supervision of a District-certified AEMS instructor.

 

540.2               A candidate for AEMS instructor shall:

 

(a)        Maintain a valid District Paramedic or greater certification or license, to include but not limited to Nurse or Physician;

 

(b)               Maintain a valid  instructor certification in a related ALS discipline, such as Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS);

 

(c)        Successfully complete a competency-based evaluation based on current District policy; and

 

(d)       Submit to the Director at the end of the interim teaching a completed AEMS instructor application signed by the medical director verifying successful evaluations and practice teaching dates.

                

540.3               Certification as an AEMS instructor shall not exceed two (2) years and shall be concurrent with the sponsoring EMS educational institution’s certification period.

 

540.4               In order to remain in good standing during the two (2) year period of approval an AEMS Instructor shall:

 

(a)        Maintain current District EMS provider certification or license at the Paramedic level or greater, to include but not limited to Nurse or Physician;

 

(b)        Successfully complete a competency-based evaluation based on current District policy;

 

(c)        Attend AEMS instructor workshops as required; and

 

(d)       Submit to the Director a completed AEMS instructor application signed by the medical director verifying successful evaluations and teaching dates.

 

540.5               If the educational institution’s medical director approves, the AEMS instructor may also function as the AEMS program director.

 

540.6               An AEMS instructor whose certification has expired may apply to the Director for reinstatement within two (2) years of expiration.

 

540.7               An applicant for reinstatement as an AEMS instructor shall:

 

(a)        Be certified or licensed as a District Paramedic or greater provider, to include but not limited to Nurse or Physician;

 

(b)        Successfully complete a competency-based evaluation based on current District policy; and

 

(c)        Submit a completed AEMS instructor application showing successful evaluations from practice teaching.

 

540.8               An AEMS instructor certification shall not exceed two (2) years and shall be concurrent with the sponsoring EMS educational institution’s certification period.

 

540.9               An AEMS instructor whose certification has lapsed for more than two (2) years shall be required to meet initial AEMS instructor requirements.

 

 

541                  CONTINUING EDUCATION INSTRUCTOR STANDARDS

 

541.1               Continuing Education (CE) courses shall be taught by:

 

(a)        District-certified EMR, EMT, or AEMS instructors consistent with the level of education being taught;

 

(b)        District-certified CE instructors;

 

(c)        CE instructor trainees under the supervision of a District-certified EMS instructor; or

 

(d)       CE instructor trainees under the supervision of an Emergency Medical Services Agency’s training director.

 

541.2               A CE instructor who is not an EMS instructor shall:

 

(a)        Currently hold and maintain a District provider certification or license at or above the level of continuing education being taught, to include but not limited to Emergency Medical Responder, Emergency Medical Technician, Advanced Emergency Medical Technician, Emergency Medical Technician-Intermediate, Paramedic, Nurse, or Physician; and

 

(b)               Currently hold and maintain an instructor certification in a related discipline, such as CPR.

                       

541.3               The EMS educational institution or the Emergency Medical Services Agency’s training director may authorize a CE Instructor to instruct in the following NREMT categories:

(a)                Basic Life Support, which shall include the following NREMT topics:

 

(1)               Preparatory;

 

(2)        Airway and Breathing;

 

(3)        Patient Assessment;

 

(4)               Medical/Behavioral;

 

(5)               Trauma;

 

(6)               Infants and Children; and

 

(7)               Obstetrics; or

 

(b)               Advanced Life Support, which shall include the following NREMT topics:

 

(1)               Operational Tasks;

 

(2)               Airway and Breathing;

 

(3)               Cardiology;

 

(4)               Medical Emergencies;

 

(5)               Trauma;

 

(6)               Pediatrics; and

 

(7)               Obstetrics.

 

541.4               The medical director of the agency shall establish a CE Instructor approval process. The process shall be documented and the documentation shall be subject to inspection and verification by officials from the District EMS Officer or designee at any time.

 

542                  EMERGENCY MEDICAL SERVICE EDUCATIONAL INSTITUTION CURRICULUM STANDARDS

 

542.1               The Director shall approve all EMS course curricula that are intended to be used for certification, continuing education, and refresher courses that are taught in the District of Columbia.

 

542.2               Courses that are taught in the District of Columbia prior to the curriculum being approved will not be approved retroactively.

 

542.3               Curricula shall conform to, and instruct according to, current national standards and guidelines, including current NREMT standards.

 

542.4               In order to receive District approval of an EMS curriculum and to be eligible to use that curriculum in a certification, continuing education or refresher course, an EMS educational institution or Emergency Medical Services Agency shall file an application with the Director.  The application shall include the following information:

 

(a)        Program director;

 

(b)        Curriculum author;

 

(c)        Curriculum title; and

 

(d)       Topic area (ALS or BLS).

 

542.5               A curriculum application shall be filed at least forty-five (45) days before the educational institution or Emergency Medical Services Agency intends to use the curriculum in a course.

 

542.6               All curricula submitted to the Director shall be assigned a curriculum tracking number. A tracking number shall be assigned regardless of whether the curriculum is approved or denied. The tracking number shall be used in all correspondence related to the curriculum.

 

542.7               To maintain approval by the Director a course curriculum shall be updated to remain current with nationally accepted standards. Any updates to the curriculum shall be submitted to the Director as a new curriculum as outlined in this section.

 

542.8               Curricula that are currently approved by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) do not need to be submitted for District approval. 

 

542.9               The educational institution or Emergency Medical Services Agency shall submit a curriculum application along with a copy of the CECBEMS curriculum approval documentation to obtain a DOH curriculum number. The DOH curriculum number shall be used on the course application when used in a District course.

 

 

543                  EMERGENCY MEDICAL SERVICE EDUCATIONAL INSTITUTION COURSE STANDARDS

 

543.1               No person shall offer an EMS certification, refresher, or continuing education course in the District unless:

 

(a)                The person is certified by the District as an EMS educational institution; or

 

(b)               The person is certified by the District as an Emergency Medical Services Agency authorized to instruct continuing education; and

 

(c)        The course has been approved by the Director.

 

543.2               A District-certified EMS educational institution certified at the ALS educational level may offer both ALS and BLS courses.

 

543.3               A District-certified EMS educational institution may sponsor an agency or individual that wishes to provide a single course, class, or activity.

 

543.4               When two (2) or more educational institutions co-sponsor a course, only one (1) approved educational institution provider number shall be used for that course.  The educational institution whose number is used shall assume the responsibility for meeting all applicable requirements of this section.

 

543.5               The sponsoring educational institution shall ensure that the course, class, or activity meets all requirements and shall serve as the educational institution provider of record.

 

543.6               In order to receive District approval of an EMS course and be eligible for NREMT testing (if applicable), an EMS educational institution or Emergency Medical Services Agency shall file an application with the Director.  The application shall include the following information:

 

(a)        Program director;

 

(b)        Course title;

 

(c)        Course type;

 

(d)       Certification level;

 

(e)        Course start and end dates;

 

(f)        A listing of District-approved course curriculum or curricula to be used; and

 

(g)        A listing of instructor(s) to be used.

 

543.7               A course application shall be filed at least thirty (30) days before the educational institution intends to start teaching the course.

 

543.8               All course applications submitted to the Director shall be assigned a course tracking number.  The tracking number:

 

(a)        Shall be used in all correspondence related to the certification course;

 

(b)        Shall appear on the students’ records and course completion certificates; and

 

(c)        Shall be assigned regardless if the certification course is approved or denied.

 

543.9               The District may revoke or deny credit for any certification, refresher, or CE course when the course or curriculum does not meet the requirements set forth in this chapter.

 

543.10             An EMS educational course taught in the District that the Director has not approved shall be reported to:

 

                        (a)        NREMT to revoke credit for the course;

 

(b)        CECBEMS if the course utilized a CECBEMS course or curriculum; and

 

(c)        The state EMS offices of any non-District provider who was in attendance.

 

 

544                  EMERGENCY MEDICAL SERVICE EDUCATIONAL INSTITUTION CERTIFICATION COURSE STANDARDS

 

544.1               A District certified EMS educational institution that desires to offer an EMS certification course in the District shall:

 

(a)        Meet the current national standards and NREMT standards for the certification level being taught;

 

(b)        Submit an application signed by the institution’s medical director requesting approval of each certification course as outlined in § 543; and

 

(c)        Submit a separate application for each course provided.

 

544.2               Certification courses shall utilize the appropriate NREMT practical skill certification exam.  The practical skill exams shall be:

 

(a)        Administered by the NREMT when required under NREMT certification standards; or

 

(b)        Administered in accordance with current District policy, when administration of the exam by the NREMT is not required under NREMT certification standards.

