9 PROPOSED ADMINISTRATIVE RULES

 

 

ORR # 2001-016

 

DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES

 

BUREAU OF HEALTH SERVICES DIRECTOR’S OFFICE

 

EMERGENCY MEDICAL SERVICES PERSONNEL LICENSING

 

Filed with the Secretary of State on

These rules take effect 7 days after filing with the Secretary of State

 

(By authority conferred on the department of public health by  sections 2226(d), 2233, 20115, 20171,  and 20771 of Act No. 368 of the Public Acts of 1978, as amended, being SS333.2226(d), 333.2233, 333.20115, 333.20171, and 333.20771 of the Michigan Compiled Laws)

 

(By authority conferred on the director of the department of consumer and industry services by 1978 PA 368 and Executive Reorganization Order No. 1996-1, MCL 333.20901)

 

R 325.23101, R. 325.23102, R 325.23103, R. 325.23104, R 325.23105, R 325.23106, R 325.23107, R

325.23201, R 325.23202, R 325.23203, R 325.23301, R 325.23302, R 325.23303, R 325.23304,   R

325.23401, R 325.23402, R 325.23403, R 325.23404,   R 325.23405, R 325.23406, R 325.23407, R

325.23501, R 325.23502, R 325.23503, R 325.23504, R 325.23505, R 325.23506, R 325.23507, R

325.23601, R 325.23602,  R 325.23603, R 325.23701, R 325.23702, R 325.23703, R 325.23704,  R

325.23705, R 325.23706,   R 325.23707, R 325.23801, R 325.23802, R 325.23803, R 325.23804, R

325.23805, R 325.23806, R 325.23807,   R 325.23808, R 325.23901, R 325.23902, R 325.23903, R

325.23904,  R 325.23905, R 325.23906, R 325.24001, R 325.24002, R 325.24003,  R 325.24005, R

325.24006, R 325.24007, R 325.24008, R 325.24009,   R 325.24010, R 325.24011, R 325.24012, R

325.24013, R 325.24014,  R 325.24015, R 325.24016, R 325.24017, R 325.24018, R 325.24020,  R

325.24101, R 325.24102, R 325.24103, R 325.24104, R 325.24105,   R 325.24106, R 325.24107, R

325.24108, R 325.24109, R 325.24110,   R 325.24111, R 325.24112, R 325.24113, R 325.24114, R

325.24115,   R 325.24116, R 325.24117, R 325.24118 of the Michigan Administrative Code are

rescinded and R 325,22301, R 325.22302, R 325.22311, R 325.22312, R 325.22313, R 325.22314, R

325.22315, R 325.22316, R325.22321,    R 325.22322, R 325.22323, R 325.22324, R 325.22325, R

325.22326,R 325.22327, R 325.22331, R 325.22332, R 325.22333, R 325.22334,    R 325.22335, R

325.22336, R 325.22337, R 325.22338, R 325.22339,    R 325.22340, R 335.22341, R 325.22342, R

325.22343, R 325.22344,  R 325. 22345, R 325.22346, R 325.22347, R 325.22348, R 325.22349, R

325.22350, R 325.22351, R 325.22352, R 325.22353, R 325.22354,   R 325.22355, R 325.22356, R

325.22357, R 325.22358, R 325.22359, R 325.22360, R 325.22361, R 325.22362, and R 325.22363

are added to the Michigan Administrative Code as follows:

 

PART 1. GENERAL PROVISIONS

 

 

R 325.22301  Definitions.

Rule 22301. As used in these rules:

(a)   “Code” means 1978 PA 368, MCL 333.1101 et seq.

(b)   “Continuing education” means programs of education or training approved by the department for use by licensees to meet requirements for renewal or relicensure.

(c)      “CPR credential” means a department-approved cardiac pulmonary resuscitation (cpr) program for a health care provider or highest equivalent level of training.

(d)   “Department” means the department of consumer and industry services.

(e)   "EMS" means emergency medical services.

(f)  “Endorsement” means the recognition of the licensing authority of one state by another state.

(g)   “NREMT” means the national registry of emergency medical technicians.

(h)     "Ongoing education" means education or training sessions,  refresher courses, and other learning activities approved by the department and designed to assist individuals who are seeking licensure, or to assist personnel in maintaining and upgrading their knowledge and skills on an ongoing basis throughout the term of their licensure.

(i)   “Ongoing education” is also referred to as continuing education.

(j)     “Ongoing education credits" means the unit of measure, equal to 50 to 60 minutes of instruction, which is assigned to a specific ongoing education topic.

(k)    “On-site program sponsor approval” means compliance with the state- approved program criteria by which an educational program is reviewed to determine its compliance with preset educational goals, expectations and equipment requirements.

(l)   "Physician" means a doctor of medicine or doctor of osteopathy who possesses a valid license to practice medicine in Michigan.

(m)    "Physician director" means a physician who serves as the medical advisor for an education program and who is responsible for establishing the standards for emergency medical care instruction utilized in the program.

(n)   “Relicensure” means the granting of a license to a person whose license has lapsed for failure to renew the license within 60 days after the expiration date.

(o)   “Renewal” means continuation of a license based on completion of requirements and payment of any fees within the time limits established.

 

R 325.22302 Terms defined in the code.

Rule 22302. Terms defined in the code have the same meanings when used in these rules. PART 2. EMERGENCY MEDICAL SERVICES PERSONNEL LICENSING

R 325.22311 Examination application.

Rule 22311. For an applicant to take the appropriate examination, an application for examination shall be completed and submitted to the department or state-designated representative within 2 years of the course completion date. An applicant who submits an application more than 2 years after the course completion date shall meet any additional requirements established for acceptance into the examination.

 

R 325.22312 Licensure by examination.

Rule 22312. An applicant for licensure by examination shall submit a completed application on a form provided by the department, together with the requisite fee.   In addition to meeting the

 

 

requirements of the code and administrative rules, an applicant for licensure by examination shall meet all of the following requirements:

(a)   Completion of an appropriate education program at the level applied for, as approved under section 20912 of the code, and the proof of completion sent directly from the education program to the department.

(b)   A first-time applicant shall attain a passing score on the appropriate department-prescribed examination. The passing scores shall be submitted directly to the department by the testing agency.

(c)    An individual applying to the department for licensure by having passed the department- prescribed examinations shall have completed an initial education course within 2 years of application.

(d)     The fees paid by an applicant who has not completed all requirements for licensure by examination within 2 years of the department’s receiving the application shall be forfeited to the department and the application shall be void.

(e)   An individual who is guilty of fraud or deceit in procuring or attempting to procure licensure, including using falsified documents to gain admittance to a department-prescribed licensure examination, shall be denied licensure for at least 2 years.

(f)   An individual shall not represent himself or herself as, function as, or perform the duties of, a licensed medical first responder, emergency medical technician, emergency medical technician specialist or paramedic until licensed by the department in accordance with the code and these rules.

 

R 325.22313 Licensure at lower levels.

Rule 22313. A current ems licensee who applies for a lower level license shall meet all of the following requirements:

(a)    A paramedic, who holds an active license, may apply for a license as an emergency medical technician specialist, emergency medical technician or medical first responder by submitting a new application for the lower level license along with the fee and proof of having earned the required continuing education at the emergency medical technician specialist, emergency medical technician, or medical first responder level.

(b)    An emergency medical technician specialist, who holds an active license, may apply for a license as an emergency medical technician or medical first responder by submitting a new application for the lower level along with the fee and proof of having earned the required continuing education at the emergency medical technician or medical first responder level.

(c)    An emergency medical technician, who holds an active license, may qualify to apply for a license as a medical first responder by submitting a new application for the lower level along with the fee and proof of having earned the required continuing education at the medical first responder level.

 

R 325.22314 Licensure by endorsement.

Rule 22314. An applicant for licensure by endorsement shall submit a completed application on a form provided by the department together with the requisite fee, and all of the following documentation:

(1)       Verification of current licensure/certification/registration in any state which granted permission to practice.

 

 

(2)    Examination scores for a department-prescribed examination which shall be submitted to department and which verify passage of examinations or nremt status, or both.

(3)   Sanctions or grounds for sanctions by another state that may exist at time of application which shall disqualify the applicant until the other state certifies that those sanctions or grounds for sanctions no longer exist for the applicant.

 

R 325.22315 Licensure by national registry status only.

Rule 22315. An applicant for licensure who has active nremt status only and who has not been licensed in any other state shall submit a completed application on the form provided by the department, together with the requisite fee, and shall meet both of the following requirements:

(1)  Request nremt to send verification of scores or nremt status, or both.

(2)    Provide proof of training that is substantially equivalent to the state-prescribed curriculum and proof of continuing education or training in areas determined deficient by the department.

 

R 325.22316 License renewal.

Rule 22316. Not more than 60 days before the date of license expiration, the department shall transmit to the last known address of the licensee an application for license renewal. Failure of the licensee to receive notice for renewal shall not relieve the licensee of the responsibility for renewing his or her license.

 

PART 3. CONTINUING EDUCATION REQUIREMENTS

 

R 325.22321 License renewal or relicensure for medical first responders; continuing education. Rule 22321. (1) An applicant for license renewal as a medical first responder who has been licensed for the 3-year period immediately preceding the expiration date of the license or an applicant for relicensure as a medical first responder shall accumulate at least 15 continuing education credit hours that are approved by the department under these rules during the 3 years preceding an application for renewal or relicensure.

(2)   An applicant for license renewal or for relicensure under section 20954 of the code, in addition to the requirements of subrule (1) of this rule, shall have an appropriate and current cpr credential as determined by the department. Continuing education credit for a cpr credential may be part of the medical continuing education category requirement.

(3)   The categories of approved continuing education activities for medical first responders shall include, but are not limited to, all of the following topics:

(a)  Preparatory.

(b)   Airway management and ventilation.

(c)  Patient assessment. (d)Trauma.

(e)    Medical.

(f)    Special considerations.

(g)    Operations.

 

R  325.22322  License  renewal  or  relicensure  for  emergency  medical  technicians;  continuing education.

Rule 22322. (1) An applicant for license renewal as an emergency medical technician who has been licensed for the 3-year period immediately preceding the expiration date of the license or an

 

 

applicant for relicensure as an emergency medical technician shall accumulate at least 30 continuing education credit hours that are approved by the department under these rules during the 3 years preceding an application for renewal or relicensure.(2) An applicant for license renewal or relicensure pursuant to section 20954 of the code, in addition to the requirements of subrule (1) of this rule, shall have an appropriate and current cpr credential as determined by the department. Continuing education credit for a cpr credential may be part of the medical continuing education category requirement.

(3)  The categories of approved continuing education activities for emergency  medical  technicians shall include, but are not limited to, all of the following topics:

(a)   Preparatory.

(b)   Airway management and ventilation.

(c)   Patient assessment.

(d)   Trauma.

(e)   Medical.

(f)  Special considerations.

(g)   Operations.

 

R  325.22323  License  renewal  or  relicensure  for  emergency  medical  technican  specialists; continuing education.

Rule 22323. (1) An applicant for license renewal as an emergency medical technician specialist who has been licensed for the 3-year period immediately preceding the expiration date of the license or an applicant for relicensure as an emergency medical technician specialist shall accumulate at least 36 continuing education credit hours that are approved by the department under these rules during the 3 years preceding an application for renewal or relicensure.

(2)   An applicant for license renewal or for relicensure under section 20954 of the code, in addition to the requirements of subrule (1) of this rule, shall have an appropriate and current cpr credential as determined by the department. Continuing education credit for a cpr credential may be part of the medical continuing education category requirement.

(3)   The categories of approved continuing education activities for emergency medical technician specialists shall include, but are not limited to, each of the following topics:

(a)   Preparatory.

(b)   Airway management and ventilation.

(c)   Patient assessment.

(d)   Trauma.

(e)   Medical.

(f)  Special considerations.

(g)   Operations.

 

R 325.22324 License renewal or relicensure for paramedics; continuing education.

Rule 22324. (1) An applicant for license renewal or relicensure as a paramedic who has been licensed for the 3-year period immediately preceding the expiration date of the license or an applicant for relicensure as a paramedic shall accumulate at least 45 continuing education credit hours that are approved by the department under these rules during the 3 years preceding an application for renewal or relicensure.

(2)   An applicant for license renewal or for relicensure under section 20954 of the code, in addition to  the  requirements  of  subrule  (1)  of  this  rule,  shall  have  an  appropriate  and  current  cpr

 

 

credential as determined by the department.  Continuing education credit for cpr credential may be part of the medical continuing education category requirement.

(3)    The categories of approved continuing education activities for paramedics shall include, but are not limited to, all of the following topics:

(a)   Preparatory.

(b)   Airway management and ventilation.

(c)   Patient assessment.

(d)   Trauma.

(e)   Medical.

(f)  Special considerations.

(g)   Operations.

 

R 325.22325 Certification of compliance; additional documentation.

Rule  22325.  (1)  Submission  of  an  application  for  renewal  or  relicensure  shall  constitute  the applicant’s certification of compliance with the requirements of these rules.

(2)   The department may require an applicant or licensee to submit documentation to demonstrate compliance with the continuing education requirement. The applicant or licensee shall maintain documentation of his or her compliance with the continuing education requirement for a period of 1 year after the expiration date of the license. Failure to provide such documentation creates a rebuttable presumption that the licensee has made a false and fraudulent statement in applying for a license to practice emergency medical services. As provided under section 20958 of the code, the department shall determine if failure to provide documentation of compliance with the continuing education requirement is a violation of section 20954 of the code.

(3)   Acceptable documentation of continuing education shall include all of the following:

(a)   Name of licensee participating in program.

(b)   Name of sponsoring organization and instructor-coordinator number.

(c)   Title of program.

(d)   Hours of continuing education credit awarded per required category.

(e)   Date of program.

(f)  Signature of instructor-coordinator or designee.

 

R 325.22326 Continuing education courses and programs; standards for approval.

Rule 22326. (1) One continuing education credit hour may be earned for each 50 to 60 minutes of instruction at an approved education program that complies with this rule and R 325.22327.

(2)    Initial education program sponsors shall be approved for up to 3 years for presentation of continuing education programs at the level consistent with education approval upon submission and approval of a continuing education sponsor application.

(3)     The department approves and adopts, by reference, the standards and criteria of the continuing education coordinating board for emergency medical services (cecbems) that are in the publication entitled “CECBEMS Standards and Requirements for Organizational Accreditation”. A copy of the publication is available for inspection and distribution to the public at cost from the Department of Consumer and Industry Services, Bureau of Health Services, P.O. Box 30670, Lansing, MI 48909. A printed copy also is available at from CECBEMS 5111 Mill Run Road Dallas, TX 75244 or on-line at http://www.cecbems.org/system.cfm at no cost. Any program approved by cecbems shall be considered a Michigan-approved continuing education program.

(4)   The department approves and accepts, by reference, the standards for

 

 

credentialing in basic and advanced life support set forth by the American heart association in the guidelines for cardiopulmonary resuscitation and emergency cardiac care for professional providers and published in “Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care” (70-2041). A copy of the guidelines for cardiopulmonary resuscitation and emergency cardiac care is available for inspection and distribution to the public at cost from the Department of Consumer and Industry Services, Bureau of Health Services, P.O. Box 30670, Lansing, MI 48909. A printed copy also is available from the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 or http://www.americanheart.org at a cost of $20 as of the adoption of these rules.

