PROPOSED RULES
Original Notice.
Preproposal statement of inquiry was filed as WSR 08-16-037.
Title of Rule and Other Identifying Information: WAC 246-976-001 through 246-976-400, 246-976-890, 246-976-920, and 246-976-950, EMS and trauma system prehospital rules and standards for training, licensure and verification, and prehospital system administration.
Hearing Location(s): Department of Health, Town Center 2 Building, 1st Floor, Conference Room 158, 111 Israel Road S.E., Tumwater, WA 98501, on May 11, 2010, at 10:30 a.m.
Date of Intended Adoption: May 14, 2010.
Submit Written Comments to: Michael Lopez, Department of Health, Office of Community Health Systems, P.O. Box 47853, Olympia, WA 98504-7853, web site http://www3.doh.wa.gov/policyreview/, fax (360) 236-2830, by May 11, 2010.
Assistance for Persons with Disabilities: Contact Michael Lopez by May 5, 2010, TTY (800) 833-6388 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the proposal is to update EMS and trauma system (EMS & TS) prehospital rules and standards that pertain to licensure of EMS services and certification of individuals to be in alignment with national industry standards, guidelines, and best practice. The anticipated effect will be more lives saved and rehabilitated because of greater efficiencies and best practices incorporated into the delivery of emergency medical and trauma services.
Reasons Supporting Proposal: Regular reviews of EMS rules are needed to keep EMS & TS regulations in alignment with industry standards and guidelines. Existing rules also require biennial review and comment on the EMS & TS prehospital rules. Current rules do not reflect recent changes in EMS industry standards and practice. Proposed rules will reflect these changes and objectives recommended by the governor's steering committee for EMS & TS in its 2006 strategic plan.
Statutory Authority for Adoption: RCW 70.168.050 and 70.168.060.
Statute Being Implemented: Chapters 18.71 and 18.73 RCW, RCW 70.24.260.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of health, office of community health systems, governmental.
Name of Agency Personnel Responsible for Drafting: Dane Kessler, 243 Israel Road S.E., Tumwater, WA 98501, (360) 236-2842; Implementation and Enforcement: Michael Lopez, 243 Israel Road S.E., Tumwater, WA 98501, (360) 236-2841.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule would not impose more than minor costs on businesses in an industry.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Michael Lopez, P.O. Box 47853, Olympia, WA 98504-7853, phone (360) 236-2841, fax (360) 236-2830, e-mail michael.lopez@doh.wa.gov.
April 5, 2010
Mary C. Selecky
Secretary
OTS-3038.4
AMENDATORY SECTION(Amending WSR 00-08-102, filed 4/5/00,
effective 5/6/00)
WAC 246-976-001
Purpose.
The purpose of these rules is
to implement RCW 18.71.200 through 18.71.215, and chapters
18.73 and 70.168 RCW; and those sections of chapter 70.24 RCW
relating to EMS((/TC)) personnel and services.
(1) This chapter establishes criteria for:
(a) Training and certification of ((basic, intermediate
and advanced life support technicians)) EMS providers;
(b) Licensure and inspection of ambulance services and aid services;
(c) Verification of prehospital trauma services;
(d) Development and operation of a statewide trauma registry;
(e) The designation process and operating requirements for designated trauma care services;
(f) A statewide emergency medical communication system;
(g) Administration of the statewide EMS/TC system.
(((3))) (2)
This chapter does not contain detailed procedures to implement
the state EMS/TC system. Request procedures, guidelines, or
any publications referred to in this chapter from the Office
of ((Emergency Medical and Trauma Prevention)) Community
Health Systems, Department of Health, Olympia, WA 98504-7853
or on the internet at www.doh.wa.gov.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-001, 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), § 246-976-001, filed 12/23/92, effective 1/23/93.]
(("ACLS" means advanced cardiac life support, a course
developed by the American Heart Association.))
"Activation of the trauma system" means mobilizing
resources to care for a trauma patient in accordance with
regional patient care procedures. ((When the prehospital
provider identifies a major trauma patient, using approved
prehospital trauma triage procedures, he or she notifies both
dispatch and medical control from the field.))
"Adolescence" means the period of physical and psychological development from the onset of puberty to maturity, approximately twelve to eighteen years of age.
"Advanced cardiac life support (ACLS)" means a department-approved course in advanced cardiac life support that includes the education and clinical interventions used to treat cardiac arrest and other acute cardiac related problems.
"Advanced emergency medical technician (AEMT)" means a person who has been examined and certified by the department as an intermediate life support technician as defined in RCW 18.71.200 and 18.71.205.
"Advanced first aid((,))" for the purposes of RCW 18.73.120, 18.73.150, and 18.73.170, as of January 1, 2012,
means ((a course of at least twenty-four hours of instruction,
which includes at least:
• CPR;
• Airway management;
• Trauma/wound care;
• Immobilization)) a department-certified EMR qualification.
"Advanced life support (ALS)" means invasive emergency medical services requiring the advanced medical treatment skills of a paramedic.
"Agency" means an aid or ambulance service licensed by the department.
"Agency response time" means the interval from ((agency
notification)) dispatch to arrival on the scene. ((It is the
combination of activation and en route times defined under
system response times in this section.))
"Aid service" means an agency licensed by the department to operate one or more aid vehicles, consistent with regional and state plans.
(("Airway technician" means a person who:
• Has been trained in an approved program to perform endotracheal airway management and other authorized aids to ventilation under written or oral authorization of an MPD or approved physician delegate; and
• Has been examined and certified as an airway technician by the department or by the University of Washington's school of medicine.
"ALS" means advanced life support.))
"Ambulance service" means an agency licensed by the
department to operate one or more ground or air ambulances. ((Ground ambulance service operation must be consistent with
regional and state plans. Air ambulance service operation
must be consistent with the state plan.))
"Approved" means approved by the department of health.
"ATLS" means advanced trauma life support, a course developed by the American College of Surgeons.
"Attending surgeon" means a physician who is board-certified or board-qualified in general surgery, and who has surgical privileges delineated by the facility's medical staff. The attending surgeon is responsible for care of the trauma patient, participates in all major therapeutic decisions, and is present during operative procedures.
"Available" for designated trauma services described in WAC 246-976-485 through 246-976-890 means physically present in the facility and able to deliver care to the patient within the time specified. If no time is specified, the equipment or personnel must be available as reasonable and appropriate for the needs of the patient.
(("BLS" means basic life support.))
"Basic life support (BLS)" means emergency medical services requiring basic medical treatment skills as defined in chapter 18.73 RCW.
"Board certified" or "board-certified" means that a physician has been certified by the appropriate specialty board recognized by the American Board of Medical Specialties. For the purposes of this chapter, references to "board certified" include physicians who are board-qualified.
"Board-qualified" means physicians who have graduated less than five years previously from a residency program accredited for the appropriate specialty by the accreditation council for graduate medical education.
"BP" means blood pressure.
"Certification" means the department ((recognizes)) has
documentation that an individual has met predetermined
qualifications, and authorizes the individual to perform
certain procedures.
"Consumer" means an individual who is not associated with the EMS/TC system, either for pay or as a volunteer, except for service on the steering committee, licensing and certification committee, or regional or local EMS/TC councils.
"Continuing medical education (((CME))) method" or
(("continuing medical education method" or "CME" or)) "CME
method" is the completion of prehospital EMS recertification
education requirements after initial ((prehospital)) EMS
certification to maintain and enhance skill and knowledge. CME requires the successful completion of ((a written))
department-approved knowledge and practical skill((s))
certification examinations to recertify.
"County operating procedures" or "COPS" means the written operational procedures adopted by the county MPD and the local EMS council specific to county needs. COPS may not conflict with regional patient care procedures.
"CPR" means cardiopulmonary resuscitation.
"Critical care transport" means the interfacility transport of a patient whose condition requires care by a paramedic who has received special training and approval by the MPD.
"Department" means the Washington state department of health.
"Dispatch" means to identify and direct an emergency response unit to an incident location.
"Diversion" ((for trauma care)) means the EMS transport
of a ((trauma)) patient past the usual receiving ((trauma
service)) facility to another ((trauma service)) facility due
to temporary unavailability of ((trauma)) care resources at
the usual receiving ((trauma service)) facility.
"E-code" means external cause code, an etiology included in the International Classification of Diseases (ICD).
"ED" means emergency department.
"Emergency medical procedures" means the scope of practice associated with EMS personnel certified by the department in this chapter.
"Emergency medical services and trauma care (EMS/TC) system" means an organized approach to providing personnel, facilities, and equipment for effective and coordinated medical treatment of patients with a medical emergency or injury requiring immediate medical or surgical intervention to prevent death or disability. The emergency medical service and trauma care system includes prevention activities, prehospital care, hospital care, and rehabilitation.
"Emergency medical responder (EMR)" means a person who has been examined and certified by the department as a first responder to render prehospital EMS care as defined in RCW 18.73.081.
"Emergency medical technician (EMT)" means a person who has been examined and certified by the department to render prehospital EMS care as defined in RCW 18.73.081.
"EMS" means emergency medical services.
"EMS provider" means an individual certified by the department or the University of Washington School of Medicine pursuant to chapters 18.71 and 18.73 RCW to provide prehospital emergency response, patient care, and transport.
"EMS/TC" means emergency medical services and trauma care.
(("EMT" means emergency medical technician.))
"First aid" for the purposes of chapter 18.73 RCW and this chapter means advanced first aid as identified in RCW 18.73.120.
"First responder" means emergency medical responder (EMR).
"General surgeon" means a licensed physician who has completed a residency program in surgery and who has surgical privileges delineated by the facility.
"ICD" means the international classification of diseases, a coding system developed by the World Health Organization.
(("ILS" means intermediate life support.))
"Injury prevention" means any combination of educational, legislative, enforcement, engineering and emergency response initiatives used to reduce the number and severity of injuries.
"Interfacility transport" means medical transport of a patient between recognized medical treatment facilities requested by a licensed health care provider.
"Intermediate life support (ILS)" means invasive emergency medical services requiring the advanced medical treatment skills of an advanced EMT (AEMT).
"Intermediate life support (ILS) technician" means ((a
person who:
• Has been trained in an approved program to perform specific phases of advanced cardiac and trauma life support as specified in this chapter, under written or oral direction of an MPD or approved physician delegate; and
• Has been examined and certified as an ILS technician by the department or by the University of Washington's school of medicine.
"Intravenous therapy technician" means a person who:
• Has been trained in an approved program to initiate IV access and administer intravenous solutions under written or oral authorization of an MPD or approved physician delegate; and
• Has been examined and certified as an intravenous therapy technician by the department or by the University of Washington's school of medicine.)) an advanced emergency medical technician (AEMT) who has been trained in an approved program to perform specific phases of advanced cardiac and trauma life support as specified in this chapter.
"IV" means ((intravenous)) a fluid or medication
administered directly into the venous system.
"Licensing and certification committee (L&C committee)" means the emergency medical services licensing and certification advisory committee created by RCW 18.73.040.
"Local council" means a local EMS/TC council authorized by RCW 70.168.120(1).
"Local medical community" means the organized local
medical society existing in a county or counties((; or)). In
the absence of an organized medical society, ((majority
physician consensus)) it means the group of physicians in the
county or counties.
"Medical control" means ((MPD authority to direct))
direction of the medical care provided by certified EMS
personnel in the prehospital EMS system by the MPD or MPD
delegate.
"Medical control agreement" means a written agreement between two or more MPDs, using similar protocols that are consistent with regional plans, to assure continuity of patient care between counties, and to facilitate assistance.
"Medical program director (MPD)" means ((medical program
director.
"Must" means shall.)) a person who meets the requirements of chapters 18.71 and 18.73 RCW and is certified by the department. The MPD is responsible for both the supervision of training and medical control of EMS providers.
"MPD delegate" means a physician appointed by the MPD and recognized and approved by the department. An MPD delegate may be one or both of the following:
• Prehospital training physician who supervises specified aspects of training EMS personnel;
• Prehospital supervising physician means a physician who provides on-line medical control of EMS personnel.
"Ongoing training and evaluation program (OTEP)" ((or
"ongoing training and evaluation program (OTEP)" or "OTEP" or
"OTEP program" or "OTEP method" is)) means a continuing
program of prehospital EMS education for EMS personnel
((that)). An OTEP is approved by the MPD and the department
((to)). An OTEP must meet the EMS education requirements and
core topic content required for recertification. The OTEP
method includes ((cognitive, affective and psychomotor))
evaluations of the knowledge and skills covered in the topic
content following ((completion of)) each topic presentation
((to determine student competence of topic content)).
"PALS" means a department-approved course in pediatric
advanced life support((, a course developed by the American
Heart Association)).
"Paramedic" or "physician's trained emergency medical
service paramedic" means a person who((:
• Has been trained in an approved program to perform all phases of prehospital emergency medical care, including advanced life support, under written or oral authorization of an MPD or approved physician delegate; and
• Has been examined and certified as a paramedic by the department or by the University of Washington's school of medicine.)) has been trained in an approved program to perform all phases of prehospital emergency medical care, including advanced life support, under written or oral authorization of an MPD or approved physician delegate, and examined and certified by the department as specified in this chapter.
"Pediatric education requirement (PER)" ((or "PER"))
means the pediatric education and training standards required
for certain specialty physicians and nurses who care for
pediatric patients in designated trauma services as identified
in WAC 246-976-886 and 246-976-887.
"PEPP" means pediatric education for prehospital professionals.
"PHTLS" means a department-approved prehospital trauma life support course.
"Physician" means an individual licensed under the provisions of chapters 18.71 or 18.57 RCW.
"Physician with specific delineation of surgical privileges" means a physician with surgical privileges delineated for emergency/life-saving surgical intervention and stabilization of a trauma patient prior to transfer to a higher level of care. Surgery privileges are awarded by the facility's credentialing process.