 

 

545                  EMERGENCY MEDICAL SERVICE EDUCATIONAL INSTITUTION REFRESHER COURSE STANDARDS

 

545.1               The Director shall approve all EMS refresher courses that are intended for renewal of NREMT certification and are taught in the District of Columbia prior to the course being taught.

 

545.2               A refresher course taught in the District of Columbia shall meet the NREMT standards in effect at the time of the application in order to be eligible for NREMT certification renewal.

 

545.3               An educational institution that desires to receive District of Columbia approval in addition to CECBEMS approval may apply for approval pursuant to this section.

 

545.4               The educational institution shall submit an application signed by the institution’s medical director requesting approval as outlined in § 543.

 

545.5               The educational institution shall submit a separate application for each refresher course.    

 

 

546                  EMERGENCY MEDICAL SERVICE CONTINUING EDUCATION COURSE STANDARDS

 

546.1               The Director shall approve all continuing education (CE) courses that are intended for renewal of NREMT certification prior to the course being offered. CE courses that are taught in the District of Columbia prior to the course being approved will not be approved retroactively.

 

546.2               A CE course taught in the District of Columbia shall be in a topic contained in the respective NREMT Re-registration Policies and Procedures.

 

546.3               The Director shall determine the total number of CE credit hours for an approved CE course taught in the District of Columbia.  CE credit hours shall be:

 

(a)        Based on District of Columbia-approved curricula; and

 

(b)        CECBEMS-approved curricula.

 

546.4               Classes or activities taught in the District of Columbia for which CE credit is authorized shall be at least one (1) CE credit hour in duration.  For CE courses greater than one (1) CE credit hour, credit may be granted in no less than half (1/2)-hour increments.

 

546.5               A person may offer a continuing education course if the course has a current approval from the CECBEMS.  The educational institution or Emergency Medical Services Agency shall submit a course application along with a copy of the CECBEMS approval documentation so that a course number can be assigned.

 

546.6               Courses and activities that shall not be applied towards the continuing education hours requirement include:

                       

(a)                Clinical rotations;

 

(b)               Cardiopulmonary resuscitation;

 

(c)                Home study programs;

 

(d)               Instructor courses;

 

(e)        Management and leadership courses;

 

(f)        Performance of duty;

 

(g)        Preceptor hours;

 

(h)        Serving as a skill examiner; and

 

(i)         Volunteer time with agencies.

 

546.7               The educational institution or Emergency Medical Services Agency shall submit a separate application for each CE course.

 

 

547                  CERTIFICATE OF COURSE COMPLETION

 

547.1               An educational program shall issue to each successful participant a certificate or proof of successful completion of a course no later than thirty (30) calendar days after completion of the course.

 

547.2               A certification course completion certificate or documentation of successful completion shall contain:

 

(a)                The name of the participant;

 

(b)               The course title and DOH-assigned course number;

                    

(c)                The length of the course in total hours;

 

(d)               The name of the sponsoring educational institution and its DOH EMS educational institution number;

 

(e)                The course completion date;

 

(f)                The program director’s signature; and

 

(g)               The medical director’s signature.

 

547.3               A refresher or CE course completion certificate or documentation of successful completion shall contain:

 

(a)                The name of participant and his or her NREMT, State, or District EMS certification number;

 

(b)               The course title and DOH-assigned course number;

                    

(c)                The total number of hours of continuing education awarded;

 

(d)       The educational institution or Emergency Medical Services Agency name, address, and DOH EMS educational institution number or Emergency Medical Services Agency number;

 

(e)        The date(s) of the course, class, or activity;

 

(f)        The program director’s signature; and

 

(g)        The medical director’s signature.

 

547.4               If a refresher or CE course is used to satisfy the requirements for maintaining an EMS provider’s certification, the refresher and CE course shall be completed during the current certification cycle, and the provider shall submit the CE certificate to NREMT in accordance with its policies in effect at the time of submission.

 

547.5               No person shall receive credit for taking the same refresher or CE course, class, or activity more than once during a single certification or licensure cycle.

 

547.6               An instructor may receive credit for instructing a certification, refresher, or CE course. Credit received shall be the same as the number of CE hours approved for the course, class, or activity.

 

547.7               The instructor shall receive credit only once during a certification cycle for instructing the same CE course, class, or activity.

 

 

548                  COURSE RECORDS

 

548.1               An education program shall maintain course records for at least five (5) years following course completion.  The records shall be maintained in a manner to prevent loss, destruction, or unauthorized use and shall contain the following:

 

(a)                A complete outline for each course given, including a brief overview, instructional objectives, comprehensive topical outline, method of evaluation, and a record of participant performance;

 

(b)               A record of the time, place, and date that each course is given;

 

(c)                A record of the number of CE hours awarded for the CE course;

 

(d)               A curriculum vitae or resume for each instructor; and

 

(e)                A roster signed by course participants that shall include the name and certificate number of each person who has taken any certification, refresher or CE course, class, or activity, and a record of any course completion certificate issued.

 

 

549                  TRANSPORTATION OF PATIENTS

 

549.1               Each District-certified emergency medical response vehicle that transports patients shall meet the following minimum staffing requirement:

 

(a)        A Basic Life Support Ambulance shall have two (2) District-certified Emergency Medical Technicians;

 

(b)        An Advanced Life Support Ambulance shall have one (1) District-certified Paramedic and one (1) District-certified Emergency Medical Technician; and

 

(c)        Each air medical response craft shall have one (1) District- certified Emergency Medical Technician – Intermediate or Paramedic and one (1) licensed pilot.

 

 

550                  EMERGENCY 9-1-1 TRANSPORTATION OF PATIENTS IN THE DISTRICT OF COLUMBIA

                       

550.1               An emergency patient who is transported by ambulance, where the point of origin is within the District, shall only be transported by a District-certified Emergency Medical Services Agency ambulance except when the transporting agency:

 

(a)        Has been requested by the District’s 9-1-1 ambulance service;

 

(b)        Is certified in another state but has a memorandum of understanding, memorandum of agreement, or mutual aid agreement with the District of Columbia Fire and Emergency; or

 

(c)        Has been requested through a mutual aid agreement or memorandum of understanding by the Department of Health.

 

550.2               A transporting agency that is not District-certified shall adhere to the protocols of the District’s 9-1-1 ambulance service unless otherwise specified through a DOH-approved agreement.

 

550.3               A patient shall be transported to the appropriate heath care facility as outlined in the District’s 9-1-1 ambulance service’s protocol.

 

550.4               Transportation of a patient by an ambulance or provider that is not certified in the District shall be reported to the state agency with jurisdiction over EMS services.  The Emergency Medical Services Agency operating the ambulance may also face civil or criminal penalties from the District of Columbia.

 

 

551                  INTER-FACILITY TRANSPORTATION OF PATIENTS WHERE THE POINT OF ORIGIN IS IN THE DISTRICT OF COLUMBIA

                       

551.1               A patient who is transported by ambulance between facilities, where the point of origin is within the District of Columbia, shall only be transported by a certified District of Columbia Emergency Medical Services Agency ambulance except when the transporting agency has been requested through a mutual aid agreement or memorandum of understanding by the Department of Health.

 

551.2               A transporting agency that is not District-certified shall adhere to the protocols of its local jurisdiction unless otherwise specified through a mutual aid agreement or memorandum of understanding.

 

551.3               Patients shall be transported to the appropriate heath care facility as outlined in the agency’s protocol.

 

 

552                  INTER-FACILITY TRANSPORTATION OF PATIENTS INTO THE DISTRICT OF COLUMBIA WHERE THE POINT OF ORIGIN IS OUTSIDE OF THE DISTRICT OF COLUMBIA

 

552.1               A patient who is transported by ambulance into the District of Columbia shall only be transported by an EMS ambulance and crew that is certified by the state agency with jurisdiction at the point of origin.

 

552.2               The same transporting ambulance agency may perform the return transport of the same patient to the point of origin; provided, that the return transport shall be performed by a crew and ambulance that is appropriate for the condition of the patient.

 

552.3               If the requirements of § 552.2 cannot be met, the transport shall be considered a new transport, with its point of origin in the District of Columbia.

 

552.4               Transportation of a patient by an EMS ambulance or crew that is not certified in the jurisdiction of origin shall be reported to the state agency with jurisdiction over EMS services at the point of origin.

 

552.5               Long-term and assisted living facilities shall utilize private, commercial, non-emergency ambulance services for inter-facility transports instead of the District 9-1-1 emergency ambulance service whenever possible and consistent with the health and safety of the patient.

 

 

553                  EMERGENCY MEDICAL DISPATCH

 

553.1               The Director may develop the District of Columbia Pre-Hospital Emergency Medical Dispatch Protocol Guidelines for Emergency Medical Dispatch Providers (Pre-Hospital EMD Guidelines).