(5)    Medical first responders completing an emergency medical technician course, or emergency medical technicians and emergency medical technician specialists completing a paramedic program may be awarded all the required ongoing education credit for the lower licensure level for the current renewal period.

(6)   Continuing education credit may be awarded for continuing education programs approved by the Michigan boards of medicine, osteopathic medicine, nursing, or pharmacy toward the ems license if directly related to the emergency medical scope of practice issues, as determined by the department.

(7)    Five continuing education credit hours may be awarded for each semester credit earned for academic courses related to ems that are offered either in an educational program approved by the Michigan boards of medicine, osteopathic medicine, or nursing, or in an approved physician assistant program.

(8)    Three continuing education credit hours may be awarded for each term credit earned for academic courses related to ems that are offered either in an educational program approved by the Michigan boards of medicine, osteopathic medicine, or nursing, or in an approved physician assistant program.

(9)     Credit may be requested for programs offered by out-of-state or military-sponsored ems agencies before license renewal.

(10)   The department or its designee shall publish a list of acceptable state or national programs sponsored by emergency medical organizations or other related organizations that do not meet any of the criteria listed in subrules (2) to (8) of this rule with pre-approved credits indicated in the publication.

 

R 325.22327 Continuing education program sponsors.

Rule 22327. (1) The department shall consider requests for approval of continuing education programs by instructor-coordinators, program sponsors, or other parties not covered in R 325.22326 who submit applications on a form provided by the department. The department or its designee shall evaluate applications for approval based on, but not limited to, the following criteria:

(a)   Educational goals or learning objectives.

(b)  Time schedule and continuing education credits to be awarded.

(c)   Sample certificate or documentation of attendance to be issued to attendees.

(d)   Documentation of qualifications of presenters.

(e)   Use of appropriate and adequate facilities for a program.

(f)  Program content that shall relate to the general subject of emergency medicine.

(g)   Evaluation tools to be used in a program.

 

 

(2)   All applications for approval to conduct continuing education courses shall be submitted to the department or its designee on forms provided by the department at least 30 days before implementing the programs.

(3)   Any individual attending out-of-state or military-sponsored ongoing education programs shall submit a request for approval of the program to the department or its designee if continuing education credits are to be awarded.

(4)   Continuing education sponsor approval may be granted for up to 3 years.

(5)    Independent study such as continuing education articles in professional journals, ongoing serial productions, or interactive computer programs shall be acceptable, if the program is developed by a professional group such as an educational institution, corporation, professional association, or other approved provider of continuing education and meets all of the following criteria:

(a)     Requires a participant to make an active and appropriate response to the educational materials presented.

(b)   Provides a test or evaluation tool.

(c)   Provides a record of completion as described in R 325.22325.

 

PART 4. INSTRUCTOR-COORDINATORS

 

R 325.22331 Licensure by examination; requirements.

Rule 22331. (1) An applicant for licensure by examination shall submit a completed application on a form provided by the department, together with the requisite fee. In addition to meeting the other requirements of the code and the administrative rules, an applicant shall do all of the following:

(a)     Be a licensed emergency medical technician, emergency medical technician  specialist, or paramedic.

(b)      Demonstrate successful completion of an approved instructor-coordinator educational program.

(c)   Have completed 3 years of full time, part time, on-call, or volunteer direct patient care with a licensed life support agency or other organization providing health care services as formally verified by a licensed physician or health care services agency director.

(d)   Pass the examination set forth in R 325.22332.

(2)    The fees paid by an applicant who has not completed all requirements for licensure by examination within 2 years of the department’s receiving the application shall be forfeited to the department and the application shall be void.

(3)   An individual who is guilty of fraud or deceit in procuring or attempting to procure licensure, including using falsified documents to gain admittance to a department-prescribed licensure examination, shall be denied licensure for a period of at least 2 years.

(4)   An individual shall not represent himself or herself as, function as, or perform the duties of, a licensed instructor-coordinator until licensed as such by the department in accordance with the code and these rules.

 

R 325.22332 Examination application for instructor-coordinator.

Rule 22332. An application for examination as an instructor-coordinator shall be completed and returned to the department within 2 calendar years of course completion. A candidate for examination whose application is received more than 2 calendar years after course completion

 

 

shall successfully complete another instructor-coordinator course before being admitted into a subsequent examination.

 

R 325.22333 Instructor-coordinator examination.

Rule 22333. The department or its designee shall administer a written examination to graduates of an instructor-coordinator education course conducted by a department-approved education program.

 

R 325.22334 Failure to pass examination; education course required; reexamination.

Rule 22334. An applicant who fails to attain a passing score on the written examination in 3 attempts shall successfully complete an approved instructor-coordinator education course or refresher course before reapplying to the department for further examination.

 

R 325.22335 Licensure by endorsement.

Rule 22335. An applicant for licensure by endorsement shall submit a completed application on a form provided by the department together with the requisite fee, and submit documentation of the following:

(1)       Verification of current licensure/certification/registration in any state which granted permission to practice.

(2)   Examination scores for a department-prescribed examination which shall be submitted to the department and which verify passage of examinations and/or nremt status.

(c)     Proof of training that is substantially equivalent to the state-prescribed curriculum and proof of continuing education or training in areas deemed deficient by the department.

(d)      Sanctions or grounds for sanctions by another state that may exist at time of application, which shall disqualify the applicant until the other state certifies that those sanctions or grounds for sanctions no longer exist for the applicant.

 

R 325.22336 Continuing education for instructor-coordinators; requirements.

Rule 22336. (1) All licensed instructor-coordinators shall accrue 30 continuing education credits in ongoing education programs specified by the department as appropriate for licensed instructor- coordinators. The continuing education credits shall be accrued during the 3-year licensure period.

(2)   All continuing education courses shall be approved by the department or its designee before implementation if continuing education credits are to be awarded.

(3)   Instructor-coordinators shall earn 30 continuing education hours in 1 of the following ways:

(a)     Completion of a minimum 30-hour department-approved instructor-coordinator refresher course.

(b)     Completion of the required 30 hours in department-approved professional development programs.

(c)   Completion of a total of 30 hours in professional development and educational experience with a minimum of 20 hours in department-approved professional development programs and a minimum of 10 hours in educational experience as defined by the department.

 

R 325.22337  Instructor-coordinator license renewal or relicensure.

Rule 22337. (1) Not more than 60 days before the date of license expiration, the department shall transmit to the last known address of the licensee, an application for license renewal.  Failure of

 

 

the licensee to receive notice for renewal shall not relieve the licensee of the responsibility for renewing his or her license.

(2) An applicant for license renewal or relicensure as an instructor-coordinator who has been licensed for the 3-year period immediately before the expiration date of the license or an applicant for relicensure, in addition to holding a current license as an emergency medical technician, emergency medical technician specialist, or paramedic, shall accumulate during the 3 years before an application for renewal or relicensure at least 30 continuing education credit hours in department-approved programs.

 

R 325.22338 Certification of compliance; additional documentation.

Rule 22338. (1) Submission of an application for renewal or relicensure shall constitute an applicant’s certification of compliance with the requirements of this rule.

(2)   The department may require an applicant or licensee to submit documentation to demonstrate compliance with the continuing education requirement. An applicant or licensee is responsible for maintaining documentation of his or her compliance with the continuing education requirement for a period of 1 year from the expiration date of the license. Failure to provide such documentation creates a rebuttable presumption that the licensee has made a false and fraudulent statement in applying for a license to practice emergency medical services. As provided under section 20958 of the code, the department shall determine if failure to provide documentation of compliance with the continuing education requirement is a violation of section 20954 of the code.

(3)   Acceptable documentation of continuing education shall include:

(a)   Name of the licensee participating in the program.

(b)   Name of sponsoring organization and instructor-coordinator number.

(c)   Title of program.

(d)   Hours of continuing education credit awarded per required category.

(e)   Date of program.

(f)  Signature of instructor-coordinator or designee.

 

PART 5. EDUCATION PROGRAM REQUIREMENTS

 

R 325.22339 Education programs; requirements.

Rule 22339. (1) A medical first responder, emergency medical technician, emergency medical technician specialist, or paramedic education program shall comply with all of the following requirements:

(2)   Be under the direction of a physician director, except for medical first responder education programs.

(3)    Be coordinated by a licensed instructor-coordinator who shall ensure that an instructor- coordinator, qualified instructor, or subject matter expert is in attendance at all didactic and practical sessions.

(4)   Apply to the department, on forms provided by the department or its designee, for educational program sponsor approval to conduct an education course at least 60 days before the start of the course, and be approved by the department through an on-site program sponsor approval process before implementation.

(5)   Advise the students before or at the first class session that the education program and course are approved by the department.

(6)   Conduct courses according to an on-site program sponsor approval process.

 

 

(7)   Provide the department and its designee within 30 calendar days of course completion with a list of students who successfully completed the course, including at least each student’s name and date of birth, with social security number, if possible.

 

R 325.22340 Instructor-coordinator education program; requirements.

Rule 22340. (1) An instructor-coordinator education program shall comply with all of the following requirements:

(a)    Be coordinated by a licensed instructor-coordinator who has coordinated at least 1 initial education program in the last 3 consecutive years.

(b)   Utilize qualified instructional staff with appropriate expertise.

(c)   Include classroom and supervised student teaching or internship experience in the curriculum.

(d)   Apply to the department, on forms provided by the department or its designee, to conduct an education course at least 60 days before the start of the course, and be approved by the department through an on-site program sponsor approval before implementation.

(2)   Conduct courses according to an on-site program sponsor approval process.

 

R 325.22341 Education program sponsor responsibilities.

Rule 22341. (1) An education program sponsor shall be responsible for the overall quality of the program and courses offered. The program sponsor, the instructor-coordinator, and the physician director shall be responsible for, but not limited to, all of the following:

(a)   Establishing admission requirements and conducting entry assessments, as required.

(b)   Establishing standards for successful course completion.

(c)   Establishing standards for instructors and approval of all instructors.

(d)   Ensuring that the medical control authority in the region is informed of the program.

(e)   Establishing clinical contracts specific to the level of the program and expected activities.

(f)   Monitoring the activities of the emergency medical services instructor-coordinator based on standards developed by the program sponsor.

(g)   Establishing an equal opportunity policy that at a minimum complies with state and federal law.

(h)     Providing an adequate and appropriate instructional facility including making available equipment that is functional, in good repair, and is of a similar type to that currently on the list of required minimum equipment for life support vehicles.

(i)   Developing examinations based on approved curricula.

(j)   Developing a process for students to appeal decisions made by the staff or sponsor relative to their performance in the course. This process shall be made available, in writing, to each student.

 

R 325.22342 Instructor-coordinator responsibilities.

Rule 22342. (1) An instructor-coordinator for all emergency medical educational training courses shall possess a current ems license that shall be at least 1 level above the training course being taught. Only an instructor-coordinator with a paramedic license may be responsible for a paramedic course.

(2)     The instructor-coordinator responsibilities shall include, but not be limited to, all of the following:

(a)      Complying with instructor-coordinator performance standards indicated in instructor- coordinator curriculum.

 

 

(b)   Being responsible for course development, evaluation, and coordination of curricular elements, including those of a clinical nature, and assisting in the selection and evaluation of instructors, with the approval of the program sponsor and physician director.

(c)   Planning the course content and ensuring that it complies with the department’s requirements.

(d)   Assisting in the evaluation and selection of students.

(e)   Evaluating and maintaining records of student performance.

(f)  Maintaining and assuring the availability of equipment and training aids.

(g)   Coordinating and maintaining records of clinical experience.

(h)   Counseling and assisting students, as appropriate.

(i)    Presenting to the department at the conclusion of the course the names of the students who have successfully met the department’s objectives for course completion.

 

R 325.22343 Education program physician director; responsibilities.

Rule 22343. (1) The education program physician director responsibilities shall include, but are not limited to, all of the following:

(a)    Conducting a periodic review of the organization and content of a course to ensure that current standards of emergency medical care are being utilized throughout the course.

(b)     Working with the education sponsor and the instructor-coordinator in carrying out the responsibilities of course development, evaluation, and coordination of curricular elements, including those of a clinical nature, and selecting and evaluating instructors.

(c)   Having clinical experience and current expertise in providing emergency care.

 

R 325.22344 Education program course instructor; requirements.

Rule 22344.  (1) An education program course instructor shall meet, at a minimum, both of the following requirements:

(a)    Have a working and practical knowledge of the objectives and components of the education course relevant to his or her area of instruction.

(b)    Be a licensed health professional with relevant and current clinical experience, or possess educational expertise that is appropriate to his or her specific topic of instruction.

 

R 325.22345 Department evaluation of education programs.

R 22345. (1) The department may evaluate an emergency medical services program at any time. An evaluation shall commence when any of the following occurs:

(a)   A request for a new program is submitted.

(b)     The failure rate on the required licensure examination for 1 calendar year of compiled statistics is more than 10% below the threshold established by the department.

(c)   Complaints regarding the conduct of the program are received and it is necessary to validate the complaints.

(2)   Evaluation processes may include any of the following:

(a)   A site visit.

(b)   A follow-up study of graduates and employers.

(c)   A review of available statistical information available regarding the program.

 

PART 6. HEARING PROCEDURES

 

R 325.22346 Applicability.

 

 

Rule 22346. (1) The procedures set forth in this part apply to hearings required by sections 20162(5), 20165, 20166, and 20168 of part 201 of the code as they relate to advanced mobile emergency care services, limited advanced mobile emergency care services, ambulances, and ambulance operations and as they relate to sections 20739, 20766, and 20767 of part 207 of the code.

(2)    Unless otherwise provided by the code, the procedures for a hearing shall comply with chapters 4 and 5 of Act No. 306 of the Public Acts  of 1969, as amended, being SS24.271 to 24.292 of the Michigan Compiled Laws.

 

R 325.22347 Compliance orders; opportunity to show compliance.

Rule 22347. (1) When the department issues a compliance order to an ambulance operation, limited advanced mobile emergency care service, or advanced mobile emergency care service under the  provision  of  section 20162(5) of the code, the compliance order shall comply with  all of the following requirements:

(a)  Describe the violation and the statute or rule violated.

(b)  Specify the corrective action to be taken and the period of time in which corrective action is to be completed.

(c)    Inform the licensee that he or she has a right to a hearing within 5 days from the time of service and that, if he or she wishes to be heard, the department will have a hearing officer present at the time or place specified in the compliance order.

(2)  Failure to raise a defense on or before the hearing, or to appear at the hearing, shall be deemed an admission of the matters asserted in the compliance order. If the respondent fails to make an appearance or to contest the notice, the compliance order shall be final without any further proceeding.

(3)     Before  commencing  the   proceedings   for   denial,   limitation, revocation, or  suspension  of a license, authorization, approval, or certification for an ambulance operation, advanced mobile emergency care service, limited advanced mobile emergency care service, or emergency personnel required to be licensed, authorized, approved, or certified by the code and these rules, the department shall give notice to the applicant or holder of the license, authorization, approval, or certification, personally or by certified mail, of the facts or conduct which warrants the intended action and shall provide the applicant or holder of the  license, authorization, approval, or certification with an opportunity to show compliance with the code and these rules at a compliance conference.

(4)   If the applicant or holder of the license, authorization, approval, or certification is unable to demonstrate compliance with all lawful requirements for licensure, authorization, approval, or certification to the satisfaction of  the  department  at  the  compliance  conference,  the department may issue a notice of hearing which shall state the grounds for the amendment, denial, suspension, or revocation or grounds for the department's intent to amend, deny, limit, suspend, or revoke the license, authorization, approval, or certification.