"Postgraduate year" means the classification system for residents who are undergoing postgraduate training. The number indicates the year the resident is in during his/her postmedical school residency program.
"Practical skills examination" means a test conducted in
an initial course, or a test ((or series of evaluations))
conducted during a recertification period, to determine
competence in each of the practical skills or group of skills
specified by the department.
"Prehospital ((agencies)) agency" means a provider((s))
of prehospital care or interfacility ambulance transport
licensed by the department.
"Prehospital index (PHI)" means a scoring system used to
((activate)) trigger activation of a hospital trauma
resuscitation team.
"Prehospital patient care protocols" means the
department-approved, written ((procedures)) orders adopted by
the MPD under RCW 18.73.030(13) and 70.168.015(26) which
direct the out-of-hospital ((emergency)) care of ((the
emergency)) patients ((which includes the trauma care
patient)). These protocols are related only to delivery and
documentation of direct patient treatment. The protocols
shall meet or exceed statewide minimum standards developed by
the department in rule as authorized in chapter 70.168 RCW.
"Prehospital provider" means EMS provider.
"Prehospital trauma care services" means ((agencies)) an
agency that ((are)) is verified by the department to provide
prehospital trauma care.
"Prehospital trauma triage procedure((s))" means the
method used by prehospital providers to evaluate injured
patients and determine whether to activate the trauma system
from the field. It is described in WAC 246-976-930(2).
"Public education" means education of the population at
large, targeted groups, or individuals, in preventive measures
and efforts to alter specific ((injury-related)) injury,
trauma, and medical-related behaviors.
"Quality improvement (QI)" or (("QI" or)) "quality
assurance (QA)" means a process/program to monitor and
evaluate care provided in trauma services and EMS/TC systems.
"Regional council" means the regional EMS/TC council established by RCW 70.168.100.
"Regional patient care procedures (((RPCP)))" means
((procedures adopted by a regional council under RCW 18.73.030(14) and 70.168.015(23), and approved by the
department. Regional patient care procedures do not relate to
direct patient care.)) department-approved written operating
guidelines adopted by the regional emergency medical services
and trauma care council, in consultation with the local
emergency medical services and trauma care councils, emergency
communication centers, and the emergency medical services
medical program director, in accordance with statewide minimum
standards. The patient care procedures shall identify the
level of medical care personnel to be dispatched to an
emergency scene, procedures for triage of patients, the level
of trauma care facility to first receive the patient, and the
name and location of other trauma care facilities to receive
the patient should an interfacility transfer be necessary.
Procedures on interfacility transfer of patients shall be
consistent with the transfer procedures in chapter 70.170 RCW.
Patient care procedures do not relate to direct patient care.
"Regional plan" means the plan defined in WAC 246-976-960 (1)(b) that has been approved by the department.
"Registered nurse" means an individual licensed under the provisions of chapter 18.79 RCW.
(("Response area" means a service coverage zone
identified in an approved regional plan.))
"Rural" means an unincorporated or incorporated area((s))
with a total population((s)) of less than ten thousand people,
or with a population density of less than one thousand people
per square mile.
"Senior EMS instructor (SEI)" means an individual
approved by the department to be responsible for the
administration, quality of instruction and the conduct of
((basic life support)) initial emergency medical responder
(EMR) and emergency medical technician (EMT) training courses.
"Special competence" means that an individual has been deemed competent and committed to a medical specialty area with documented training, board certification and/or experience, which has been reviewed and accepted as evidence of a practitioner's expertise:
• For physicians, by the facility's medical staff;
• For registered nurses, by the facility's department of nursing;
• For physician assistants and advanced registered nurse practitioners, as defined in the facility's bylaws.
"Specialized training" means MPD and department-approved
training of certified EMS personnel to use a special skill,
technique, or equipment that is not included in the ((standard
course curriculum)) instructional standards and guidelines.
"State plan" means the emergency medical services and trauma care system plan described in RCW 70.168.015(7), adopted by the department under RCW 70.168.060(10).
"Steering committee" means the EMS/TC steering committee created by RCW 70.168.020.
"Suburban" means an incorporated or unincorporated area
with a population of ten thousand to twenty-nine thousand nine
hundred ninety-nine or any area with a population density of
between one thousand ((to)) and two thousand people per square
mile.
"System response time" for trauma means the interval from discovery of an injury until the patient arrives at a designated trauma facility. It includes:
• "Discovery time": The interval from injury to
discovery of the injury((;)).
(("System access time": The interval from discovery to
call received;
"911 time": The interval from call received to dispatch notified, including the time it takes the call answerer to:
• Process the call, including citizen interview; and
• Give the information to the dispatcher;
"Dispatch time": The interval from call received by the dispatcher to agency notification;
• "Activation time": The interval from agency notification to start of response;
• "En route time": The interval from the end of activation time to the beginning of on-scene time;
• "Patient access time": The interval from the end of en route time to the beginning of patient care;
• "On scene time": The interval from arrival at the scene to departure from the scene. This includes extrication, resuscitation, treatment, and loading;
• "Transport time": The interval from leaving the scene to arrival at a health care facility;)) • "System access time": The interval from discovery of the injury to call received by 9-1-1 public safety answering point (PSAP).
• "Call processing time": The interval from the time the PSAP answers the call and the time it takes the PSAP to:
– Process the call, including caller interrogation; and
– Provide the call interrogation information to the EMS dispatcher.
• "Dispatch time": The total time interval, including the call processing time, from when the call is received by the PSAP until the EMS agency is notified.
• "En route time": The time interval from the time the agency is notified until the EMS vehicle is en route to the call.
• "Arrival time": The time interval from when the EMS vehicle is en route until arrival at the incident scene.
• "On scene time": The time interval from arrival at the scene until the EMS transport vehicle departs the incident scene.
• "Transport time": The time interval from when the EMS transport vehicle leaves the incident scene until arriving at the health care facility.
"Training ((agency)) program" means an organization ((or
individual)) that is approved by the department to be
responsible for specified aspects of training of EMS
personnel.
(("Training physician" means a physician delegated by the
MPD and approved by the department to be responsible for
specified aspects of training of EMS personnel.))
"Trauma rehabilitation coordinator" means a person designated to facilitate early rehabilitation interventions and the trauma patient's access to a designated rehabilitation center.
"Trauma response area" means a service coverage zone identified in an approved regional plan.
"Trauma service" means the clinical service within a hospital or clinic that is designated by the department to provide care to trauma patients.
"Urban" means:
• An incorporated area over thirty thousand; or
• An incorporated or unincorporated area of at least ten thousand people and a population density over two thousand people per square mile.
"Verification" means the credentialing of a prehospital agency capable of providing verified trauma care services and shall be a part of the licensure process required in chapter 18.73 RCW.
"Wilderness" means any rural area not readily accessible by public or private maintained road.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 05-01-221, § 246-976-010, filed 12/22/04, effective 1/22/05; 00-08-102, § 246-976-010, filed 4/5/00, effective 5/6/00. Statutory Authority: Chapter 18.71 RCW. 96-03-052, § 246-976-010, filed 1/12/96, effective 2/12/96. Statutory Authority: RCW 43.70.040 and chapters 18.71, 18.73 and 70.168 RCW. 93-01-148 (Order 323), § 246-976-010, filed 12/23/92, effective 1/23/93.]
(2) EMS training program requirements, responsibilities:
(a) Training program requirements: To apply for initial department approval as an EMS training program, applicants must:
(i) Be one of the following:
(A) A local EMS and trauma care council or a county office responsible for EMS training for the county;
(B) A regional EMS and trauma care council providing EMS training throughout the region;
(C) An accredited institution of higher education; or
(D) A private educational business, licensed as a private vocational school.
In the absence of entities in (a)(i)(A) through (D) of this subsection, or their inability to provide an EMS training program, the local EMS and trauma care council may recommend another entity that is able to provide training. In the absence of a local EMS council, the regional EMS and trauma care council may provide such recommendation.
(E) Initial training courses may be conducted for licensed EMS agencies when under the oversight of a department-approved EMS training program.
(ii) Complete a DOH EMS training program application in which the applicant will provide:
(A) A description of classroom and laboratory facilities;
(B) A list of equipment and supplies on hand (or accessible) for use in the training program;
(C) A description of course entry prerequisites, selection criteria, and the process used to screen applicants for each EMS level of training being conducted;
(D) A student handbook for each level of training to be conducted that provides:
(I) Training program policies, including minimum standards to enter training consistent with this chapter;
(II) Course requirements and minimum standards required for successful completion of examinations, clinical/field internship rotations, and the EMS course;
(III) Initial certification requirements the student must meet to become certified as identified in WAC 246-976-141; and
(IV) A listing of clinical and field internship sites available to students.
(iii) Demonstrate need for new or additional EMS training programs.
(b) Local government agencies: The department recognizes county agencies established by ordinance and approved by the MPD to coordinate and conduct EMS programs. These agencies must comply with the requirements of this section.
(c) Training program approval is for a period of five years.
(d) Training program responsibilities. An approved training program must:
(i) Conduct courses following department requirements;
(ii) In conjunction with the course instructor, screen course applicants and approve or deny applicants consistent with WAC 246-976-041;
(iii) Maintain clinical and field internship sites to meet course requirements, including the requirement that internship rotations on EMS vehicles must be performed as a third person, not replacing required staff on the vehicle;
(iv) For the purposes of program and course evaluation, provide access to all course related materials to the department, county MPD, or MPD delegate;
(v) Conduct examinations over course lessons and other Washington state required topics;
(vi) Coordinate activities with the department-approved certification examination provider, including:
(A) Register the training;
(B) Assisting students in registering with the examination provider;
(C) Providing verification of cognitive knowledge and psychomotor skills for students successfully completing the EMS course; and
(D) Assisting students in scheduling the examination.
(vii) Maintain student records for a minimum of four years;
(viii) Monitor and evaluate the quality of instruction for the purposes of quality improvement, including course examination scores for each level taught;
(ix) Submit an annual report to the department which includes:
(A) Annual, overall certification examination results;
(B) A summary of complaints against the training program and what was done to resolve the issues;
(C) Quality improvement activities including a summary of issues and actions to improve training results; and
(x) Participate in local/regional EMS and trauma care council educational planning.
(3) Training program reapproval: To obtain reapproval from the department, an EMS training program must:
(a) Be in good standing with the department and:
(i) Have no violations of the statute and rules;
(ii) Have no pending disciplinary actions;
(iii) Maintain an overall pass rate of eighty percent on department-approved state certification examinations;
(b) Complete the requirements in subsection (2) of this section; and
(c) Complete and submit an updated EMS training program application to the department at least six months prior to the program expiration date.
(4) Discipline of EMS training programs.
(a) The department may deny, suspend, modify, or revoke the approval of a training program when it finds:
(i) Violations of chapter 246-976 WAC;
(ii) Pending disciplinary actions;
(iii) Failure to maintain an overall pass rate of eighty percent on department-approved state certification examinations;
(iv) Falsification of EMS course documents; or
(v) Failure to update training program information with the department as changes occur.
(b) The training program may request a hearing to contest department decisions in regard to denial, suspension, modification, or revocation of training program approval in accordance with the Administrative Procedure Act (APA) (chapter 34.05 RCW) and associated administrative codes.
[]
(2) Training course requirements.
(a) General requirements:
(i) A course instructor responsible for the quality of instruction and the conduct of the course as identified in subsection (3) of this section;
(ii) Instruction in multicultural health appropriate to the level of training;
(iii) Written course approval from the department;
(iv) Students must meet the minimum standards identified in WAC 246-976-041 as a prerequisite to enter training;
(v) Each student must receive a student handbook;
(vi) Prior to beginning their field internship rotations, students must receive current, county specific, county medical program director field protocols and any specific information they will need while completing the internship; and
(vii) Field internship preceptors are used to monitor and evaluate students in a standard and consistent manner.
(b) Course curriculum or instructor guidelines:
(i) The emergency medical responder (EMR) instructional materials include:
(A) The National Emergency Medical Services Training Standards - Emergency Medical Responder Instructor Guidelines published January 2009;
(B) A department-approved, four hour infectious disease training that meets the requirements of chapter 70.24 RCW; and
(C) Other Washington state required content.
(ii) The emergency medical technician (EMT) instructional materials include:
(A) The National Emergency Medical Services Training Standards - Emergency Medical Technician Instructor Guidelines published January 2009;
(B) A department-approved, four hour infectious disease training program that meets the requirements of chapter 70.24 RCW; and
(C) Other Washington state required content.
(iii) The advanced EMT (AEMT) instructional materials include:
(A) The National Emergency Medical Services Training Standards - Advance EMT Instructor Guidelines published January 2009; and
(B) Other Washington state required content.
(iv) Paramedic - EMS training programs training paramedics must be accredited by a national accrediting organization approved by the department. Instructional materials include:
(A) The National Emergency Medical Services Training Standards - Paramedic Instructor Guidelines published January 2009; and
(B) Other Washington state required content.
(3) EMS course instructional personnel requirements.
(a) For emergency medical responder (EMR) and EMT courses:
(i) The training program and the senior EMS instructor are required to screen EMS course applicants and allow entrance only to those meeting the requirements in WAC 246-976-041.
(ii) A department-approved senior EMS instructor (SEI) is required to supervise and instruct emergency medical responders (EMR) and EMT courses with the following substitutions:
(A) Senior EMS instructor candidates for the purpose of demonstrating instructional proficiency to the SEI;
(B) The MPD, MPD delegate or other physicians approved by the MPD;
(C) Guest instructors when knowledgeable and skilled in the topic and approved by the MPD;
(D) Department-approved EMS evaluators, if knowledgeable and skilled in the topic and approved by the MPD, may instruct individual lessons to assist the SEI in the instruction of the course.
(iii) The SEI identified as the course instructor must be available on-site during each class to provide instruction or to supervise any other course instruction, unless arrangements have been made for another SEI to fulfill this responsibility. For substitutes listed in (a)(ii)(B) through (D) of this subsection, the supervisor need not be physically present but must be immediately available for consultation by the substitute course instructor.
