Answers to Questions

Q: Appendix U to the Statewide Treatment Protocols cites Temperature as a vital sign. Are BLS ambulances now permitted to carry thermometers when acting in accordance with appendix U?

A: No. It is entirely up to the fire service or police agency using EMS as rehab to provide/require whatever temperature monitoring equipment they want. It is not an optional piece of equipment for carriage by an ambulance service because it has no other role in the MA EMS Prehospital Treatment Protocols for patient care.

Q:  When will ambulance services be required to submit data in compliance with MATRIS(Massachusetts Ambulance Trip Record Information System)?

A: OEMS will continue to pilot the MATRIS with a few ambulance services throughout the fall in anticipation of full implementation and required compliance by the end of 2008

Q: Are new federal regulations going into effect in November that would require certain ANSI compliant vests for ambulance personnel responding to incidents on highways? If so, do ANSI compliant jackets meet this burden?

A: Yes. Title 23, Code of Federal Regulation Part 634 requires, as of November 24, 2008, that responders to incidents on Federal-aid highways wear high-visibility safety apparel which meets the Performance Class 2 (reflective vest) or Class 3 (reflective jacket) of the ANSI/ISEA 107-2004 publication "American National Standard for High-Visibility Safety Apparel and Headwear."

Q: How much money do CPR instructors make?

A: CPR instructors set their own fees for courses so their income varies. In addition to the initial cost of an instructor course, there are costs associated with the instructor manuals and videos. Course fees must also cover the cost of text books, student supplies (e.g., barrier shields and masks), manikins, AED trainers, and cards.

Q: Will a BLS for Healthcare Provider card meet the requirements for First Responder training?

A:  No.  First Responder training includes the BLS for Healthcare Provider CPR training, but it also includes advanced First Aid training.  First Responder training must meet the requirements set forth in MDPH/OEMS Administrative Requirement 2-100 available at: http://www.cmemsc.org/protocols-state/ARManualTableofContents.shtml

Q: Is it within a minor's right to refuse ambulance transport?

A: Refer to Administrative Requirement 5-610 "Responding to Scenes Involving Minors Refusing Treatment or Transport"

Q: How much money can you make per hour after you get trained?

A: According to the US Department of Labor; Bureau of Labor Statistics: "Earnings of EMTs and paramedics depend on the employment setting and geographic location as well as the individual's training and experience. Median annual earnings of EMTs and paramedics were $27,070 in May 2006.

Q: If a PT has suspected head trauma and is found laying down, can the PT be put on the KED, then on a stair chair for extrication from a House?

A: The KED is intended for extrication from difficult areas (e.g., mangled motor vehicle) in order to minimize patient movement upon transferring to a long board. A patient as described in question should be immobilized directly to a long board according to spine immobilization training.

Q: As an EMT, if I hold a current card as an AHA BLS Instructor, do I need a separate Healthcare Provider card?

A: No, the AHA BLS Instructor card is sufficient.

Q: Is there a maximum temperature for IV fluids?

A: 104° - 108° F (40°– 42° C); this is the recommended temperature for the treatment of hypothermia.

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. The full text of this regulation may be found at: http://www.cmemsc.org/protocols-state/emsregsMay2005.pdf

Q: Is there a maximum number of non-certified EMTs (ex: observers/First
Responders) that can be on an ambulance at any given time?

A: The number is limited to service policy but may not exceed the number of seatbelts to which these individuals can be safely restrained without interfering with patient care.

Q: My Ambulance Service has a document to assist New EMTS and Student EMTS gather all the information needed for a PCR including Patient Name, Address, DOB, medical history, and medications. After Transport of the PT the EMT uses this document to help write the PCR. Once all information is transferred and the PCR is completed, should this document be destroyed, or how should this document be handled as it does contain confidential PT information?

A: The HIPAA Privacy Rule requires that covered entities implement reasonable safeguards to limit incidental uses or disclosures of protected health information. See 45 CFR 164.530(c)(2). Although the regulation does not dictate specific means or provide guidance on acceptability of methods of destruction for confidential materials, shredding (and subsequent recycling) is convenient, effective, and has minimal environmental impact.

Q: If I'm a certified EMT-Paramedic working for a service licensed at the
Intermediate level, am I allowed to perform to the Intermediate Level?

A: You are restricted to working only to the EMT-Intermediate level if that is the level of licensure for the service. (If you are a certified EMT-P working at a service licensed at the Basic level, then you would be restricted to operating at the EMT-B level).

Q: As an AHA BLS instructor, what does the state of MA allow me to certify
people as CPR only, or can I also certify first responders?

A: The Commonwealth of Massachusetts does not govern your American Heart Association Instructor status; that is the responsibility of the AHA Training Center listed on the back of your BLS Instructor card. There is no "certification" for First Responders. There must be documentation that First Responder training was completed in accordance with the OEMS Administrative Requirement 2-100. This AR includes the primary instructor qualification requirements, which includes certification as an instructor, (but not specifically as an AHA BLS instructor). NOTE: The AHA has a First Aid course designed for laypeople. It is NOT equivalent to First Responder training.

