|
|
|
|
|
Questions Submit a Question directly below or read Answers to Questions at bottom. Please email
with ANY questions since we are experiencing technical difficulty with out question submission form. Sorry for any inconvenience.
A: 105 CMR 170.345 mandates that records be stored for a period of not
less than seven years. The full text of this EMS regulation is available
at:
http://www.mass.gov/Eeohhs2/docs/dph/regs/105cmr170.pdf
A: No; according to 105 CMR 170.390, an ambulance must be stored in a
temperature-controlled garage. The full text of this EMS regulation is
available at:
http://www.mass.gov/Eeohhs2/docs/dph/regs/105cmr170.pdf A: 105 CMR 170.355 (A) "Responsibility to Dispatch, Treat and Transport"
covers the issue of abandonment. The full text of this regulation may be found
at:
http://www.cmemsc.org/protocols-state/emsregsMay2005.pdf A: If a paramedic is off-duty, he is not
considered a paramedic. His duties as a paramedic are only in effect when he is
associated ("on the clock") with a licensed ambulance service. Along these same
lines, if an individual is certified as a paramedic (or any other level of EMT)
but works for a police or fire department that does not have an ambulance
license, s/he is operating as a First Responder. A: Contrary to rumor, the Department has NOT extended the deadline for Service Zone compliance. The
deadline was December 31, 2006. A: Police Departments may not operate as an extension of an ambulance
service's license. Epinephrine Auto-Injector administration is not part of the
standard First Responder curriculum, and police officers who hold an EMT
certification may only operate as EMTs when working for a licensed ambulance
service, or a licensed EFR. When working at the police department (a First
Responder Agency) they may only operate as First Responders. Under 105 CMR
171.227, there is a provision made for optional use of Epinephrine
Auto-Injectors by First Responders, but this requires that the community state
in their Service Zone Plan that they plan to use their First Responder Agency to
provide Epi. If the community does this, then the First Responders need to be
trained in accordance with 105CMR 171.165, but the MDPH has not yet established
the Administrative Requirements for the training program as of yet. A: OEMS requirements for ambulance service written
policies under 105 CMR 170.330 which could be interpreted as related to driver
training is limited to “orientation of all ambulance service employees,” “duties
of transportation and policies relating to delivery of patients to appropriate
health care facilities,” and “use of lights and warning signals.” Ambulance
services may, if they so choose, set their own policies for driver training
requirements, but specific driver training requirements for EMTs or ambulance
services have not been set by OEMS. Each ambulance service is required, under
105 CMR 170.285(C), to ensure that its EMTs carry on their person or in their
EMS vehicle, a valid motor vehicle operator’s license. A: According to the MDPH/OEMS, the patient should be transported to the
nearest hospital emergency department in all cases, which may or may not be
(depending on distance) the initial sending facility. A: No. It is entirely up to the fire service or police agency using EMS as
rehab to provide/require whatever temperature monitoring equipment they want. It
is not an optional piece of equipment for carriage by an ambulance service
because it has no other role in the MA EMS Prehospital Treatment Protocols for
patient care. A: Massachusetts EMT-Intermediates are NOT allowed to administer D-50 (They
are also not A: All EMTs need to complete a protocol update whenever a new version of the
protocols is released (every two years). A service may require their EMTs to
successfully complete a protocol update exam as a condition of employment. A: Your suggestion has been implemented. For Region II Guidelines
click here. A: Nerve Agent Antidotes (such as Mark-1 kits) are optional. Your service may
choose to purchase them for the ambulance(s), but they are not required to do
so. There are stockpiles of Nerve Agent Antidotes within the region/state in
case they’re needed for a disaster type incident, in which case your service
would contact CMED to request deployment of this resource.
