Original Notice.

     Preproposal statement of inquiry was filed as WSR 01-11-162.

     Title of Rule: WAC 246-976-031 Senior EMS instructor (SEI), 246-976-960 Regional emergency medical services and trauma care councils, and 246-976-970 Local emergency medical and trauma care councils.

     Purpose: The purpose of the proposed rule changes are to (a) amend the current approval process of SEIs, WAC 246-976-031, in order to seek a quality improvement approach in the development, recommendation, and approval of SEIs, and (b) provide language in WAC 246-976-960 which would clarify those responsibilities when no local EMS/TC council exists.

     Statutory Authority for Adoption: RCW 18.73.081 and 70.168.120.

     Statute Being Implemented: RCW 18.73.081 and 70.168.120.

     Summary: The proposed rule amendments to WAC 246-976-031 set specific, consistent performance and documentation standards for all SEI candidates.

     The proposed rule amendments to WAC 246-976-960 clarify what should be done when there is no local EMS/TC council available to make recommendations. Only local EMS/TC councils have statutory authority to nominate individuals to be appointed as regional EMS/TC council members by Department of Health (DOH). The proposed language will enable DOH to appoint or reappoint members to a regional council if there is no local council to make nominations to DOH for appointment to the regional EMS/TC council.

     Reasons Supporting Proposal: The current WAC 246-976-031 does not guide SEIs by specific standards, there is no measure of performance, and instructional quality varies. The proposed rule is intended to improve the quality of instruction by SEIs, and ultimately improve patient care.

     The proposed rule amendments to WAC 246-976-960 clarify what should be done when there is no local EMS/TC council available to make recommendations.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Dane Kessler and Dick Benjamin, 2725 Harrison Avenue N.W., Suite 500, Olympia, WA 98504-7853, (360) 705-6700.

     Name of Proponent: Department of Health, governmental.

     Rule is not necessitated by federal law, federal or state court decision.

     Explanation of Rule, its Purpose, and Anticipated Effects: (a) WAC 246-976-031 clarifies how to become a senior EMS instructor and how to maintain status. The purpose of this proposal is to seek a quality improvement approach in the development, recommendation and approval of SEIs. Constituents recommended that a precise consistent method of approving instructors based on performance and evaluations needs to be established. The current approach is an inconsistent method of determining quality instructors. The proposed rule amendments will provide specific, consistent performance and documentation standards for all SEI candidates. They will encourage active quality improvement by each SEI candidate and will provide a means of identifying strengths and weaknesses of each SEI candidate. In addition, it will improve the quality of instruction by SEIs, and the ultimate goal of improving the care received by injured patients and the education of EMS personnel.

     (b) Current WAC 246-976-960 specifies the roles and responsibilities of the regional EMS/TC councils, but does not provide an alternative in those cases where a local EMS/TC council does not exist. Only local EMS/TC councils have statutory authority to nominate individuals to be appointed as regional EMS/TC council members by DOH. Without the inclusion of the proposed language, DOH is unable to appoint or reappoint members to a regional council if no local council exists to make recommendations for membership, because it is not mandated that local EMS/TC councils must exist. The proposed rule amendments will clarify what should be done when there is no local EMS/TC council available to make recommendations.

     (c) WAC 246-976-970 is amended to assure consistency with the new requirements of WAC 246-976-031.

     Proposal Changes the Following Existing Rules: (a) WAC 246-976-031 will be revised to include many current department policies. The proposed rule will now require applicants to document the completion of all requirements on forms provided by the department. For those seeking initial recognition applicants must now demonstrate knowledge of current EMS training and certification statutes, WAC and the UDA, but must only assist in the coordination and instruction of one entire EMT-B course. This coordination and instruction will now require documentation of receiving evaluation in sixteen identified lessons, and coordinating and conducting an EMT-B final end of course comprehensive practical skills evaluation. For those seeking renewal recognition applicants must now demonstrate knowledge of current EMS training and certification statutes, WAC and the UDA. The proposed rule only allows two choices for courses to coordinate and teach, and it also requires them to perform two evaluations on the instruction of course lessons taught by either initial or renewing SEI candidate, and they must also receive two evaluations on the instruction of course lessons in which they taught.

