[43 Pa.B. 6093]
[Saturday, October 12, 2013]

[Continued from previous Web Page]

§ 1021.83. Complaints

Comment

 Section 1021.83 (relating to complaints) states that the Department will investigate complaints regarding the delivery of services by trauma centers and the Department will forward the results of the investigation to the Trauma Foundation along with a recommendation for action. A commentator was concerned regarding the possibility of duplicative complaint investigations conducted by the Bureau and the Department's Division of Acute and Ambulatory Care that regulates hospitals. IRRC also commented on this section and requested that the Department explain how these investigations will be conducted and whether there is duplication. IRRC further noted that if there is duplication, the Department should explain why the duplication is needed and how the cost of the duplication may be justified.

Response

 Section 1021.83 is promulgated under section 8105(b)(15) of the EMS System Act. Section 8105(b)(15) of the EMS System Act requires the Department to investigate complaints concerning the delivery of services by trauma centers and report the investigation results to the Trauma Foundation. This requirement is not new as there was a similar requirement in former § 1001.83. This requirement was in place since the original EMS regulations were promulgated in 1989 under the prior EMS Act.

 While the Bureau and the Division of Acute and Ambulatory Care may have overlapping areas of authority, the functions of the two offices differ. The Bureau's function is to regulate the Commonwealth's EMS system. Therefore, an investigation performed by the Bureau will focus on EMS services and not hospital services. During an investigation, the Bureau will interview EMS providers to determine whether violations of the EMS System Act or regulations occurred. To the extent that the Bureau interviews hospital personnel, the focus of those interviews will be on how EMS was provided by EMS providers. The investigation will not concern hospital personnel not licensed by the Bureau, nor will the Bureau interview hospital personnel to see if there were violations of regulations outside of the Bureau's jurisdiction. However, if in its investigation the Bureau uncovers possible issues outside of its jurisdiction, it will refer those issues to the entity with the appropriate oversight authority.

§ 1021.103. Governing body

Comment

 IRRC commented on § 1021.103(d) (relating to governing body) that stated that a regional EMS council's governing body must make available to the public its annual report. IRRC sought clarification whether a governing body could satisfy this requirement by placing this annual report on the council's or governing body's web site and, if so, whether the section should be revised accordingly.

Response

 The Department agrees with this comment and revised this section to provide that a regional EMS council's governing body may meet this requirement by posting the annual report on the regional EMS council's web site no later than 30 days after the end of the fiscal year, which is the same time frame imposed by the grant agreement for regional EMS councils to submit annual reports to the Department.

Department-initiated changes to § 1021.103.

 The Department revised § 1021.103(d) to require the governing body to make the annual report available to the Department in hard copy or electronic format. The Department also added a requirement that the annual report shall be provided to the Department and to the public within 30 days after the end of the fiscal year.

§ 1021.104. Responsibilities of regional EMS councils

Comment

 A commentator questioned whether § 1021.104 (relating to responsibilities of regional EMS councils) requires hospitals to complete an EMS plan.

Response

 The Department agrees that § 1021.104(5), as proposed, was not clear. The Department revised this paragraph to clarify that regional EMS councils are to provide assistance to hospitals, as requested, when the hospital is developing its own emergency care plan under § 117.11 (relating to emergency services plan). Section 117.11 was promulgated by the Department under the HCFA and it requires a hospital to have a comprehensive written plan for emergency care based on community need and the capability of the hospital. In reviewing § 1021.104(5), the Department determined that the language used in the current regulation, with minor revisions, is clearer in scope. In addition, that provision has been in place since the first EMS regulations were promulgated in 1989. Therefore, the Department revised § 1021.104(5) to closely track former § 1001.123(5).

Chapter 1023. Personnel

Comment

 IRRC commented on Chapter 1023 (relating to personnel) regarding the roles, responsibilities and minimum qualifications for personnel within the EMS system. Specifically, IRRC noted that some EMS personnel are required to complete an application for certification while others are not. In addition, some personnel are required to complete a triennial renewal of that certification while others are not required to do so. IRRC specifically referenced EMS agency medical directors (§ 1023.1), medical command physicians (§ 1023.2), medical command facility medical directors (§ 1023.3), regional EMS medical directors (§ 1023.4 (relating to regional EMS medical director)) and the Commonwealth EMS Medical Director (§ 1023.5 (relating to Commonwealth EMS Medical Director)). IRRC pointed out that while medical command physicians and medical command facility medical directors are required to complete an application for certification and are subject to triennial registration of their certification, EMS agency medical directors, regional EMS medical directors and the Commonwealth EMS Medical Director are not. IRRC questioned whether the health and safety of the citizens of this Commonwealth are adequately protected without similar requirements for each position.

Response

 Section 8126 of the EMS System Act requires medical command physicians and medical command facility medical directors to complete an application for certification and be subject to triennial registration of their certification.

 Section 8125 of the EMS System Act sets forth the minimum qualifications for an EMS agency medical director but does not require a separate application for the EMS agency medical director nor does it require Department certification. Even though an application process and certification are not required, an EMS agency must identify its EMS agency medical director on its EMS agency license application to ensure that the person meets the qualification in section 8125 of the EMS System Act and § 1023.1. Thus, the Department does have indirect oversight of EMS agency medical directors through the EMS agency licensure process. Finally, the Department can take disciplinary action against an EMS agency if the EMS agency is not staffed by responsible persons and the EMS agency refuses to remove those persons. See section 8142(a)(8) of the EMS System Act (relating to emergency medical services agency license sanctions).

 Section 8109(c)(11) of the EMS System Act (relating to regional emergency medical services councils) mandates that regional EMS councils are to designate a regional EMS medical director. The EMS System Act does not require a separate application for the regional EMS medical director nor does it require Department certification. However, the Department does have indirect control over the regional EMS medical director through the contract or grant that is entered into with the regional EMS council under section 8112 of the EMS System Act. If the regional EMS council employed a regional EMS medical director that does not abide by the requirements under the EMS System Act and the regulations, the Department can choose not to renew the contract or grant with that regional EMS council.

 The Commonwealth EMS Medical Director is one person selected and employed by the Department to advise and formulate policy on matters pertaining to emergency medical services. See the definition of ''Commonwealth EMS medical director'' in section 8103 of the EMS System Act. As an at-will employee of the Department, the Commonwealth EMS Medical Director can be removed outside of the disciplinary process in the EMS System Act for certified EMS providers.

§ 1023.21. General rights and responsibilities

Comment

 A commentator questioned § 1023.21(b) that requires: (1) an applicant for EMS provider or EMSVO certification to report to the Department misdemeanor, felony and other criminal convictions and disciplinary sanctions that have been imposed on the license or other authorization of the applicant to practice an occupation or profession; and (2) an applicant for EMSVO certification to report a conviction of an offense involving reckless driving or driving under the influence of alcohol or drugs. Section 1023.21(b)(4) imposes an ongoing obligation on both the EMS provider and the EMSVO to report the same information ''within 30 days after each conviction, discipline and exclusion.'' The commentator is concerned that the obligation to report a conviction for reckless driving or driving under the influence of alcohol or drugs applies only to EMS providers that operate EMS ambulance vehicles. The commentator believed the obligation to report should be imposed without regard to the type of vehicle the individual might operate, and that the Department should ensure that operators of QRS, rescue, squad, police and fire vehicles should be held to the same standard.

Response

 The obligation on an EMSVO to make a report regarding convictions for reckless driving, driving under the influence of alcohol or drugs or other conviction that results in the EMSVO having his driver's license suspended applies regardless the type of EMS vehicle the EMSVO operates. The obligation is triggered not by the type of vehicle that the individual operates but certification as an EMSVO. EMSVOs, regardless whether they operate an ambulance, QRS, rescue or squad vehicle or other vehicle, are subject to the requirement to report convictions for reckless driving or driving under the influence of alcohol or drugs or driver's license suspensions due to the use of drugs or alcohol or a moving traffic violation.

§ 1023.31. Continuing education requirements

Comment

 IRRC commented on § 1023.31(a) and noted that, unlike the continuing education sections pertaining to EMS providers, this subsection fails to specify subject areas appropriate for continuing education for EMSVOs.

Response

 The Department agrees with this comment and made revisions to § 1023.31(a) to reflect that an EMSVO shall complete continuing education requirements in subjects regarding effective driving of a ground EMS vehicle.

§ 1023.51. Certified EMS instructors

Comment

 A commentator questioned § 1023.51(a)(3). Specifically, the commentator questioned why the educational requirements for certified EMS instructors in § 1023.51(a)(3) differ from the requirements in section 8124(a)(3) of the EMS System Act. Under proposed § 1023.51(a)(3), a certified EMS instructor was required to successfully complete an EMS instructor's course approved by the Department or possess, at a minimum, a bachelor's degree in education or a teacher's certification in education. Under section 8124(a)(3) of the EMS System Act, however, a certified EMS instructor can also have a doctorate or master's degree. IRRC noted the commentator's comment in its comments to the Department. IRRC sought clarification for the Department's reason for deviating from the EMS System Act and whether an individual with a doctorate or master's degree would satisfy the requirements regarding certified EMS instructors.

Response

 The Department agrees with IRRC and the commentator. The Department revised § 1023.51(a)(3) to mirror the language in section 8124(a)(3) of the EMS System Act.

Department-initiated changes to Chapter 1023

 In § 1023.1(a)(1)(vi), the reference in the second sentence to ''this paragraph'' has been changed to ''this subparagraph.''

 The Department revised § 1023.2 to clarify that, in addition to documenting patient information and medical command orders when they receive calls from EMS providers for assistance, medical command physicians also are required to document patient information and medical command orders when the medical command physician is providing medical command while actually at the scene of patient care. The change made to this section does not change the requirements for EMS providers to complete EMS PCR reports as required under § 1021.41.

