16 Del. Admin. Code § 4302-5.0
Current through Register Vol. 28, No. 7, January 1, 2025
Section 4302-5.0 - Staffing5.1 Air Medical Personnel Classifications The aircraft, by virtue of medical staffing and retrofitting of medical equipment, becomes a patient care unit specific to the needs of the patient. Staffing shall be commensurate with the mission statement and scope of care of the air medical service.
5.1.1 Administrative Air Medical Staff 5.1.1.1 Medical Director The Medical Director of the program is a physician who is responsible for supervising and evaluating the quality of medical care provided by the air medical personnel.
5.1.1.1.1 Credentials/Experience 5.1.1.1.1.1 The Medical Director shall be licensed and authorized to practice medicine in the state in which the air medical service is based unless the flight program is providing primary 911 or 'point to point' transfer services in the State of Delaware. If either of these services is provided, the physician must be licensed in Delaware. The medical director must have educational and clinical experiences in Emergency Medicine as well as other areas of medicine that are commensurate with the mission statement of the air medical service (e.g., adult trauma, pediatrics, neonatal transport, etc.). When specific missions fall outside the scope of expertise of the medical director, specialty care physicians must serve as consultants.5.1.1.1.1.2 The medical director shall be experienced in both air and ground emergency medical services (as appropriate to the mission statement) and be familiar with the general concepts of appropriate utilization of air medical services.5.1.1.1.1.3 Additionally, the medical director shall have the following educational experiences as appropriate to the mission statement and scope of care of the air medical service:5.1.1.1.1.4 The Medical Director shall also have education in the following areas: 5.1.1.1.1.4.1 Specialty education consistent with the mission statement of the air medical service (e.g., Neonatal Resuscitation Certification Program, Pediatric Advanced Life Support, etc. or equivalent education in these areas). Alternately, the medical directors must have immediate access to specialty physicians as consultants.5.1.1.1.1.4.2 In-flight patient care capabilities and limitations (e.g., assessment and invasive procedures).5.1.1.1.1.4.3 Infection control as it relates to prehospital, aircraft and hospital environment.5.1.1.1.1.4.4 Stress recognition and management.5.1.1.1.1.4.5 Altitude physiology/stressors of flight.5.1.1.1.2 General Areas of Responsibility 5.1.1.1.2.1 The medical director must be actively involved in the quality assurance/continuous quality improvement (QA/CQI) program for the service.5.1.1.1.2.2 The medical director must be involved in administrative decisions affecting medical care for the service.5.1.1.1.2.3 The medical director must be involved in training and continuing education of all air medical personnel for the service.5.1.1.1.2.4 The medical director must be actively involved in the care of critically ill and/or injured patients.5.1.1.1.2.5 The medical director must be actively involved in orienting physicians providing on line (in-flight) medical direction to the policies, procedures and patient care protocols of the air medical service.5.1.1.1.2.6 When applicable, the medical director or his designee sets cabin air pressure altitude limits, for specific disease processes of the patient(s) (through policies and procedures) and maximum altitudes, for specific disease processes of the patient(s) for rotor wing transports.5.1.1.2 Clinical Care Supervisor The responsibility for supervision of patient care provided by the various clinical care providers (e.g., EMT-B, EMT-P, RN, etc.) will be the responsibility of the medical director, unless the responsibilities are assigned to another professional (flight nurse, flight physician, or flight paramedic) who possesses the knowledge, experience and is legally qualified to provide clinical supervision.
