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Answers to Questions
Latest FAQs
Mass General Law / EMS Regulations
Q: Is it acceptable for any EMT or ambulance service to create their
own state EMT patch or are they supposed to be standardized to lend
credibility and encourage professionalism? Lately I’ve seen EMTs
wearing “state” EMT patches that are red and white, and another that was
all gray!
A: The state does not regulate patch design nor do they issue
patches. There is no requirement on the design of the state EMT patch
and there is no state requirement that EMTs must wear them. (There is
an EMS regulation that prohibits a non-EMT from holding her/himself out
as being an EMT when s/he is not, so if a non-EMT wore a state EMT
patch, action would be taken).
Q: As an EMT, am I required to leave a copy of the patient care report (PCR)
at the hospital after transporting a patient?
A: Yes, 105 CMR 170.345(C)(2) indicates: The EMTs on each transporting
ambulance shall leave a copy of the trip record at the receiving health
care facility with the patient at the time of transport. The
receiving health care facility shall keep such trip records with the
patient's medical record.
Q: Is there a regulation which requires EMTs to report to OEMS suspension
of driver’s license or a conviction of a misdemeanor or felony? What about
reporting to the service where I work?
A: Yes; 105 CMR 170.937 requires that each EMT or EFR file a written
report to the service where s/he provides EMS and the Department (OEMS)
within five days of suspension or loss of driver’s license as well as any
conviction of a misdemeanor or felony, other than a minor traffic
violation for which less than $1,000 was assessed. The EMT must also file
a written report with the service s/he works within five days of OEMS
action against the EMT’s certification.
Q: How long should an ambulance service keep records (including copies of
patient care reports)?
Q: A Paramedic is off duty and comes across a MVA, stops to assist and
assumes care of the PT when a Basic Ambulance comes to Transport. Would
transferring care to the BLS Ambulance be considered a form of abandonment? We
are only supposed to transfer to equal or greater level of care.
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.
Q: I have heard, although unofficially, that the Service Zone Planning
requirement for Dec. 31, 2006 was extended to June. Can you tell me if this
is accurate?
A: Contrary to rumor, the Department has NOT extended the deadline for Service Zone compliance. The
deadline was December 31, 2006.
Q: Our local police department has expressed an interest in carrying EpiPens
in the cruisers. Can they do this as an extension of our Ambulance service's
license? All officers are trained as 1st Responders and several are trained as
EMTs.
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.
Q: Does OEMS require any information from ambulance services in order for an
EMT to be eligible to drive an ambulance?
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.
Q: You respond to a single-vehicle MVA with minor damage and find two
patients ambulatory outside of the vehicle. One is walking around and the other
has fled the scene on foot but is caught by police a 1/4 mile away and returned
for EMS evaluation. Upon patient assessment, both patients adamantly refuse
treatment or transport. It is noted that both patients have a strong odor of
alcohol on their breath and both admit to heavy drinking. Neither have any
apparent injuries but both have a staggering gate and inappropriate responses to
questions. After a lengthy assessment, one patient accepts transport, but the
other still refuses. What are the protocols for a patient such as this?
A: Any patient that provides inappropriate responses to assessment
questions should be considered in a state of altered mental status and Protocol
3.3 Altered Mental/Neurological Status should be followed. Explain to the
patient that you are required to treat and transport based on your assessment
findings and ask for police assistance if needed.
Q: What is the policy on TASER dart removal? I have been asked by the
Police Department if we will remove the darts. I did not think we would be
allowed, I would consider it an impaled object. The Police Chief said that they
were allowed, after training, to remove them from anywhere but the head and
neck.
A: You are correct; impaled probes (such as the dart-like electrodes
fired from a TASER device) are impaled objects and shall not be removed by EMS
personnel unless their removal is necessary to provide life- or limb-saving
treatment (see OEMS Advisory
“TASERs and EMS Response" 9/1/2006)
Q: Can Intermediates perform blood draws?