 The Department revised § 1023.21(b) to include the requirement that EMSVOs shall report to the Department a driver's license suspension due to the use of drugs or alcohol or from a moving traffic violation. This addition mirrors section 8122(a)(7)(ii) of the EMS System Act.

 The Department added § 1023.21(c)(6) to mirror section 8113(e)(6) of the EMS System Act.

 The Department revised § 1023.21(e)(2) by replacing ''later'' with ''more'' to clarify the requirement. The Department revised § 1023.21(e)(3) by replacing ''and'' with ''or'' to clarify the requirement.

 The Department revised § 1023.21(h) to clarify that EMSVOs operate ''ground EMS vehicles'' and not ''EMS vehicles.'' The definition of EMSVOs specifies that the Department licenses individuals to operate ground EMS vehicles, which is further defined in section 8103 of the EMS System Act. An ''EMS vehicle'' is defined to include ground EMS vehicles, water ambulances; and air ambulances. While the Department licenses water ambulances and air ambulances, it does not license the drivers of those vehicles. For the same reason, the Department revised the reference in § 1023.22(d)(5) of ''EMS vehicles'' to ''ground EMS vehicles.''

 The Department revised § 1023.22(d)(3) to clarify the requirements an EMSVO shall meet when his EMSVO registration expires. The Department added language to distinguish the requirements for securing a new registration of EMSVO certification within 2 years of the registration's expiration and those for securing a new registration when more than 2 years have passed since the registration expired. For new registrations sought more than 2 years after the registration expired, the Department deleted the requirement that the EMSVO complete continuing education requirements due to the fact that the emergency vehicle operator course that the EMSVO is required to take will provide the needed education for the EMSVO. The statutory authority to promulgate this regulation is section 8122(b)(4) of the EMS System Act.

 The Department revised the order in which EMS providers are addressed in the regulations to coincide with the order in which they are addressed in the EMS System Act. PHRNs are addressed under final-form § 1023.28 (relating to prehospital registered nurse) and PHPEs are addressed under final-form § 1023.29 (relating to prehospital physician extender). The Department also revised the order PHRNs and PHPEs are addressed for purposes of continuing education. PHRNs are addressed under final-form § 1023.31(f) and PHPEs are addressed under final-form § 1023.31(g).

 The Department changed the heading of § 1023.31(a) from ''EMS vehicles operators'' to ''EMSVOs'' and the heading of § 1023.31(f) from ''prehospital registered nurses'' to ''PHRNs.'' The Department made these changes to maintain continuity in the manner of referencing EMS provider types and EMS vehicle operators by using their abbreviated titles.

 The Department added § 1023.31(j) regarding the proration of continuing education requirements for EMS providers on a 2-year registration cycle, including those that also have an EMSVO certification. The statutory authority to promulgate this regulation is in sections 8113(n)(2) and 8122(b)(3) of the EMS System Act. Those sections require the Department to prorate the continuing education requirements of an EMS provider (on a 2-year registration cycle) for the period following the EMS provider's first registration of certification. The Department added the language applicable to all EMS providers on a 2-year registration cycle in § 1023.31(j) and deleted portions of § 1023.31(d)(1), (e)(1), (f)(1), (g)(1) and (h)(1) that dealt with the same subject. The Department also revised § 1023.31(f)(1), (g)(1) and (h)(1) regarding the 27 hours of continuing education that a PHRN, PHPE and PHP shall fulfill in clinical patient care and other core continuing education courses to ensure consistency among the regulations addressing core continuing education courses.

 The Department revised § 1023.32(a) (relating to credit for continuing education) to clarify that EMS providers and EMSVOs may not receive additional continuing education credit for repeating a course in the same registration cycle and that continuing education credits in excess of the amount required in a given registration cycle will not carry over from one registration cycle to the next. The statutory authority to add this language is in section 8113(d) of the EMS System Act, which gives the Department authority to coordinate the education of EMS providers.

 The Department revised § 1023.52. After consulting with the State Fire Commissioner, the Department learned that the State Fire Commissioner no longer offers a course for a ''basic rescue practices technician.'' Therefore, the Department deleted proposed subsection (a) and the definition of ''basic rescue practices technician'' in § 1021.2. A ''basic vehicle rescue technician'' is now called a ''vehicle rescue technician.'' The Department made this change in §§ 1021.2 and 1023.52. The Department renumbered this section accordingly.

Chapter 1025. Education

Department-initiated changes to § 1025.1

 Following publication of the proposed rulemaking, the Department noted an omission in § 1025.1(b)(1) (relating to accreditation and operational requirements of EMS educational institutes). The Department intended to permit educational institutes that are accredited by the Department to offer BLS educational courses to offer educational courses for AEMTs. In the proposed rulemaking, however, only ALS educational institutes were permitted to offer courses for AEMTs. The Department revised § 1025.1(b)(1) to permit BLS educational institutes to offer educational courses for EMRs, EMTs and AEMTs. In addition, the Department revised § 1025.1(b)(2) to permit ALS educational institutes to offer any educational course listed under § 1025.1(b)(1) in addition to education courses for paramedics.

 Following publication of the proposed rulemaking, the Department noted that the operating procedures imposed on a EMS educational institute, including, among other things, the requirement that the institute adopt and implement a nondiscrimination policy and maintain a file on each enrolled student in § 1025.1(l) were not in logical order, thus making the section potentially confusing. Therefore, the Department reordered the operating procedures in subsection (l). The contents of each paragraph remain unchanged except for the addition of language to paragraph (10) to clarify that a student is required to complete an update to the form that is specified in paragraph (8).

§ 1025.22. Responsibilities of continuing education sponsors

Comment

 IRRC commented that the provision in § 1025.22(f) (relating to responsibilities of continuing education sponsors) requiring continuing education sponsors to retain records for ''at least'' 4 years from the presentation of the course is vague.

Response

 The Department agrees with this comment and revised this section to replace ''at least'' with ''a minimum of.'' The Department also revised this section to clarify that the 4 years run from the completion of the course, not the presentation of the course.

Chapter 1027. EMS agencies

Department-initiated changes to Chapter 1027

 After adding ''water ambulance'' to the definition of ''ambulance'' in §§ 1021.2 and 1027.1, the Department determined that a section within Chapter 1027 was needed to address the regulation of water ambulances. The Department added § 1027.42 regarding water ambulance services. Similar to ground ambulance services, water ambulance services can be licensed as BLS, intermediate ALS or ALS water ambulance services. Therefore, as stated in subsection (c), final-form §§ 1027.33—1027.35 apply to those types of water ambulances, except for the requirement regarding EMSVOs. The Department also noted in § 1027.42(b) that water ambulance services are subject to any regulation regarding ambulances, EMS agencies and EMS vehicles except when specifically exempted. The Department included § 1027.42(b) so the regulated community would understand that there may be other provisions within the regulations that apply to water ambulance services in addition to those referenced in § 1027.42(c).

§ 1027.1. General provisions

Comment

 A commentator requested clarification regarding the requirement for providing EMS service 24 hours a day, 7 days a week in § 1027.1(b)(3). The commentator suggested adding a definition with criteria that include response time requirements that can be used to determine compliance. The commentator noted that without criteria that include a minimum response time, the requirement for EMS service 24 hours a day, 7 days a week has no impact on the system and compliance cannot be determined.

Response

 The Department did not change to § 1027.1 in response to this comment. Section 1027.1(b)(3) provides that an applicant for an EMS agency license must meet staffing standards for the vehicles that it seeks to operate and the services that it seeks to provide. The EMS agency shall also provide EMS services 24 hours a day, 7 days a week, unless the EMS agency participates in a county-level or broader-level EMS response plan approved by the Department or one of the exceptions in final-form § 1027.6 (proposed § 1027.5) applies. The requirements do not include a minimum response time.

 The Department is not able to set minimum response times for EMS agencies. This Commonwealth as a whole is very diverse in geography. This Commonwealth has both urban and rural areas. It also has densely populated areas and sparsely populated areas. The Department could not adequately dictate to each municipality in this Commonwealth the mandatory response time for each city, town and borough. A response time adequate for one municipality may not be adequate for another. The Department believes that it is best left up to each municipality to determine the appropriate response times for EMS services within their boundaries.

Department-initiated changes to § 1027.1

 The Department added BLS water ambulance service, intermediate ALS water ambulance service, ALS water ambulance service and EMS agency dispatch center to the types of EMS services requiring licensure under § 1027.1(a).

 The Department revised the term ''intermediate squad service'' used in the proposed rulemaking. The term should have read ''intermediate ALS squad service'' as set forth in § 1021.2.

 The Department revised § 1027.1(e)(2) to reflect that ambulance services and QRSs may continue to operate as an ambulance service or a QRS without an EMS agency medical director until April 10, 2014. In the proposed rulemaking, the Department stated that ambulance services and QRSs could continue to operate under the prior EMS Act. The prior EMS Act has been repealed, so the Department does not have authority to provide for this. However, the EMS System Act provides that the final-form regulations for EMS agencies do not take effect for 180 days after the publication date of this final-form rulemaking. Therefore, the current regulations pertaining to ambulance services and QRSs will remain in effect for 180 days after the publication date of this final-form rulemaking.

§ 1027.3. Licensure and general operating standards

Comment

 A commentator suggested that municipalities, not public safety answering points (PSAP), should set response times for EMS providers to be en route to an EMS call.

