| EXTENSION, WITHDRAWAL &
RESTORATION OF COOPERATION All decisions of the Monroe County Medical Control Board/Authority related to cooperation for limited and advanced life support services and personnel are subject to approval of Mercy Memorial Hospital Board of Trustees (or designee). Once the Board/Authority has made a determination related to the extension, withdrawal or restoration of cooperation, this finding shall be forwarded to Mercy Memorial Hospital Administration for confirmation. AN EXTENSION OF COOPERATION TO ADVANCED LIFE SUPPORT (ALS) UNITS 1. ALS Provider Application Review (initial applications, renewals, and expansion applications for change in operation that would affect the ability to operate under the criteria). a. Prospective ALS providers must submit a written request for endorsement to the Monroe County Medical Control Board/Authority. Such requests must include: 1. Copy of proposed MDCIS (Michigan Department of Consumer and Industry Services Application 2. Commitment of 24 hours a day, seven days a week availability of ALS service meeting Monroe County Medical Control Board/Authority criteria. 3. Detailed information on geographical location, boundaries and target population of proposed service area. 4. Justification of ALS service endorsement based upon Monroe County Medical Control Board/Authority criteria. 5. Detailed communications plan outlining existing and proposed communications capability. (Requests for inclusion into the Monroe County EMS Communications system must include propagation studies showing ninety percent (90%) guaranteed coverage. 6. Declaration of understanding and agreement to comply with all Monroe County Medical Control Board/Authority criteria for endorsement of ALS Providers. 7. A brief but complete description of the service that would be implemented under this proposal. Reference, at a minimum, vehicle location, method of dispatch, back-up coverage, and relationships anticipated with fire rescue vehicles. b. Prospective ALS providers shall submit a minimum of sixteen (16) ALS application copies to the Monroe County Medical Control Board/Authority at least sixty (60) days prior to submission of application of MDCIS. 2. The endorsement of providers seeking licensure from the MDCIS to provide Advanced Life Support (ALS) services in the Monroe County Medical Control Board/Authority region will be considered with reference to the criteria set forth below. The EMS Medical Director and/or the Monroe County Medical Control Board can temporarily or permanently withdraw cooperation for failure to meet these criteria by providing written notification to the ALS provider. These criteria are based upon the standard of a maximum of ten (10) minutes response time to ninety (90%) percent of all emergency runs. The ultimate goal is that prehospital advanced life support services shall be provided to all citizens of Monroe County. ALS units should be located and assigned so as to provide for maximum population coverage with minimum response times. 3. Standards for ALS Units a. Two (2) EMT-Paramedics shall staff all transporting ALS units at all times. A non-transporting ALS unit shall be staffed by a minimum of one (1) paramedic at all times. Assigned personnel shall be licensed in compliance with appropriate statues and regulations. Consideration will be given only to those providers demonstrating that sufficiently trained personnel meeting the Michigan Department of Consumer and Industry Services (MDCIS) requirements (Part 3 of the EMS regulations) which exist at the time the application is being made. b. Medical equipment and supplies utilized by the ALS teams shall meet such criteria as may be established by the Monroe County Medical Control Authority as well as MDCIS. c. ALS units shall be identified through application of standard terminology and uniform numbering system established by the MDÇIS. d. The Monroe County EMS Communications system shall be utilized by all ALS units. e. ALS providers shall enter into a Coordination of Services agreement (Appendix E) with all other appropriate ALS providers. f. The ALS provider shall agree that each paramedic will participate in a Medical Control Authority approved skills maintenance program that combines field and/or hospital experience. Attendance at EMS review sessions is mandatory. (See Policy for EMS Review Sessions - Appendix B) The EMS Medical Director can excuse, for any good cause, any paramedic from attending a given meeting. Persons with an excessive number of unexcused absences can have cooperation withdrawn. g. ALS provider shall agree in writing to participate in first responder training programs. h. ALS provider shall secure and maintain the following insurance and shall not begin functioning until this insurance has been obtained and proof submitted to the Monroe County Medical Control (existing providers have thirty (30) days to comply). Insurance amounts must be in conformance with R.325.23901(c) of the 1990- EMS rules. 