A: No; EMT-Intermediates are not authorized to perform blood draws.
Q: How should an EMT handle a patient with a tracheostomy tube?
A: See Tracheostomy Tube Obstruction Management within Protocol 3.15 Adult Upper
Airway Obstruction.
Q: If you are transporting a patient with a valid CC/DNR and during the
transport the patient dies; where should the patient be transported?
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.
Q: Appendix U to the Statewide Treatment Protocols cites Temperature as a
vital sign. Are BLS ambulances now permitted to carry thermometers when acting
in accordance with appendix U?
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.
Q: Can EMT-Intermediates administer D-50 after confirming a low blood
sugar and starting a line?
A: Massachusetts EMT-Intermediates are NOT allowed to administer D-50 (They
are also not
allowed to administer D5W). Please refer to the Altered Mental/Diabetic Protocol
3.3 available at:
http://www.cmemsc.org/protocols-state/state-protocols.shtml.
Q: Is it required for an EMT-I to take a protocol upgrade exam?
A: All services need to ensure their EMTs are aware of changes to the protocols as they
occur and whenever a new version of the protocols is released (every calendar
year). A service may also require their EMTs to successfully complete a
protocol update exam as a condition of employment.
Q: Where are the Regional Guidelines and Protocols the State EMS
Pre-Hospital Treatment Protocols make reference to? I would like to suggest a
link to them be put on the side bar index so they all may be viewed on line.
Thank you
A: Your suggestion has been implemented. For Region II Guidelines
click here.
Q: Is pulse oximetry a BLS skill? We want to put extra portable pulse ox’s in our “first-in” bags.
A: No; you can’t put anything on the ambulance (or in bags for EMT use)
that isn’t specifically on the state approved ambulance equipment list for the
level of the provider using it. Pulse co-oximetry is on the optional list but
only for use with the Fire Rehab protocol (Appendix U.)
Q: Are tourniquets allowed for bleeding control?
A: Tourniquets should be avoided, except when it’s required to prevent death
due to massive hemorrhage. (See Protocol 4.10 Traumatic Amputations)
Q: Is there a state law or regulation on when to use the stair chair versus
a stretcher?
A: OEMS has released an advisory on cot (stretcher) safety (attached) but has
not issued one specifically for the stair chair. The cot safety advisory was a
result of an issue where EMTs did not use a stretcher properly and a patient
sustained a fall.
Each ambulance service should have its own policy on stair chair use; but a good
rule-of-thumb is to secure a patient to a stair chair if the patient needs to be
moved over more than 3 steps. When a patient is secured to a stretcher, an
increased incline causes the center of gravity to be high, the weight
distribution is uneven, and the stretcher becomes unwieldy. This puts the
patient and EMTs at a much greater risk of fall and/or injury.
Q: Is there a state definition for "intubation attempt"? Is it merely
placing the blade in the mouth or is it the attempt to pass an ET tube?
A: In accordance with national guidelines, it is "blade in mouth."
Q: We don't have Mark-1 kits on our ambulance. What should we do?
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.
Q: What is the para gravida scale for pregnancies?
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.
Q: If a PT has suspected head trauma and is found laying down, can the PT be
put on the KED, then on a stair chair for extrication from a House?
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.
Q: Is there a maximum temperature for IV fluids?
A: 104° - 108°F (40°- 42°C); this is the recommended temperature for the
treatment of hypothermia.
Q: Are vents allowed to be used on an emergent call?
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.
Q: How many doses of each medication should be carried on an ambulance?
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.
Q: Does OEMS approve/recommend certain glucometers for use in the
field?
A: OEMS requires that a service use a glucose monitoring device that is:
approved by the FDA;
utilizes capillary action;
measures whole blood;
uses one-time lancet;
uses small specimen size to decrease the risk of bloodborne pathogen
exposure, and;
requires minimal calibration and cleaning
Q: Can we now pull the MAST pants off of the ambulances. I have been told by
our med control Dr that we need to keep them but can't find them on the state
list of equipment to have on the ambulance.
