6 Colo. Code Regs. § 1015-3-2-19

Current through Register Vol. 47, No. 11, June 10, 2024

Section 6 CCR 1015-3-2-19 - Clinical Setting

19.1 Any licensed or certified EMT, AEMT, EMT-I, or Paramedic may perform the medical acts within their applicable scope, as set forth in Appendices A, B, C, D, E, F, and G in a clinical setting pursuant to orders or instructions from, and under the medical supervision of, a medical supervisor.

19.1.2 An EMT-IV may perform the medical acts within the EMT-IV scope of practice in a clinical setting if authorized by a clinical medical director consistent with Section 6.6 and pursuant to orders or instructions from, and under the medical supervision of, a medical supervisor.

19.1.3 A Paramedic with a Critical Care endorsement may perform the medical acts within the P-CC scope, as set forth in Appendices E and F, in a clinical setting pursuant to orders or instructions from, and under the medical supervision of, a medical supervisor.

19.1.4 A Paramedic with a Community Paramedic endorsement may perform the medical acts within the P-CP scope, as set forth in Appendix G, in a clinical setting pursuant to orders or instructions from, and under the medical supervision of, a medical supervisor.

19.1.5 Nothing in these rules alters the authority of a physician or registered nurse to delegate acts to an EMS provider that are outside of the EMS provider's applicable scope of practice in the clinical setting, pursuant to Sections 12-240-107 and 12-255-131, C.R.S.. Such delegation shall be in conformance with the applicable rules of the Colorado Medical Board and the Colorado Nursing Board.

19.2 A licensed or certified health care facility that employs EMS providers to perform in-scope tasks and procedures in a clinical setting shall:

19.2.1 Collaborate with its clinical medical director, medical supervisors, and EMS providers to establish policies and procedures ensuring that EMS providers are limited to performing medical acts within their scopes of practice.

19.2.2 Require its clinical medical director to:

(i) Determine and document each EMS provider's scope of practice in the clinical setting; and

(ii) Communicate the authorized medical acts that each individual EMS provider may perform under medical supervision to the facility's medical supervisors.

19.3 Clinical medical directors are responsible for the medical direction of EMS providers in the clinical setting. Their duties shall include:

19.3.1 Being aware of and familiar with the medical acts that all EMS provider types may be authorized to perform in a clinical setting pursuant to the scope of practice put forth in these rules in Appendices A, B, C, D, E, F, and G, as applicable.

19.3.2 Collaborating with the medical supervisor(s) and EMS providers to establish policies and procedures ensuring that EMS providers only perform medical acts that are within the applicable EMS provider's scope of practice.

19.3.3 Ensuring that each EMS provider working in the clinical setting is limited to performing medical acts that are within the applicable scope of practice and are performed competently under medical supervision. This shall include, but not be limited to, determining those medical acts that each EMS provider may perform under medical supervision and communicating to the medical supervisor(s) the authorized medical acts that each individual EMS provider may perform.

19.3.4 Ensuring that all clinical protocols issued by the clinical medical director are appropriate for the certification or license and skill level of each EMS provider to whom the performance of medical acts is authorized and compliant with accepted standards of medical practice. Ensure that a system is in place for timely access to communication of verbal orders.

19.3.5 Being actively and routinely involved with the EMS providers providing care in the clinical setting. Involvement does not require that a physician have such experience prior to becoming a clinical medical director, but it does require such involvement during the time that the physician acts as a medical director. Involvement could include, by way of example and not limitation, involvement in continuing education, audits, and protocol development. Passive or negligible involvement with the EMS providers does not meet this requirement.

19.3.6 Being actively involved in the facility's medical continuous quality improvement (CQI) program for EMS providers. The medical CQI program shall assure the continuing competency of the performance of the EMS providers. This medical CQI program shall include, but not be limited to: appropriate protocols and standing orders applicable to the EMS providers' scopes of practice, provision for medical care audits, observation, critiques, continuing medical education, and supervisory communications.

19.3.7 Providing oversight, direction, and medical management of the medical performance of EMS providers in the clinical setting. This includes ensuring that EMS providers have adequate clinical knowledge of and are competent in performing medical acts within the EMS provider's scope of practice authorized by the clinical medical director. These duties and operations may be delegated to other physicians or other qualified health care professionals designated by the clinical medical director. However, the clinical medical director shall retain ultimate authority and responsibility for the oversight, direction, and medical management of the medical performance of EMS providers in the clinical setting, for establishing protocols and standing orders, and for the competency of the performance of authorized medical acts.

19.3.8 Being familiar with the training, knowledge, and competence of EMS providers subject to their oversight and ensuring that EMS providers are appropriately trained and demonstrate ongoing competency in all medical acts authorized to be performed under medical supervision.

19.3.9 Being aware that certain skills, procedures, and medications contained within Appendices A, B, C, D, E, F, and G may not be included in the National EMS Education Standards and ensuring that appropriate additional training is provided to EMS providers, if necessary, for the performance of an authorized skill or act.

19.3.10 Physicians acting as clinical medical directors responsible for the oversight and authorization of a P-CC shall have training and experience in the acts and skills for which they are providing oversight and authorization. Additional duties related to clinical medical directors responsible for the oversight and authorization of a P-CC are set forth in Section 17 of these rules.

19.3.11 Physicians acting as clinical medical directors responsible for the oversight and authorization of a P-CP shall have training and experience in the acts and skills for which they are providing oversight and authorization. Additional duties related to clinical medical directors responsible for the oversight and authorization of a P-CP are set forth in Section 18 of these rules.

19.4 Medical supervision of the EMS provider in a clinical setting must be provided by a medical supervisor who is:

19.4.1 A Colorado licensed physician, physician assistant, advanced practice nurse, or registered nurse licensed in good standing,

19.4.2 Trained and experienced in the acts and skills for which supervision is being provided,

19.4.3 Knowledgeable about the maximum skills, acts, or medications that an EMT, EMT-IV, AEMT, EMT-I, Paramedic, P-CC, and P-CP are authorized to perform pursuant to these rules, and

19.4.4 Immediately available and physically present at the clinical setting where the care is being delivered to provide oversight, guidance, or instruction to the EMS provider during the performance of medical acts.

6 CCR 1015-3-2-19

37 CR 12, June 25, 2014, effective 5/21/2014

37 CR 12, June 25, 2014, effective 7/15/2014

37 CR 22, November 25, 2014, effective 12/15/2014

38 CR 24, December 25, 2015, effective 1/14/2016

40 CR 10, May 25, 2017, effective 7/1/2017

40 CR 20, October 25, 2017, effective 1/1/2018

40 CR 21, November 10, 2017, effective 1/1/2018

41 CR 23, December 10, 2018, effective 1/14/2019

43 CR 22, November 25, 2020, effective 1/1/2021

44 CR 23, December 10, 2021, effective 12/30/2021

45 CR 10, May 25, 2022, effective 6/14/2022