a) Critical care transport
may be
provided by:
1)
Department-approved critical care transport providers, not owned or
operated by a hospital, utilizing EMT-Paramedics with additional training,
nurses, or other qualified health professionals; or
2)
Hospitals, when utilizing any
vehicle service provider or any hospital-owned or operated vehicle service
provider. Nothing in the Act requires a hospital to use, or to
be, a Department-approved critical care transport provider when transporting
patients, including those critically injured or ill. Nothing in the
Act shall restrict or prohibit a hospital from providing, or arranging
for, the medically appropriate transport of any patient, as determined by a
physician licensed to practice medicine in all of its
branches, an APRN, or a PA. (Section 3.10(f-5) of the Act)
3) Physician medical direction for critical
care, approved by the EMS MD, shall have the qualifications consistent with the
acuity and conditions of the critical care patients transported. Such medical
direction includes an Illinois licensed practicing physician with competency in
critical care transport medicine and board certification in a specialty
relevant to the provider agency mission or experience in critical care
transport medicine consistent with the types, acuity and severity of patients
transported.
b)
All critical care transport providers must function within a
Department-approved EMS System. Nothing in this Part shall
restrict a hospital's ability to furnish personnel, equipment, and medical
supplies to any vehicle service provider, including a critical care transport
provider. (Section 3.10(g-5) of the Act)
c) For the purposes of this Section,
"expanded scope of practice" includes the accepted national curriculum plus
additional education, experience and equipment (see Section
515.360) as approved by the
Department pursuant to Section 3.55 of the Act. Tier I transports are
considered "expanded scope of practice".
d) For the purposes of this Section, CCT
plans are defined in three tiers of care. Tier II and Tier III are considered
Critical Care Transports.
e) Tier I
(Expanded Scope ALS)
Tier I provides a level of care for patients who require care
beyond the Department-approved Paramedic scope of practice, up to but not
including the requirements of Tiers II and III. Tier I transport may include
the use of a ventilator, the use of infusion pumps with administration of
medication drips, and maintenance of chest tubes.
1) Personnel Staffing and Licensure
A) Licensure
i) Licensed Illinois Paramedic, PHRN, PHPA or
PHAPRN;
ii) Scope of practice more
comprehensive than the national EMS scope of practice model approved by the
Department in accordance with the EMS System plan (see Sections
515.310 and
515.330); and
iii) Approved to practice by the Department
in accordance with the EMS System plan.
B) Minimum Staffing
i) System authorized EMT, A-EMT, EMT-I,
Paramedic, PHRN, PHPA or PHAPRN as driver; and
ii) System authorized expanded scope of
practice Paramedic, PHRN, PHPA, PHAPRN or physician who shall remain with the
patient at all times.
2) Education, Certification and Experience
A) Initial Education. Documentation of
initial education and demonstrated competencies of expanded scope of practice
knowledge and skills as required by Tier I Level of Care and approved by the
Department in accordance with the EMS System plan.
B) CE Requirements
i) Annual competencies of expanded scope of
practice knowledge, equipment and procedures shall be completed; and
ii) The EMS vehicle service provider shall
maintain documentation of competencies and provide documentation to the EMS
System upon request.
C)
Certifications. Tier I personnel shall maintain all of the following renewable
certifications and credentials in active status:
i) Advanced Cardiac Life Support
(ACLS);
ii) Pediatric Education for
Pre-Hospital Professionals (PEPP) or Pediatric Advance Life Support
(PALS);
iii) International Trauma
Life Support (ITLS) or Pre-Hospital Trauma Life Support (PHTLS); and
iv) Any additional educational course work or
certifications required by the EMS MD.
D) Experience
i) Minimum of 6 months of experience
functioning in the field at an ALS level or as a physician in an emergency
department; and
ii) Documentation
of education and demonstrated competencies of expanded scope of practice
knowledge and skills required for Tier I Level of Care, approved by the
Department and included in the EMS System plan.
3) Medical Equipment and Supplies
Authorized equipment as approved by the EMS MD and the
Department and included in the system plan.
4) Vehicle Standards
Any vehicle used for providing expanded scope of practice
care shall comply at a minimum with Section
515.830 (Ambulance Licensing
Requirements) or Sections
515.900 (Licensure of SEMSV
Programs -General) and 515.920 (SEMSV Program Licensure Requirements for Air
Medical Transport Programs) regarding licensure of SEMSV Programs and SEMSV
vehicle requirements, including additional medical equipment and ambulance
equipment as defined in the EMS system plan. Any vehicle used for expanded
scope of practice transport shall be equipped with an onboard alternating
current (AC) supply capable of operating and maintaining the AC current needs
of the required medical devices used in providing care during the transport of
a patient.