Response

 The Department did not change § 1027.3 in response to this comment. Section 1027.3(g)(2) does not give PSAPs the authority to set response times. It merely requires an EMS agency to communicate with the PSAP if it is going to be delayed or otherwise cannot provide the requested level of service after receiving a dispatch call from the PSAP.

 The Department neither regulates nor empowers PSAPs. The authority to regulate PSAPs is vested in PEMA. However, the Department does recognize that PSAPs are the entities that dispatch EMS agency services either because the PSAP has the authority to make the dispatch decision or because it implements dispatch protocols that have been prescribed by some other entity. In general, a PSAP dispatches an EMS agency to an EMS call. If the PSAP does not get a response from the EMS agency in a certain amount of time, the PSAP may call the EMS agency again or it may dispatch another EMS agency. Municipalities are not precluded, however, from setting their own prescribed dispatch times and relaying this information to the appropriate PSAPs.

 As stated, this section merely requires an EMS agency to inform the PSAP that it is unable to respond to a call or will be delayed. The PSAP needs to know if the EMS agency will be delayed, or that it does not have the equipment needed to respond, so that the PSAP is able to dispatch another EMS agency to the call.

Comment

 A commentator suggested that the Department should include language in § 1027.3(g)(4) to permit municipal-based EMS agencies to reserve resources for response within its community unless otherwise agreed to by the municipality and approved by the Department. The commentator argued that as written this section requires a municipality to use municipal resources to serve a surrounding area even if there is not an agreement among municipalities specifying the terms and conditions for the provision of services.

Response

 The Department has not changed § 1027.3 in response to this comment. Section 1027.3(g) requires EMS agencies to communicate with PSAPs regarding unavailability, delayed responses and response to calls for emergency assistance as dispatched by a PSAP. Section 1027.3(g)(4) does not permit an EMS agency to refuse to respond to a dispatch based upon a desire to keep some portion of its resources in reserve. The requirements under § 1027.3(g) are similar in scope to former § 1005.10(e).

 The Department does not mandate that a particular entity agree to cover set geographic areas. When an entity applies for a license to become an EMS agency, the entity shall list the municipalities it wishes to serve. See § 1027.2(a)(6) (relating to license and registration applications). Therefore, it is up to the EMS agency to determine the areas of this Commonwealth it will cover. PSAPs are made aware of the municipalities that each EMS agency has elected to cover. This enables the PSAP to know which EMS agencies are available when an emergency arises and allows the PSAPs to effectively dispatch EMS agencies from neighboring municipalities when coverage is needed.

 An EMS agency has multiple options regarding the municipalities it will cover. If an EMS agency cannot cover a neighboring municipality on a given night, for example, subsection (g)(1) requires the EMS agency to communicate with the PSAP concerning its unavailability. However, if the EMS agency has not communicated its unavailability, the EMS agency shall respond to a PSAP dispatch provided the EMS agency is able.

 An EMS agency has the option to revise the scope of its EMS agency license with the Department if it no longer wishes to serve a particular municipality. The EMS agency will be removed from the list of EMS agencies serving the area and PSAPs may not call the EMS agency to respond to calls in that municipality.

Comment

 A commentator questioned proposed § 1027.3(h) setting forth requirements for an EMS agency that operates its own EMS agency dispatch center. The commentator is concerned that by having EMS agency dispatch centers, the 911 system could get fragmented and this would be contrary to efficient emergency medical service delivery. The commentator suggests that the 911 system should be used for emergency calls and that an alternative to 911 should only be encouraged for nonemergency services.

Response

 The Department has not made a change to § 1027.3(h) (final-form § 1027.4) in response to this comment. The Department's authority to promulgate regulations addressing EMS agency dispatch centers comes from section 8129(i) of the EMS System Act. Under section 8129(i) of the EMS System Act, an EMS agency can elect to operate an EMS agency dispatch center and calls for EMS may be made to the EMS agency dispatch center instead of dialing 911. For the first time, EMS agency dispatch centers will be regulated by the Department as part of an EMS agency's license.

 Limiting the calls made to an EMS agency dispatch center to calls in nonemergency situations is not possible because there is not a clear distinction between what is, and what is not, an emergency. What is considered an emergency to one person may be considered a nonemergency to another person. The Department cannot make a distinction between the two terms and expect an individual to determine whether he should call a 911 center or an EMS agency dispatch center. Patient safety would be at risk if the Department were to attempt to make the distinction in the regulation.

Comment

 IRRC asked the Department to clarify its statutory authority to require an EMS agency to bear the costs associated with the training, certification and recertification of the EMS agency's dispatch center's call-takers and dispatchers. IRRC also questioned how the training, certification and recertification of an EMS agency dispatch center's call-takers and dispatchers will be implemented.

Response

 It is not a requirement that an EMS agency operate its own dispatch center. A dispatch center operated by an EMS agency is voluntary, as there is already a 911 system in place that can be used. However, if an EMS agency chooses to operate its own dispatch center, the EMS agency or its employees shall pay the costs of training, certifying and recertifying the employees. If an EMS agency chooses to operate a dispatch center separate from the 911 system, it shall ensure compliance with applicable standards and sufficient resources to cover the costs of running this service.

 An EMS agency's dispatch center will be a part of the EMS agency license, and thus subject to discipline under section 8142 of the EMS System Act. The Department has coordinated with PEMA for PEMA to certify call-takers and dispatchers under PEMA's authority in 35 Pa.C.S. § 5303(a)(6). The Department drafted final-form § 1027.4 to allow time for PEMA to fully develop the training requirements for EMS agencies and to give EMS agencies the time to come into compliance with this section. Section 1027.4(a) provides that an EMS agency that chooses to operate its own dispatch center has until October 13, 2015, to use call-takers and dispatchers certified by PEMA. In addition, final-form § 1027.4(c)(2) provides that EMS agencies have until July 9, 2014, to use the EMD program employed by the emergency communications center of the county in which the EMS agency dispatch center is located. In sum, these effective dates give EMS agencies 9 months from the effective date of the final-form rulemaking in which to begin using the same dispatch program used by the county in which the EMS agency dispatch center is located and 2 years from the effective date of the final-form rulemaking in which to use call-takers and dispatchers that are certified by PEMA.

Comment

 IRRC asked the Department to explain the anticipated cost to the entire EMS agency community for training, certification and recertification of an EMS agency dispatch center's call-takers and dispatchers.

Response

 In responding to this comment, the Department consulted with PEMA regarding certification pre-requisites and costs of training call-takers and dispatchers. The initial EMD certification requires the applicant to be able to read and write at a high school graduate or GED level and complete an approved EMD course in which the applicant must complete a written certification exam and obtain a passing score. Once the applicant passes an EMD course, PEMA will provide the applicant with an additional Commonwealth EMD test. This test is completed on the current learning management system at no additional cost to the EMS agency or the applicant. The applicant must also be certified in CPR.

 The EMD course is approximately 24 to 40 hours in length with a cost of approximately $200, depending on which Nationally-recognized program the EMS agency uses. The EMS agency or applicant would also bear the cost for the applicant to complete a CPR course with a cost of approximately $35, depending on which program the EMS agency uses. The Department estimates that these requirements will affect fewer than ten EMS agencies currently, since most EMS agencies are using the county dispatch center for their emergency responses instead of their own EMS agency dispatch center.

Comment

 IRRC commented on proposed § 1027.3(h)(5), which referenced and required compliance with PEMA's regulations in 4 Pa. Code §§ 120d.104 and 120d.105 (relating to time frames and procedures for quality assurance reviews; and quality assurance review standards) and stated that ''PEMA,'' ''911 communications centers'' and ''remote dispatch points'' were replaced with ''Department'' and ''EMS agency dispatch centers,'' as appropriate. Section 120d.104 of 4 Pa. Code sets forth the requirements for quality assurance reviews for 911 communication centers. Section 120d.105 of 4 Pa. Code sets forth the quality assurance standards for call-takers and dispatchers that work at the 911 communication centers. IRRC felt that the regulated community would be better served if the Department incorporated the provisions of 4 Pa. Code §§ 120d.104 and 120d.105 within the EMS regulations rather than incorporating them by reference.

Response

 The Department agrees with this comment and revised § 1027.3 accordingly. Due to the breadth and scope of PEMA's requirements, the Department decided to separate EMS agency dispatch centers from § 1027.3 and added final-form § 1027.4. Because of this decision, proposed §§ 1027.4—1027.13 have been renumbered as final-form §§ 1027.5—1027.14. In addition, the Department decided to not insert PEMA's requirements in the regulation word-for-word but instead use them as a guideline. The Department made this decision partly because EMS agency dispatch centers do not operate exactly like 911 communication centers. Under final-form § 1027.4, EMS agencies that wish to operate an EMS agency dispatch center will be required to meet certain standards for call-taking and dispatching. Section 1027.4(c)(3) and (4) provides minimum requirements that EMS agency dispatch centers shall meet when developing their call-taking and dispatching standards that are to be based on Nationally-accepted EMD standards. The Department will not dictate which Nationally-accepted EMS standards an EMS agency dispatch center shall use in developing standards, as there are several, including those from the National Highway Traffic Safety Administration, the Association of Public Safety Communications Officials, the National Academy of Emergency Medical Dispatch and PowerPhone, Inc., among others.

 As with the proposed regulation, final-form § 1027.4(c)(2) requires EMS agency dispatch centers to use the EMD program used by the emergency communications center of the county in which the EMS agency dispatch center is located. This requirement will ensure coordination between the EMS agency dispatch center and the county communications center, particularly in the scenario when the EMS agency dispatch center refers a call for EMS to the 911 communications center because the EMS agency does not have the resources to adequately address the call. If they use the same EMD program, the EMS agency dispatch center and the county communications center will use the same computer program, verbiage and classification system for EMS calls, thus lessening the possibility of confusion between the two agencies.

