Code of Maryland RegulationsTitle 30 Maryland Institute for Emergency Medical Services Systems
Objectives • Following the completion of this presentation the participant will be able to: • Locate and reference the Code of Maryland Regulations (COMAR), Title 30 • Describe the impact of Title 30 on the daily operations of emergency services • Recognize the Provider Review Process (PRP) • Recognize the role of Quality Review as outlined in Title 30
Why Regulate? • Why Regulate? • In its infancy MIEMSS established guidelines based on an informal process. • The result was inconsistency, and the lack of coordination often caused confusion among providers. • There were no formal policies or procedures.
Maryland Regulations • Regulations are the generally applicable rules under which a state agency operates. • The legislature must authorize an agency to promulgate regulations. • The agency then must follow detailed rules in drafting and enacting the regulations.
What is COMAR? • The Regulations of all Maryland Agencies are collected in the Code of Maryland Regulations known as “COMAR”.
COMAR Description • COMAR is divided into “Titles”. Each title is numbered and generally represents the rules for a separate state agency. • Examples: • MIEMSS -Title 30 • Department of Health -Title 10
COMAR Description • Titles are then broken down into “Subtitles” or “Chapters”. • Examples from MIEMSS Title 30: • Subtitle 02: Emergency Medical Services Providers • Chapter 03: Scope of Practice and Duties
COMAR Description • The information in each chapter defines the regulations relating to that title. • The chapter is written in outline format (much like the Maryland Medical Protocols) for ease of reference. • Each Subtitle contains a list of definitions for terms used in the chapter.
Where Can I Locate a Copy? • A copy is located in the reference section of each public library. • COMAR can also be located on-line at https://constmail.gov.state.md.us/comar/dsd_web/default.htm
Who Does it Impact? • TITLE 30 effects: ...“any EMS service or provider who operates in the State of Maryland”...
Operational Impact • Day-to-day influence of Title 30 • Licensure / Certification / Credential • Scope of Practice and Duties • Prohibited Conduct • Disciplinary Procedures • Operational Suspensions • Hearings • Summary Suspension of License or Certification
Maryland Title 30 Overview • Subtitle 01: General • Subtitle 02: Emergency Medical Services Providers • Subtitle 03: EMS Operational Programs • Subtitle 04: Emergency Medical Services Education Programs and Courses • Subtitle 06: Automated External Defibrillation Program
Maryland Title 30 • Subtitle 07: Emergency Medical Communications System • Subtitle 08: Designation of Trauma and Specialty Referral Centers • Subtitle 09: Commercial Ambulances Services • Subtitle 05 will cover EMS Regional Councils tentatively beginning July 1, 2002.
Subtitle 01General • Explains “Incorporation by Reference” • The mechanism for including the Maryland Medical Protocols into COMAR. • Designates the MIEMSS “Open Meeting” policy. • Outlines the process for the access and/or correction of public records. • Governs the procedures for obtaining a declaratory ruling from the EMS Board.
Subtitle 02Emergency Medical Services Providers • Defines the Licensure and Certification Process • Including: • Establishing fees for testing • Requirements for providers • Reciprocity • Examination and reexamination • Issuance of a license or certificate • Renewal, surrender and/or reinstatement of a license or certificate • Criteria for denial of a license or certificate
Subtitle 02Emergency Medical Services Providers • Chapter 3 of this subtitle establishes the “Scope of Practice” (based on the Maryland Medical Protocols) and duties for all levels of EMS providers including: • Emergency Medical Dispatchers • First Responders • The chapter also contains the requirement that an EMS provider must function under an EMS Operational Program.
Subtitle 02Emergency Medical Services Providers • Chapter 4 defines “Prohibited Conduct” • Outlines the actions that can be taken as a result of prohibited conduct • Reprimand or probation • Suspend or revoke a license or certificate • Deny a license or certificate • Refuse to renew a license or certificate
Subtitle 02Emergency Medical Services Providers • Chapter 05 specifies the disciplinary procedures including: • Investigation of incident reports • Review by the Provider Review Panel • Action by the EMS Board • Case resolution conference • Hearings • EMS Board action
Subtitle 02Emergency Medical Services Providers Chapter 5 continued: • Designates the composition of the Provider Review Panel • Establishes the process for summary suspension of a license or certification • Provides confidentiality and admissibility of proceedings, records, and files used throughout the provider review process.