1) Workers' Compensation Insurance 2) Bodily Injury Liability 3) Property Damage Liability insurance 4) Professional Liability The Monroe County Medical Control Authority, Mercy Memorial Hospital, the EMS Director and its members, as well as all agents, officers and employees of these organizations, and the County of Monroe shall be named additional insured on all insurance policies listed above and shall be endorsed that in the event the policy is canceled, a minimum of ten (10) days written notice is required to all Certificate Holders. i. The ALS providers shall agree to utilize procedures and protocols for communications and operations established by the Monroe County Medical Control Authority. j. ALS providers shall agree to act in accordance with the medical procedures and policies as noted in the Medical Protocol guidelines and defined by the Monroe County Medical Control Authority and other policies as promulgated by the Monroe County Medical Control Authority. k. ALS providers operating in Monroe County shall agree, in writing, to defend, hold harmless and indemnify the Monroe County Medical Control Authority and its members, as well as all agents, officers and employees of these organizations, Mercy Memorial Hospital, the EMS Medical Director and the County of Monroe, and from any and all claims of liability arising either directly or indirectly from the agency's performance or non-performance. l. ALS providers shall use the authorized Monroe County EMS Run Report for all emergency patients. Further, the provider will supply copies of this form to the Monroe County Medical Control Authority and comply with all other data gathering activities. m. ALS providers shall allow Mercy Memorial Hospital to direct the activities of field personnel during the provision of advanced life support services while in radio or telephone contact with designated medical or nursing staff at Mercy Memorial Hospital. ALS providers shall agree that all medical judgments relevant to the program embraced by these criteria shall be within the province of the EMS Medical Director or his/her designated representative, and that judgments by the EMS Medical Director concerning the competence and/or continuing performance of any advanced life support personnel employed by the provider shall be final and undisputed. The EMS Medical Director and/or the Monroe County Medical Control Board/Authority can temporarily or permanently withdraw cooperation for failure to meet these criteria by providing written notification to the ALS provider. Any individual/provider having cooperation withdrawn will have the right to appeal this withdrawal in accordance with the Medical Control Authority approved appeal process. n. ALS providers shall provide the EMS Medical Director with adequate and appropriate access to advanced life support personnel in their working environment for purposes of performance evaluation and training. Reasonable times and methods will be used so as not to interfere with the ALS provider. o. Advanced life support personnel shall meet the Monroe County Medical Control recertification criteria as outlined in Appendix C. B. WITHDRAWAL OF COOPERATION FOR ALS UNITS The Monroe County Medical Board/Authority shall utilize the following procedure when withdrawing cooperation from a limited or advanced service. 1. Basic, Limited and Advanced services may have cooperation withdrawn and EMS Dispatch privileges suspended for violations of the Monroe County Treatment Protocols and Standard Operating Procedures that pose a serious threat to health and safety. 2. Upon being notified of an incident of this type, the EMS Medical Director, the EMS Coordinator and the Continuous Quality Improvement Committee shall assess the situation and confer on a course of action. All EMS reports and other pertinent information will be reviewed. The service shall be contacted immediately to determine the facts and seek voluntary compliance with Protocol 3. If voluntary compliance cannot be obtained and if the CQI Committee determines that the incident is significant enough to warrant withdrawal of cooperation, the CQI Committee shall not continue discussion nor take action until the service involved has been provided notification. The Monroe County Medical Control Executive Committee and the Mercy Memorial Hospital Board's designee will also be notified. 4. Notification shall consist of the delivery of a registered letter to the appropriate service that sets forth the date and time of a meeting to be held within ten (10) working days, subject matter to be discussed and potential actions to be taken. The service will be encouraged to attend. Attorneys will not be permitted to attend. 5. At the date and time specified in the notification procedure the CQI committee shall meet with appropriate representatives of the service. Every effort will be made to rectify the problems and avert withdrawal of cooperation. If a course of action can be agreed upon other than withdrawal of cooperation, this will be reduced to writing and signed by the EMS Medical Director and the service's representative. 