A: MAST (Medical Anti-Shock Trousers) are no longer required for carriage on
ambulances in Massachusetts and may be removed.
Q: Our ALS Affiliation Agreement requires that we meet quarterly or as
needed and that each EMT should attend at least 2 M&M rounds per year. Our
service has provided these rounds with our medical control liaison (Affiliate
Hospital Medical Director designee) every other month. Most of our EMT-Paramedics
are in compliance, but there are some that have not met the requirement. What
should I do?
A: Contact the Affiliate Hospital Medical Director and report it. S/he may
want to suspend authorization to practice since s/he’s ultimately responsible
for these paramedics.
Q: Can you lose your EMT certification if you are charged with insurance
fraud but it is not related to a call you did?
A: It depends on what the final criminal conviction is (regardless if it
occurred during your duties as an EMT). MDPH/OEMS handles each on a case by case
basis because circumstances vary. A criminal act can lead to an action taken
against your certification (suspension or revocation).
Q: Can an EMT work at a private event such as a dance, party, horse show,
fair as a private EMT ( not connected with a municipality or private service) or
would they be considered a First Responder only?
A: An EMT can work at a private event, but unless they are working on behalf
of a licensed ambulance service with immediate access to activate an ambulance,
they are not working under EMT certification. They are not even considered a
First Responder. First Responder is defined in MA regulation as one who is
working at a police or fire department, or a life guard. EMTs (of all levels)
are limited to the First Responder level when they are employed by one of these
agencies (unless, of course, the police or fire department has an ambulance
license and they are assigned to operate in that capacity).
EMTs at a private event can provide limited first aid based on their training
as an EMT (take vital signs, perform bleeding control, maintain manual C-spine
stabilization, or use an AED if available) but they are not authorized to
administer oxygen (a controlled substance) or aspirin and epinephrine (EMTs are
allowed to administer these drugs with an ambulance service that has a
Memorandum of Agreement with a hospital for medical oversight). In fact, MGL
Chapter 111C , Section 19 (a)(3) prohibits them from even wearing an EMT patch
unless they are working on behalf of the ambulance service. Individuals who
agree to provide first aid at a private event should make it clear to the event
coordinator ahead of time that they are not working in the capacity of a
certified EMT and should also consider issues of personal liability.
Q: What steps should an EMT take to limit liability if s/he agrees to
provide first aid at a private event?
A: To limit liability when providing first aid at a private event while NOT
on behalf of an ambulance service, an EMT may want to provide written notice to
the event coordinator explaining that first aid will be provided based on EMT
training, not certification, and that the first aid will not equal what would be
rendered by an EMT staffing an ambulance. One might add that an ambulance will
be activated immediately when needed, if that is the case. It may also be wise
to consider options for liability insurance, especially if you own a home. Some
insurance companies offer an umbrella policy that may protect you in the event
you are sued.
Q: Does a paramedic operate under a physician's license?
A: No; the MDPH/OEMS certifies the paramedic and the Affiliate Hospital
Medical Director (AHMD) authorizes a paramedic to provide care while working at
a licensed ambulance service with which the AHMD and Affiliate Hospital has an
ALS Affiliation Agreement.
Q: Is there a liability issue for a Paramedic or Intermediate working at a
level lower than they are trained? (e.g., a paramedic functioning at the BLS
level and having to limit care of a cardiac arrest to the BLS level.)
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.
Q: How do I apply for MA EMT certification based on my out-of-state EMT
training or certification?
A: Submit the required application, fee, and
verification form found at the OEMS web site.
Q: I was certified as an EMT-Basic several years ago, but missed the
recertification deadline since I was out of the country. Can I still renew my
certification?
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.