(iv) Department-approved SEIs or EMS evaluators to conduct psychomotor evaluations and provide corrective instruction for students. For EMR and EMT courses, evaluators must be certified as an EMT or higher level.
(b) Advanced EMT (AEMT) (ILS) courses:
(i) The training program and the course instructor are required to screen EMS course applicants and allow entrance only to those meeting the requirements in WAC 246-976-041.
(ii) The course instructor for advanced EMT courses must be:
(A) An AEMT that is recognized by the department as an SEI; or
(B) A paramedic; or
(C) Program instructional staff when training is provided by an accredited paramedic training program; or
(D) An RN with prehospital EMS knowledge, skills, and experience; or
(E) The MPD, MPD delegate or other licensed physician; or
(F) Guest instructors may instruct individual lessons if knowledgeable and skilled in the topic; and
(G) Approved by the county medical program director.
(iii) Department-approved evaluators for advanced EMT courses must be certified at the AEMT or paramedic level.
(c) Paramedic/EMT-paramedic courses:
(i) The training program and the course instructor are required to screen EMS course applicants and allow entrance only to those meeting the requirements in WAC 246-976-041.
(ii) The course instructor for paramedic courses:
(A) Must have clinical experience at the paramedic level or above;
(B) May also hold a current credential as paramedic, RN, MD, DO or PA; and
(C) Must have the approval of the training program's medical director and the county medical program director.
(d) The EMS course instructors identified in this section, under the general supervision of the county medical program director (MPD) are responsible:
(i) For the overall conduct of the course, quality of instruction, and administrative paperwork;
(ii) For following the course curricula or instructional guidelines identified in this section;
(iii) For evaluating the students' knowledge and practical skills throughout the course.
(4) Specialized training. The department may approve pilot training programs to determine the need for additional training. This approval would allow MPDs to research field use of skills, techniques, or equipment that is not included in standard course curricula/instructional guidelines.
(a) To obtain approval of a pilot training program, the following documents must be provided to the licensing and certification (L&C) advisory committee for review:
(i) Course curriculum/lesson plans;
(ii) Type of instructional personnel required to conduct the pilot training;
(iii) Course prerequisites;
(iv) Criteria for successful course completion, including student evaluations and/or examinations; and
(v) Prehospital patient care protocols for use in the pilot program.
(A) The L&C committee may consult with other groups, in its review before making its recommendation to the department.
(B) The department will approve or deny pilot training programs.
(b) Pilot training programs must report the results of the pilot training to the L&C committee and the department.
(c) The L&C committee will recommend to the department to approve or deny the pilot training program for statewide use.
(d) If approved, the department will adopt it as specialized training and notify the county MPDs to advise if the skill is required or not.
[]
(a) The SEI is responsible for the overall instructional
quality ((of)) and the administrative paperwork associated
with initial ((first responder)) emergency medical responders
(EMR) or EMT((-basic)) courses, under the general supervision
of the medical program director (MPD).
(b) The SEI must ((conduct courses following)):
(i) Follow department-approved curricula/instructional
guidelines identified in WAC ((246-976-021. The SEI candidate
shall)) 246-976-023;
(ii) Approve or deny applicants for training consistent with requirements in WAC 246-976-041 and 246-976-141; and
(iii) Document the completion of requirements for initial and renewal recognition as a senior EMS instructor on forms provided by the department.
(2) Initial recognition as a senior EMS instructor.
((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)) at
the EMT or higher EMS certification level;
(ii) At least three years prehospital EMS experience ((as
an)) at the 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;)) Approval as an EMS evaluator as
identified in WAC 246-976-161 (4)(e)(i);
(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 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, or equivalent instructor course approved by the
department;
(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) and course
administration.
(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)) Initial Recognition
Application Procedures (IRAP) for Senior EMS Instructors,
which include the Initial Senior EMS Instructor Application
and Agreement, instructor objectives, instructions and forms
necessary for initial recognition.
(((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 potential EMT((-basic)) course ((students))
applicants of course entry prerequisites;
(iii) Assure ((students)) that applicants selected for
admittance to the course meet ((DOH)) department 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, including practical skills, under
the supervision of the course lead SEI((;)) utilizing the
EMT((-basic)) training course ((curriculum)) instructor
guidelines identified in WAC ((246-976-021)) 246-976-023, and
be evaluated on the instruction of each of the following
sections/lessons:
(A) ((Lesson 1-2 -- Well Being of the EMT-Basic))
Preparatory section, including Infectious Disease Prevention
for EMS Providers, Revised ((10/1997)) 01/2009 (available from
the department of health, office of ((emergency medical and
trauma prevention)) community health systems);
(B) ((Lesson 2-1 -- ))Airway section;
(C) ((Lesson 3-2 -- Initial)) Assessment section;
(D) ((Lesson 3-3 -- Focused History and Physical Exam:
Trauma)) Pharmacology section;
(E) ((Lesson 3-4 -- Focused History and Physical Exam:))
Medical section, Cardiovascular and Respiratory lessons;
(F) ((Lesson 3-5 -- Detailed Physical Exam)) Special
Patient Populations section, Obstetrics, Neonatal Care, and
Pediatrics lessons;
(G) ((Lesson 3-6 -- Ongoing Assessment)) Trauma section,
Head, Facial, Neck and Spine Trauma and Chest Trauma lessons;
(H) ((Lesson 3-9 -- Practical Lab: Patient Assessment))
EMS Operations section, Vehicle Extrication, Incident
Management, and Multiple Casualty Incidents lessons; and
(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).)) Multicultural Awareness lesson; and
(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; and
(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 (RAP) 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)) A 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 for each recognition period:
(i) Coordinate and perform as the lead SEI for one
initial ((first responder)) emergency medical responder or
((EMT-basic)) EMT course including the supervision of all
practical skills evaluations;
(ii) Receive performance evaluations from a currently
recognized SEI, on two candidate instructed EMR (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)) department-approved SEI or
instructor improvement 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((.)); and
(iii) An objective completion 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((.)); and
(iv) Successful completion of an examination developed
and administered by the department on current EMS training and
certification statutes, WAC ((and)), the UDA, and course
administration.
(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 period. The recognition period
as ((a)) an 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 the SEI has:
(i) ((Violations of)) Violated chapter 18.130 RCW, the
Uniform Disciplinary Act;
(ii) ((A failure)) Failed to:
(A) Maintain EMS certification;
(B) Update the following personal information with
((DOH)) the department 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, and course
administration;
(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; or
(I) Maintain security on all department-approved 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.
(6) Reactivation. Any SEI recognition expired for longer than twelve months must complete the initial recognition process.
(7) Reciprocity. An EMS instructor approved in another state, country, or U.S. military branch may obtain reciprocal certification. To become an SEI, the applicant must:
(a) Meet the initial recognition prerequisites as defined in this section; and
(b) Provide proof of at least three years of instructional experience as a state approved EMS instructor. If the applicant cannot provide proof of instructional experience, the initial recognition application process must be completed; and
(c) Instruct two initial EMT course topics, be evaluated on the instruction by a current Washington SEI, and receive a positive recommendation for approval by the SEI; and
(d) Complete the renewal application and submit it to the department.
[Statutory Authority: RCW 18.73.081 and 70.168.120. 02-14-053, § 246-976-031, filed 6/27/02, effective 7/28/02. 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.]
(2) An applicant for training at the intermediate (((IV,
airway and ILS technicians)) AEMT) ((and advanced life support
(paramedic) levels, you)) level, must ((have completed)) be
currently certified as an EMT with at least one year ((as a
certified EMT or above)) of experience.
(3) An applicant for training at the advanced life support (paramedic) level, must have at least one year of experience as a certified EMT, or equivalent prehospital experience and meet all entry requirements of the state approved paramedic training program.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-041, filed 4/5/00, effective 5/6/00.]
(a) ((Examinations. An applicant may have up to three
attempts within six months after course completion to
successfully complete the examinations;)) Identify
department-approved certification examinations including the
process for registration and administration;
(b) ((The process for administration of examinations; and
(c) Administrative requirements and the necessary forms.)) Provide the requirements, instructions and forms necessary to apply for certification.
(2) Applicant responsibilities. To apply for ((initial))
certification, submit to the department:
(a) ((An)) Proof of qualifying education:
(i) For an applicant completing an initial Washington state approved EMS course: Successful course completion of a Washington state approved initial EMS course for the level of certification sought, which:
(A) Includes additional training as required in chapter 70.24 RCW and WAC 246-976-023; and
(B) May include Washington state approved EMT special skills training as identified in WAC 246-976-023;
(ii) For an (out-of-state) applicant seeking certification under reciprocity:
(A) Current certification from another state or national certifying agency approved by the department;
(B) For paramedic applicants whose training started after June 30, 1996: Proof of successful course completion from a paramedic training program accredited by a national organization approved by the department; and
(C) A four-hour infectious disease course or a seven-hour HIV/AIDS course approved by the department as required by chapter 70.24 RCW;
(iii) An applicant who holds an active, valid health care credential may apply for certification and challenge the department's education requirements. The applicant must document equivalent EMS training including:
(A) Course completion documents showing education equivalent to the knowledge and skills at the EMR, EMT, or AEMT level;
(B) Paramedic applicants must complete a course from a paramedic training program accredited by a national organization approved by the department;
(C) A four-hour infectious disease course or a seven-hour HIV/AIDS course approved by the department as required by chapter 70.24 RCW; and
(D) Acceptance of the documentation for the purposes of issuing a certification is at the discretion of the department.
(b) Proof of successful completion of a department-approved certification examination:
(i) A candidate is allowed three attempts to successfully complete the examination within twelve months of course completion.
(ii) After three unsuccessful attempts to pass the certification examination, the candidate must repeat a training course meeting the requirements of this section in order to be certified.
(iii) Results of department-approved examination:
(A) For an applicant completing initial Washington EMS course, the results are valid for twelve months from the date of course completion.
(B) For reciprocal and challenge certification applicants, the results are valid for twelve months from the date of examination.
(c) A completed application for certification on forms
provided by the department((;)):
(((b))) (i) Within the application period:
(A) For applicants completing an initial Washington EMS course, within twelve months from the date of course completion.
(B) For reciprocal and challenge applicants, within twelve months from the date of examination; and
(ii) Provide the following information:
(A) Proof of identity: An official photo identification
(((which may be)) state, federal or military identification,
drivers' license, or passport);
(((c))) (B) Proof of age: You must be at least eighteen
years of age to apply. Variances to this age requirement will
not be granted;
(((d) Proof of completion of an approved course or
courses for the level of certification sought;
(e) Proof of completion of approved infectious disease training to meet the requirements of chapter 70.24 RCW;
(f) Proof of successful completion of an approved examination within eighteen months prior to application;
(g))) (C) For EMTs, proof of high school graduation, GED, or equivalent;
(D) Proof of active membership, paid or volunteer, in one
of the following ((EMS/TC)) organizations:
(((i))) (I) Licensed ((provider of aid or)) ambulance
service or aid service((s)); or
(((ii))) (II) Law enforcement agency; or
(((iii) Other affiliated EMS/TC service;)) (III)
Businesses with organized safety response teams, who perform
exclusively on company property. These organizations must
integrate into all aspects of the local EMS system;
(((h))) (E) The MPD's recommendation for certification
and specialized training; and
(((i) For EMTs, proof of high school graduation, GED, or
equivalent;
(j) Other information required by this chapter)) (F) Information as required by the department related to information discovered while conducting required background checks.
(3) Certification is effective on the date the department
issues the certificate((, and will be)). The certification is
valid for three years ((except as extended by)). The
department ((for)) may extend this time period to accommodate
the efficient processing of ((license renewals))
recertification applications. The expiration date will be
indicated on the certification card.
(((4))) (a) Certification of ((intermediate level
technicians)) advanced EMTs and paramedics is valid only:
(((a))) (i) In the county or counties where recommended
by the MPD and approved by the department;
(((b))) (ii) In other counties where formal EMS((/TC))
medical control agreements are in place; or
(((c))) (iii) In other counties when accompanying a
patient in transit ((from a county meeting the criteria in (a)
or (b) of this subsection.
With approval of the MPD,)).
(b) A certified ((intermediate level technician))
advanced EMT or paramedic may function ((as an EMT)) at a
lower certification level in counties other than those
described in (a)(i) through (((c))) (iii) of this subsection,
with approval of that county's MPD.
(4) When EMS personnel change or add membership with an EMS agency, or their contact information changes, they must notify the department within thirty days. Changes will be made on forms provided by the department.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-141, filed 4/5/00, effective 5/6/00.]
(((a))) (1) CME topic content:
(((i))) (a) Must meet annual and certification period
educational requirements identified in Table A of this
section, utilizing:
(((A) Cognitive, affective and psychomotor objectives))
(i) Knowledge and skills found in ((curricula)) instructor
guidelines identified in WAC ((246-976-021)) 246-976-023, for
the level of certification being taught((.));
(((B))) (ii) Current national standards at the health
care provider level published for CPR, foreign body airway
obstruction (FBAO), and automatic defibrillation((.));
(((C))) (iii) County medical program director (MPD)
protocols, regional patient care procedures, ((and)) county
operating procedures((.)) and state triage destination
procedures; and
(((D))) (iv) Training updates in standards as identified
by the department((.));
(((ii))) (b) Must be approved by the MPD((.)); and
(((iii))) (c) May incorporate nationally recognized
training programs as part of CME for content identified in
(a)(i)(((A))) of this subsection.
(((b))) (2) To complete the CME method you must:
(((i))) (a) Complete and document the ((educational))
requirements, indicated in Table A of this section,
((appropriate to)) for your level of certification.
(((ii))) (b) Complete and document the skills maintenance
requirements, indicated in Table B of this section,
((appropriate to)) for your level of certification.