 

R 325.22348 Hearing; initiation; content of notice; conduct.

Rule 22348. (1) A hearing is initiated by the department by giving notice thereof to the respondent, either personally or by certified mail. Notice shall include all of the following information:

(a)   The time, date, place, and nature of the hearing.

(b)   The action intended by the department and a brief statement of the facts involved.

(c)   The legal authority and jurisdiction under which the hearing is to be held.

 

 

(d)   A reference to the applicable sections of the code and the rules involved.

(2) The hearing shall be conducted by the director or 1 or more hearing officers designated by the director.

 

R 325.22349 Service; proof of service.

Rule 22349 . Unless otherwise specified, service of a document upon any party shall be made by personal delivery or by certified mail to the last known address of the party or the authorized representative of a party as indicated on the records of the department, and proof of service shall be filed with the department.

 

R 325.22350 Appearance.

Rule 22350. A party may appear in person,  by  an  authorized representative, or by legal counsel.

 

R 325.22351  Pleadings and documents.

Rule 22351. (1) All pleadings shall contain the department's caption and docket number, if assigned, and shall include a clear and plain statement of facts alleged and the relief sought.

(2)   A pleading, other than an exhibit, shall be typewritten, double spaced, and on letter-size opaque paper, approximately 8 1/2 inches by 11 inches. The left margin shall be 1 1/2 inches and the right margin 1 inch. A pleading and other documents shall be fastened in the upper left corner.

(3)   A hearing shall be titled "In the matter of (name of  respondent)."  This caption shall appear at the upper left side of the first page of each filed pleading or document other than an exhibit.

(4)   The first page of a pleading or document, other than an exhibit, shall show at its upper right side, opposite the caption, the docket number assigned by the department, if known.

 

R 325.22352  Extension of time; request.

Rule 22352. A request for an extension of time for the filing of a pleading or document shall be made in writing and served on the presiding officer and all parties not less than 5 days before the date on which the pleading or document is due to be filed.

 

R 325.22353  Answer.

Rule 22353. Within 15 days after service of a notice of hearing, a respondent may file a written answer with the department. The answer shall respond to all allegations in the notice of hearing which the party plans to contest and shall raise any affirmative defenses. All allegations not denied by written answer are deemed admitted.

 

R 325.22354  Consolidation; severance.

Rule 22354. (1) Cases may be consolidated, for good cause, on the motion of any party or the hearing officer's own motion, in such circumstances as justice and the administration of the code and these rules require. A motion for the consolidation of cases shall be filed within 20 days after service of the notice of hearing on each party to the cases which would be consolidated. Within 10 days after service of the motion, the other parties may file a response thereto. Unless a request for oral argument is made and granted, the termination of the motion shall be made  on  the pleadings.

 

 

(2) Upon his or her own motion, or upon motion of any party, the hearing officer, for good cause, may order any case severed as to some or all issues or parties.

 

R 325.22355  Presiding officer; powers and duties; disqualification.

Rule 22355. (1) A presiding officer shall have all  powers  necessary  or appropriate to conduct a fair, full, and impartial hearing, including the power to do all of the following:

(a)   Administer oaths and affirmations.

(b)   Rule upon offers of proof and receive relevant evidence.

(c)   Provide for the taking of testimony by deposition.

(d)   Regulate the course of the hearings, set  the  time  and  place  for continued hearings, fix the time for filing of briefs and other documents, and issue subpoenas.

(e)   Consider and rule upon procedural requests.

(f)  Hold conferences for the settlement or simplification of the issues by consent of the parties.

(g)   Prepare proposed decisions, if required.

(2) When a hearing officer believes himself or herself disqualified to preside over a particular hearing, he or she shall withdraw therefrom by notice on the record directed to the director. A party who claims that a hearing officer should be disqualified to preside, or to continue to preside, over a particular hearing may file with the director a motion to

disqualify. The motion shall be supported by affidavits setting forth the alleged grounds for disqualification. The director shall rule upon the motion, and the decision  shall  be determinative for purposes of the hearing.

 

R 325.22356  Prehearing conference.

Rule 22356. (1) The presiding officer, upon request of any party or on his or her own motion, may order a prehearing conference for the purpose of facilitating the disposition of a contested case.

(2)   The purposes of the prehearing conference are as follows:

(a)   State and simplify the factual and legal issues to be litigated.

(b)   Admit matters of fact and the authenticity of documents and resolve other evidentiary matters to avoid unnecessary proof.

(c)   Exchange lists of witnesses and the nature of their testimony.

(d)   Estimate the time required for the hearing.

(e)   Resolve other matters that may aid in the disposition of the case.

(3)   At the prehearing conference, the presiding officer may make rulings on motions pertaining to evidence, law, and procedure, when practicable. A record shall be made of all motions and rulings and other matters deemed appropriate at the presiding officer's discretion and shall become a part of the hearing record.

(4)   The parties to a hearing are encouraged to  voluntarily  confer  for the purpose of facilitating the disposition of a case.

 

R 325.22357 Adjournment.

Rule 22357. A party may request an adjournment of a scheduled hearing by motion to the presiding officer assigned to conduct the hearing. The presiding officer shall not rule on the request until  opposing  parties have had an opportunity to be  heard  on  the  request.  However, if all parties agree to the adjournment, then the presiding officer may rule on

the request immediately.

 

 

 

R 325.22358  Agreement before final order.

Rule 22358. (1) At any time before a final order is issued, the  parties  may  negotiate  an agreement containing consent findings and an order disposing of the whole or a part of the case. This agreement shall be submitted to the presiding  officer  who  shall  rule  upon  it after considering the nature of the proceeding, the representations of the parties, and the probability that the agreement will result in a just disposition of the issues involved.

(2)    The agreement containing consent findings and an order disposing of a proceeding shall contain all of the following provisions:

(a)   That the consent finding and order shall have the same force and effect as if made after a full hearing.

(b)   That the record on which an order may be based shall consist solely of the pleadings and the agreement.

(c)   A waiver of any further proceedings before the hearing officer and the director.

(d)    A waiver of any right to challenge or contest, in any forum, the validity of the consent findings and order made in accordance with the agreement.

 

R 325.22359  Discovery.

Rule 22359. (1) The same rights to discovery and depositions provided in the general court rules of this state applicable to civil cases shall apply to all hearings commenced and conducted pursuant to the code and these rules. The presiding officer shall rule on all motions relative to depositions and discovery.

(2)   Discovery depositions and motions for discovery shall not be allowed by the presiding  officer if they are likely to interfere with the efficient conduct of the hearing, unless serious prejudice would result there from.

 

R 325.22360 Preliminary motions.

Rule 22360. (1) Not less than 5 days before the date set for hearing in the notice, all preliminary motions shall be filed, unless the presiding officer, for good cause shown, permits the filing of such motions at a later date. These motions include all of the following:

(a)   Motions for a more definite statement.

(b)   Motions to strike pleadings.

(c)   Motions to amend pleadings.

(d)   Motions for accelerated judgment.

(e)   Motions for summary judgment.

(f)  Discovery motions.

(g)   Motions relative to depositions.

(2)   On the date set for hearing in the notice, the presiding officer shall first hear all pending preliminary motions. He or she shall decide them in the same manner as provided for in the general court rules of the state for civil cases. Thereafter, all motions are to be made and heard at the direction of the presiding officer.

(3)     After hearing all pending preliminary  motions, if any, the presiding officer may  hold a prehearing conference as provided for in these rules.

 

R 325.22361 Direct testimony.

 

 

Rule 22361. When in any case it is deemed necessary or desirable, the presiding officer may direct that the direct testimony of any witness or witnesses be submitted in written form, together with any exhibits to be sponsored by the witness, before the hearing. Such direct testimony  shall be submitted in typewritten form on 8 1/2-inch by 11-inch paper and shall be in question and answer form. The direct testimony of each witness so submitted shall be made a separate exhibit, and the name  and  address of the witness, together with the caption of the  case,  shall  appear  on a cover sheet. Each witness is required to be present at the hearing to introduce his or her written testimony as  an exhibit  and  for cross-examination at such date, time, and place as directed by the presiding officer.

 

R 325.22362  Hearing record; transcripts.

Rule 22362. Hearings shall be recorded, but need not be transcribed unless requested by a party. The party requesting the transcript shall pay for the transcript.

 

R 325.22363  Proposal for decision.

Rule 22363. (1) Following the conclusion of a hearing, the hearing officer, if other than the director, shall deliver to the department the official case file and his or her proposal for decision. The department shall serve the proposal for decision upon the parties by registered or certified mail or personal service, and each party shall have 10 days from the date of service of the proposal for decision to file exceptions or present written arguments to the director.

(2)   Following review of the record or the proposal for  decision  and exceptions thereto, if any, the director shall issue an order setting forth findings of fact, conclusions of law, and his or her final order or an order for further proceedings. The department shall serve copies  of  the director's order upon all parties.

(3)    If no exceptions are filed, the proposal for decision shall become the final order of the department, unless the director issues his or her order within 90 days  from  the  date  of  service of the proposal for decision.

 

PART 1. GENERAL PROVISIONS

 

R 325.23101  Definitions; A. Rescinded.  Rule 101. As used in these rules:

(a)   “Advanced mobile emergency care vehicle” means any vehicle, public or private, used or designated  for the purpose of rendering advanced mobile emergency care services to the public.

(b)    “Ambulance attendant training program” means an advanced first aid and emergency care course conducted by the American red cross, including the cardiopulmonary resuscitation course prescribed  by the American red cross, or an equivalent training course approved by the department.

 

R 325.23102  Definitions; B, C. Rescinded.  Rule 102. As used in these rules:

(a)     “Basic mobile emergency care service” means a person other than an advanced or limited advanced mobile emergency care service who provides, for profit or otherwise, the personnel, vehicles, and other equipment required to perform 1 or both of the following services to the public:

(i)   A licensed ambulance operation.

(ii)   A nontransporting prehospital life support service which provides basic emergency care.

 

 

(b)    “Cardiac monitoring” means the use of an apparatus which displays all or part of a patient’s electrocardiogram.

(c) “Categorization” means an inventory of emergency department facilities which classifies each  hospital emergency department as to  the availability of services for emergency treatment of acutely ill  or injured patients.

(d)  “Certified advanced cardiac life support provider” means a person who is currently certified in  the  American heart association  advanced cardiac life support course  or  an  equivalent  course  approved  by the department.

(e)   “Code” means Act No. 368 of the Public Acts of 1978, as amended, being S333.1101 et seq. of the Michigan Compiled Laws, and known as the public health code.

(f)    “Communications failure” means the loss of communications or the inability to establish communications, either verbally or telemetrically

between the advanced emergency medical technician or the emergency medical technician specialist and the attending physician or the physician’s designee, or both, at a time when advanced or limited advanced emergency care services are required.

(g)   “Cooperating hospital” means a licensed hospital which supports a limited advanced or advanced mobile emergency care service as required by sections 20761(a) and 20763(b) of the code.

 

R 325.23103  Definitions; E to 0. Rescinded.  Rule 103. As used in these rules:

(a)   “Direct communications device” means medical control supervision of persons performing limited advanced or advanced medical techniques through the following methods of intercommunication:

(i)   Direct interpersonal communications at the scene of the emergency.

(ii)   Direct vocal communication by means of a 2-way telecommunications system.

(iii)    Written orders which shall be limited to those limited advanced or advanced medical techniques which the medical control board determines may be initiated under specific circumstances prior to vocal authorization and which are immediately reported when direct communications are established by either  of the other 2 methods of direct communications defined in this subdivision.

(b)   “EMS” means emergency medical services.

(c)    “EMS telecommunications” means the reception and transmission of messages and data in the emergency medical services system from the time of initial incident report to the time of arrival of the patient at a hospital and all other messages and data transmitted and received within the MEDCOM  system.

(d)  “Health care facility” means any health facility or agency as defined by section 20106(1) of the code, except for ambulance operations, limited advanced mobile emergency care services, or  advanced mobile emergency care services.

(e) “Health  service  area”  means  geographical  areas  in  Michigan designated pursuant to Public Law 93-641, 42 U.S.C. S300k et seq., or other law, as domains for regional health systems planning.

(f)   “Local” means of or pertaining to a geographical area which may be considered a subdivision of a health service area.

(g) “MEDCOM” means the Michigan emergency medical  services communications system established by the department pursuant to section 20722(g) of the code.

(h)     “Medical control board” means an executive committee appointed by a department-approved organization of authority  for  medical  control established pursuant to section 20705(2) of the code.

(i)   “Off-road ground vehicle” means a vehicle capable  of  reaching  a patient in areas inaccessible to an authorized ambulance. This definition includes 4-wheel drive vehicles and snowmobiles.

 

 

(j)     “Ongoing education” means training sessions, refresher courses, and other learning activities approved by the  department and designed  to assist individuals who are  seeking licensure, certification, or approval in accordance with the code and these rules or  to  assist personnel in maintaining and upgrading their knowledge and skills on an ongoing basis throughout the term of their licensure, certification, or approval.

(k)   “Ongoing education credits” means a numerical value which is assigned to a specific ongoing education topic and which is awarded upon successful completion of an ongoing education class addressing that topic.

These numerical values are listed on department form number J-126 dated November, 1981, for  advanced emergency medical technicians, on department form number J-235 dated November, 1981, for emergency medical technician specialists, and on department form number J-201 dated November,  1981, for emergency medical technicians.

(l)   “Other lifesaving items” means any of the following:

(i)   Endotracheal tubes.

(ii)   Esophageal obturator airways.

(iii)   Intravenous tubing and administration sets.

(iv)   Laryngoscopes.

(v)   Intravenous catheters.

(vi)   Scalp vein needles.

(vii)   Syringes.

 

R 325.23104  Definitions; P. Rescinded.  Rule 104. As used in these rules:

(a)   “Patient record” means the patient record chart created and used by the emergency department of a hospital.

(b)   “Physician” means a doctor of medicine or doctor of osteopathy who possesses a valid license to practice medicine in Michigan.

(c)   “Physician director” means a physician who acts as  the  medical advisor for a training program and who is responsible for establishing the standards for emergency medical care instruction utilized in the program.

(d)   “Physician’s designee” means a registered  nurse  or  certified advanced cardiac life support provider whose qualifications are reviewed and approved according to hospital operating procedures by  the director of the emergency department of the cooperating hospital and who relays verbal physician  orders to the advanced emergency medical technician or emergency medical technician specialist at the scene of the emergency when existing circumstances prevent the issuance of a direct order by the physician.

(e)   “Prehospital life support service” means a person who routinely provides emergency medical care  for human illness or injury before the admission of an injured or ill person to a hospital providing  emergency department service.

(f)  “Project medical director” means a physician who is designated as responsible for the direction of a medical control board appointed by a department-approved organization of authority for  medical control established pursuant to section 20705(2) of the code.

(g)   “Public service agency” means a department, bureau, or other office of a government subdivision, including counties, cities, villages, townships, districts, and similar governmental entities and authorities.

 

 

R 325.23105  Definitions; R to T. Rescinded.  Rule 105. As used in these rules:

(a)   “Regional” means of or pertaining to a health service area.

(b) “Resources” means facilities, vehicles, equipment,  personnel, services, and organizations.

(c)   “Star of life” means the 6-barred cross upon which  is  superimposed the medical symbol  known  as  the staff of Aesculapius and which is copyrighted by the United States department of transportation.