6. If the CQI Committee elects to withdraw cooperation, this decision and the underlying facts will be forwarded to Mercy Memorial Hospital Board's designee. Within five (5) working days after receiving the decision of the CQI committee, Mercy Memorial Hospital Board's designee shall accept or reject the decision and notify the service by registered letter of its determination. If cooperation is to be withdrawn, the Monroe County Medical Control Authority will set forth the effective date and time of the withdrawal. Simultaneously, the Michigan Department of Consumer and Industry Services will be notified of the withdrawal of cooperation. ADVANCED/LIMITED ADVANCED LIFE SUPPORT APPLICATION PROCESS A service desiring to provide prehospital emergency medical care in Monroe County shall apply to the Monroe County Medical Control Authority (MCA) for approval at the Advanced Life Support (ALS) level or the Limited Advanced Life Support (LALS) level at least ninety (90) days prior to their requested implementation date. The MCA may approve such request for service provided the agency applying meets the following criteria: 1. The service and vehicle(s) comply with all rules and regulations promulgated by the Michigan Department of Consumer and Industry Services (MDCIS), the Monroe County Medical Control Authority (MCA), the Monroe County Ambulance Authority, Monroe County disaster plan and any local ordinances as they refer to the provision of ALS within Monroe County. 2. Each vehicle shall be equipped with communications equipment properly maintained and utilized in accordance with the MDCIS MEDCOM Plan. 3. Care shall be available twenty-four (24) hours a day, seven (7) days a week. 4. Each approved transporting Advanced Life Support vehicle shall be staffed by two (2) Michigan State licensed Emergency Medical Technician-Paramedics (EMT-P). Each approved transporting Limited Advanced Life Support vehicle shall be staffed by two (2) Michigan State licensed Emergency Medical Technician Specialists (EMT-S). All personnel must have fulfilled the credentialling requirements of the MCA. 5. The service agrees to adhere to the treatment protocols, continuing education requirements, communications policies, reporting requirements, participation in audit programs, and adherence to all other guidelines and programs established by the MCA. 6. Basic and Advanced medical equipment utilized by the ALS and Limited ALS units shall meet the criteria established by the MCA and the MDCIS requirements for licensure. 7. The service shall provide a sixty (60) day work schedule for the personnel for each unit being applied for. 8. No vehicle shall have a chassis age over five (5) years. 9. ALS units shall be identified through application of standard terminology and a uniform numbering system throughout Monroe County as established by the MCA. 10. The service shall agree to work with existing services for coordination of unit utilization. The service's vehicle(s) will function within the EMS system to provide countywide coverage, and will be moved appropriately within the system to best serve the populace of Monroe County. 11. The service shall agree to have the placement of its ALS unit/station approved by the MCA. Whenever possible, all locations shall include appropriate crew facilities and heated garage. In approving unit locations the MCA will attempt to: a. Avoid overlap or duplication of primary service areas. b. Provide maximum coverage in the provision of ALS for the entire population. 12. The service must demonstrate through run volume projections, personnel rotation, or by other acceptable means that its personnel will be able to meet in an ongoing fashion the experience requirements established by the MCA for approval to function as EMT-S or EMTP, consistent with present skills maintenance program. 13. The service shall have demonstrable experience in the provision of ALS care, through other areas of coverage, background of its management and personnel, or through other acceptable means. 14. The service shall provide in writing appropriate back-up coverage for their ALS/LALS unit(s) through acceptable means, i.e., mutual aid agreements, multiple units, etc. 15. The service shall demonstrate a commitment to quality pre-hospital care through community involvement. This may be accomplished through a variety of programs including: a. A series of CPR classes open to the public. b. A series of lectures available to the public on EMS. c. Educational program for professional agencies within the county. d. Other programs as deemed acceptable by the MCA. 16. The service shall provide to the MCA the following information: a. The name, address, and phone number of the applicant and the owner of the vehicle. b. A description of each vehicle to be authorized, including make, model, year of manufacture, Michigan License number, color schemes, and marking. c. The location(s) and description of the location(s), including heated garage facilities, from which it intends to operate. d. The proposed date for implementation of service. e. The ambulance operation license number issued by the State of Michigan to the service. f. Personnel list with licensure, qualifications and social security number. g. Such other information as the MCA shall deem reasonably necessary to grant cooperation to a potential service. 