 Section 1027.4(c)(6) sets forth the qualifications and duties of an EMS agency dispatch center's quality assurance reviewer. The quality assurance reviewer shall ensure that an EMS agency dispatch center is adhering to its own standards and protocols as well as the Department's regulations. The quality assurance reviewer will do this in part by conducting quality assurance reviews of the dispatch center's call-takers and dispatchers.

 As a result of these revisions, the Department was required to add several new definitions to § 1021.2. The Department added definitions of ''call-taker,'' ''call-taking,'' ''dispatcher,'' ''dispatching,'' ''emergency medical dispatch,'' ''emergency dispatch calls,'' ''emergency medical dispatch protocols,'' ''performance appraisal,'' ''quality assurance action,'' ''quality assurance review,'' ''quality assurance reviewer,'' ''radio activity'' and ''standard operating procedures.'' These definitions are based in part on the definitions used by PEMA in 4 Pa. Code § 120d.102 (relating to definitions) and revised as needed for EMS agency dispatch centers. The Department also revised the definition of ''EMS agency dispatch center'' to reiterate that final-form § 1027.4 does not apply to entities certified by PEMA under 35 Pa.C.S. §§ 5301—5398. PEMA licenses county and municipal 911 centers. The Department will be licensing EMS agency's that wish to operate EMS agency dispatch centers.

 The Department also added a requirement under final-form § 1027.4(c)(9) that EMS agencies ensure that persons are not denied access to EMS because of their inability or limited ability to communicate in the English language, including hearing impaired and deaf persons. This provision is derived from Title VI of the Civil Rights Act of 1964 (42 U.S.C.A. §§ 2000d—2000d-7), which applies to access to Federally-assisted and Federally-conducted programs and activities. The Department is expanding this requirement to apply to all EMS agency dispatch centers, regardless whether they receive Federal funding or Federal payments through Medicare or Medicaid. Finally, after the addition of final-form § 1027.4 addressing EMS agency dispatch centers, the Department found it necessary to revise § 1027.3(l) regarding an EMS agency's quality improvement committee. Section 1027.3(l) requires that an EMS agency that operates an EMS agency dispatch center must require the quality improvement committee to be responsible for the quality improvement of the EMS agency dispatch center. This section also requires the quality improvement committee to participate in the county PSAP quality assurance process. These revisions were incorporated to ensure committee oversight of EMS agency dispatch centers and also ensure that the EMS agency quality improvement committees will work closely with the county PSAP quality assurance process to improve communications and interactions between the EMS agency and the county.

Department-initiated changes to § 1027.3

 The Department revised § 1027.3(d) to reflect legislation that was enacted by the General Assembly after publication of the proposed rulemaking. The Child Labor Act (43 P. S. §§ 40.1—40.14) repealed the Child Labor Law (43 P. S. §§ 41—66.1). The Department recognized this change in the regulation.

 As proposed, § 1027.3(f) stated that ''an EMS agency shall also provide the Department with advance notice, 30 days if possible, of any change in its management personnel to include as a new member of its management team a person who has reported to it information required under this subsection.'' This wording was taken from former § 1005.10(d)(3). In reviewing the language following the proposed rulemaking, the Department determined that use of ''if possible'' made the provision difficult to enforce and a potential longer-term issue for the Department and EMS agencies. Therefore, the Department revised this sentence to require EMS agencies to provide the Department with notice of any change in its management personnel at least 30 days in advance.

 Final-form § 1027.3(i) (proposed § 1027.3(j)) addresses the use of lights and sirens by EMS vehicles. The Department determined that the subsection as proposed was difficult to understand and required EMS providers to decide whether the use lights and a siren would enable the provider to get a patient to a proper facility in less time. The Department substituted language similar to § 1005.10(g), which was in place since 2000. Since former § 1005.10 was in effect since 2000, EMS providers are already familiar with its requirements. Further, former § 1005.10 was more straightforward as it only required EMS providers to determine that a patient presents, or in good faith is perceived to present, a combination of circumstances resulting in a need for immediate medical intervention and that the need for immediate medical intervention is beyond the capabilities of the ambulance crew using available supplies and equipment and, if so, the EMS provider may use lights and a siren.

§ 1027.6. Statewide EMS response plan

Comment

 A commentator suggested that the Department should revise proposed § 1027.5 (final-form § 1027.6), permitting an exception to the requirement that an EMS agency operate 24 hours a day, 7 days a week if the EMS agency operates in accordance with a county-level or broader-level EMS response plan approved by the Department. The commentator requested that municipalities also should approve county-level or broader-level response plans, particularly if a municipality will be expected to contribute resources because an EMS agency in the other municipality does not operate 24 hours a day, 7 days a week. In addition, the commentator believed that the regulation should specify that approved response plans must provide EMS 24 hours a day, 7 days a week in all areas covered by the plan.

Response

 The Department has not made changes to the proposed section in response to this comment. The municipality is responsible for ensuring that EMS and fire services are provided within the municipality. Nonetheless, the Department will be reviewing the feasibility of any county-level or broader-level EMS response plan and welcomes input from the effected municipalities. The Department does have the authority to reject a county-level or broader-level response plan if it determines that it is not in the public interest to approve a plan.

 As for the suggestion that the Department should specify that an approved plan must provide for EMS 24 hours a day, 7 days a week in all areas covered by the plan, a change is not required as this is already a requirement. Section 1027.1(b)(3) already requires coverage by each EMS agency 24 hours a day, 7 days a week unless the EMS agency is a part of a county-level or broader-level EMS response plan, unless it operates exclusively as an air ambulance service, or in certain situations when it is operating as a tactical EMS service. Under a county-level or broader-level EMS response plan, the EMS agencies that make up this plan will not all be required to provide EMS 24 hours a day, 7 days a week. However, the plan as a whole must provide for coverage around the clock under its response plan. If a response plan submitted for Department approval does not ensure EMS 24 hours a day, 7 days a week within the area that the response plan covers, the Department could not approve the plan because it does not meet statutory and regulatory requirements.

Department-initiated changes to § 1027.6.

 The Department revised final-form § 1027.6(1) to include water ambulances under the exception to the rule that an EMS agency operate 24 hours a day, 7 days a week. Water ambulances, particularly during winter, do not operate 24 hours a day, 7 days a week, yet the proposed regulation did not provide for this exception. The Department addressed this omission.

 The Department added final-form § 1027.6(4) to provide that an EMS agency that operates an intermediate ALS ambulance service may operate it less than 24 hours a day, 7 days a week so long as the EMS agency operates a BLS ambulance service or an ALS ambulance service at the same location through which it is licensed to provide the intermediate ALS ambulance service. This exception was added because for purposes of dispatching, a BLS ambulance or an ALS ambulance will be dispatched first because those types of ambulance services will be able to handle most EMS situations. Thus, requiring an EMS agency also to operate an intermediate ALS ambulance 24 hours a day, 7 days a week could present an unnecessary financial burden for EMS agencies. However, if the EMS agency only operates an intermediate ALS ambulance service, or if it maintains its BLS or ALS ambulances at a separate location from its intermediate ALS ambulance, then it will be required to operate the intermediate ALS ambulance 24 hours a day, 7 days a week.

Department-initiated changes to § 1027.11

 Following publication of the proposed rulemaking, the Department noted that the first sentence of final-form § 1027.11(a) (relating to plan of correction) (proposed § 1027.10) should reference ''the act or this subpart,'' not ''the act or this chapter.'' The Department made the necessary revision.

Department-initiated changes to § 1027.31

 The Department revised § 1027.31(6) (relating to general standards for providing EMS) to provide that an EMS vehicle seeking assistance in attending to the needs of a patient may contact a PSAP or its own EMS agency dispatch center for additional assistance.

Department-initiated changes to § 1027.32

 The Department revised § 1027.32(c) (relating to quick response service) to include the term ''intermediate ALS squad vehicle.''

Department-initiated changes to § 1027.33

 The Department revised § 1027.33(a) and (b) and deleted § 1027.33(c)(2) regarding standards that a BLS ambulance service must meet when operating at the AEMT service level. To operate at the AEMT level of care, the EMS agency must meet the requirements for an intermediate ALS ambulance service under final-form § 1027.34. The statutory authority to make this revision is section 8129(l) of the EMS System Act, which authorizes the Department to change staffing standards for ambulances through regulation.

§ 1027.35. Advanced life support ambulance service

Comment

 A commentator questioned the minimum staffing requirements in final-form § 1027.35(b) (proposed § 1027.34). When an ALS crew is responding to a call to provide EMS to a patient who requires EMS above the skill level of an AEMT, the minimum staffing requirement is an EMSVO, a provider at or above the EMT level, and a provider above the AEMT level. The alternative is a two-person crew so long as the EMSVO is also one of the EMS providers and an EMS provider above the AEMT level is available to attend to the patient during patient transport. The commentator observed that a rural ambulance service cannot utilize an EMR to drive the ambulance for an ALS response and cannot use an EMSVO to drive the ambulance unless the EMSVO is at or above the EMT level. The commentator is concerned that the staffing requirements limit the use of EMRs and the use of an EMSVO who is not trained at or above the EMT level.

Response

 While the Department understands staffing issues may be a challenge to EMS agencies generally, the Department cannot promulgate a regulation contrary to the EMS System Act. The Department followed the parameters in the EMS System Act when it promulgated final-form § 1027.35(b). While the Department may change staffing standards under section 8129(l) of the EMS System Act, the Department has chosen not to do so at this time.