(((A))) (i) IV starts for ((IV technicians, combined
IV/airway technicians, ILS technicians, combined ILS/airway
technicians)) EMTs with IV therapy skill, AEMTs, or
paramedics:
(((I) During your first certification period, you must
perform a minimum of)) (A) Perform at least one hundred eight
successful IV starts the first certification period or three
years.
• ((During)) The first year, you must perform a minimum
of thirty-six successful IV starts.
• ((During)) The second and third year, you must perform
a minimum of ((thirty-six)) seventy-two successful IV starts
((per year, which may be averaged)) over the ((second and
third years of the certification)) two-year period.
(((II))) (B) If you have completed a certification
period, you must demonstrate proficiency in starting IVs to
the satisfaction of the MPD (see later certification periods
in Table B of this section).
(((B))) (ii) Endotracheal intubations for ((airway
technicians, combined IV/airway technicians, combined
ILS/airway technicians or)) paramedics:
(((I) During your first certification period, you must
perform a minimum of)) (A) Perform at least thirty-six
successful endotracheal intubations the first certification
period or three years.
• ((During)) The first year, you must perform a minimum
of twelve successful endotracheal intubations ((of which)).
Four of ((the)) these endotracheal intubations must be
performed on humans.
• During the second and third year, you must perform a
minimum of ((twelve)) twenty-four endotracheal intubations
((per year, which may be averaged)) over the ((second and
third years of the certification)) two-year period. Four of
these endotracheal intubations per year must be performed on
humans.
(((II))) (B) If you have completed a certification
period, you must perform a minimum of ((four)) twelve
successful human endotracheal intubations ((per year, which
may be averaged)) over the three-year certification period
(see later certification periods in Table B of this section).
Two of these endotracheal intubations per year must be
performed on humans.
(((III))) (C) Upon approval of the MPD, individuals
unable to complete the required endotracheal intubations
during the certification period, may meet the endotracheal
intubation requirements by completing ((a)) an MPD and
department-approved intensive airway management training
program, ((utilizing cognitive, affective and psychomotor
objectives)) covering all knowledge and skill aspects of
emergency airway management.
(((iii))) (c) Successfully complete ((the Washington
state written examination)) department-approved knowledge and
practical skill((s)) examinations as identified in WAC 246-976-171.
(((c))) (3) Any applicant changing from the CME method to
the OTEP method must meet all requirements of the OTEP method.
(((d))) (4) Ongoing training and evaluation programs:
(((i))) (a) Must meet annual and certification period
educational requirements identified in Table A, utilizing:
(((A) Cognitive, affective and psychomotor objectives))
(i) Knowledge and skills found in ((curricula)) instructor
guidelines identified in WAC ((246-976-021)) 246-976-023, for
the level of certification being taught, in the following core
content areas:
(((I))) (A) Airway/ventilation (including intensive
airway management training for personnel with advanced airway
qualifications to determine competency).
(((II))) (B) Cardiovascular.
(((III))) (C) Medical emergencies/behavioral.
(((IV))) (D) Trauma (including intensive IV therapy
training for personnel with qualifications to determine
competency).
(((V))) (E) Obstetrics ((and pediatrics)).
(((VI))) (F) Geriatrics.
(G) Pediatrics.
(H) Operations.
(((B))) (ii) The current national standards at the health
care provider level published for CPR, foreign body airway
obstruction (FBAO), and defibrillation and patient care
appropriate to the level of certification.
(((C))) (iii) County medical program director (MPD)
protocols, regional patient care procedures, ((and)) county
operating procedures and state triage destination procedures.
(((D))) (iv) Training updates in standards as identified
by the department((.));
(((ii))) (b) Must provide ((cognitive, affective and
psychomotor)) knowledge and skill evaluations following
completion of each topic presentation to determine student
competence of topic content.
((Psychomotor)) (i) Practical skill evaluations must be
recorded on skill evaluation forms from nationally recognized
training programs, or on department-approved practical skill
evaluation forms ((provided in approved curricula identified
in WAC 246-976-021)), for the level of certification being
taught.
(ii) If an evaluation form is not provided, a skill
evaluation form must be developed and approved by the MPD and
the department to evaluate the skill((.));
(((iii))) (c) Must be conducted at least on a quarterly
basis;
(d) Must be approved by the MPD and the department; any
additions or major changes to an approved OTEP requires
documented approval from the county MPD and the
department((.));
(((iv))) (e) Must be presented and evaluated by course
personnel meeting the following qualifications:
(((A))) (i) Evaluators must:
(((I))) (A) Be a currently certified ((BLS or ALS))
Washington EMS provider who has completed at least one
certification cycle. Certification must be at or above the
level of certification being evaluated((.));
(((II))) (B) Complete an MPD approved evaluator's
workshop, specific to the level of certification being
evaluated, ((and teach)) which teaches participants to
properly evaluate practical skills using the skill evaluation
forms identified in (b) of this subsection. Participants must
demonstrate proficiency ((in utilizing skill evaluation forms
identified in (d) (ii) of this subsection;)) to successfully
complete the workshop;
(((III))) (C) Complete the evaluator application, DOH
Form 530-012;
(((IV))) (D) Be approved by the county MPD and the
department((.));
(E) Meet education and participation requirements as identified by the county medical program director;
(F) Be recommended for reapproval by the county medical program director upon EMS credential recertification.
(((B))) (ii) Instructors must:
(((I))) (A) Be a currently certified ((BLS or ALS))
Washington EMS provider who has completed at least one
certification cycle at or above the level of certification
being taught((.));
(((II))) (B) Be a currently approved evaluator certified
at or above the level of certification being taught((.));
(((III))) (C) Be approved by the county MPD to instruct
and evaluate EMS topics.
(((C))) (iii) Guest lecturers, when utilized, must have
specific knowledge and experience in the skills of the
prehospital emergency care field for the topic being presented
and be approved by the county MPD to instruct EMS topics((.));
(((v))) (f) May incorporate nationally recognized
training programs within an OTEP for the core content areas
identified in (((d)(i)(A))) (a)(i) of this subsection.
(g) May use on-line training to provide all or a portion of an OTEP when:
(i) On-line training provides sufficient topics to meet all annual and certification period requirements;
(ii) Each didactic training topic requires an on-line cognitive evaluation after the training. Successful completion of the topic evaluation is required to receive credit for the topic;
(iii) Instruction and demonstration of all practical skills are provided in person by an SEI or qualified EMS evaluator approved by the MPD to instruct the practical skills;
(iv) Each practical evaluation is completed and scored in the presence of a state approved EMS evaluator or SEI. Each evaluation must be successfully completed to receive credit for the practical skill.
(((e))) (5) To complete the OTEP method you must:
(((i))) (a) Complete a ((department- and MPD-approved))
county MPD and department-approved OTEP that includes
requirements indicated in Table A of this section, appropriate
to your level of certification((.));
(((ii))) (b) Complete and document the skills maintenance
requirements, indicated in Table ((B)) C of this section,
appropriate to your level of certification.
(((A))) (i) IV starts for EMTs with IV ((technicians,
combined IV/airway technicians)) therapy skill, ((ILS
technicians, combined ILS/airway technicians)) advanced EMTs,
or paramedics:
(((I) During your)) (A) Perform at least thirty-six
successful IV starts the first certification period((, you
must perform a minimum of thirty-six successful IV starts)) or
three years.
• ((During)) The first year, you must perform a minimum
of twelve successful IV starts.
• During the second and third year, you must perform a
minimum of ((twelve)) twenty-four successful IV starts ((per
year, which may be averaged)) over the ((second and third
years of the certification)) two-year period.
(((II))) (B) If you have completed a certification
period, you must demonstrate proficiency in starting IVs to
the satisfaction of the MPD (see later certification periods
in Table ((B)) C of this section).
(((B))) (ii) Endotracheal intubations for ((airway
technicians, combined IV/airway technicians, combined
ILS/airway technicians or)) paramedics:
(((I) During your first certification period, you must))
(A) Perform ((a minimum of)) at least twelve successful
endotracheal intubations the first certification period or
three years.
• ((During)) The first year, you must perform a minimum
of four successful human endotracheal intubations.
• During the second and third year, you must perform a
minimum of ((four)) eight human endotracheal intubations ((per
year, which may be averaged)) over the ((second and third
years of the certification)) two-year period.
(((II))) (B) If you have completed a certification
period, you must perform a minimum of ((two)) six successful
human endotracheal intubations ((per year, which may be
averaged)) over the three-year certification period (see later
certification periods in Table ((B)) C of this section).
(((C))) (iii) Skills maintenance requirements may be
obtained as part of the OTEP.
(((D))) (iv) Individuals ((participating in an)) using
the OTEP method meet skill maintenance requirements by
demonstrating proficiency in the application of those skills
to the county MPD during the OTEP.
(((f))) (6) Any applicant changing from the OTEP method
to the CME method must meet all requirements of the CME
method.
(((g))) (7) Education requirements for recertification - Table A:
| (( EDUCATION REQUIREMENTS FOR RECERTIFICATION |
(EMT-Intermediate Levels) |
(ALS) |
||||||
| EMR | EMT | AEMT | Paramedic | |
| Annual Requirements | ||||
| Cardiovascular | X | X | X | X |
| Spinal immobilization | X | X | X | X |
| Patient assessment | X | X | X | X |
| Certification Period Requirements | ||||
| Infectious disease | X | X | X | X |
| Trauma | X | X | X | X |
| Pharmacology | X | X | X | |
| Other pediatric topics | X | X | X | X |
| * Total minimum education hours per certification period: | 15 hrs | 30 hrs | 60 hrs | 150 hrs |
| "X" indicates an individual must demonstrate knowledge and competency in the topic or skill. | |
| *Individuals obtaining education through the CME method must complete the total number of educational course hours indicated above. However, due to the competency-based nature of OTEP, fewer class hours may be needed to complete these requirements than the total course hours indicated above. |
| (( SKILLS MAINTENANCE REQUIREMENTS |
(EMT-Intermediate Levels) |
(ALS) |
|||||
(4 must be performed on humans for each method) |
|||||||
(4 per year must be performed on humans for each method) |
|||||||
(2 per year must be performed on humans for each method) |
|||||||
| EMR | EMT | Advanced EMT | Paramedic | ||
| First certification period or three years | |||||
| • | First year | ||||
| IV starts | EMT w/IV therapy skill 36 | 36 | 36 | ||
| Endotracheal intubations (4 must be performed on humans) | 12 | ||||
| Intraosseous infusion placement | EMT w/IV therapy skill X | X | X | ||
| • | Second & third years | ||||
| IV starts over the two-year period | EMT w/IV therapy skill 72 | 72 | 72 | ||
| Endotracheal intubations over the two-year period (4 per year must be performed on humans) | 24 | ||||
| Intraosseous infusion placement | EMT w/IV therapy skill X | X | X | ||
| During the certification period | |||||
| Pediatric airway management | X | ||||
| Supraglottic airway placement | EMT w/supraglottic airway skill X | X | X | ||
| Defibrillation | X | X | X | X | |
| Later certification periods | |||||
| • | Annual requirements | ||||
| IV starts | EMT w/IV therapy skill X | X | X | ||
| Endotracheal intubations (2 per year must be performed on humans) | 4 | ||||
| Intraosseous infusion placement | EMT w/IV therapy skill X | X | X | ||
| • | During the certification period | ||||
| Pediatric airway management | X | ||||
| Supraglottic airway placement | EMT w/supraglottic airway skill X | X | X | ||
| Defibrillation | X | X | X | X | |
| "X" indicates an individual must demonstrate proficiency of the skill to the satisfaction of the MPD. |
| EMR | EMT | Advanced EMT | Paramedic | ||
| First certification period or three years | |||||
| • | First year | ||||
| IV starts | EMT w/IV therapy skill 12 | 12 | 12 | ||
| Human endotracheal intubations | 4 | ||||
| Intraosseous infusion placement | EMT w/IV therapy skill X | X | X | ||
| • | Second & third years | ||||
| IV starts over the two-year period | EMT w/IV therapy skill 12 | 24 | 24 | ||
| Human endotracheal intubations over the two-year period | 8 | ||||
| Intraosseous infusion placement | EMT w/IV therapy skill X | X | X | ||
| During the certification period | |||||
| Pediatric airway management | EMR & EMT X | X | X | ||
| Supraglottic airway placement | EMT w/supraglottic airway skill X | X | X | ||
| Defibrillation | X | X | X | X | |
| Later certification periods | |||||
| • | Annual requirements | ||||
| IV starts | EMT w/IV therapy skill X | X | X | ||
| Human endotracheal intubations | 2 | ||||
| Intraosseous infusion placement | EMT w/IV therapy skill X | X | X | ||
| • | During the certification period | ||||
| Pediatric airway management | EMR & EMT X | X | X | ||
| Supraglottic airway placement | EMT w/supraglottic airway skill X | X | X | ||
| Defibrillation | X | X | X | X | |
| "X" indicates an individual must demonstrate proficiency of the skill to the satisfaction of the MPD. |
(((i))) (a) Reciprocity candidates credentialed less than
three years must meet Washington state's skill maintenance
requirements for the initial certification period identified
above.
(((ii))) (b) Reciprocity candidates credentialed three
years or more must meet Washington state's skill maintenance
requirements for second and subsequent certification periods.
(((iii))) (c) The county MPD may evaluate an individual's
skills to determine if the individual is proficient in the
application of those skills prior to recommending
certification. The MPD may recommend an individual obtain
specific training to become proficient in any skills deemed
insufficient by the MPD or delegate.
(((j))) (11) Description of selected terms used in Tables
A, B and ((B)) C:
(((i) Class hours: Actual hours spent to become
knowledgeable in a topic(s) or proficient in a skill(s).
(ii) Course hours: The predetermined time scheduled to conduct a course or topic.