A: Gravida/para status refers to a woman's
obstetric history. Gravida indicates the total number of pregnancies a woman has
had (including the current one if applicable), regardless of whether they were
carried to term. Para (in general) indicates the number of offspring. Para can
be further broken down into the numbers that were term, pre-term, aborted, or
living (TPAL). Example: G2 P0111 would mean the patient was pregnant twice, did
not carry any to full-term, had one pre-term (“pre-mature”), had one abortion
(or spontaneous abortion which is commonly referred to as miscarriage), and one
(the twin to the one delivered pre-term) is living. For the purposes of EMS
personnel; simply indicating the number of pregnancies and the number of
full-term/successful births is sufficient. Example: a woman who has had two
pregnancies (both of which were carried to full-term) would be noted as G2P2. A: The KED is intended for extrication from difficult areas (e.g., mangled
motor vehicle) in order to minimize patient movement upon transferring to a long
board. A patient as described in question should be immobilized directly to a
long board according to spine immobilization training. A: 104° - 108° F (40°– 42° C); this is the recommended temperature for the
treatment of hypothermia. A: When responding to an emergency call where a patient is found on a vent,
the individual assisting the patient with the vent (e.g., either a family member
at home, or staff at a nursing facility) must accompany the patient in the
ambulance to attend to the vent. EMTs should be prepared to provide manual
ventilation (BVM) in the event of mechanical failure. A: Ambulances, according to design by Federal Ambulance Specifications
(KKK-A-1822-E), are equipped to treat two patients. Past practice has been to
stock sufficient medication to treat two patients and/or afford the capability
to attend to back-to-back calls. A: OEMS requires that a service use a glucose monitoring device that is: A: MAST (Medical Anti-Shock Trousers) are no longer required for carriage on
ambulances in Massachusetts and may be removed. A: An EMT-Paramedic and EMT-Intermediate may only work to the level at which
the service is licensed (so an EMT-Paramedic working at a BLS licensed ambulance
service must only work to the BLS level). If an ambulance service is licensed at
the ALS level, the EMT-P and EMT-I must work at the ALS level in accordance with
their certification, as long as there are no limits placed on the EMT-Paramedic
and/or EMT-Intermediate by the service or Affiliate Hospital Medical Director
due to any deficiencies. A: Submit the required application, fee, and
verification form found at the OEMS web site. A. An application for reinstatement of EMT certification may be made if no
more than one year has passed since certification expiration. The required
refresher training must have been completed no more than one year prior to the
application for reinstatement. The applicant must also send the appropriate fee,
proof of current BLS (CPR) training, and successfully complete the Massachusetts
EMT Basic written and practical examination. Individuals who missed recertification requirements due to serving in active
duty military may apply for an extension of their certification with acceptable
proof of mobilization for active duty and discharge summary. A: Individuals seeking to challenge the EMT-P based on RN, MD, or PA
licensure
must follow Administrative Requirement 2-322 (this form is not available
electronically, but is available by calling our office at 508-854-0111).
The field internship ("clinical") cannot be waived. A: The care of a patient is the responsibility of BOTH EMTs since they are
considered working together as a team. An EMT (no matter what level; paramedic, intermediate, or basic), may only
perform duties to the LICENSURE LEVEL OF THE SERVICE. An EMT (no matter what
level) working for a First Responder service (e.g., police department, on-call
fire department that is NOT licensed as an ambulance service) may only perform
duties to the First Responder level. A: A town determines what level of service will be provided within its
community (BLS or ALS- there is no such thing as "ILS"). A town may choose not
to renew their contract with an ALS service, or if provided by a municipal
service, not renew their license at the ALS level. This determination should be
made after careful consideration of all factors contributing to providing
optimal pre-hospital care and examining alternative options such as regionalized
ALS.
