2010 MD REG TEXT 219090 (NS)
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2010 MD REG TEXT 219090 (NS)
Maryland Regulation Text - Netscan
COMAR 30.01.01.02; COMAR 30.03.01.01; COMAR 30.03.04.04, 06, 07; COMAR 30.08.04.05; COMAR
30.09.01.02; COMAR 30.09.08.06; COMAR 30.09.11.02, 04
Final Actions on Regulations
October 08, 2010
Institute for Emergency Medical Services Systems
On September 14, 2010, the Maryland Emergency Medical Services Board adopted: Amendments to Regulation .02
under COMAR 30.01.01 Definitions; Amendments to Regulation .01 under COMAR 30.03.01 Definitions; The repeal
of existing Regulations .04, .06, and .07 and new Regulations .04 and .06 under COMAR 30.03.04 Quality Assurance.
COMAR 30.01.01.02
*COMAR 30.01.01.02 Definitions.*
A. In this title, the following terms have the meanings indicated.
B. Terms Defined.
(1) “Advanced life support (ALS)” means care that may only be rendered by EMT-Ps or CRTs under the Maryland
Medical Protocols for Emergency Medical Services Providers.
(2) “Affiliated” means having employment or membership as an EMS provider with an EMS operational program.
(3) “Automated external defibrillator (AED)” means a medical heart monitor and defibrillator device that:
(a) Has been cleared for market by the Food and Drug Administration;
(b) Is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia and
determining, without intervention by an operator, whether defibrillation should be performed; and
(c) Upon determining that defibrillation should be performed, automatically charges and requests delivery of an
electrical impulse to an individual's heart and requires user intervention to deliver the electrical impulse or automatically continues with the delivery of the electrical impulse.
(4) “Base station” means a unit of a hospital which has been approved by the EMS Board under COMAR 30.03.06 to
provide online medical direction to EMS providers.
(5) “Basic life support (BLS)” means care rendered by EMT-Bs or first responders under the Maryland Medical
Protocols for Emergency Medical Services Providers that is not ALS care.
(6) “Cardiac rescue technician (CRT)” means an individual licensed by the EMS Board as a CRT.
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2010 MD REG TEXT 219090 (NS)
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(6-1) “Electronic Maryland Ambulance Information System (EMAIS®)” means the Web-based electronic prehospital
data collection system developed and operated by MIEMSS.
(7) “Emergency medical dispatcher (EMD)” means an individual licensed by the EMS Board as an EMD.
(8) “Emergency medical services (EMS)” has the meaning stated in Education Article, §13-516(a)(5), Annotated
Code of Maryland.
(9) “Emergency Medical Services (EMS) Board” means the Board established by Education Article, §13-503, Annotated Code of Maryland.
(10) “Emergency medical services (EMS) operational program” means:
(a) A jurisdictional EMS operational program; or
(b) An institution, agency, corporation, or other entity that is licensed by MIEMSS as a commercial service under
Education Article, §13-515, Annotated Code of Maryland.
(11) “Emergency medical technician-basic (EMT-B)” means an individual certified by the EMS Board as an EMT-B.
(12) “Emergency medical technician-paramedic (EMT-P)” means an individual licensed by the EMS Board as an
EMT-P.
(13) “EMS provider‘ means an individual licensed or certified by the EMS Board to provide emergency medical
services.
(14) “Executive Director” means the Executive Director of MIEMSS.
(15) “First responder (FR)” means an individual certified by the EMS Board as a first responder.
(16) “Institutional review board” means a group of individuals designated by an institution in compliance with 45 CFR
46, to review the use of human subjects in proposed research.
(17) “Jurisdictional EMS operational program (jurisdiction)” means an EMS operational program which is approved
under COMAR 30.03.02.03 and is not licensed as a commercial service under Education Article, §13-515, Annotated
Code of Maryland.
(18) “Maryland Ambulance Information System (MAIS)” means the prehospital patient care record system for Maryland.
(19) “Maryland Institute for Emergency Medical Services Systems (MIEMSS)” means the State agency established by
Education Article, §13-503, Annotated Code of Maryland.
(20) “Statewide Emergency Medical Services Advisory Council (SEMSAC)” means the body established by Education Article, §13-511, Annotated Code of Maryland.