(d)   “Telemetry” means the electronic transmission of cardiographic  data of a patient from the scene of  an emergency to a cooperating hospital.

(e)   “Training program sponsor” means a licensed hospital, or other person or organization having access to the clinical facilities of a licensed hospital, which provides courses of instruction for  advanced emergency medical technicians, emergency medical technician  specialists,  emergency medical technicians, or instructor-coordinators.

 

R 325.23106  Terms defined in the code. Rescinded.

Rule 106. Terms defined in the code have the same meanings when used in these rules.

 

R 325.23107  Rescission. Rescinded.

Rule 107. R 325.2201 to R 325.2208 and R 325.2211 to R 325.2246  of  the Michigan Administrative Code, appearing on pages 1911 to 1922 of the 1979 Michigan Administrative Code, are Rescinded.

 

PART 2. EMERGENCY MEDICAL SERVICES SYSTEM

 

R 325.23201  EMS resources inventory. Rescinded.

Rule 201. (1) EMS resources inventory data requested by  the  department pursuant to section 20722(b) of the code may include any of the following information:

(a)   Personnel location.

(b)   Response times.

(c)   Mutual aid agreements.

(d)  Equipment.

(e) Information  necessary  for  the  development,  coordination,   and administration of the statewide  EMS system.

(f)   Information necessary to  assess  the  need  for  emergency  medical services under the statewide  EMS system.

(2) Information or data supplied to the department for the development of the EMS resources inventory shall be submitted in the manner prescribed by the department.

R 325.23202 EMS  communications  system  (MEDCOM);  system  plan  and operational procedures; federal rules and regulations; coordination. Rescinded.Rule 202. (1) All persons providing, coordinating, or participating in EMS telecommunications activities shall operate in  accordance  with the MEDCOM plan and operational procedures developed by the department pursuant to section  20722(g) of the code.

(2)     The department may approve variations from the MEDCOM plan when such variations are necessary because of local conditions or operations, or both, and when it has been determined that  such variations will not cause

harmful interference or be detrimental to MEDCOM system compatibility.

(3)    Ambulance operations, limited advanced and advanced mobile emergency care  services,   health care   facilities,   and   government   entities participating in EMS telecommunications activities shall

 

 

have the current copy of the MEDCOM plan on hand at all times. Copies of the MEDCOM plan are available from the Michigan department of public health, division of emergency medical services.

(4)    All radio communications systems and components operating on MEDCOM frequencies shall be consistent with all applicable statutes, rules, and specifications relating to the MEDCOM plan.

(5)   All frequencies, code access numbers, and other designations shall be assigned by the department pursuant to the MEDCOM plan. Deviations from such assignments shall not be made without prior  authorization of the department.

(6)   A radio base station operating on MEDCOM frequencies shall not radiate more power than the minimum required for satisfactory technical operations commensurate with the size of the area to be served and local conditions which affect radio transmission and reception. In cases of harmful interference, the department may require that application be made to the federal communications commission for a change in power or antenna height, or both.

(7)    All radio systems and components operating in the MEDCOM system shall be maintained in  good operating condition and shall be regularly tested for proper performance by technical personnel  who are licensed in accordance with federal communications commission rules and regulations. (8)  Federal communications commission and MEDCOM  radio operation procedures, unit identification numbers, and message content guidelines shall be utilized in all radio transmissions in support of  emergency medical services on MEDCOM frequencies.

(9)   All activities involving system development and operations with EMS communications systems in other states or the Dominion of Canada, as well as with other non-EMS licensees in the special emergency radio service, shall be reported to the department. The department shall be the coordinating agency for all such activities.

(10)     A regional or local agency, authority, or other local government unit shall  not establish procedures, rules, or ordinances regulating EMS telecommunications operations which  are  in conflict with, or less stringent than, those required by the MEDCOM plan and operational procedures.

 

R 325.23203  Categorization of hospital emergency departments. Rescinded.

Rule 203. (1) All hospital emergency departments shall be surveyed, assessed, and categorized by the department as to their emergency care capabilities at least once in every 3 years. A hospital  may  request recategorization under section 20722(h) of the code at any time. The requesting hospital shall be resurveyed by the department in accordance with categorization criteria and procedures established pursuant to section 20722(h) of the code, except that the resurvey may be limited to those elements which have changed since the previous categorization.

(2)     The department shall notify surveyed hospitals by  mail  of  its  emergency  department categorization designations or redesignations.

(3)   The hospital may appeal the department categorization designation or redesignation of the hospital emergency department by filing a notice of appeal with the statewide emergency medical services advisory council within 15 days of issuance of the department notice. The council shall make a final determination after the opportunity for a formal hearing is provided. The appeal hearing shall be held pursuant to the contested case provisions of the Administrative Procedures Act of 1969, being sections  71 to 87 of Act No. 306 of the Public Acts of 1969, as amended, being SS24.271 to 24.287 of the Michigan Compiled Laws.

(4)   A person shall not represent a hospital emergency department’s categorization  designation  as  other than that  authorized  by  the department.

 

 

PART 3. AMBULANCE PERSONNEL, AMBULANCE ATTENDANTS

 

R 325.23301  Ambulance personnel. Rescinded.

Rule 301. (1) An ambulance operation shall staff each authorized vehicle with personnel licensed, authorized, or approved by the department in accordance with the code and these rules.

(2) Ambulance personnel from another state or  the  Dominion  of  Canada shall meet the requirements  of the code and these rules when providing emergency medical care in this state.

 

R 325.23302  Ambulance personnel; use of symbols, emblems, or insignias. Rescinded.

Rule 302. (1) A person shall not display any symbol which resembles, wholly or in part, any symbol  issued or publicized by the department as an official department logo, unless such symbol is an integral part of a license decal provided by the department.

(2)   The department shall approve emblems or other insignia which identify emergency medical services personnel licensed as ambulance attendants, emergency medical technicians, emergency medical technician specialists, and advanced emergency medical technicians. A  person  shall not wear any emblem or other insignia which indicates a license which he or she does not currently hold.

(3)    Under normal circumstances, licensed emergency medical services personnel shall wear the approved emblem or insignia appropriate to their level of licensure at the scene of a medical emergency to which they respond. The patch or insignia shall be worn on the outermost layer of  clothing in a conspicuous manner.

 

R 325.23303  Ambulance attendants; application for licensure; additional requirements. Rescinded.  Rule 303. (1) An individual who applies for licensure  as  an  ambulance attendant shall hold a current certificate of successful completion of  an advanced first aid and emergency care course approved  by  the  department and current cardiopulmonary resuscitation basic life support certification approved by  the department. The individual shall submit a copy of such certificates with the application.

(2) An application for licensure shall be completed on a form provided by the department and shall be returned to the department together with the appropriate nonrefundable fee and a department-  provided physical examination form. The physical examination form shall  be  signed  by  a physician and shall be current within 1 year of the date of the application to the department.

(3)    The department shall issue a license to each applicant who meets the requirements of section 20727(a) of the code and these rules. The license holder shall notify the department of any change of  name or address within 45 days of such change.

(4)    Upon receipt of a properly completed application, the department may issue a temporary license certificate to an applicant in anticipation of the issuance of a regular license.

(5)   An individual who possesses a valid license or certificate from another state and who wishes to practice in Michigan as an ambulance attendant shall submit proof to the department that he or she possesses a current certification in advanced first aid and emergency care approved by the department and cardiopulmonary resuscitation basic life support certification approved by the department.

(6)   An individual whose out-of-state training and credentials are not acceptable to the department shall meet the requirements of subrule (1) of this rule before applying to the department for licensure.

(7)   An individual shall not function as, or perform the duties  of,  an ambulance attendant until licensed as such by the department in accordance with the code and these rules.

 

R 325.23304  Ambulance attendants; relicensure. Rescinded.

 

 

Rule 304. (1) Not less than 45 days before the date of license expiration, an application for  relicensure shall be sent to the last known address of the licensed ambulance attendant. Failure to receive such application for relicensure does not relieve the licensee of the responsibility to maintain current licensure.

(2)   An application for ambulance attendant relicensure shall include all of the following:

(a)   The appropriate fee, which is not refundable.

(b)   Proof of certification required by subrule (3) of this rule.

(c)   Proof of completion of a physical examination applicable to the license. The physical examination shall be current within 1 year of the date of application for relicensure or reapproval and shall be signed by a physician.

(3)   An ambulance attendant applying for relicensure shall possess, at the time of relicensure, current certification of successful completion of an advanced first aid and emergency care course approved by  the department and current cardiopulmonary resuscitation basic life support certification approved by  the department.

(4)   Compliance with subrule (3) of this rule meets ongoing education requirements for ambulance attendant relicensure.

(5)    An individual whose license expires shall not function or perform the duties of an ambulance attendant after the date of expiration. During the 60 days following license expiration, an individual may make application for reinstatement of the expired license. The application for relicensure shall meet all requirements of subrule (2) of this rule.  If application for reinstatement is not received within the 60 days following license expiration, that license shall automatically be revoked on  the sixty-first  day following expiration.

 

PART   4.   ADVANCED   EMERGENCY   MEDICAL   TECHNICIANS,EMERGENCY   MEDICAL TECHNICIAN SPECIALISTS, EMERGENCY MEDICAL TECHNICIANS

 

R 325.23401  Application for examination. Rescinded.

Rule 401. An application for examination shall be completed and returned to the department within 1  year of course completion. A candidate for examination whose application is received more than 1  calendar year after course completion shall successfully complete the appropriate refresher course before being admitted into a subsequent examination.

 

R 325.23402  Examinations. Rescinded.

Rule 402. (1) The department shall administer a written examination and proctor a practical examination to graduates of an emergency medical technician, emergency medical technician specialist, or an advanced emergency medical technician training course conducted by a department-approved training program.

(2)    To participate in the licensure examination for an emergency medical technician specialist or  advanced emergency medical technician, an individual shall have passed both the written and practical examinations for emergency medical technician.

(3)   An applicant for examination who is unable to attend the examination as scheduled, and who has so  notified the department in writing, may be rescheduled for another examination.

(4)    An applicant for examination who does not successfully complete the examination within 1 year following course completion or upon application  for  examination  to  the  department  shall  successfully complete  the appropriate refresher course before being admitted to a subsequent examination.

 

 

(5)     An individual who graduates from an emergency medical technician,  emergency  medical technician specialist, or advanced emergency medical technician training program which was not approved by the department shall not be eligible to participate in the examination for licensure, except as  provided for in R 325.23404(6).

 

R 325.23403  Failure to pass examination; refresher course required; reexamination. Rescinded.  Rule 403. An individual who fails to attain a passing  score  on  either the written examination or the practical examination for   licensure   in   2 attempts shall successfully   complete   the   appropriate refresher                   course  before  applying  to  the  department  for     reexamination.        An     individual      who  subsequently fails to pass the examination in 1 attempt shall successfully complete the appropriate training course approved by the department before reapplying to the department for further examination.

 

R 325.23404  Licensure; approval. Rescinded.

Rule 404. (1) The department shall provide an application for licensure to an individual who has  successfully passed the required examination for licensure.

(2)   An application for licensure or approval shall be completed on  a form provided by the department and returned to the department, together with the appropriate nonrefundable fee, not later than 90  calendar days after the date of mailing of the application to the candidate. A department-provided physical examination  form  shall  be  completed  and returned with the application and shall be  signed  by a  physician.  The physical examination shall be  current  within  1  year  of  the  date  of application to the department.

(3)   A candidate for licensure or approval whose application is received by the department more than 90  calendar days after the date of mailing by the department shall retake the appropriate examination before licensure.

(4)     The department shall  issue a license or approval to an applicant who successfully meets the requirements of the code and these rules.  The license holder shall notify the department within 45 days of any change of name or address.

(5)   Upon receipt of a properly completed application, the department may issue a temporary license or  approval certificate to an applicant in anticipation of the issuance of a regular license.

(6)     The department may waive emergency medical technician, emergency medical technician specialist, or advanced emergency medical technician training requirements for an individual who wishes to practice in Michigan and who possesses a valid course completion certificate from another state which is approved by the department. The individual shall submit verification of course completion on forms provided by the department relative to the appropriate level of training. An  individual whose credentials and training satisfy this requirement shall successfully pass the written and practical examination in accordance with the code and these rules.

(7)    Individuals having received training in  another  state  as  an emergency medical technician specialist or department-approved equivalent, or as an advanced emergency medical technician or  department-approved equivalent, and who are seeking licensure in this state at either of these levels shall, as a prerequisite, pass the emergency medical technician written and practical examinations prescribed by the department prior to being permitted participation in the emergency medical technician specialist or advanced emergency medical technician examinations.

(8)   An individual who is guilty of fraud  or  deceit  in  procuring  or attempting  to  procure  licensure  or approval, including the use of falsified documents to gain admittance to  a  department-  prescribed licensure examination, shall be denied licensure or approval for a period of not less than 2  years.

 

 

(9)   An individual shall not represent himself or herself as, function as, or perform the duties of, an emergency medical technician, emergency medical technician specialist, or advanced emergency  medical technician until licensed or approved as such by the department in accordance  with the code and these rules.

 

R 325.23405  Ongoing education; requirements. Rescinded.

Rule 405. (1) All ongoing education courses shall be coordinated by a certified instructor-coordinator  and shall be approved by the department prior to implementation if ongoing education credits are to be awarded.

(2)    All applications for approval to conduct ongoing education courses shall be submitted to the department on forms provided by the department not less than 60 days before implementing the course.

(3)    All individuals licensed or approved shall be responsible for providing the department with  proof of completion of ongoing education programs which have been approved by the department.

(4)   An individual wishing to  attend  out-of-state  ongoing  education programs shall submit a  request  for  approval  of  the  program  to  the department prior to attending it if ongoing education credits  are to be awarded.

(5)    Ongoing education for licensed or approved emergency medical technicians and emergency  medical technician specialists shall include a minimum total award of 30 ongoing  education  credits over the 3-year licensure or approval period. In addition, an emergency medical technician specialist shall obtain certification by a project medical director attesting to the licensed or approved emergency medical technician specialist’s competence in all of the following areas:

(a)   Patient assessment.

(b)   Endotracheal intubation.

(c)   The use of the esophageal obturator airway.

(d)  Intravenous therapy.

(6)    A licensed or approved advanced emergency medical technician shall accrue not less than 45  ongoing education credits over the 3-year licensure or approval period. In addition, an advanced emergency medical technician shall obtain certification by a project medical director attesting to satisfactory performance of the licensed or approved advanced emergency medical technician in all of  the following areas:

(a)   Patient assessment.

(b)   Initiation of endotracheal intubation.

(c)   Use of the esophageal obturator airway.

(d)  Intravenous therapy.

(e)   The identification and treatment of cardiac rhythms.

 

R 325.23406  Relicensure. Rescinded.

Rule 406. (1) Not less than 90 days before the date of license  or approval expiration, a notice of  need for relicensure or reapproval shall be sent to the last known address of the licensee. Failure to receive such notification for relicensure does not  relieve  the  licensee   of  the responsibility to maintain current licensure.

(2)    Not less than 60 days before license or approval expiration, an applicant for relicensure or  reapproval shall submit to the department evidence that, during the 3 years before application for  renewal, the applicant has obtained ongoing education credits as required by these rules.

(3)   An application for relicensure or reapproval shall be sent to the candidate when the department determines that all ongoing education requirements have been met.

 

 

(4)   An application for relicensure or reapproval shall include the appropriate fee, which shall not be refundable, and proof of completion of a physical examination applicable to the license or approval. The physical examination shall be current within 1 year of the date of application for relicensure or  reapproval and shall be signed by a physician.