 

553.2               The Director may appoint an Emergency Medical Dispatch (EMD) review committee to assist in the development, review, and recommendations of the Pre-Hospital EMD Guidelines.

 

553.3               The EMS Officer shall review and the Director shall approve the EMD protocols of each Emergency Medical Services Agency prior to their implementation.

 

553.4               The Director may issue an emergency protocol or revision which shall have immediate effect if a delay in the issuance of a protocol, protocol revision, or supplemental protocol would pose a threat to the health and welfare of patients.

 

 

 

554                  PRE-HOSPITAL MEDICAL PROTOCOLS

 

554.1               The Director may develop the District of Columbia Pre-Hospital Medical Protocol Guidelines for Emergency Medical Services Providers.

 

554.2               The Director may appoint a protocol review committee to assist in the development, review, and recommendations of the Pre-Hospital Medical Protocol Guidelines.

 

554.3               The EMS Officer shall review and the Director shall approve the pre-hospital protocols of each Emergency Medical Services Agency prior to their implementation.

 

554.4               The Director may issue an emergency protocol or revision which shall have immediate effect if a delay in the issuance of a protocol, protocol revision, or supplemental protocol would pose a threat to the health and welfare of patients.

 

 

555                  MEDICAL CONTROL BASE STATIONS

 

555.1               The Director may develop the District of Columbia Pre-Hospital Medical Control Base Station Operational Guidelines for Medical Control Base Station Providers (Pre-Hospital Medical Control Guidelines).

 

555.2               The Director may appoint a medical control review committee to assist in the development, review, and recommendations of the Pre-Hospital Medical Control Guidelines.

 

555.3               The EMS Officer shall review and the Director shall approve the operational protocols of each Medical Control Base Station prior to its implementation.

 

555.4               The Director may issue an emergency protocol or revision which shall have immediate effect if a delay in the issuance of a protocol, protocol revision, or supplemental protocol would pose a threat to the health and welfare of patients.

 

 

 

556                  CLINICAL QUALITY ASSURANCE AND IMPROVEMENT

 

556.1               Each Emergency Medical Services Agency shall designate a quality improvement officer who is certified or licensed at or above the certification level of the Emergency Medical Services Agency.

 

556.2               The medical director may act in the role of the quality improvement officer.

 

556.3               Each Emergency Medical Services Agency shall compile and submit a written quality improvement plan, which the agency’s medical director shall approve.  The quality improvement plan shall:

 

(a)        Require the review of data concerning patient care rendered by EMS providers affiliated with the Emergency Medical Services Agency operational program;

 

(b)        Require the identification and analysis of trends in EMS care rendered by EMS providers affiliated with the Emergency Medical Services Agency’s operational program;

 

(c)        Specify the method and manner to annually report to the Director on quality assurance issues;

 

(d)       Require the provision of remedial action to resolve any patient care issues involving EMS providers or the EMS system which should be addressed at the organizational level;

 

(e)        Identify violations of the District of Columbia Emergency Medical Services Protocols or Director approved organizational EMS protocols; and

 

(f)        Require a review of oral or written allegations that:

 

(1)        An EMS provider failed to act in accordance with applicable law or protocols; or

 

(2)        Pre-hospital patient care was below the applicable standard of care.

 

 

557                  CLINICAL QUALITY ASSURANCE AND IMPROVEMENT REPORTS

 

557.1               Each Emergency Medical Services Agency shall file an annual report, due no earlier than January 1 and not later than March 1 of each year, which shall state the number EMS incidents to which the Emergency Medical Services Agency responded to in the prior calendar year and the number of ambulance collisions for the same time period.

 

557.2               Each of the following incidents shall be reported to the District EMS Officer no later than seventy-two (72) hours after discovery:

 

(a)                Unexpected loss of physical or mental function of the patient;

 

(b)               Administration of incorrect medication to the patient, regardless of the outcome;

 

(c)                Administration of an incorrect dose of medication to the patient, regardless of the outcome;

 

(d)               Termination of resuscitation in the field;

(e)                Pediatric cardiac arrest;

 

(f)                Invocation of a District EMS Comfort Care Order/Do Not Resuscitate Order;

(g)               Denial or refusal of transport to or by any patient with a Glasgow Coma Score of fourteen (14) or less at the time of denial or refusal;

(h)               An ambulance involved in motor vehicle collision while in service;

 

(i)                 Positive results on an EMS provider drug test; and

 

(j)                 Any incident that the Director has determined to threaten public safety.

 

 

558                  EMERGENCY MEDICAL SERVICES AGENCY DATA COLLECTION STANDARDS

 

558.1               Emergency Medical Services Agency incident and patient care data collected by means of computer systems within the District of Columbia shall conform to the National EMS Information System requirements (NEMSIS) as established by the National Highway Traffic Safety Administration.          

                                               

 

559                  TRAUMA AND SPECIALTY CENTERS

 

559.1               The Director shall designate Trauma Centers in the District of Columbia.

 

559.2               Criteria for the designation of Level I and Level II Trauma Centers shall be consistent with the guidelines of the American College of Surgeons Committee on Trauma and as outlined in Chapters 27, “Adult Trauma Care,” and 28, “Pediatric Trauma Care,” of Subtitle B of Title 22 of the DCMR.

 

559.3               Designation as a District Trauma Center shall be for five (5) years or less.

 

559.4               The Director shall designate Specialty Centers in the District of Columbia.

 

559.5               Designation as a District Specialty Center shall be for five (5) years or less.

 

 

560                  MASS CASUALTY INCIDENTS

 

560.1               Each Emergency Medical Services Agency is required to develop a plan to mitigate a Mass Casualty Incident (MCI).

 

560.2               Each MCI plan shall comply with the National Incident Management System requirements and the District MCI plan.

 

560.3               Each MCI plan shall be submitted to the Director for his or her approval.

 

560.4               Each Emergency Medical Services Agency shall use the triage system approved by the Director.

 

 

561                  SPECIAL EVENT MEDICAL AID STATIONS

 

561.1               An Emergency Medical Services Agency that provides services at a special event medical aid station shall be certified by the Director to provide Special Event EMS services

 

561.2               The Agency shall utilize a Patient Care Report (PCR), on a form and in a manner prescribed by the Director, in accordance with Section 509, to collect emergency medical services data.

                       

561.3               A PCR shall be completed, with all patient contacts, for each patient to whom care is provided. A PCR shall also be completed for each patient who refuses treatment or transportation.

 

561.4              A PCR shall be maintained in a secure area within the Medical Aid Station in accordance with HIPAA and federal and local privacy laws, regulations, and policies.

 

561.5               A PCR shall be maintained for six (6) years and shall be stored in accordance with District laws and regulations.

 

561.6               Medical Aid Stations shall conform to the personnel and equipment standards outlined in DOH policy.

 

 

562                  SPECIAL STUDIES AND PILOT PROJECTS

 

562.1               The Department may allow Emergency Medical Services Agencies to undertake studies of the EMS system or pilot projects in the interest of improving patient care services.

 

562.2               All requests to undertake a special study or pilot project shall be submitted to the Director for his or her approval.  The request shall include the following information:

 

(a)                A description of the purpose of the study or project, clearly describing the expected benefits to District residents;

 

(b)               An operational plan that maximizes patient safety while minimizing potential risk to the patient; and

 

(c)                A quality assurance and improvement plan that clearly describes how the data will be collected and used, as well as the indicators for immediate termination of the project or study. 

 

562.3               The Director shall approve all special studies and pilot projects prior to beginning the project.

 

 

563                  ENFORCEMENT OF VIOLATIONS

 

563.1               Any person who violates or participates in the violation of a provision of this chapter shall be subject to civil and criminal penalties in accordance with the Emergency Medical Services Act of 2008, effective March 25, 2009 (D.C. Law 17-357; D.C. Official Code §§ 7-2341.01, et seq. (2012 Supp.)) (Act).

 

563.2               The DOH may audit, inspect, or investigate an EMS provider or agency, at any time, with or without prior notification, to confirm compliance with the regulations contained in this chapter or any other relevant District regulation or law.

 

563.3               A complaint against an EMS provider or agency shall:

 

(a)        Be submitted in writing on a form specified by the District EMS Officer;

 

(b)        State the facts or circumstances that form the basis of the complaint; and

 

(c)        Be submitted to the District EMS Officer.

 

563.4               The District EMS Officer shall establish a record upon receipt of a complaint or incident report alleging facts which, if proven, would constitute sufficient grounds for denial, suspension, or revocation of a certification to, or reprimand of a holder of a certification to:

 

(a)                Operate an Emergency Medical Services Agency;

 

(b)               Operate an emergency response vehicle;

 

(c)                Operate an emergency medical services educational institution;

 

(d)               Perform the duties of an emergency medical services provider; or

 

(e)                Perform the duties of an emergency medical services instructor under Sections 16, 17, 18, and 25(c) of the Act.

