BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.104.101 and 37.104.212 pertaining to emergency medical services (EMS)
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On January 12, 2011 at 10:30 a.m. the Department of Public Health and Human Services will hold a public hearing in the auditorium of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of the above-stated rules.
2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on January 6, 2011, to advise us of the nature of the accommodation that you need. Please contact Gwen Knight, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-9503; fax (406) 444-9744; or e-mail firstname.lastname@example.org.
3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.104.101 DEFINITIONS The following definitions apply in subchapters 1 through 4:
(1) through (19)(c) remain the same.
(20) "EMS incident" means an instance in which an ambulance service or nontransporting unit is requested to provide emergency medical services, including a mutual aid request, and for which:
(a) a patient was assessed;
(b) medical care was rendered;
(c) a patient was transported;
(d) a patient was pronounced dead at the scene;
(e) a patient was transferred to another licensed service;
(f) a patient was transferred from one medical facility to another; or
(g) the person or persons for whom EMS was dispatched refused treatment, transport, or both.
(20) through (24) remain the same but are renumbered (21) through (25).
(26) "Patient care report" means an accurate and complete record of the response by an ambulance service or nontransporting unit to each EMS incident.
(25) through (34) remain the same but are renumbered (27) through (36).
AUTH: 50-6-323, MCA
IMP: 50-6-323, MCA
37.104.212 RECORDS AND REPORTS (1) Each emergency medical service must maintain a
trip report patient care record for every run in which patient care was offered or provided, which contains at least the following information: EMS incident.
identification of the emergency medical services provider; Written patient care record forms shall be submitted and approved by the department.
date of the call; In incidents where more than one patient is encountered, one patient care record shall be completed for each patient.
patient's name and address; In the event more than one emergency medical service arrives at the scene of an EMS incident, each service having actual contact with a patient is responsible for completing a patient care record on the patient.
(d) type of run;
(e) identification of all emergency medical services providers, riders, trainees, or service personnel officially responding to the call;
(f) the time:
(i) the dispatcher was notified;
(ii) the emergency medical service was notified;
(iii) the emergency medical service was enroute;
(iv) of arrival on the scene;
(v) the service departed the scene or turned over the patient to an ambulance service; and
(vi) of arrival at receiving hospital, if applicable;
(g) history of the patient's illness or injury, including the findings of the physical examination;
(h) treatment provided or offered by the emergency medical services personnel, including, when appropriate, a record of all medication administered, the dose, and the time administered;
(i) record of the patient's vital signs, including the time taken, if applicable;
(j) utilization of online medical control, if applicable; and
(k) destination of the patient, if applicable.
(2) Ambulance services and nontransporting units shall collect data as identified by the department in this rule.
(3) Electronic data submitted to the department shall be in the format prescribed by the National Emergency Medical Services Information System (NEMSIS).
(a) For emergency medical services directly using the reporting system provided by the department, the data is considered submitted to the department as soon as it has been entered or updated in the department-provided system.
(b) For emergency medical services using third party software, the data is considered submitted to the department as soon as it has been uploaded or updated into the department-provided system.