5.1.1.2.1 Credentials/Experience The clinical care supervisor must possess the following qualifications:
5.1.1.2.1.1 If the clinical care supervisor is a Physician: 5.1.1.2.1.1.1 ABEM, or ABOEM certified or currency in CPR, ACLS, and Advanced Trauma Life Support (ATLS).5.1.1.2.1.2 If the clinical care supervisor is a Registered Nurse: 5.1.1.2.1.2.1 Currency in CPR, ACLS and the Flight Nurse Advanced Trauma Course (FNATC). 5.1.1.2.1.2.1.1 ATLS may be audited in lieu of FNATC.5.1.1.2.1.3 If the clinical care supervisor is a Paramedic: 5.1.1.2.1.3.1 Currency in CPR, ACLS, and PHTLS or BTLS (Advanced).5.1.1.2.1.4 General Requirements regardless of provider level: 5.1.1.2.1.4.1 Current specialty education consistent with the mission statement of the air medical service (i.e., Neonatal Resuscitation Certification Program, Pediatric Advanced Life Support, etc.). Alternatively, the clinical care supervisor must have immediate access to specialty personnel as consultants.5.1.1.2.1.4.2 In-flight patient care limitations, e.g., assessment and invasive procedures.5.1.1.2.1.4.3 Infection control.5.1.1.2.1.4.4 Stress recognition and management.5.1.1.2.1.4.5 Altitude physiology/stressors of flight.5.1.1.2.1.4.6 Appropriate utilization of air medical services.5.1.1.2.1.4.7 Delaware Emergency Medical Services system.5.1.1.2.1.4.8 Hazardous materials scene recognition and response (helicopter services).5.1.1.2.2 General Areas of Responsibility 5.1.1.2.2.1 Active involvement in the flight program's QA/ CQI process.5.1.1.2.2.2 Active involvement in all administrative decisions affecting patient care for the service.5.1.1.2.2.3 Active involvement in hiring, training, and continuing education of all non-physician air medical personnel for the service.5.1.1.2.2.4 Active involvement in the care of the critically ill and/or injured patients.5.1.1.2.2.5 Ensuring adequate mechanisms are in place for evaluating the clinical practice of the patient care providers.5.1.2 Direct Care Providers 5.1.2.1 General 5.1.2.1.1 The type of medical care providers staffing each mission shall be directly related to the mission type: advanced life support, specialty care or basic life support.5.1.2.1.2 All medical care providers must have current appropriate state licensure or certification which legally allows them to function in their respective professions. 5.1.2.1.2.1 Delaware based programs and out of state programs providing prehospital 911 service must be staffed with Delaware licensed RN's and Delaware-certified paramedics.5.1.2.1.2.2 Out of state programs providing 'point to point' services must be staffed with Delaware licensed RN's. Paramedics must be certified in their state of origin.5.1.2.1.2.3 Out of state programs providing 'one way' or mutual aid services must be staffed with providers licensed or certified to practice by their state of origin.5.1.2.1.3 Initial and continuing education requirements for all levels of medical care providers are specified in Appendix A.5.1.2.1.4 Interhospital/Interfacility Transports 5.1.2.1.4.1 A minimum of two (2) air medical team members are required to staff interhospital/ interfacility ALS missions. One of the air medical ALS providers must be a member of the regular ALS staff of the air medical ambulance service.5.1.2.1.4.2 All air medical team members must be licensed, certified, or permitted according to the appropriate state regulations with current re-licensing, recertification, or re-permitting status.5.1.2.1.4.3 A qualified flight physician or flight RN must be designated as the primary care provider during interfacility or interhospital transports.5.1.2.1.4.4 A flight paramedic or an approved flight specialty care provider may serve as the second ALS air medical team during an interfacility or interhospital ALS mission. 5.1.2.1.4.4.1 The specialty care provider must have expertise relative to the needs of the patient.5.1.2.1.4.4.2 Point to point interfacility transfers within Delaware must utilize the Delaware receiving facility for Online Medical Control.5.1.2.1.4.4.3 In lieu of compliance with paragraph (ii) of this section, this, all physicians providing centralized Medical Control must be Delaware licensed and a status update must be provided to the receiving facility prior to arrival of the patient.5.1.2.1.4.4.4 The paramedic on such missions must be certified and function according to their standard treatment protocols.5.1.2.1.4.5 One ALS air medical care provider may be considered sufficient staff for ALS missions, where the patient has been categorized and documented as being stable, by the sending physician, and requires 'limited ALS care'. 5.1.2.1.4.5.1 'Limited ALS care' shall mean patient assessment, monitoring and interventions common to, and within the scope of practice of the paramedic. Patients may require cardiac monitoring and/or intravenous therapy (without medication additives).5.1.2.1.4.5.2 A flight paramedic or RN may serve as the single care provider for the transport of stable ALS patients who meet the criteria as established by the operation or agency medical director.5.1.2.1.5 Prehospital Scene Responses 5.1.2.1.5.1 Except as provided below, the Delaware State Police (DSP) paramedic service is the primary air medical service authorized to engage in prehospital scene responses and transports in the State of Delaware.5.1.2.1.5.2 A flight paramedic must be a crew member on all prehospital missions. 5.1.2.1.5.2.1 The Aeromedical crew assumes patient care responsibility at the time the patient is secured on the aircraft.5.1.2.1.5.3 Non-scheduled personnel may be added as the second medical team member according to the protocols of the air medical services as long as an orientation has been conducted which includes in-flight treatment protocols, general aircraft safety, emergency procedures, operational policies, and infection control.5.1.2.1.5.4 Air medical ambulance services, other than DSP, may engage in prehospital scene responses and transports under certain unusual conditions that will be defined in a service agreement with the Division and DSP to perform prehospital scene responses and transports, an air medical ambulance service must have previously entered into a service agreement with the Division and the Delaware State Police.5.1.2.1.5.5 All requests for air medical services, other than the DSP, must be initiated by the emergency communications center responsible for managing or coordinating Emergency Medical Services resources in the county where the need for assistance exists.5.1.2.1.5.6 All patient care services provided by the air medical ambulance crew during a prehospital scene response shall be documented using the Delaware Emergency Data Information Network (EDIN). Data provided will be used for descriptive and quality management purposes, including air service utilization review. 5.1.2.1.5.6.1 This shall be provided in addition to any documentation that the service generates internally.5.1.2.1.5.6.2 The EDIN system is a secure Internet based data management system. 5.1.2.1.5.6.2.1 Access to an Internet connection is necessary to provide the documentation required by these regulations.5.1.2.2 Advanced Life Support (ALS) Mission Providers An Advanced Life Support (ALS) mission is defined as the transport of a patient who receives care during a prehospital or interfacility/ interhospital transport that is commensurate with the scope of practice of a flight physician, flight nurse or flight paramedic.]