 

563.5               The record of all complaints or incident reports shall be maintained in a confidential database exclusively for the purposes of tracking and monitoring compliance with EMS laws, regulations, and protocols and for the improvement of emergency medical services in the District.

 

563.6               The records of all complaints and incident reports collected by the District EMS Officer and shall be maintained for at least ten (10) years.

 

563.7               The Director shall refer each complaint and incident report to the medical director of the applicable Emergency Medical Services Agency or educational institution.

 

563.8               The medical director of each responsible agency shall be responsible for the investigation of each complaint or incident report to determine whether the agency, vehicle, provider, instructor, or educational institution has failed to comply with the provisions of the Act, rules promulgated pursuant to the Act, protocols established pursuant to the Act, or regulations promulgated pursuant to the Act.

 

563.9               The results of each investigation shall be reported by the emergency medical services agency or educational institution to the District EMS Officer upon completion of the investigation by the agency’s medical director.

 

563.10             The District EMS Officer may conduct an independent investigation of a complaint or incident report.  The Emergency Medical Services Agency or educational institution shall cooperate fully in such an investigation.

 

563.11             The District EMS Officer shall refer the complaint or incident report, together with the results of the investigation, to the Director and shall make a recommendation to the Director for proposed action, if any.

 

563.12             The Director shall make a determination of any actions to be taken.

 

563.13             Sufficient grounds for denial, suspension, or revocation of a certification granted to an Emergency Medical Services Agency or reprimand of an Emergency Medical Services Agency shall include:

 

(a)                Fraudulently or deceptively obtaining or attempting to obtain a certificate or license for itself or for another;

 

(b)               Fraudulently or deceptively using a certificate or license;

 

(c)                Abandoning a patient;

 

(d)               Willfully making or filing a false report or record related to the provision of emergency medical services;

 

(e)                Willfully failing to file or record, willfully impeding or obstructing the filing or recording, or willfully destroying a report or record related to the provision of emergency medical services required to be filed by statute or regulation;

 

(f)                Knowingly providing emergency medical services with an unauthorized individual or knowingly aiding an unauthorized individual in providing emergency medical services;

 

(g)               Being disciplined by a licensing or disciplinary authority, or convicted or disciplined by a court of any state or country, or disciplined by any branch of the United States government for an act that would be grounds for disciplinary action under this regulation;

 

(h)               Failing to meet or violating appropriate protocols or standards of care for the delivery of emergency medical services;

 

(i)                 Willfully submitting a false statement to collect a fee;

 

(j)         Surrendering a certificate or license issued by another jurisdiction as a result of an investigation or disciplinary action by a certifying, licensing, or disciplinary authority or by a court of another jurisdiction for an act that would be grounds for disciplinary action under this chapter;

 

(k)        Knowingly failing to report suspected child abuse or neglect in violation of the Prevention of Child Abuse and Neglect Act of 1977, effective September 23, 1977 (D.C. Law 2-22; D.C. Official Code § 4-1301.02(3) (2012 Supp.));  

 

(l)         Selling, prescribing, giving away, or administering drugs for illegal purposes;

 

(m)       Breaching patient confidentiality in violation of HIPAA or any other applicable privacy law or regulation;

 

(n)        Providing emergency medical services beyond the agency’s authorized scope of practice;

 

(o)        Refusing, withholding from, denying, or discriminating against an individual in need of emergency medical services, with regard to the provision of services which the licensee or certificate holder is licensed or certified and qualified to render due to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, familial status, family responsibilities, matriculation, political affiliation, genetic information, disability, source of income, status as a victim of an intrafamily offense, or place of residence or business;

 

(p)        Failing to comply with the District of Columbia EMS guidelines on standard protocols;

 

(q)        Intentionally misrepresenting the level of emergency medical services certification held by individuals or the agency;

 

(r)        Failure to maintain required levels of insurance and liability coverage;

 

(s)        Failure to have a medical director;

 

(t)        Failure to have an operational director;

 

(u)        Failure to submit or have an approved Quality Assurance and Improvement Plan;

 

(v)        Failure to report to DOH the incidents outlined in the Quality Assurance and Improvement Plan;

 

(w)       Failure to maintain records in accordance with this chapter or DOH policy;

 

(x)        Withdrawal by the District government of the Certificate of Need (CON) for the ambulance service;

 

(y)        Failure to submit an annual report to DOH; or

 

(z)        Failure to notify DOH of changes in medical director, agency, or program.

 

563.14             Sufficient grounds for denial, suspension, or revocation of a certification granted to an emergency medical response vehicle shall include:

 

(a)                The ground ambulance was not in compliance with:

 

(1)        Federal Specification for the Star-of-Life Ambulance KKK-A-1822 at the time of its manufacture; or

 

(2)        National Fire Protection Association (NFPA) 1917 “Standard for Automotive Ambulances” at the time of its manufacture.

 

(b)               The ground ambulance is not equipped with the mandatory items specified in the American College of Surgeons’ (ACS) Equipment for Ambulances joint document;

 

(c)                The ground or air ambulance is not covered by the insurance required in this chapter;

 

(d)               The ground ambulance is not registered by the motor vehicle agency for the jurisdiction from which the vehicle will operate;

 

(e)                The sponsoring Emergency Medical Services Agency’s certification has been revoked or has not been renewed;

 

(f)                The ground ambulance is unable to pass a motor vehicle agency inspection;

 

(g)               The air ambulance is unable to pass a FAA inspection;

 

(h)               The motor vehicle agency registration for the ground ambulance has been revoked;

 

(i)                 The FAA registration for the air ambulance has been revoked;

 

(j)                 Failure to maintain adequate records on the ground or air ambulance;

 

(k)               Failure to maintain the emergency medical response vehicle according to CDC recommendations;

 

(l)                 Failure to report an air or ground ambulance collision to the Director; or

 

(m)             Failure to provide proof of a safety inspection performed by the state in which the emergency medical response vehicle is registered.

 

563.15             Sufficient grounds for denial, suspension, or revocation of a certification granted to an educational institution shall include:

 

(a)                Fraudulently or deceptively obtaining or attempting to obtain a certificate or license for itself or for another;

 

(b)               Fraudulently or deceptively using a certificate or license;

 

(c)                Willfully making or filing a false report or record related to the provision of emergency medical services instruction;

 

(d)               Willfully failing to file or record, willfully impeding or obstructing the filing or recording, or willfully destroying a report required to be filed by statute or regulation;

 

(e)                Knowingly providing emergency medical services instruction through an individual who is not certified to provide instruction or is not authorized to provide instruction in the area in which he or she is providing instruction, or knowingly aiding an uncertified or unauthorized individual in providing emergency medical services instruction;

 

(f)                Being disciplined by a licensing or disciplinary authority, or adjudicated by a court of any state or country, or disciplined by any branch of the United States government for an act that would be grounds for disciplinary action under this regulation;

 

(g)               Willfully submitting a false statement to collect a fee;

 

(h)               Surrendering the certificate or license issued by another jurisdiction as a result of an investigation or disciplinary action by a certifying, licensing, or disciplinary authority or by a court of another jurisdiction for an act that would be grounds for disciplinary action under this chapter;

 

(i)         Providing emergency medical services instruction beyond the institution’s authorized scope of instruction;

 

(j)         Providing emergency medical services instruction beyond the instructor’s authorized scope of instruction;

 

(k)        Refusing, withholding from, denying, or discriminating against an individual requesting emergency medical services instruction due to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, familial status, family responsibilities, matriculation, political affiliation, genetic information, disability, source of income, status as a victim of an intrafamily offense, or place of residence or business;

 

(l)                 Intentionally misrepresenting the level of emergency medical services instructional certification held by individuals or the institution;

 

(m)             Failure to maintain required levels of insurance and liability coverage;

 

(n)               Failure to have a medical director;

 

(o)               Failure to have a program director;

 

(p)               Failure to submit an annual report to DOH;

 

(q)               Failure to maintain records in accordance with this chapter or DOH policy;

 

(r)                 Failure to teach the appropriate curriculum or according to the National Educational Standards;

 

(s)                Failure to pass a site visit inspection;

 

(t)                 Failure to notify DOH of changes in medical director, agency, or program;

 

(u)               Failure to conduct at least one (1) full length certification course every two (2) years;

 

(v)               Failure to obtain, revocation of, or failure to renew licensure through the ELC for those institutions required to be licensed by ELC;

 

(w)             Failure to make necessary improvements to an educational program when an institution has been placed in a one (1) year probation period; or

 

(x)               Failure to maintain Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) accreditation for paramedic education programs.

 

563.16             Sufficient grounds for denial, suspension, or revocation of a certification granted to an emergency medical service instructor, or reprimand of an instructor, shall include:

 

(a)                Fraudulently or deceptively obtaining or attempting to obtain a certificate or license for oneself or for another;

 

(b)               Fraudulently or deceptively using a certificate or license;

 

(c)                Providing instruction in an area for which the instructor is not certified;

 

(d)               Failure to obtain satisfactory teaching evaluations;

 

(e)                Failure to maintain an adequate number of teaching hours during the instructor’s certification period;

 

(f)                Failure to maintain provider certification equal to the instructor’s level of instruction;

 

(g)               Loss of certification by the sponsoring EMS educational institution;

 

(h)               Failure to attend instructor workshops when required;

 

(i)                 Failure to maintain an associated instructional certification for EMS and CE instructors;

 

(j)                 Failure to maintain an associated ALS instructional certification, for AEMS instructors;

 

(k)               Failure to maintain paramedic certification, for AEMS instructors;

 

 

(l)                 Willfully making or filing a false report or record related to the provision of emergency medical services instruction;

 

(m)             Willfully failing to file or record, willfully impeding or obstructing the filing or recording, or willfully destroying a report required to be filed by statute or regulation;

 

(n)               Knowingly providing emergency medical services instruction with an unauthorized individual, or knowingly aiding an unauthorized individual in providing emergency medical services instruction;

 

(o)               Being disciplined by a licensing or disciplinary authority, or convicted or disciplined by a court of any state or country, or disciplined by any branch of the United States government for an act that would be grounds for disciplinary action under this regulation;

 

(p)               Willfully submitting a false statement to collect a fee;

 

(q)               Refusing, withholding from, denying, or discriminating against an individual requesting emergency medical services instruction due to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, familial status, family responsibilities, matriculation, political affiliation, genetic information, disability, source of income, status as a victim of an intrafamily offense, or place of residence or business; or

 

(r)                 Intentionally misrepresenting the level of emergency medical services instructional certification held by the individual.

 

563.17             Sufficient grounds for denial, suspension, or revocation of a certification granted to an emergency medical services provider, or reprimand of the provider, shall include:

 

(a)                Fraudulently or deceptively obtaining or attempting to obtain a certificate or license for himself or herself or for another;

 

(b)               Fraudulently or deceptively using a certificate or license;

 

(c)                Engaging in unprofessional or illegal conduct while providing emergency medical services;

 

(d)               Being adjudicated incompetent;

 

(e)                Abandoning a patient;

 

(f)                Providing emergency medical services while:

 

(1)        Under the influence of alcohol; or

 

(2)        Using a narcotic or controlled dangerous substance, as defined in District of Columbia law, that is in excess of therapeutic amounts or without valid medical indication or a valid prescription or abusing any other drug or substance in a manner that is harmful;

 

(g)               Willfully making or filing a false report or record related to the provision of emergency medical services;

 

(h)               Willfully failing to file a report or record, willfully impeding or obstructing the filing or a report or record, or willfully destroying a report or record required to be filed by statute or regulation;

 

(i)                 Knowingly providing emergency medical services with an unauthorized individual, or knowingly aiding an unauthorized individual in providing emergency medical services;

 

(j)                 Being disciplined by a licensing or disciplinary authority, or convicted or disciplined by a court of any jurisdiction, or disciplined by any branch of the United States government for an act that would be grounds for disciplinary action under this regulation;

 

(k)               Failure to meet or violating appropriate protocols or standards of care for the delivery of emergency medical services;

 

(l)                 Willfully submitting a false statement to collect a fee;

 

(m)             Surrendering a certificate or license issued by another jurisdiction as a result of an investigation or disciplinary action by a certifying, licensing, or disciplinary authority or by a court of another jurisdiction for an act that would be grounds for disciplinary action under this chapter;

 

(n)               Knowingly failing to report suspected child abuse or neglect in violation of the Prevention of Child Abuse and Neglect Act of 1977, effective September 23, 1977 (D.C. Law 2-22; D.C. Official Code § 4-1301.02(3) (2012 Supp.));

 

(o)               Selling, prescribing, giving away, or administering drugs for illegal purposes;

 

(p)               Breaching patient confidentiality in violation of HIPAA or any other applicable privacy law or regulation;

 

(q)               Providing emergency medical services beyond the individual's authorized scope of practice;

 

(r)                 Conviction of, pleading guilty or nolo contendere to, or receiving probation before judgment with respect to a felony, a serious crime of violence against a person, a crime involving controlled dangerous substances, a serious crime against property, a crime involving sexual misconduct, a crime in which the victim is a patient or other individual entrusted to the care or protection of the applicant or EMS provider, or a crime involving moral turpitude, whether any appeal or other proceeding is pending to have the conviction or plea set aside, except that the individual may apply for reinstatement upon any successful appeal or upon the conviction being set aside;

 

(s)                Providing or attempting to provide a medical procedure without having received the required education, internship, or experience in the use of the procedure;

 

(t)                 Refusing, withholding from, denying, or discriminating against an individual in need of emergency medical services, with regard to the provision of services which the certificate holder is certified and qualified to render due to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, familial status, family responsibilities, matriculation, political affiliation, genetic information, disability, source of income, status as a victim of an intrafamily offense, or place of residence or business;

 

(u)               Failing to comply with the District of Columbia EMS guidelines on standard protocols except when the District EMS Officer determines it is impractical or not feasible;

 

(v)               Intentionally misrepresenting the level of emergency medical services certification held by the individual;

 

(w)             Failure to comply with the terms of a probation, suspension, or  disposition agreement;

 

(x)               Failure to maintain NREMT certification;

 

(y)               Failure to maintain affiliation with a District EMS Agency; or

 

(z)                Withdrawal of sponsorship by the sponsoring medical director.

 

 

564                  NOTICE AND HEARING

 

564.1               A holder of a certificate shall be given notice of, and an opportunity for, a hearing before the Office of Administrative Hearings if the effect of the action would be one (1) of the following:

 

(a)        To revoke a certificate;

 

(b)        To suspend a certificate;

 

(c)        To reprimand the holder of a certificate;

 

(d)       To impose a civil fine;

 

(e)        To require a course of remediation;

 

(f)        To require a period of probation; or

 

(g)        To refuse to renew the certificate for any cause other than failure to pay the required renewal fee.

 

564.2               If the Director proposes to take an action listed in § 564.1, the Director shall give written notice to the respondent in accordance with Section 16 of the Act, D.C. Official Code § 7-2341.15 (2012 Supp.). The notice shall contain:

 

(a)        A statement that the Director has sufficient evidence in support of the complaint or incident report, which, if proven to be true, justifies taking the proposed action;

 

(b)        A description of the nature of the evidence that serves as the basis for the underlying complaint;

 

(c)        A statement that the Director may take the proposed action, without further notice, unless the applicant requests a hearing before the Office of Administrative Hearings no later than twenty (20) days after service of the notice, and that the Director may take the proposed action if the respondent fails to appear at a scheduled hearing;

 

(d)       A description of the rights of the respondent at a hearing as specified in § 564.3; and

 

(e)        A statement that the respondent may request a hearing before the Office of Administrative Hearings in accordance with Section 18 of the Act, D.C. Official Code § 7-2341.17 (2012 Supp.) and Chapter 28 of Title 1 of the DCMR, and that upon such a request the Office of Administrative Hearings will hold a hearing consistent with its regulations and procedures.

 

564.3               A respondent entitled to a hearing shall have the following rights:

              

(a)                The right to be represented by an attorney;

 

(b)               The right to present all relevant evidence by means of witnesses and books, papers, and other documents;

 

(c)        The right to examine all opposing witnesses on any matter relevant to the issues; and

 

(d)       The right to have subpoenas issued to compel the attendance of witnesses and the production of relevant books, papers, and other documents upon making a request approved by the Administrative Law Judge in accordance with the Office of Administrative Hearings Rules of Practice and Procedure, as set forth in Chapter 28 of Title 1 of the DCMR, and D.C. Official Code § 2-1831.09(b) (2007 Repl. and 2012 Supp.).

 

564.4               If a person who was sent a notice of a proposed action pursuant to § 564.2 does not mail or deliver a request for a hearing within the time and in the manner required under that section, the Director may, without a hearing, take the action contemplated in the notice.

 

564.5               If, after an investigation, the Director determines that the allegations in the complaint or incident report or other information obtained in the investigation present an imminent danger to the health, safety, or welfare of any person or of the general public, the Director may summarily suspend the certification prior to a hearing.

 

564.6               The Director shall serve a written notice of a summary suspension or restriction of a certificate under a health professional in accordance with Section 17 of the Act (D.C. Official Code § 7-2341.16 (2012 Supp.)).

