Code of Maryland Regulations
Title 30
Maryland Institute for
Emergency Medical Services Systems
Objectives
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Following the completion of this presentation
the participant will be able to:
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Locate and reference the Code of Maryland
Regulations (COMAR), Title 30
Describe the impact of Title 30 on the daily
operations of emergency services
Recognize the Provider Review Process (PRP)
Recognize the role of Quality Review as outlined in
Title 30
Why Regulate?
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Why Regulate?
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In its infancy MIEMSS established guidelines based
on an informal process.
The result was inconsistency, and the lack of
coordination often caused confusion among
providers.
There were no formal policies or procedures.
Maryland Regulations
Regulations are the generally applicable
rules under which a state agency operates.
 The legislature must authorize an agency
to promulgate regulations.
 The agency then must follow detailed rules
in drafting and enacting the regulations.
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What is COMAR?
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The Regulations of all Maryland Agencies are
collected in the Code of Maryland Regulations
known as “COMAR”.
COMAR Description
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COMAR is divided into “Titles”. Each title is
numbered and generally represents the rules for a
separate state agency.
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Examples:
MIEMSS -Title 30
 Department of Health -Title 10
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COMAR Description
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Titles are then broken down into “Subtitles” or
“Chapters”.
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Examples from MIEMSS Title 30:
Subtitle 02: Emergency Medical Services Providers
 Chapter 03: Scope of Practice and Duties
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COMAR Description
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The information in each chapter defines the
regulations relating to that title.
The chapter is written in outline format (much
like the Maryland Medical Protocols) for ease of
reference.
Each Subtitle contains a list of definitions for
terms used in the chapter.
Where Can I Locate a Copy?
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A copy is located in the reference section of
each public library.
COMAR can also be located on-line at
https://constmail.gov.state.md.us/comar/dsd_w
eb/default.htm
Who Does it Impact?
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TITLE 30 effects:
...“any EMS service
or provider who
operates in the
State of Maryland”...
Operational Impact
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Day-to-day influence of Title 30
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Licensure / Certification / Credential
Scope of Practice and Duties
Prohibited Conduct
Disciplinary Procedures
Operational Suspensions
Hearings
Summary Suspension of License or Certification
Maryland Title 30 Overview
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Subtitle
Subtitle
Subtitle
Subtitle
01:
02:
03:
04:
General
Emergency Medical Services Providers
EMS Operational Programs
Emergency Medical Services Education
Programs and Courses
Subtitle 06: Automated External Defibrillation
Program
Maryland Title 30
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Subtitle 07: Emergency Medical
Communications System
Subtitle 08: Designation of Trauma and
Specialty Referral Centers
Subtitle 09: Commercial Ambulances Services
Subtitle 05 will cover EMS Regional Councils
tentatively beginning July 1, 2002.
Subtitle 01
General
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Explains “Incorporation by Reference”
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The mechanism for including the Maryland Medical
Protocols into COMAR.
Designates the MIEMSS “Open Meeting” policy.
Outlines the process for the access and/or
correction of public records.
Governs the procedures for obtaining a
declaratory ruling from the EMS Board.
Subtitle 02
Emergency Medical
Services Providers
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Defines the Licensure and Certification Process
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Including:
Establishing fees for testing
 Requirements for providers
 Reciprocity
 Examination and reexamination
 Issuance of a license or certificate
 Renewal, surrender and/or reinstatement of a license or
certificate
 Criteria for denial of a license or certificate
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Subtitle 02
Emergency Medical
Services Providers
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Chapter 3 of this subtitle establishes the “Scope
of Practice” (based on the Maryland Medical
Protocols) and duties for all levels of EMS
providers including:
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Emergency Medical Dispatchers
First Responders
The chapter also contains the requirement that
an EMS provider must function under an EMS
Operational Program.
Subtitle 02
Emergency Medical
Services Providers
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Chapter 4 defines “Prohibited Conduct”
Outlines the actions that can be taken as a
result of prohibited conduct
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Reprimand or probation
Suspend or revoke a license or certificate
Deny a license or certificate
Refuse to renew a license or certificate
Subtitle 02
Emergency Medical
Services Providers
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Chapter 05 specifies the disciplinary procedures
including:
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Investigation of incident reports
Review by the Provider Review Panel
Action by the EMS Board
Case resolution conference
Hearings
EMS Board action
Subtitle 02
Emergency Medical
Services Providers
Chapter 5 continued:
 Designates the composition of the Provider
Review Panel
 Establishes the process for summary suspension
of a license or certification
 Provides confidentiality and admissibility of
proceedings, records, and files used throughout
the provider review process.