(iii) CPR and airway management)) (a) Cardiovascular
includes health care provider level CPR, foreign body
obstruction (FBAO), and the use of airway adjuncts appropriate
to the level of certification, for adults, children and
infants following national standards, ((assuring the following
pediatric objectives are covered.
Pediatric objectives - The EMS provider must be able to:
(A) Identify and demonstrate airway management techniques for infants and children.
(B) Demonstrate infant and child CPR.
(C) Demonstrate FBAO technique for infants and children)) and training in the care of cardiac and stroke patients.
(((iv))) (b) Endotracheal intubation: Proficiency
includes the verification of proper tube placement and
continued placement of the endotracheal tube in the trachea
through procedures identified in county MPD protocols.
(((v))) (c) Infectious disease: Infectious disease
training must meet the requirements of chapter 70.24 RCW.
(((vi))) (d) Intraosseous infusion: Proficiency in
intraosseous line placement ((in pediatric patients)).
(((vii))) (e) IV starts: Proficiency in intravenous
catheterization performed on sick, injured, or preoperative
adult and pediatric patients. With written authorization of
the MPD, IV starts may be performed on artificial training
aids.
(((viii) Multi-lumen)) (f) Supraglottic airway placement:
Proficiency includes the verification of tube placement and
continued placement of the ((multi-lumen)) supraglottic airway
through procedures identified in county MPD protocols.
(((ix))) (g) Other pediatric topics: This includes
anatomy and physiology and medical problems including special
needs patients appropriate to the level of certification((,
assuring the following pediatric objectives are covered.
(A) Anatomy and physiology - The EMS provider must be able to:
(I) Identify the anatomy and physiology and define the differences in children of all ages.
(II) Identify developmental differences between infants, toddlers, preschool, school age and adolescents, including special needs children.
(B) Medical problems including special needs patients - The EMS provider must be able to:
(I) Identify the differentiation between respiratory distress and respiratory failure.
(II) Identify the importance of early recognition and treatment of shock in the infant and child patient.
(III) Identify causes and treatments for seizures.
(IV) Identify life-threatening complications of meningitis and sepsis.
(V) Identify signs and symptoms of dehydration.
(VI) Identify signs and symptoms of hypoglycemia.
(VII) Identify how hypoglycemia may mimic hypoxemia.
(VIII) Identify special needs pediatric patients that are technologically dependant (tracheotomy tube, central line, GI or feeding tubes, ventilators, community specific needs).
(IX) Identify the signs and symptoms of suspected child abuse.
(X) Identify the signs and symptoms of anaphylaxis and treatment priorities.
(XI) Identify the importance of rapid transport of the sick infant and child patient)).
(((x))) (h) Patient assessment: This includes adult,
pediatric and geriatric patients appropriate to the level of
certification((, assuring the following pediatric objectives
are covered.
Pediatric objectives - The EMS provider must be able to:
(A) Identify and demonstrate basic assessment skills according to the child's age and development.
(B) Demonstrate the initial assessment skills needed to rapidly differentiate between the critically ill or injured and the stable infant and child patient.
(C) Identify and demonstrate the correct sequence of priorities to be used in managing the infant and child patient with life threatening injury or illness.
(D) Identify that the priorities for a severely injured and critically ill infant and child are:
• Airway management,
• Oxygenation,
• Early recognition and treatment of shock,
• Spinal immobilization,
• Psychological support.
(E) Demonstrate a complete focused assessment of an infant and a child.
(F) Demonstrate ongoing assessment of an infant and a child.
(G) Identify the differences between the injury patterns of an infant and a child compared to that of an adult.
(H) Identify the psychological dynamics between an infant and a child, parent or caregiver and EMS provider)).
(((xi))) (i) Pharmacology: Pharmacology specific to the
medications approved by the MPD (not required for ((first
responders)) EMRs).
(((xii))) (j) Proficiency: Ability to demonstrate and
perform all aspects of a skill properly to the satisfaction of
the MPD or delegate.
(((xiii))) (k) Spinal immobilization and packaging: This
includes adult, pediatric and geriatric patients appropriate
to the level of certification((, assuring the following
pediatric objectives are covered.
Pediatric objectives - The EMS provider must be able to:
(A) Demonstrate the correct techniques for immobilizing the infant and child patient.
(B) Identify the importance of using the correct size of equipment for the infant and child patient.
(C) Demonstrate techniques for adapting adult equipment to effectively immobilize the infant and child patient)).
(((xiv))) (l) Trauma: For adult, pediatric and geriatric
patients appropriate to the level of certification((, assuring
the following pediatric objectives are covered.
Pediatric objectives - The EMS provider must be able to:
(A) Identify the importance of early recognition and treatment of shock in the infant and child patient.
(B) Identify the importance of early recognition and treatment of the multiple trauma infant and child patient.
(C) Identify the importance of rapid transport of the injured infant and child patient)).
[Statutory Authority: Chapters 18.71 and 18.73 RCW. 04-08-103, § 246-976-161, filed 4/6/04, effective 5/7/04. Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-161, filed 4/5/00, effective 5/6/00.]
(2) Proof of successful completion of education and skills maintenance, required for the level of certification, as defined in this chapter and identified in Tables A and B of WAC 246-976-161.
(3) Demonstrate knowledge and practical skills competency:
(a) For individuals participating in the OTEP method of education at the level of certification, successful completion of the OTEP fulfills the requirement of the DOH written and practical skills examinations.
(b) Individuals completing the CME method of education must provide proof of successful completion of the DOH written examination and practical skills examination for the level of certification.
(i) Basic life support (BLS) and intermediate life support (ILS) personnel must successfully complete the DOH approved practical skills examination for the level of certification.
(ii) Paramedics must successfully complete practical skills evaluations required by the MPD to determine ongoing competence.)) (1) Recertification:
(a) Complete the education requirements for recertification identified in WAC 246-96-161, Tables A, B, and C.
(i) Individuals participating in the CME method of education must provide the following to the MPD or delegate:
(A) Proof of successfully obtaining the educational requirements at the level of certification being sought;
(B) Proof of successful completion of department-approved knowledge and practical skill certification examinations for the level of certification being sought, within twelve months prior to application.
(ii) Individuals participating in the OTEP method of education must provide the following to the MPD or delegate:
(A) Documentation of successfully completing the OTEP educational requirements at the level of certification being sought;
(B) Documentation of successful completion of the OTEP knowledge and skill evaluations at the level of certification being sought. These evaluations fulfill the requirement of department-approved knowledge and practical skill certification examinations.
(iii) Provide the county medical program director documentation of successful completion of skills maintenance, required for the level of certification, as specified in this chapter and identified in WAC 246-96-161, Tables A, B, and C.
(iv) The county MPD may require additional knowledge and/or skill examinations to determine competency on department-approved MPD protocols prior to recommendation of recertification.
(b) Complete the recertification application; obtain the MPD recommendation for recertification and endorsement of EMT specialized training, then submit the recertification application to the department.
(2) Voluntary reversion to a lower level of certification.
Meet the current educational requirements for recertification:
(a) CME.
(i) Document education;
(ii) Complete recertification application;
(iii) Provide proof of successful completion of department-approved knowledge and practical skill examinations for the level of certification desired in the recertification application; and
(iv) Submit the application to the department.
(b) OTEP.
(i) Document completion of OTEP, including knowledge and skill evaluations;
(ii) Complete recertification application; and
(iii) Submit the application to the department.
(3) Reactivation of an expired Washington state EMS certification:
(a) The EMS provider must not provide EMS care until the certification is returned to active status;
(b) A certification is returned to active status by complying with the following:
(i) Expired for one year or less:
(A) Comply with educational requirements for the previous certification period;
(B) Complete one year of annual recertification education requirements;
(C) Successfully complete the department-approved knowledge and practical skill certification examinations; and
(D) Complete the recertification application, obtain the MPD recommendation for recertification and submit the recertification application to the department;
(ii) Expired for greater than one and less than two years:
(A) Comply with educational requirements for the previous certification period;
(B) Complete one year of annual recertification education requirements;
(C) Complete twenty-four hours of educational topics and hours specified by the department and the county MPD;
(D) Successfully complete the department-approved knowledge and practical skill certification examinations; and
(E) Complete the recertification application, obtain the MPD recommendation for recertification and submit the application to the department;
(iii) Expired for more than two years:
(A) Nonparamedic EMS personnel must:
(I) Complete a department-approved initial training program, and successfully complete department-approved knowledge and practical skill certification examinations;
(II) Complete the initial certification application process as identified in WAC 246-976-141;
(B) Paramedics whose certification has been expired between two and six years must:
(I) Document current status as a provider or instructor in the following: ACLS, PHTLS or BTLS, PALS or PEPPS, or state approved equivalent;
(II) Document current status in health care provider level CPR;
(III) Document completion of a state approved forty-eight hour EMT-paramedic refresher training program or completes forty-eight hours of ALS training that consists of the following core content:
• Airway, breathing and cardiology - sixteen hours.
• Medical emergencies - eight hours.
• Trauma - six hours.
• Obstetrics and pediatrics - sixteen hours.
• Operations - two hours;
(IV) Document completion of any additional required MPD and department-approved program of refresher training;
(V) Document MPD required clinical and field evaluation;
(VI) Document successful completion of department-approved knowledge and practical skill certification examinations;
(VII) Complete the recertification application process as identified in WAC 246-976-141;
(c) A request for reactivation of a paramedic certification that has been expired greater than six years will be reviewed by the department to determine the disposition.
(4) Reinstatement of a suspended or revoked Washington state EMS certification.
(a) A person whose EMS certification is suspended or revoked may petition for reinstatement as provided in RCW 18.130.150.
(b) The EMS provider must not provide EMS care until the certification is returned to active status.
(c) If reinstatement is granted, prior to reinstatement of the certification, the petitioner must:
(i) Provide proof of completion of all requirements identified by the departmental disciplinary authority; and
(ii) Meet the reactivation requirements in this section.
(5) When EMS personnel change or add membership with an EMS agency, or their contact information changes, they must notify the department within thirty days. Changes will be made on forms provided by the department.
[Statutory Authority: Chapters 18.71 and 18.73 RCW. 04-08-103, § 246-976-171, filed 4/6/04, effective 5/7/04. Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-171, filed 4/5/00, effective 5/6/00.]
(a) When performing in a prehospital emergency setting or during interfacility ambulance transport; and
(b) When performing for a licensed EMS agency or an organization recognized by the department; and
(c) Within the scope of care that is:
(((a))) (i) Included in the approved curriculum for the
individual's level of certification; or
(((b))) (ii) Included in approved specialized training;
and
(((c) That is)) (iii) Included in state approved county
MPD protocols.
(2) ((When a patient is identified as needing care which
is not authorized for the providers, the certified person in
charge of that patient must consult with medical control as
soon as possible,)) If protocols and regional patient care
procedures do not provide ((adequate)) off-line direction for
the situation, the certified person in charge of the patient
must consult with their on-line medical control as soon as
possible. Medical control can only authorize a certified
person to perform within their scope of practice.
(3) ((For trauma patients,)) All prehospital providers
must follow ((the)) state approved ((trauma)) triage
procedures, regional patient care procedures and county MPD
patient care protocols.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-182, filed 4/5/00, effective 5/6/00.]
(2) Modification, suspension, revocation, or denial of
certification((. The procedures)) will be consistent with the
requirements of the Administrative Procedure Act (chapter 34.05 RCW), the Uniform Disciplinary Act (chapter 18.130 RCW),
and ((practice and procedure ())chapter 246-10 WAC(())).
(((2) The department will publish procedures:
(a) To investigate complaints and allegations against certified personnel;
(b) For)) (3) MPDs ((to recommend corrective action)) may
perform counseling regarding certified individuals.
(((3))) (4) Before recommending ((revocation, suspension,
modification, or denial of a certificate)) disciplinary
action, the MPD must initiate ((corrective action)) counseling
with the certified individual, consistent with department
((procedures)) guidelines.
(((4))) (5) The MPD may request the department to
summarily suspend certification of an individual if the MPD
believes that continued certification ((will be detrimental to
patient care)) is an immediate and critical threat to public
health and safety.
(((5) In cases where the MPD recommends denial of
recertification, the department will investigate the
individual, and may revoke his or her certification.))
(6) ((If)) The MPD may recommend denial or renewal of an
individual's certification.
(7) As required by RCW 18.130.080 an employing or
sponsoring agency ((disciplines a certified individual for
conduct or circumstances as described in RCW 18.130.070, the
Uniform Disciplinary Act, the agency must report the cause and
the action taken to the department)) is subject to the
reporting requirements identified in chapter 246-16 WAC. An
employing or sponsoring agency must report to the department
the following:
(a) When the certified individual's services have been terminated or restricted based upon a final determination that the individual has either committed an act or acts that may constitute unprofessional conduct; or
(b) That the certified individual may not be able to practice his or her profession with reasonable skill and safety to consumers as a result of a mental or physical condition; or
(c) When a certified individual is disciplined by an employing or sponsoring agency for conduct or circumstances that would be unprofessional conduct under RCW 18.130.180 of the Uniform Disciplinary Act.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-191, filed 4/5/00, effective 5/6/00.]
