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Frequently Asked QuestionsEmergency Medical Dispatch FAQWhere can I get a look at this new EMD law?Public Law 303, An Act to Implement Emergency Medical Dispatch Services for E-9-1-1 Calls, can be found on the State of Maine website. Where can I get a look at the Maine EMS administrative Rules that will further specify the EMD law?The Maine EMS Rules for EMD went into effect on September 1st, 2006. Chapters 3-A, and 5-A of the Rules describe the certification requirements for Emergency Medical Dispatch Services and Emergency Medical Dispatchers while Chapter 9-A contains the rules regarding training courses and EMD instructors. Read Maine EMS Rules (PDF). I work at a Public-Safety Answering Point (PSAP). Will I have to be EMD certified?Yes, as of January 1, 2007, if you work at a PSAP and may ever be assuming call-taking duties, you will need to have a Maine EMD certification. I have already taken an EMD class in the past. Will I be able to gain Maine EMD certification?The State is currently in the process of establishing criteria for acceptable EMD Priority Reference Systems, which include Dispatch Life Support (DLS) protocols, EMD Quality Assurance components, and the EMD training program. We will then compare existing national certification programs to these criteria to determine which will be Maine EMS-approved and what supplemental training and/or changes may be required. Providing that the training program that you already completed is approved by Maine EMS, it will be very important that you have kept current status in that program and all of Maine EMS’ requirements. An Application is available on the EMD page. I have not had the opportunity to take an EMD class. How do I go about taking one?First, you should check in at this website, or with our office, in late Spring or early Summer to find out if there has been a decision on which course(s) have been approved. If you would like to take a course before this decision has been made, you may do so, though we cannot guarantee that it will be approved. Some training is offered locally. PSAP training from the Emergency Services Communication Bureau (ESCB) is available at the Maine Criminal Justice Academy in Vassalboro I supervise a PSAP. What are some of my key responsibilities in accordance with this EMD project?To begin, select a Director of EMD Services for your PSAP. This person should be capable of supervising EMD, actively pursue quality assurance, coordinate agency-level continuing education, and other activities relevant to Emergency Medical Dispatch. He or she should be a cooperative partner with Maine EMS and the ESCB. The State plans to put together resource materials for EMD Directors, but in the meantime, there are places where you can get information relevant to EMD management. What about liability? Are PSAPs more likely to get sued if they are providing medical advice over the phone?In this era of contemporary public safety and emergency medical services, astute legal advisors point out that there is a greater liability associated with NOT providing EMD services. EMD is nationally recognized, and published in places like the American Society for Testing and Materials as the industry standard for modern 911 telecommunications. Emergency Medical Dispatch Standard Summaries. What about mode of response? If local emergency services worked with the regional PSAP and a physician medical director to establish different priority levels of response mode and configuration based on EMD findings, would that put them at legal risk?Again, there is actually a lot of support for critical thinking about emergency response. Over recent years, many sophisticated emergency services have developed response protocols that take into account that not every call may warrant the risks posed by lights and sirens. Responding to very minor calls with lights and sirens may, in fact, pose a danger to providers and the public and thus increase liability. Many, arguably all, ambulance crashes are preventable in some respect. Ambulance Crash Log How does regionalization of PSAPs, consolidation of dispatch, and changes in the Maine EMS system affect this EMD project?There are a lot of changes afoot in Maine EMS, public safety, and emergency communications in particular. Although there will almost certainly be some growing pains, many of the same parties are involved with these different decision-making processes, and every effort will be made to assure that each project takes the others into account. Further InformationHealth Insurance Portability & Accountability Act of 1996 FAQShould I still report cases of abuse of children and incapacitated or dependent adults?Yes. Sections 164.512(b)(1)(ii) and 164.512(c)(1)(i) allow covered entities to make these types of disclosures. Under Maine law, you MUST report these situations if you have reasonable cause to suspect abuse, neglect, or (adult) exploitation. 22 MRSA §§ 3477, 4011-A. Can I still give a copy of a run report to a law enforcement officer?Yes. Section 164.512(f) permits certain disclosure of PHI to law enforcement officers. The Maine Freedom of Access Law permits law enforcement officers who are conducting a criminal investigation to obtain copies of run reports upon request. 1 MRSA § 402 (3)(H). Our recommendation is that your service establish a procedure that such requests be in writing. These requests should be kept by your Privacy Officer as described in HIPAA. Does HIPAA affect our dispatch center?The effect of HIPAA on EMS dispatch centers will depend mainly upon their structure. In most cases, dispatch centers will not be considered covered entities because they offer no direct treatment to patients. This is generally true for dispatch centers that are organizationally independent of other health care providers. (Source: National EMSC Data Analysis & Resource Center) Is it OK to provide copies of run reports with the regional quality assurance/improvement program?Yes. Section 164.512(d) permits covered entities to disclose PHI to a health oversight agency for certain functions including quality assurance/improvement – and the Maine EMS Protocols require all EMS providers to participate in the regional QA/I programs. Are there some web sites that have useful and accurate HIPAA information?Yes. Further Information
