Ariz. Admin. Code § R9-25-201 - Administrative Medical Direction (Authorized by A.R.S. Sections 36-2201, 36-2202(A)(3) and (A)(4), 36-2204(5), (6), and (7), 36-2204.01, and 36-2205(A) and (D))

A. An emergency medical services provider or ambulance service shall:

1. Except as specified in subsection (B) or (C), designate a physician as administrative medical director who meets one of the following:

a. Has emergency medicine certification issued by a member board of the American Board of Medical Specialties;

b. Has emergency medical services certification issued by the American Board of Emergency Medicine;

c. Has emergency medicine certification issued by the American Osteopathic Board of Emergency Medicine;

d. Has emergency medicine certification issued by the American Board of Physician Specialties;

e. Has completed an emergency medicine residency training program accredited by the Accreditation Council for Graduate Medical Education or approved by the American Osteopathic Association; or

f. Is an emergency medicine physician in an emergency department located in Arizona and has current certification in:

i. Advanced emergency cardiac life support that includes didactic instruction and a practical skills test, consistent with training recognized by the American Heart Association;

ii. Advanced emergency trauma life support that includes didactic instruction and a practical skills test, consistent with training recognized by the American College of Surgeons; and

iii. Pediatric advanced emergency life support that includes didactic instruction and a practical skills test, consistent with training recognized by the American Heart Association;

2. If the emergency medical services provider or ambulance service designates a physician as administrative medical director according to subsection (A)(1), notify the Department in writing:

a. Of the identity and qualifications of the designated physician within 10 days after designating the physician as administrative medical director; and

b. Within 10 days after learning that a physician designated as administrative medical director is no longer qualified to be an administrative medical director; and

3. Maintain for Department review:

a. A copy of the policies, procedures, protocols, and documentation required in subsection (E); and

b. Either:

i. The name, e-mail address, telephone number, and qualifications of the physician providing administrative medical direction on behalf of the emergency medical services provider or ambulance service; or

ii. If the emergency medical services provider or ambulance service provides administrative medical direction through an ALS base hospital or a centralized medical direction communications center, a copy of a written agreement with the ALS base hospital or centralized medical direction communications center documenting that the administrative medical director is qualified under subsection (A)(1).

B. Except as provided in R9-25-502(A)(3), if an emergency medical services provider or ambulance service provides only BLS, the emergency medical services provider or ambulance service is not required to have an administrative medical director.

C. If an emergency medical services provider or ambulance service provides administrative medical direction through an ALS base hospital or a centralized medical direction communications center, the emergency medical services provider or ambulance service shall ensure that the ALS base hospital or centralized medical direction communications center designates a physician as administrative medical director who meets one of the requirements in subsections (A)(1)(a) through (f).

D. An emergency medical services provider or ambulance service may provide administrative medical direction through an ALS base hospital certified according to R9-25-203(C), if the emergency medical services provider or ambulance service:

1. Uses the ALS base hospital for administrative medical direction only for patients who are children, and

2. Has a written agreement for the provision of administrative medical direction with an ALS base hospital that meets the requirements in R9-25-203(B)(1) or a centralized medical direction communications center.

E. An emergency medical services provider or an ambulance service shall ensure that:

1. An EMCT receives administrative medical direction as required by A.R.S. Title 36, Chapter 21.1 and this Chapter;

2. Protocols are established, documented, and implemented by an administrative medical director, consistent with A.R.S. Title 36, Chapter 21.1 and this Chapter, that include:

a. A communication protocol for:

i. How and from what sources an EMCT requests and receives on-line medical direction,

ii. When and how an EMCT notifies a health care institution of the EMCT's intent to transport a patient to the health care institution, and

iii. What procedures an EMCT follows in the event of a communications equipment failure;

b. A triage protocol for:

i. How an EMCT assesses and prioritizes the medical condition of a patient,

ii. How an EMCT selects a health care institution to which a patient may be transported,

iii. How a patient is transported to the health care institution, and

iv. When on-line medical direction is required;