     (b) WAC 246-976-960 will be revised to include the following language to clarify statutory roles and responsibilities where no local EMS/TC council exists: "In areas where no local EMS/TC council exists, the regional EMS/TC council shall (a) make recommendations to the department regarding appointing members to the regional EMS/TC council, and (b) review applications for initial training classes and OTEP programs, and make recommendations to the department."

     (c) WAC 246-976-970 is amended to assure consistency with the new requirements of WAC 246-976-031.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The rule has been reviewed and analyzed, and the department has found that for the proposed rule amendments to WAC 246-976-031 costs have been reduced and therefore no small business economic impact statement (SBEIS) is required. For proposed rule amendments to WAC 246-976-960, it was determined that because local and regional EMS/TC councils are nonprofit organizations they do not fit the definition of a small business as defined under chapter 19.85 RCW, no SBEIS was done for this proposed rule amendment either. To obtain a copy of the analysis contact Tami Schweppe, DOH, EMS and Trauma, P.O. Box 47853, Olympia, WA 98504-7853, (360) 705-6748, fax (360) 705-6706, e-mail tami.schweppe@doh.wa.gov.

     RCW 34.05.328 applies to this rule adoption. The proposed rule is a significant legislative rule because it establishes, alters, or revokes any qualification or standard for the issuance, suspension, or revocation of a license or permit. In this instance the proposed rule establishes standards to be recognized as a senior EMS instructor.

     Hearing Location: Department of Health, Office of Emergency Medical and Trauma Prevention, Training Room, 2725 Harrison Avenue N.W., Suite 500, Olympia, WA 98504-7853, on Tuesday, June 4, 2002, at 9:00 a.m.

     Assistance for Persons with Disabilities: Contact Tami Schweppe by May 28, 2002, TDD (800) 833-6368, or (360) 705-6748.

     Submit Written Comments to: Tami Schweppe, Rules Coordinator, Department of Health, EMS and Trauma, P.O. Box 47853, Olympia, WA 98504-7853, fax (360) 705-6706, by May 28, 2002.

     Date of Intended Adoption: June 4, 2002.

April 30, 2002

Mary C. Selecky

Secretary

OTS-5234.4

AMENDATORY SECTION(Amending WSR 00-08-102, filed 4/5/00, effective 5/6/00)

WAC 246-976-031   Senior EMS instructor (SEI).   (1) Responsibilities. The SEI is responsible for the overall instructional quality of ((the)) initial first responder or EMT-basic courses, under the general supervision of the medical program director (MPD). The SEI must conduct courses following department-approved curricula((, and follow the department's policies, procedures and administrative requirements)) identified in WAC 246-976-021. The SEI candidate shall document the completion of requirements for initial and renewal recognition on forms provided by the department.

     (2) ((Qualifications. The department will publish procedures to recognize senior EMS instructors (SEIs).

     (3) Initial recognition. To apply for initial recognition as a SEI, submit to the department:

     (a) Proof of high school graduation, GED or equivalent;

     (b) Proof of)) Initial recognition. The department will publish Initial Recognition Application Procedures for Senior EMS Instructors (IRAP), which include the Initial Senior EMS Instructor Application and Agreement, instructor objectives, instructions and forms necessary for initial recognition.

     (a) Prerequisites. Candidates for initial recognition must document proof of the following:

     (i) Current Washington state certification as an EMT or ((above)) higher EMS certification;

     (((c) Proof of)) (ii) At least three years prehospital EMS experience ((at the EMT level or above;

     (d) Proof of at least one recertification;

     (e) Proof of)) as an EMT or higher EMS certification level, with at least one recertification;

     (iii) Successful completion of an approved ongoing training and evaluation program (OTEP)/basic life support (BLS) evaluator workshop;

     (iv) Current recognition as a CPR instructor for health care providers by the American Heart Association, the American Red Cross, the National Safety Council, or other nationally recognized organization with substantially equivalent standards ((to any of the above mentioned;

     (f) Successful completion of an approved instructor workshop;

     (g) Experience assisting with two EMT courses, performing a minimum of three hours of lectures and six hours of practical skills in each course;

     (h) Recommendation by the local EMS/TC council;

     (i) Recommendation by the MPD.

