Subchapter A. ADMINISTRATIVE AND SUPERVISORY EMS PERSONNEL
Sec.
1023.1. EMS agency medical director.
1023.2. Medical command physician.
1023.3. Medical command facility medical director.
1023.4. Regional EMS medical director.
1023.5. Commonwealth EMS Medical Director.§ 1023.1. EMS agency medical director.
(a) Roles and responsibilities. An EMS agency medical director is responsible for:
(1) Providing medical guidance and advice to the EMS agency, including:
(i) Reviewing the Statewide EMS protocols and Department-approved regional EMS protocols that are applicable to the EMS agency and ensuring that its EMS providers and other relevant personnel are familiar with the protocols applicable to the EMS agency.
(ii) Performing medical audits of EMS provided by the EMS agency’s EMS providers.
(iii) Participating in and reviewing quality improvement and peer reviews of EMS provided by the EMS agency.
(iv) Reviewing regional mass casualty and disaster plans and providing guidance to the EMS agency regarding its provision of EMS under those plans.
(v) Providing guidance to the EMS agency, when applicable, with respect to the ordering, stocking and replacement of medications, and compliance with laws and regulations impacting upon the EMS agency’s acquisition, storage and use of those medications.
(vi) Making an initial assessment of each EMS provider at or above the AEMT level to determine whether the EMS provider has the knowledge and skills to competently perform the skills within the EMS provider’s scope of practice, and a commitment to adequately perform other functions relevant to the EMS provider providing EMS at that level. This subparagraph does not apply if the EMS provider was working for the EMS agency at the same level prior to the physician becoming the medical director for the EMS agency and the EMS provider was credentialed at that EMS agency within the last 12 calendar months as being able to perform at the EMS provider’s certification level.
(vii) Making an assessment, within 12 calendar months of the last assessment, of each EMS provider at or above the AEMT level to determine whether the EMS provider has demonstrated competency in the knowledge and skills to perform the skills within the EMS provider’s scope of practice, and a commitment to adequately perform other functions relevant to the EMS provider providing EMS at that level.
(viii) Recommending to the EMS agency that an EMS provider not be permitted to provide EMS at the EMS provider’s certification level if the EMS agency medical director determines that the EMS provider has not demonstrated competency in the knowledge and skills to perform the skills within the EMS provider’s scope of practice, or a commitment to adequately perform other functions relevant to the EMS provider providing EMS at that level, and recommending restrictions on the EMS provider’s practice for the EMS agency, if appropriate, to ensure patient safety.
(ix) Providing medical direction for the EMS agency dispatch center if the EMS agency operates an EMS agency dispatch center.
(2) Maintaining a liaison with the regional EMS medical director.
(3) Participating in the regional and Statewide quality improvement programs.
(4) Recommending to the relevant regional EMS council, when appropriate, EMS protocols for inclusion in the Statewide and regional EMS protocols.
(5) Recommending to the Department the suspension, revocation or restriction of an EMS provider’s certification.
(b) Minimum qualifications. To qualify and continue to function as an EMS agency medical director, an individual shall:
(1) Be a physician.
(2) Satisfy one of the following:
(i) Have successfully completed an emergency medicine residency program accredited by a residency program accrediting body recognized by the State Board of Medicine or the State Board of Osteopathic Medicine.
(ii) Have successfully completed a residency program in surgery, internal medicine, family medicine, pediatrics or anesthesiology, accredited by a residency program accrediting body recognized by the State Board of Medicine or the State Board of Osteopathic Medicine. The physician shall also have successfully completed or taught the ACLS course within the preceding 2 years and have completed, at least once, the ATLS course and PALS course or APLS course, or other programs determined by the Department to meet or exceed the standards of these programs.
(iii) Have served as an ALS medical director under the Emergency Medical Services Act (35 P. S. § § 6921—6938) (repealed by the act of August 18, 2009 (P. L. 308, No. 37)) prior to February 16, 2010.
(3) Have a valid Drug Enforcement Agency number.
(4) Have completed an EMS agency medical director course or an EMS fellowship or other EMS training program that is determined by the Department to be equivalent. This training shall ensure that the EMS agency medical director has knowledge of:
(i) The scope of practice of EMS providers.
(ii) The provision of EMS under Statewide EMS protocols.
(iii) The interface between EMS providers and medical command physicians.
(iv) Quality improvement and peer review principles.
(v) Emergency medical dispatch principles and EMS agency communication capabilities.
(vi) EMS system design and operation.
(vii) Federal and State laws and regulations regarding EMS.
(viii) Regional and State mass casualty and disaster plans.
(ix) Patient and EMS provider safety principles.
Cross References This section cited in 28 Pa. Code § 1023.21 (relating to general rights and responsibilities); 28 Pa. Code § 1027.3 (relating to licensure and general operating standards); and 28 Pa. Code § 1033.2 (relating to administration, management and medical direction requirements).
§ 1023.2. Medical command physician.