 The Department notes that section 8140 of the EMS System Act (relating to conditional temporary licenses) authorizes the Department to issue a conditional temporary license to an EMS agency that is unable to provide service 24 hours a day, 7 days a week. An EMS agency can seek a conditional temporary license due to its inability to meet staffing standards at all times or its inability to participate in a county-level or broader-level emergency response plan approved by the Department. Upon approval of the conditional temporary license by the Department, the EMS agency can operate under a conditional temporary license for up to one year. The conditional temporary license may be renewed as many times as the Department determines that it is in the public interest to do so.

Department-initiated changes to § 1027.35.

 Final-form § 1027.35(b) (proposed § 1027.34) was meant to mirror section 8130(b)(1) of the EMS System Act (relating to advanced life support ambulances) and to set forth the minimum staffing requirements for an ALS ambulance crew when responding to a call to provide EMS to a patient who requires EMS ''above the skill level of an AEMT.'' Following publication of the proposed rulemaking, the Department noted that the reference to ''above the skill level of an EMT'' in final-form § 1027.35(b) was incorrect and the reference should have been to ''above the skill level of an AEMT'' per section 8130(b)(1) of the EMS System Act. The Department made this change.

 The Department revised final-form § 1027.35(d) (proposed § 1027.34) and renumbered it as final-form § 1027.35(e) to clarify that an ALS ambulance service needs to meet the standards in § 1027.33 when responding to a call for a patient who requires EMS below the AEMT level of care. While section 8130(b)(2) of the EMS System Act only requires an ALS ambulance service to meet the minimum staffing requirements for a BLS ambulance when responding to a call that requires EMS at or below the AEMT level of care, section 8129(l) of the EMS System Act authorizes the Department by regulation to revise minimum staffing standards for ALS ambulance services. While a BLS ambulance service can employ an AEMT if it wishes to respond to patients who require EMS at the skill level of an AEMT, it is only required to staff its BLS ambulance with EMS providers at the EMR and EMT levels. Due to this minimum staffing requirement, the Department did not want to have a gap in EMS service if an ALS ambulance service responded to a patient who needed EMS at the skill level of an AEMT with only an EMR and an EMT. This circumstance would then require the PSAP or EMS agency dispatch center to dispatch another unit to care for the patient, thus delaying proper care to the patient.

 To provide for those instances in which an ALS ambulance service responds to a patient who requires EMS at the skill level of an AEMT, the Department added final-form § 1027.35(d), which requires an ALS ambulance service to meet the standards in final-form § 1027.34.

Department-initiated changes to § 1027.38

 The Department revised final-form § 1027.38(a) to incorporate language that mirrors section 8132(a) of the EMS System Act (relating to advanced life support squad vehicles) regarding the purpose of an ALS squad service.

Department-initiated changes to §§ 1027.39, 1027.40 and 1027.41

 Following publication of the proposed rulemaking, the Department noted that the language in final-form §§ 1027.39(d), 1027.40(f) and 1027.41(b)(1) concerning expanded scopes of practice differed. This was not the intention of the Department. Therefore, the Department revised these sections to make the language, and the interpretation of requirements, consistent.

§ 1027.41. Special operations EMS services

Comment

 Under § 1027.41, EMS agencies shall meet minimum staffing requirements and staff members shall complete an educational program approved by the Department. An EMS agency will have to show that its EMS providers have the requisite training for the EMS agency to be able to offer special operations EMS services. A commentator requested that the Department consider using the Nationally-recognized American Safety & Health Institute's wilderness medicine curriculum as one of the approved courses to certify wilderness EMS responders in this Commonwealth.

Response

 As licensure of special operations EMS services is new to the EMS system in this Commonwealth, the Department is still considering various programs through which EMS agencies may offer special operations EMS services. The Department will consider the curriculum suggested by the commentator, as well as other curriculum, for special operations EMS services. The Department is willing to meet with interested stakeholders to implement educational requirements and standards for special operations EMS services. The Department will publicize approved courses for special operations EMS services in the Pennsylvania Bulletin and on the Bureau's web site.

Comment

 A commentator questioned whether ski patrollers who provide EMS services in this Commonwealth are subject to the regulations, in particular § 1027.41.

Response

 The Department determined prior to publication of the proposed rulemaking not to impose regulatory requirements on ski patrol EMS services. Regulation of ski patrol services was not included in the final-form rulemaking submitted by the Department. Meanwhile, the Department will continue to monitor ski patrol services in this Commonwealth and work with interested stakeholders to establish a voluntary program in which ski patrol EMS services may participate.

Department-initiated changes to § 1027.41

 Following publication of the proposed rulemaking, the Department noted that it referenced an incorrect subsection of the regulation. The reference in § 1027.41 should be to § 1027.3(j), not § 1027.3(h).

Chapter 1029. Medical command facilities and receiving facilities

§ 1029.21. Receiving facilities

Comment

 Section 8128(b) of the EMS System Act authorizes the Department by regulation to recognize other types of facilities to serve as receiving facilities for purposes of serving patients who have special medical needs. Under this statutory authority, the Department proposed § 1029.21(b). Proposed § 1029.21(b) stated that the Department would publish a list in the Pennsylvania Bulletin of receiving facilities specializing in trauma, percutaneous coronary intervention, acute strokes and serious burns, and receiving facilities appropriate for other patients with special needs as described in the Statewide EMS protocols.

 IRRC and another commentator commented on this section. The commentator was concerned that listing specialty receiving facilities through a notice in the Pennsylvania Bulletin would give the Department authority to determine where patients are transported without providing the criteria through regulation upon which the Department's decisions would be made. IRRC wanted clarification on the Department's specific statutory authority to establish, maintain and update a list of specialty receiving facilities by means of publication in the Pennsylvania Bulletin. IRRC also requested that the Department consider adding provisions to the regulation explaining the process that will be used to update the list and how the affected parties will have the opportunity to comment on any contemplated changes.

Response

 The Department decided to delete the text in § 1029.21(b) concerning the Department's establishment of a list of specialty receiving facilities. The Department will continue to discuss this matter with interested parties and may address this issue in a future rulemaking.

Department-initiated changes to § 1029.21

 Proposed § 1029.21 contained a provision mandating that a receiving facility had to be a fixed location. However, following publication of the proposed rulemaking and a review of section 8128(b) of the EMS System Act, the Department noted that while section 8128(b) of the EMS System Act requires a receiving facility to have a fixed location, a receiving facility can have temporary locations so long as it has at least one fixed location. Therefore, the Department revised § 1029.21(a) to comply with section 8128(b) of the EMS System Act.

Chapter 1031. Complaints, disciplinary actions, adjudications and appeals

Comment

 IRRC recognized the Department's authority to discipline EMS providers, EMSVOs and EMS agencies. However, IRRC questioned the Department's statutory authority for imposing discipline on the other entities in Chapter 1031 (relating to complaints, disciplinary actions, adjudications and appeals). In addition, IRRC questioned the Department's statutory authority under §§ 1031.6 and 1031.9 (relating to temporary suspension of EMS provider and EMS vehicle operator certifications; and automatic suspension for incapacity). IRRC's comment addressed §§ 1031.6—1031.9 and 1031.11—1031.16.

Response

 The Department's statutory authority to promulgate §§ 1031.6—1031.9 and 1031.11—1031.16 permitting disciplinary sanctions against certain EMS personnel derives from specific sections of the EMS System Act.

 Section 8123(a) of the EMS System Act (relating to suspension of certification) authorizes the Department to temporarily suspend an EMS provider's or EMSVO's certification without a hearing if the Department determines that the person is a clear and immediate danger to the public health and safety. Section 1031.6 is promulgated under this statutory authority.

 Section 8124(d) of the EMS System Act authorizes the Department to impose discipline against an EMS instructor under specified circumstances. If discipline is authorized, section 8124(e) of the EMS System Act empowers the Department to impose certain types of discipline against EMS instructors. Section 1031.7 (relating to discipline of EMS instructors) is promulgated under this statutory authority.

 Section 8126(h) of the EMS System Act authorizes the Department to impose discipline against a medical command physician or a medical command facility medical director under specified circumstances. If discipline is authorized, section 8126(i) of the EMS System Act empowers the Department to impose certain types of discipline against medical command physicians and medical command facility medical directors. Section 1031.8 (relating to discipline of medical command physicians and medical command facility medical directors) is promulgated under this statutory authority.

 Section 8123(b) of the EMS System Act authorizes the Department to automatically suspend a certification issued under the EMS System Act if the EMS provider has been adjudicated as incapacitated under 20 Pa.C.S. § 5511 (relating to petition and hearing; independent evaluation). Section 8123(b) of the EMS System Act also authorizes the Department to lift the suspension upon the person establishing to the Department that the person has been adjudicated to have regained capacity under 20 Pa.C.S. § 5517 (relating to adjudication of capacity and modification of existing orders). Section 1031.9 is promulgated under this statutory authority.

 Section 8127(g) of the EMS System Act authorizes the Department to impose discipline against a medical command facility under specified circumstances. If discipline is authorized, section 8127(h) of the EMS System Act empowers the Department to impose certain types of discipline against medical command facilities. Section 1031.11 (relating to discipline of medical command facilities) is promulgated under this statutory authority.

 Section 8113(d)(4) of the EMS System Act authorizes the Department to impose discipline against an EMS educational institute under specified circumstances. If discipline is authorized, that section also empowers the Department to impose certain types of discipline against EMS educational institutes. Section 1031.12 (relating to discipline of EMS educational institutes) is promulgated under this statutory authority.

 Section 8113(d)(4) of the EMS System Act authorizes the Department to impose discipline against a provider of EMS continuing education under specified circumstances. If discipline is authorized, that section also empowers the Department to impose certain types of discipline against providers of EMS continuing education. Section 1031.13 (relating to discipline of providers of EMS continuing education) is promulgated under this statutory authority.