Q: What are the requirements for a nurse to challenge the paramedic
exam? and if a nurse were to take the didactic portion of a paramedic
program could they forego the clinical and just take the state exam
A: Individuals seeking to challenge the EMT-P based on RN, MD, or PA
licensure must follow
Administrative Requirement 2-322. The field internship ("clinical") cannot
be waived.
Q: If a Paramedic is working for a service licensed at the Basic or
Intermediate level is the medic at all responsible for the care of the patient
or actions of the other technician?
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.
Q: If a town has decided to change its EMS provider does that town have to
continue the previous level of care? For example, if a town has a private ALS
service and that town wants to take over the ambulance, does the town have to
staff the ambulance at the ALS level or can the town reduce the care being
provided by making the service BLS or ILS?
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.
Q: Do you have to be specially trained and certified to teach people how to use
the PAPR (Powered Air Purifying Respirators)?
A: Yes, you need to have training in order to teach the program. Contact the
Massachusetts Department of Public Health’s Emergency Preparedness Bureau at:
(617) 624-5289.
Q: How does someone apply for a "blanket" OEMS continuing education approval
number in order to teach the same course multiple times in a calendar year
without re-applying each time?
A: The Instructor or Program Coordinator must complete
OEMS Form
200-46. At 7(a) Program date(s), enter "various" and the calendar year. At
7(b) Class time, enter "TBD" (to be determined). NOTE: The Region and OEMS must
be notified two weeks prior to delivering a course under a “blanket” approval
number. Complete the online notification form at:
http://cmemsc.org/training/EMTb/blanket-approval.shtml
Q: Can ANY EMT teach a 1st responder course for firefighters, police
officers etc.?
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".
Q: How much money can you make per hour after you get trained?
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.
Q: How much training does it take to become a paramedic?
A: You can review requirements on the Massachusetts Paramedic Training Programs
web page.
Q: What are the course requirements for a Paramedic Assist Class?
A: The ALS/BLS Interface Training (formerly referred to as “Paramedic Assist”) is
required for ALL levels of EMTs (Basic, Intermediate, and Paramedic) before
staffing an ambulance licensed at the ALS level when the staffing configuration
is less than two paramedics (e.g., PB or PI). The specific requirements are
included in
AR 2-260 Requirements
for ALS/BLS Interface Training. The
ALS/BLS Interface course outline is available.
Q: Is a paramedic, who is credentialled in Region II only but has
taken an interfacility transfer class, able to attend a transfer that
originates outside of Region II or in another state (ex: call coming out of
Boston or Rhode Island)? (The medic is not nationally certified).
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.
Q: Are there any requirements for M+M rounds at the paramedic level?
A: Ambulance Services licensed at the ALS level are required to maintain an ALS
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).
Q: Are there any plans to restructure the Mass EMT system in accordance with
the National Scope of Practice model or the National Registry guidelines? (e.g.,
Expand EMT-I Scope of Practice).
A: The state EMS Education subcommittee which reports to OEMS has been tasked with
developing curricula for four initial training programs for levels within the
National EMS Scope of Practice: Emergency Medical
Responder (This is a special EMR level, not First Responder); EMT; Advanced EMT
(currently EMT-Intermediate); and Paramedic. The training guidelines will
incorporate state approved skills selected from the
National EMS Education
Standards.
Q: Do you know of any upcoming I/C courses?
A: Instructor Coordinator (I/C) Courses are coordinated through OEMS. Contact
Russ Johansen for information at: 617-753-7302.
Q: Is there a state entity that provides training related to the how to and
reasons for a clinical investigation?
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.
Q: Do you have to be an Instructor/ Coordinator to submit for credit
and teach a BLS refresher?
Q: How many CEUs do I need to renew my EMT certification?
A: EMT-Basic: 28 hours plus 24 hour refresher
EMT-Intermediate: 28 hours plus 36 hour refresher
EMT-Paramedic: 25 hours plus 48 hour refresher
Q: What ceu's can I use toward my emt recertification?
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.
Q: How many continuing education credits does OEMS allow an individual to
acquire through on-line EMS training programs?