A: Yes, you need to have training in order to teach the program. Contact Sue
Neaz at the Department of Fire Services for details: 978-567-3250 or susan.neaz@state.ma.us A: The Instructor or Program Coordinator should fill out
OEMS Form 200-46 according to the
instructions. At 6(a) Program date(s), enter "various" and the calendar
year. At 6(b) Class time, enter "TBD" (to be determined). A: No, EMTs must meet the primary instructor qualifications listed within
OEMS
Administrative Requirement 2-100 "Minimum
Standards for First Aid Training for First Responders". A: According to the US Department of Labor;
Bureau of Labor
Statistics: "Earnings of EMTs and paramedics depend on the employment
setting and geographic location as well as the individual's training and
experience. Median annual earnings of EMTs and paramedics were $27,070 in May 2006. A: You can review requirements on the Massachusetts Paramedic Training Programs
web page. A: MDPH/OEMS
Administrative Requirement 5-256 for Paramedic/Basic Staffing Waivers simply
states that the Department (meaning MDPH/OEMS) shall "ensure that all EMTs, at
all levels of certification, who work under P/B waivers have completed required,
Department-approved training for P/B waivers" An example of the content that has
been approved by the Department in the past is available at:
http://www.cmemsc.org/protocols2/staffing_waivers.shtml A: Any paramedic certified in Massachusetts who has successfully completed
the latest Inter-facility Transfer training program may transfer any patient
within the Commonwealth or any patient originating outside the Commonwealth. At
all times the scope of practice is limited to the IFT guidelines found in
Appendix N of the Mass EMS Pre-hospital Treatment Protocols. A: Once the Medical Control regulations and associated EMS System regulatory
changes that affect Affiliation Agreements are in effect (the deadline was
extended until "further notice" on October 31, 2007), morbidity and mortality (M
& M) rounds will be required. Ambulance Services licensed to the ALS level will
be required to maintain an Affiliation Agreement with a hospital licensed by the
Department of Public Health to provide medical control. According to 105 CMR
170.300 (A)(7), the Affiliation Agreement must include a provision to ensure
"regular consultation between medical and nursing staffs and EMS personnel
providing ALS services, including but not limited to attendance at morbidity and
mortality rounds and chart reviews;" The hospital is similarly bound to this
requirement through their hospital regulations governing hospitals providing
medical control (see 105 CMR 130.1502(K). A: OEMS plans to release dates to meet with various stakeholders statewide
before determining what will and won't be adopted from the
National EMS Education Standards (the final draft was released 8/4/08) and
relates to the National EMS Scope of Practice Model. A: Instructor Coordinator (I/C) Courses are coordinated through OEMS. Contact
Russ Johansen for information at: 617-753-7302. A: There are no clinical investigation "training programs"
but the process is as follows: Investigations are usually initiated after a report is made
to OEMS in the form of a complaint against a service, EMS provider, or both.
These complaints may be submitted by a patient, family member, bystander, first
responder, hospital staff, or other pre-hospital provider. Each Region is also
bound by regulation to report any violation of 105 CMR 170.000 (these are the
EMS regulations which cover everything from ambulance licensing requirements to
adherence to protocols). Sometimes, these reports are made by the service itself
since they have a duty to report serious incidents. Such reportable
incidents include, but are not limited to: Medication errors resulting in serious injury; Failure to provide treatment in accordance with the
Statewide Treatment Protocols resulting in serious injury; or Major medical or communications device failure, or other
equipment failure or user error resulting in serious injury or delay in response
or treatment. When OEMS receives a complaint, it determines first whether
the issue is within its jurisdiction; second, whether an investigation is
warranted, or whether the issue is one that is more appropriately handled as
an ambulance licensure matter by the OEMS ambulance inspector for that service.
Investigations are coordinated and in most cases conducted by the OEMS Compliance Coordinator, Michael Clapp, EMT-Paramedic. Once an
investigation is completed, the investigator presents a summary of findings and recommendations to a team that reviews all OEMS compliance cases
(the team includes the OEMS Director or Acting Director, Medical Director,
Clinical Coordinator and the Policy and Regulatory Specialist). In all cases, an investigation report is drafted which contains
a summary of the facts, investigation, findings, and a resolution plan if
needed. When there is a valid finding, most result in some sort of letter (e.g.,
Advisory Letter, Letter of Clinical Deficiency, Letter of Reprimand, Notice of Serious Deficiency) and a resolution plan that involves
remediation, as overseen by a medical director. In very few cases where the
findings are of a serious nature, or in which the EMT or service has a repeated compliance history with the
Department, the OEMS team may propose Department agency action for suspension or
revocation of an EMT's certification and the case file is forwarded to the Department's Office of General Counsel. The Office of General
Counsel will review the case file and the OEMS recommendation, and if it
believes an agency action is defensible, will manage the agency
action. Additional information regarding complaints is available at the OEMS
website.