 Section 8156(c) of the EMS System Act (relating to penalties) authorizes the Department to impose a civil money penalty against a person who owns or operates an EMS agency in this Commonwealth without having a license to operate that EMS agency. Further, that section also authorizes the Department to impose a civil money penalty against a person who provides EMS without an EMS provider's certification or other legal authority to provide EMS. Section 1031.14 (relating to civil money penalty for practicing without a license or certification) is promulgated under this statutory authority.

 Section 8106(f) of the EMS System Act authorizes the Department to impose a civil money penalty against a vendor of EMS PCR software under specified circumstances. Section 1031.15 (relating to discipline of vendors of EMS PCR software) is promulgated under this statutory authority.

 Section 8129(f) of the EMS System Act authorizes the Department to deny, withdraw or condition approval to an entity to provide management services for an EMS agency under specified circumstances. Section 1031.16 (relating to discipline of management companies) is promulgated under this statutory authority.

§ 1031.1. Administrative and appellate procedure

Comment

 IRRC commented on proposed § 1031.1(b) (relating to administrative and appellate procedure) regarding rules that supplement 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure) (GRAPP). To assist the regulated community with compliance, IRRC recommended that the Department include cross references to show which GRAPP provisions are being supplemented.

Response

 After further consideration, the Department deleted proposed § 1031.1(b) from the final-form rulemaking. The Department will conduct formal proceedings under GRAPP, except when otherwise indicated in the regulations. To accommodate this revision, the Department has renumbered proposed subsection (c) as final-form subsection (b).

§ 1031.2. Complaints and investigations

Comment

 A commentator was concerned about the language in § 1031.2 (relating to complaints and investigations), specifically, subsection (a). Section 1031.2(a) states that a person may file a complaint with the Department for a violation of the EMS System Act or the regulations by an individual or entity that is regulated by the Department under the act or this subpart or by an individual or entity believed to have provided EMS or other care under the EMS System Act or regulations without the proper license, certification or authorization to do so.

 The commentator was concerned that this section could be broadly construed and could subject hospitals or other entities to multiple complaint investigations initiated by different bureaus within the Department. The commentator suggested that § 1031.2 should state that the Department's authority is to investigate complaints regarding EMS providers. The commentator suggested that the Department should clarify how complaints are investigated.

Response

 The Department did not change this section in response to this comment. The wording of this section, which is modeled after section 8105(a)(14) of the EMS System Act, was purposeful to make plain the Department's investigative authority not only in circumstances when the applicability of the EMS System Act and its regulations are clear but also in circumstances when an individual or entity may be providing EMS without authorization to do so. The broad language that the commentator has pointed out, which is also in the EMS System Act, is necessary to give the Department the authority to levy civil money penalties against an individual or entities that are engaged in EMS without a proper license or certification. See section 8156 of the EMS System Act. In addition, section 8156 of the EMS System Act provides for criminal penalties against individuals or entities that provide EMS without the proper license or certification. Therefore, the regulation cannot be limited to just EMS providers, as the Department has the authority to investigate possible violations against unlicensed entities or uncertified persons providing EMS without the authority to do so.

 The Department cannot specify investigation procedures in its regulations because doing so could hamper investigations. Each incident lends itself to a different type of investigation and different procedures. The Bureau works with other entities, both within the Department and outside of the Department, in situations when jurisdictions may overlap. The Bureau's focus will be on the EMS System Act and its regulations. If the Bureau were to find possible violations outside of the scope of its authority, it will refer those issues to the appropriate office or agency.

Department-initiated changes to § 1031.2

 The Department revised the first sentence in § 1031.2(a) to read ''subpart'' instead of ''part.'' The Department revised the heading of § 1031.2(c) to read ''status of complaint,'' not ''status of complainant.''

 The Department revised § 1031.2(d) to clarify that it will not provide the name of a complainant to the person or entity being investigated, except under limited circumstances. The Department will withhold the complainant's name even if the Department determines that it will notify the subject of the complaint that a complaint was received. The Department added this section out of concern that complainants may not come forward or may fear for their personal safety if their names are not kept confidential. Withholding the name of the complainant also comports with section 708(b)(17) of the Right-to-Know Law (65 P. S. § 67.708(b)(17)), regarding exceptions to public records, which precludes access to records regarding an agency's noncriminal investigation, including complaints submitted to an agency.

 The Department also revised § 1031.2(e) to clarify that it will not provide to the complainant communications between the Department and a person involved in the investigation, including the subject of the complaint. This includes the results of the investigation, except when disclosure of the results of the investigation is required by law. As with the revision to subsection (d), the revision to subsection (e) comports with section 708(b)(17)(vi)(A) of the Right-to-Know Law, which exempts access to a record that would reveal the ''institution, progress or result of an agency investigation, except the imposition of a fine or civil penalty, the suspension, modification or revocation of a license, permit, registration, certification or similar authorization issued by an agency. . . .''

Department-initiated changes to § 1031.3

 The Department revised § 1031.3(b) (relating to discipline of EMS providers) to clarify that it has the authority to impose one or more disciplinary sanctions against an EMS provider. The Department has this statutory authority under section 8121(d) of the EMS System Act (relating to certification sanctions).

Department-initiated changes to § 1031.4

 The Department revised § 1031.4 (relating to petition for certification after revocation) to mirror section 8121(d) of the EMS System Act. The Department wanted to clarify that a person who applies for reinstatement is actually applying for a new certification as opposed to reinstatement of a certification that had been previously revoked. The Department also revised the heading to this section to clarify that a person is filing a petition for certification after their original certification has been revoked.

Department-initiated changes to § 1031.6

 The Department revised § 1031.6 to mirror the language used in section 8123(a) of the EMS System Act. Specifically, the Department replaced ''emergency'' with ''temporary.''

Department-initiated changes to § 1031.7

 The Department revised § 1031.7(b) to clarify that it has the authority to impose one or more disciplinary sanctions against an EMS instructor. The Department has statutory authority under section 8124(e) of the EMS System Act.

Department-initiated changes to § 1031.8

 The Department revised § 1031.8(b) to clarify that it has the authority to impose one or more disciplinary sanctions against a medical command physician or a medical command facility medical director. The Department has statutory authority under section 8126(i) of the EMS System Act.

Department-initiated changes to § 1031.10

 The Department revised the heading of § 1031.10(a) (relating to discipline of EMS agencies) to ''grounds for discipline'' to mirror the headings of the other sections of Chapter 1031 addressing discipline. The Department revised § 1031.10(b) to clarify that it has the authority to impose one or more disciplinary sanctions against an EMS agency. The Department has statutory authority under section 8142(b) of the EMS System Act.

Department-initiated changes to § 1031.11

 The Department revised the heading of § 1031.11(a) to ''grounds for discipline'' to mirror the headings of the other sections of Chapter 1031 addressing discipline. The Department revised § 1031.11(b) to clarify that it has the authority to impose one or more disciplinary sanctions against a medical command facility. The Department has statutory authority under section 8127(h) of the EMS System Act.

Department-initiated changes to § 1031.12

 The Department revised this section to follow the wording of section 8113(d) of the EMS System Act regarding the grounds for discipline and the types of discipline the Department may seek against EMS educational institutes.

Department-initiated changes to § 1031.13

 The Department revised § 1031.13 to follow the wording in section 8113(d) of the EMS System Act regarding the grounds for discipline and the types of discipline the Department may seek against EMS continuing education sponsors.

Chapter 1033. Special event EMS

Comment

 IRRC requested clarification on how Chapter 1033 (relating to special event EMS) will be administered in conjunction with final-form § 1027.41(e) (proposed § 1027.38(e)), regarding mass-gathering EMS service.

Response

 The focus of mass-gathering EMS services, which are a part of special operations EMS services under final-form § 1027.41, is the actual mass-gathering, such as a concert or a sporting event. By contrast, special event EMS deals with issues beyond the actual event. For example, special event EMS may include planning for the event and traffic flow issues for the event. Mass-gathering EMS and special event EMS are needed in combination to protect the health and safety of the citizens of this Commonwealth. At a music concert, for example, mass-gathering EMS would focus on the music concert and the people attending the concert and ensuring the availability of EMS to those persons who might require it. Special event EMS, on the other hand, would focus on the broader EMS issues, including the traffic flow patterns and other traffic safety issues should the need arise to evacuate the music concert because of an emergency situation.

 Mass-gathering EMS services require a license to operate as a special operations EMS service under section 8136 of the EMS System Act. Special event EMS services under a special event EMS plan are optional under § 1033.1(a) (relating to special event EMS planning requirements) and those entities who opt to prepare a plan and submit it to the Department for approval do not need a specific special event EMS license. An entity that is responsible for the management and administration of a special event may submit a special event EMS plan to the Department if the entity needs assistance in developing the plan. An entity that opts to submit a plan for approval shall comply with the special event EMS regulations and follow the final plan that is approved by the Department.

C. Fiscal Impact

Regulated community

 There could be additional costs to some EMS agencies because of the requirement that EMS agencies operate 24 hours a day, 7 days a week. However, the requirement that EMS agencies operate 24 hours a day, 7 days a week is imposed by the EMS System Act, not the regulations. Permission to operate less than 24 hours a day, 7 days a week requires a determination by the Department that operating less than 24 hours a day, 7 days a week is not contrary to the public interest. The costs incurred by those EMS agencies that are operating other than on a full-time basis will be less than those EMS agencies operating on a full-time basis.