(2) To become licensed as an ambulance or aid service, an
applicant must submit ((application forms to the department,
including)):
(a) ((A declaration that the service is able to comply
with standards, rules, and regulations of this chapter;
(b) A declaration that staffing will meet the personnel requirements of RCW 18.73.150 and 18.73.170;
(c) A declaration that operation will be consistent with the statewide and regional EMS/TC plans and approved patient care procedures;
(d) Evidence)) A completed application for licensure on forms provided by the department;
(b) Proof of ((liability)) the following insurance
coverage:
(i) Motor vehicle liability coverage required in RCW 46.30.020 (ambulance and aid services only);
(ii) Professional and general liability coverage;
(((e) A description of the general area to be served and
the number of vehicles to be used. The description includes:
(i) The services to be offered (e.g., emergency response and/or interfacility transports);
(ii) The dispatch process, including a backup plan if the primary unit is unavailable;
(iii) A plan for tiered response that is consistent with approved regional patient care procedures;
(iv) A plan for rendezvous with other services that is consistent with approved regional patient care procedures;
(v))) (c) A map of the proposed response area;
(((vi))) (d) The level of service to be provided: Basic
life support (BLS), intermediate life support(ILS), or
advanced life support (ALS) (paramedic); and the scheduled
hours of operation((; and
(vii))). Minimum staffing required for each level is as follows:
(i) For aid service response:
(A) A BLS level service will provide care with at least one person qualified in advanced first aid (after January 1, 2012, at least one emergency medical responder);
(B) An ILS level service will provide care with at least one ILS technician (AEMT);
(C) An ALS level service will provide care with at least one paramedic.
(ii) For ambulance services:
(A) A BLS level service will provide care and transport with at least one emergency medical technician (EMT) and one person trained in advanced first aid. Beginning January 1, 2012, emergency medical responder (EMR) will replace the advanced first aid requirement;
(B) An ILS service will provide care and transport with at least one ILS technician and one EMT;
(C) An ALS service will provide care and transport with at least one paramedic and one EMT or higher level of EMS certification;
(D) For critical care interfacility ambulance transports, have sufficient medical personnel on each response to provide patient care specific to the transport;
(e) For licensed ambulance services, a written plan to continue patient transport if a vehicle becomes disabled, consistent with regional patient care procedures.
(3) To renew a license, submit application forms to the department at least thirty days before the expiration of the current license.
(4) Licensed ambulance and aid services must comply with
((the)) department-approved prehospital ((trauma)) triage
procedures ((defined in WAC 246-976-010)).
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-260, 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), § 246-976-260, filed 12/23/92, effective 1/23/93.]
(a) Failure to comply with the requirements of chapters 18.71, 18.73, 18.130, or 70.168 RCW, or other applicable laws or rules, or with this chapter;
(b) Failure to comply or ensure compliance with prehospital patient care protocols or regional patient care procedures;
(c) Failure to cooperate with the department in inspections or investigations;
(d) Failure to supply data as required in chapter 70.168 RCW and this chapter; or
(e) Failure to consistently meet trauma response times identified by the regional plan and approved by the department for trauma verified services.
(2) Under the provisions of the Administrative Procedure Act, chapter 34.05 RCW, and the Uniform Disciplinary Act, chapter 18.130 RCW, the department may impose sanctions against a licensed service as provided in chapter 18.130 RCW. The department will not take action against a licensed, nonverified service under this section for providing emergency trauma care consistent with regional patient care procedures when the wait for the arrival of a verified service would place the life of the patient in jeopardy or seriously compromise patient outcome.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-270, 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), § 246-976-270, filed 12/23/92, effective 1/23/93.]
(2) All ambulance vehicles must be clearly identified as
an EMS vehicle and display the agency identification by
((appropriate)) emblems and markings on the front, side, and
rear of the vehicle. A current state ambulance credential
must be prominently displayed in a clear plastic cover
positioned high on the partition behind the driver's seat.
(3) Tires must be in good condition ((with not less than
two-thirty-seconds inch useable tread, appropriately sized to
support the weight of the vehicle when loaded)).
(4) The electrical system must meet the following requirements:
(a) Interior lighting in the driver compartment must be designed and located so that no glare is reflected from surrounding areas to the driver's eyes or line of vision from the instrument panel, switch panel, or other areas which may require illumination while the vehicle is in motion; and
(b) Interior lighting in the patient compartment must be
((adequate)) provided throughout the compartment, and provide
an intensity of twenty foot-candles at the level of the
patient; and
(c) Exterior lights must ((comply with the appropriate
sections of Federal Motor Vehicle Safety Standards)) be fully
operational, and include body-mounted flood lights over the
((rear)) patient loading doors ((which)) to provide
((adequate)) loading visibility; and
(d) Emergency warning lights must be provided in accordance with RCW 46.37.380, as administered by the state commission on equipment.
(5) Windshield wipers and washers must be dual, electric,
multispeed, and ((maintained in good condition)) functional at
all times.
(6) Battery and generator system:
(a) The battery ((with a minimum seventy ampere hour
rating)) must be capable of sustaining all systems. It must
be located in a ventilated area sealed off from the vehicle
interior, and completely accessible for checking and removal;
(b) The generating system must be capable of supplying the maximum built-in DC electrical current requirements of the ambulance. If the electrical system uses fuses instead of circuit breakers, extra fuses must be provided.
(7) The ambulance must be equipped with:
(a) Seat belts that comply with Federal Motor Vehicle
Safety Standards 207, 208, 209, and 210. Restraints must be
provided in all seat positions in the vehicle, including the
attendant station((.)); and
(((8))) (b) Mirrors on the left side and right side of
the vehicle. The location of mounting must provide maximum
rear vision from the driver's seated position((.)); and
(((9))) (c) One ABC two and one-half pound fire
extinguisher.
(((10))) (8) Ambulance body requirements:
(a) The length of the patient compartment must be at least one hundred twelve inches in length, measured from the partition to the inside edge of the rear loading doors; and
(b) The width of the patient compartment, after cabinet and cot installation, must provide at least nine inches of clear walkway between cots or the squad bench; and
(c) The height of the patient compartment must be at least fifty-three inches at the center of the patient area, measured from floor to ceiling, exclusive of cabinets or equipment; and
(d) There must be secondary egress from the ((curb side
of the patient compartment)) vehicle; and
(e) Back doors must open in a manner to increase the width for loading patients without blocking existing working lights of the vehicle; and
(f) The floor at the lowest level permitted by
clearances. It must be flat and unencumbered in the access
and work area, with no voids or pockets in the floor to side
wall areas where water or moisture can become trapped to cause
rusting ((and/))or unsanitary conditions; and
(g) Floor covering applied to the top side of the floor surface. It must withstand washing with soap and water or disinfectant without damage to the surface. All joints in the floor covering must have minimal void between matching edges, cemented with a suitable water-proof and chemical-proof cement to eliminate the possibility of joints loosening or lifting; and
(h) The finish of the entire patient compartment must be impervious to soap and water and disinfectants to permit washing and sanitizing; and
(i) Exterior surfaces must be smooth, with appurtenances kept to a minimum; and
(j) Restraints must be provided for all litters. If the litter is floor supported on its own support wheels, a means must be provided to secure it in position. These restraints must permit quick attachment and detachment for quick transfer of patient.
(((11))) (9) Vehicle brakes, ((tires,)) regular and
special electrical equipment, ((windshield wipers,)) heating
and cooling units, safety belts, and window glass, must be
((in good working order)) functional at all times.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-290, 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), § 246-976-290, filed 12/23/92, effective 1/23/93.]
| Note: "asst" means assortment | ||
| TABLE (( |
AMBULANCE |
AID VEHICLE |
| AIRWAY MANAGEMENT | ||
| Airway Adjuncts | ||
| Oral airway (( |
(( |
(( |
| (( |
||
| Suction | ||
| Portable(( |
1 | 1 |
| Vehicle mounted and powered, providing: Minimum of 30 L/min. & vacuum > 300 mm Hg | 1 | 0 |
| Tubing, suction | 1 | 1 |
| Bulb syringe, pediatric | 1 | 1 |
| Rigid suction tips | 2 | 1 |
| Catheters as required by local protocol | ||
| Water-soluble lubricant | 1 | 1 |
| Oxygen delivery system built in | 1 | 0 |
| 3000 L Oxygen (( |
1 | 0 |
| 300 L Oxygen (( |
2 | 1 |
| (( |
||
| Cannula, nasal, adult | 4 | 2 |
| O2 mask, nonrebreather, adult | 4 | 2 |
| O2 mask, nonrebreather, pediatric | 2 | 1 |
| BVM, with O2 reservoir | ||
| Adult, pediatric, infant | 1 ea | 1 ea |
| (( |
||
| (( |
||
| PATIENT ASSESSMENT AND CARE | ||
| Assessment | ||
| Sphygmomanometer | ||
| Adult, large | 1 | (( |
| Adult, regular | 1 | 1 |
| Pediatric | 1 | (( |
| Stethoscope, adult | 1 | 1 |
| Thermometer, (( |
1(( |
0 |
| Flashlight, w/spare or rechargeable batteries & bulb | 1 | 1 |
| (( |
1 | 1 |
| Personal infection control and protective equipment as required by the department of labor and industries | ||
| Length based tool for estimating pediatric medication and equipment sizes | 1 | 1 |
| TRAUMA EMERGENCIES | ||
| (( |
||
| Triage identification for 12 patients per county protocol | Yes | Yes |
| Wound care | ||
| Dressing, sterile | asst | asst |
| Dressing, sterile, trauma | 2 | 2 |
| Roller gauze bandage | asst | asst |
| Medical tape | asst | asst |
| Self adhesive bandage strips | asst | asst |
| Cold packs | 4 | 2 |
| Occlusive dressings | 2 | 2 |
| (( |
||
| Scissors, bandage | 1 | 1 |
| Irrigation solution | 2 | 1 |
| Splinting | ||
| Backboard with straps | 2 | 1 |
| Head (( |
1 | 1 |
| Pediatric immobilization device | 1 | (( |
| Extrication collars, rigid | ||
| Adult (small, medium, large) | asst | asst |
| Pediatric or functionally equivalent sizes | asst | asst |
| Immobilizer, cervical/thoracic, adult | 1 | 0 |
| Splint, traction, adult w/straps | 1 | 0 |
| Splint, traction, pediatric, w/straps | 1 | 0 |
| Splint, adult (arm and leg) | 2 ea | 1 ea |
| Splint, pediatric (arm and leg) | 1 ea | 1 ea |
| General | ||
| Litter, wheeled, collapsible, with a functional restraint system per the manufacturer | 1 | 0 |
| Pillows, plastic covered or disposable | 2 | 0 |
| Pillow case, cloth or disposable | 4 | 0 |
| Sheets, cloth or disposable | 4 | (( |
| Blankets | 2 | 2 |
| Towels, cloth or disposable 12" x 23" minimum | 4 | (( |
| Emesis collection device | 1 | 1 |
| Urinal | 1 | 0 |
| Bed pan | 1 | 0 |
| OB kit | 1 | 1 |
| Epinephrine appropriate for level of certification | ||
| Adult | 1 | 1 |
| Pediatric | 1 | 1 |
| Storage and handling of pharmaceuticals in ambulances and aid vehicles must be in compliance with the manufacturers' recommendations. | ||
| Extrication plan: Agency must document how extrication will be provided when needed. | ||
| (( |
||
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-300, 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), § 246-976-300, filed 12/23/92, effective 1/23/93.]
(a) Is consistent with state and regional plans;
(b) Is in good working order;
(c) Allows direct two-way communication between the vehicle and its dispatch control point; and
(d) Allows communication with medical control.
(2) If cellular telephones are used, there must also be another method of radio contact with dispatch and medical control for use when cellular service is unavailable.
(3) Licensed ambulance services must provide each licensed ambulance with communication equipment which:
(a) Allows direct two-way communication with medical control and all hospitals in the service area of the vehicle, from both the driver's and patient's compartment; and
(b) Incorporates appropriate encoding and selective
signaling devices((; and
(c) When transporting patients, allows communications with medical control and designated EMS/TC receiving facilities)).
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-310, 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), § 246-976-310, filed 12/23/92, effective 1/23/93.]
(1) Air ambulance services must:
(a) Comply with all regulations and standards in this chapter pertaining to verified ambulance services and vehicles, except that WAC 246-976-290 and 246-976-300 are replaced for air ambulance services by subsection (4)(b) and (c) of this section;
(b) ((Comply with the standards in this section for all
types of transports, including interfacility and prehospital
transports;
(c) Be in current compliance with all state and Federal Aviation Administration statutes and regulations that apply to air carriers, including, but not limited to, those regulations that apply to certification requirements, operations, equipment, crew members, and maintenance, and any specific regulations that apply to air ambulance services;
(d) Air ambulance services must provide a physician director who is practicing medicine in the response area of the aircraft, as identified in the state EMS/TC plan.)) Comply with the standards in this section for all types of transports, including interfacility and prehospital transports;
(c) Provide proof of compliance with Federal Acquisition Regulation (FAR), 14 CFR Part 135 of the operating requirements; commuter and on demand operations and rules governing persons on board such aircraft.
(2) Air ambulance services currently licensed or seeking
relicensure ((after July 31, 2001,)) must have and maintain
accreditation by the commission on accreditation of medical
transport services (CAMTS) or another accrediting organization
approved by the department as having equivalent requirements
as CAMTS for aeromedical transport. ((Until August 1, 2001,
subsections (4) and (5) of this section apply to air ambulance
services currently licensed or seeking relicensure.))
(3) Air ambulance services requesting initial licensure that are ineligible to attain accreditation because they lack a history of operation at the site, must meet the criteria of subsections (4) and (5) of this section and within four months of licensure must have completed an initial consultation with CAMTS or another accrediting organization approved by the department as having equivalent requirements as CAMTS for aeromedical transport. A provisional license will be granted for no longer than two years at which time the service must provide documentation that it is accredited by CAMTS or another accrediting organization approved by the department as having equivalent requirements as CAMTS for aeromedical transport.
(4) Air ambulance services must provide:
(a) A physician director ((who is)):
(i) ((Practicing medicine in the response area of the
aircraft, as identified in the state EMS/TC plan;)) Licensed
to practice in the state of Washington;
(ii) Trained and experienced in emergency, trauma, and critical care;
(iii) Knowledgeable of the operation of air medical services; and
(iv) Responsible for supervising and evaluating the quality of patient care provided by the air medical flight personnel;
(b) If the air medical service utilizes Washington certified EMS personnel:
(i) The physician director must be a delegate of the MPD in the county where the air service declares its primary base of operation.