Subtitle 02
Emergency Medical
Services Providers
Chapter 6:
 Contains the procedures for administrative
hearings regarding:
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Licensure
Certification
Disciplinary action of an EMS provider
Subtitle 02
Emergency Medical
Services Providers
Chapter 7:
 Governs summary procedures for suspending an
EMS providers license or certificate based on the
protection of public health, safety or welfare.
Subtitle 03
EMS Operational Programs
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Defines the criteria for approval of an EMS
Operational Program
Establishes the policy for Medical Direction
including the appointment of the EMS Medical
Directors.
Provides the guidelines for quality assurance,
protocol development and designation of Base
stations.
Subtitle 03
EMS Operational Programs
Quality Assurance (QA)
 Each EMS Operational Program must have:
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A written QA plan approved by the medical director
A medical Review Committee
Quality Assurance
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Quality assurance plan components
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Data review
Identification and analysis of trends
Positive
 Negative
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Identification of protocol violations
Remediation for patient care issues at the
jurisdictional level.
Quality Assurance
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Quality assurance plan requirements
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Notify MIEMSS within 30 days of incidents that may
have resulted in patient harm, require disciplinary
actions from MIEMSS, or require a change in state
protocol.
Review written and oral allegations that an EMS
provider failed to act in accordance with applicable
law or protocol.
Medical Review Committee
Medical Review Committee (MRC) responsibilities:
 Every operational program must designate a
MRC.
 The committee is selected by the operational
program and its medical director.
 It shall be the duty of the MRC with the
participation of the medical director to carry out
the quality assurance plan.
Medical Review Committee
Medical Review Committee (MRC) responsibilities:
 The MRC is subject to the confidentiality and
immunity provisions as provided by COMAR.
 Each member must sign a confidentiality
agreement.
Subtitle 03
EMS Operational Programs
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Protocol development is also covered under this
subtitle.
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Chapter 05 section .02 defines the composition of
the Protocol Review Committee.
This section also established the process for
protocol development and approval including:
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Pilot Protocols
Research Protocols
Optional Protocols
Emergency Protocols
Subtitle 03
EMS Operational Programs
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Chapter 06 governs the approval and operation
of an EMS Base Station.
Specific requirements are outlined for:
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Approval and renewal
Specialty centers and consultation centers
Out-of-state centers
Denial or rescission of approval
Appeal process
Subtitle 04
Emergency Medical Services
Education Programs and Courses
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Governs the Educational Programs for:
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Emergency Medical Dispatchers
Basic Life Support Providers
Advanced Life Support Providers
Subtitle 04
Emergency Medical Services
Education Programs and Courses
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Governs the Educational Programs for:
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Emergency Medical Dispatchers
Basic Life Support Providers
Advanced Life Support Providers
Requirements for continuing education
programs are also contained within this subtitle.
Subtitle 06
Automated External
Defibrillation Program
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Establishes the criteria for the authorization of
“Public Access” AED Programs
Specific requirements for PAD programs include:
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Medical direction
Protocols
Quality assurance and maintenance
Training
Subtitle 07
Emergency Medical Services
Communications System
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Establishes the system
for helicopter
communication
to SYSCOM.
Subtitle 08
Designation of Trauma and
Specialty Referral Centers
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Provides the criteria for the designation of
trauma and specialty referral centers.
In addition it outlines the following standards
for the trauma and specialty referral centers
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Data Collection and Quality Management
Designation and verification criteria
Disciplinary Action for subtitle violation
Subtitle 08
Designation of Trauma and
Specialty Referral Centers
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This subtitle establishes the standards for the
following:
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Trauma Centers
Burn Centers
Specialty Referral Centers
Pediatric Trauma Centers
Eye Trauma Centers
Perinatal and Neonatal Referral Centers
Subtitle 09
Commercial Ambulance Services
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This subtitle provides the standards for
Commercial Ambulance Services in the State of
Maryland.
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Licensing process is defined
Operational requirements are established
Eligibility, application and renewal procedures are
included
Record keeping and MIEMSS record submission are
outlined
Subtitle 09
Commercial Ambulance Services
Commercial Ambulance Services continued
 Chapter 09 governs the enforcement of
commercial ambulance statutes and regulations.
 A standard commercial ambulance service
equipment list (for ALS and BLS) is located in
Chapters 10 & 11.
 The last chapter of the commercial ambulance
service subtitle governs the operation of
neonatal ambulance services.
Maryland Title 30
Maryland Information
System
 Each operational
program shall provide
to MIEMSS on a monthly
basis a report of patient
encounters.
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Maryland Title 30
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How do we get to compliance?
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Education
Communications
Cooperation
Consensus
Summary
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COMAR provides the framework for the
Maryland EMS System.
More Information
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If you need additional information please
contact the MIEMSS, Office of the Assistant
Attorney General
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Monty Magee
Sarah Sette
(410) 706-8531
(410) 706-8514
Maryland Title 30
Questions ???
Comments ???