A: One does not need to be an Instructor/Coordinator to teach a BLS
refresher, but there are instructor requirements as outlined on page 10 of the
state training manual available at:
http://www.cmemsc.org/training/AHAinstructors/OEMSTrainingManual.pdf A: EMT-Basic: 28 hours plus 24 hour refresher A: Continuing education programs that have received approval by OEMS and have
a Department issued continuing education approval number may be applied toward
EMT recertification. Contact Paul Coffey at 617-753-8300 with questions
regarding Special Programs. A: At this time there is no limit to how many on-line credit hours can be
applied to recertification requirements. A: Authorized instructors who teach EMS related subjects may earn up to a
maximum of 20 hours credit (if an EMT-B) and 10 hours (if an EMT-P) toward
recertification. An EMT earns one hour of credit for each two hours of
unassisted teaching. Co-instructors split credit hours. These special credit
hours are awarded on an individual basis after review by OEMS. Submit a
letter of request with documentation that supports the request to: A: Continuing education approval numbers are effective for the date of the
program unless the training coordinator applies for an "open" date for the year,
and then they are effective until the end of the calendar year. A: JEMS prints some very good CE courses in their journal each month. You may
submit them (to the appropriate region) with a continuing education application
to request OEMS continuing education credits. Be sure to credit JEMS for the
program. (You may even want to create a PowerPoint presentation to enhance the
delivery of the course and add supporting videos, practical activities, and
group discussions to make the most of the program). The quiz at the end of each
CE program does not include the answer key. Be sure you know the material well
enough to complete the quiz accurately to avoid relaying the wrong information
to your students. UMass is
the only ACS (American College of Surgeons) verified Level 1 Trauma Center in
Region II and is identified as the only Trauma Center in the Region II Trauma
Point of Entry Designation:
http://www.cmemsc.org/cmed/point_of_entry.htm [answer updated July 6, 2006] A: STEMI patients must be transported according to
MDPH approved Regional Point-of-Entry Plans which may include out-of state
hospitals:
http://www.cmemsc.org/protocols-state/StrokePOE/STEMI_poe.shtml CVA (Stroke) patients should be transported to
a Massachusetts Primary Stroke Service (PSS) since there are specific MA
requirements not met by out-of-state hospitals. Refer to the approved statewide
Primary Stroke Designation List at:
http://www.cmemsc.org/protocols-state/StrokePOE/stroke_poe.shtml A:
Point of Entry for Trauma (burns
are included in trauma),
Stroke,
STEMI (ST Elevated
Myocardial Infarction) and Need-Based
Conditions are located on our website under the menu title of "Region II Guidelines". A: The state med channels 220, 280, and 340 are no longer used in Region II. A: The Hospital Emergency Alerting Radio (HEAR)is a VHS system that allows
direct radio communication between ambulance and hospital and was primarily used
several decades ago before the UHF CMED communication system was established.
