6205592 Health, Department of - Notice of Proposed Rulemaking - Amendment to Section 526, EMS PROVIDERS: SCOPE OF SERVICES, of Chapter 5, EMERGENCY MEDICAL SERVICES
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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 Repl.)), and Mayor’s Order 2009-89, dated June 1, 2009, hereby gives notice of the intent to adopt the following rules to amend Chapter 5 (Emergency Medical Services) of Title 29 (Public Welfare) of the District of Columbia Municipal Regulations (DCMR), in not less than thirty (30) days after the publication of this notice in the D.C. Register.
This rulemaking will provide for termination of resuscitation in the field by paramedics and remote pronouncement of death by certain medical doctors following termination of resuscitation by a certified 911 paramedic.
Pursuant to D.C. Official Code § 7-2341.23(b), this rulemaking shall be submitted to the Council of the District of Columbia for a forty-five (45) day period of review, excluding Saturdays, Sundays, legal holiday, and days of Council recess.
Chapter 5, EMERGENCY MEDICAL SERVICES, of Title 29 DCMR, PUBLIC WELFARE, is amended as follows:
Section 526, EMS PROVIDERS: SCOPE OF SERVICES, is amended by adding new Subsections 526.6-526.13 to read as follows:
526.6 A paramedic sponsored by the District of Columbia Government’s 911 EMS agency may terminate resuscitation in the field if:
(a) The paramedic is issued a proper order by a Medical Control Base Station Physician currently licensed in the District of Columbia and authorized by the Medical Director of the District Government’s 911 EMS agency;
(b) The paramedic is currently certified by the District of Columbia and authorized by the Medical Director of the District Government’s 911 EMS agency;
(c) The paramedic follows the termination of resuscitation protocol that has been approved by the Department of Health; and
(d) All paramedics present on the scene and involved in the resuscitation agree that termination is appropriate.
526.7 Once a termination of resuscitation order has been issued, resuscitation efforts shall stop and the Metropolitan Police Department shall be notified by the 911 EMS provider on the scene, except as otherwise provided in the Fire and Emergency Medical Services Department’s pre-hospital treatment protocols.
526.8 A Medical Control Base Station Physician or the Medical Director of the District Government’s 911 EMS agency may pronounce a person dead following termination of resuscitation in the field, as authorized pursuant to Subsection 526.6, without personally examining that person’s body only if:
(a) The authorized paramedic has recited the facts of the person’s present medical condition;
(b) The paramedic attests that he or she adhered to the termination of resuscitation protocol; and
(c) The Medical Control Base Station Physician or Medical Director of the District Government’s 911 EMS agency is satisfied that death has occurred.
526.9 If a person is determined presumed dead on arrival by a District Government 911 EMS provider holding any certification level, a Medical Control Base Station Physician or the Medical Director of the District Government’s 911 EMS agency may pronounce that person dead without personally examining the person’s body only if:
(a) The patient presents pulseless and apneic with one (1) or more of the following:
(1) Rigor mortis;
(2) Dependent lividity;
(3) Decomposition;
(4) Traumatic injuries incompatible with life such as organ destruction of the brain or thoracic contents, or decapitation;
(5) Incineration;
(6) Submersion for greater than twenty-four (24) hours;
(7) A valid out-of-hospital do not resuscitate order is present; or
(8) A licensed physician on the scene orders that resuscitation not be attempted.
(b) The District Government’s 911 EMS provider on the scene has recited the facts of the person’s present medical condition to the Medical Central Base Station Physician or the Medical Director of the District Government’s 911 EMS agency; and
(c) The District Government’s 911 EMS provider attests that the patient is not:
(1) Obviously pregnant; or
(2) Hypothermic.
526.10 Nothing shall be removed from the decedent’s person, including any medical equipment, after a termination of resuscitation order has been issued or a death is pronounced in the field.
526.11 When death is pronounced in the field by the Medical Control Base Station Physician or the Medical Director of the District Government’s 911 EMS agency in communication with the District Government’s 911 EMS provider on the scene, that EMS provider shall document the following on the patient care report:
(a) The decedent’s time of death;
(b) Criteria used to determine death;
(c) Location of the decedent;
(d) Position of the decedent;
(e) Condition of the decedent;
(f) Any care provided to the decedent prior to the pronouncement of death; and
(g) Name of the Medical Control Base Station Physician or Medical Director of the District Government’s 911 EMS agency who pronounced the death.
526.12 The District Government’s 911 EMS agency shall provide a copy of the patient care report, upon request, to the Office of the Chief Medical Examiner (“OCME”) or the decedent’s primary care physician in order for the OCME or the decedent’s primary care physician to complete the pronouncement section or sections of the decedent’s certificate of death.
526.13 The Office of the Chief Medical Examiner shall review all incidents where an order to terminate resuscitation in the field is issued and shall issue a report on incidents where the termination of resuscitation protocol was not followed. The report shall be transmitted to the director of the Department of Health and to the Medical Director of the District Government’s 911 EMS agency no less than once annually.
Comments on this proposed regulation should be submitted, in writing, to Marie-Claire Brown, Senior Assistant General Counsel, District of Columbia Department of Health, Health Emergency Preparedness and Response Administration, 899 North Capitol Street, N.E., 5th Floor, Washington, D.C. 20002 or marie-claire.brown@dc.gov, within thirty (30) days of the publication of this notice in the D.C. Register. Additional copies of this proposed regulation are available at the above address.