     (4) Renewal of recognition. Recognition as a SEI is for three years. To renew recognition, submit to the department:

     (a) Proof of current Washington state EMS certification as an EMT or above;

     (b) Proof of current or previous recognition as a senior EMS instructor;

     (c) Proof of current recognition as a CPR instructor for health care providers by a nationally recognized organization approved by the department;

     (d) Recommendation by the local EMS/TC council;

     (e) Recommendation by the MPD)) approved by the department;

     (v) Successful completion of an instructor training course by the U.S. Department of Transportation, National Highway Traffic Safety Administration, or an instructor training course from an accredited institution of higher education;

     (vi) Successful completion of an examination developed and administered by the department on current EMS training and certification statutes, Washington Administrative Code (WAC) and the Uniform Disciplinary Act (UDA).

     (b) Submission of prerequisites. Candidates must submit proof of successful completion of the prerequisites to the department.

     (i) Candidates meeting the prerequisites will be issued the IRAP by the department.

     (ii) The department will provide instruction to each candidate prior to beginning the initial recognition process.

     (c) Candidate objectives. Candidates who have been issued the IRAP and received instructions on the recognition process must successfully complete the IRAP, under the supervision of a currently recognized, EMT-basic course lead SEI:

     As part of an initial EMT-basic course, the candidate must demonstrate to the course lead SEI, the knowledge and skills necessary to complete the following instructor objectives;

     (i) Accurately complete the course application process and meet application timelines;

     (ii) Notify EMT-basic course students of course entry prerequisites;

     (iii) Assure students selected for admittance to the course meet DOH training and certification prerequisites and notify training agency selection board of discrepancies;

     (iv) Maintain course records adequately;

     (v) Track student attendance, scores, quizzes, and performance, and counsel/remediate students as necessary;

     (vi) Assist in the coordination and instruction of one entire EMT-basic course under the supervision of the course lead SEI; utilizing the EMT-basic training course curriculum identified in WAC 246-976-021, and be evaluated on the instruction of each of the following lessons:

     (A) Lesson 1-2 -- Well Being of the EMT-Basic, including Infectious Disease Prevention for EMS Providers, Revised 10/1997 (available from the department of health, office of emergency medical and trauma prevention);

     (B) Lesson 2-1 -- Airway;

     (C) Lesson 3-2 -- Initial Assessment;

     (D) Lesson 3-3 -- Focused History and Physical Exam: Trauma;

     (E) Lesson 3-4 -- Focused History and Physical Exam: Medical;

     (F) Lesson 3-5 -- Detailed Physical Exam;

     (G) Lesson 3-6 -- Ongoing Assessment;

     (H) Lesson 3-9 -- Practical Lab: Patient Assessment;

     (I) Lesson 4-1 -- General Pharmacology;

     (J) Lesson 4-2 -- Respiratory Emergencies;

     (K) Lesson 4-3 -- Cardiovascular Emergencies;

     (L) Lesson 4-9 -- Obstetrics/Gynecology;

     (M) Lesson 5-4 -- Injuries to the Head and Spine, Chest and Abdomen;

     (N) Lesson 5-5 -- Practical Lab: Trauma;

     (O) Lesson 6-1 -- Infants and Children;

     (P) Lesson 7-2 -- Gaining Access (including patient removal, treatment and transport).

     (vii) Coordinate and conduct an EMT-basic final end of course comprehensive practical skills evaluation.

     (d) Candidate evaluation. Performance evaluations will be conducted by an SEI for each instructor objective performed by the candidate on documents identified in the IRAP. These documents consist of:

     (i) An evaluation form, to evaluate lesson instruction objectives performed by the candidate;

     (ii) A quality improvement record, to document improvement necessary to successfully complete an instructor objective performed by the candidate;

     (iii) An objective completion record, to document successful completion of each instructor objective performed by the candidate.