 

564.7               A notice of summary suspension or restriction issued under this section shall state the following:

 

(a)        The action taken;

 

(b)        The reasons for which the action was taken;

 

(c)        That the action shall be effective upon service of the notice or at a time and date specified in the notice;

 

(d)       That the respondent has a right to make a written request for a hearing before the Office of Administrative hearings within five (5) business days  of the service of the notice;

 

(e)        That the respondent’s request for a hearing shall not stay the action;

 

(f)        That the respondent has a right to a hearing within five (5) days of the Director's receipt of the respondent’s request for a hearing;

 

(g)        A description of a respondent's rights at a hearing as specified in § 564.3; and

 

(h)        The address to which the respondent's request for a hearing shall be delivered or mailed.

 

564.8               An action under this section shall take effect immediately upon service, unless the notice states that it takes effect at a later time, and shall remain in effect until superseded by a decision of the Director or a disposition by the Office of Administrative Hearings or until a termination date set forth in the order.

 

 

565                  FEES

 

565.1               The Director shall collect the following fees from applicants for certification as basic life support providers (Emergency Medical Responders and Emergency Medical Technicians) and for provisional and replacement cards:

 

(a)                Application fee (initial and renewal) - $15;

 

(b)               Initial certification fee - $30;

 

(c)                Renewal of certification fee - $30;

 

(d)               Provisional cards - $10;

 

(e)                Replacement cards - $10; and

 

(f)                Out of State processing fee – Application fee plus ten dollars ($10).

 

565.2               The initial certification fee under § 565.1 shall be prorated based on the length of initial certification as follows:

 

(a)        One (1) to ninety (90) days - $3.75;

 

(b)        Ninety-one (91) to one hundred eighty (180) days - $7.50;

 

(c)        One hundred eighty-one (181) to two hundred seventy (270) days - $11.25;

 

(d)       Two hundred seventy-one (271) to three hundred sixty-five (365) days - $15;

 

(e)        Three hundred sixty-six (366) to four hundred fifty-five (455) days - $18.75;

 

(f)        Four hundred fifty-six (456) to five hundred forty-five (545) days - $22.50;

 

(g)        Five hundred forty-six (546) to six hundred thirty-five (635) days - $26.25; and

 

(h)        Six hundred thirty-six (636) to seven hundred thirty (730) days - $30. 

 

565.3               The Director shall collect the following fees from applicants for certification as advanced life support providers (Advanced Emergency Medical Technicians, Emergency Medical Technician-Intermediates, and Paramedics) and for provisional and replacement cards:

 

(a)                Application fee - $25;

 

(b)               Initial certification fee - $50;

 

(c)                Renewal of certification fee - $30;

 

(d)               Provisional cards - $10;

 

(e)                Replacement cards - $10; and

 

(f)                Out of State processing fee – Application fee plus ten dollars ($10).

 

565.4               Certification fee shall be prorated based on the length of initial certification as follows:

 

(a)        One (1) to ninety (90) days - $6.25;

 

(b)        Ninety-one (91) to one hundred eighty (180) days - $12.50;

 

(c)                One hundred eighty-one (181) to two hundred seventy (270) days - $18.75

 

(d)       Two hundred seventy-one (271) to three hundred sixty-five (365) days - $25;

 

(e)        Three hundred sixty-six (366) to four hundred fifty-five (455) days - $31.25;

 

(f)        Four hundred fifty-six (456) to five hundred forty-five (545) days - $37.50;

 

(g)        Five hundred forty-six (546) to six hundred thirty-five (635) days - $43.75; and

 

(h)        Six hundred thirty-six (636) to seven hundred thirty (730) days - $50. 

 

565.5               The Director shall collect the following fees for inspecting and certifying ambulances, including Basic Life Support ambulances and Advanced Life Support ambulances:

 

(a)                Advanced Life Support ambulances - $600;

 

(b)               Basic Life Support ambulances - $400; and

 

(c)                Follow-up inspections of ambulances following a failed inspection - $50.

 

565.6               The Director shall collect the following fees for certifying Emergency Medical Service instructors:

 

(a)                Application fee - $5;

 

(b)               Initial certification fee - $15; and

 

(c)                Renewal of certification fee - $15.

 

565.7               The Director shall collect the following fees for certifying emergency medical services educational institutions:

 

(a)                Application fee - $100;

 

(b)               Initial certification fee - $150; and

 

(c)                Renewal of certification fee - $200.

 

 

566                  APPLICABILITY OF FEES AND PENALTIES TO DISTRICT GOVERNMENT AGENCIES

 

566.1               No District government agency shall be required to pay personnel or organizational fees established by this chapter. 

 

566.2               District government agencies shall be liable for penalties that may be imposed for violation of a provision of this chapter.

                       

 

567                 EMERGENCY AMBULANCE FEES AND BILLING

 

567.1               The following fees are hereby established for emergency ambulance life support service, and for the transportation of a person in a District of Columbia Fire and Emergency Medical Services Department (FEMSD) emergency ambulance vehicle:

              

(a)                Basic Life Support (BLS) Unit Transportation Fee: A fee of four hundred twenty-eight dollars ($428) shall be charged for the transportation of each patient in an ambulance staffed by two (2) Emergency Medical Technicians, or an Emergency Medical Technician and an Emergency Medical Technician Intermediate or Paramedic when basic life support is administered to the patient or patients being transported;

 

(b)               Advanced Life Support (ALS) Unit Transportation Fee: A fee of five hundred eight dollars ($508) shall be charged for the transportation of each patient in an ambulance staffed by an Emergency Medical Technician and an Emergency Medical Technician Intermediate or Paramedic when advanced life support is administered to the patient or patients being transported;

 

(c)                Advanced Life Support-Level 2 (ALS2) Unit Transportation Fee: A fee of seven hundred thirty five dollars ($735) shall be charged for the transportation of each patient in an ambulance requiring the provision of medically necessary supplies and services including (1) at least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid fluids) or (2) ground ambulance transport, medically necessary supplies and services, and the provision of at least one of the ALS2 procedures listed below:

 

(1)   Manual defibrillation/cardioversion;

 

(2)   Endotracheal intubation;

 

(3)   Central venous line;

 

(4)   Cardiac pacing;

 

(5) Chest decompression;

 

(6)  Surgical airway; or

 

(7)  Intraosseous line; and

 

 (d)      Total Mileage Transportation Fee: A fee of six dollars and fifty-five cents ($6.55) per mile traveled, or any fraction thereof, shall be charged to each patient transported in any of the methods listed in this subsection.

 

567.2               The FEMSD may waive or reduce the charges imposed by this section for persons who demonstrate economic hardship.

 

567.3               The FEMSD may waive or reduce charges for reasons other than economic hardship as necessary, where to do so is in the District’s best interest, as determined by the Chief of the Fire and Emergency Medical Services Department, or the Chief’s designee, in the exercise of his or her discretion.

 

567.4               Any person transported in a FEMSD ambulance, or that person's legal guardian or duly authorized representative (collectively referred to in this section as the "person"), shall be responsible for payment of ambulance charges in effect at the time of service except as follows:

 

(a)                The FEMSD shall accept payment of Medicare, Medicaid, or D.C. Healthcare Alliance healthcare plan related benefits which may cover in whole or in part the costs of ambulance transportation, according to the rules of such plans;

 

(b)        The FEMSD shall not bill, nor hold financially responsible, anyone enrolled in a D.C. Medicaid or other out-of-state Medicaid plan for the services provided by the Department;

 

(c)        The FEMSD shall not bill, nor hold financially responsible, anyone enrolled in a D.C. Healthcare Alliance healthcare plan, unless such a plan requires a co-payment or deductible payment to be made by the patient as a requirement of the plan; and

 

(d)       The FEMSD shall not bill, nor hold financially responsible, any District resident who is a Medicare beneficiary not covered by any other secondary health insurance program for any out of pocket expenses, including co-payments, deductibles and co-insurance.

 

567.5               Any person transported shall remain personally liable for any fee or portion of a fee not covered by an exception listed in § 567.2 through § 567.4.

 

567.6               In no event shall any person be denied emergency ambulance service because of inability to pay, nor shall any person be questioned about the ability to pay at the time service is requested.

 

567.7               The FEMSD, through its duly authorized representative, shall attempt to obtain from each person transported by a FEMSD ambulance sufficient information to enable FEMSD to submit a healthcare insurance claim or mail a bill of ambulance charges to the person for the transportation provided. This information may include, but shall not be limited to, the following:

 

(a)        Full legal name;

 

(b)        Residential address;

 

(c)        Date of birth;

 

(d)       Sex; and

 

(e)        If applicable, healthcare or other insurance information.