(5)   An individual whose license or approval expires shall not represent himself or herself as, function  as, or perform the duties of, a licensed or approved emergency medical technician, emergency medical technician specialist, or advanced emergency medical technician after the date of expiration.  During the 60 days following license or approval expiration, an individual may submit proof of  completion of the required ongoing education and make application for reinstatement of the expired  license or approval. If application for reinstatement is not received within the 60 days following license  or approval expiration, that license or  approval shall  automatically  be  revoked  on  the  sixty-first  day  following expiration.

(6)   An individual whose license or approval has been revoked under subrule (5) of this rule shall be allowed the period of 1 year from the date of license or approval  revocation  to  successfully complete the appropriate refresher course and the department’s written and practical examinations and make application for licensure or approval.

(7)   An individual whose license or approval has been revoked  for  more than 1 year under subrule (5) of this rule shall successfully complete an appropriate department-approved training course and the department’s written and practical examinations in order to apply for licensure or approval.

 

R 325.23407 Licensed nurse functioning as emergency medical technician, emergency medical technician specialist, or advanced emergency medical technician; department approval. Rescinded.

Rule 407. (1) A person who is licensed  as  a  registered  professional nurse or licensed practical nurse  in the state of Michigan may receive department approval to function as an emergency medical technician, emergency medical technician specialist, or advanced emergency medical technician if the following requirements are met:

(a)   The department receives evidence that the nurse has successfully completed required curriculum content which is equivalent to that provided in the emergency medical technician training module for nurses as defined in department form number J-247, dated July, 1982, and has passed the department written and  practical  examinations  for  emergency  medical technician. An applicant for approval as  an emergency medical technician specialist or advanced emergency medical technician shall comply with the requirements for approval as an emergency medical technician and, in addition, shall obtain and submit a written endorsement from the physician director of a department-approved emergency medical technician specialist or advanced emergency medical technician training program that the  nurse has successfully completed training equivalent to that of the emergency medical technician specialist or advanced emergency medical technician.

(b)     The individual makes application for, and successfully passes, both the written and practical examinations as prescribed by the department.

(2) A nurse who receives department approval shall comply with the code and these rules as they relate to the ongoing education and relicensure requirements for emergency medical  technicians, emergency medical technician specialists, or advanced emergency medical technicians, as  appropriate.

 

PART 5. INSTRUCTOR-COORDINATORS

 

R 325.23501  Application for examination. Rescinded.

 

 

Rule 501. An application for examination as an instructor-coordinator shall be completed and returned to the department within 1 year of course completion. A candidate for examination who does not  successfully complete the examination within 1 calendar year after course completion shall successfully complete an approved instructor-coordinator training course before being admitted into a subsequent examination.

 

R 325.23502  Examinations. Rescinded.

Rule 502. (1) The department shall administer a written examination to graduates of an instructor-  coordinator training course conducted by a department-approved training program.

(2) To   participate   in   the   certification   examination    for instructor-coordinators, the candidate shall have attained a score of not less than 85% on each section of the emergency medical technician written examination, taken within the last calendar year from the date of application for the certification examination, and have passed the practical examination for emergency medical technicians.

(3)   An applicant for examination who is unable to attend the examination as scheduled and who has so  notified the department in writing may be rescheduled for another scheduled examination date.

 

R 325.23503  Failure to pass examination; training course required; reexamination. Rescinded.   Rule 503. An individual who fails to  attain  a  passing  score  on  the written examination in 2 attempts shall successfully complete an  approved instructor-coordinator training course before reapplying to the department for further examination.

 

R 325.23504  Certification. Rescinded.

Rule 504.  (1)  The  department  shall  provide  an  application  for certification to an individual who has passed the required examination for certification.

(2) An applicant for certification shall be a licensed or approved emergency medical technician, emergency medical technician specialist, or advanced emergency medical technician.

(3)   An application for certification shall be completed on a form provided by the department and returned to the department not later than 90 calendar days after the date of  mailing  of  the  application  to the candidate.

(4)   A candidate for certification whose application is received more than 90 calendar days from the date of mailing by the department shall retake the appropriate examination before certification.

(5)     An individual who is guilty of fraud or deceit in procuring or attempting to procure certification, including the use of falsified documents to gain  admittance  to  a  department-  prescribed certification examination, shall be denied certification for a period of not less than 2 years.

(6)   An individual shall not represent himself or herself as, function

as, or perform the duties of,  a  certified  instructor-coordinator  until certified as such by the department in accordance with the code and these rules.

 

R 325.23505  Ongoing education; requirements. Rescinded.

Rule 505. (1) All individuals certified as instructor-coordinators under the code and these rules shall accrue not less than 30 ongoing education credits over the 3-year certification period in ongoing education programs approved by the department and specified by the department as appropriate for  certified instructor-coordinators. Not less than 15 ongoing education credits shall be accrued in subjects directly related to professional development as an instructor-coordinator.

 

 

(2) All ongoing education courses shall be approved  by  the  department prior to implementation if ongoing education credits are to be awarded.

 

R 325.23506  Recertification. Rescinded.

Rule 506. (1) Not less than 90 days before the date of certification expiration, a notice of need for  recertification shall be sent to the last known address of the certificate holder.  Failure  to  receive  such notification for recertification does not relieve the certificate holder of the responsibility to maintain current certification.

(2)   Not less than 60 days before certification expiration, an applicant for recertification shall submit to the department evidence that during the 3 years before application for renewal the applicant has  obtained ongoing education credits as required by these rules.

(3)   An application for recertification shall be sent to the candidate when the department determines  that all ongoing education requirements have been met.

(a)    Possess, at the time of recertification, current department-approved certification as a basic life  support or basic cardiac life support instructor.

(b) Be currently licensed or approved as an emergency medical technician, emergency medical technician specialist, or advanced emergency medical technician.

(5)    An individual whose certification expires shall not function or perform the duties of an  instructor-coordinator after the date of expiration. During the 60 days following the expiration of  certification, an individual may submit proof of completion of the required ongoing education  and make  application  for  reinstatement  of  the   expired certification. If application for reinstatement is not received within the 60 days following the expiration of certification, that certification shall automatically be revoked on the  sixty-first  day  following expiration.

(6)   An individual whose certification has been revoked under subrule (5) of this rule shall be allowed the period of 1 year from the date of revocation of certification to satisfactorily complete the department’s written examination and make application for certification. An individual whose  certification has been revoked for more than 1 year under subrule

(5) of this rule shall satisfactorily complete a department-approved instructor-coordinator course and participate in the department’s written examination in order to apply for certification.

 

R 325.23507  Required licensure; responsibilities. Rescinded.

Rule 507. (1) An instructor-coordinator for an emergency medical technician specialist or advanced emergency medical technician training course shall be a licensed or approved emergency medical technician specialist or advanced emergency medical technician, respectively, except that a licensed or  approved advanced emergency medical technician may serve as an instructor-coordinator for an emergency medical technician specialist training course.

(2) An instructor-coordinator shall have all  of  the  following responsibilities:

(a)   Comply with certified instructor-coordinator performance standards as specified in department form  number J-234, dated December, 1982.

(b)   With the approval of the physician director, be responsible  for course development, evaluation, and coordination of curricular elements, including those of a clinical nature, and assist in the selection and evaluation of instructors.

(c)   Plan the course content and ensure that it is in compliance with department requirements.

(d)  Assist in the evaluation and selection of students.

 

 

(e)   Evaluate and maintain records of student performance.

(f)  Maintain and assure the availability of equipment and training aids.

(g)   Coordinate and maintain records of clinical experience.

(h)   Counsel and assist students, as appropriate.

(i)    At the conclusion of the course, present to the department the names of the students who   have  successfully met the objectives for course completion set forth by the department.

 

PART 6. TRAINING PROGRAM REQUIREMENTS

 

R 325.23601  Training programs; requirements.

Rescinded. Rule 601. (1) An  emergency  medical  technician,  emergency  medical technician specialist,  advanced  emergency   medical   technician,   or instructor-coordinator training program shall comply with all of the following requirements:

(a)   Except for instructor-coordinator training programs, be under the direction of a physician director.

(b)    Be coordinated by a department-certified instructor-coordinator who shall ensure that there is an instructor-coordinator in attendance at all didactic and practical sessions.

(c)   Make application  to  the  department, on forms provided by the department, to conduct a training course not less than 60 days before the start of the course, and be  approved  by  the  department before implementation.

(d)   Prior to or at the first class session, advise the students that the training program and course are approved by the department.

(e) Utilize clearly stated behavioral objectives and performance criteria to evaluate student proficiency in clinical and  academic activities.

(f)    Conduct courses in adequate classrooms, with appropriate, modern, functional equipment and supplies in sufficient quantities.

(g)    Cooperate with the department in an effort to make available to the department appropriate equipment  and  space   for   the   department’s examination of graduates of the course for the  purpose of licensure or approval.

(h)   Within 30 calendar days of course completion, provide the department with a list of students who successfully complete the course.

(i)    Include clinical experience training in affiliation with a hospital. The hospital shall be capable of  meeting the clinical training objectives set forth by the department for the appropriate course.

(2)   In addition to the requirements set forth in subrule (1) of this rule, a training program providing advanced emergency medical technician courses shall comply with all of the following requirements:

(a)   Establish an advisory committee  for  purposes  of  reviewing  the curriculum and course content.  At a minimum, the committee shall be composed of all of the following persons:

(i)   Training program physician director.

(ii)   A registered professional nurse.

(iii)   The instructor-coordinator.

(iv)    An advanced emergency medical technician. One individual on the committee shall be familiar with the utilization of performance objectives as approved by the department for  advanced emergency medical technician training. A list of the advisory committee members shall be made available to the department.

(b)   If non-hospital-sponsored, develop and provide to the department a formal contractual agreement with each licensed hospital providing clinical training. The agreement shall incorporate areas of  shared and separate responsibility.

 

 

(c)   With the approval of the physician director,  select  students for admission to the program by use of  an admissions committee. The  committee shall  include  the  advanced  emergency   medical technician instructor-coordinator.

(d)  Conduct courses in adequate classrooms and laboratories, with appropriate, modern, functional equipment and supplies in sufficient quantities, and provide a readily accessible library containing adequate, up-to-date resources of current emergency medical texts, periodicals, and other reference materials pertinent to the training course.

(3)    In addition to the requirements of subrule (1) of this rule, a training program  providing emergency medical technician  specialist training shall, if non-hospital-sponsored,  develop  and provide to the department a formal contractual agreement with each licensed hospital providing clinical training. The agreement shall incorporate areas of shared and separate  responsibilities  and shall clearly indicate that compliance with the clinical requirements set forth by the department will be obtained.

 

R 325.23602  Training program physician director; responsibilities. Rescinded.  Rule 602. The training program physician director shall do all of the following:

(a)   Be responsible for the periodic review of the organization and content in order to ensure that current standards of emergency medical care are being utilized throughout the course.

(b)   Act as the medical advisor in directing the instructor-coordinator in carrying out the responsibilities  of course development, evaluation, and coordination of curricular elements, including those of a clinical nature, and the selection and evaluation of instructors.

(c)   Be currently active in providing emergency care if the physician is directing an emergency medical technician specialist or advanced emergency medical technician training program.

 

R 325.23603  Training program course instructors; requirements. Rescinded.

Rule 603. All training program course instructors shall meet the following requirements:

(a)   Have a working and practical knowledge of the objectives and components of  the  training course relevant to his or her area of instruction.

(b)    Be a physician, registered professional nurse, advanced emergency medical technician, or an individual who possesses educational expertise which is appropriate to his or her specific topic of  instruction.

 

PART 7. MEDICAL CONTROL

 

R 325.23701  Medical control authority; approval. Rescinded.

Rule 701. (1) The governing board of a hospital or system of hospitals which intends to organize a medical control authority pursuant to section 20705(2) of the code shall do both of the following:

(a)   Organize a medical control board and make formal application to  the department for approval of the  proposed medical control board on forms provided by the department.

(b)   Be approved by the department before providing medical control pursuant to the code and  these rules. Such approval shall  remain  in continuous effect contingent upon  compliance  with  the  code and these rules.

(2) When 2 or more licensed hospitals are located within a proposed medical control region, the application for department approval shall include documentation which demonstrates that each licensed hospital in the proposed medical control region has been offered an opportunity to participate in the medical control authority.

 

 

 

R 325.23702  Medical control board; requirements. Rescinded.

Rule 702. To be eligible for department approval, a  medical  control board shall comply with all of  the following requirements:

(a)   Be appointed and administered by a hospital or system of hospitals under the direction of a project medical director designated by the hospital or system of hospitals.

(b)   Prepare written operational procedures, including all of the following:

(i)    Selection and removal procedures with specified terms of office for board members, including the project medical director.

(ii)   Provisions for medical supervision in the absence of the project medical director.

(iii)    Procedures for arbitration of conflicts which may arise between the medical control board and other personnel, services, and organizations providing emergency medical services within the emergency medical services system.

(iv)    In a medical control board comprised of 2 or more hospitals, procedures for arbitration of  conflicts which may arise between hospitals participating in the medical control board.

 

R 325.23703  Medical control regions. Rescinded.

Rule 703. (1) Except as provided for in subrule (2) of this rule, each Michigan county shall be designated a region for medical control, and  not more than 1 medical control board shall be  approved in each  designated region, except that 2 or more designated medical control  regions  or  any parts of 2 or more designated medical control regions may be combined under 1 medical control board with the approval of the department.

(2) Wayne county shall be subdivided into 2 regions for medical control as follows:

(a)    That area encompassed by the cities of Detroit, Grosse Pointe, Grosse Pointe Farms, Grosse  Pointe Park, Grosse Pointe Shores, Grosse Pointe Woods, Hamtramck, Harper Woods,  and Highland Park shall be a designated medical control region.

(b)   That area of Wayne county not described in subdivision (a) of this subrule shall be a designated medical control region.

 

R   325.23704     Promulgation of minimum emergency care standards; review by the department.

Rescinded.

Rule 704. (1) The medical control board shall adopt minimum standards of medical care, protocols, and operational procedures for all advanced, limited advanced, nonemergency transporting, and basic mobile emergency care services and all personnel associated with those services within the authorized region of authority of the medical control board. These minimum standards of medical care, protocols, and operational procedures shall include all of the following:

(a)   Patient treatment protocols.

(b)   Patient care quality review procedures.

(c)   Procedures to assure the availability and efficacy of training and continuing education programs.

(d)  System telecommunications procedures.

(e)   Agreement for the coordination of services.

(f)  In medical control regions where advanced or limited advanced mobile emergency care services are provided, procedures for the elective withdrawal and restoration of hospital cooperation with such  services when necessary to assure compliance with minimum standards of medical  care, protocols, and operational procedures or to protect the public health, safety, or welfare.

 

 

(g)   In medical control regions where advanced or limited advanced mobile emergency care services  are provided, procedures for pharmaceutical security, control, and exchange.

(h)     Procedures for voluntary enforcement of minimum standards of medical care, protocols, and operational procedures, including procedures for issuing notices of noncompliance and for the conduct of informal hearings when such notices are appealed.

(2) Before adopting any minimum standards of medical care, protocols, and operational procedures, the medical control board shall submit  the proposed minimum standards of medical  care,  protocols, and operational procedures to the department for review and approval.

 

R 325.23705  Telecommunications. Rescinded.