c. A treatment protocol for:

i. How an EMCT performs a medical treatment on a patient or administers an agent to a patient, and

ii. When on-line medical direction is required while an EMCT is providing treatment; and

d. A protocol for the transfer of information to the emergency receiving facility for:

i. What information is required to be communicated to emergency receiving facility staff concurrent with the transfer of care and by what method, including the condition of the patient, the treatment provided to the patient, and the patient's response to the treatment;

ii. What information is required to be documented on a prehospital incident history report; and

iii. The time-frame, which is associated with the transfer of care, for completion and submission of a prehospital incident history report;

3. Policies and procedures are established, documented, and implemented by an administrative medical director, consistent with A.R.S. Title 36, Chapter 21.1 and this Chapter, that:

a. Are consistent with an EMR's or EMCT's scope of practice, as specified in Table 5.1;

b. Cover for an EMCT:

i. Medical recordkeeping;

ii. Medical reporting, including to whom and by what method medical reporting is accomplished;

iii. Completion and submission of prehospital incident history reports;

iv. Obtaining, storing, transferring, and disposing of agents to which an EMCT has access including methods to:

(1) Identify individuals authorized by the administrative medical director to have access to agents,

(2) Maintain chain of custody for controlled substances, and

(3) Minimize potential degradation of agents due to temperature extremes;

v. Administration, monitoring, or assisting in patient self-administration of an agent;

vi. Monitoring and evaluating an EMCT's compliance with treatment protocols, triage protocols, and communications protocols specified in subsection (E)(2);

vii. Monitoring and evaluating an EMCT's compliance with medical recordkeeping, medical reporting, and prehospital incident history report requirements;

viii. Monitoring and evaluating an EMCT's compliance with policies and procedures for agents to which the EMCT has access;

ix. Monitoring and evaluating an EMCT's competency in performing skills authorized for the EMCT by the EMCT's administrative medical director and within the EMCT's scope of practice, as specified in Table 5.1;

x. Ongoing education, training, or remediation necessary to maintain or enhance an EMCT's competency in performing skills within the EMCT's scope of practice, as specified in Table 5.1;

xi. The process by which administrative medical direction is withdrawn from an EMCT; and

xii. The process for reinstating an EMCT's administrative medical direction;

c. Cover for an EMR:

i. If applicable, the process and criteria for the administrative medical director to approve an individual to function as an EMR for the emergency medical services provider, according to A.R.S. § 36-2201(16), including:

(1) Verifying that the individual has documentation of hands-on training in cardiopulmonary resuscitation through instruction consistent with American Heart Association recommendations;

(2) Ensuring that the individual has competency in using an automated external defibrillator;

(3) Ensuring that the individual has competency in using noninvasive diagnostic devices; and

(4) Ensuring that the individual has competency in obtaining a patient's blood pressure, pulse, and respiratory rate,

ii. Monitoring and evaluating an EMR's competency in performing skills authorized for the EMR by the EMR's administrative medical director and within the EMR's scope of practice, as specified in Table 5.1;

iii. Ongoing education, training, or remediation necessary to maintain or enhance an EMR's competency in performing skills within the EMR's scope of practice, as specified in Table 5.1;

iv. If applicable, the process by which the administrative medical director may withdraw approval of the individual to function as an EMR; and

v. If applicable, the process for reinstating the administrative medical director's approval of the individual to function as an EMR; and

c.d. Include a quality assurance process to evaluate the effectiveness of the administrative medical direction provided to EMCTs;

4. Protocols in subsection (E)(2) and policies and procedures in subsection (E)(3) are reviewed annually by the administrative medical director and updated as necessary;

5. Requirements in A.R.S. Title 36, Chapter 21.1 and this Chapter are reviewed annually by the administrative medical director;

6. The Department is notified in writing no later than ten days after the date:

a. Administrative medical direction is withdrawn from an EMCT; or

b. An EMCT's administrative medical direction is reinstated; and

7. If the emergency medical services provider's administrative medical director had approved an individual to function as an EMR for the emergency medical services provider, according to A.R.S. § 36-2201(16) and subsection (E)(3)(c)(i), the Department is notified no later than ten days after the date the administrative medical director:

a. Withdraws approval of the individual to function as an EMR, or

b. Reinstates approval of the individual to function as an EMR.