 

567.8               FEMSD employees operating emergency ambulance vehicles shall not be permitted to accept payment of any fee, or any portion of any fee, from any person.

 

567.9               The FEMSD through its duly authorized representative, shall mail a billing and insurance information form to each person transported by FEMSD ambulance. The person who was transported shall complete the form and return it to the FEMSD in the envelope provided, together with full payment or insurance identification information.

 

567.10             If the billing and insurance information form is not returned to the FEMSD or if the FEMSD, through its duly authorized representative, cannot identify patient insurance information or coverage to submit a claim for paying ambulance charges, FEMSD may use patient, hospital, District, FEMSD, and authorized third party records, including electronic records, to identify, confirm, or recover patient and insurance information for ambulance billing purposes. Techniques and practices shall include, but are not limited to:

 

(a)        Recovery of personal identity information including full legal name, date of birth, sex, or other distinguishing characteristics to prevent fraudulent patient identification; and 

 

(b)        Recovery of the person’s billing information including District resident status, residential address, telephone number(s), health insurance information, auto insurance information, or other information to help identify insurance coverage status or file an insurance claim.

 

567.11             The FEMSD through its duly authorized representative, shall submit claims to insurance companies and other third parties identified as being responsible for payment of ambulance charges. The FEMSD through its duly authorized representative, shall pursue payment of ambulance charges considered due and owing from persons who were transported by a FEMSD ambulance for a period of at least twenty four (24) months after the date of transport by FEMSD ambulance.

 

567.12             Reasonable and acceptable methods to be utilized by the FEMSD through its duly authorized representative, for collection of payments may include but are not limited to, the following:

 

                        (a)        Filed paper and electronic claims;

 

                        (b)        Mailed invoices, letters, and other memoranda;

 

                        (c)        Telephone calls to insurers, persons, or other responsible parties; and

 

(d)       Other methods, including automated electronic notifications, that do not constitute “harassment or abuse,” “false or misleading representations,” or “unfair practices” as defined by the Fair Debt Collection Practices Act, 15 U.S.C. §§ 1692-1692p.

 

567.13             A health care facility shall reimburse the FEMSD for the cost of emergency ambulance services incurred by a patient resident of the health care facility if the health care facility requests ambulance transport services from the FEMSD and the patient’s healthcare insurance denies payment for the ambulance transport after a determination that the transportation did not meet the medical necessity standard as provided in Section 410.40(d) of Title 42 of the Code of Federal Regulations.

 

(a)        “Health care facility” shall have the same meaning as provided in Section 2(5) of the Nurse Staffing Agency Act of 2003, effective March 10, 2004 (D.C. Law 15-74; D.C. Official Code § 44-1051.02(5) (2005 Repl.).

 

567.14             The FEMSD may make a determination of “economic hardship” upon request by a District resident who is unable to pay ambulance charges because he or she:

                       

(a)        Has an annual income of less than one hundred fifty percent (150%) of poverty level for an individual or family or domestic partner arrangement as determined by “Poverty Guidelines for the 48 Contiguous States and the District of Columbia” published each year by the Federal Department of Health and Human Services;

(b)        Is unemployed and receiving unemployment benefits; or

(c)        Is considered “permanently disabled” for tax reporting purposes; and

(d)       Is not and will not be eligible for Medicare, Medicaid or other public healthcare insurance coverage during a twelve (12) month period after the date of transport by FEMSD ambulance;

(e)        Is not and will not be eligible for private healthcare insurance or other insurance coverage during a twelve (12) month period after the date of transport by FEMSD ambulance; and

(f)        Is not eligible to receive any other recognized insurance or other third party payment that could pay due and owing ambulance charges during a twenty four (24) month period after the date of transport by FEMSD ambulance.

 

567.15             Ambulances charges shall be paid by check or money order made payable to the order of the “D.C. Treasurer.”

 

567.16             When the FEMSD, through its duly authorized representative, identifies that a person responsible for payment of ambulance charges received funds for payment of such charges from a third party entity and nonetheless failed to remit payment to the FEMSD not later than thirty (30) calendar days after having received such funds, the FEMSD shall, by request to the Office of the Attorney General, undertake legal proceedings to collect payment of such funds. Payments from third party entities shall include, but are not limited to:

 

(a)        Workers’ compensation payments;

 

(b)        Workers’ compensation insurance payments;

 

(c)        Disability insurance payments;

 

(d)       Employer third party payments;

 

(e)        Civil settlements, awards, or claim payments;

 

(f)        Third party settlements or payments; and

 

(g)        Other recognized insurance program payments.

 

567.17             If the person responsible for payment of ambulance charges has not fulfilled his or her obligations as set forth in this section after receiving the initial billing and two (2) subsequent notices at least thirty (30) days apart, the Fire and EMS Chief, or his or her duly authorized representative, may, at his or her discretion, request the Office of the Attorney General to undertake legal proceedings to collect the unpaid portion of any fee.

 

 

599                  DEFINITIONS

 

599.1               When used in this chapter, the following terms and phrases shall have the meanings ascribed:

 

ACEP -  the American College of Emergency Physicians.

 

Act -  the Emergency Medical Services Act of 2008, effective March 25, 2009 (D.C. law 17-357; D.C. Official Code §§ 7-2341.01, et seq. (2012 Supp.)).

 

ACS - the American College of Surgeons.

 

Administrative Law Judge - a hearing examiner authorized to hear cases pursuant to the Office of Administrative Hearings Establishment Act of 2001, effective March 6, 2002 (D.C. Law 14-76; D.C. Official Code §§ 2-1831.02, et seq. (2007 Repl. and 2012 Supp.)).

 

Advanced Cardiac Life Support (ACLS) - the educational and certification program operated that the American Heart Association operates.

 

Advanced Emergency Medical Services (AEMS) instructor - an individual who meets the necessary educational requirements to teach Advanced EMT, EMT-Intermediate, and Paramedic courses.

 

Advanced Life Support (ALS) - the level of care which may be rendered by an individual certified as an:

 

(a)        Advanced Emergency Medical Technician (AEMT);

 

(b)        Emergency Medical Technician – Intermediate (EMT-I); or

 

(c)        Paramedic.

 

Advanced Life Support (ALS) education program - an individual, agency, corporation, association, or other entity that prepares individuals for District emergency medical services (EMS) certification at the ALS level.

 

Advertising - information communicated by oral, electronic, written, or graphic means including handbills, newspapers, business cards, letterhead, other business stationery, television, billboards, radio, and telephone directories, including ambulance markings, but not including   novelty items such as key chains, pens, pencils, or mugs.

 

Affiliated - having employment or membership as an EMS provider with an Emergency Medical Services Agency or EMS Educational Institution.

 

AHA- the American Heart Association.

 

Air ambulance - any aircraft designed and constructed or modified and equipped to be used, maintained, or operated as an ambulance.

 

Air medical - an Emergency Medical Services Agency that responds to medical emergencies to offer care and provides transport to a hospital by an air ambulance.

 

Ambulance - any motor vehicle or aircraft designed and constructed or modified and equipped to be used, maintained, or operated for the transportation of individuals who are sick, injured, wounded, or incapacitated.  The term “ambulance” does not include a motor vehicle or aircraft designed and constructed or modified and equipped with a hydraulic lift which is used, maintained, or operated exclusively for transporting, in wheelchairs, patients who do not require the use of equipment and trained personnel found in an ambulance.

 

Automated External Defibrillator (AED) - a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient and is able to treat them through defibrillation.

 

Base station - a unit which has been approved by the Director to provide online medical direction to EMS providers.

 

Basic Life Support (BLS) - the level of care which may be rendered by an individual certified as an:

 

(a)        Emergency Medical Responder (EMR); or

 

(b)        Emergency Medical Technician (EMT).

 

Basic life support (BLS) education program- an individual, agency, corporation, association, or other entity that prepares individuals for EMS certification at the BLS level.

           

Candidate - a person who has applied for initial certification or renewal of an existing certification as an EMS provider.

 

CDC - the Centers for Disease Control and Prevention.

 

CECBEMS - the Continuing Education Coordinating Board for Emergency Medical Services, a national accrediting body for EMS continuing education courses and course providers.

 

Certification course - a course of instruction designed to allow the participant to obtain certification as an EMS provider at the BLS or ALS level.

 

CoAEMSP - the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions which is a national committee that accredits programs instructing EMS curricula.

 

Continuing Education (CE) - education used for renewal of EMS licensure or certification.

 

Continuing Education Hour -   One (1) CE hour  is any one (1) of the following:

 

(a)        Fifty (50) minutes of approved classroom or skills laboratory activity; or

 

(b)        One (1) hour of approved media-based or periodical-based CE (such as films, videos, computer simulation, interactive computer modules, and magazine articles).