CMED uses the HEAR for communications with other CMEDs and A: EMS regulations don't prohibit a service's paramedics from getting medical
direction from a receiving facility's ED physician, to whom they are calling
with an entry notification and asking which medical control option within the
Protocols they should use for a patient they are transporting to them; but... A: OEMS
Administrative Requirement 2-305 (Minimum Skill Requirements for
EMT-Paramedic Training) requires that "during the field internship,
EMT-Paramedic students must be precepted by a certified/licensed EMT-Paramedic
with greater than two years of experience." Conversely, OEMS
Administrative
Requirement 5-256 (Paramedic/Basic Staffing Waiver) requires that ambulance
services submit to the Department a plan that "defines levels of experience",
but there is no specific requirement that ensures services staff their
ambulances with experienced paramedics when operating under a staffing waiver. A: No. OEMS has no intention of eliminating staffing waivers that allow
Paramedic-Basic staffing of ambulances. This rumor stems from the Department's
examination of the waiver issuing process to ensure that services are complying
with Administrative Requirement 5-256. A: When operating under a PB waiver, the
ambulance service must meet the requirements of
AR
5-256. A: Although OEMS anticipates full implementation and required compliance by
the end of 2008, OEMS
Administrative Requirement 5-403 indicates “no later than September 1,
2009.” A: The HIPAA Privacy Rule requires that covered entities implement reasonable
safeguards to limit incidental uses or disclosures of protected health
information. See 45 CFR 164.530(c)(2). Although the regulation does not dictate
specific means or provide guidance on acceptability of methods of destruction
for confidential materials, shredding (and subsequent recycling) is convenient,
effective, and has minimal environmental impact. A: First Responders may cancel an incoming ambulance for “no EMS” calls
(e.g., 9-1-1 call for an MVA which is then determined to be just a disabled
motorist). First Responders are not prohibited from obtaining a patient refusal
but there should be a policy in place between the First Responder service (e.g., police
or fire department) and the ambulance service, since ultimately; the
ambulance crew is responsible for the response to the patient. First
Responders should receive the appropriate training in dealing with patient
refusals and continue ambulance response for any patient that a refusal of care
may not be prudent. A: Refer to
Administrative Requirement 5-610 "Responding to Scenes Involving Minors
Refusing Treatment or Transport" A: Yes they do ! A: Private Services must comply with OSHA standards by providing annual
training on Bloodborne Pathogens, Tuberculosis, and Hazardous Chemicals
encountered with the job. An ambulance service (management personnel) may
contact the Massachusetts Division of Occupational Safety OSHA Compliance
Consultation for assistance with compliance training: (617) 969-7177. The
Massachusetts Division of Occupational Safety Workplace Safety & Health Program
requires compliance with OSHA standards for municipalities through MGL
Chap
149 Section 6. Assistance to cities/towns with training and developing
written policies and procedures is available by contacting: (617) 969-7177. See
Public Sector Employee Health and Safety FAQ. A: Yes. Title 23, Code of Federal Regulation Part 634 requires, as of
November 24, 2008, that responders to incidents on Federal-aid highways wear
high-visibility safety apparel which meets the Performance Class 2 (reflective
vest) or Class 3 (reflective jacket) of the ANSI/ISEA 107-2004 publication
"American National Standard for High-Visibility Safety Apparel and Headwear." A: CLIA, a federal regulation, does apply to ambulance services. A
certificate of waiver is required to carry glucometers on ambulances. Download
the application at our webpage:
http://www.cmemsc.org/protocols-state/glucometer.shtml A: Massachusetts regulations allow EMTs, RNs, and MDs to administer
epinephrine auto injectors. There is also a law that allows bus drivers and
teachers to administer these injections to school children. First Responders
(police, fire) may do so only if working for a licensed ambulance service or a
licensed EFR (and then it has to be spelled out in the town's Service Zone Plan
and MDPH approved training must be done which hasn’t been created yet). The
so-called "Good Samaritan" law (MGL
Chap 112: Section 12V) limits liability to those providing CPR and AED. A: The American Heart Association does not offer courses solely for the
relief of Foreign Body Airway Obstruction (FBAO). Explain to the restaurant that
this is because if someone is choking (respiratory arrest), cardiac arrest will
immediately follow and rescuers need to be prepared to administer CPR. The AHA
Heartsaver CPR course would be a good choice to cover both of these skills.
You'll note the law also refers to the OPTION of having a "device" on premises
for food removal. AHA courses do not offer any training in these devices. A: The Course Director (that would be you) has the final authority for
allowing a student to take a renewal course if he or she does not have a current
AHA Provider card or an AHA accepted equivalent card (e.g., American Red Cross
Professional Rescuer CPR). Students who present an expired Provider card or do
not possess a Provider card may be allowed to take a renewal course but will not
be given the option of remediation. These students will need to complete the
entire Provider Course if they cannot successfully meet the course completion
requirements when tested. Source: AHA Program Administration Manual
updated 10/2008 pg. 50 A: CPR instructors set their own fees for courses so their income varies. In
addition to the initial cost of an instructor course, there are costs associated
with the instructor manuals and videos. Course fees must also cover the cost of
text books, student supplies (e.g., barrier shields and masks), manikins, AED
trainers, and cards. A: No.