(4) The following NEMSIS demographic data elements for ambulance service or nontransporting unit licensing must be reported and updated no less than annually:
D01_01 EMS Agency Number
D01_02 EMS Agency Name
D01_03 EMS Agency State
D01_04 EMS Agency County
D01_07 Level of Service
D01_08 Organizational Type
D01_09 Organization Status
D01_10 Statistical Year
D01_12 Total Service Size Area
D01_13 Total Service Area Population
D01_14 911 Call Volume per Year
D01_15 EMS Dispatch Volume per Year
D01_16 EMS Transport Volume per Year
D01_17 EMS Patient Contact Volume per Year
D01_19 EMS Agency Time Zone
D01_21 National Provider Identifier
D02_01 Agency Contact Last Name
D02_02 Agency Contact Middle Name/Initial
D02_03 Agency Contact First Name
D02_04 Agency Contact Address
D02_05 Agency Contact City
D02_06 Agency Contact State
D02_07 Agency Contact Zip Code
D02_08 Agency Contact Telephone Number
D02_09 Agency Contact Fax Number
D02_10 Agency Contact Email Address
D03_01 Agency Medical Director Last Name
D03_02 Agency Medical Director Middle Name/Initial
D03_03 Agency Medical Director First Name
D03_04 Agency Medical Director Address
D03_05 Agency Medical Director City
D03_06 Agency Medical Director State
D03_07 Agency Medical Director Zip Code
D03_08 Agency Medical Director Telephone Number
D03_09 Agency Medical Director Fax Number
D03_11 Agency Medical Director Email Address
D04_02 EMS Unit Call Sign
D05_01 Station Name
D05_02 Station Number
D05_04 Station GPS
D05_05 Station Address
D05_06 Station City
D05_07 Station State
D05_08 Station Zip
D05_09 Station Telephone Number
D06_01 Unit/Vehicle Number
D06_03 Vehicle Type
D06_04 State Certification/Licensure Levels
D06_07 Vehicle Model Year
D06_08 Year Miles/Hours Accrued
D06_09 Annual Vehicle Hours
D06_10 Annual Vehicle Miles
D07_01 Personnel's Agency ID Number
D07_02 State/Licensure ID Number
D07_05 Personnel's Level of Certification/Licensure for Agency
D08_01 EMS Personnel's Last Name
D08_02 EMS Personnel's Middle Name/Initial
D08_03 EMS Personnel's First Name
D08_04 EMS Personnel's Mailing Address
D08_05 EMS Personnel's City of Residence
D08_06 EMS Personnel's State
D08_07 EMS Personnel's Zip Code
D08_09 EMS Personnel's Home Telephone
D08_10 EMS Personnel's Email Address
D08_15 State EMS Certification Licensure Level
D08_17 State EMS Current Certification Date
(5) The following NEMSIS EMS data elements must be reported by ambulance services for each incident:
E01_01 Patient Care Report Number
E02_01 EMS Agency Number
E02_04 Type of Service Requested
E02_05 Primary Role of the Unit
E02_06 Type of Dispatch Delay
E02_07 Type of Response Delay
E02_08 Type of Scene Delay
E02_09 Type of Transport Delay
E02_10 Type of Turn-Around Delay
E02_12 EMS Unit Call Sign (Radio Number)
E02_20 Response Mode to Scene
E03_01 Complaint Reported by Dispatch
E03_02 EMD Performed
E05_02 PSAP Call Date/Time
E05_04 Unit Notified by Dispatch Date/Time
E05_05 Unit En Route Date/Time
E05_06 Unit Arrived on Scene Date/Time
E05_07 Arrived at Patient Date/Time
E05_09 Unit Left Scene Date/Time
E05_10 Patient Arrived at Destination Date/Time
E05_11 Unit Back in Service Date/Time
E05_13 Unit Back at Home Location Date/Time
E06_08 Patient's Home Zip Code
E06_15 Age Units
E07_01 Primary Method of Payment
E07_34 CMS Service Level
E07_35 Condition Code Number
E08_05 Number of Patients at Scene
E08_06 Mass Casualty Incident
E08_07 Incident Location Type
E08_15 Incident ZIP Code
E09_01 Prior Aid
E09_02 Prior Aid Performed by
E09_03 Outcome of the Prior Aid
E09_04 Possible Injury
E09_11 Chief Complaint Anatomic Location
E09_12 Chief Complaint Organ System
E09_13 Primary Symptom
E09_14 Other Associated Symptoms
E09_15 Provider's Primary Impression
E09_16 Provider's Secondary Impression
E10_01 Cause of Injury
E11_01 Cardiac Arrest
E11_02 Cardiac Arrest Etiology
E11_03 Resuscitation Attempted
E12_01 Barriers to Patient Care
E12_19 Alcohol/Drug Use Indicators
E18_03 Medication Given
E18_08 Medication Complication
E19_05 Number of Procedure Attempts
E19_06 Procedure Successful
E19_07 Procedure Complication
E20_07 Destination Zip Code
E20_10 Incident/Patient Disposition
E20_14 Transport Mode from Scene
E20_16 Reason for Choosing Destination
E20_17 Type of Destination
E22_01 Emergency Department Disposition
E22_02 Hospital Disposition
(6) Emergency medical services shall provide patient care report data to the department at least quarterly based on a calendar year or on a schedule submitted to and approved by the department.
(a) These quarterly data must be submitted to the department within 60 days of the end of the quarter (i.e., data for EMS responses occurring in January through March must be submitted by June 1; for responses in April through June by September 1; for responses in July through September by December 1; for responses in October through December by March 1).