A: At this time there is no limit to how many on-line credit hours can be
applied to recertification requirements.
Q: How do I get teaching credit? I helped teach a BLS refresher and I
am currently certified at the BLS level.
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:
MDPH/OEMS; 99 Chauncy Street; 11th Floor; Boston, MA 02111; Attn:
Paul Coffey
Q: How long are continuing education approval numbers good for? Do
they expire?
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.
Q: Can magazine articles such as those printed in JEMS or EMS be submitted
to OEMS for continuing education credit, and what is the process for applying
for a con-ed number for these articles? Ex. JEMS charges to submit these for
credit through them. Is there a loop-hole so I do not have to pay a fee and can
offer it to other EMTs and Paramedics for con-ed hours?
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.
Q: Which are the level 1 and trauma centers in Region 2?
A: UMass is
the only ACS (American College of Surgeons) verified Level 1 Trauma Center in
Region II.
View details
Q: While working near the state border, can we transport a STEMI or CVA
patient to an appropriate facility (one that can actually treat such patient, ie
interventional cath lab, ect) out of state?
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
Q: When can we expect approved Point of entry plans from the department
(DPH/OEMS) so we can legitimize what we are presently doing in the field? i.e,
Trauma, Cardiac, Burns, and other specialties?
Q: Q: What should I do if a hospital asks for the patient's name over the CMED radio?
A: Tell them you will provide that information upon arrival at the hospital (do
not give patient names over the CMED radio).
Q: When transporting patients from the scene of a declared MCI, should I
make my own entry notification through CMED?
A: No. Entry Notifications are coordinated by CMED with information provided
by the Transportation Officer on scene. At the direction of CMED, the
Transportation Officer will tell the transporting EMTs the destination hospital.
CMED will contact the appropriate hospital with patient information. EMTs must
NOT make individual entry notifications. Doing so reduces the effectiveness of
the system and interferes with vital MCI radio communications. The only
exception is to notify (through CMED) the hospital when, during transport, the
patient's condition has significantly deteriorated.
Q: Under what circumstances would one use the State Med Channels?
A: The state med channels 220, 280, and 340 are no longer used in Region II.
Q: Does CMED monitor the VHF HEAR frequencies? If so, can CMED patch
through a hospital on HEAR?
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
does not monitor it for ambulance traffic or provide entry notification
facilitation (i.e., a "patch")to the hospitals via HEAR. HEAR radio use for
ambulance to hospital communications does not allow for recorded radio traffic
or for the coordination of the flow of traffic to the hospital in cases of Mass
Casualty Incidents.
Q: I am told that a paramedic unit can get medical control for an emergency
from any hospital that they are transporting to even though the service does not
have a formal agreement with that Hospital. Is this true?
A: According to medical control regulations, an Affiliate Hospital Medical Director
may allow the service they hold an ALS Affiliation Agreement with to receive
online medical control from a different hospital to which the patient is being
transported, but the facility MUST be licensed to provide medical
control.
The affiliate hospital medical director has ultimate responsibility for the medical control
provided and needs to be informed as to what kind of medical control paramedics
are getting on a standard basis from another
facility.
Q: Is there a regulation or Administrative Requirement (AR) that requires an
inexperienced EMT staff an ambulance with an experienced EMT?
A: There is no specific regulation or AR that requires an inexperienced EMT
staff an ambulance with an experienced EMT unless it’s specified in an ALS
Affiliation Agreement (for EMT-Paramedics or EMT-Intermediates), a BLS
Memorandum of Agreement (for EMT-Basics), or through ambulance service policy.
Q: When staffing the Ambulance at the PB level is there any special
requirements for the Medic or Basic?
A: Yes; staffing regulations and associated Administrative Requirements,
including AR 2-260 need to be followed.
Q: You respond to a call for a motor vehicle collision. You arrive on scene
and the occupants of the vehicles all report they are not injured. Are EMTs
required to obtain patient refusals for all parties in all vehicles, even if no
one is claiming injuries, or do they obtain refusals for only those who report
an injury, but do not wish transport?