 EMS agencies are required to have a medical director. Currently, all ALS operations and about 80% of the BLS operations have a medical director. There may be additional costs to EMS agencies that do not currently have a medical director. Once again, this requirement is imposed by the EMS System Act, not the regulations, and costs will vary depending upon several factors. These factors include whether the medical director will be paid or serve on a voluntary basis and whether the medical director will be overseeing a densely populated urban area or a less populated rural area. EMS agencies in the more densely populated areas of this Commonwealth likely will have to pay more for their medical directors than EMS agencies in less densely populated areas.

 Based on information the Department received from regional EMS councils, the majority of EMS agencies have volunteer agency medical directors and a majority of the EMS agencies that contract for a medical director have a part-time medical director that is paid $50 to $85 per hour for approximately 10 to 20 hours of work per month. While the top-salaried medical director earns approximately $130,000 per year, the medical director has job duties in addition to those as medical director.

 Regulation of EMS agency dispatch centers, per the EMS System Act and the regulations, is new. The Department consulted with PEMA for guidance on training and recertification costs for call-takers and dispatchers for EMS agency dispatch centers, as PEMA oversees training of call-takers and dispatchers for 911 dispatch centers and will certify call-takers and dispatchers for EMS agency dispatch centers as required under section 8129(i)(1) of the EMS System Act. The initial EMD certification requires the applicant to be able to read and write at a high school graduate or GED level and enroll in an approved EMD course, complete a written certification exam and obtain a passing score. Once the applicant passes an EMD course, PEMA will provide the applicant with an additional Commonwealth EMD test. This test is completed at no additional cost to the EMS agency or the applicant. The EMD course is approximately 24 to 40 hours in length with a cost of approximately $200, depending on which Nationally-recognized program the EMS agency uses. The applicant also must be certified in CPR. The EMS agency or applicant would also bear the cost for the applicant to complete a CPR course with a cost of approximately $35, depending on which program the EMS agency uses. The Department estimates that these requirements will affect fewer than ten EMS agencies currently, since most EMS agencies are using the county dispatch center for their emergency responses instead of their own EMS agency dispatch center. Certification costs will be paid for by either the EMS agency or the applicant as part of his work requirements.

Local government

 There will be neither significant additional costs nor savings to local governments because the changes as a result of the regulations do not affect local governments. Although some of the regional EMS councils are a unit of a county government, regional EMS councils will continue to operate as they have been under the current regulations. In addition, while some local governments have their own EMS providers, those providers will be performing essentially the same work under the EMS System Act and the regulations that they are currently performing. If a local government chooses to add more EMS providers or expand the scope of EMS that it provides, that decision will be made by the local government and will not be one imposed by the EMS System Act or the regulations.

State government

 There will be an increase in costs to the Department associated with its duty to license and certify EMS providers and other persons and entities involved in the EMS system. However, these additional costs are imposed by the EMS System Act, not the regulations. There are new costs associated with issuing certifications and registrations for EMSVOs, EMRs, AEMTs, PHPEs, medical command physicians and medical command facility medical directors. Issuance of certifications and registrations will require the development of additional patches and decals to recognize the new levels of certification at an estimated cost of $1,500 per new type of EMS provider certification, approximately $6,000 total. The Department will manage this cost within the Bureau's annual budget.

 There will be a need for enhancement to the EMSRS software and AAS software. In the process of making enhancements required under the regulations, the Department will make required improvements to the EMSRS and AAS to meet National standards for EMS credentialing. The work will be accomplished by one staff position funded from Federal grants through the Department's Bureau of Public Health Preparedness.

 The Department's disciplinary authority has been expanded under the EMS System Act to include the ability to impose civil money penalties and this authority has been addressed in the final-form rulemaking. Depending upon the type of entity against which a civil money penalty is imposed, fines can be $1,000 to $5,000 per violation. When the provisions for civil money penalties take effect, civil money penalties could generate at least $10,000 per year for EMSOF.

 Additional State savings will be realized in the contract and grant award process because the Department will not be required to devote staff time to justify sole source contracting with regional EMS councils when those grants expire every 3 years. Section 8112(l) of the EMS System Act provides that the Department may renew a contract or grant with a regional EMS council without engaging in competitive bidding if the Department determines that the regional EMS council has met its responsibilities under the grant or contract.

 Various provisions of the EMS System Act require an applicant for EMS provider or EMSVO certification to report to the Department misdemeanor, felony and other criminal convictions that are not summary or equivalent offenses and disciplinary sanctions that have been imposed upon a license, certification or other authorization of the applicant to practice an occupation or profession. An applicant for EMSVO certification is to report to the Department any other conviction of an offense involving reckless driving or driving under the influence of alcohol or drugs, or a conviction that results in a driver's license suspension due to drugs or alcohol or a moving traffic violation. The regulations require the applicant to arrange for the custodian of the criminal charging, judgment and sentencing documents for each conviction and the custodian of adjudications or other documents imposing discipline against the applicant to provide the Department with a certified copy of those records. Self-reporting will save the Department the cost and time in requesting and receiving the required documents to review in deciding whether to grant, deny or impose conditions on a certification.

 The EMS System Act, as well as the regulations, requires the medical director of an EMS agency to conduct an initial and annual assessment of each EMS provider of the EMS agency at or above the AEMT level to determine whether to allow the EMS provider to provide EMS at the skill level at which the provider is certified. Once this assessment is completed and a decision rendered, there is no right of appeal to the Department as there was previously under the prior EMS Act. The elimination of the administrative appeal process to the Department provides a cost savings for the Department, but that savings is difficult to calculate.

D. Paperwork Requirements

 There are paperwork requirements under the regulations that were not imposed by the prior EMS Act. The regulations foster the use of electronic transmission of documents. In addition, there are changes regarding the submission of paper documents.

 Section 1021.41(a) requires EMS agencies to prepare and submit an EMS PCR form for each call for assistance to which the agency responds. Under the prior EMS Act, an EMS provider was required to complete and submit the EMS PCR to the receiving facility within 24 hours. Under the final-form rulemaking, the EMS provider is to submit the completed EMS PCR to the receiving facility within 72 hours after the EMS agency concluded patient care. EMS agencies that paid staff an overtime rate to complete the full EMS PCR within 24 hours will realize a cost savings.

 Section 1021.41(c) requires an EMS agency transporting a patient to a receiving facility to verbally, and in writing or by other means, report to the individual at the receiving facility assuming responsibility for the patient the patient information that is essential for immediate transmission for patient care. Transfer of patient information, verbally and in writing, must occur prior to the ambulance departing from the receiving facility. The Department will publish a notice in the Pennsylvania Bulletin specifying the types of essential patient care information that shall be transmitted to the receiving facility at the time of patient delivery. This patient transfer document is not new, as it has been developed and employed in a pilot project to address the transfer of a patient to a higher level of care.

 Paperwork responsibilities associated with special operations EMS services will be different from those for standard EMS services. Under § 1027.41, an EMS agency that offers special operations EMS will need to maintain a log of every patient encounter, but the documentation form for the patient may differ, depending on the level of EMS provided to the patient. The special operations EMS agency will only be required to complete a full EMS PCR for a patient transported by ambulance if the patient receives EMS at a level that exceeds the scope of practice of an EMT. Otherwise, the agency will complete the less extensive written transfer of care form referenced in § 1021.41(c). If the special operations EMS agency does not transport the patient, it will need to complete an EMS PCR only for a patient who refuses EMS or dies while under the care of the special operations EMS service.

E. Statutory Authority

 The Department derives its authority to promulgate the final-form rulemaking from the EMS System Act. In addition, section 7 of Act 37 provides that the EMS System Act shall be liberally construed to authorize the Department to promulgate regulations to carry out the EMS System Act. Section 7 of Act 37 also states that the absence of express authority to adopt regulations in a provision of the EMS System Act may not be construed to preclude the Department from adopting a rulemaking to carry out that provision. Further, section 2102(g) of The Administrative Code of 1929 (71 P. S. § 532(g)) provides the Department with general authority to promulgate its regulations.

 Specific sections of the EMS System Act also authorize the promulgation of regulations. Section 8103 the EMS System Act defines a few terms in a manner that expressly permits the Department to expand the definition by regulation. The terms ''EMS agency—emergency medical services agency'' and ''EMS provider—emergency medical services provider'' are defined in a manner to permit the Department to expand the scope of those definitions by regulation.

 Section 8105 of the EMS System Act includes several provisions allowing the Department to carry out responsibilities by adopting regulations. Subsection (b)(2) authorizes the Department to establish by regulation standards and criteria governing the awarding and administration of contracts and grants by the Department for the initiation, maintenance and improvement of regional EMS systems. Subsection (b)(4) empowers the Department to collect, under the Department's regulations, information about patients admitted to various facilities. Subsection (b)(11) authorizes the Department to promulgate regulations to establish standards and criteria for EMS systems.

 Section 8106 of the EMS System Act authorizes the Department to promulgate regulations concerning EMS PCR information that an EMS agency must submit to the Department or a regional EMS council.

 Sections 8113 of the EMS System Act authorizes the Department to develop standards through regulation for the accreditation and reaccreditation of EMS educational institutes, for the approval of continuing education courses, for the accreditation of entities that provide continuing education courses and for taking and passing EMS provider certification examinations. This section prescribes the form or process for EMS provider certification through regulation. This section also permits the Department to change those standards through regulation.

 Sections 8114—8120 of the EMS System Act, pertaining to the certification and registration requirements for the various types of EMS providers and the scope of their practice, authorize the Department to expand the functions of each type of EMS provider through regulation. These sections also prescribe the application process for EMS provider certification and recertification through regulation.

 Section 8122 of the EMS System Act contains provisions similar to those in sections 8113—8120 of the EMS System Act that authorize the Department through regulation to prescribe the manner in which applications for EMSVO certification and registration of the certification are to be submitted and requirements for registering a certification after the registration has expired through regulation.

