Advanced Life Support - Arizona Department Of Health Services PDF Free Download

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The Department of Health Services, Bureau of Emergency Medical Services and Trauma System (The Department) isreceiving regular inquiries related to the rules and regulations for organizations employing EMCTs who deliver IVhydration therapy (also known as infusion therapy). This document is provided as a guide for organizations andemergency medical care technicians (“EMCT”) wishing to provide this service in a manner that does not contradictArizona law.On the next few pages, the Bureau has provided copies of pertinent statute and rules governing EMCTs which relate onlyto the role and responsibility of EMS related personnel, practices and medications in Arizona. Other Arizona statutes andrules likely apply, and it is the responsibility of the organization and its staff to ensure compliance with all pertinent laws.A.R.S. § 36-2201(3) defines "Advanced life support" as the level of assessment and care identified in the scope ofpractice approved by the director for the advanced emergency medical technician, emergency medical technician I-99 andparamedic. The EMCT may only provide ALS services under the delegated authority of the organization’seligible Administrative Medical Director as prescribed in Arizona Administrative Code(“A.A.C.”) R9-25-201(A)(1); and While working, the EMCT must be able to immediately contact an eligible On-line MedicalDirector; as prescribed in A.A.C. R9-25-202(A) and A.A.C. R9-25-502(A)(2)(b); and The EMCT may only administer medications approved by the organizations AdministrativeMedical Director as prescribed in A.A.C. R9-25-502(A)(4) and from the table of approvedEMS medications outlined in Table 5.2 of the Arizona Administrative Code; and The EMCT may only perform a skill approved by the organization‘s Administrative MedicalDirector as prescribed in A.A.C. R9-25-502(A)(2)(a) and the approved scope of practice skilltable outlined in Table 5.1 of the Arizona Administrative Code; and The EMCT must record each administration of a chemical or biological substance that isadministered to a patient to treat or prevent a medical condition (“Agent”) on a prehospitalincident history report as prescribed in A.A.C. R9-25-201(F)(2)(b)(vii).An EMCT that is not meeting the standards listed above is operating outside of law. The EMCT, his or herAdministrative Medical Director, and the organization may be investigated. If during the course of the investigation theallegations are substantiated, the EMCT may be sanctioned, up to and including probation, civil penalties, and loss of statecertification.Thank you for the opportunity to provide education and guidance on the statutory and regulatory implications forEmergency Medical Care Technician’s (“EMCT”) and EMS provider organizations. If you have any questions or if youare unsure whether any EMCT is operating in a fashion contrary to law, please feel free to contact Hugh Fox,Enforcement Manager, at 602-364-3181 or hugh.fox@azdhs.gov for further assistance.Douglas A. Ducey GovernorCara M. Christ, MD, MS DirectorBureau of Emergency Medical Services and Trauma System150 North 18th Avenue, Suite 540, Phoenix, AZ 85007-3248 P 602-364-3150 F 602-364-3568Health and Wellness for all ArizonansW azhealth.gov

R9-25-202. On-line Medical Direction (Authorized by A.R.S. §§ 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:I.Ensure that a physician provides on-line medical direction to EMCTs on behalf of theemergency medical services provider or ambulance service only if the physician meets oneof the following:a.Has emergency medicine certification issued by a member board of the AmericanBoard of Medical Specialties;50

b.Has emergency medical services certification issued by the American Board ofEmergency Medicine;c.Has completed an emergency medicine residency training program accredited by theAccreditation Council for Graduate Medical Education or approved by the AmericanOsteopathic Association; ord.Is an emergency medicine physician in an emergency department located in Arizonaand has current certification that meets the requirements in R9-25-201(A)(l)(d)(i)through (iii);2.For each physician providing on-line medical direction on behalf of the emergency medicalservices provider or ambulance service, maintain for Depmiment review either:a.The name, e-mail address, telephone number, and qualifications of the physicianproviding on-line medical direction on behalf of the emergency medical servicesprovider or ambulance service; orb.If the emergency medical services provider or ambulance service provides on-linemedical direction through an ALS base hospital or a centralized medical directioncommunications center, a copy of a written agreement with the ALS base hospital orcentralized medical direction communications center documenting that the physicianproviding on-line medical direction is qualified under subsection (A)(l);3.Ensure that the on-line medical direction provided to an EMCT on behalf of the emergencymedical services provider or ambulance service is consistent with:a.The EMCT's scope of practice, as specified in Table 5.1; andb.Communication protocols, triage protocols, treatment protocols, and protocols forprehospital incident history rep011s, specified in R9-25-201(E)(2); and4.Ensures that a physician providing on-line medical direction on behalf of the emergencymedical services provider or ambulance service relays on-line medical direction onlythrough one of the following individuals, under the supervision of the physician andconsistent with the individual's scope of practice:B.a.Another physician,b.A physician assistant,c.A registered nurse practitioner,d.A registered nurse,e.A Paramedic, orf.An EMT-1(99).An emergency medical services provider or ambulance service may provide on-line medicaldirection through an ALS base hospital that is a special hospital, if the emergency medical servicesprovider or ambulance service:51

,(',('Obstruction - direct laryngoscopyObstruction - manual,(',(',(',('Oxygen therapy - humidifiers,(',(',(',('Oxygen therapy - nasal cannula,(',(',(',('Oxygen therapy - non-rebreather mask,(',(',(',('Oxygen therapy - partial rebreather mask,(',(',(',('Oxygen therapy - simple face mask,(',(',(',('Oxygen therapy - venturi mask,(',(',(',(',(',('PEEP - therapeuticPulse oximetry,(',(',(',('Suctioning - upper airway,(' *,(',(',(',('AEMTEMT-I (99)ParamedicCardiac monitoring - multiple lead (interpretive),(',('Cardiac monitoring - single lead (interpretive),(',('Suctioning - ac - multiple lead acquisition (non-interpretive)Cardiopulmonary TR,(',(',('v'Cardioversion - electricalCarotid massage - (:517 years)Defibrillation - automatic/semi-automatic,(',('Defibrillation - manualHemorrhage control - direct pressme,(',(',('v'Hemorrhage control - tourniquet,(',(',(',(',(',('STRSTR,('v'Internal; cardiac pacing - monitoring onlySTRMechanical CPR deviceSTRTranscutaneous pacing - manualEMTAEMTEMT-I (99)ParamedicSpinal immobilization - cervical collar,(',(',(',('Spinal immobilization - long board,(',(',(',('Spinal immobilization - manual,(',(',('v'Spinal immobilization - seated patient (KED, etc.),(',(',(',('Spinal immobilization - rapid manual extrication,(',(',(',('Extremity stabilization - manual,(',(',(',('Extremity splinting,(',(',(',('Splint- traction,(',(',('v'Mechanical patient restraint,(',(',(',('Emergency moves for endangered patients,(',(',(',('ImmobilizationRevised 4-19-1788

Has emergency medical services certification issued by the American Board of Emergency Medicine; c. 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 d. Is an emergency medicine physician in an emergency .