(ii) Certified EMS personnel must follow department-approved MPD protocols when providing care;
(c) Sufficient air medical personnel on each response to
provide ((adequate)) patient care, specific to the mission,
including:
(i) One specially trained, experienced registered nurse or paramedic; and
(ii) One other person who must be a physician, nurse, physician's assistant, respiratory therapist, paramedic, EMT, or other appropriate specialist appointed by the physician director. If an air ambulance responds directly to the scene of an incident, at least one of the air medical personnel must be trained in prehospital emergency care;
(((c))) (d) Aircraft that, when operated as air
ambulances:
(i) Are configured so that the medical ((attendants))
personnel can access the patient. The configuration must
allow medical personnel to begin and maintain advanced life
support and other treatment;
(ii) Allow loading and unloading the patient without excessive maneuvering or tilting of the stretcher;
(iii) Have appropriate communication equipment:
(A) The capability to ((insure internal crew and
air-to-ground exchange of information)) communicate between
flight personnel ((and)), hospitals, medical control, and the
((flight operations)) services communication center((, and air
traffic control facilities));
(B) Helicopters must also have the capability to communicate with ground EMS services and public safety vehicles;
(iv) Are equipped with:
(A) ((Appropriate navigational aids;
(B))) Airway management equipment, including:
(I) Oxygen;
(II) Suction;
(III) Ventilation and intubation equipment, adult and pediatric;
(((C))) (B) Cardiac monitor/defibrillator;
(((D))) (C) Supplies, equipment, and medication as
required by the program physician director, for emergency,
cardiac, trauma, pediatric care, and other missions; and
(((E))) (D) The ability to maintain appropriate patient
temperature; ((and))
(v) Have ((adequate)) interior lighting for patient care
((arranged so as not to interfere with the pilot's vision;
(d) If using fixed-wing aircraft, pressurized, multiengine aircraft when appropriate to the mission;
(e) If using helicopter aircraft:
(i) A protective barrier sufficiently isolating the cockpit, to minimize in-flight distraction or interference;
(ii) Appropriate communication equipment to communicate with ground EMS/TC services and public safety vehicles, in addition to the communication equipment specified in (c)(iii) of this subsection.)); and
(vi) Helicopter aircraft must have a protective barrier sufficiently isolating the cockpit, to minimize in-flight distraction or interference.
(5) All air medical personnel must:
(a) Be certified in ACLS;
(b) Be trained in:
(i) Emergency, trauma, and critical care;
(ii) Altitude physiology;
(iii) EMS communications;
(iv) Aircraft and flight safety; and
(v) The use of all patient care equipment on board the aircraft;
(c) Be familiar with survival techniques appropriate to the terrain;
(d) Perform under protocols.
(6) Exceptions:
(a) If aeromedical evacuation of a patient is necessary because of a life threatening condition and a licensed air ambulance is not available, the nearest available aircraft that can accommodate the patient may transport. The physician ordering the transport must justify the need for air transport of the patient in writing to the department within thirty days after the incident.
(b) Excluded from licensure requirements ((those)) are:
(i) Air services operating aircraft for primary purposes
other than civilian air medical transport((, but which)).
These services may be called ((into service)) to initiate an
emergency air medical transport of a patient to the nearest
available treatment facility or rendezvous point with other
means of transportation. Examples are: United States Army
Military Assistance to Safety and Traffic, United States Navy,
United States Coast Guard, Search and Rescue, and the United
States Department of Transportation;
(ii) Air ambulance services that solely transport patients into Washington state from points originating outside of the state of Washington.
[Statutory Authority: RCW 18.73.140. 00-22-124, § 246-976-320, filed 11/1/00, effective 12/2/00. Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-320, 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), § 246-976-320, filed 12/23/92, effective 1/23/93.]
(a) Current certification levels of all personnel;
(b) Any changes in staff affiliation with the ambulance and aid service to include new employees or employee severance; and
(c) Make, model, and license number of all EMS response
vehicles((; and
(c) Each patient contact with at least the following information:
(i) Names and certification levels of all personnel;
(ii) Date and time of medical emergency;
(iii) Age of patient;
(iv) Applicable components of system response time as defined in this chapter;
(v) Patient vital signs;
(vi) Procedures performed on the patient;
(vii) Mechanism of injury or type of illness;
(viii) Patient destination;
(ix) For trauma patients, other data points identified in WAC 246-976-430 for the trauma registry)).
(2) ((Transporting agencies)) The certified EMS provider
in charge of patient care must provide ((an initial written
report of patient care to the receiving facility at the time
the patient is delivered. For patients meeting the state of
Washington prehospital trauma triage (destination) procedures,
as described in WAC 246-976-930(3), the transporting agency
must provide additional trauma data elements described in WAC 246-976-430 to the receiving facility within ten days)) the
following information to the receiving facility staff:
(a) At the time of arrival at the receiving facility, a minimum of a brief patient report including:
(i) Date and time of the medical emergency;
(ii) Patient vital signs including serial vital signs where applicable;
(iii) Patient assessment findings;
(iv) Procedures and therapies provided by EMS personnel;
(v) Any changes in patient condition while in the care of the EMS personnel;
(vi) Mechanism of injury or type of illness.
(b) Within twenty-four hours of arrival, a complete written or electronic patient care report that includes at a minimum:
(i) Names and certification levels of all personnel;
(ii) Date and time of medical emergency;
(iii) Age of patient;
(iv) Applicable components of system response time as defined in this chapter;
(v) Patient vital signs, including serial vital signs if applicable;
(vi) Patient assessment findings;
(vii) Procedures performed and therapies provided to the patient; this includes the times each procedure or therapy was provided;
(viii) Document patient response to procedures and therapies while in the care of the EMS provider;
(ix) Mechanism of injury or type of illness;
(x) Patient destination.
(c) For trauma patients, all other data points identified in WAC 246-976-430 for inclusion in the trauma registry must be submitted within ten days of transporting the patient to the trauma center.
(3) Licensed services must make all patient care records available for inspection and duplication upon request of the county MPD or the department.
[Statutory Authority: RCW 70.168.060 and 70.168.090. 02-02-077, § 246-976-330, filed 12/31/01, effective 1/31/02. Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-330, 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), § 246-976-330, filed 12/23/92, effective 1/23/93.]
(a) Publish procedures for verification. Verification will expire with the period of licensure. The application for verification will be incorporated in the application for licensure;
(b) Verify prehospital trauma care services in the following categories:
(i) Aid service: Basic, intermediate and advanced (paramedic) life support;
(ii) Ground ambulance service: Basic, intermediate and advanced (paramedic) life support;
(iii) Air ambulance service: After July 31, 2001, the department will consider that an air ambulance service has met the requirements of subsections (4), (6), and (9) of this section if it has been accredited by CAMTS or another accrediting organization approved by the department as having equivalent requirements as CAMTS for aeromedical transport;
(c) Review the minimum response times for verified prehospital trauma services at least biennially, considering data available from the trauma registry and with the advice of the steering committee;
(d) Forward applications for verification for aid and ground ambulance services to the appropriate regional council for review and comment;
(e) Approve an applicant to provide verified prehospital trauma care, based on satisfactory evaluations as described in this section;
(f) Notify the regional council and the MPD in writing of the name, location, and level of verified services;
(g) Renew approval of a verified service upon reapplication, if the service continues to meet standards established in this chapter and verification remains consistent with the regional plan.
(2) The department will identify minimum and maximum numbers of prehospital services, based on the approved regional and state plans. The department will:
(a) Establish and review biennially the minimum and maximum number of prehospital services based upon distribution and level of service identified for each response area in the approved regional plan.
(b) Evaluate an applicant for trauma verification based upon demonstrated ability of the provider to meet standards defined in this section 24-hours every day.
(c) Verify the trauma capabilities of a licensed prehospital service if it determines that the applicant:
(i) Proposes services that are identified in the regional plan for ground services, or the state plan for air ambulance services, in the proposed response areas.
(ii) Agrees to operate under approved regional patient care procedures and prehospital patient care protocols.
(3) Regional council responsibilities regarding verification are described in WAC 246-976-960.
(4) To apply for verification, a licensed ambulance or aid service must submit application on forms provided by the department, including:
(a) Documentation required for licensure specified by WAC 246-976-260(2);
(b) A policy that a trauma training program is required for all personnel responding to trauma incidents. The program must meet learning objectives established by the department and be approved by the MPD;
(c) Documentation that the provider has the ability twenty-four hours every day to deliver personnel and equipment required for verification to the scene of a trauma within the agency response times identified in this section; and
(d) Documentation that the provider will participate in an approved regional quality assurance program.
(5) Verified aid services must provide personnel on each trauma response including:
(a) Basic life support: At least one individual, first responder or above;
(b) Intermediate life support:
(i) At least one ILS technician; or
(ii) At least one IV/airway technician; or
(iii) At least two individuals, one IV technician and one airway technician.
(c) Advanced life support - Paramedic: At least one paramedic.
(6) Verified ambulance services must provide personnel on each trauma response including:
(a) Basic life support: At least two certified individuals -- one EMT plus one first responder;
(b) Intermediate life support:
(i) One ILS technician, plus one EMT; or
(ii) One IV/airway technician, plus one EMT; or
(iii) One IV technician and one airway technician;
(c) Advanced life support - Paramedic: At least two certified individuals -- one paramedic and one EMT.
(7) Verified BLS vehicles must carry equipment identified in WAC 246-976-300, Table C.
(8) Verified ILS and paramedic vehicles must provide equipment identified in Table D, in addition to meeting the requirements of WAC 246-976-300:
| (( (NOTE: "ASST" MEANS ASSORTMENTS) |
|||||||
(9) Verified air ambulance services must meet equipment
requirements described in WAC 246-976-320.
(10) Verified aid services must meet the following minimum agency response times for all major trauma responses to response areas as defined by the department and identified in the regional plan:
(a) To urban response areas: Eight minutes or less, eighty percent of the time;
(b) To suburban response areas: Fifteen minutes or less, eighty percent of the time;
(c) To rural response areas: Forty-five minutes or less, eighty percent of the time;
(d) To wilderness response areas: As soon as possible.
(11) Verified ground ambulance services must meet the following minimum agency response times for all major trauma responses to response areas as defined by the department and identified in the regional plan:
(a) To urban response areas: Ten minutes or less, eighty percent of the time;
(b) To suburban response areas: Twenty minutes or less, eighty percent of the time;
(c) To rural response areas: Forty-five minutes or less, eighty percent of the time;
(d) To wilderness response areas: As soon as possible.
(12) Verified air ambulance services must meet minimum agency response times as identified in the state plan.)) (1) The department verifies prehospital EMS services. Verification is a higher form of licensure that requires twenty-four-hour, seven day a week compliance with the standards outlined in chapter 70.168 RCW and this chapter. Verification will expire with the prehospital EMS service's period of licensure.
(2) To qualify you must be a licensed ambulance or aid service as specified in WAC 246-976-260.
(3) The following EMS services may be verified:
(a) Aid service: Basic, intermediate (AEMT), and advanced (paramedic) life support;
(b) Ground ambulance service: Basic, intermediate (AEMT), and advanced (paramedic) life support;
(c) Air ambulance service.
(4) Personnel requirements:
(a) Verified aid services must provide personnel on each trauma response including:
(i) Basic life support: At least one individual, EMR or above;
(ii) Intermediate life support: At least one AEMT;
(iii) Advanced life support - paramedic: At least one paramedic;
(b) Verified ambulance services must provide personnel on each trauma response including:
(i) Basic life support: At least two certified individuals - one EMT plus one EMR;
(ii) Intermediate life support: One AEMT, plus one EMT;
(iii) Advanced life support - paramedic: At least two certified individuals - one paramedic and one EMT;
(c) Verified air ambulance services must provide personnel as identified in WAC 246-976-320.
(5) Equipment requirements:
(a) Verified BLS vehicles must carry equipment identified in WAC 246-976-300, Table D;
(b) Verified ILS and paramedic vehicles must provide equipment identified in Table E of this section, in addition to meeting the requirements of WAC 246-976-300;
(c) Verified air ambulance services must meet patient care equipment requirements described in WAC 246-976-320.
| TABLE E: EQUIPMENT FOR VERIFIED TRAUMA SERVICES (NOTE: "ASST" MEANS ASSORTMENTS) |
AMBULANCE | AID VEHICLE | ||||||
| PAR | ILS | PAR | ILS | |||||
| AIRWAY MANAGEMENT | ||||||||
| Airway adjuncts | ||||||||
| Adjunctive airways, assorted per protocol | X | X | X | X | ||||
| Laryngoscope handle, spare batteries | 1 | 1 | 1 | 1 | ||||
| Adult blades, set | 1 | 1 | 1 | 1 | ||||
| Pediatric blades, straight (0, 1, 2) | 1 ea | 1 ea | 1 ea | 1 ea | ||||
| Pediatric blades, curved (2) | 1 ea | 1 ea | 1 ea | 1 ea | ||||
| McGill forceps, adult & pediatric | 1 | 1 | 1 | 1 | ||||
| ET tubes, adult and pediatric | asst | 0 | asst | 0 | ||||
| Supraglottic airways per MPD protocol | X | X | X | X | ||||
| End-tidal CO2 detector | 1 ea | 1 ea | 1 ea | 1 ea | ||||
| Oxygen saturation monitor | 1 ea | 1 ea | 1 ea | 1 ea | ||||
| TRAUMA EMERGENCIES | ||||||||
| IV access | ||||||||
| Administration sets and intravenous fluids per protocol: | ||||||||
| Adult | 4 | 4 | 2 | 2 | ||||
| Pediatric volume control device | 2 | 2 | 1 | 1 | ||||
| Catheters, intravenous (14-24 ga) | asst | asst | asst | asst | ||||
| Needles | ||||||||
| Hypodermic | asst | asst | asst | asst | ||||
| Intraosseous, per protocol | 2 | 2 | 1 | 1 | ||||
| Sharps container | 1 | 1 | 1 | 1 | ||||
| Syringes | asst | asst | asst | asst | ||||
| Glucose measuring supplies | Yes | Yes | Yes | Yes | ||||
| Pressure infusion device | 1 | 1 | ||||||
| Length based tool for estimating pediatric medication and equipment sizes | 1 | 1 | 1 | 1 | ||||
| Medications according to local patient care protocols | ||||||||
(a) To urban response areas: Eight minutes or less, eighty percent of the time;
(b) To suburban response areas: Fifteen minutes or less, eighty percent of the time;
(c) To rural response areas: Forty-five minutes or less, eighty percent of the time;
(d) To wilderness response areas: As soon as possible.
