Commenter:
Richard Rubino, Stonewall Jackson VFD on behalf of Battalion 1 Departments
Comments of Battalion 1 Departments to Proposed OEMS Regulations
The Nokesville Volunteer Fire & Rescue Department, Stonewall Jackson Volunteer Fire Department and Rescue Squad, Yorkshire Volunteer Fire Department and Evergreen Volunteer Fire Department (collectively, “Battalion 1 Departments”) submit the following comments to the proposed regulations of the State Board of Health.
1.Revocation of EMT level certifications – Currently, the term “Revocation” is defined as “the permanent removal of an EMS agency license, vehicle permit, training certification, ALS coordinator endorsement, EMS education coordinator, EMS physician endorsement or other designation issued by the Office of EMS.”
Under the regulations as proposed, the revocation of a provider’s EMT certification would be permanent without recourse for appeal at some future date. This stance is harsher than that applied to those licensed to practice any of the healing arts by the Commonwealth. In this regard, Section 54.1-2917 of the Code of Virginia permits the holder of a medical license that has been revoked in certain circumstances to apply for reinstatement of the license. Because the revocation of a medical license may not be permanent in all situations, the Health Commissioner should create a vehicle for providers whose EMT certifications have been revoked to demonstrate that they have been rehabilitated. The Battalion 1 Departments believe that this is consistent with the structure of the regulations that allow for certification of a provider in the first instant following certain criminal convictions after the passage of the requisite period from release for custodial confinement and/or probation.
2.12VAC5-31-210 – Civil Penalty: During EMS Symposium, the Office of EMS advised that the purpose of civil penalties was to impel compliance with the Office of EMS regulations where other enforcement actions had not been successful. In reviewing the language of the proposed section, the following phrase is used: “may impose a civil penalty on any agency or entity that fails or refuses compliance with these regulations.” If the purpose of this provision is to provide the Office of EMS with a last resort to address non-compliance issues, then this section should be revised accordingly. The Battalion 1 Departments recommend that the words “fails or” be removed from the phrase described above so that it is clear that the standard of non-compliance is a refusal to comply and not merely a failure to comply, the latter of which could result in the imposition of a civil penalty in the first instant.
3.12VAC5-31-570 – EMS Agency Status Report: Under the proposed regulation, the Office of EMS has proposed to delete the “Chief of operations” from the positions that must be kept up to date with the Office of EMS. The Battalion 1 Departments believe that the removal of the Chief of operations as a reportable position is inappropriate and could potentially be dangerous. This is because the Chief of operations in most volunteer fire and rescue agencies is also the Chief of the department and ultimately responsible for the day-to-day operations of the agency in the field. Additionally, mailings from the Office of EMS are frequently more appropriately addressed to the Chief of operations rather than the Training Officer, Infection Control Officer or Chief executive officer.
4.12VAC5-31-700 – Possession of firearms and weapons: In the draft regulations, the Office of EMS has proposed, without explanation, to eliminate the prohibition against the carrying of a firearm, weapon or explosive or incendiary device on any EMS vehicle. For the safety of their personnel, the Battalion 1 Departments submit that this prohibition should be reinstated. The Battalion 1 Departments can find no logical reason to permit an individual (other than a law enforcement officer in the performance of their official duties) to carry a weapon on an EMS vehicle. Further, allowing patients and/or providers to carry weapons only increases the potential for danger should a patient become combative and a scuffle ensue.
5.12VAC5-31-750 – EMS Vehicle Occupant Safety: The Office of EMS has proposed to require that all stretcher patients be secured on the stretcher utilizing a minimum of three straps unless contraindicated by patient condition. The Battalion 1 Departments believe that the proposed requirement is not strong enough and should be strengthened to require the use of all straps in accordance with the stretcher manufacturer’s recommendations, unless otherwise contraindicated by patient condition and/or size/placement on the stretcher (e.g., use of straps would cut across patient’s neck, etc.). On April 3, 2009, there was a significant crash on I-81 involving an ambulance licensed to Carillion Clinic that was involved in an interfacility transport. The March 2010 issue of EMS Magazine reports that the patient was properly secured to the stretcher using all of the straps (including shoulder harnesses, as recommended by the stretcher’s manufacturer). During the accident, the stretcher broke free of its mounting hardware, became airborne, and landed at a 45-degree angle facing the bench seat, with the patient landing on his left side. EMS Magazine further reported that the patient did not receive any injuries as a result of the collision and was able to be transferred to his destination for treatment of his original injuries. Had the patient not been properly restrained in accordance with the cot manufacturer’s recommendations, it is quite possible that the patient would have suffered additional injury in the crash. The shoulder straps provide an important tool for properly restraining a patient to the cot in those circumstances where the straps can be appropriately fitted to the patient. The drafting of a regulation to permit the routine use of the patient cot in a manner that is inconsistent with manufacturer recommendations or otherwise permits the routine disregard of safety equipment sends a bad message and potentially could result in injury to the public and further liability to EMS agencies.
