KENTUCKY BOARD OF EMERGENCY MEDICAL SERVICES KBEMS Agency License - - PowerPoint PPT Presentation

KBEMS Agency License & Vehicle Inspection Webinar December 19, 2018

KENTUCKY BOARD OF EMERGENCY MEDICAL SERVICES

KBEMS FIELD STAFF

• Paul Phillips, Director of Field Operations
• Paula Coyle, KBEMS Inspector/Liaison
• Ray Chesney, KBEMS Inspector/Liaison
• Eddie Slone, KBEMS Inspector/Liaison

2019 Inspection Responsibilities:

Paul Phillips – District 15 (Counties: Harrison, Nicholas, Bourbon, Scott, Franklin, Woodford, Fayette, Clark, Powell,

Estill, Madison, Jessamine, Anderson, Mercer, Boyle, Lincoln)

Paula Coyle – District 1 (Fulton, Hickman, Carlisle, Ballard, McCracken, Graves, Marshall, Calloway), District 2

(Livingston, Lyon, Trigg, Christian, Todd, Muhlenberg, Hopkins, Caldwell, Crittenden), District 3 (Union, Webster, Henderson, McLean, Daviess, Hancock, Ohio), District 4 (Logan, Butler, Warren, Simpson, Allen, Barren, Edmonson, Hart, Metcalfe, Monroe), District 14 (Cumberland, Adair, Green, Taylor, Russell, Clinton, Wayne, McCreary, Pulaski, Casey)

Ray Chesney – District 8 (Bracken, Robertson, Mason, Fleming, Lewis), District 9 (Rowan, Morgan, Menifee, Bath,

Montgomery), District 10 (Elliott, Lawrence, Carter, Greenup, Boyd), District 11 (Magoffin, Johnson, Floyd, Martin, Pike), District 12 (Wolfe, Lee, Owsley, Breathitt, Knott, Perry, Leslie, Letcher), District 13 (Rockcastle, Jackson, Laurel, Clay, Knox, Whitley, Bell, Harlan)

Eddie Slone – District 5 (Grayson, Breckinridge, Meade, Hardin, Larue, Nelson, Washington, Marion), District 6

(Bullitt, Spencer, Jefferson, Shelby, Oldham, Henry, Trimble), District 7 (Owen, Carroll, Gallatin, Grant, Boone, Pendleton, Kenton, Campbell)

AGENCY INSPECTIONS

Regulations

Ground Ambulance *NEW*

202 KAR 7:501 Ambulance Providers and Medical First Response Agencies 202 KAR 7:545 License Classifications 202 KAR 7:550 Required Equipment and Vehicle Standards 202 KAR 7:555 Ground Agencies 202 KAR 7:560 Ground Vehicle Staff

AGENCY INSPECTIONS

 Review New Agency License & Vehicle Inspection Manual  Review New Agency Renewal and Inspection Process  Answer Questions previously submitted  Field Questions from participants

TODAY’S OBJECTIVES

GROUND REGULATIONS FAQ

GROUND REGULATION FAQ

Q - 202 KAR 7:550 (d) Stow all equipment weighing three (3) pounds or more in an enclosure, bracket, mount, or other appropriate securing device - Please clarify if this is just inside personnel compartments or whole vehicle and please clarify what would constitute a proper stowage means is for a medical jump bag. A - All equipment within the entire ambulance (including personal items of the crew) will need to be properly stowed or

• secured. This will need to be a via a commercially manufactured

mounting device designed for the purpose of securing that item (monitor, suction device, etc), or a securing device permanently mounted to the vehicle (including seat belts).

GROUND REGULATION FAQ

Q - 202 KAR 7:501 Section 5 (3) (d) states “A licensed agency shall not be disciplined for responding to calls outside of its geographic service area if the agency is providing (d) Interfacility medical transfer to residents of its service area, who are patients in facilities

• utside of its service area, for the purpose of returning the patients to their home service area
• r transporting them to another health facility.” 202 KAR 7:555 Section 3 (12) states “An

agency shall not respond to requests for emergency service outside of its licensed geographic service area without first receiving authorization from the licensed agency in the geographic service area in which the request originates.” Please clarify. A - Interfacility transfers to return a resident of your service area to a destination in your service area is allowable without authorization from an agency in that service area. Emergent transports, including emergency interfacility transports, are time sensitive and would fall upon the agency with the service area of the facility. If that agency is unable to make that EMERGENT transport within 10 minutes they are required to contact the next closest appropriate agency.

GROUND REGULATION FAQ

Q - Is a CON required to apply for a Class VI license? A - Yes, a CON is required for all levels of licensure with

• KBEMS. Any questions regarding this process may be answered

by contacting the Cabinet for Health and Family Services.

GROUND REGULATION FAQ

Q - Is the Non-licensed BLS First Response Agency required to have a separate agreement with a Medical Director, or can the Medical Direction be covered by the Class I Agency’s Medical Director via the Mutual Aid agreement? If covered by the Class I Agency’s Medical Director, does the Class I Agency’s Medical Director Agreement need to reflect that the Class I Agency’s Medical Director is acting as Medical Director for any Non-Licensed BLS First Response Agencies with a MOU with the Class I Agency? If the Class I Agency’s Medical Director is providing Medical Direction, are they also required to provide QA/QC of the Non-licensed BLS First Response Agencies? A - These items were intentionally left ambiguous to allow the local Class I agency to define these items. You are required to address the items listed below, per the Ground Agency Regulations, but how they are addressed is determined at the local level. The simple answer is that it is up to the Class I Agency to define each of the items required within their agreement with the BLS First Response Agency.