COMAR 30.03.01.01
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2010 MD REG TEXT 219090 (NS)
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*COMAR 30.03.01.01 Definitions.*
A. In this subtitle, the following terms have the meanings indicated.
B. Terms Defined.
(1) “American Board of Medical Specialties (ABMS)” means the umbrella organization for the 24 approved medical
specialty boards in the United States.
(2) “Commercial Ambulance Service Advisory Council” means the advisory committee to the EMS Board on commercial ambulance service matters.
(3) “Credentialing” means the process by which an EMS operational program medical director and EMS operational
program review and evaluate the qualifications and skills of an EMS provider in the course of delegating aspects of the
practice of medicine to the EMS provider.
(4) “Direct supervision” means oversight exercised by a supervising physician who is close enough to the individual
being supervised that the supervising physician can hear, see, and intervene as necessary.
(4-1) “EMS provider-in-charge” means the highest medically certified or licensed EMS provider who assesses or
provides care to a patient.
(5) “House officer” means an individual in a postgraduate medical training program who:
(a) Has completed at least the first year of that program;
(b) Is authorized to practice medicine without a license under Health Occupations Article, §14-302, Annotated Code
of Maryland; and
(c) Is functioning as a resident in a residency program at a hospital that has a base station.
(6) “Jurisdictional Advisory Committee” means the advisory committee to the EMS Board on jurisdictional EMS
operational program matters.
(7) “Licensed physician” means a physician licensed or otherwise authorized to practice medicine by the State Board
of Physicians or its predecessor under Health Occupations Article, Title 14, Annotated Code of Maryland.
(8) “Medical direction” has the meaning stated in Education Article, §13-516(a)(12), Annotated Code of Maryland.
(9) “MIEMSS Institutional Review Board” means the group of individuals designated by the EMS Board in compliance with 45 CFR 46, to review the use of human subjects in proposed research.
(10) “Off-line medical direction” means prospective and retrospective medical oversight of an EMS operational
program by a medical director including credentialing, quality assurance, education, and planning.
(11) “On-line medical direction” means medical oversight and orders by licensed physicians to EMS providers
providing patient care.
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2010 MD REG TEXT 219090 (NS)
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(12) “Pediatric Emergency Medical Advisory Group” means the advisory committee to the EMS Board on pediatric
matters.
(13) “Privileges” means the ability of an EMS provider to provide EMS under the delegated authority of an EMS
operational program medical director.
(14) “Quality assurance (QA)” means an organized method of auditing and evaluating care provided within an EMS
system.
(15) “Specialty care transport” has the meaning defined in COMAR 30.09.01.02B(40).
(16) “System medical director” means any of the following:
(a) The Executive Director of MIEMSS;
(b) The State EMS Medical Director;
(c) The Associate State Medical Director for Pediatrics;
(d) The regional medical directors;
(e) The associate regional pediatric medical directors;
(f) The EMS operational program medical directors; and
(g) The assistant EMS operational program medical directors.
COMAR 30.03.04.04
*COMAR 30.03.04.04 Maryland Ambulance Information System.*
A. Each EMS operational program shall, within 24 hours of a call's dispatch, ensure the completion of an EMS patient
care report for each unit:
(1) That responds to a call within the State;
(2) That responds to a call from within the State;
(3) That provides EMS care;
(4) That provides EMS transport; or
(5) That applies the Maryland Medical Protocols for Emergency Medical Services Providers.
B. The EMS provider-in-charge of each unit shall ensure the accurate and timely completion of the patient care report.
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2010 MD REG TEXT 219090 (NS)
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C. The patient care report shall be complete without reference to any other documentation.
D. EMS Documentation Delivered to the Receiving Facility.
(1) If a patient is transported to a health care facility, a completed patient care report shall, if possible, be left at the
receiving facility before the EMS unit leaves the facility.
(2) If a completed patient care report is not left at the health care facility, the transporting unit shall:
(a) Provide documentation of the patient's prehospital care on a template and in a format provided or approved by
MIEMSS for inclusion in the patient care record before leaving the facility; and
(b) Deliver the completed patient care report for the patient to the receiving facility not later than in 24 hours after
transfer of care.
