Iowa Admin. Code r. 641-144.5 - Air ambulance service program-off-line medical direction
(1) The medical
director shall be responsible for providing appropriate medical direction and
overall supervision of the medical aspects of the service program and shall
ensure that those duties and responsibilities are not relinquished before a new
or temporary replacement is functioning in that capacity.
(2) The medical director's duties include,
but need not be limited to:
a. Developing,
approving and updating protocols to be used by service program personnel that
meet or exceed the minimum standard protocols developed by the
department.
b. Developing and
maintaining liaisons between the service, other physicians, physician
designees, hospitals, and the medical community served by the service
program.
c. Monitoring and
evaluating the activities of the service program and individual personnel
performance, including establishment of measurable outcomes that reflect the
goals and standards of the EMS system.
d. Assessing the continuing education needs
of the service and individual service program personnel and assisting them in
the planning of appropriate continuing education programs.
e. Being available for individual evaluation
and consultation to service program personnel.
f. Performing or appointing a designee to
complete the medical audits required in subrule 144.5(4).
g. Developing and approving an applicable
continuous quality improvement policy to be used for all patient care
encounters, including an action plan and follow-up.
h. Informing the medical community of the
emergency medical care being provided according to approved protocols in the
service program area.
i. Helping to
resolve service operational problems.
j. Approving or removing an individual from
service program participation.
(3) Supervising physicians, physician
designees, or other appointees as defined in the continuous quality improvement
policy referenced in paragraph 144.5(2) "g" may assist the
medical director by:
a. Providing medical
direction.
b. Reviewing the
emergency medical care provided.
c.
Reviewing and updating protocols.
d. Providing and assessing continuing
education needs for service program personnel.
e. Helping to resolve operational
problems.
(4) The
medical director or other qualified designees shall randomly audit (at least
quarterly) documentation of calls where emergency medical care was provided.
The medical director shall randomly review audits performed by the qualified
appointee. The audit shall be in writing and shall include, but need not be
limited to:
a. Reviewing the patient care
provided by service program personnel and remedying any deficiencies or
potential deficiencies that may be identified regarding medical knowledge or
skill performance.
b. Response time
and time spent at the scene.
c.
Overall EMS system response to ensure that the patient's needs were matched to
available resources including, but not limited to, mutual aid and tiered
response.
d. Completeness of
documentation.
(5)
On-line medical direction when provided through a hospital.
a. The medical director shall designate in
writing at least one hospital which has established a written on-line medical
direction agreement with the department. It shall be the medical director's
responsibility to notify the department in writing of changes regarding this
designation.
b. Hospitals signing
an on-line medical direction agreement shall:
(1) Ensure that the supervising physicians or
physician designees will be available to provide on-line medical direction via
telecommunications on a 24-hour-per-day basis.
(2) Identify the service programs for which
on-line medical direction will be provided.
(3) Establish written protocols for use by
supervising physicians and physician designees who provide on-line medical
direction.
(4) Administer a quality
assurance program to review orders given. The program shall include a mechanism
for the hospital and service program medical directors to discuss and resolve
any identified problems.
c. A hospital which has a written medical
direction agreement with the department may provide medical direction for any
or all service program authorization levels and may also agree to provide
backup on-line medical direction for any other service program when that
service program is unable to contact its primary source of on-line medical
direction.
d. Only supervising
physicians or physician designees shall provide on-line medical direction.
However, a physician assistant, registered nurse or EMT (of equal or higher
level) may relay orders to emergency medical care personnel, without
modification, from a supervising physician. A physician designee may not
deviate from approved protocols.
e.
The hospital shall provide, upon request to the department, a list of
supervising physicians and physician designees providing on-line medical
direction.
f. The department may
verify a hospital's communications system to ensure compliance with the on-line
medical direction agreement.
g. A
supervising physician or physician designee who gives orders (directly or via
communications equipment from some other point) to an emergency medical care
provider is not subject to criminal liability by reason of having issued the
orders and is not liable for civil damages for acts or omissions relating to
the issuance of the orders unless the acts or omissions constitute
recklessness.
h. Nothing in these
rules requires or obligates a hospital, supervising physician or physician
designee to approve requests for orders received from emergency medical care
personnel.
Note: Hospitals in other states may participate provided that the applicable requirements of this subrule are met.
Notes
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