GROUND REGULATION FAQ

Q - What BLS protocols should be used if a Non-licensed BLS First Response Agency does not have an MOU with a Class I Agency? If using State Protocols, can the Non-licensed BLS First Response Agency restrict the scope of practice (or restrict the BLS protocol) for BLS Responders of that agency (I.E. – Not Authorize the administration of Albuterol or Epinephrine)? If a Non-licensed BLS First Response Agency has a MOU with a Class I Agency, are the Class I Agency’s BLS protocols followed if the Class I Agency is not using State Protocols? Can either the Non-Licensed BLS First Response Agency or the Class I Agency restrict the scope of practice (or restrict the BLS protocol) for BLS responders of the Non-licensed BLS First Response Agency? Would BLS protocols that limit the scope

• f practice of BLS Responders for a Non-licensed BLS First Response Agency need to be submitted to

KBEMS for approval by the State Medical Director? If the Non-Licensed BLS First Response Agency has EMRs (Emergency Medical Responders), what protocols do they follow since State Protocols do not address EMRs? If we develop protocols for EMRs, do they have to be submitted to KBEMS for approval? A - Any protocols that are developed, including protocols for BLS First Response agencies under an agreement with a Class I agency, would require approval by the KBEMS Medical Advisor and should be submitted via the Medical Protocol app in KEMSIS. As stated previously, these items are allowed to be defined at the local level and should be specifically addressed within the agreement between the Class I agency and the BLS First Response Agency.

GROUND REGULATION FAQ

Q - What issues must be addressed under Response Protocols (Only certified personnel will respond; HIPPA Compliance; Photo/Social Media Concerns; Other Issues)? If a Non-Licensed BLS First Response Agency is allowing non-certified personnel to respond to medical emergencies, is the Class I Agency (with or without an MOU) required to notify KBEMS? Is there a minimum equipment requirement for Non-licensed BLS First Response Agencies either with or without a MOU with a Class I Agency? A - As stated previously, these items should be addressed locally within the contents of the agreement between the Class I agency and BLS First Response agency. You, the Class I agency, have the ability to address any concerns you have in your agency agreement(s).

GROUND REGULATION FAQ

Q - We would establish Geographic Service Area as the BLS First Response Agency’s Fire Protection District. Are there any restrictions to allowing response to other areas of the Class I Agency’s Geographic Service Area at the Class I Agency’s request? A - These items would need to be addressed in mutual aid agreements between the Class I agency and the BLS First Response Agency.

GROUND REGULATION FAQ

Q - If a Non-Licensed BLS First Response Agency does not have a MOU with a Class I Agency, what training & documentation are required above current certification? A - There are no requirements for documentation from a non-licensed BLS First Response Agency who is unable to secure an agreement with a local Class I agency.

GROUND REGULATION FAQ

Q - If a Non-Licensed BLS First Response Agency has a MOU with a Class I Agency, is the Class I Agency required to provide or verify training/certification of the Non-Licensed BLS First Response Agency’s BLS providers or is a requirement in a MOU requiring the Non-Licensed BLS First Response Agency to verify training/certification sufficient? A - These items will not be checked during the inspection process, but training/cert requirements that are addressed in the agreement should be retained by the BLS First Response Agency. While not required, I would recommend that “records retention” be addressed during the agreement as well.

GROUND REGULATION FAQ

Q - What does the Quality Assurance Process need to address and what are the responsibilities of each agency and the Medical Director? A - I believe this to be in reference to the agreement between Class I and BLS First Response Agencies. As stated previously, these items should be addressed locally within the contents of the agreement between the Class I agency and BLS First Response agency.

GROUND REGULATION FAQ

Q - Are Non-Licensed BLS First Response Agencies required to have the same liability limits as a licensed agency? Are Class I agencies required to verify liability insurance of Non-licensed BLS First Response Agencies if a MOU is in place? If liability for Non- licensed BLS First Response Agency providers is addressed in the MOU, and liability is assigned to the Non-licensed BLS First Response Agency exclusively for their providers actions, is this acceptable to KBEMS? A - Locally addressed within the agreement.

GROUND REGULATION FAQ

Q - If a Non-Licensed BLS First Response Agency is unable to obtain a MOU with a Class I Agency, what additional documentation is required of the Non-Licensed BLS First Response Agency (I.E. The requirements of the MOU if it were in place)? Who is responsible for enforcement/verification of the requirements? Can KBEMS certified/licensed providers by individually disciplined for affiliation and/or response for a Non-Licensed BLS First Response Agency that is not in compliance with KBEMS regulations? A - The only documentation required is verification of the denial from at least one local Class I agency. If no agreement exists then KBEMS will not hold the Class I agency responsible for the actions of an individual outside of their

• rganization.

Q - Please define appropriate securing device (Webbing, Velcro, Bungee Cords, etc.). Is there a minimum amount of force that must be accounted for in restraining items? Does this regulation apply to ambulances with

• pen shelves instead of cabinets (does an older ambulance with open

shelves have to be retrofitted to meet the regulation)? If using webbing to secure items, is there a maximum opening size between the webbing straps? A - As noted previously, a securing device should be a commercially manufactured mounting device designed for the purpose of securing that item (monitor, suction device, etc), or a securing device permanently mounted to the vehicle (including seat belts). All ambulances that are permitted by KBEMS will be required to meet this regulation.

GROUND REGULATION FAQ

GROUND REGULATION FAQ

Q - It states that we must have a minimum of 2 complete sets suitable for adult and pediatric populations. Does this mean 1 each size will suffice or do we need 2 each size for a total of 4? A - You will be required to have 2 sets of each (ped & adult) for a total of 4.