Rule 705. (1) A medical control board shall designate a single  facility which  shall  be   responsible  for  maintaining  records  of  all telecommunications activities in support of medical control of  limited and advanced mobile emergency care services within the jurisdiction of the medical control authority. Such records may be in the  form  of  detailed written logs or electronic recordings and shall be maintained for not less than 60 days.

(2) In a medical control authority comprised of 2 or more hospitals, the medical control board shall designate a single hospital or other appropriate facility as the primary resource facility for  coordination of interregional medical control telecommunications and regional medical control as  promulgated by the medical control board and approved by the department. Such designation shall be made for not less than 1 year.

 

Rule 706. (1) All advanced, limited advanced, and basic mobile emergency care services and all personnel associated with those services, when providing emergency medical care within the region  of   authority   of   a department approved medical control board, shall comply with   the   minimum standards of medical care, protocols, and operational procedures adopted by the medical control board.  (2) If a medical control board believes any advanced, limited advanced, or basic mobile emergency care service or any person associated with  such a service is or has been in violation of a minimum medical care  standard, protocol, or operational procedure adopted by the medical  control  board, the medical control board shall initiate voluntary enforcement procedures. If it is determined the service or person  is  unable  to  demonstrate voluntary  compliance,  the  medical  control  board  shall  request            the department to investigate the matter and to initiate compliance procedures as specified in these rules, if deemed appropriate by the department.

 

R 325.23707 Emergency enforcement of minimum emergency care standards; advanced, limited advanced, and basic mobile emergency care services. Rescinded.

Rule 707. If a project medical director or the medical control board believes that a violation of  minimum medical care standards, protocols, or operational procedures by an advanced, limited advanced, nonemergency transporting, or a basic mobile emergency care service or any person  associated with such a service seriously affects the public health, safety, or welfare of individuals receiving emergency care or services, the project  medical  director  or  the  medical  control  board shall immediately advise the department by telephone or telegram of all facts concerning the violation.  If the department determines that the  violation does seriously affect the public health, safety, or welfare  of individuals receiving emergency care or services, the department may issue an emergency order  suspending the service or person or take other appropriate action pursuant to the code and these rules.

 

 

 

PART 8. ADVANCED AND LIMITED ADVANCED MOBILE EMERGENCY CARE SERVICES

 

R 325.23801 Advanced and limited advanced mobile  emergency  care services; licensure; changes in operation. Rescinded.

Rule 801. (1) A person who intends to operate an advanced or limited advanced mobile emergency care service shall do all of the following:

(a)     Submit, to the department, a notice of intent to provide advanced or limited advanced mobile emergency care services. The notice of intent shall specify the proposed geographical service area.

(b)   Provide the department with documented endorsements by all proposed cooperating hospitals and the medical control board responsible for the region in which the service intends to operate.

(c)    Provide the department with a current list of names and license or approval numbers of all advanced emergency medical technicians and emergency medical technician  specialists.  The department shall be notified semiannually of any change in advanced emergency  medical  technician  or emergency medical technician specialist personnel.

(d)    Comply with the pre-application procedures established by the department,  including attendance with appropriate representation at pre-application meetings and the provision of  documentation and plans for implementation.

(e)   Submit to the department a formal application to render that service subsequent to compliance with subdivision (d) of this subrule. (2) An advanced or limited advanced mobile emergency care service shall be licensed pursuant to the code and these rules by the department before implementation of the service. Licensure shall be valid for 1 year. Subsequent annual licensure shall be contingent upon  compliance with the code and these rules based upon a determination by the department.

(3)    A licensed advanced or limited advanced mobile emergency care service shall advise the department, within 14 days, of any of the following changes in operation:

(a)   Any change of ownership.

(b)   Vehicles permanently removed from or placed into service.

(c)   Any changes in radio communications capability.

(d)  Any other changes in the requirements for original licensure.

 

R  325.23802   Advanced  and  limited  advanced  mobile   emergency   care services; requirements.

Rescinded.

Rule 802. (1) An advanced or limited  advanced  mobile  emergency  care service shall comply with all  of the following requirements:

(a)   Maintain, on a standard report form approved by the department, accurate files on all  cases  in which limited advanced or  advanced emergency care is rendered. Files shall be maintained for a period of 5 years and shall, upon request, be made available to the department for review.

(b)    Promptly notify the medical control authority of any advanced or limited advanced mobile emergency care vehicle which has been temporarily removed from service. If the vehicle is removed from service for more than 5 consecutive days, the department shall be promptly notified.

(c)     Assure secondary response capability within the primary geographical service area in which it intends to operate by providing for cooperative agreements with at least 1 of the following EMS  providers:

(i)   Basic mobile emergency care service.

(ii)   Limited advanced mobile emergency care service.

(iii)   Advanced mobile emergency care service.

 

 

(2) An advanced mobile emergency care service shall, in addition to  the other applicable requirements  of this rule, do all of the following:

(a) Acquire  and  replace  drugs,  intravenous  solutions,  hypodermic syringes,  hypodermic  needles, and intravenous needles through the cooperating hospital pharmacy and under the supervision of a licensed pharmacist.

(b)    In cooperation with a cooperating hospital pharmacy, stock only those drugs approved by the medical control board.

(c)   Provide locked and secure compartments or  other  locking  devices approved by the department on  the advanced mobile emergency care vehicle to prevent access to stored drugs by unauthorized  persons.

(d)   Comply with procedures of drug storage, security, dispensing, and accountability in  accordance with the criteria established by the cooperating hospital pharmacy, in compliance with the board of  pharmacy and approved by the department.

(3)   A limited advanced mobile emergency care service shall, in addition to the applicable requirements  of this rule, do all of the following:

(a)    Equip each vehicle, at a minimum, with the equipment and solutions prescribed by the medical control board.

(b)   Acquire and replace intravenous solutions,  tubing  and  related apparatus, intravenous needles, and catheters through  the cooperating hospital pharmacy and under the supervision of a licensed pharmacist.

(c)   Comply with procedures of intravenous fluid storage, security, dispensing, and accountability in accordance with criteria established by the cooperating hospital pharmacy in compliance with the state board of pharmacy and approved by the department.

 

R 325.23803  Relicensure. Rescinded.

Rule 803. (1) Not less than 90 days before the date of license expiration, a notice of need for relicensure and an application  for relicensure shall be sent to the  last  known  address  of  the licensee. Failure to receive the notice of need or the application for relicensure does not relieve the licensee of the responsibility to apply for relicensure.

(2) An advanced or limited advanced mobile emergency care service shall complete an application for  relicensure and shall return the application to the department within 20 days from the date of receipt of  the renewal application.

(3)   A license not renewed before its expiration date shall be in a grace period for 60 days and may be renewed within those 60  days  upon application for relicensure.  If  not  renewed  under  this  subrule, the license is automatically revoked.

 

R 325.23804  Extent of responsibility for care of patient. Rescinded.

Rule  804.  An  emergency  medical  technician  specialist  or  advanced emergency medical  technician  who  has  instituted  advanced  or  limited advanced emergency care services  is  responsible  for  the care  of  the patient and may only transfer care  of  the  patient  to  personnel  of  a transporting service licensed by the department to provide equal  or  more advanced mobile emergency care. If the vehicle providing transportation of the patient to the receiving hospital is not so licensed, all   appropriate personnel, treatment supplies, and communications equipment   necessary   to maintain the level of  emergency care initiated by the  advanced  emergency medical technician or the emergency medical technician specialist shall be transported with the patient to the emergency department of the receiving hospital.

 

 

 

R  325.23805    Advanced  mobile  emergency    care    service;    cooperating hospital requirements.

Rescinded.

Rule 805. A hospital wishing to serve as a cooperating hospital to an advanced mobile emergency care service shall comply with all of the following requirements:

(a)   Participate in a department-approved medical control authority.

(b)   Support the medical control board and the project medical director in the promulgation of medical control, as required in part 7 of these rules.

(d)     Be capable of receiving transmitted electrocardiogram data and maintaining verbal communications with an advanced emergency medical technician at the scene of an emergency through an advanced mobile emergency care communications system, as specified in the code and these rules.

(e)    Designate a licensed pharmacist on its staff to be responsible for the control, placement, and replacement of drugs, intravenous solutions, hypodermic syringes, hypodermic needles, and intravenous needles utilized by the advanced mobile emergency care service.

 

R  325.23806    Limited advanced mobile emergency care service; cooperating hospital requirements.

Rescinded.

Rule 806. A hospital wishing to serve as a cooperating hospital to a limited advanced mobile emergency care service shall comply with all of the following requirements:

(a)   Participate in a department-approved medical control authority.

(b)   Support the medical control board and the project medical director in the promulgation of medical control, as required in part 7 of these rules.

(c)   Staff an emergency department 24 hours a day, 7 days a week with a physician and a physician’s designee. If the physician does not remain on the hospital premises, he or she shall be available for  consultation with the physician designee and the limited advanced mobile emergency care service by  means of telephone interface equipment capable of remotely maintaining 2-way  verbal communications through the hospital base station. As an alternative to equipping the off-premises  physician for remote consultation, the cooperating hospital may make a written agreement with another hospital approved to cooperate with the same limited  advanced mobile emergency care service to provide on-line  physician  support,  as needed, through a radio or wire link, or both, capable  of maintaining all communications as specified in subdivision (d) of this rule.

(d)    Be capable of maintaining verbal communications with  an  advanced  emergency  medical technician or emergency medical technician specialist at the scene of an emergency through a limited advanced mobile emergency care communications system, as specified in the code and these rules.

 

 

(e)    Designate a licensed pharmacist on its staff to be responsible for the control, placement, and replacement of intravenous solutions, tubing and related apparatus, intravenous needles, and catheters utilized by the limited advanced mobile emergency care service.

 

R 325.23807 Communications between cooperating hospital and advanced or limited advanced mobile emergency care services. Rescinded.

Rule 807. (1) A cooperating hospital and an advanced or limited advanced mobile emergency care service shall do all of the following:

(a)    Submit to the department a radio communications system plan for providing communications appropriate to the applicable level of mobile emergency care proposed within the geographical service area specified in the notification of intent submitted to the department. The plan shall be consistent with MEDCOM guidelines for radio spectrum conservation, regional compatibility, channel utilization, and medical control.

(b)   Upon approval of the department, implement the plan required by subdivision (a) of this subrule.

(c)    Utilize MEDCOM channel assignments and operating procedures as promulgated by the department pursuant to the code.

(d)     Maintain all components of the communications system in good working order and assure  compliance with all applicable federal, state, and local rules and regulations.

(2) If advanced or limited advanced emergency medical techniques are performed in the absence of  communication capabilities as required in the code and these rules due to communications equipment  failure, inadequate signal strength, or for any other reason, the advanced or limited advanced mobile emergency care service shall do both of the following within 24 hours of the incident:

(a)   Forward a detailed report, which shall include the concurrence of the cooperating hospital, to the department citing the causes of the communications failure and an outline of the techniques employed by the advanced emergency medical technician or emergency medical  technician specialist.

(b)   Forward a report of communications failure to the project medical director of the medical control region in which the incident occurred. (3) Repeated communications failures are cause for  the denial, revocation, or suspension of advanced or limited advanced mobile emergency care service licensure as specified in the code and these rules.

 

R 325.23808  Words, phrases, signs, symbols, or insignia; permitted use. Rescinded.

Rule 808. (1) Only those persons licensed by the department as an advanced mobile emergency care service may use words, phrases, signs, symbols, or insignia which indicate to the public  that advanced mobile emergency care service is provided.

(2) Only those persons licensed by the department as a limited advanced mobile emergency care service may use words, phrases, signs, symbols, or insignia which indicate to the  public  that  limited advanced mobile emergency care is provided.

 

PART 9. AMBULANCE OPERATIONS

 

R 325.23901  Ambulance operations; licensure; changes in operation. Rescinded.

Rule 901. (1) A person who wishes to  obtain  a  license  for  ambulance operation shall do all of the  following:

 

 

(a)   Submit to the department a completed formal application on a  form provided by the department.  An application shall include a nonrefundable fee, in the amount established by the code, for each vehicle for which authorization is requested.

(b)   Meet all applicable specifications for ambulances described in part 10 of these rules.

(c)    Provide a certificate of no-fault insurance with residual   liability coverage   of   not   less   than

$1,000,000.00 per accident or proof of equivalent insurance coverage or proof of equivalent self-insured authority.

(d)  Provide the department with a current list of the names and license numbers of all personnel and the training level of each. The department shall be notified semiannually of any changes in personnel.

(e)    Provide the department with the primary geographical service area in which the ambulance operation accepts responsibility for  providing ambulance service.

(f)   Provide the department with the geographic locations at which vehicles will be based for  emergency response.

(2)Upon receipt of a properly completed application for ambulance operation licensure, the department shall evaluate the  proposed operation  and provide for  inspection of all  vehicles and equipment as required in the code and these rules.

(3)Upon a determination  that  the  proposed  operation  meets   the requirements of the code and these rules, the department shall issue the applicant a license for ambulance operation. The license shall be valid for 1 year, shall specify the vehicles authorized to operate, and shall serve to notify all concerned that the named  operation is  licensed in accordance with the code. An ambulance operation shall be licensed by the department before implementation of the service.

(4)    A licensed ambulance operation shall advise the department, within 14 days, of any of the  following:

(a)   Vehicles permanently removed from or placed into service.

(b)   Any changes in radio communications capability.

(c)   Any other changes in the requirements for original licensure.

 

R 325.23902  Relicensure. Rescinded.

Rule 902. (1) Not less than 90 days before the date of license expiration, a notice of need for relicensure and an application  for relicensure shall be sent to the  last  known  address  of  the licensee. Failure to receive the notice of requirement or the application for relicensure does not relieve the licensee of the responsibility to reapply for relicensure.

(2)   An ambulance operation shall complete an application for relicensure and shall return the application to the department with the appropriate nonrefundable fee within 20 days from the date of receipt of  the renewal application.

(3)   A license not renewed before its expiration date shall be in a grace period for 60 days and may be renewed within those 60  days  upon application for relicensure. If  not  renewed  under  this  subrule, the license is automatically revoked.

 

R 325.23903  Coordination; requests for emergency medical assistance. Rescinded.

Rule 903. (1) A land ambulance operation shall coordinate with other land ambulance operations to provide for secondary response capability for medical emergencies within its primary geographical service area.

(2)If at any time a land ambulance operation does not have an ambulance staffed according to the code and these rules available for  immediate response within the bounds of its primary geographical service area, the land ambulance operation shall do both of the following:

 

 

(a) Notify  all  appropriate  MEDCOM  designated  emergency   resource coordination centers and other public safety agencies from which requests for service are regularly received.

(b)   Activate all pertinent secondary response capabilities.

(3)   When receiving a request for emergency medical assistance from a central dispatch or other public agency, an ambulance operation shall immediately inform the requesting agency as to the geographic location from which the response will be made and an estimated time of dispatch.

(4)   If a safe and timely response is not possible,  the  ambulance operation or the central dispatch or  other public agency shall activate any alternative emergency medical  service  response  capability more immediately available to the emergency.

 

R 325.23904  One-year nonrenewable conditional licenses. Rescinded.

Rule 904. (1) An ambulance operation seeking a 1-year nonrenewable conditional license in accordance with the code shall submit all of the following information to the department in writing:

(a)   A statement of the reasons for the operation’s inability to comply with the code for licensure.

(b)   An explanation of how the absence of the operation’s service would affect the public safety, health, and welfare of the residents it serves.