5) Treatment and
Transport Protocols shall address the following:
A) Written operating procedures and protocols
signed by the EMS MD and approved for use by the Department in accordance with
the System plan; and
B) Use of
authorized equipment as approved by the EMS MD.
6) Quality Assurance Program
A) The Tier I transport provider shall
develop a written Quality Assurance (QA) plan approved by the EMS System and
the Department in accordance with subsection (e)(6)(D). The provider shall
provide quarterly QA reports to the EMS Systems and to the Department upon
request for the first 12 months of operation.
B) The EMS System shall establish the
frequency of quality reports after the first year if the System has not
identified any deficiencies or adverse outcomes.
C) An EMS MD or a SEMSV MD shall oversee the
QA program.
D) The QA plan shall
evaluate all expanded scope of practice activity. The review shall include at a
minimum:
i) Review of transferring physician
orders and evidence of compliance with those orders;
ii) Documentation of vital signs and
frequency and evidence that abnormal vital signs or trends suggesting an
unstable patient were appropriately detected and managed;
iii) Documentation of any side
effects/complications, including hypotension, extreme bradycardia or
tachycardia, increasing chest pain, dysrhythmia, altered mental status and/or
changes in neurological examination, and evidence that interventions were
appropriate for those events;
iv)
Documentation of any unanticipated discontinuation of a catheter or rate
adjustments of infusions, along with rationale and outcome;
v) Documentation that any unusual occurrences
were promptly communicated to the EMS System; and
vi) A root cause analysis of any event or
care inconsistent with standards.
E) The QA plan shall be subject to review as
part of an EMS System site survey and as deemed necessary by the Department
(e.g., in response to a complaint).
f) Tier II (Critical Care)
Tier II provides an expanded scope of practice more
comprehensive than Tier I and approved by the EMS MD and the Department in
accordance with the system plan.
1)
Licensure and Personnel Staffing
A) Licensure
- Licensed Illinois Paramedic, PHRN, PHPA or PHAPRN:
B) Minimum Staffing:
i) System authorized Paramedic, PHRN, PHPA or
PHAPRN; and
ii) System authorized
Paramedic, PHRN, PHPA, PHAPRN or physician who is critical care prepared and
who shall remain with the patient at all times.
2) Education, Certification and Experience
A) Initial Advanced Formal Education.
i) At a minimum, 80 didactic hours of
established higher collegiate critical care education nationally recognized; or
two years of experience in critical care or emergency care with completion of
an EMS MD or SEMSV MD approved critical care training program (consisting of,
at minimum, 80 didactic hours) and obtaining a nationally recognized advanced
certification within two years; and
ii) Demonstrated competencies, as documented
by the EMS MD or SEMSV MD and approved by the Department.
B) CE Requirements
i) The EMS System shall document and maintain
annual competencies of expanded scope of practice knowledge, equipment and
procedures;
ii) The following
current credentials, as a minimum, shall be maintained: ACLS, PEPP or PALS,
ITLS or PHTLS, TPATC or ATLS;
iii)
A minimum of 40 hours of critical care level education shall be completed every
four years;
iv) The EMS provider
shall maintain documentation of compliance with subsections (f)(2)(B)(i)
through (iii) and shall provide documentation to the EMS System upon request;
and
v) Nationally recognized
critical care certifications shall be maintained and renewed based on national
recertification criteria.
C) Experience. Minimum of one year experience
functioning in the field at an ALS level for Paramedics, PHRNs, PHPAs, and
PHAPRNs and one year experience in an emergency department for
physicians.
3) Medical
Equipment and Supplies
A) Infusion pumps;
and
B) Other authorized equipment
as approved by the SEMSV MD and the Department and included in the system
plan.
4) Vehicle
Standards
Any vehicle used for providing critical care transport shall
comply at a minimum with Section
515.830 (Ambulance Licensing
Requirements) or Sections
515.900 (Licensure of SEMSV
Programs - General) and 515.920 (SEMSV Program Licensure Requirements for Air
Medical Transport Programs) regarding licensure of SEMSV Programs and SEMSV
vehicle requirements, including additional medical equipment and ambulance
equipment as defined in the EMS System Plan. Any vehicle used for CCT shall be
equipped with an onboard AC supply capable of operating and maintaining the AC
current needs of the required medical devices used in providing care during the
transport of a patient.