Narcan FAQUnder what circumstance should an Emergency Medical Technician Intermediate (EMT-I) be administering Narcan?The EMT-I must be appropriately trained and working with a service that is licensed at or permitted to an EMT-I, EMT-C, or EMT-P level service. In the training module there are modifications to three protocols that identify when EMT-Intermediates should consider Narcan administration (Adult Coma, Gold 3; Pediatric Coma, Pink 1; and Toxins, for Narcotics, Yellow 5). In such a case, the EMT-I must contact medical control prior to administering Narcan. As with all medications administered by EMT-Intermediates, these cases will be reviewed by regional Quality Assurance programs so that we may better evaluate the effectiveness of these protocols. Who can teach the EMT-I Narcan Module?The EMT-I Narcan Module may be taught by an instructor qualified to teach the topic (same standard as applied to CEH programs). This would generally be considered to include a paramedic, nurse, or physician, but would not include an EMT-I previously trained in this program. Final instructor approval is up to each region. The program is NOT meant to be a self-study course. Who must complete the Narcan Module?The program must be completed by all current EMT-I licensees who have already taken the EMT-I Update program. The Narcan Module will be included in all future Update programs and all EMT-I courses. Those who could be waived from the program would include EMT-I’s who were previously paramedics or who are also RN’s. Waiver approval is up to each region. How will the Narcan Module be distributed?The program will be posted on the Maine EMS web site, and will be mailed to each regional office. A letter will be mailed to each service advising of this program and the need for their EMT-I personnel to be trained. How will we track who has completed the training program?CEH rosters from each class will need to be submitted through the regional office to Maine EMS, where a master list of who has completed the class will be maintained. Is Narcan administration via an endotracheal tube or by intramuscular (IM) injection an option?Yes. However, because the Maine EMS protocol for Narcan administration by EMT-I’s includes the ET and IM routes and these routes are not covered in our current EMT-I program, information on medication administration via an endotracheal tube and intramuscular (IM) injection is included in this module. Where in the Maine EMS Protocols should Narcan be placed with regard to endotracheal intubation?In 2 of the 3 protocols (Adult Coma and Pediatric Coma), the step of Narcan administration is inserted after the steps dealing with the airway. In the protocol Toxins – For Narcotics the step of Narcan administration is inserted prior to the step of advanced airway because the administration of Narcan may eliminate the need for an advanced airway, and the prehospital complications associated with the removal of an ET in a patient who has the return of a gag reflex. This encourages the effective usage of a nasal airway and bag-valve-mask ventilation. Is there a psychomotor or evaluation component involved in the Narcan Module?Yes. There is a psychomotor component for both ET and IM medication administration. Are there any costs associated with the program?Similar to other CEH programs, this module has no automatic associated costs with it. If there is a shortage of 2mg ampules of Narcan, is there an alternative planned?Yes, in such a situation, the pharmacy from which the Narcan is received may develop an alternative to the 2mg ampules as long as the service has a minimum of 8mg on board. Will the protocols associated with this module be sent to all services and providers?Yes. The 3 protocols associated with the Narcan Module will be sent to all EMT-I, EMTC, and EMT-P licensed or permitted services; in addition it will be posted on our web site, and will be included in a future article in the Journal of Maine EMS. Will new out of drug box policies have to be filed and signed by the local hospitals and services prior to implementation of this new skill?Yes. Existing out of drug box policies will need to be amended to include Narcan and services will have to implement policies that include monitoring Narcan storage and administration. Will the state written and practical exam be changed to reflect this new module?No. There are no changes in the state written or practical exam that need to be made at this time due to this program. Future changes could include written or practical exam questions from this program. When will the new protocols become effective?The new protocols will become effective on August 1, 2002, when they can be utilized by EMT-I’s who have received training in the Narcan Module. What will the QA form and process be?The QA form currently being used whenever an EMT-I gives a medication will also be used for this new medication. The forms will continue to be returned to the regions by the EMS service utilizing the new protocol. Further InformationParamedic Interfacility Transfer Program FAQWhat is PIFT?PIFT stands for Paramedic Interfacility Transfer. The original PIFT program was designed in the early 1990s to assist Maine hospitals by allowing specially