(b) The data may be submitted more frequently than quarterly.
(c) An emergency medical service with no EMS incidents during the quarter must report such to the department.
(7) Ambulance services are not required to submit other NEMSIS data elements, but may do so. Nontransporting units are not required to submit NEMSIS data, but may do so.
(8) Other software may be used to submit required data, but agencies must seek prior approval from the department.
(9) If the department determines that there are errors in the data, it may ask the service for corrections. The service shall correct the data and resubmit it to the department within 30 days of notice from the department. If data are returned to the emergency medical service for corrections, the service is not in compliance with this rule until corrected data is returned, accepted, and approved by the department.
(10) The department adopts and incorporates by reference the National Emergency Medical Services Information System (NEMSIS) Uniform Pre-Hospital Emergency Medical Services Dataset, Version 2.2.1, (2006) published by the National Highway Traffic Safety Administration (NHTSA). A copy may be obtained at http://nemsis.org/softwareDevelopers/downloads/datasetDictionaries.html or from the Department of Public Health and Human Services, Public Health and Safety Division, Emergency Medical Services and Trauma Systems Section, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.
(2) (11) Trip Patient care reports may be reviewed by the department.
(3) (12) Copies of trip patient care reports must be maintained by the service for a minimum of seven years.
(4) Each emergency medical service must provide the department with a quarterly report, on a form provided by the department, that specifies the number and types of runs occurring during the quarter, the type of emergency, and the average response times.
(5) (13) Immediately or as soon as possible upon arrival at a receiving facility, but no later than 48 24 hours after the end of the patient transport, an ambulance service must provide a copy of the trip patient care report to the hospital that receives the patient.
(a) If a completed patient care report cannot be left at the facility at the end of the patient transfer to the licensed hospital, an abbreviated patient encounter form containing information essential to continued patient care shall be provided until a patient care record can be left.
(b) If an immediate response to another patient is required of an ambulance delivering a patient to a licensed hospital, a complete oral report on the patient being delivered will be given to the receiving facility until a patient encounter form or patient care record can be provided.
AUTH: 50-6-323, MCA
IMP: 50-6-323, MCA
4. The Department of Public Health and Human Services (the department) is proposing the amendment of ARM 37.104.101 and 37.104.212 pertaining to emergency medical services (EMS). These proposed rule changes are updates to the records and reports requirements for licensed EMS services. Current rules require EMS services to collect patient care records on their calls and to provide quarterly reports to the department. These proposed rule amendments require ambulance services to report minimum, electronic data to a web-based department database. Additionally, these rules update data collection to meet National EMS Information System (NEMSIS) data standards.
The department is proposing a new definition to ARM 37.104.101, "EMS incident". EMS services currently interpret broadly when they need to complete a patient care record. This definition is reasonably necessary in order to assure that all services consistently collect patient care records.
The department is also proposing new definition, "patient care report". This definition is reasonably necessary to clarify that a patient record will be completed on each EMS incident. It is also necessary as there currently is some confusion whether or not nontransporting units are required to complete a patient record or not.
The department is proposing the amendment of ARM 37.104.212(1) to update current industry terminology for the report and EMS incident. It is reasonably necessary to delete ARM 37.104.212(1)(a) through (1)(k) as they are too generic to be useful for data collection purposes, they are not compliant with the NEMSIS data standard, and they are better defined in proposed rules below which require collection of NEMSIS demographic and patient EMS sets. The new language for ARM 37.104.212(1)(a) is reasonably necessary to allow the department to assure that EMS services use written patient care records that meet current minimum data collection standards and medical record rules. The proposed new language in ARM 37.104.212(1)(b) and (c) clarify the procedure for documentation where there are multiple patient incidents or incidents in which multiple services respond. This is currently unclear.
The proposed amendment to ARM 37.104.212(2) is reasonably necessary to require that all EMS services will collect data as defined in the remaining proposed rules.
NEMSIS is the national standard for EMS data collection. ARM 37.104.212(3) is reasonably necessary to assure that all services collect data using the NEMSIS standard. Data collected using multiple definitions and standards, would be useless for statewide data analysis. ARM 37.104.212(3)(a) is reasonably necessary in order to clarify that EMS services may collect data in the department-based software to be compliant with data collection requirements. ARM 37.104.212(3)(b) is reasonably necessary to clarify that EMS services using other third party software must upload their data into the department-based software to be compliant with data collection requirements.