6.12VAC5-31-900 – EMS Provider Notice: The proposed regulation requires that providers notify the Office of EMS within 15 days of any change in contact information, including: mailing address, e-mail address or telephone number. The fifteen day standard in this section is stricter than the 30-day standard for agencies in 12VAC5-31-570. The Battalion 1 Departments believe that a more reasonable standard would be 30 days, which is the time-frame allotted to agencies for the update of their records.
7.12VAC5-31-910 – Criminal History: At the outset, the Battalion 1 Departments believe that if a criminal offense is sufficient to be a bar to hold a certification from the Office of EMS it should likewise be a bar to affiliation with an EMS agency. This is because of the governmental interest in protecting the public from potential harm that could result from individuals with criminal pasts. Accordingly, the Battalion 1 Departments urge the Office of EMS to change the threshold for criminal history impacts from a bar to certification to a bar to affiliation.
The Battalion 1 Departments support the Office of EMS’ proposal to require national criminal background checks rather than background checks limited to the Commonwealth of Virginia. It is well known that much of Virginia, especially northern Virginia and Tidewater are very transient in nature. As a result, it is very possible that an individual could have a clean record in Virginia, but otherwise have a criminal past from another state or military jurisdiction that would go undetected.
The proposed regulations require the conduct of a criminal background check not earlier than 60 days prior to application. The Battalion 1 Departments feel that this requirement will result in a snap-shot in time and urge the Office of EMS to require recurring background checks on a periodic basis (either bi-annual or tri-annual) without any grandfather provisions for existing members. This is because public safety demands that the system ensure that we protect the public from individuals who have received convictions for offenses that would constitute a bar to affiliation and/or certification. These bars are in place for a reason – namely to ensure the safety of the lives and property of the citizens that we serve. The Battalion 1 Departments can think of nothing more embarrassing than to have a provider commit a criminal act, only to discover that had a background check been run subsequent to affiliation, that the individual would have been discovered before he could enter the citizen’s house and perpetrate his criminal activity during an incident.
8.12VAC5-31-1140 – Provision of Patient Care Documentation: The Battalion 1 Departments oppose recommendations from Emergency Room physicians to require that EMS units be required to leave their pre-hospital care reports at the receiving facility prior to taking the next call for service. While the Battalion 1 Departments agree that leaving pre-hospital patient care reports at the receiving facility at the time of patient transport is important and in certain cases could impact patient outcome in the hospital setting, the likelihood is diminished if there is a proper transfer of care at the time the patient is delivered to the Emergency Department. As a result, the recommendation of these physicians needs to be balanced with the needs of the EMS system at the time in question. In most circumstances, EMS crews are not so busy that they cannot complete their report prior to leaving the receiving facility. However, there are times where there is sufficient call volume when an EMS unit must clear the hospital in order to provide emergency medical service to the public. In those circumstances, the EMS unit should be allowed to clear and submit the completed patient care report to the receiving facility as soon thereafter, but in any event, no later than 24-hours after transferring the patient to the receiving facility. The Battalion 1 Departments would recommend that in those instances where an EMS unit clears the hospital without first leaving the prehospital patient care report, that the Attendant in Charge notify the nursing and/or medical staff at the receiving facility prior to departure.
It should also be noted that many agencies have not moved to computer based EMS patient care reporting. Because the reporting system relies on mechanical devices (e.g., computers, printers, fax machines, etc.), it is important to provide an exception for equipment failure, whether it be with the underlying computer or the fax machine or printer at the hospital.