     (e) Application and approval.

     (i) Candidates must submit the completed IRAP, including the application/agreement and all documents completed during the initial recognition process, to the county MPD to obtain a recommendation of approval to the department.

     (ii) Upon recommendation of approval by the county MPD, the SEI candidate will submit the following documents to the department:

     (A) Current proof of completion of prerequisites listed in subsection (2)(a)(i), (iv) and (vi) of this section;

     (B) The original initial SEI application/agreement, signed by the candidate and the MPD; and

     (C) The original completed IRAP document and all forms used for evaluation, quality improvement purposes, and verification of successful completion as identified in the IRAP.

     (3) Renewal of recognition. The department will publish Renewal Application Procedures for Senior EMS Instructors (RAP), which include the Senior EMS Instructor Renewal Application and Agreement, instructor objectives, instructions and forms necessary for renewal.

     (a) The RAP will be provided by the department to individuals upon recognition as a SEI, to be completed during the recognition period.

     (b) Candidate objectives. Candidates who have been issued the RAP must successfully complete the RAP during each approval period, which includes the following instructor objectives:

     (i) Coordinate and perform as the lead SEI for one initial first responder or EMT-basic course including the supervision of all practical skills evaluations;

     (ii) Receive performance evaluations from a currently recognized SEI, on two candidate instructed first responder or EMT-basic course lessons;

     (iii) Perform two performance evaluations on the instruction of first responder or EMT-basic course lessons for SEI initial or renewal recognition candidates; and

     (iv) Attend one DOH approved SEI workshop.

     (c) Candidate evaluation. Evaluations of the performance of instructor objectives will be conducted by an SEI and completed on documents identified in the RAP. These documents consist of:

     (i) An evaluation form, to evaluate lesson instruction objectives performed by the candidate.

     (ii) A quality improvement record, to document improvement necessary to successfully complete an instructor objective performed by the candidate.

     (iii) An objective evaluation record, to document successful completion of each instructor objective performed by the candidate.

     (d) Prerequisites. Candidates for renewal of recognition must document proof of the following:

     (i) Current or previous recognition as a Washington state SEI;

     (ii) Current Washington state certification as an EMT or higher EMS certification;

     (iii) Current recognition as a CPR instructor for health care providers by the American Heart Association, the American Red Cross, the National Safety Council, or other nationally recognized organization with substantially equivalent standards.

     (iv) Successful completion of an examination developed and administered by the department on current EMS training and certification statutes, WAC and the UDA.

     (e) Application and approval.

     (i) Candidates must submit the completed RAP, including the application/agreement and all documents completed during the renewal of recognition process, to the county MPD to obtain a recommendation of approval to the department.

     (ii) Upon recommendation of approval by the county MPD, the renewal candidate must submit the following documents to the department:

     (A) Current proof of successful completion of the prerequisites listed in subsection (3)(d)(ii), (iii), and (iv) of this section;

     (B) The original SEI renewal application/agreement that has been signed by the candidate and the MPD; and

     (C) The original completed RAP document and all forms used for evaluation, quality improvement purposes and verification of successful completion as identified in the RAP.

     (4) Length of recognition. Recognition as a SEI is for three years.

     (5) Denial, suspension, modification or revocation of SEI recognition.

     (a) The department may deny, suspend, modify or revoke an SEI's recognition when it finds:

     (i) Violations of chapter 18.130 RCW, the Uniform Disciplinary Act;

     (ii) A failure to:

     (A) Maintain EMS certification;

     (B) Update the following personal information with DOH as changes occur:

     (I) Name;

     (II) Address;

     (III) Home and work phone numbers;

     (C) Maintain knowledge of current EMS training and certification statutes, WAC and the UDA;

     (D) Comply with requirements in WAC 246-976-031(1);

     (E) Participate in the instructor candidate evaluation process in an objective and professional manner without cost to the individual being reviewed or evaluated;

     (F) Adequately complete all forms and adequately maintain records in accordance with this chapter;

     (G) Demonstrate all skills and procedures based on current standards;

     (H) Follow the requirements of the Americans with Disabilities Act;

     (I) Maintain security on all department examination materials.