Additional information regarding First Responder requirements and regulations is available at http://www.cmemsc.org/first-responder/first-responder.shtml

Q: Can a EMT become a CPR INSTRUCTOR?

A: Yes, an EMT can become a CPR, or more accurately, a BLS Instructor. Courses are available through various training associations (e.g., American Heart Association, Red Cross). CMEMSC offers this training through its AHA Training Center. The registration form for the next course is available at
our website under the AHA/CPR heading.

Q: What ceu's can I use toward my emt recertification?

A: Continuing education programs that have received approval by OEMS and have a Department issued continuing education approval number may be applied toward EMT recertification. Contact Paul Coffey at 617-753-8300 with questions regarding Special Programs.

Q: Are vents allowed to be used on an emergent call?

A: When responding to an emergency call where a patient is found on a vent, the individual assisting the patient with the vent (e.g., either a family member at home, or staff at a nursing facility) must accompany the patient in the ambulance to attend to the vent. EMTs should be prepared to provide manual ventilation (BVM) in the event of mechanical failure.

Q:  Do only First Responders need to re-cert in CPR each year or when it
says first responders does that include EMT's B, I & P?

A: According to regulation, only First Responders need to renew their CPR (healthcare professional level) training on a yearly basis. EMTs (all levels) must renew every two years.

Q: Are there any requirements for M+M rounds at the paramedic level?

A: Once the Medical Control regulations and associated EMS System regulatory changes that affect Affiliation Agreements are in effect (the deadline was extended until "further notice" on October 31, 2007), morbidity and mortality (M & M) rounds will be required. Ambulance Services licensed to the ALS level will be required to maintain an Affiliation Agreement with a hospital licensed by the Department of Public Health to provide medical control. According to 105 CMR 170.300 (A)(7), the Affiliation Agreement must include a provision to ensure "regular consultation between medical and nursing staffs and EMS personnel providing ALS services, including but not limited to attendance at morbidity and mortality rounds and chart reviews;" The hospital is similarly bound to this requirement through their hospital regulations governing hospitals providing medical control (see 105 CMR 130.1502(K).

Q: Are vents allowed to be used on an emergent call?

A: When responding to an emergency call where a patient is found on a vent, the individual assisting the patient with the vent (e.g., either a family member at home, or staff at a nursing facility) must accompany the patient in the ambulance to attend to the  vent. EMTs should be prepared to provide manual ventilation (BVM) in the event of  mechanical failure.

Q: Are there any plans to create a 2008 protocol update program, available for use and approved for CEUs?

A: OEMS has not assigned the state training committee the task of creating a 2008 protocol update training program, so the updates will need to be provided at the service level.

Q: How many CEUs do I need to renew my EMT certification?

A: EMT-Basic: 28 hours plus 24 hour refresher
     EMT-Intermediate: 28 hours plus 36 hour refresher
     EMT-Paramedic: 25 hours plus 48 hour refresher

Q: Under what circumstances would one use the State Med Channels?

A: The state med channels 220, 280, and 340 are no longer used in Region II.
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Q: How many continuing education credits does OEMS allow an individual to acquire through on-line EMS training programs?

A: At this time there is no limit to how many on-line credit hours can be applied to recertification requirements.

Q: I was certified as an EMT-Basic several years ago, but missed the recertification deadline since I was out of the country. Can I still renew my certification?

A. An application for reinstatement of EMT certification may be made if no more than one year has passed since certification expiration. The required refresher training must have been completed no more than one year prior to the application for reinstatement. The applicant must also send the appropriate fee, proof of current BLS (CPR) training, and successfully complete the Massachusetts EMT Basic written and practical examination.

Individuals who missed recertification requirements due to serving in active duty military may apply for an extension of their certification with acceptable proof of mobilization for active duty and discharge summary.

Q: Is it required for an EMT-I to take a protocol upgrade exam?

A: All EMTs need to complete a protocol update whenever a new version of the protocols is released (every two years). A service may require their EMTs to successfully complete a protocol update exam as a condition of employment.

Q: What are the requirements for a nurse to challenge the paramedic
exam? and if a nurse were to take the didactic portion of a paramedic
program could they forego the clinical and just take the state exam

A: Individuals seeking to challenge the EMT-P based on RN, MD, or PA licensure must follow Administrative Requirement 2-322 (this form is not available electronically, but is available by calling our office at 508-854-0111). The field internship ("clinical") cannot be waived.

Q: Can EMT-Intermediates administer D-50 after confirming a low blood
sugar and starting a line?