17. Proof of insurance coverage (Workers' Compensation and liability insurance). 18. Provide letter from governmental agencies within jurisdiction indicating support of licensure. 19. Provide Monroe County MCA with comprehensive communication plan. 20. Provide an application fee of One Thousand Dollars ($1000.00) with submission of the application to the MCA. AIR AMBULANCE APPLICATION PROCESS FOR MONROE COUNTY A service desiring to provide prehospital emergency medical care in Monroe County shall apply to the Monroe County Medical Control Authority (MCA) for approval to provide service at the Advanced Life Support (ALS) level at least ninety (90) days prior to their requested implementation date. The MCA may approve such request for service provided the agency applying meets the following criteria: 1. The service and vehicle(s)/aircraft(s) comply with all rules and regulations promulgated by the Michigan Department of Consumer and Industry Services (MDCIS), the Monroe County Medical Control Authority (MCA), the Monroe County Ambulance Authority, Monroe County disaster plan and any local ordinances as they refer to the provision of EMS within Monroe County. 2. Each vehicle shall be equipped with communications equipment properly maintained and utilized in accordance with the MDCIS MEDCOM Plan. 3. Care shall be available twenty-four (24) hours a day, seven (7) days a week. 4. Each approved vehicle shall be staffed by a minimum of one (1) licensed physician, and one (1) licensed RN/EMT. 5. The service agrees to adhere to the treatment protocols, continuing education requirements, communications policies, reporting requirements, participation in audit programs, and adherence to all other guidelines and programs established by the MCA. 6. Basic and/or Advanced medical equipment utilized by the air ambulance shall meet the criteria established by the MCA and the MDCIS requirements for licensure. 7. The service shall provide a sixty (60) day work schedule for the personnel for each unit being applied for. 8. Aircraft shall be licensed through in accordance with regulations. 9. All units shall be identified through application of standard terminology and a uniform numbering system throughout Monroe County as established by the MCA. 10. The service shall agree to work with existing services for coordination of unit utilization. The service's vehicle(s) will function within the EMS system to provide countywide coverage, and will be moved appropriately within the system to best serve the populace of Monroe County 11. The service shall have demonstrable experience in the provision of prehospital care, through other areas of coverage, background of its management and personnel, or through other acceptable means. 12. The service shall provide in writing appropriate back-up coverage for their aircraft through acceptable means, i.e., mutual aid agreements, multiple units, etc. 13. The service shall demonstrate a commitment to quality pre-hospital care through community involvement. This may be accomplished through a variety of programs including: a. A series of CPR classes open to the public. b. A series of lectures available to the public on EMS. c. Educational program for professional agencies within the county. d. Other programs as deemed acceptable by the MCA. 14 The service shall provide to the MCA the following information: a. The name, address, and phone number of the applicant and the owner of the vehicle. b. A description of each vehicle to be authorized, including make, model, year of manufacture, State License number, color schemes, and marking. c. The location(s) and description of the location(s) from which it is intended to operate. d. The proposed date for implementation of service. e. The ambulance operation license number issued by the State of Michigan to the service. f. Personnel list with licensure, qualifications and social security number. g. Such other information as the MCA shall deem reasonably necessary to grant cooperation to a potential service. 15. Proof of insurance coverage (Workers' Compensation and liability insurance). 16. Provide letter from governmental agencies within jurisdiction indicating support of licensure. 17. Provide Monroe County MCA with comprehensive communication plan. 18. Provide application fee of One Hundred Dollars ($100.00) with submission of the application to the MCA. |