A: An example of a "no EMS" call is getting dispatched for an "unresponsive
in a car" only to learn that a gentleman was taking a pleasant nap until
awakened by EMTs rapping on the window. Clearly, the call to 911 was good
intentioned, but unwarranted (there was no emergency). You get into murky waters
when the call is for an MVA, and those involved were actually in the MVA; no
matter how minor. Failure to obtain a refusal may cause a legal issue if an
individual involved in the MVA decides to pursue legal action against everyone
on scene. It will be difficult to defend your actions when an attorney subpoenas
the patient care report and finds there is nothing documenting what happened
except "no EMS" (hard to justify when you were dispatched to an MVA). OEMS
strongly advises each ambulance service to have its legal counsel review and
approve its patient refusal policies, procedures and forms.
Q: When will ambulance services be required to submit data in
compliance with MATRIS(Massachusetts Ambulance Trip Record Information System)?
A: As of December 15, 2010, each trip record (aka “patient care report”) must
include the data elements indicated in
Administrative Requirement 5-403 Statewide EMS Minimum Dataset and be uploaded or directly entered into the
MATRIS website within 14 days of the call at: https://matris.dph.state.ma.us
Q: My Ambulance Service has a document to assist New EMTS and Student EMTS
gather all the information needed for a PCR including Patient Name, Address,
DOB, medical history, and medications. After Transport of the PT the EMT uses
this document to help write the PCR. Once all information is transferred and the
PCR is completed, should this document be destroyed, or how should this document
be handled as it does contain confidential PT information?
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.
Q: Can first responders (not certified EMT's) obtain refusals from
patients at an emergency scene? Example- Fire Dept. running a Class 5
ambulance not fully staffed by EMTs, but required to document every EMS run,
including patient refusals not obtained by the private EMS provider.
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.
Q: Is it within a minor's right to refuse ambulance transport?
Q: If a competent patient initially refuses care but goes unconscious while
crew is in process of informing patient of possible consequences of refusing
care: does the crew then operate under implied consent?
Q: Is there a set criteria of classes that new hires at a company need to be
taught in order to become up to date with the latest OSHA Compliance Guidelines?
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.
Q: Do federal regulations require ANSI compliant vests for ambulance personnel
responding to incidents on highways? If so, do ANSI compliant jackets meet this
requirement?
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."
Q: Do Clinical Laboratory Improvement Amendments (CLIA) apply to
ambulance companies? Do they have to apply for this certification to use
glucometers? A/R 5-520 is not very clear on this.
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
Q: What is the acceptable MA protocol for an AHA First Aid trained rescuer
regarding administration of aspirin to someone with chest pain?
A: MA EMS protocol doesn’t cover lay rescuers trained in First Aid. Where
aspirin is an over-the-counter drug (not like oxygen which is a controlled
substance), it is included in the AHA First Aid training. Bear in mind though,
that it is not for aspirin administration, it’s an aspirin recommendation:
“First aid providers are encouraged to activate the EMS system for anyone
with chest discomfort. While waiting for EMS to arrive, first aid providers
should advise the patient to chew 1 adult (non–enteric-coated) or 2 lowdose
“baby” aspirins if the patient has no history of allergy to aspirin and no
recent gastrointestinal bleeding.”
Q: I am preparing to teach HeartSaver First Aid. Does Massachusetts have any
particular guidance/regulations/laws regarding EpiPen
administration? Would the Good Samaritan law pertain to a care giver who assists
a victim administer an EpiPen?
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.
Q: I am an American Heart Association BLS Instructor and have been asked by
a restaurant to teach a “Choke Save” course. What should I do?
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.
Reference: MGL Chap94
Section 305 D and
105 CMR
605.000.
