Q: When does the Privacy Rule allow covered entities to disclose protected health information to law enforcement officials?

A: This issue is covered by federal regulations, not state. Click here for full answer.

 

Q:  I have heard that MA is "not an OSHA state" and that OSHA type standards set by the state apply to private services, but not to municipal (e.g., fire departments). How can I be sure I'm protected?

A:  MA Department of Labor Standards (MDLS) regards OSHA standards and other consensus standards (e.g., ANSI) as minimally acceptable work practice standards for both private and public sectors.   (State and municipal employers are not subject to OSHA type fines and penalties.)

Private and public sector employees are covered by MGL Chapter 149 Section 6 for prevention of work related injuries and illnesses.

MGL Chapter 149 section 18A requires personal protective equipment. The MDLS follows OSHA 29 CFR 1910.132 and OSHA 29 CFR 1910.1030 for guidance on selecting the correct PPE for First Responders (including EMTs).

 

Q: Are ambulance services required to report a motor vehicle collision involving an ambulance to OEMS?

A: Ambulance services must report to OEMS any ambulance collision that occurred while a patient was on board, any collision where an EMT sustained an injury, any collision where an EMT was cited by police, any serious collision, and any that would be reported to the Registry of Motor Vehicles.  (M.G.L. Chapter 90, Section 26 requires a person who was operating a motor vehicle involved in a crash in which (i) any person was killed or (ii) injured or (iii) in which there was damage in excess of $1,000 to any one vehicle or other property, to complete and file a Crash Operator Report with the Registrar within five (5) days after such crash. A copy must also be sent to the police department having jurisdiction.)

 

Q: If you are providing care to a patient in cardiac arrest and the family or nursing home staff cannot find the DNR/MOLST form, what can you do if they find a valid DNR/MOLST form while you’re still on scene performing patient care either in the house or in your ambulance still on their premises? Should you bring the deceased back to where you found them? Do you transport them non-emergently to the nearest ED?

A: When a family member or nursing staff produces a valid DNR, resuscitative efforts should cease (in the case of MOLST, the EMT needs to provide care or withhold efforts as indicated on the form).  The patient should remain, or be returned to, their home or facility if the ambulance is still on scene; preferably placed in his/her own bed while preserving as much dignity as possible.  105CMR 170.365 prohibits an ambulance to be used to transport a dead body except in special circumstances where it is in the interest of public health and/or safety to do so.

 

Q: What are the MA regulations in regard to the use of oxygen by a first aid squad operating at a company or on a college campus?

A: MA regulation is specific about the definition of First Responder (members of police or fire departments and also life guards).  Any other individuals operating first aid teams for a college or business are not "First Responders" by MA regulation, unless they are campus police officers.

College campuses sometimes have certified EMTs working on a first aid team, but if they do not operate under the college's own ambulance license or EFR* license, they are not allowed to work to the level of EMT-Basic for which there are specific requirements for medical oversight to cover the administration of drugs.

"According to the U.S. Food and Drug Administration (FDA), oxygen for administration to humans is a prescription drug and is therefore, a controlled substance in Massachusetts. Oxygen does not meet the FDA criteria to be sold as an over-the-counter-drug. All administration of oxygen to a human must be done in accordance with state and federal law. In brief, such oxygen must be manufactured by a registered manufacturer, properly labeled and administered only pursuant to the order or prescription of a practitioner and administered only by an individual authorized by the law to administer oxygen using only approved medical devices. Any manufacture, possession, dispensing or administration of oxygen that does not follow state and federal law is not legal."  (Source: MDPH).  See also the  Controlled Substance regulation.

(*EFR means Emergency First Responder.  This refers to a First Responder agency, such as a police or fire department, which is licensed as an EFR at the EFR, BLS, or ALS level.  There are only a few in the state and they usually operate in areas with extended ambulance response times.)

 

Q: Is it an acceptable and legal practice for basic EMTs to operate in an ambulance that has a locked cabinet with paramedic use only medications and drugs in it?

A: No; two EMT-Basics staffing an ambulance (i.e., working at the BLS level) must carry only equipment allowed on the approved OEMS BLS Equipment list and/or the approved optional equipment list applicable to the BLS level.  ALS medications, regardless if they are “locked” should not be carried on a BLS level staffed ambulance.

 

Q: Is it acceptable for any EMT or ambulance service to create their own state EMT patch or are they supposed to be standardized to lend credibility and encourage professionalism?  Lately I’ve seen EMTs wearing “state” EMT patches that are red and white, and another that was all gray!

A: The state does not regulate patch design nor do they issue patches.  There is no requirement on the design of the state EMT patch and there is no state requirement that EMTs must wear them.  (There is an EMS regulation that prohibits a non-EMT from holding her/himself out as being an EMT when s/he is not, so if a non-EMT wore a state EMT patch, action could be taken).

 

Q: As an EMT, am I required to leave a copy of the patient care report (PCR) at the hospital after transporting a patient?

A: Yes, 105 CMR 170.345(C)(2) indicates: The EMTs on each transporting ambulance shall leave a copy of the trip record at the receiving health care facility with the patient at the time of transport. The receiving health care facility shall keep such trip records with the patient's medical record.

 

Q: Is there a regulation which requires EMTs to report to OEMS suspension of driver’s license or a conviction of a misdemeanor or felony? What about reporting to the service where I work?

A: Yes; 105 CMR 170.937 requires that each EMT or EFR file a written report to the service where s/he provides EMS and the Department (OEMS) within five days of suspension or loss of driver’s license as well as any conviction of a misdemeanor or felony, other than a minor traffic violation for which less than $1,000 was assessed. The EMT must also file a written report with the service s/he works within five days of OEMS action against the EMT’s certification.

 

Q: How long should an ambulance service keep records (including copies of patient care reports)?

A: 105 CMR 170.345 mandates that records be stored for a period of not less than seven years. The full text of this EMS regulation is available HERE

 

Q: Is it acceptable to store an ambulance outside?

A: No; according to 105 CMR 170.390, an ambulance must be stored in a temperature-controlled garage. The full text of this EMS regulation is available HERE

 

Q: Where can I find the MGL pertaining to EMTs and patient abandonment?

A: 105 CMR 170.355 (A) "Responsibility to Dispatch, Treat and Transport" covers the issue of abandonment.

 

Q: A paramedic is off-duty and comes across an MVA and stops to assist and assumes care of a patient when a BLS ambulance arrives to transport. Would transferring care to the BLS crew be considered a form of abandonment since we are only supposed to transfer to equal or greater level of care?

A: No; if a paramedic is off-duty, he is not considered a paramedic. His duties as a paramedic are only in effect when he is associated ("on the clock") with a licensed ambulance service. Along these same lines, if an individual is certified as a paramedic (or any other level of EMT) but works for a police or fire department that does not have an ambulance license, s/he is simply operating as a First Responder, along with all the other First Responders at the department.

 

Q: I have heard, although unofficially, that the Service Zone Planning requirement for Dec. 31, 2006 was extended to June. Can you tell me if this is accurate?

A: Contrary to rumor, the Department has NOT extended the deadline for Service Zone compliance. The deadline was December 31, 2006.

 

Q: Does OEMS require any information from ambulance services in order for an EMT to be eligible to drive an ambulance?

A: OEMS requirements for ambulance service written policies under 105 CMR 170.330 which could be interpreted as related to driver training is limited to "orientation of all ambulance service employees", "duties of transportation and policies relating to delivery of patients to appropriate health care facilities", and "use of lights and warning signals". Ambulance services may, if they so choose, set their own policies for driver training requirements, but specific driver training requirements for EMTs or ambulance services have not been set by OEMS. Each ambulance service is required, under 105 CMR 170.285(C), to ensure that its EMTs carry on their person or in their EMS vehicle, a valid motor vehicle operator's license.