W. Va. Code R. § 64-48-9

Current through Register Vol. XLI, No. 43, October 25, 2024

Section 64-48-9 - Medical Direction

9.1. Offline Medical Direction.

9.1.1. State Medical Director. -- The State Medical Director must be a physician appointed by the Commissioner to be in charge of overseeing the medical aspects of the West Virginia emergency medical services system.

9.1.1.a. The State Medical Director must have:

9.1.1.a.1. A valid, unrestricted license to practice medicine in the state of West Virginia;

9.1.1.a.2. Experience in emergency management of acutely ill or injured patients;

9.1.1.a.3. Experience in online medical direction of emergency medical services personnel;

9.1.1.a.4. Experience in the education of emergency medical services personnel;

9.1.1.a.5. Experience in the medical audit, review, and critique of emergency medical services personnel and agencies;

9.1.1.a.6. Board certification in emergency medicine; and

9.1.1.a.7. Experience in medical administration and management.

9.1.1.b. The State Medical Director shall:

9.1.1.b.1. Act as the primary medical authority on all medical issues pertaining to the statewide EMS system;

9.1.1.b.2. Chair the Medical Policy and Care Committee (MPCC);

9.1.1.b.3. Review and recommend to the Commissioner the appointment of all regional EMS Medical Directors;

9.1.1.b.4. Establish and review all system-wide medical protocols and policies in consultation with the state Emergency Medical Policy and Care Committee;

9.1.1.b.5. Designate all regional medical command centers;

9.1.1.b.6. Consult with the Commissioner, as requested, concerning revocations of emergency medical services personnel certification;

9.1.1.b.7. Assist OEMS in establishing certification, recertification, and continuing education requirements for EMS personnel;

9.1.1.b.8. Review and recommend the designation of specialty care centers to the Commissioner;

9.1.1.b.9. Maintain liaison with the members of the Legislature on medical issues related to EMS;

9.1.1.b.10. Review state procedures, plans, and processes for compliance with current standards of emergency medical care;

9.1.1.b.11. Appoint physician specialists and other appropriate medical personnel to the MPCC;

9.1.1.b.12. Delegate portions of his or her authority to other qualified physicians; and

9.1.1.b.13. Perform other duties assigned by the Commissioner.

9.1.1.c. The State Medical Director has the following authority:

9.1.1.c.1. To make the final decision on all matters of a medical nature related to OEMS;

9.1.1.c.2. To restrict privileges of emergency medical services personnel at any time in order to assure quality patient care;

9.1.1.c.3. To establish medical policies and procedures to carry out the activities outlined in this rule; and

9.1.1.c.4. Any other authority designated by the Commissioner.

9.1.2. Medical Policy and Care Committee (MPCC). -- The MPCC is composed of each regional medical director and may include physicians representing specialty areas such as pediatrics, trauma, cardiology and others as necessary. The committee serves as the primary policy making body and advisory body to the State Medical Director concerning medical issues involving the emergency medical services system. The committee shall meet at least annually, or more frequently as necessary.

9.1.2.a. The MPCC shall:

9.1.2.a.1. Create, review, and approve treatment, triage, and transportation protocols used within the state EMS system;

9.1.2.a.2. Determine medications, equipment, and procedures used within OEMS;

9.1.2.a.3. Establish scopes of practice for all certified emergency medical services personnel;

9.1.2.a.4. Act on and advise the State Medical Director on emergency health related issues;

9.1.2.a.5. Establish policies and procedures governing categorization of individual facility medical capabilities in order to determine the appropriateness of transport to that facility;

9.1.2.a.6. Implement procedures necessary to carry out its duties; and

9.1.2.a.7. Perform other duties assigned by the State Medical Director or the Commissioner.

9.1.2.b. Whenever any changes in protocol, medication and procedure, scope of practice, or policy and procedure as authorized in paragraph 9.1.2.a. are proposed, a notice of the proposal will be electronically mailed to each EMS Agency and the full text of proposed changes in protocol, medication and procedure, scope of practice, or policy and procedure, will be published on the OEMS website. Notice of the proposed changes in protocol, medication and procedure, scope of practice, or policy and procedure as authorized in paragraph 9.1.2.a., is subject to a 30-day public comment period prior to their being effective. However, the MPCC may waive the public comment period when it finds that exigent circumstances exist and that the proposed changes in protocol, medication and procedure, scope of practice, or policy and procedure must be implemented immediately to ensure patient safety.

9.1.3. Regional Medical Director. -- The regional medical director must be a physician, recommended by the regional board of directors, and appointed by the Commissioner in consultation with the State Medical Director to oversee medical aspects of a regional emergency medical services system.

9.1.3.a. The regional medical director must have:

9.1.3.a.1. A valid, unrestricted license to practice medicine in the state of West Virginia;

9.1.3.a.2. Experience in emergency management of acutely ill or injured patients;

9.1.3.a.3. Experience in online medical direction of emergency medical services personnel;

9.1.3.a.4. Experience in the education of personnel;

9.1.3.a.5. Experience in the medical audit, review, and critique of personnel and agencies; and

9.1.3.a.6. Board certification in emergency medicine. This requirement may be waived by the State Medical Director.