Subtitle 02Emergency Medical Services Providers Chapter 6: • Contains the procedures for administrative hearings regarding: • Licensure • Certification • Disciplinary action of an EMS provider
Subtitle 02Emergency Medical Services Providers Chapter 7: • Governs summary procedures for suspending an EMS providers license or certificate based on the protection of public health, safety or welfare.
Subtitle 03EMS Operational Programs • Defines the criteria for approval of an EMS Operational Program • Establishes the policy for Medical Direction including the appointment of the EMS Medical Directors. • Provides the guidelines for quality assurance, protocol development and designation of Base stations.
Subtitle 03EMS Operational Programs Quality Assurance (QA) • Each EMS Operational Program must have: • A written QA plan approved by the medical director • A medical Review Committee
Quality Assurance • Quality assurance plan components • Data review • Identification and analysis of trends • Positive • Negative • Identification of protocol violations • Remediation for patient care issues at the jurisdictional level.
Quality Assurance • Quality assurance plan requirements • Notify MIEMSS within 30 days of incidents that may have resulted in patient harm, require disciplinary actions from MIEMSS, or require a change in state protocol. • Review written and oral allegations that an EMS provider failed to act in accordance with applicable law or protocol.
Medical Review Committee Medical Review Committee (MRC) responsibilities: • Every operational program must designate a MRC. • The committee is selected by the operational program and its medical director. • It shall be the duty of the MRC with the participation of the medical director to carry out the quality assurance plan.
Medical Review Committee Medical Review Committee (MRC) responsibilities: • The MRC is subject to the confidentiality and immunity provisions as provided by COMAR. • Each member must sign a confidentiality agreement.
Subtitle 03EMS Operational Programs • Protocol development is also covered under this subtitle. • Chapter 05 section .02 defines the composition of the Protocol Review Committee. • This section also established the process for protocol development and approval including: • Pilot Protocols • Research Protocols • Optional Protocols • Emergency Protocols
Subtitle 03EMS Operational Programs • Chapter 06 governs the approval and operation of an EMS Base Station. • Specific requirements are outlined for: • Approval and renewal • Specialty centers and consultation centers • Out-of-state centers • Denial or rescission of approval • Appeal process
Subtitle 04 Emergency Medical Services Education Programs and Courses • Governs the Educational Programs for: • Emergency Medical Dispatchers • Basic Life Support Providers • Advanced Life Support Providers
Subtitle 04 Emergency Medical Services Education Programs and Courses • Governs the Educational Programs for: • Emergency Medical Dispatchers • Basic Life Support Providers • Advanced Life Support Providers • Requirements for continuing education programs are also contained within this subtitle.
Subtitle 06Automated External Defibrillation Program • Establishes the criteria for the authorization of “Public Access” AED Programs • Specific requirements for PAD programs include: • Medical direction • Protocols • Quality assurance and maintenance • Training
Subtitle 07Emergency Medical Services Communications System • Establishes the system for helicopter communication to SYSCOM.
Subtitle 08Designation of Trauma and Specialty Referral Centers • Provides the criteria for the designation of trauma and specialty referral centers. • In addition it outlines the following standards for the trauma and specialty referral centers • Data Collection and Quality Management • Designation and verification criteria • Disciplinary Action for subtitle violation
Subtitle 08Designation of Trauma and Specialty Referral Centers • This subtitle establishes the standards for the following: • Trauma Centers • Burn Centers • Specialty Referral Centers • Pediatric Trauma Centers • Eye Trauma Centers • Perinatal and Neonatal Referral Centers
Subtitle 09Commercial Ambulance Services • This subtitle provides the standards for Commercial Ambulance Services in the State of Maryland. • Licensing process is defined • Operational requirements are established • Eligibility, application and renewal procedures are included • Record keeping and MIEMSS record submission are outlined
Subtitle 09Commercial Ambulance Services Commercial Ambulance Services continued • Chapter 09 governs the enforcement of commercial ambulancestatutes and regulations. • A standard commercial ambulance service equipment list (for ALS and BLS) is located in Chapters 10 & 11. • The last chapter of the commercial ambulance service subtitle governs the operation of neonatal ambulance services.
Maryland Title 30 • Maryland Information System • Each operational program shall provide to MIEMSS on a monthly basis a report of patient encounters.
Maryland Title 30 • How do we get to compliance? • Education • Communications • Cooperation • Consensus
Summary • COMAR provides the framework for the Maryland EMS System.
More Information • If you need additional information please contact the MIEMSS, Office of the Assistant Attorney General • Monty Magee (410) 706-8531 • Sarah Sette (410) 706-8514
Maryland Title 30 Questions ??? Comments ???