Q: I am an American Heart Association BLS Instructor and have been asked to
conduct a BLS for Healthcare Providers renewal course, but some of the
participants have expired cards. Can they take the renewal course?
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
Q: How much money do CPR instructors make?
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.
Q: Will a BLS for Healthcare Provider card meet the requirements for First
Responder training?
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
Q: As an EMT, if I hold a current card as an AHA BLS Instructor, do I need a
separate Healthcare Provider card?
A: No, the AHA BLS Instructor card is sufficient.
Q: As an AHA BLS instructor, what does the state of MA allow me to certify
people as CPR only, or can I also certify first responders?
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.
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. Contact
Q: Do only First Responders need to re-cert in CPR each year or when
it
says first responders does that include EMT's B, I & P?
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.
Q: Will AHA CPR rosters suffice as proof of certification of training
while awaiting cards?
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.
Q: When do CPR cards actually expire? Is there such a thing as "a 30 day
grace period" to recertify?
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. To top of FAQ List
General Miscellaneous
Q: I have 2 crew members who responded to a 6 month old with some
"alarming" injuries. They filed a 51A, as did the ED staff. Our local
police were notified and they are now asking one of my crew to go to the
police department to give a detailed statement. What should we do?
A: The EMT should comply with the police request in this case since it is
now part of an investigation.
Q: I know with children and the elderly we are required to file a report
when abuse is suspected, but what if a police officer asks an EMT to let
them know if a patient who is not a child or elderly that s/he has been a
victim of domestic violence?
A: The EMT would need to ask permission of the patient to pass that on to
the police.
Q: What do I do if I am on-scene and a physician tells me to do something
contrary to the statewide treatment protocols?
A: EMTs operate under "off-line" medical control through the MA EMS
pre-hospital treatment protocols while "punched in" at a licensed
ambulance service. (EMT certification doesn't apply "off-duty").
If an EMT is working for a service and is assigned to cover a football
game with instant radio communication for immediate ambulance dispatch,
and a physician on-scene wants to provide advice that conflicts with the
current MA EMS pre-hospital treatment protocols; the EMT should contact
medical control (the Affiliate Hospital Medical Director for an ALS level
service, the service medical director for a BLS level service, or an ED
physician at a hospital licensed to provide medical control to which the
patient will likely be transported). This communication should be
facilitated through CMED to ensure the transmission is recorded. Bear in
mind that the physician on-line will likely ask how the EMT knows they are
dealing with an MD, so the EMT should ask for proof beforehand that the
individual is, in fact, a physician with training in Emergency Medicine.
(It's not likely OEMS will accept your reasoning for not immobilizing a
patient because a dermatologist said it was ok not to do so).
If, in extenuating circumstances, there is a communications failure (see
Communication Failure Policy at:
http://www.cmemsc.org/cmed/cmed_proc.shtml) and medical control is not
reached; the EMT should tell the physician on scene that s/he will need to
accompany the EMT/patient to the hospital if the EMT accepts the advice
given by the physician on scene.
As with all calls, the EMT should carefully document everything that
transpired on the patient care report.
Q: On a 911 response, once the EMTs have determined that the patient needs
to be transported to a hospital ED; may the crew choose to transport the
patient without the use of emergency lights and sirens?
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.
Q: What types of call information is acceptable to give to newspapers for
police blotter columns.
A: Response address.
Q: What is the average billing rate for an ambulance transport in MA?
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"
Q: Does the region ever acknowledge years of service from its EMT's and
Paramedic's? After 20 years of certification as a Nationally Registered EMT or
Paramedic they send you a very nice certificate.
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 held on the first Tuesday of May.
Q: Are both EMTs eligible for a stork pin when the ambulance crew attends to
a childbirth or is the pin limited to the EMT who provided patient care?
A: There is no set rule about the stork pin. Since both EMTs are responsible
for patient care, both can wear the pin.
Q: Is there a maximum number of non-certified EMTs (ex: observers/First
Responders) that can be on an ambulance at any given time?
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.