9.1.3.b. The Regional EMS Medical Director shall:

9.1.3.b.1. Serve as the medical liaison with the Medical Director;

9.1.3.b.2. Serve as a member of the MPCC;

9.1.3.b.3. Serve as the primary medical authority on medical issues of the regional emergency medical services system;

9.1.3.b.4. Review the appointments of all Agency Medical Directors;

9.1.3.b.5. Implement and monitor a regional performance improvement program;

9.1.3.b.6. Educate, train, and monitor the medical command physicians who operate in the regional command centers;

9.1.3.b.7. Serve as medical director of the regional medical command center;

9.1.3.b.8. Establish and review protocols in conjunction with the MPCC;

9.1.3.b.9. Serve as medical liaison to the regional EMS board of directors;

9.1.3.b.10. Assist OEMS in ensuring that personnel in the regional EMS system comply with certification, recertification, credentialing, and continuing education requirements established by OEMS;

9.1.3.b.11. Recommend to OEMS disciplinary actions involving personnel;

9.1.3.b.12. Delegate portions of his or her authority to other qualified physicians as needed, with the approval of the State Medical Director;

9.1.3.b.13. Review plans, procedures, and processes within the region for compliance with current standards of emergency care; and

9.1.3.b.14. Meet with the Agency Medical Directors within the region, at least annually, or when necessary to disseminate information regarding activities of the OEMS system.

9.1.3.c. Authority. -- The Regional EMS Medical Director may restrict privileges of any prehospital personnel within the region at any time in order to assure quality patient care. This may be accomplished in conjunction with the agency Medical Director. This restriction of privileges must be according to guidelines established by OEMS.

9.1.4. Agency Medical Director. -- The agency medical director, by written agreement with the Agency, and concurrence of the Regional EMS Medical Director and State Medical Director, oversees medical aspects of an EMS agency or local EMS system and extends or restricts the privilege to practice to personnel associated with the agency.

9.1.4.a. Qualifications. -- The Agency Medical Director must possess:

9.1.4.a.1. A valid, unrestricted license to practice medicine in the state of West Virginia;

9.1.4.a.2. Experience in prehospital and emergency department management of acutely ill or injured patients;

9.1.4.a.3. The Agency Medical Director must have the following qualifications unless they are waived by the Regional Medical Director:

9.1.4.a.3.A. Experience in online medical direction of emergency medical services personnel;

9.1.4.a.3.B. Experience in the education of emergency medical services personnel;

9.1.4.a.3.C. Experience in the medical audit, review, and critique of emergency medical services personnel and agencies; and

9.1.4.a.3.D. Board certification in emergency medicine;Provided: That this requirement may be waived by the Regional Medical Director.

9.1.4.b. Responsibilities. -- The Agency Medical Director shall:

9.1.4.b.1. Provide advice and guidance on all aspects of the medical care provided by the agency or county;

9.1.4.b.2. Be the physician on whose authority all medical care is administered by agency or county EMS personnel;

9.1.4.b.3. Grant, restrict or deny privileges for emergency medical services personnel practice within the agency or county;

9.1.4.b.4. Oversee the medical review of patient care provided by the agency or county;

9.1.4.b.5. Meet with the Regional Medical Director annually; and

9.1.4.b.6. Perform other duties assigned by the regional or Medical Directors or the Commissioner.

9.1.4.c. Authority. -- The Agency Medical Director may restrict privileges of EMS personnel affiliated with the agency or county at any time in order to assure quality patient care. This restriction of privileges must be according to guidelines established by OEMS.

9.2. Online Medical Direction.

9.2.1. Regional Medical Command Centers are centers designated by the MPCC and OEMS with advice of the respective Regional EMS Board of Directors to serve as the regional medical command center for all online medical control of EMS personnel operating in a particular region.

9.2.1.a. Requirements/Designation. -- Regional medical command centers shall:

9.2.1.a.1. Be equipped with appropriate communication equipment, as specified by OEMS, to communicate with EMS vehicles and personnel and interface with the OEMS communications system;

9.2.1.a.2. Meet all requirements listed in this rule;

9.2.1.a.3. Agree to abide by all policies and procedures contained in the state or regional communications systems plan as established by OEMS; and

9.2.1.a.4. Agree to abide by medical treatment protocols or guidelines, triage and destination protocols or guidelines, and other policies and procedures approved by the OEMS Medical Direction System.

9.2.1.b. Staffing. -- The Regional Command Center must be staffed 24-hours per day, 365-days per year by paramedic communication specialists and shall have ready access to medical command physicians at all times.

9.2.1.c. Responsibilities. -- The regional medical command facility shall:

9.2.1.c.1. Serve as the authoritative medical command center for its primary designated area, but with the possibility of an expanded coverage area in the event of a disaster or the in operability of other medical command centers;

9.2.1.c.2. Control and facilitate all communications of a medical nature for the EMS agencies and personnel operating in its region including ground and aeromedical EMS vehicles;

9.2.1.c.3. Serve as the final decision maker regarding the provision of patient care for all prehospital EMS incidents within the region, including, but not limited to, interpretation and authorization of patient treatment, facility destination or diversion protocols and guidelines;

9.2.1.c.4. Assist EMS agencies and personnel with medical direction for inter-facility transfer patient care, as needed;

9.2.1.c.5. Follow all procedures and guidelines governing delivery of medical command and direction of units as established by OEMS including, but not limited to, data collection and quality assurance;

9.2.1.c.6. Maintain a record keeping system as outlined by OEMS guidelines and make those records available to state or regional Medical Directors, or OEMS investigators, for review as requested;

9.2.1.c.7. Perform other duties assigned by regional or state Medical Directors; and

9.2.1.c.8. Provide online medical command to emergency medical services personnel passing through the region who require medical direction.

9.2.1.d. Authority. -- The regional medical command center may implement procedures necessary to carry out its duties outlined in this rule and OEMS guidelines.

9.2.1.e. Alternative Facilities. -- Regions may elect to have alternate command facilities in the event of equipment malfunction or when the primary center cannot be contacted for any reason. These backup facilities must be approved by the State Medical Director and included in the regional communication plan. In the event none of the command facilities can be reached, then the receiving hospital may provide medical command as needed to emergency medical services personnel.

W. Va. Code R. § 64-48-9