(a) Roles and responsibilities. A medical command physician functions under the direction of a medical command facility medical director and the auspices of a medical command facility. A medical command physician is responsible for:
(1) Providing medical command to EMS providers whenever they seek direction.
(2) Issuing medical command consistent with Statewide protocols and protocols that are in effect either in the region in which EMS originates or the region from which the EMS providers who are providing EMS begin receiving medical command direction. For good cause, a medical command physician may give medical command that is inconsistent with these protocols.
(3) Documenting patient information received from EMS providers and medical command given to EMS providers, including when the medical command physician is providing medical command at the scene.
(b) Minimum qualifications. To qualify and continue to function as a medical command physician, an individual shall be serving as a medical command physician immediately prior to February 16, 2010, or:
(1) Complete an application for medical command physician certification on a form or through an electronic application process, as prescribed by the Department.
(2) Be a physician.
(3) Satisfy one of the following:
(i) Have successfully completed a residency program in emergency medicine accredited by a residency program accrediting body recognized by the State Board of Medicine or the State Board of Osteopathic Medicine.
(ii) Have had an emergency medicine practice in another jurisdiction and establish to the Department that the physician has a combination of training, education and emergency medicine practice that makes the physician qualified to serve as a medical command physician.
(iii) Have successfully completed or taught the ACLS course within the preceding 2 years and have completed or taught the ATLS course and either an APLS or PALS course or other program determined by the Department to meet or exceed the standards of these programs.
(4) Have an arrangement with a medical command facility to serve as a medical command physician for that facility after receiving certification as a medical command physician.
(5) Be practicing as an emergency medicine physician, be participating as a resident in a second or subsequent year in an emergency medicine residency program accredited by an accrediting body recognized by the State Board of Medicine or the State Board of Osteopathic Medicine or have had at least 3 years of experience as a full-time emergency medicine physician.
(6) Have a current Drug Enforcement Agency (DEA) number or be an emergency medicine resident in an emergency medicine residency program accredited by an accrediting body recognized by the State Board of Medicine or the State Board of Osteopathic Medicine who is authorized to use a hospital’s DEA number for practice within the emergency medicine residency program.
(7) Have successfully completed the medical command course.
(c) Triennial registration. A medical command physician’s certification is deemed registered for 3 years. Thereafter, a medical command physician shall triennially register the certification on a form or through an electronic process, as prescribed by the Department. The Department will issue a new registration within 30 days after the application for registration is filed if the application demonstrates that the medical command physician:
(1) Maintains licensure as a physician.
(2) Has an arrangement with a medical command facility to serve as a medical command physician for that facility.
(3) Is practicing as an emergency medicine physician or has had at least 3 years of experience as a full-time emergency medicine physician.
(4) Has completed the most recent update or refresher course that the Department provided on Statewide and other applicable Department-approved EMS protocols.
Cross References This section cited in 28 Pa. Code § 1031.8 (relating to discipline of medical command physicians and medical command facility medical directors).
§ 1023.3. Medical command facility medical director.
(a) Roles and responsibilities. A medical command facility medical director is responsible for the following for the medical command facility:
(1) Medical command.
(2) Quality improvement.
(3) Liaison with regional EMS medical director.
(4) Participation in prehospital training activities.
(5) Clinical and continuing education training of EMS providers.
(6) Verifying to the Department that an applicant for medical command physician certification has an arrangement to serve as a medical command physician for the medical command facility under the direction of the medical command facility medical director and meets all medical command physician certification requirements.
(7) Monitoring the operation of the medical command facility and the performance of its medical command physicians to ensure that they are satisfying all statutory and regulatory requirements.
(8) Reviewing a departure from the Statewide EMS protocols of one of the facility’s medical command physicians when requested by the Department and apprising the Department whether the medical command facility medical director believes there is good cause for the departure.
(b) Minimum qualifications. To qualify and continue to function as a medical command facility medical director, an individual shall be serving as a medical command facility medical director immediately prior to February 16, 2010, or:
(1) Complete an application for medical command facility medical director certification on a form or through an electronic application process, as prescribed by the Department.
(2) Currently serve as a medical command physician.
(3) Satisfy one of the following:
(i) Have completed a residency program in emergency medicine accredited by a residency program accrediting body recognized by the State Board of Medicine or the State Board of Osteopathic Medicine.
(ii) Have completed a residency program in surgery, internal medicine, family medicine, pediatrics or anesthesiology accredited by a residency program accrediting body recognized by the State Board of Medicine or the State Board of Osteopathic Medicine and completed or taught the ACLS course within the preceding 2 years, the ATLS course and either an APLS or PALS course or other program determined by the Department to meet or exceed the standards of these programs.
(4) Have experience in prehospital and emergency department care of the acutely ill or injured patient.
(5) Have experience in providing medical command direction to EMS providers.
(6) Have experience in the training of EMS providers above and below the AEMT level.
(7) Have experience in the medical audit, review and critique of EMS providers above and below the AEMT level.