     (b) The candidate or SEI may request a hearing to contest department decisions in regard to denial, suspension, modification or revocation of SEI recognition in accordance with the Administrative Procedure Act (APA) (chapter 34.05 RCW) and associated administrative codes.

[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-031, filed 4/5/00, effective 5/6/00.]

     (a) Identify and analyze system trends to evaluate the EMS/TC system and its component subsystems, using trauma registry data provided by the department;

     (b) Develop and submit to the department regional EMS/TC plans to:

     (i) Identify the need for and recommend distribution and level of care (basic, intermediate or advanced life support) for verified aid and ambulance services for each response area. The recommendations will be based on criteria established by the department relating to agency response times, geography, topography, and population density;

     (ii) Identify EMS/TC services and resources currently available within the region;

     (iii) Describe how the roles and responsibilities of the MPD are coordinated with those of the regional EMS/TC council and the regional plan;

     (iv) Describe and recommend improvements in medical control communications and EMS/TC dispatch, with at least the elements of the state communication plan described in RCW 70.168.060 (1)(h);

     (v) Include a schedule for implementation.

     (2) In developing or modifying its plan, the regional council must seek and consider the recommendations of:

     (a) Local EMS/TC councils;

     (b) EMS/TC systems established by ordinance, resolution, interlocal agreement or contract by counties, cities, or other governmental bodies.

     (3) In developing or modifying its plan, the regional council must use regional and state analyses provided by the department based on trauma registry data and other appropriate sources;

     (4) Approved regional plans may include standards, including response times for verified services, which exceed the requirements of this chapter.

     (5) An EMS/TC provider who disagrees with the regional plan may bring its concerns to the steering committee before the department approves the plan.

     (6) The regional council must adopt regional patient care procedures as part of the regional plans. In addition to meeting the requirements of RCW 18.73.030(14) and 70.168.015(23):

     (a) For all emergency patients, regional patient care procedures must identify:

     (i) Guidelines for rendezvous with agencies offering higher levels of service if appropriate and available, in accordance with the regional plan.

     (ii) The type of facility to receive the patient, as described in regional patient destination and disposition guidelines.

     (iii) Procedures to handle types and volumes of trauma that may exceed regional capabilities, taking into consideration resources available in other regions and adjacent states.

     (b) For major trauma patients, regional patient care procedures must identify procedures to activate the trauma system.

     (7) In areas where no local EMS/TC council exists, the regional EMS/TC council shall:

     (a) Make recommendations to the department regarding appointing members to the regional EMS/TC council;

     (b) Review applications for initial training classes and OTEP programs, and make recommendations to the department.

     (8) Matching grants made under the provisions of chapter 70.168 RCW may include funding to:

     (a) Develop, implement, and evaluate prevention programs; or

     (b) Accomplish other purposes as approved by the department.

[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-960, filed 4/5/00, effective 5/6/00. Statutory Authority: RCW 43.70.040 and chapters 18.71, 18.73 and 70.168 RCW. 93-01-148 (Order 323), § 246-976-960, filed 12/23/92, effective 1/23/93.]

     (2) In addition to meeting the requirements of chapter 70.168 RCW and this chapter, local EMS/TC councils must:

     (a) Participate with the MPD and emergency communication centers in making recommendations to the regional council about the development of regional patient care procedures; and

     (b) ((Review senior EMS instructor applications and make recommendations to the department.

     (c))) Review applications for initial training classes and OTEP programs, and make recommendations to the department.

     (3) Local EMS/TC councils may make recommendations to the department regarding certification and termination of MPDs, as provided in RCW 18.71.205(4).

[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-970, filed 4/5/00, effective 5/6/00. Statutory Authority: RCW 43.70.040 and chapters 18.71, 18.73 and 70.168 RCW. 93-01-148 (Order 323), § 246-976-970, filed 12/23/92, effective 1/23/93.]

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