5)
Treatment and Transport Protocols shall address equipment and medications used
on Tier II transport.
6) Quality
Assurance Program
A) The EMS Systems and
providers shall have a quality improvement program, approved by the Department,
that uses national standards performance indicators to evaluate the
appropriateness and quality of patient care. The method and results of the
quality improvement projects shall be available to the Department upon
request.
B) An EMS MD or SEMSV MD
shall oversee the QA program.
g) Tier III (Critical Care)
Tier III provides the highest level of transport care for
patients who require advanced level treatment modalities and interventions as
approved by the EMS MD and the Department and identified in the system
plan.
1) Minimum Personnel Staffing
and Licensure
A) One driver holding a current
Illinois EMS license; and
B) Two
critical care prepared providers, who shall remain with the patient at all
times:
i) Paramedic, PHRN, PHPA or PHAPRN;
and
ii) RN, PHRN, PHPA or
PHAPRN.
2)
Education, Certification, and Experience: Paramedic, PHRN, PHPA or PHAPRN
A) Initial Advanced Formal Education
i) At a minimum, 80 didactic hours of
established higher collegiate critical care education nationally recognized, or
two years of experience in critical care or emergency care with completion of
an EMS MD or SEMSV MD approved critical care training program (consisting of,
at minimum, 80 didactic hours) and obtaining a nationally recognized advanced
certification within two years; and; and
ii) Demonstrated competencies, as documented
by EMS MD and SEMSV MD and approved by the Department.
B) CE Requirements
i) The EMS System shall document and maintain
annual competencies of expanded scope of practice knowledge, equipment and
procedures;
ii) The following valid
credentials, at a minimum, shall be maintained: ACLS, PEPP or PALS and NRP or
system approved equivalent, ITLS or PHTLS;
iii) A minimum of 40 hours of critical care
level CE shall be completed every four years;
iv) The EMS provider shall maintain
documentation of compliance with subsection (g)(2)(B)(i) and shall provide
documentation to the EMS System upon request; and
v) Nationally recognized critical
certifications shall be maintained and renewed based on national
recertification criteria.
C) Experience
i) Minimum of two years experience
functioning in the field at an ALS Level;
ii) Documented demonstrated competencies;
and
iii) Completion of annual
competencies of expanded scope knowledge, equipment and
procedures.
3)
Education, Certification and Experience - Registered Professional Nurse
A) CE Requirements
i) A minimum of 48 hours of critical care
level education shall be completed every four years; and
ii) The EMS provider shall maintain
documentation of compliance with subsection (g)(3)(A)(i) and shall provide
documentation to the EMS Resource Hospital upon request.
B) Certifications
Tier III personnel shall maintain the following valid
critical care certifications and credentials:
i) ACLS;
ii) PALS, PEPP or ENPC;
iii) NRP or system approved equivalent;
and
iv) ITLS, PHTLS, TNCC or TNS,
TPATC or ATLS.
C)
Experience
Minimum of two years full-time critical care
experience.
4)
Medical Equipment and Supplies as approved by the EMS MD and the Department and
included in the system plan.
5)
Vehicular Standards
Any vehicle used for providing CCT shall comply, at a
minimum, with Section
515.830 (Ambulance Licensing
Requirements) or Sections
515.900 (Licensure of SEMSV
Programs - General) and 515.920 (SEMSV Program Licensure Requirements for Air
Medical Transport Programs) regarding licensure of SEMSV Programs and SEMSV
vehicle requirements, including additional medical equipment and ambulance
equipment as defined in the EMS System Plan. Any vehicle used for CCT shall be
equipped with an onboard AC supply capable of operating and maintaining the AC
current needs of the required medical devices used in providing care during the
transport of a patient.
6)
Treatment and Transport Protocols shall address the equipment and medications
used on Tier III transport.
7)
Quality Assurance Program
A) The EMS Systems
and providers shall have a quality improvement program, approved by the
Department, that uses national standards performance indicators to evaluate the
appropriateness and quality of patient care. The method and results of the
quality improvement projects will be available to the Department upon
request.
B) An EMS MD or SEMSV MD
shall oversee the QA program.