 Section 8124 of the EMS System Act authorizes the Department to adopt regulations to set standards for EMS instructors in providing instruction in EMS educational institutes.

 Section 8125 of the EMS System Act authorizes the Department to prescribe the roles and responsibilities of an EMS agency medical director by regulation.

 Section 8126 of the EMS System Act authorizes the Department to prescribe the process that applications for certification and registration of the certification for medical command physicians and facility medical directors are to be submitted.

 Section 8127 of the EMS System Act authorizes the Department to prescribe the process that applications for certification and registration for certification for medical command facilities are to be submitted. This section also authorizes the Department to promulgate by regulation requirements, in addition to those in this section, for a medical command facility to ensure that it operates in an effective and efficient manner to achieve the purposes for which it is certified.

 Section 8128 of the EMS System Act authorizes the Department, through regulations, to establish parameters for special facilities to receive patients transported by ambulance who have special medical needs.

 Section 8129 of the EMS System Act authorizes the Department to prescribe the process that EMS agency certifications and registration of those certifications are to be submitted. This section also authorizes the Department to specify by regulation other vehicles and services the operation of which will require an EMS agency license. This section provides that the Department may, by regulation, establish other criteria an applicant for an EMS agency license shall demonstrate its EMS agency medical director satisfies based upon the types of EMS vehicles the applicant is applying to operate and the types of services it is applying to provide. This section also authorizes the Department to specify types of EMS vehicles that must display a Department-issued inspection sticker as prescribed by the Department by regulation and further provides that the Department, by regulation, may require other types of EMS vehicles to display a Department-issued inspection sticker. Section 8129 of the EMS System Act also authorizes the Department to promulgate regulations to revise the staffing standards for EMS agencies that are designated in sections 8130—8135 of the EMS System Act. Finally, this section authorizes the Department to promulgate regulations setting forth requirements for EMS agencies in the Commonwealth based upon the types of EMS vehicles they operate and the services they provide.

 Section 8136 of the EMS System Act authorizes the Department to promulgate regulations to provide for specific types of special operations teams. This section permits the Department, by regulation, to prescribe additional training and expertise requirements for the EMS agency medical director and the EMS providers who staff a special operations EMS service. This section authorizes the Department to employ regulations to establish staffing, equipment, supply and other requirements for special operations EMS services.

 Section 8138 of the EMS System Act authorizes the Department to promulgate regulations to establish EMS vehicle and service standards for EMS vehicles and services not specified in the EMS System Act.

F. Effective Date/Sunset Date

 Several of the final-form regulations will go into effect when published in the Pennsylvania Bulletin. Other regulatory sections, including the statutory provisions to which they relate, will not go into effect until 180 days after the final-form rulemaking is published. Under section 9(1) of Act 37, sections 8113(a), (c), (d) and (n), 8114—8120, 8122, 8129—8138 and 8140—8142 of the EMS System Act will be effective on April 10, 2014. Sections 1023.22—1023.32, 1023.52, 1025.1—1025.3, 1025.21—1025.23, 1027.1—1027.13, 1027.31—1027.42, 1027.52, 1031.5, 1031.10, 1031.12, 1031.13 and 1031.16 will be effective on April 10, 2014.

 A sunset date will not be imposed. The Department will monitor the regulations to ensure that they meet EMS needs that are within the scope of the Department's authority to address through regulations.

G. Regulatory Review

 Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on October 11, 2011, the Department submitted a copy of the notice of proposed rulemaking, published at 41 Pa.B. 5865, to IRRC and the Chairpersons of the Senate Committee on Public Health and Welfare and the House Committee on Veterans Affairs and Emergency Preparedness for review and comment.

 Under section 5(c) of the Regulatory Review Act, IRRC and the House and Senate Committees were provided with copies of the comments received during the public comment period, as well as other documents when requested. In preparing the final-form rulemaking, the Department has considered all comments from IRRC, the House and Senate Committees and the public.

 Under section 5.1(j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.2)), on August 21, 2013, the final-form rulemaking was deemed approved by the House and Senate Committees. Under section 5.1(e) of the Regulatory Review Act, IRRC met on August 22, 2013, and approved the final-form rulemaking.

H. Contact Person

 Questions regarding this final-form rulemaking may be submitted to Richard L. Gibbons, Director, Bureau of Emergency Medical Services, Department of Health, Room 606, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120-0701. Persons with disabilities who require an alternative format of this final-form rulemaking (for example, large print, Braille or audiotape) should contact Richard Gibbons at the previously listed address or (717) 787-8740 to make the necessary arrangements. Speech or hearing impaired persons may use VTT at (717) 783-6514 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).

I. Findings

 The Department finds that:

 (1) Public notice of the intention to adopt the regulations adopted by this order has been given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202), known as the Commonwealth Documents Law, and the regulations thereunder, 1 Pa. Code §§ 7.1 and 7.2.

 (2) A public comment period was provided as required by law and the comments were considered.

 (3) The adoption of the regulations in the manner provided by this order is necessary and appropriate for the administration of the authorizing statutes.

J. Order

 The Department, acting under the authorizing statutes, orders that:

 (a) The regulations of the Department, 28 Pa. Code, are amended by deleting §§ 1001.1—1001.7, 1001.21—1001.28, 1001.41, 1001.42, 1001.61, 1001.62, 1001.65, 1001.81—1001.84, 1001.101, 1001.121—1001.125, 1001.141—1001.143, 1001.161, 1003.1—1003.5, 1003.21—1003.23, 1003.23a, 1003.24, 1003.25a, 1003.25b, 1003.26—1003.34, 1005.1, 1005.2, 1005.2a, 1005.3—1005.7, 1005.7a, 1005.8—1005.15, 1007.1, 1007.2, 1007.7, 1007.8, 1009.1, 1009.2, 1009.4—1009.6, 1011.1, 1011.3, 1011.4, 1013.1—1013.8, 1015.1 and 1015.2 and by adding §§ 1021.1—1021.8, 1021.21—1021.28, 1021.41—1021.43, 1021.61—1021.64, 1021.81—1021.83, 1021.101—1021.104, 1021.121—1021.123, 1021.141, 1023.1—1023.5, 1023.21—1023.34, 1023.51, 1023.52, 1025.1—1025.3, 1025.21—1025.23, 1027.1—1027.14, 1027.31—1027.42, 1027.51, 1027.52, 1029.1—1029.6, 1029.21, 1031.1—1031.16 and 1033.1—1033.7 to read as set forth in Annex A.

 (Editor's Note: Final-form §§ 1027.4, 1027.34, 1027.36, 1027.37 and 1027.42 were not included in the proposed rulemaking published at 41 Pa.B. 5865. Accordingly, final-form §§ 1027.5—1027.14, 1027.35 and 1027.38—1027.41 were renumbered from the proposed rulemaking.)

 (b) The Secretary shall submit this order and Annex A to the Office of General Counsel and the Office of Attorney General for approval as required by law.

 (c) The Secretary shall submit this order and Annex A to IRRC, the Senate Committee on Public Health and Welfare and the House Committee on Veterans Affairs and Emergency Preparedness for their review and action as required by law.

 (d) The Secretary shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.

 (e) This final-form rulemaking takes effect as follows:

 The rescission of §§ 1001.1—1001.7, 1001.21—1001.28, 1001.41, 1001.42, 1001.61, 1001.62, 1001.65, 1001.81—1001.84, 1001.101, 1001.121—1001.125, 1001.141—1001.143, 1001.161, 1003.1—1003.5, 1003.23a, 1003.27, 1003.28, 1009.1, 1009.2, 1009.4—1009.6 and 1013.1—1013.8 takes effect upon publication in the Pennsylvania Bulletin.

 The rescission of §§ 1003.21—1003.23, 1003.24, 1003.25a, 1003.25b, 1003.26, 1003.29—1003.34, 1005.1, 1005.2, 1005.2a, 1005.3—1005.7, 1005.7a, 1005.8—1005.15, 1007.1, 1007.2, 1007.7, 1007.8, 1011.1, 1011.3, 1011.4, 1015.1 and 1015.2 takes effect on April 10, 2014.

 Sections 1021.1—1021.8, 1021.21—1021.28, 1021.41—1021.43, 1021.61—1021.64, 1021.81—1021.83, 1021.101—1021.104, 1021.121—1021.123, 1021.141, 1023.1—1023.5, 1023.21, 1023.33, 1023.34, 1023.51, 1027.51, 1029.1—1029.6, 1029.21, 1031.1—1031.4, 1031.6—1031.9, 1031.11, 1031.14, 1031.15 and 1033.1—1033.7 take effect upon publication in the Pennsylvania Bulletin.

 Sections 1023.22—1023.32, 1023.52, 1025.1—1025.3, 1025.21—1025.23, 1027.1—1027.13, 1027.31—1027.42, 1027.52, 1031.5, 1031.10, 1031.12, 1031.13 and 1031.16 take effective on April 10, 2014.

 Section 1027.14 takes effect on October 7, 2014.

 Sections 8113(a), (c), (d) and (n), 8114—8120, 8122, 8129—8138 and 8140—8142 of the EMS System Act take effective on April 10, 2014.

MICHAEL WOLF, 
Secretary

 (Editor's Note: For the text of the order of the Independent Regulatory Review Commission relating to this document, see 43 Pa.B. 5435 (September 7, 2013).)

 (Editor's Note: See 43 Pa.B. 6179 (October 12, 2013) for a notice relating to this final-form rulemaking.)

 Fiscal Note: Fiscal Note 10-190 remains valid for the final adoption of the subject regulations.

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