trained paramedics to transport stable patients receiving medications that were outside the normal scope of paramedic practice, thus alleviating the need for nursing staff to accompany these patients. Why has the program changed?Over the last decade, the PIFT program has continually evolved as more medications or procedures were added to the course. However, different paramedics had received different versions of the training program, leading to confusion and differences in the standard of care across the state and even in some services. In early 2005, the Medical Directions and Practice Board (MDPB) reexamined the PIFT program and tasked Maine EMS with revising the curriculum to reflect a much broader scope of practice that would include a knowledge base capable of reacting to ongoing changes in clinical practice procedures or preferences. Who are the MDPB and what qualifies them to approve this program?The Medical Directions and Practice Board (MDPB) is the committee of regional and state EMS medical directors who govern the protocols that all Maine EMS providers operate under. This program has been extensively reviewed by these EMS physicians for medical efficacy, safety, and appropriateness of patient care in the Interfacility setting. Who developed this program?The program was developed by Maine EMS over almost a two-year period with the assistance of a variety of EMS clinicians, nurses, physicians, and educators from across Maine. Who is overseeing this program?Every service providing PIFT transfers is now required to have a service level medical director that reviews 100% of all PIFT calls. In addition, the PIFT paramedic will be able to contact the sending physician, receiving physician, service medical director, or local on-line medical control (OLMC) in the ED for guidance should it be needed. Is every paramedic in Maine a PIFT paramedic?No, paramedics must complete an additional training program that reviews the specific components of PIFT. In addition, they may only use the expanded PIFT scope of practice when employed by a Maine EMS approved PIFT service in the Interfacility transfer setting. Does this eliminate the paramedic level in Maine?No, paramedics will continue to operate under the existing scope of practice and formulary contained in the 2005 Maine EMS Prehospital Treatment Protocols in all other settings (i.e. 911 responses). Why does having a PIFT paramedic make a difference?The intent of the PIFT program has not changed; it is to facilitate Interfacility transport of stable patients who are receiving therapies outside of the normal scope of paramedic practice. With the expanded training in the 2006 PIFT program, paramedics trained to this standard will be able to transport patients on a much wider variety of medications then before. How is the new PIFT program different from earlier versions?The 2006 PIFT program represents a substantial change in the way paramedics are educated. The program focuses on problem solving, resource use, clinical judgment, and general familiarity with specific medication classes and devices. Rather than memorizing a list of just a few medications, PIFT trained paramedics have been exposed to general concepts and some specifics for 18 classes of medications plus over the counter (OTC) drugs. In addition, 6 specific devices have been added to the PIFT paramedic’s scope of practice. The net result is that PIFT paramedics will now be able to transport patients receiving a much larger array of medications or devices than before. How do I know if this transport requires a paramedic or a PIFT paramedic?All PIFT services have been encouraged to work with their local hospitals to help educate staff in the decision matrix about what is or is not a PIFT transfer. Ultimately, the paramedic at the bedside will be able to tell if the medications or devices the patient is receiving fall within the scope of PIFT practice or not. Our local EMS service has critical care transport paramedics (CCEMT-P). Are these the same thing as PIFT paramedics?CCEMT-P is a certification awarded to paramedics or nurses who have successfully completed the University of Maryland Baltimore County (UMBC) training program for critical care transport. This class covers a wider variety of topics then the Maine EMS PIFT program and does include a nationally recognized exam on course completion. Maine EMS allows paramedics who successfully complete the CCEMT-P program to operate as PIFT paramedics. However, the scope of practice for interfacility transports in Maine is governed by the accepted PIFT curriculum. UMBC graduates are not allowed to transport additional medications, devices, or perform procedures from the UMBC CCEMT-P course in Maine at this time since they fall outside of the PIFT scope of practice. Simply having the certification indicates a level of professional achievement but does not delineate clinical practice privileges much like a nursing certification (i.e. CEN) does. Are there going to be transports that still require our institution to provide appropriate staff (i.e. RN, RRT, etc.)?The cornerstone of PIFT is patient stability. PIFT is based on the premise that the PIFT paramedic is caring for a single, stable patient while alone in the back of the ambulance. The PIFT paramedic has been trained to use a stability assessment matrix for each call before deciding to accept the transport. Should the patient be deemed by the paramedic not to be stable for transport under the PIFT guidelines, the PIFT paramedic will request additional staff resources in order to transport the patient. Does that mean that the PIFT paramedic can refuse to transport a patient?Yes, the final call for transport using the PIFT parameters and scope of practice falls to the PIFT paramedic. The PIFT paramedic has the safety of the patient as his/her first priority. Maine EMS and the MDPB support the paramedic’s clinical judgment in these cases since the paramedic has the best understanding of his or her scope of practice, personal limitations, and comfort level after a hands-on assessment of the patient at the time of transport. If the PIFT paramedic can refuse, how do we get the patient transferred?Maine EMS recognizes that unstable patients need to be transported to higher levels of care. EMS transports will still occur that do not qualify as a PIFT transport just as they do today with additional staff in attendance of the patient (i.e. RN/EMT-P team). The desired result for all parties involved should be transporting the patient safely. To that end, the PIFT paramedic has been asked to work with the sending facility to arrange additional therapies to stabilize the patient, arrange for additional personnel resources from the EMS agency, or request additional personnel from the sending facility (RN, RRT, etc.) based on what is most clinically appropriate in the situation. What will the PIFT paramedics need from the hospital staff (clerical or nursing) for each PIFT transport?Please instruct your clerical or nursing staff that the PIFT paramedic will now require several additional items for transport. Specifically, legible copies of each of the following are needed for the PIFT paramedic’s records in addition to the transfer packet:
In addition, if the PIFT paramedic will be responsible for titrating any type of vasoactive medications during the transport, specific written orders outlining these parameters must be included (i.e. titrate nitroglycerin drip to SBP > 90 mm Hg or chest pain free). Specifically, what is the training program these PIFT paramedics have completed?The 2006 PIFT program consists of between 8 and 12 additional hours of training in topics related to Interfacility transport. Some of the items covered include legal issues in Interfacility transfer, EMTALA, QA/QI, a basic pharmacology review, documentation, an in-depth pharmacology review of each new medication class, and a review of the new PIFT approved devices. The entire program can be found on the Training Materials Page. What are the classes of medications included in the 2006 PIFT program?
What if the patient is on a medication not covered in the above list?If the patient is receiving a medication not on the list of approved PIFT medications, then a nurse must accompany the patient during transport or the medicine discontinued for transport. Are over the counter medications (OTC) approved for PIFT?Yes, if the patient has received it before as part of their normal care, if a specific order is written by the sending physician for the medication specifying time, route, frequency, dose and indications; and if the medication is packaged and dispensed by the sending facility, a PIFT paramedic may administer it. Can PIFT paramedics now administer the patient’s regularly scheduled medications by other routes (i.e. oral, SQ insulin, nebulizer, mdi, etc.)?Yes, with the same caveats as the OTC meds above. Specific transfer orders for these meds must be included in the documentation provided to the PIFT medic. What special devices are included in the 2006 PIFT program?
What if the patient has a device not listed in the PIFT approved device list that is essential for continued use in transport?The MDPB has authorized certain additional exceptions that PIFT paramedics may transport. The key is that the device must be low risk and require little to no intervention from the paramedic. The PIFT paramedic will work with you to resolve this issue through the service medical director or Maine EMS at the time of transfer. What can our staff do to help facilitate transferring patients under the 2006 PIFT guidelines?First, maintain open lines of communication with your EMS services. Each service is attempting to implement the required training and administrative pieces over the next few months as quickly as possible. Unfortunately, due to the additional training requirements, some services will be capable of using the newly expanded PIFT scope of practice before others. However, paramedics with prior versions of the PIFT training can continue to transport patients using only those 19 medications as before until June 30, 2007. Second, realize that this is a learning process for the paramedics, services, and the hospitals involved. Patience and cooperation are the keys to success. Third, ask questions of your EMS service chiefs about when and how they will be implementing this program. Forth, remind your staff that the paramedics will be asking for additional paperwork, more in-depth patient reports, and clarification of orders for a specific reason- it is required as part of the stability assessment that must be completed before a PIFT transfer can occur. My physicians and nurses have concerns over the quality of care these paramedics can provide with this program. What can we do?Maine EMS and the MDPB feel we have created an aggressive and effective training curriculum in the 2006 PIFT program. Quality is being constantly monitored by the services, with a local service medical director reviewing 100% of all PIFT charts. In addition, the state EMS QA/QI committee will also be watching the development of this program very closely. If specific issues with a provider or service arise, please contact the service chief and Regional EMS Office. It is very important that if you feel that the patient is too unstable to be cared for by a PIFT trained paramedic, then you should arrange to send nursing or other staff with the patient during transport or arrange alternative transport (i.e. air medical). Further Information
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