F. An administrative medical director for an emergency medical services provider or ambulance service shall ensure that:

1. An EMCT for whom the administrative medical director provides administrative medical direction:

a. Has access to at least the minimum supply of agents required for the highest level of service to be provided by the EMCT, consistent with requirements in Article 5 of this Chapter;

b. Administers, monitors, or assists in patient self-administration of an agent according to the requirements in policies and procedures; and

c. Has access to a copy of the policies and procedures required in subsection (F)(2) while on duty for the emergency medical services provider or ambulance service;

2. Policies and procedures for agents to which an EMCT has access:

a. Specify that an agent is obtained only from a person:

i. Authorized by law to prescribe the agent, or

ii. Licensed under A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; and 4 A.A.C. 23 to dispense or distribute the agent;

b. Cover chain of custody and transfer procedures for each supply of agents, requiring an EMCT for whom the administrative medical director provides administrative medical direction to:

i. Document the name and the EMCT certification number or employee identification number of each individual who takes physical control of the supply of agents;

ii. Document the time and date that each individual takes physical control of the supply of agents;

iii. Inspect the supply of agents for expired agents, deteriorated agents, damaged or altered agent containers or labels, and depleted, visibly adulterated, or missing agents upon taking physical control of the supply of agents;

iv. Document any of the conditions in subsection (F)(2)(b)(iii);

v. Notify the administrative medical director of a depleted, visibly adulterated, or missing controlled substance;

vi. Obtain a replacement for each affected agent in subsection (F)(2)(b)(iii) for which the minimum supply is not present; and

vii. Record each administration of an agent on a prehospital incident history report;

c. Cover mechanisms for controlling inventory of agents and preventing diversion of controlled substances; and

d. Include that an agent is kept inaccessible to all individuals who are not authorized access to the agent by policies and procedures required under subsection (E)(3)(b)(iv)(1) and, when not being administered, is:

i. Secured in a dry, clean, washable receptacle;

ii. While on a motor vehicle or aircraft registered to the emergency medical services provider or ambulance service, secured in a manner that restricts movement of the agent and the receptacle specified in subsection (F)(2)(d)(i); and

iii. If a controlled substance, in a hard-shelled container that is difficult to breach without the use of a power cutting tool and:

(1) Locked inside a motor vehicle or aircraft registered to the emergency medical services provider or ambulance service,

(2) Otherwise locked and secured in such a manner as to deter misappropriation, or

(3) On the person of an EMCT authorized access to the agent;

3. The Department is notified in writing within 10 days after the administrative medical director receives notice, as required subsection (F)(2)(b)(v), that any quantity of a controlled substance is depleted, visibly adulterated, or missing; and

4. Except when the emergency medical services provider or ambulance service obtains all agents from an ALS base hospital pharmacy, which retains ownership of the agents, agents to which an EMCT has access are obtained, stored, transferred, and disposed of according to policies and procedures; A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; 4 A.A.C. 23; and requirements of the U.S. Drug Enforcement Administration.

G. An administrative medical director may delegate responsibilities to an individual as necessary to fulfill the requirements in this Section, if the individual is:

1. Another physician,

2. A physician assistant,

3. A registered nurse practitioner,

4. A registered nurse,

5. A Paramedic, or

6. An EMT-I(99).

Notes

Ariz. Admin. Code § R9-25-201

Adopted effective October 15, 1996 (Supp. 96-4). Former R9-25-201 renumbered to R9-25-207; new R9-25-201 made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). Amended by final rulemaking at 25 A.A.R. 953, effective 7/1/2019. Amended by final rulemaking at 31 A.A.R. 332, effective 12/31/2024.