E. EMS Data Submitted to MIEMSS.
(1) If the EMS operational program uses MAIS or CMAIS forms, EMS data shall be submitted to MIEMSS monthly
by delivery of a copy of the form, or in some other form acceptable to MIEMSS, provided the EMS operational program retains the ribbon copy of each MAIS or CMAIS form as the official record of the data contained therein.
(2) If the EMS operational program uses EMAIS®, all EMS data shall be submitted to MIEMSS electronically via
EMAIS®.
(3) If the EMS operational program records health care data electronically in a form other than EMAIS®:
(a) All EMS data shall be delivered electronically to MIEMSS with content and format acceptable to MIEMSS; and
(b) The EMS data shall be submitted to MIEMSS at least once every 24 hours to include all newly completed patient
care reports.
(4) Changes to a completed patient care report or dataset after it has been submitted to MIEMSS shall be managed as
an amendment to the original record or dataset and will not overwrite the original file. No amendments will be accepted after 30 days.
F. After December 31, 2010, all EMS operational programs shall only submit EMS data to MIEMSS through
EMAIS® or electronically with content and format acceptable to MIEMSS.
G. All electronic EMS data reports shall prominently display on each patient care report a unique 11-character report
identifier in which:
(1) The first three characters shall show the unique identifier assigned to the EMS operational program by MIEMSS;
(2) The fourth and fifth characters shall show the year of the event reported on; and
(3) The remaining 6 characters shall show the EMS operational program sequential report number which shall be reset
to zero for the first event reported in each calendar year.
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H. EMAIS® patient care report data will be made available to an EMS operational program by MIEMSS in accordance with the Maryland Confidentiality of Medical Records Act, Health-General Article, §4-301 et seq., Annotated
Code of Maryland, and, if applicable, the federal Health Insurance Portability and Accountability Act (HIPAA) privacy regulations, 45 CFR §164.500 et seq., for treatment, quality assurance, and billing, if requested by the EMS
operational program and pursuant to the terms of a memorandum of understanding with MIEMSS.
I. Compliance with this regulation shall be required for an EMS Operational Program to meet the requirements for
funding under Public Safety Article, §8-103(b)(7), Annotated Code of Maryland, (Amoss Fund) with respect to the
Maryland Ambulance Information System and to be eligible for MIEMSS grants.
COMAR 30.03.04.06
*COMAR 30.03.04.06 Occupational Exposure Reporting.*
Each EMS operational program shall deliver monthly to MIEMSS a report of occupational exposures to blood in a
form acceptable to MIEMSS.
COMAR 30.03.04.07
*COMAR 30.03.04.07 Repealed.*
COMAR 30.08.04.05
*COMAR 30.08.04.05 Responsibilities of Emergency Medical Services Providers.*
A. Prehospital services shall provide prehospital patient care reports and EMS data in accordance with COMAR
30.03.04.04 that include trauma or specialty care patient data about:
(1) Trauma victims dead at the scene of the trauma;
(2) Patients meeting State trauma or specialty triage criteria who are transported to a hospital;
(3) Patients transported in accordance with interfacility transfer policies to receive a higher level of care or for special
resources; and
(4) Patients transported to specialty referral centers.
B. Designated trauma or specialty care centers shall use the patient criteria described in Regulation .01B and C of this
chapter.
COMAR 30.09.01.02
*COMAR 30.09.01.02 Definitions.*
A. In this subtitle, the following terms have the meanings indicated.
B. Terms Defined.
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(1) “Administrative law judge” means an individual appointed under State Government Article, §9-1605, Annotated
Code of Maryland.
(2) “Advanced life support provider” means an individual licensed by the EMS Board as an EMT-P or CRT.
(3) Advertising.
(a) “Advertising” means information communicated by any oral, electronic, written, or graphic means including
handbills, newspapers, business cards, letterhead, other business stationery, television, billboards, radio, and telephone directories.
(b) “Advertising” includes ambulance markings.
(c) “Advertising” does not include novelty items such as key chains, pens, pencils, or mugs.
(4) “Air ambulance” means any aircraft designed and constructed or modified and equipped to be used, maintained, or
operated as an ambulance.
(5) Ambulance.
(a) “Ambulance” or “commercial ambulance ‘” means any motor vehicle or aircraft designed and constructed or
modified and equipped to be used, maintained, or operated for the transportation of individuals who are sick, injured,
wounded, or otherwise incapacitated.
(b) “Ambulance” or “commercial ambulance” does not include a motor vehicle or aircraft designed and constructed or
modified and equipped with a hydraulic lift which is used, maintained, or operated exclusively for transporting, in
wheelchairs, patients who do not require the use of equipment and trained personnel found in an ambulance.
(6) “Automated external defibrillator (AED)” means a medical heart monitor and defibrillator device that:
(a) Has been cleared for market by the Food and Drug Administration;
(b) Is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia and
determining, without intervention by an operator, whether defibrillation should be performed; and
(c) Upon determination that defibrillation should be performed, automatically charges and requests delivery of an
electrical impulse to an individual's heart and requires user intervention to deliver the electrical impulse or automatically continues with the delivery of the electrical impulse.
(7) “Basic life support provider” means an individual certified by the EMS Board as a first responder or an EMT-B.
(8) “CAMTS” means Commission on Accreditation of Medical Transport Systems.
(9) “Cardiac rescue technician (CRT)” means an individual licensed by the EMS Board as a CRT.
(10) “CMAIS” means Commercial Maryland Ambulance Information System.
(11) “Commercial ambulance crew (crew)” means:
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(a) For ground ambulances, at least two EMS providers, one of whom may also be the driver; or
(b) For air ambulances, at least two health care providers, at least one of whom shall be an EMS provider and one pilot
as required by CAMTS.
(12) “Commercial ambulance license” means a license issued to a commercial ambulance service by MIEMSS under
this subtitle, authorizing the use of a specific commercial ambulance.
(13) Commercial Ambulance Service.
(a) “Commercial ambulance service” means an individual, firm, partnership, limited liability company, corporation,
association, or organization engaged in the business of transporting, by ambulance, individuals who are sick, injured,
wounded, or otherwise incapacitated.
(b) “Commercial ambulance service” does not include transporting individuals in an ambulance owned by, operated
by, or under the jurisdiction of a unit of State government, a political subdivision of the State, a volunteer fire company, a volunteer ambulance company, or a volunteer rescue squad or other jurisdictional EMS operational program
recognized by the EMS Board.
(14) “Commercial ambulance service license” means a license issued to a commercial ambulance service by MIEMSS
under this subtitle, authorizing the operation of a commercial ambulance service.
(15) “Confidential business information” means information that:
(a) Is used in the business of a commercial ambulance service;
(b) Gives the commercial ambulance service the opportunity to obtain advantage over a competitor;
(c) Is known only to the commercial ambulance service and employees or agents of the commercial ambulance service
to whom the commercial ambulance service needs to confide the information; and
(d) Is kept secure from disclosure by the commercial ambulance service.
(16) “Consumer price index (CPI)” means the Consumer Price Index, U.S. City Average (seasonally unadjusted) For
All Items/All Urban Consumers (CPI-U 1982/84 = 100), published in the “Monthly Labor Review” as well as other
publications of the Bureau of Labor Statistics of the United States Department of Labor.
(17) “Emergency” means any sudden or serious symptoms in a patient which might indicate a condition which:
(a) Is threatening to the patient's physical or psychological well-being; and
(b) Requires immediate medical attention to prevent possible deterioration, disability, or death of the patient.
(18) “Emergency Medical Services (EMS) Board‘ means the Board established by Education Article, §13-505, Annotated Code of Maryland.
(19) “Emergency medical services (EMS) provider” means an individual licensed or certified by the EMS Board to
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provide emergency medical services.
(20) “Emergency medical technician-basic (EMT-B)” means an individual certified by the EMS Board as an EMT-B.
(21) “Emergency medical technician-paramedic (EMT-P)” means an individual licensed by the EMS Board as an
EMT-P.
(22) “EMRC” means the Emergency Medical Resources Center operated by MIEMSS to coordinate online medical
direction.
(23) “Executive Director” means the Executive Director of the Maryland Institute for Emergency Medical Services
Systems.
(24) “FAA” means the Federal Aviation Administration.
(25) “First responder (FR)” means an individual certified by the EMS Board as a first responder.
(26) “Ground ambulance” means a motor vehicle designed and constructed or equipped to be used, maintained, or
operated as an ambulance.
(27) “Health care provider” means a person licensed, or otherwise certified in Maryland or authorized to practice in
Maryland as a:
(a) Physician;
(b) Registered nurse;
(c) Nurse practitioner;
(d) Respiratory therapist; or
(e) Emergency medical services provider.
(28) “Helipad‘ means a designated area usually with a prepared surface used for take-off, landing, or parking helicopters.
(29) “Heliport” means an area of land or structure used for the landings and take-offs of helicopters and may include
its buildings and facilities.
(30) “Jurisdictional EMS operational program (jurisdiction)” means an EMS operational program which is:
(a) Approved under COMAR 30.03.02.03; and
(b) Not licensed as a commercial ambulance service under Education Article, §13-515, Annotated Code of Maryland.
(31) Repealed.
(32) “MIEMSS” means the Maryland Institute for Emergency Medical Services Systems established in Education
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Article, §13-503, Annotated Code of Maryland.
(33) “Neonatal referral center” means an out-of-State center operating under an agreement with MIEMSS to provide
comprehensive neonatal services.
(34) “Neonatal Resuscitation Program” means the neonatal resuscitation course cosponsored by the American Heart
Association and the American Academy of Pediatrics.
(35) “Neonate” or “neonatal patient” means a patient who:
(a) Is younger than 28 days; or
(b) Has been an inpatient since birth.
(36) “Neonatologist” means a pediatrician certified by the American Board of Pediatrics in neonatology.
(37) “Perinatal referral center” means a center in Maryland designated by MIEMSS, or an out-of-State center operating under an agreement with MIEMSS, to provide comprehensive obstetrical and neonatal services.
(38) “Physician” means an individual authorized to practice medicine in Maryland.
(39) “Registered nurse” means an individual authorized to practice registered nursing in Maryland.
(40) “Specialty care transport (SCT)” means the transport of a patient who either:
(a) Requires care or monitoring commensurate within the scope of practice of a physician or registered nurse and
beyond the scope of a paramedic credentialed to provide specialty care transport; or
(b) Meets the following conditions:
(i) Requires ongoing care or monitoring which is within the scope of a paramedic who is credentialed to provide
specialty care transport as defined in the Maryland Medical Protocols for EMS Providers; and
(ii) Does not currently need or is not anticipated to need intervention during transport that would be beyond the scope
of a paramedic credentialed to provide specialty care transport under the Maryland Medical Protocols for EMS Providers.
(41) “State Office of Commercial Ambulance Licensing and Regulation (SOCALR)” means the MIEMSS department
responsible for implementing and enforcing the provisions of this subtitle.
(42) “SYSCOM” means the Systems Communication Center operated by MIEMSS under Education Article, §13-509,
Annotated Code of Maryland, and COMAR 30.07.01.
COMAR 30.09.08.06
*COMAR 30.09.08.06 Submission of Reports.*
A commercial ambulance service shall:
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A. Upon reasonable request from SOCALR, submit within a reasonable time:
(1) Reports;
(2) Surveys;
(3) Complaint investigation findings;
(4) Patient care records;
(5) Personnel records;
(6) Training records; and
(7) Vehicle records;
B. Notify SOCALR orally within 72 hours, and in writing within 5 calendar days, of all:
(1) New names registered with the Maryland Department of Assessments and Taxation for the purpose of doing
business;
(2) Additions, or deletions, to the physical locations of operation;
(3) Changes in:
(a) Medical direction,
(b) ALS coordinator,
(c) Information included on an application, and
(d) Operation of the ambulance service;
(4) Reports submitted to the deputy State health officer in accordance with COMAR 10.06.01;
(5) Reports submitted in accordance with COMAR 30.03.04;
(6) Violations of this subtitle by:
(a) A commercial ambulance service employee, or
(b) Anyone acting as an agent for a commercial ambulance service;
(7) Events involving the commercial ambulance service which results in:
(a) Bodily injury, or
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(b) Death;
C. Submit every proposed change to ambulance markings for review and approval before making any changes to
ambulance markings, including but not limited to:
(1) Numbering;
(2) Lettering; or
(3) Symbols;
D. Submit patient care reports and EMS data in accordance with COMAR 30.03.04.04.
E. Submit a current personnel list quarterly, before the 15th of January, April, July, and October; and
F. Submit by the 15th of each month for the preceding month a summary report listing the number of calls for the
month that were:
(1) BLS;
(2) ALS;
(3) Neonatal;
(4) SCT;
(5) Accompanied by a physician, nurse, or other health care provider;
(6) Referred to 911; or
(7) BLS calls in which the AED was used.
COMAR 30.09.11.02
*COMAR 30.09.11.02 Additional Operational Requirements.*
A. An ALS commercial ambulance service shall retain at least one licensed EMT-P to function as an ALS coordinator
who:
(1) Is approved by the ALS service medical director;
(2) Participates on the ALS service's quality review committee; and
(3) Oversees:
(a) ALS operations;and
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(b) The submission of patient care reports and EMS data in accordance with COMAR 30.03.04.04.
B. An ALS commercial ambulance service may provide BLS service with an ambulance licensed as either:
(1) ALS; or
(2) BLS.
C. An ALS commercial ambulance service may not provide scheduled ALS service with a BLS-licensed commercial
ambulance vehicle unless:
(1) It uses a BLS-licensed ambulance for a period of not more than 30 calendar days for reasons related to:
(a) Routine maintenance; or
(b) Mechanical failure of an ALS-licensed commercial ambulance vehicle;
(2) The BLS-licensed ambulance has, in addition to the equipment required in COMAR 30.09.10, all the equipment
required in this chapter; and
(3) It has notified SOCALR of the proposed use before its occurrence and has been issued a confirmation number
verifying authorization.
COMAR 30.09.11.04
*COMAR 30.09.11.04 Additional Requirements for Obstetrical Transports.*
A. An ALS-licensed ambulance may not transport an obstetrical patient from one hospital to another for a higher level
of obstetrical care unless:
(1) The admitting hospital:
(a) Is a perinatal center;
(b) Before designation of perinatal centers by the EMS Board, has a certificate of need issued by the Maryland Health
Resources Planning Commission for its neonatal intensive care unit or approval from the Health Services Cost Review
Commission for a neonatal intensive care cost center; or
(c) Before the EMS Board has completed the process of entering into an agreement with an out-of-State hospital to
serve as an out-of-State perinatal referral center, possesses all government approvals required to operate a neonatal
intensive care unit under the laws of the jurisdiction in which it is located including, if required, a certificate of need
and all necessary licenses;
(2) The additional equipment required under §B of this regulation is onboard; and
(3) In addition to the staffing required under COMAR 30.09.07.02A(4), there is a registered nurse or physician experienced in the care of obstetrical patients onboard.
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B. Equipment Requirements.
(1) The additional equipment required under §B(2) of this regulation may be provided by the referring or admitting
hospital and shall be onboard when transporting an obstetrical patient.
(2) In addition to the equipment required under COMAR 30.09.10 and this chapter, the following shall be onboard:
(a) One doppler;
(b) One reflex hammer;
(c) One neonatal bag valve mask with manometer and newborn and premature infant size masks;
(d) One IV infusion pump; and
(e) The following medications:
(i) Four vials oxytocin (10 units/milliliter);
(ii) Two vials methergine (0.2 milligram/milliliter);
(iii) Two vials 10 percent calcium gluconate (10 milliliters);
(iv) Three vials terbutaline (1 milligram/milliliter); and
(v) Eight vials 50 percent magnesium sulfate (10 milliliters).
C. Additional Record Keeping Requirements.
(1) In addition to the requirements in COMAR 30.09.08, the following information shall be documented on the patient
report:
(a) Name of the referring hospital;
(b) Name of the referring physician;
(c) Name of the receiving hospital;
(d) Name of the receiving physician;
(e) Names and license or certification level of the commercial ambulance driver and commercial ambulance personnel;
(f) Time the request for transport was received by the commercial ambulance service;
(g) Time en route to the referring hospital;
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(h) Time of arrival at the referring hospital;
(i) Time of departure from the referring hospital;
(j) Time of arrival at the admitting hospital;
(k) Maternal gestational age;
(l) Reason for transport; and
(m) Care provided during transport.
(2) Patient care reports and EMS data shall be submitted in accordance with COMAR 30.03.04.04.
D. The additional requirements for obstetrical transports listed in §§A and B of this regulation may be waived when an
ALS-licensed commercial ambulance is transporting an uncomplicated obstetrical patient from a hospital without an
obstetrical service.
END OF DOCUMENT
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