 

Continuing education instructor - an individual who meets necessary educational requirements to teach only continuing education courses.

 

Curriculum - the required educational content of an EMS course that the DOH approves for certification as an EMS provider.

 

Day - a calendar day.

 

Department - the District of Columbia Department of Health.

 

Director - the Director of the District of Columbia Department of Health or his or her designee.

 

Distance education - a method of acquiring knowledge and skills through mediated information and instruction, encompassing all technologies and forms of learning at a distance.

 

District EMS Officer – a physician in the District of Columbia Department of Health who is appointed by the Director to oversee the District’s Emergency Medical Services.

 

DOH - the District of Columbia Department of Health.

 

Education Licensure Commission (ELC) - the Commission that licenses, approves, or oversees all private postsecondary educational institutions in the District of Columbia.

 

EMD - an emergency medical dispatch program.

 

Emergency - a sudden or serious symptom in a patient which might indicate a condition which:

 

(a)        Is threatening to the patient's physical or psychological well-being; and

 

(b)        Requires immediate medical attention to prevent possible deterioration, disability, or death of the patient.

 

Emergency Medical Response Vehicle - a vehicle or conveyance used to respond to the scene of a medical emergency for the purpose of rendering medical assistance, including the provision of medical assistance on the scene or the transportation of patients to a health care facility or other treatment facility. The term "emergency medical response vehicle" includes:

 

(a)        Ambulances which operate as motor vehicles, watercraft, or aircraft; and

 

(b)        Fire engines, motor vehicles, Segways, or other ground, water, or air vehicles used to transport emergency medical services personnel, supplies, or equipment to the scene of an emergency.

 

Emergency Medical Services (EMS) - medical services provided pre-hospital to prevent imminent death or aggravation of illness or injury; transport from the scene of a medical emergency to a hospital or other appropriate facility whether or not medical services are provided; medical inter-facility transport services to an appropriate facility; or medical inter-facility critical care transport to an appropriate facility.

 

Emergency Medical Services Agency (EMSA) - a certified agency providing medical care at the Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), EMT-I, or Paramedic level as a transport agency or non-transporting first responder agency.

 

EMR instructor - an individual who has met the necessary educational requirements to teach Emergency Medical Responder courses.

 

EMS provider - an individual certified by DOH to provide emergency medical services.

 

EMT instructor - an individual who has met the necessary educational requirements to teach Emergency Medical Technician courses.

 

FAA - the Federal Aviation Administration.

 

First Responder Emergency Medical Services Agency - an Emergency Medical Services Agency that responds to medical emergencies to offer care but does not provide transport to a hospital.

 

Glasgow Coma Scale (GCS) - a standardized system for assessing the degree of conscious impairment in the critically ill and for predicting the duration and ultimate outcome of coma.

 

Ground Transport EMR Agency - an Emergency Medical Services Agency that responds to medical emergencies to offer care and provides transport to a hospital by ambulance.

 

Health Insurance Portability and Accountability Act (HIPAA) - the federal law that provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information.

 

HEPRA - the Health Emergency Preparedness and Response Administration, an administration within the DOH.

 

JCAHO - the Joint Commission on Accreditation of Healthcare Organizations.

 

Licensed physician - an individual holding a current and valid license to practice medicine in the District of Columbia.

 

Mass Casualty Incident (MCI) - an incident in which emergency medical services personnel and equipment at a scene are unable to timely and adequately provide emergency medical services, because of the large number and severity of casualties.

 

Medical aid station - a temporary-use facility, such as a tent or a room within an existing building structure, designated to provide basic or advanced life support emergency medical care prior to arrival, treatment, or transport by an EMSA or its personnel during special events or emergencies.

 

Medical control - supervision by an EMS agency’s physician who is responsible for the care of the patient by the agency’s medical providers.

 

Medical control orders - medical instructions that may be direct by two (2)-way voice communications (on-line) or indirect by protocol (off-line).

 

Medical director - an agency’s licensed physician who has overall responsibility for the EMS agency and who works with either the operational or educational section of the agency to provide medical oversight of EMS activities.

 

Medication – a substance taken by mouth; injected into the muscle, blood vessel, or cavity of the body; or applied topically to treat or prevent a disease or condition.

 

NAEMSP - the National Association of Emergency Medical Service Physicians.

 

National Emergency Medical Services Information System (NEMSIS) – a national repository designed to store EMS data from every state in the nation.

 

National Registry of Emergency Medical Technicians (NREMT) - the not-for-profit independent non-governmental agency that provides standardized national testing and registration for emergency medical technicians based on national training standards.

 

NHTSA - the United States National Highway Transportation Safety Administration. 

 

NIMS - the National Incident Management System.

 

Non-transport emergency medical response vehicle - a vehicle certified to respond to a medical emergency that is not designated to transport a patient to a hospital or other health care facility.

 

On-line medical control physician - the physician who directly communicates with the agency’s EMS providers regarding appropriate patient care procedures while on the scene of a medical emergency or en route to the hospital.

 

Operational CE programs - a continuing education program that is sponsored by an Emergency Medical Services Agency.

 

Operational director - a District-certified or licensed provider, who is certified or licensed at a level equal to that of the Emergency Medical Services Agency by which he or she is employed, who is responsible for the operations, treatment, and transport of patients in the pre-hospital setting.

 

OSSE - the District of Columbia Office of the State Superintendent of Education.

 

Person – an individual, firm, corporation, association, or governmental agency either as owner, agency, or otherwise.

 

Preceptor hours - the time spent on an emergency medical response vehicle to observe and assist with the training of EMS providers.

 

Quality Assurance (QA) - an organized method of auditing and evaluating care provided within an EMS system.

 

Quality Improvement (QI) - a systematic review of pre-hospital care designed to improve the overall delivery of care within the EMS system.

 

Quality improvement officer – a District-certified or licensed provider, who is certified or licensed at a level equal to that of the EMR agency by which he or she is employed, who is responsible for the quality improvement activities within the agency.

 

Refresher course - a continuing education course which provides continuing education requirements required for renewal of an EMS license or certificate.

 

Representative – A person to whom authority for a particular act has been delegated by the Director.

 

Respondent - a person against whom an adverse action is contemplated, proposed, or taken.

 

Revocation - action taken by the Department that permanently voids a certification such that the holder may no longer perform the function associated with the certification.

 

Sponsoring EMS agency – a District certified Emergency Medical Services Agency or educational institution.

Special Event – includes, but is not limited to, a circus, rodeo, carnival, fair, concert, parade, flea market, marathon, walkathon, race, bicycle event, festival, celebration, performance, singing, playing of musical or other instruments, dancing or amusement of any kind, preaching, exhorting, or lecturing conducted or operating in a building, tent or temporary structure of any kind, on vacant land, or in a yard or area appurtenant to any building, on public or private space.

 

Star-of-Life ambulance - an ambulance which is constructed in compliance with Federal Specification KKK-A-1822.

 

Suspension - action taken by the Department that temporarily voids a certification such that the holder may no longer perform the function associated with the certification until the holder has complied with the statutory requirements and other conditions imposed by DOH.

 

Time call is dispatched - the date and time the responding unit was notified by dispatch.

 

Time call received - the date and time the phone rings (911 call to public safety answering point or other designated entity) requesting EMS services.

 

Time patient was transported to the hospital - the date and time the responding unit left the scene (started moving) en route to the hospital.

 

Time patient arrived at the hospital - the date and time the responding unit arrived with the patient at the hospital destination or transfer point.

 

Time personnel arrive on the scene - the date and time the responding unit arrived on the scene; that is, the time the vehicle stopped moving.

 

Time personnel respond - the date and time the unit responded; that is, the time the vehicle started moving.

 

Time personnel returned to service - the date and time the unit was back in service and available for response (finished with call, but not necessarily back in home location).

 

Time transport service was requested - the date and time the non-transport EMS agency initiated contact with another EMS agency for transport.

 

Triage tag - a tool for EMS providers to use during a mass casualty incident to identify those patients that need immediate care (red tag), are potentially unstable (yellow tag), are stable patients and can reasonably wait for emergency medical service (green tag), and are deceased (black tag).

 

Type of call - the type of complaint dispatch reported to the responding unit.

 

 

All persons desiring to comment on the subject matter of this proposed rulemaking should file comments in writing not later than thirty (30) days after the date of publication of this notice in the D.C. Register. Comments should be sent to the Department of Health, Health Emergency Preparedness and Response Administration, 55 M Street, S.E., Suite 300, Box 4, Washington, D.C. 20003, attention: Marie-Claire Brown, Senior Assistant Attorney General, email: [e-mail], telephone [phone]. Copies of the proposed rule may be obtained from the Department at the same address during the hours of 8:30 a.m. and 5:00 p.m., Monday through Friday, excluding holidays.