6 Colo. Code Regs. § 1011-4, pt. 8

Current through Register Vol. 47, No. 17, September 10, 2024

Part 8 - CLINICAL, MEDICAL, AND OPERATING STANDARDS AND PROCEDURES

8.1 Parameters for Secure Transportation. Secure transport clients shall only be transported under the following circumstances:

(A) The client is experiencing a behavioral health crisis.

(B) The client is in need of urgent transportation to a facility that is defined at Part 2.22(C).

(C) The client does not and will not need either:

(1) Medical treatment during transport, or

(2) Active or ongoing medical monitoring.

(D) The client does not and will not need to be chemically restrained during secure transport as a behavioral intervention.

8.2 Policies and Procedures

(A) The county shall ensure that all secure transportation services have policies and procedures that follow national best practice guidelines where available, that address, at a minimum:

(1) Appropriate procedures to assess initially whether the client requires a higher level of transport than the service can provide;

(2) Appropriate procedures to follow when, during a secure transport, it becomes apparent that a client needs medical attention or a higher level of transport than the service can provide;

(3) Appropriate procedures to confirm the receiving facility's acceptance of the client prior to initiation of the secure transport;

(4) Criteria used for pickup and drop-off, including the circumstances that determine a secure transport client's eligibility as set forth in Part 8.1;

(5) The level of support and protection needed for both client and staff safety;

(6) Compliance with vehicle safety standards and procedures set forth in Part 3.3(A)(10);

(7) Proper evacuation of the vehicle during emergencies if the windows and/or exits of the vehicle are blocked or inaccessible;

(8) Infection prevention and control, including the decontamination of the vehicle after each transport;

(9) Parental and/or guardian level of support and involvement;

(10) Meeting client needs on extended transports including meals, water, and bathroom breaks;

(11) Documentation of all steps in the process from initial pickup request to drop-off, including but not limited to documenting all stops made during the secure transportation service.

(B) In addition, the county shall ensure that all Class A secure transportation services have the following policies and procedures that address, at a minimum:

(1) The circumstances under which staff who provide direct client support may apply individual physical restraint during the course of the secure transportation service, given the parameters outlined in Part 8.3, and

(2) The application of individual physical restraint, including training protocols and safety precautions, to ensure the restraints do not restrict the client's airway or breathing ability.

8.3 Restraint

(A) No chemical restraint shall be administered during a secure transport. If chemical restraint is needed to ensure client safety, then the client shall receive an ambulance transport.

(B) Physical restraint, as defined at Part 2.21 for the purposes of this chapter, shall only be utilized for health and safety purposes under the following circumstances:

(1) In cases of emergency, when the client is at risk of causing serious, probable, and imminent threat of bodily harm to themselves or to others and where there is the present ability to effect such bodily harm; and

(2) After the failure of less restrictive alternatives, including verbal de-escalation; or

(3) After a determination that such alternatives would be inappropriate or ineffective under the circumstances.

(C) If physical restraint is utilized during a transport, the service shall document the time at which the physical restraint was applied and removed (if applicable) and the type of physical restraint used.

8.4 The secure transportation service shall transport one (1) client per vehicle transport, except under the following circumstances:

(A) Each client has received behavioral health clearance from the treating provider at the sending facility, no physical restraint is needed, and there is a low probability of behavioral destabilization;

(B) Each client has received medical clearance from the treating provider at the sending facility, is medically stabilized, and has a low probability of medical destabilization;

(C) Each client has received an assessment from the treating provider at the sending facility that the client is an appropriate candidate for a transport with one or more individuals;

(D) The transport is an inter-facility transport as defined at Part 2.22(C); and

(E) Each client has given their consent to be transported with another individual(s).

8.5 The secure transportation service shall create and maintain accurate and detailed logs of client transports, including professional incident reports.

8.6 To ensure the needs of clients are met, secure transportation services that do not provide 24/7 services shall provide the client with their after-hours contact information and with contact information for the secure transportation service's back-up providers.

6 CCR 1011-4, pt. 8

45 CR 14, July 25, 2022, effective 8/14/2022