(c)   A statement outlining what action is being considered to rectify all deficiencies before the expiration of the 1-year nonrenewable conditional license.

(2)    An ambulance operation which is granted a 1-year nonrenewable conditional license by the department shall staff each ambulance with not less than 2 licensed ambulance attendants. One  licensed  ambulance attendant shall be in the patient compartment during patient transport.

(3)   The holder of a 1-year nonrenewable conditional license shall comply with fee requirements set forth in the code.

 

R 325.23905  Ambulance operation located in another state or  the  Dominion of Canada and operating in this state. Rescinded.

Rule 905. An ambulance operation located in another state or in the Dominion of Canada while providing transportation or transportation and treatment of patients in this state shall comply with the code and these rules, except when such services are rendered during times of disaster.

 

R 325.23906  Air ambulance operations. Rescinded.

Rule 906. (1) Each air  ambulance  operation  shall  comply  with  all applicable parts of federal aviation administration regulations. (2) Each air ambulance operation shall maintain  accurate medical and flight records concerning the transportation of each emergency patient in intrastate flights or  interstate flights originating in Michigan. Such records shall be made available to the department on  request.

(3) Licensure as an air ambulance operation is not required for those services which provide air transport for nonemergency patients only. Nonemergency transporting aircraft shall be registered with the department in accordance with section 20722(1)(iv) of the code.

 

PART 10. VEHICLE STANDARDS

 

R 325.24001  Land ambulance; certificate of compliance. Rescinded.

Rule 1001. (1) A person intending to make application to the department for land ambulance authorization as required by the code and these rules shall provide the department with a notarized certificate   of   compliance with   all   applicable   requirements   of   this   part.   The   certificate   of

 

 

compliance shall be executed by the final manufacturer  of  the  land ambulance and shall be on a  form prescribed by the department. A photocopy of the certificate of compliance may be substituted for  the original if the location of the original is noted on the photocopy. (2) A manufacturer executing a certificate of compliance as required by subrule (1) of this rule shall maintain test data demonstrating compliance with the applicable requirements of this part for a period of not less than 10 years and shall, upon request, make such data available to the department.

(3)   A person shall not modify an ambulance certified as complying with the applicable requirements of  this part in any manner which would affect the original terms of compliance.

 

R 325.24002  Land ambulance; types; classes; floor plans. Rescinded.

Rule 1002. (1) For the   purposes   of   this   part,   ambulances   shall   be classified according to the following types and classes:

(a)   Type I/class 1: Conventional, cab-chassis with modular ambulance body, rear 2-wheel drive.

(b)   Type I/class 2: Conventional, cab-chassis with modular ambulance body, 4-wheel drive.

(c)   Type II/class 1: Standard van, forward control integral cab-body ambulance, rear 2-wheel drive.

(d)  Type II/class 2: Standard van, forward control integral cab-body ambulance, 4-wheel drive.

(e)   Type III/class 1: Specialty van, forward control integral cab-body ambulance, rear 2-wheel drive.

(f)  Type III/class 2: Specialty van, forward control integral cab-body ambulance, 4-wheel drive.

(g)   Type III/class 3: Specialty van, forward control integral cab-body ambulance, front 2-wheel drive.  (2) Type I, type II, or type III vehicles may have 1 of 2 floor plans as

follows:

(a)   Floor plan A: Elevating cot and squad bench standard.

(b)   Floor plan B: Elevating cot and wheeled cot-bench optional.

 

R 325.24003  Land ambulance; general body construction. Rescinded.

Rule 1003. (1) The body of type I modular units and the types II and III integral cab-body units shall be  of prime commercial quality metal or other material which is at least as strong as an all-steel  unit. Wood shall not be used for structural framing.

(2) Prior to the attachment of outside devices, the ambulance body shall be designed and built to provide impact and penetration resistance and shall be of sufficient strength to support the entire weight of the fully loaded vehicle on its top or side if overturned without crushing, separation of joints, or  permanently deforming the roof  bow  or reinforcements, body  post,  doors,  strainers,  stringers, floor, inner linings, outer panels, rub rails, and other reinforcements. As evidence that the ambulance  body meets the criteria set forth in this rule, the body manufacturer shall furnish each body model with a certificate which verifies that the ambulance body meets the static load test code  for  ambulance body structure, ambulance manufacturers’ division standard no. 001. This standard is available from the Truck Body and Equipment Manufacturers Association, Inc., Ambulance Manufacturers Division, Suite 1220, 5530 Wisconsin Avenue, N.W., Washington, DC 20015.

 

R 325.24004  Land ambulance; electrical systems. Rescinded.

Rule 1004. The ambulance shall be equipped with complete and operative 12-volt-potential, electric generating, starting, and lighting systems; electronic equipment and devices; and applicable accessory wiring systems.

 

R 325.24005  Land ambulance; lighting. Rescinded.

Rule 1005. (1) The basic exterior vehicle lighting shall include all of the following:

 

 

(a)   Headlights.

(b)   Parking lights.

(c)   Directional signal lights.

(d)  Taillight and stoplight.

(e)   Side marker lights.

(f)  License plate lamp.

(g)   Backup lights.

(h)   Hazard warning lights.

(i)   Clearance lamps, when applicable.

(j)   Emergency beacon light and corner warning lights.

(k)   Flood lights.

(l)   Spotlight.

(2) The basic interior ambulance lighting shall include all of the following:

(a)   Driver compartment dome light.

(b)   Instrument panel lights and indicators.

(c)   Master switch panel or console lights.

(d)  Other warning lights.

(e)   Door-open indicator.

(f)  Glove box light, when applicable.

(g)   Patient compartment overhead lighting.

(3)    Patient compartment lighting on type I and type III  vehicles  shall include a step-well light and switch panel lighting.

(4)   Lighting shall be  designed  and  located  so  that  glare  is  not reflected from the surrounding area to the driver’s eyes or line of vision or from instrument and switch panels or other areas that are illuminated while the vehicle is in motion.

(5)   Illumination shall be adequate throughout the compartment and shall provide a minimum intensity  of 40 footcandles at the floor level of the patient compartment. Not less than 4 recessed and nearly  flush dome lights shall be furnished.

 

R 325.24006  Land ambulance; patient compartment interior dimensions. Rescinded.

Rule 1006. The patient compartment shall provide a minimum of 300  cubic feet of space, less a 10%  deviation for cabinets, and shall comply with all of the following provisions:

(a)   The patient compartment, measured from the partition to the inside edge of the rear loading doors at the floor, shall be not less than 116 inches in length.

(b)   The  width  of  the  patient  compartment  after  cabinet  and  cot installations shall provide not less  than 12 inches of clear walkway between a cot or cots and the squad bench.

(c)    The patient compartment shall provide not less  than  60  inches  of height over the patient area, measured from floor to ceiling, exclusive of cabinets or equipment.

 

R 325.24007  Land ambulance; patient compartment; enclosed compartments and spaces. Rescinded.  Rule 1007. (1) The interior of the patient compartment shall  provide  a minimum of 30 cubic feet of  enclosed storage cabinetry, compartment space, and shelf space, which shall be conveniently located for  medical supplies, devices, and installed systems as applicable   for   the   service   intended. Enclosed compartments and spaces shall  be  located  at,  in,  or  on  the patient compartment partition, side walls, interior roof, squad bench, technician seat, and doors. Compartments under the floor, with opening panels inside the patient compartment, are not permitted.

 

 

(2) All cabinetry, patient care equipment, and other equipment shall be

properly stored and anchored. The large oxygen tank  supplying  the  piped oxygen system shall be securely moored.

 

R 325.24008  Land ambulance; environmental systems. Rescinded.

Rule 1008. All ambulances shall be equipped with a  complete  climate environmental system to supply and maintain clean air conditions and a comfortable level of inside temperature  in  both driver and patient compartments. The environmental system may be a separate or  combination  system and shall permit the independent control of environment within each compartment. The air systems shall be of high volume capacity with low velocity delivery for minimum draft circulation while providing a positive pressure within each closed compartment when the vehicle is in service. Environmental system components shall be readily accessible for service at the installed locations.

 

R 325.24009  Land ambulance; vehicle identification. Rescinded.  Rule 1009. All land ambulances shall be identified as follows:

(a)    A current ambulance authorization decal issued by the department shall be conspicuously displayed and visible from the outside  of  each vehicle. An ambulance authorization decal issued by  the department shall not be displayed on any vehicle not currently authorized as an ambulance by the department.

(b)   The word “ambulance” shall be in block letters, not less than 6 inches in height, alongside or  under the “Star of Life,” and centered on each side of the vehicle body.

(c)    A block-type blue “Star of Life” on a white field, which is not less than 12 inches high, may be displayed. The “Star of Life” emblem may be provided on each window glass of the rear doors when  white field space is limited.

(d)  The agency or service name shall be prominently displayed on both the left and right side of any of  the following vehicles:

(i)   Land ambulance.

(ii)   Nontransporting pre-hospital life support vehicle.

(iii)   Limited advanced mobile emergency care vehicle.

(iv)   Advanced mobile emergency care vehicle.

 

R 325.24010  Ambulance equipment and supplies. Rescinded.

Rule 1010. An ambulance shall be equipped at all times with equipment and patient care supplies as  specified on department form J-82, dated December, 1982.

 

R 325.24011  Ambulances equipped with intravenous fluids and  other  lifesaving items; requirements. Rescinded.

Rule 1011. (1) An ambulance may be equipped with intravenous fluids and other lifesaving items, as  defined in R 325.23103(3), when all of the following requirements are met:

(a)   Except for an ambulance authorized as an advanced mobile emergency care vehicle, all intravenous fluids and other lifesaving items shall be stored within a locked compartment in the patient compartment of the ambulance. An ambulance authorized as an advanced mobile emergency care vehicle may store intravenous fluids and other lifesaving items in any appropriate location within the ambulance, except for syringes which shall be stored within a locked compartment in the patient compartment. An ambulance authorized as a limited advanced mobile emergency care vehicle

may store intravenous fluids in any appropriate location in the ambulance.

 

 

(b) All intravenous fluids and other lifesaving items  shall  be maintained in sealed and appropriately sterile packaging.

(c)     Intravenous fluids and syringes shall be obtained and exchanged as necessary according to protocols adopted by a medical  control  board through a licensed  hospital  pharmacist  to  assure  that only current, noncontaminated syringes and intravenous fluids are available on the ambulance.

(d)   A licensed hospital pharmacist shall inspect, not less often than quarterly, the intravenous fluid inventory carried in the ambulance and shall replace such items in accordance with all  state  and  federal regulations.

(2)   Intravenous fluids and other lifesaving items carried in an ambulance which is not authorized as  a limited advanced emergency care or advanced mobile emergency care vehicle shall only be made available for use at the scene of an emergency by a licensed physician or other health professional qualified to carry out invasive medical procedures under the direct order of a licensed physician. It is the responsibility of the ambulance operation to determine that any person allowed access to such  intravenous solutions or other lifesaving items is so qualified.

(3)   Intravenous fluids and other lifesaving items carried in an ambulance authorized as a limited advanced emergency care or advanced mobile emergency care  vehicle  may  be  utilized  by  emergency medical technician specialists and advanced emergency medical technicians in accordance with the code and these rules, except that an emergency medical technician specialist shall only use those intravenous fluids and other lifesaving items necessary to perform limited advanced emergency care procedures as defined in section 20106(7) of the code.

 

R 325.24012  Ambulance; optional systems, equipment, accessories, and supplies. Rescinded.

Rule 1012. Optional systems, equipment, accessories, and supplies may be incorporated in an  ambulance in addition to the standard  ambulance component systems and devices specified in this part. The optional items shall not supersede those systems, equipment, accessories, and supplies required by this part.

 

R 325.24013  Ambulance sanitation; procedures and equipment. Rescinded.

Rule 1013. The following sanitation standards apply to all ambulances:

(a)    The interior and the equipment within the ambulance shall   be   clean and maintained in good working order at all times.

(b)    Freshly laundered or disposable linens shall be used on all  litters and pillows, and linen shall be changed after each patient is transported.

(c)   Blankets to be used by patients shall be kept clean and stored properly.

(d)  Plastic bags shall be provided for the disposal of soiled items and the storage of soiled supplies until  such time that they may be removed from the ambulance or cleaned.

 

R 325.24014 Ambulance, nontransporting  pre-hospital life support vehicle, nonemergency transporting vehicle, or rescue and extrication vehicle; radio equipment operation on MEDCOM  frequencies. Rescinded.

Rule 1014. (1) An ambulance, nontransporting pre-hospital life support vehicle, or nonemergency transporting vehicle shall be equipped with 2-way radio equipment meeting the specifications of, and utilizing  the frequencies and continuous or pulsed audio tones specified by, the MEDCOM

plan.

(2) An ambulance, nontransporting pre-hospital life support vehicle, nonemergency transporting vehicle, or rescue and extrication vehicle shall not be equipped  for  radio  transmission  on  MEDCOM

 

 

frequencies unless specifically assigned to the  service  by  the  MEDCOM  plan,  except  as approved  by the department in exceptional circumstances.

 

R 325.24015  Air ambulance; minimum specifications. Rescinded.

Rule 1015. Air ambulances, both fixed and rotor wing, shall comply with all of the following minimum specifications:

(a)   Be authorized as part of a licensed air ambulance operation.

(b)    The aircraft and its equipment shall be in  compliance  with prevailing federal aviation regulations for the type of  aircraft  in question and the flying  conditions  under  which  the  aircraft will be operated, as specified in the air taxi certificate of operation of the air ambulance provider.

(c)   The aircraft shall be capable of carrying a minimum of 1 patient in a horizontal position on a litter  located so as  not  to  obstruct  the pilot’s vision or interfere with the performance  of  any  member  of  the flight crew or required medical attendant.

(d)  There shall exist a means of securing the litter and attached patient to the floor,  walls,  seats, specific litter rack, or any combination thereof.

(e)   If the aircraft provides for the carrying of more than 1 litter patient at a time, there shall be a minimum vertical spacing of 30 inches between litters.

(f)   The upper surface of the single or upper litter shall not be closer than 30 inches to the ceiling of the aircraft.

(g)   The head and thorax of a patient secured to a litter in an air ambulance shall be accessible to a minimum of 1 emergency medical technician from at least 1 side of the litter without obstruction.

(h)    The patient compartment shall have sufficient lighting available for patient observation, with a minimum of 40 footcandles at the floor level.

(i)   The patient compartment shall have fresh air ventilation  and temperature regulation for patient and emergency medical technician comfort.

(j)     The aircraft shall provide 1 door large enough to provide for easy litter patient loading and unloading in the supine position.

(k)   The electrical system of the aircraft shall be capable of supporting all ancillary equipment without the threat of overload or system failure and shall be equipped with sufficient outlets and  plugs  styled  for the type of equipment used.

(l)   All air ambulance equipment shall be securely moored and stored for easy accessibility.

 

R 325.24016  Water ambulance; minimum specifications. Rescinded.

Rule 1016. All water ambulances shall meet all of the following requirements:

(a)   Comply with all applicable coast guard and Michigan department of natural resources rules and regulations.

(b)   Be authorized as part of a licensed water ambulance operation.

(c)   Meet patient compartment design requirements as approved by the department.

 

R 325.24017  Off-road ground vehicles. Rescinded.