ARM 37.104.212(4) specifies which NEMSIS demographic data set fields must be collected. These fields are primarily related to the EMS service licensing module of the department-based software and are necessary for administration and regulation of these service licenses.
Additionally, ARM 37.104.212(4) is being proposed to ensure that licensing records are more up-to-date. In the previous, paper-based licensing process, most service license information was only updated once every two years upon relicensure. As such, much of the information the department maintained about licensed EMS services was very outdated and inaccurate. With the new electronic system, information can be easily updated by the EMS on a regular basis and in any case, no less than annually.
Proposed amendment ARM 37.104.212(5) is a list of the minimum, national data elements described in the NEMSIS data dictionary. This rule requires ambulance services to report these minimum data elements on all incidents. No patient identifiers and only minimal service identifiers are included in the minimum data set. Services will only be able to access their own data for reports. Summary reports from other services and the EMS system will be produced by the department. Currently, 27 states are submitting national data to the National EMS Database. It is the intent of the department to be one of 20 additional states capable of submitting state data in 2011. As in the state data system, the service data in the national database is nonidentifiable, except to the service. Like the department system, the national database allows the service to view detailed reports about their own service and only summary reports of other services reporting into the system.
ARM 37.104.212(6), (a), (b), and (c) are necessary in order to establish a minimum schedule for data to be submitted into the department's data system. This rule also requires services that have no runs during the quarter to report such to the department so that compliance with these rules can be monitored.
The department's data system accommodates entry of many more data elements than the minimum elements described above. ARM 37.104.212(7) clarifies that services may optionally enter additional data and, as such, have access to more complete demographic and statistical reports in the system.
ARM 37.104.212(8) is reasonably necessary to assure that EMS services that choose to purchase or develop their own data systems will use software that is NEMSIS compliant and capable of uploading data into the department's data software. Without this requirement, services may invest considerable time and funds obtaining a system that is not compatible and would not allow them to meet the data collection requirements of these rules.
ARM 37.104.212(9) is reasonably necessary to provide the department with the ability to enforce complete and accurate data collection. While the department will make every effort to provide technical assistance and training towards this goal, if a service refuses to comply with appropriate intervention, this rule could be applied as an additional regulatory tool.
ARM 37.104.212(10) is reasonably necessary to adopt the NEMSIS national data standard. This standard specifies data definitions, electronic format, and other standards which ensures that all services collect data the same way.
ARM 37.104.212(2) and (3) have been renumbered to ARM 37.104.212(11) and (12), and are being updated to the more current terminology of the industry.
The current rule language in ARM 37.104.212(4) is being deleted. This language has been replaced and clarified by several other sections of these proposed rules.
ARM 37.104.212(5) is being renumbered to ARM 37.104.212(13). The department is proposing amendment to ARM 37.104.212(13) as it is necessary to resolve cases in which EMS leaves a patient at a hospital but does not also relay essential information about the patient that is necessary for continuity of care. First, the requirement for submission of a patient care report to the hospital has been changed from 48 hours to 24 hours. There have been numerous comments from field providers and hospitals that 24 hours is more than adequate for submission of this very important information.
ARM 37.104.212(13)(a) is necessary as information that EMS has collected about a patient is essential to the ongoing care of the patient after they leave. In cases in which EMS cannot leave a patient care record at the hospital at the conclusion of the call, this rule requires services to leave an "encounter form". This form provides essential information about the patient to the hospital and helps assure continuity of care in the absence of a complete patient care record.
ARM 37.104.212(13)(b) requires a service that may need to leave immediately due to backup of multiple calls still needs to provide at least a verbal report of this essential patient information before they leave the hospital.
5. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Gwen Knight, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail email@example.com, and must be received no later than 5:00 p.m., January 20, 2011.
6. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
7. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 5 above or may be made by completing a request form at any rules hearing held by the department.
8. An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register. The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered. In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.
9. The bill sponsor contact requirements of 2-4-302, MCA do not apply.
/s/ Shannon McDonald /s/ Anna Whiting Sorrell
Rule Reviewer Anna Whiting Sorrell, Director
Public Health and Human Services
Certified to the Secretary of State December 13, 2010.