(8) Have an arrangement with a medical command facility to serve as its medical director after receiving certification as a medical command facility medical director.
(c) Triennial registration. A medical command facility medical director’s certification is deemed registered for 3 years. Thereafter, a medical command facility medical director shall triennially register the certification on a form or through an electronic process, as prescribed by the Department. The Department will issue a new registration within 30 days after the application for registration is filed if the application demonstrates that the medical command facility medical director shall be:
(1) Serving as a medical command physician and a medical command facility medical director for a medical command facility.
(2) Providing prehospital and emergency department care of acutely ill or injured patients.
(3) Performing medical audit, review and critique of EMS providers above and below the AEMT level.
Cross References This section cited in 28 Pa. Code § 1031.8 (relating to discipline of medical command physicians and medical command facility medical directors).
§ 1023.4. Regional EMS medical director.
(a) Roles and responsibilities. A regional EMS medical director shall carry out the following duties:
(1) Maintain liaison with the Commonwealth EMS Medical Director.
(2) Assist the regional EMS council, after consultation with the regional medical advisory committee, to establish and revise, subject to Department approval, regional EMS protocols.
(3) Assist the regional EMS council to develop, subject to Department approval, criteria to recommend to PSAPs for emergency medical dispatch, including criteria for prearrival instructions, level of care to be dispatched to respond to various clinical conditions, types of EMS resources to be sent and mode of EMS resource response.
(4) Serve as a member of the regional EMS council’s quality improvement committee and as that committee’s liaison to the regional EMS council’s medical advisory committee.
(5) Serve on the State EMS Quality Improvement Committee.
(6) Serve as chairperson of the regional EMS council’s medical advisory committee.
(7) Assist, as appropriate, the regional EMS council in its investigations, analysis of investigation information and recommendations to make to the Department on actions the Department should pursue, if any, against certifications, licenses, accreditations and other authorizations issued by the Department under the act.
(8) Review regional plans, procedures and processes for compliance with State standards of EMS.
(b) Minimum qualifications. A regional EMS medical director shall have the following qualifications:
(1) Be a physician.
(2) Experience in prehospital and emergency department care of the acutely ill or injured patient.
(3) Experience as a medical command physician and as an EMS agency medical director or as an ALS service medical director under the Emergency Medical Services Act (35 P. S. § § 6921—6938) (repealed by the act of August 18, 2009 (P. L. 308, No. 37)).
(4) Completed a residency program in emergency medicine accredited by a residency program accrediting body recognized by the State Board of Medicine or the State Board of Osteopathic Medicine or have served as a medical command physician in this Commonwealth prior to October 14, 2000.
(5) Experience in the training of EMS providers above and below the AEMT level.
(6) Experience in the medical audit, review and critique of EMS providers above and below the AEMT level.
(c) Disclosure. A regional EMS medical director shall disclose to a regional EMS council and the Department all financial or other interest in entities regulated by the Department under the act and in other matters which present a potential conflict of interest.
Cross References This section cited in 28 Pa. Code § 1021.104 (relating to responsibilities of regional EMS councils); and 28 Pa. Code § 1023.5 (relating to Commonwealth EMS Medical Director).
§ 1023.5. Commonwealth EMS Medical Director.
(a) Roles and responsibilities. The Commonwealth EMS Medical Director is responsible for:
(1) Providing medical advice and recommendations to the Department regarding the EMS system.
(2) Assisting in the development and implementation of a Statewide EMS quality improvement program.
(3) Evaluating and making recommendations on regional EMS quality improvement programs and on programs to improve patient and provider safety and provider wellness.
(4) Assisting the Department in revising or modifying the scope of practice of EMS providers.
(5) Providing advice and guidance to the Department on investigations and the pursuit of disciplinary actions against EMS providers and other persons and entities regulated by the Department under the act.
(6) Reviewing, evaluating and making recommendations for the Statewide EMS protocols.
(7) Reviewing, evaluating and making recommendations regarding regional EMS protocols that supplement Statewide EMS protocols.
(8) Providing direction and guidance to the regional EMS medical directors for training and quality improvement monitoring and assistance.
(9) Meeting with representatives and committees of regional EMS councils and the Advisory Board as necessary and as directed by the Department to provide guidance and direction.
(10) Reviewing, evaluating and making recommendations to the Department on requests, for research purposes, for data made confidential by the act.
(11) Assisting the Department in the development of regulations under the act.
(12) Providing other services relating to the Department’s administration of the act as assigned by the Department.
(b) Minimum qualifications. The Commonwealth EMS Medical Director shall possess the same qualifications as a regional EMS medical director under § 1023.4 (relating to regional EMS medical director).
(c) Disclosure. The Commonwealth EMS Medical Director shall disclose to the Department all financial or other interest in EMS agencies and other entities regulated by the Department and other matters which present a potential conflict of interest.
(d) Prohibition against dual service. A physician may not simultaneously serve as the Commonwealth EMS Medical Director and a regional EMS medical director.
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