First Responder training includes the BLS for Healthcare Provider CPR training,
but it also includes advanced First Aid training. First Responder training must
meet the requirements set forth in MDPH/OEMS Administrative Requirement 2-100
available at:
http://www.cmemsc.org/protocols-state/ARManualTableofContents.shtml A: No, the AHA BLS Instructor card is sufficient. A: The Commonwealth of Massachusetts does not govern your American Heart
Association Instructor status; that is the responsibility of the AHA Training
Center listed on the back of your BLS Instructor card. There is no
"certification" for First Responders. There must be documentation that First
Responder training was completed in accordance with the OEMS Administrative
Requirement 2-100. This AR includes the primary instructor qualification
requirements, which includes certification as an instructor, (but not
specifically as an AHA BLS instructor). NOTE: The AHA has a First Aid course
designed for laypeople. It is NOT equivalent to First Responder training. Additional information regarding First Responder requirements and regulations
is available at
http://www.cmemsc.org/first-responder/first-responder.shtml A: Yes, an EMT can become a CPR, or more accurately, a BLS Instructor.
Courses are available through various training associations (e.g., American
Heart Association, Red Cross). CMEMSC offers this training through its AHA
Training Center. The
registration form for the next course is available at A: According to regulation, only First Responders need to renew their CPR
(healthcare professional level) training on a yearly basis. EMTs (all levels)
must renew every two years. A: A fully completed AHA roster with the signature of a valid AHA instructor
is sufficient to provide evidence that the course was completed while awaiting
cards except for EMTs who are required to hold a current training card at all
times while operating on an ambulance. A: American Heart Association CPR cards are valid for two years from training
and expire the last day of the month indicated on the card's expiration date.
Instructors aligned with the CMEMSC AHA Training Center may use their own
discretion to allow a thirty day "grace period" for individuals taking the
Healthcare Provider Renewal course rather than mandating the Healthcare Provider
Initial course. There are no other AHA courses available in the "renewal"
format.
A: Yes; a crew may choose to transport a stable patient without lights and
sirens. Transporting stable patients without lights and sirens in the
normal flow of traffic is the safest means of transport for patient, crew,
and public.
A: The state's medical services committee formed an "airway subgroup" to
discuss issues related to competency and quality assurance for airway.
Part of the discussions included a proposed algorithm for the use of a
non-visualized airway, such as the King LT, by EMT-Basics. The proposal
was met with mixed response and the group agreed further discussion and
revision was needed. In order for a scope of practice change to occur, the
state medical services committee would have to agree upon the change, then
the state executive committee would have to concur, and finally, OEMS
would have to proceed with implementation. A: Response address. A: Reimbursement rates for ambulance services vary depending on insurance
companies, but a good reference point is the rate set by the state for
individuals receiving publicly aided coverage. These rates are listed in 114.3
CMR 27.00 Section 27.03 "General Rate
Provisions and Maximum Fees" A: The Region does not have a database of EMTs working in Region II with the
length of time they’ve been certified so we are unable to issue milestone
recognition certificates. We do accept nominations for EMS Outstanding
Performance Recognition awards which are presented each year at our annual
meeting (scheduled this year for May 1st).
Nomination applications
are available from our homepage. A: There is no set rule about the stork pin. Since both EMTs are responsible
for patient care, both can wear the pin. A: The number is limited to service policy but may not exceed the number of
seatbelts to which these individuals can be safely restrained without
interfering with patient care. Under 105 CMR 170.310, such “additional
personnel” must “be currently trained in Basic Life Support cardiopulmonary
resuscitation through completion of a course not less than the standards
established by the Committee on Cardiopulmonary Resuscitation and Emergency
Cardiac Care of the American Heart Association.” In addition, such personnel can
only function in accordance with the policies of the ambulance service. |
Updated: