Code of Maryland Regulations Title 30 Maryland Institute for Emergency Medical Services Systems.

Code of Maryland Code of Maryland RegulationsRegulations

Title 30Title 30

Maryland Institute for Maryland Institute for Emergency Medical Services Emergency Medical Services

SystemsSystems

ObjectivesObjectives

Following the completion of this presentation Following the completion of this presentation the participant will be able to:the participant will be able to: Locate and reference the Code of Maryland Locate and reference the Code of Maryland

Regulations (COMAR), Title 30Regulations (COMAR), Title 30 Describe the impact of Title 30 on the daily Describe the impact of Title 30 on the daily

operations of emergency servicesoperations of emergency services Recognize the Provider Review Process (PRP)Recognize the Provider Review Process (PRP) Recognize the role of Quality Review as outlined Recognize the role of Quality Review as outlined

in Title 30in Title 30

Why Regulate?Why Regulate?

Why Regulate?Why Regulate? In its infancy MIEMSS established guidelines In its infancy MIEMSS established guidelines

based on an informal process.based on an informal process. The result was inconsistency, and the lack of The result was inconsistency, and the lack of

coordination often caused confusion among coordination often caused confusion among providers.providers.

There were no formal policies or procedures. There were no formal policies or procedures.

Maryland RegulationsMaryland Regulations

Regulations are the generally applicable rules under which a state agency operates.

The legislature must authorize an agency to promulgate regulations.

The agency then must follow detailed rules in drafting and enacting the regulations.

What is COMAR?What is COMAR?

The Regulations of all Maryland Agencies The Regulations of all Maryland Agencies are collected in the Code of Maryland are collected in the Code of Maryland Regulations known as “COMAR”.Regulations known as “COMAR”.

COMAR DescriptionCOMAR Description

COMAR is divided into “Titles”. Each title is COMAR is divided into “Titles”. Each title is numbered and generally represents the numbered and generally represents the rules for a separate state agency.rules for a separate state agency. Examples:Examples:

MIEMSS -Title 30MIEMSS -Title 30 Department of Health -Title 10Department of Health -Title 10

COMAR DescriptionCOMAR Description Titles are then broken down into “Subtitles” Titles are then broken down into “Subtitles”

or “Chapters”. or “Chapters”. Examples from MIEMSS Title 30:Examples from MIEMSS Title 30:

Subtitle 02: Emergency Medical Services ProvidersSubtitle 02: Emergency Medical Services Providers Chapter 03: Scope of Practice and DutiesChapter 03: Scope of Practice and Duties

COMAR DescriptionCOMAR Description

The information in each chapter defines The information in each chapter defines the regulations relating to that title.the regulations relating to that title.

The chapter is written in outline format The chapter is written in outline format (much like the Maryland Medical (much like the Maryland Medical Protocols) for ease of reference. Protocols) for ease of reference.

Each Subtitle contains a list of definitions Each Subtitle contains a list of definitions for terms used in the chapter.for terms used in the chapter.

Where Can I Locate a Where Can I Locate a Copy?Copy?

A copy is located in the reference section A copy is located in the reference section of each public library. of each public library.

COMAR can also be located on-line at COMAR can also be located on-line at https://constmail.gov.state.md.us/comar/dhttps://constmail.gov.state.md.us/comar/dsd_web/default.htmsd_web/default.htm

Who Does it Impact?Who Does it Impact? TITLE 30 effects:TITLE 30 effects:

...“any EMS service ...“any EMS service

or provider who or provider who

operates in the operates in the

State of Maryland”... State of Maryland”...

Operational ImpactOperational Impact Day-to-day influence of Title 30Day-to-day influence of Title 30

Licensure / Certification / CredentialLicensure / Certification / Credential Scope of Practice and DutiesScope of Practice and Duties Prohibited ConductProhibited Conduct Disciplinary ProceduresDisciplinary Procedures Operational Suspensions Operational Suspensions HearingsHearings Summary Suspension of License or CertificationSummary Suspension of License or Certification

Maryland Title 30 Maryland Title 30 OverviewOverview

Subtitle 01: General Subtitle 01: General Subtitle 02: Emergency Medical Services ProvidersSubtitle 02: Emergency Medical Services Providers Subtitle 03: EMS Operational ProgramsSubtitle 03: EMS Operational Programs Subtitle 04: Emergency Medical Services Subtitle 04: Emergency Medical Services

Education Education Programs and Courses Programs and Courses

Subtitle 06: Automated External Defibrillation Subtitle 06: Automated External Defibrillation Program Program

Maryland Title 30Maryland Title 30

Subtitle 07: Emergency Medical Subtitle 07: Emergency Medical Communications System Communications System

Subtitle 08: Designation of Trauma and Subtitle 08: Designation of Trauma and Specialty Referral Centers Specialty Referral Centers

Subtitle 09: Commercial Ambulances ServicesSubtitle 09: Commercial Ambulances Services

Subtitle 05 will cover EMS Regional Councils Subtitle 05 will cover EMS Regional Councils tentatively beginning July 1, 2002.tentatively beginning July 1, 2002.

Subtitle 01Subtitle 01

GeneralGeneral Explains “Incorporation by Reference” Explains “Incorporation by Reference”

The mechanism for including the Maryland Medical The mechanism for including the Maryland Medical Protocols into COMAR.Protocols into COMAR.

Designates the MIEMSS “Open Meeting” policy.Designates the MIEMSS “Open Meeting” policy. Outlines the process for the access and/or Outlines the process for the access and/or

correction of public records.correction of public records. Governs the procedures for obtaining a Governs the procedures for obtaining a

declaratory ruling from the EMS Board.declaratory ruling from the EMS Board.


Emergency Medical Emergency Medical Services ProvidersServices Providers

Defines the Licensure and Certification ProcessDefines the Licensure and Certification Process Including:Including:

Establishing fees for testingEstablishing fees for testing Requirements for providersRequirements for providers ReciprocityReciprocity Examination and reexaminationExamination and reexamination Issuance of a license or certificateIssuance of a license or certificate Renewal, surrender and/or reinstatement of a license or Renewal, surrender and/or reinstatement of a license or

certificatecertificate Criteria for denial of a license or certificateCriteria for denial of a license or certificate



Chapter 3 of this subtitle establishes the Chapter 3 of this subtitle establishes the “Scope of Practice” (based on the Maryland “Scope of Practice” (based on the Maryland Medical Protocols) and duties for all levels of Medical Protocols) and duties for all levels of EMS providers including:EMS providers including: Emergency Medical Dispatchers Emergency Medical Dispatchers First RespondersFirst Responders

The chapter also contains the requirement The chapter also contains the requirement that an EMS provider must function under an that an EMS provider must function under an EMS Operational Program. EMS Operational Program.


Emergency MedicalEmergency Medical Services Providers Services Providers

Chapter 4 defines “Prohibited Conduct”Chapter 4 defines “Prohibited Conduct” Outlines the actions that can be taken as Outlines the actions that can be taken as

a result of prohibited conducta result of prohibited conduct Reprimand or probationReprimand or probation Suspend or revoke a license or certificateSuspend or revoke a license or certificate Deny a license or certificateDeny a license or certificate Refuse to renew a license or certificate Refuse to renew a license or certificate



Chapter 05 specifies the disciplinary Chapter 05 specifies the disciplinary procedures including: procedures including: Investigation of incident reportsInvestigation of incident reports Review by the Provider Review PanelReview by the Provider Review Panel Action by the EMS BoardAction by the EMS Board Case resolution conferenceCase resolution conference HearingsHearings EMS Board actionEMS Board action



Chapter 5 Chapter 5 continued: continued:

Designates the composition of the Provider Designates the composition of the Provider Review PanelReview Panel

Establishes the process for summary Establishes the process for summary suspension of a license or certificationsuspension of a license or certification

Provides confidentiality and admissibility of Provides confidentiality and admissibility of proceedings, records, and files used proceedings, records, and files used throughout the provider review process.throughout the provider review process.



Chapter 6Chapter 6: :

Contains the procedures for Contains the procedures for administrative hearings regarding:administrative hearings regarding: LicensureLicensure CertificationCertification Disciplinary action of an EMS providerDisciplinary action of an EMS provider



Chapter 7Chapter 7: :

Governs summary procedures for Governs summary procedures for suspending an EMS providers license or suspending an EMS providers license or certificate based on the protection of certificate based on the protection of public health, safety or welfare.public health, safety or welfare.


EMS Operational ProgramsEMS Operational Programs

Defines the criteria for approval of an EMS Defines the criteria for approval of an EMS Operational ProgramOperational Program

Establishes the policy for Medical Establishes the policy for Medical Direction including the appointment of the Direction including the appointment of the EMS Medical Directors.EMS Medical Directors.

Provides the guidelines for quality Provides the guidelines for quality assurance, protocol development and assurance, protocol development and designation of Base stations. designation of Base stations.



Quality Assurance (QA)Quality Assurance (QA) Each EMS Operational Program must Each EMS Operational Program must

have:have: A written QA plan approved by the medical A written QA plan approved by the medical

directordirector A medical Review CommitteeA medical Review Committee

Quality AssuranceQuality Assurance

Quality assurance plan componentsQuality assurance plan components Data reviewData review Identification and analysis of trends Identification and analysis of trends

PositivePositive NegativeNegative

Identification of protocol violationsIdentification of protocol violations Remediation for patient care issues at the Remediation for patient care issues at the

jurisdictional level.jurisdictional level.

Quality AssuranceQuality Assurance

Quality assurance plan requirementsQuality assurance plan requirements Notify MIEMSS within 30 days of incidents that Notify MIEMSS within 30 days of incidents that

may have resulted in patient harm, require may have resulted in patient harm, require disciplinary actions from MIEMSS, or require a disciplinary actions from MIEMSS, or require a change in state protocol.change in state protocol.

Review written and oral allegations that an Review written and oral allegations that an EMS provider failed to act in accordance with EMS provider failed to act in accordance with applicable law or protocol. applicable law or protocol.

Medical Review Medical Review CommitteeCommittee

Medical Review Committee (MRC) responsibilities:Medical Review Committee (MRC) responsibilities: Every operational program must designate a Every operational program must designate a

MRC.MRC. The committee is selected by the operational The committee is selected by the operational

program and its medical director.program and its medical director. It shall be the duty of the MRC with the It shall be the duty of the MRC with the

participation of the medical director to carry out participation of the medical director to carry out the quality assurance plan.the quality assurance plan.

Medical Review Medical Review CommitteeCommittee

Medical Review Committee (MRC) Medical Review Committee (MRC) responsibilities:responsibilities:

The MRC is subject to the confidentiality The MRC is subject to the confidentiality and immunity provisions as provided by and immunity provisions as provided by COMAR.COMAR.

Each member must sign a confidentiality Each member must sign a confidentiality agreement.agreement.


EMS Operational ProgramsEMS Operational Programs Protocol development is also covered under this Protocol development is also covered under this

subtitle.subtitle. Chapter 05 section .02 defines the composition of the Chapter 05 section .02 defines the composition of the

Protocol Review Committee.Protocol Review Committee. This section also established the process for This section also established the process for

protocol development and approval including:protocol development and approval including: Pilot ProtocolsPilot Protocols Research ProtocolsResearch Protocols Optional Protocols Optional Protocols Emergency ProtocolsEmergency Protocols



Chapter 06 governs the approval and operation Chapter 06 governs the approval and operation of an EMS Base Station.of an EMS Base Station.

Specific requirements are outlined for:Specific requirements are outlined for: Approval and renewalApproval and renewal Specialty centers and consultation centersSpecialty centers and consultation centers Out-of-state centersOut-of-state centers Denial or rescission of approval Denial or rescission of approval Appeal processAppeal process


Emergency Medical Emergency Medical Services Services Education Programs and Education Programs and

CoursesCourses Governs the Educational Programs for:Governs the Educational Programs for:

Emergency Medical DispatchersEmergency Medical Dispatchers Basic Life Support ProvidersBasic Life Support Providers Advanced Life Support ProvidersAdvanced Life Support Providers


Emergency Medical Emergency Medical Services Education Programs and Services Education Programs and

CoursesCourses Governs the Educational Programs for:Governs the Educational Programs for:

Emergency Medical DispatchersEmergency Medical Dispatchers Basic Life Support ProvidersBasic Life Support Providers Advanced Life Support ProvidersAdvanced Life Support Providers

Requirements for continuing education Requirements for continuing education programs are also contained within this programs are also contained within this subtitle.subtitle.


Automated External Automated External Defibrillation ProgramDefibrillation Program

Establishes the criteria for the authorization of Establishes the criteria for the authorization of “Public Access” AED Programs“Public Access” AED Programs

Specific requirements for PAD programs Specific requirements for PAD programs include:include: Medical directionMedical direction ProtocolsProtocols Quality assurance and maintenanceQuality assurance and maintenance TrainingTraining


Emergency Medical Emergency Medical Services Communications SystemServices Communications System

Establishes the system Establishes the system

for helicopter for helicopter

communication communication

to SYSCOM.to SYSCOM.


Designation of Trauma and Designation of Trauma and Specialty Referral CentersSpecialty Referral Centers

Provides the criteria for the designation of Provides the criteria for the designation of trauma and specialty referral centers.trauma and specialty referral centers.

In addition it outlines the following In addition it outlines the following standards for the trauma and specialty standards for the trauma and specialty referral centersreferral centers Data Collection and Quality ManagementData Collection and Quality Management Designation and verification criteriaDesignation and verification criteria Disciplinary Action for subtitle violationDisciplinary Action for subtitle violation


Designation of Trauma and Designation of Trauma and Specialty Referral CentersSpecialty Referral Centers

This subtitle establishes the standards for This subtitle establishes the standards for the following:the following: Trauma CentersTrauma Centers Burn CentersBurn Centers Specialty Referral CentersSpecialty Referral Centers Pediatric Trauma CentersPediatric Trauma Centers Eye Trauma CentersEye Trauma Centers Perinatal and Neonatal Referral CentersPerinatal and Neonatal Referral Centers


Commercial Ambulance Commercial Ambulance ServicesServices

This subtitle provides the standards for This subtitle provides the standards for Commercial Ambulance Services in the State Commercial Ambulance Services in the State of Maryland. of Maryland. Licensing process is definedLicensing process is defined Operational requirements are establishedOperational requirements are established Eligibility, application and renewal procedures Eligibility, application and renewal procedures

are includedare included Record keeping and MIEMSS record submission Record keeping and MIEMSS record submission

are outlinedare outlined


Commercial Ambulance Commercial Ambulance ServicesServices

Commercial Ambulance Services Commercial Ambulance Services continuedcontinued

Chapter 09 governs the enforcement of Chapter 09 governs the enforcement of commercial ambulancecommercial ambulance statutes and statutes and regulations.regulations.

A standard commercial ambulance service A standard commercial ambulance service equipment list (for ALS and BLS) is located in equipment list (for ALS and BLS) is located in Chapters 10 & 11. Chapters 10 & 11.

The last chapter of the commercial ambulance The last chapter of the commercial ambulance service subtitle governs the operation of service subtitle governs the operation of neonatal ambulance services. neonatal ambulance services.


Maryland Information Maryland Information SystemSystem

Each operational Each operational

program shall provide program shall provide

to MIEMSS on a monthlyto MIEMSS on a monthly

basis a report of patient basis a report of patient

encounters.encounters.


How do we get to compliance?How do we get to compliance? Education Education CommunicationsCommunications CooperationCooperation ConsensusConsensus

SummarySummary

COMAR provides the framework for the COMAR provides the framework for the Maryland EMS System. Maryland EMS System.

More InformationMore Information

If you need additional information please If you need additional information please contact the MIEMSS, Office of the contact the MIEMSS, Office of the Assistant Attorney GeneralAssistant Attorney General Monty Magee Monty Magee (410) 706-8531(410) 706-8531 Sarah SetteSarah Sette (410) 706-8514(410) 706-8514


Questions ???Questions ???

Comments ???Comments ???

Code of Maryland Regulations Title 30 Maryland Institute for Emergency Medical Services Systems.

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