Rule 1017. A person who  intends  to   provide  off-road  ground transportation of a patient or  patients under extraordinary circumstances or when geographical barriers and environmental conditions make the patient or patients inaccessible to an authorized ambulance shall do both

of the following:

(a)   Register the vehicle with the department on forms prescribed by the department.

 

 

(b)   Equip each vehicle with those items specified in the essential equipment list established by the department for ambulances. An exception to this subdivision is a snowmobile, which shall carry, at a minimum, all of the following equipment:

(i)   Long spine board.

(ii)   Traction splint.

(iii)   Padded board splints.

(iv)   Dressings that may be needed for open wounds.

(v)   A complete set of oropharyngeal airways.

 

R 325.24018  Nontransporting  pre-hospital  life  support  vehicles; requirements. Rescinded.

Rule 1018. A person who intends to operate a nontransporting vehicle routinely used or designated as  available to perform basic emergency care shall do all of the following:

(a)   Register each vehicle so used or designated with the department.

(b)   Equip each vehicle in accordance with section 20746(1) of the code.

© Equip each  vehicle  with  radio  communication  capabilities  as specified by the MEDCOM plan  for class I and class II pre-hospital life support vehicles. For the purposes of this rule, classification of  these vehicles is as follows:

(i)   For classification within the class I category, a pre-hospital life support vehicle shall be staffed with at least 1 licensed emergency medical technician who is available 24 hours a day, 7 days a week.

(ii)    For classification within the class II category, a pre-hospital life support vehicle shall be staffed with at least 1 person who possesses current department-approved certification in advanced  first  aid and emergency care and cardiopulmonary resuscitation basic life support and who is available 24 hours a day, 7 days a week.

 

R  325.24020    Advanced  or  limited  advanced    mobile    emergency    care vehicles; requirements.

Rescinded.

Rule 1020. (1) An advanced or limited advanced mobile emergency care vehicle shall be equipped with medical emergency  supplies which permit performance of authorized procedures and with other types of equipment deemed necessary by the medical control advisory board. Patient care and other equipment shall be provided in accordance with minimum standards as specified on department form J- 226, dated November, 1983, for limited advanced mobile emergency care vehicles or as specified on  department form J-198, dated November, 1983, for advanced mobile emergency care vehicles. Nontransporting vehicles are exempt from carrying patient litters and equipment permanently installed in an ambulance for use in transport.

(2) In addition to the requirements in subrule (1) of this rule, an advanced mobile emergency care vehicle shall comply with the following requirements:

(a)   Be equipped with a department-approved, 2-way radio system capable of maintaining both 1-way  telemetry and 2-way verbal communications directly between the advanced emergency medical technician rendering advanced emergency care at the scene of an emergency and the cooperating hospital. The radio system shall include a portable component capable of establishing and maintaining telemetry and verbal communications at the patient’s side with the physician or the physician’s designee at the cooperating hospital when removed to a distance of 1,250 feet, over average terrain, from the advanced mobile emergency care vehicle.

(b)   Be equipped with all of the following:

(i)   A defibrillator.

 

 

(ii)   An electrocardiogram monitor capable of direct interface into the portable radio component and an auxiliary capability for interface into an ordinary telephone terminal as an alternative means of  telemetry transmission to the cooperating hospital.

(iii)   An inventory of drugs and intravenous fluids deemed essential by the medical control board.

(iv)   Other appropriate treatment supplies deemed essential by the medical control board.

(3)   In addition to the requirements in subrule (1) of this  rule,  a limited advanced mobile emergency care vehicle shall be equipped with a department-approved, 2-way radio system capable of  maintaining 2-way verbal communications directly between the emergency medical technician specialist or the advanced emergency medical technician rendering limited advanced emergency care at the scene of an emergency and the cooperating hospital. The radio system shall include a portable component capable of establishing and maintaining verbal communications at the  patient’s  side with the physician or the physician’s designee at the cooperating hospital when removed to a distance of 1,250 feet, over average terrain, from the vehicle.

 

PART 11. HEARING PROCEDURES

 

R 325.24101  Applicability. Rescinded.

Rule 1101. (1) The procedures set forth in this part apply to hearings required by sections 20162(5), 20165, 20166, and 20168 of part 201 of the code as they relate to advanced mobile emergency care services, limited advanced mobile emergency care  services,  ambulances,  and  ambulance operations and as they relate to sections 20739, 20766, and 20767 of part 207 of the code.

(2) Unless otherwise provided by the code, the procedures for a hearing shall comply with chapters 4  and 5 of Act No. 306 of the Public Acts of 1969, as amended, being SS24.271 to 24.292 of the Michigan Compiled Laws.

 

R 325.24102  Compliance orders; opportunity to show compliance. Rescinded.

Rule 1102. (1) When the department issues a compliance order to an ambulance operation, limited advanced mobile emergency care service, or advanced mobile emergency care service under the provision of section 20162(5) of the code, the compliance order shall comply with all of the following requirements:

(a)   Describe the violation and the statute or rule violated.

(b)   Specify the corrective action to be taken and the period of time in which corrective action is to be completed.

(c)   Inform the licensee that he or she has a right to a hearing within 5 days from the time of service and  that, if he or she wishes to be heard, the department will have a hearing officer present at the time or  place specified in the compliance order.

(2) Failure to raise a defense on or before the hearing, or to appear at the hearing, shall be deemed an admission of the matters asserted in the compliance order. If the respondent fails to make an appearance or to contest the notice, the compliance order shall be final  without  any further proceeding.

(3) Before commencing the proceedings for  denial,  limitation, revocation, or  suspension  of  a license, authorization, approval, or certification for an ambulance operation, advanced  mobile emergency care service, limited advanced mobile emergency care service, or emergency personnel required to be licensed, authorized, approved, or certified by the code and these rules, the department shall give notice to  the applicant  or  holder  of  the  license,  authorization,  approval,  or  certification, personally or by certified mail, of the facts or conduct which warrants the intended action

 

 

and  shall  provide  the  applicant  or holder of the license, authorization, approval, or certification  with an opportunity to show compliance with the code and these rules at a compliance conference.

(4)    If the applicant or holder of the license, authorization, approval, or certification is unable to demonstrate compliance with all lawful requirements for licensure, authorization, approval, or  certification to the satisfaction of the department at the compliance conference,  the department may  issue a notice of hearing which shall state the grounds for the amendment, denial, suspension, or  revocation or grounds for the department’s intent to amend, deny, limit, suspend, or revoke the license, authorization, approval, or certification.

 

R 325.24103  Hearing; initiation; content of notice; conduct. Rescinded.

Rule 1103. (1) A hearing is initiated by the department by giving notice thereof to the respondent, either personally or by certified mail. Notice shall include all of the following information:

(a)   The time, date, place, and nature of the hearing.

(b)   The action intended by the department and a brief statement of the facts involved.

(c)   The legal authority and jurisdiction under which the hearing is to be held.

(d)  A reference to the applicable sections of the code and the rules involved.

(2) The hearing shall be conducted by the director or 1 or more   hearing officers designated by the director.

 

R 325.24104  Service; proof of service. Rescinded.

Rule 1104. Unless otherwise specified, service of a document upon any party shall be made by  personal delivery or by certified mail to the last known address of the party or the authorized representative of a party as indicated on the records of the department, and proof of service shall be  filed with the department.

 

R 325.24105  Appearance. Rescinded.

Rule 1105. A party may appear  in  person,  by  an  authorized representative, or by legal counsel.

 

R 325.24106  Pleadings and documents. Rescinded.

Rule 1106. (1) All pleadings shall contain the department’s caption and docket number, if assigned, and shall include a clear and plain statement of facts alleged and the relief sought.

(2)   A pleading, other than an exhibit, shall be typewritten, double spaced, and on letter-size opaque paper, approximately 8 ½ inches by  11 inches. The left margin shall be 1 ½ inches and the right margin  1 inch. A pleading and other documents shall be fastened in the upper left corner.

(3)   A hearing shall be titled “In the matter of (name of respondent).” This caption shall appear at the upper left side of the first page of each filed pleading or document other than an exhibit.

(4)   The first page of a pleading or document, other than an exhibit, shall show at its upper right side, opposite the caption, the docket number assigned by the department, if known.

 

R 325.24107  Extension of time; request. Rescinded.

Rule 1107. A request for an extension of time for the filing of a pleading or document shall be made in writing and served on the presiding officer and all parties not less than 5 days before the date on  which the pleading or document is due to be filed.

 

R 325.24108  Answer. Rescinded.

 

 

Rule 1108. Within 15 days after service of a notice of hearing, a respondent may file a written  answer with the department. The answer shall respond to all allegations in the notice of hearing which the party plans to contest and shall raise any affirmative defenses. All allegations not denied by written  answer are deemed admitted.

 

R 325.24109  Consolidation; severance. Rescinded.

Rule 1109. (1) Cases may be consolidated, for good cause, on the motion of any party or the hearing officer’s own motion, in such circumstances as justice and the administration of the code and these rules require. A motion for the consolidation of cases shall be filed within 20 days after service of the notice of hearing on each party to the cases which would be consolidated. Within 10 days after  service  of the motion, the other parties may file a response thereto. Unless a request for oral argument is made and granted, the termination of the motion shall be made on the pleadings.

(2) Upon his or her own motion, or upon motion of any party, the hearing officer, for good cause, may  order any case severed as to some or all issues or parties.

 

R 325.24110  Presiding officer; powers and duties; disqualification. Rescinded.

Rule 1110. (1) A presiding officer shall have all  powers  necessary  or appropriate to conduct a fair, full, and impartial hearing, including the power to do all of the following:

(a)   Administer oaths and affirmations.

(b)   Rule upon offers of proof and receive relevant evidence.

(c)   Provide for the taking of testimony by deposition.

(d)  Regulate the course of the hearings, set  the  time  and  place  for continued hearings, fix the time for  filing of briefs and other documents, and issue subpoenas.

(e)   Consider and rule upon procedural requests.

(f)  Hold conferences for the settlement or simplification of the issues by consent of the parties.

(g)   Prepare proposed decisions, if required.

(2) When a hearing officer believes himself or herself disqualified  to preside over a particular hearing,  he or she shall withdraw therefrom  by notice on the record directed to the director. A party who claims  that a hearing officer should be disqualified to preside, or to continue to preside, over a particular hearing may file with the director a motion to disqualify. The motion shall be supported by affidavits setting forth the alleged grounds for disqualification. The director shall rule upon the motion, and the decision shall be determinative for purposes of the hearing.

 

R 325.24111  Prehearing conference. Rescinded.

Rule 1111. (1) The presiding officer, upon request of any party or on his or her own motion, may order a prehearing conference for the purpose of facilitating the disposition of a contested case.

(2)   The purposes of the prehearing conference are as follows:

(a)   State and simplify the factual and legal issues to be litigated.

(b)    Admit matters of fact and the authenticity of documents and  resolve other evidentiary matters to avoid unnecessary proof.

(c)   Exchange lists of witnesses and the nature of their testimony.

(d)  Estimate the time required for the hearing.

(e)   Resolve other matters that may aid in the disposition of the case.

(3)    At the prehearing conference, the presiding officer may make rulings on motions pertaining to evidence, law, and procedure, when practicable. A record shall be made of all motions and rulings and

 

 

other  matters  deemed appropriate at the presiding officer’s discretion and shall become a  part of the hearing record.

(4)    The parties to a hearing are encouraged to  voluntarily  confer  for the purpose of facilitating the disposition of a case.

 

R 325.24112  Adjournment. Rescinded.

Rule 1112. A party may request an adjournment of a scheduled hearing by motion to the presiding officer assigned to conduct the hearing. The presiding officer shall not rule on the request until opposing parties have had an opportunity to be heard on the request. However, if all parties agree to the adjournment, then the presiding officer may rule on the request immediately.

 

R 325.24113 Agreement before final order. Rescinded. Rule 1113. (1) At any time before a final order is issued, the parties may negotiate an agreement containing consent findings and an order disposing of the whole or a part of the case. This agreement shall be submitted to the presiding officer  who  shall  rule  upon  it  after considering the nature of  the  proceeding,  the  representations  of the parties, and the probability that the agreement will result in a just disposition of the issues  involved.

(2) The agreement containing consent findings and an order disposing of a proceeding shall contain all  of the following provisions:

(a)    That the consent finding and order shall have the same force and effect as if made after a full hearing.

(b)    That the record on which an order may be based shall consist solely of the pleadings and the agreement.

(c)   A waiver of any further proceedings before the hearing officer and the director.

(d)   A waiver of any right to challenge or contest, in any forum,  the validity of the consent findings and order made in accordance with the agreement.

 

R 325.24114  Discovery. Rescinded.

Rule 1114. (1) The same rights to discovery and depositions provided in the general court rules of this state applicable to civil cases shall apply to all hearings commenced and conducted pursuant  to  the code and these rules. The presiding officer shall rule on all motions relative to depositions and discovery.

(2) Discovery depositions and motions for discovery shall not be allowed by the presiding officer if they are likely to interfere with the efficient conduct of the hearing, unless serious prejudice  would  result there from.

 

R 325.24115 Preliminary motions. Rescinded.  Rule 1115. (1) Not less than 5 days before the date set  for hearing in the notice, all preliminary motions shall be filed, unless the presiding officer, for good  cause shown, permits the filing of such motions at a later date. These motions include all of the  following:

(a)   Motions for a more definite statement.

(b)   Motions to strike pleadings.

(c)   Motions to amend pleadings.

(d)  Motions for accelerated judgment.

(e)   Motions for summary judgment.

(f)  Discovery motions.

 

 

(g)   Motions relative to depositions.

(2)    On the date set for hearing in the notice, the presiding officer shall first hear all pending preliminary motions. He or she shall decide them in the same manner as provided for in the general court rules of the state for civil cases. Thereafter, all motions are to be made and heard at the direction  of the presiding officer.

(3)   After hearing all pending preliminary motions, if any, the presiding officer may hold a prehearing conference as provided for in these rules.

 

R 325.24116  Direct testimony. Rescinded.

Rule 1116. When in any case it is deemed  necessary or desirable, the presiding officer may direct that the direct testimony of any witness or witnesses be submitted in written form, together with any  exhibits to be sponsored by the witness, before the hearing. Such direct testimony shall be submitted in typewritten form on 8 ½-inch by 11-inch paper and shall be in question and answer form. The direct testimony of each witness so submitted shall be made a separate exhibit, and the name and address of  the witness, together with the caption of the case, shall appear on a cover sheet. Each witness is required to be present at the hearing to introduce his or her written testimony as an exhibit and  for cross-examination at such date, time, and place as directed by the presiding officer.

 

R 325.24117  Hearing record; transcripts. Rescinded.

Rule 1117. Hearings shall be recorded, but need not be transcribed unless requested by a party. The party requesting the transcript shall pay for the transcript.

 

R 325.24118  Proposal for decision. Rescinded.

Rule 1118. (1) Following the conclusion of a hearing,  the  hearing officer, if other than the director, shall deliver to the department the official case file and his or her proposal for decision. The department shall serve the proposal for decision upon the parties by registered or certified mail or  personal service, and each party shall have 10 days from the date of service of the proposal for decision to file exceptions or present written arguments to the director.

(2) Following review of the record or the proposal for decision and exceptions thereto, if any, the director shall issue an order setting forth findings of fact, conclusions of law, and his or her final order or an order for further proceedings. The department shall serve copies of the director’s order upon  all parties.

(3)   If no exceptions are filed, the proposal for decision shall become the final order of the department,  unless the director issues his or her order within 90 days from  the  date  of  service  of  the  proposal  for decision.