(7) Ground ambulance service response time requirements: Verified ground ambulance services must meet the following minimum agency response times for all EMS and trauma responses to response areas as defined by the department and identified in the regional plan:
(a) To urban response areas: Ten minutes or less, eighty percent of the time;
(b) To suburban response areas: Twenty minutes or less, eighty percent of the time;
(c) To rural response areas: Forty-five minutes or less, eighty percent of the time;
(d) To wilderness response areas: As soon as possible.
(8) Verified air ambulance services must meet minimum agency response times as identified in the state plan.
(9) Verified ambulance and aid services must comply with the approved prehospital trauma triage procedures defined in WAC 246-976-010.
(10) The department will:
(a) Identify minimum and maximum numbers of prehospital services, based on:
(i) The approved regional EMS and trauma plans, including: Distribution and level of service identified for each response area; and
(ii) The Washington state EMS and trauma plan;
(b) With the advice of the steering committee, consider all available data in reviewing response time standards for verified prehospital trauma services at least biennially;
(c) Administer the BLS/ILS/ALS verification application and evaluation process;
(d) Approve an applicant to provide verified prehospital trauma care, based on satisfactory evaluations as described in this section;
(e) Obtain comments from the regional council as to whether the application(s) appears to be consistent with the approved regional plan;
(f) Provide written notification to the applicant(s) of the final decision in the verification award;
(g) Notify the regional council and the MPD in writing of the name, location, and level of verified services;
(h) Approve renewal of a verified service upon reapplication, if the service continues to meet standards established in this chapter and verification remains consistent with the regional plan.
(11) The department may:
(a) Conduct a preverification site visit; and
(b) Grant a provisional verification not to exceed one hundred twenty days. The department may withdraw the provisional verification status if provisions of the service's proposal are not implemented within the one hundred twenty-day period, or as otherwise provided in chapter 70.168 RCW and this chapter.
[Statutory Authority: RCW 18.73.140. 00-22-124, § 246-976-390, filed 11/1/00, effective 12/2/00. Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-390, 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), § 246-976-390, filed 12/23/92, effective 1/23/93.]
(a) Provide a description of the documents an applicant must submit to demonstrate that it meets the standards as identified in chapter 70.168 RCW and WAC 246-976-390;
(b) Conduct a preverification on-site review for:
(i) All ALS ambulance service applications;
(ii) All ILS ambulance service applications; and
(iii) All BLS ambulance applications if and when there is any question of duplication of services or lack of coordination of prehospital services within the region;
(c) Request comments from the region in which a verification application is received, to be used in the department's review;
(d) Apply the department's evaluation criteria; and
(e) Apply the department's decision criteria.
(2) To apply for verification you must:
(a) Be a licensed prehospital EMS ambulance or aid service as specified in WAC 246-976-260;
(b) Submit a completed application:
(i) If you are applying for verification in more than one region, you must submit a separate application for each region;
(ii) You must apply for verification when you are:
(A) An agency that responds to 9-1-1 emergencies as part of its role in the EMS system;
(B) A new business or legal entity (new UBI) that is formed through consolidation of existing services or a newly formed EMS agency;
(C) An EMS agency that seeks to provide prehospital emergency response in a region in which it previously has not been operating; or
(D) A service that is changing, or has changed its type of verification or its verification status.
(3) The department will evaluate each prehospital EMS service applicant on a point system. In the event there are two or more applicants, the department will verify the most qualified applicant. The decision to verify will be based on at least the following:
(a) Total evaluation points received on all completed applications:
(i) Applicants must receive a minimum of one hundred fifty points of the total two hundred points possible from the overall evaluation scoring tool to qualify for verification.
(ii) Applicants must receive a minimum of thirty points in the evaluation of its clinical and equipment capabilities section of the evaluation scoring tool to qualify for verification;
(b) Recommendations from the on-site review team, if applicable;
(c) Comment from the regional council(s);
(d) Dispatch plan;
(e) Response plan;
(f) Level of service;
(g) Type of transport, if applicable;
(h) Tiered response and rendezvous plan;
(i) Back-up plan to respond;
(j) Interagency relations;
(k) How the applicant's proposal avoids unnecessary duplication of resources or services;
(l) How the applicant's service is consistent with and will meet the specific needs as outlined in their approved regional EMS and trauma plan including the patient care procedures;
(m) Ability to meet vehicle requirements;
(n) Ability to meet staffing requirements;
(o) How certified EMS personnel have been, or will be, trained so they have the necessary understanding of department-approved medical program director (MPD) protocols, and their obligation to comply with the MPD protocols;
(p) Agreement to participate in the department-approved regional quality improvement program.
(4) Regional EMS and trauma care councils may provide comments to the department regarding the verification application, including written statements on the following if applicable:
(a) Compliance with the department-approved minimum and maximum number of verified trauma services for the level of verification being sought by the applicant;
(b) How the proposed service will impact care in the region to include discussion on:
(i) Clinical care;
(ii) Response time to prehospital incidents;
(iii) Resource availability; and
(iv) Unserved or under served trauma response areas;
(c) How the applicant's proposed service will impact existing verified services in the region.
(5) Regional EMS/TC councils will solicit and consider input from local EMS/TC councils where local councils exist.
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(1) The department shall promptly notify in writing: The service, the MPD, and the local and regional EMS/TC councils.
(2) Within thirty days of the department's notification, the service must submit a corrective plan to the department, the MPD, and the local and regional councils outlining proposed action to return to compliance.
(3) If the service is either unable or unwilling to comply with the verification standards, under the provisions of chapter 34.05 RCW, the department may suspend or revoke the verification. The department shall promptly notify the local and regional councils and the MPD of any revocation or suspension of verification.
If the MPD ((or)), the local council, or regional council
receives information that a service is out of compliance with
the regional plan, they may forward their recommendations for
corrections to the department.
(4) The department will review the plan within thirty
days, including consideration of any recommendations from the
MPD ((or)), local council, and regional council. The
department will notify the service whether the plan is
accepted or rejected.
(5) The department will monitor the service's progress in fulfilling the terms of the approved plan.
(6) A verified prehospital service that is not in compliance with verification standards will not receive a participation grant.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-400, 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), § 246-976-400, filed 12/23/92, effective 1/23/93.]
(1) Have written guidelines consistent with ((your))
their written scope of trauma service to identify and transfer
patients with special care needs exceeding the capabilities of
the trauma service((.));
(2) Have written transfer agreements with other
designated trauma services. The agreements must address the
responsibility of the transferring hospital, the receiving
hospital, and the prehospital transport agency, including a
mechanism to assign medical control during interhospital
transfer((.));
(3) Have written guidelines, consistent with ((your))
their written scope of trauma service, to identify trauma
patients who are transferred in from other facilities, whether
admitted through the emergency department or directly into
other hospital services((.));
(4) Use verified prehospital trauma services for interfacility transfer of trauma patients.
[Statutory Authority: RCW 70.168.060 and 70.168.070. 04-01-041, § 246-976-890, filed 12/10/03, effective 1/10/04. Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-890, filed 4/5/00, effective 5/6/00. Statutory Authority: Chapter 70.168 RCW. 98-04-038, § 246-976-890, filed 1/29/98, effective 3/1/98. Statutory Authority: RCW 43.70.040 and chapters 18.71, 18.73 and 70.168 RCW. 93-01-148 (Order 323), § 246-976-890, filed 12/23/92, effective 1/23/93.]
(a) Be knowledgeable in the administration and management of prehospital emergency medical care and services;
(b) Provide medical control and direction of EMS/TC certified personnel in their medical duties, by oral or written communication;
(c) Develop and adopt written prehospital patient care protocols to direct EMS/TC certified personnel in patient care. These protocols may not conflict with regional patient care procedures or with the authorized care of the certified prehospital personnel as described in WAC 246-976-182;
(d) Establish protocols for storing, dispensing, and administering controlled substances, in accordance with state and federal regulations and guidelines;
(e) Participate with the local and regional EMS/TC councils and emergency communications centers to develop and revise regional patient care procedures;
(f) Participate with the local and regional EMS/TC councils to develop and revise regional plans and make timely recommendations to the regional council;
(g) Work within the parameters of the approved regional patient care procedures and the regional plan;
(h) Supervise training of all EMS/TC certified personnel;
(i) Develop protocols for special training described in WAC 246-976-021(5);
(j) Periodically audit the medical care performance of EMS/TC certified personnel;
(k) Recommend to the department certification, recertification, or denial of certification of EMS/TC personnel;
(l) Recommend to the department disciplinary action to be taken against EMS/TC personnel, which may include modification, suspension, or revocation of certification;
(m) Recommend to the department individuals applying for recognition as senior EMS instructors.
(2) In accordance with department policies and procedures, the MPD may:
(a) Delegate duties to other physicians, except for duties described in subsection (1)(c), (k), and (l) of this section. The delegation must be in writing;
(i) The MPD must notify the department in writing of the names and duties of individuals so delegated, within fourteen days;
(ii) The MPD may remove delegated authority at any time, which shall be effective upon written notice to the delegate and the department;
(b) Delegate duties relating to training, evaluation, or examination of certified EMS/TC personnel, to qualified nonphysicians. The delegation must be in writing;
(c) Enter into EMS/TC medical control agreements with other MPDs;
(d) Recommend denial of certification to the department for any applicant the MPD can document is unable to function as an EMS provider, regardless of successful completion of training, evaluation, or examinations; and
(e) Utilize examinations to determine the knowledge and abilities of IV technicians, airway technicians, intermediate life support technicians, or paramedics prior to recommending applicants for certification or recertification.
(3) The department may withdraw the certification of an MPD for failure to comply with the Uniform Disciplinary Act (chapter 18.130 RCW) and other applicable statutes and regulations.)) (1) Qualifications - applicants for certification as a medical program director (MPD) must:
(a) Hold and maintain a current and valid license to practice medicine and surgery pursuant to chapter 18.71 RCW or osteopathic medicine and surgery pursuant to chapter 18.57 RCW; and
(b) Be qualified and knowledgeable in the administration and management of emergency medical care and services; and
(c) Complete a medical director training course approved by the department; and
(d) Be recommended for certification by the local medical community and local emergency medical services and trauma care council.
(2) MPD certification process. In certifying the MPD, the department will:
(a) Work with the local EMSTC council to identify physicians interested in serving as the MPD;
(b) Receive letter of interest and curriculum vitae from the MPD candidate;
(c) Perform required background checks identified in RCW 18.130.064;
(d) Work with and provide technical assistance to local EMSTC councils on evaluating MPD candidates;
(e) Obtain letters of recommendation from the local EMSTC council and local medical community;
(f) Make final appointment of the MPD.
(3) The certified MPD must:
(a) Provide medical control and direction of EMS certified personnel in their medical duties. This is done by oral or written communication;
(b) Develop and adopt written prehospital patient care protocols to direct EMS certified personnel in patient care. These protocols may not conflict with regional patient care procedures. Protocols may not exceed the authorized care of the certified prehospital personnel as described in WAC 246-976-182;
(c) Establish policies for storing, dispensing, and administering controlled substances. Policies must be in accordance with state and federal regulations and guidelines;
(d) Participate with local and regional EMS/TC councils to develop and revise:
(i) Regional patient care procedures;
(ii) County operating procedures when applicable; and
(iii) Participate with the local and regional EMS/TC councils to develop and revise regional plans;
(e) Work within the parameters of the approved regional patient care procedures and the regional plan;
(f) Supervise training of all EMS certified personnel;
(g) Develop protocols for special training described in WAC 246-976-023(4);
(h) Periodically audit the medical care performance of EMS certified personnel;
(i) Recommend to the department certification, recertification, or denial of certification of EMS personnel;
(j) Recommend to the department disciplinary action to be taken against EMS personnel, which may include modification, suspension, or revocation of certification; and
(k) Recommend to the department individuals applying for recognition as senior EMS instructors.
(4) In accordance with department policies and procedures, the MPD may:
(a) Delegate duties to other physicians, except for duties described in subsection (3)(b), (i), (j), and (k) of this section. The delegation must be in writing;
(i) The MPD must notify the department in writing of the names and duties of individuals so delegated, within fourteen days;
(ii) The MPD may remove delegated authority at any time, which shall be effective upon written notice to the delegate and the department.
(b) Delegate duties relating to training, evaluation, or examination of certified EMS personnel, to qualified nonphysicians. The delegation must be in writing;
(c) Enter into EMS medical control agreements with other MPDs;
(d) Recommend denial of certification to the department for any applicant the MPD can document is unable to function as an EMS provider, regardless of successful completion of training, evaluation, or examinations; and
(e) Utilize examinations to determine the knowledge and abilities of certified EMS personnel prior to recommending applicants for certification or recertification.
(5) The department may withdraw the certification of an MPD for failure to comply with the Uniform Disciplinary Act (chapter 18.130 RCW) and other applicable statutes and regulations.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-920, 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), § 246-976-920, filed 12/23/92, effective 1/23/93.]
The following sections of the Washington Administrative Code are repealed:
| WAC 246-976-021 | Training course requirements. |
| WAC 246-976-151 | Reciprocity, challenges, reinstatement and other actions. |