5.1.2.3 Specialty Care Mission Providers 5.1.2.3.1 A specialty care mission is defined as the transport of a patient requiring special patient care by one or more professionals who must be added to the regularly scheduled air medical team. Dedicated teams providing specialty-oriented care (e.g., neonatal transport teams, IABP transport teams) must follow the specific mission standards.5.1.2.3.2 The air medical team must minimally consist of a specially trained physician or registered nurse as the primary caregiver whose expertise must be consistent with the needs of the patient.5.1.2.3.3 Specialty care missions require at least two air medical team members while a patient(s) is on board. Personnel shall be available for each transport within a reasonable time determined by the service.5.1.2.3.4 All specialty team members must have received a basic minimum orientation to the air medical service which includes in-flight treatment protocols, general aircraft safety and emergency procedures, operational policies and infection control.5.1.2.3.5 Specialty care mission personnel must be accompanied by at least one regularly scheduled air medical staff member, of the air medical service, except when independent, dedicated flight specialty teams are used.5.1.2.3.6 Specialty care personnel must be educated in in-flight treatment modalities, altitude physiology, general aircraft safety, and emergency procedures.5.1.2.4 Basic Life Support Mission Providers A Basic Life Support (BLS) mission is generally defined as the transport of a patient who receives care during an interfacility/interhospital transport that is commensurate with the scope of practice of an Emergency Medical Technician-Basic (EMT-B). In the State of Delaware, when such care is provided in the air medical environment, it must be assumed, at a minimum, by a flight Emergency Medical Technician-Paramedic (EMT-P).
5.2 Pilot Personnel 5.2.1 There shall be a sufficient number of pilots permanently assigned to the air medical service to provide services approved by the Division of Public Health, and which assures adequate crew rest as per FAA regulations.5.2.2 All pilots must possess a commercial rotorcraft-helicopter airman's certificate.5.2.3 Pilot in Command (PIC) must possess 2000 rotorcraft flight hours as PIC prior to assignment with an air medical service or be currently employed by the Delaware State Police (DSP) and have completed a DSP pilot training program.5.2.4 A planned structure program must be provided for relief pilots, which at a minimum includes specific roles and responsibilities, and familiarization with the region served.5.2.5 A lead pilot and designated safety officer must be appointed by the FAR 135 certificate holder to insure adherence to operational safety regulations for the program. Adequate training and experience in air medical missions management and evaluation skills must be possessed to carry out these duties.5.2.6 The pilot has the right to decline or abort any portion of a mission if there is doubt as to the safety of the mission.5.2.7 The pilot shall meet education and experience requirements as listed in Appendix A. 5.2.7.1 Pilots employed by DSP must comply with the requirements set by that agency.5.3 General Staff Policies - Operational policies must be present to address the following areas: 5.3.1 Medical Flight Personnel 5.3.1.1 Minimize duty-related fatigue5.3.1.2 Hearing protection5.3.1.3 Crash survivability 5.3.1.3.1 Flame retardant clothing5.3.1.3.2 Seat belts/shoulder harnesses5.3.1.3.3 Head-strike protection5.3.1.3.4 Securement of on-board and carry-on medical equipment5.3.1.4 Protective clothing and dress codes relative to: 5.3.1.4.2 Infection control5.3.1.5 Universal infection control5.3.1.6 Flight status during pregnancy5.3.1.7 Flight status during acute illnesses (especially respiratory ailments)5.3.1.8 Flight status while taking medications that may cause dizziness5.3.1.9 Weight/height and/or lifting abilities if appropriate5.3.2 Pilot Personnel 5.3.2.1 Minimize duty-related fatigue5.3.2.2 A policy of the certificate holder that specifies higher weather minimums for new pilots for a time frame based on the pilot's experience, flight time, local environment and personal adaptation. An evaluation tool applied individually to each new pilot by the flight program shall define the time frame.16 Del. Admin. Code § 4302-5.0
4 DE Reg. 1827 (5/1/01)
5 DE Reg. 1727 (3/1/02)