A: Massachusetts EMT-Intermediates are NOT allowed to administer D-50 (They are also not
allowed to administer D5W). Please refer to the Altered Mental/Diabetic Protocol 3.3 available at:
http://www.cmemsc.org/protocols-state/state-protocols.shtml.
 

Q: While working near the state border, can we transport a STEMI or CVA patient to an appropriate facility (one that can actually treat such patient, ie interventional cath lab, ect) out of state?

A: CVA (Stroke) patients should be transported according to the Region II Point of Entry Plan for Stroke which is based on state criteria and available at: http://www.cmemsc.org/protocols-state/StrokePOE/RegionIIStrokePOEPlan.doc

A Cardiac Point of Entry Plan is not in place yet. The state is working on the final criteria for such a plan. In the meantime, STEMI patients should be transported to the closest facility.
 

Q: Does the region ever acknowledge years of service from its EMT's and Paramedic's? After 20 years of certification as a Nationally Registered EMT or Paramedic they send you a very nice certificate.

A: The Region does not have a database of EMTs working in Region II with the length of time they’ve been certified so we are unable to issue milestone recognition certificates. We do accept nominations for EMS Outstanding Performance Recognition awards which are presented each year at our annual meeting (scheduled this year for May 1st). Nomination applications are available from our homepage.
 

Q: What is the para gravida scale for pregnancies?

A: Gravida/para status refers to a woman's obstetric history. Gravida indicates
the total number of pregnancies a woman has had, regardless of whether they
were carried to term. Para indicates the number of births of viable
children.

For example, a woman who has had two pregnancies (both of which resulted in
live births) would be noted as G2P2. A woman who had 4 pregnancies, one of
which was miscarried, would be noted as G4P3.

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 CMED monitor the VHF HEAR frequencies? If so, can CMED patch through a hospital on HEAR?

A: The Hospital Emergency Alerting Radio (HEAR)is a VHS system that allows direct radio communication between ambulance and hospital and was primarily used several decades ago before the UHF CMED communication system was established. CMED uses the HEAR for communications with other CMEDs and
does not monitor it for ambulance traffic or provide entry notification facilitation (i.e., a "patch")to the hospitals via HEAR. HEAR radio use for ambulance to hospital communications does not allow for recorded radio traffic or for the coordination of the flow of traffic to the hospital in cases of Mass Casualty Incidents.

Q: I am told that a paramedic unit can get medical control for an emergency from any hospital that they are transporting to even though the service does not have a formal agreement with that Hospital. Is this true?

A: EMS regulations don't prohibit a service's paramedics from getting medical direction from a receiving facility's ED physician, to whom they are calling with an entry notification and asking which medical control option within the Protocols they should use for a patient they are transporting to them; but...

The affiliate hospital medical director has ultimate responsibility for medical control, and needs to be informed as to what kind of medical control paramedics are getting on a standard basis from another facility.

Ideally, in these cases, the affiliate hospital medical director would delegate medical direction responsibility for calls to another facility's ED docs, and have a mechanism in place for getting information back on what happened on those calls.

Otherwise, the affiliate hospital medical director's QA for that service and its paramedics is inadequate and incomplete.
 

Q: How do I get teaching credit? I helped teach a BLS refresher and I am currently certified at the BLS level.

A: Authorized instructors who teach EMS related subjects may earn up to a maximum of 20 hours credit (if an EMT-B) and 10 hours (if an EMT-P) toward recertification. An EMT earns one hour of credit for each two hours of unassisted teaching. Co-instructors split credit hours. These special credit hours are awarded on an individual basis after review by OEMS.  Submit a letter of request with documentation that supports the request to:
OEMS; 2 Boylston St. 3rd Floor; Boston, MA 02116; Attn: Paul Coffey.

Does OEMS approve/recommend certain glucometers for use in the field?

A: OEMS requires that a service use a glucose monitoring device that is:

1. approved by the FDA;
2. utilizes capillary action;
3. measures whole blood;
4. uses one-time lancet;
5. uses small specimen size to decrease the risk of bloodborne pathogen exposure, and;
6. requires minimal calibration and cleaning

Q: When can we expect approved Point of entry plans from the department (DPH/OEMS) so we can legitimize what we are presently doing in the field? i.e, Trauma, Cardiac, Burns, and other specialties?

A: We currently have state criteria for Point of Entry for Trauma (burns are included in trauma) and Stroke. The regional guidelines that apply to these designate the approved facilities. Details are found on our website under "Region II Guidelines". State criteria for Cardiac Point of Entry is in draft form. Finalization is expected sometime in 2007. Once that is complete, the region will designate the approved cardiac facilities.

Q: Do you know of any upcoming I/C courses?

A: Instructor Coordinator (I/C) Courses are coordinated through OEMS. Contact Russ Johansen for information at: 617-753-7302.

Q: Can we now pull the MAST pants off of the ambulances. I have been told by our med control Dr that we need to keep them but can't find them on the state list of equipment to have on the ambulance.

A: MAST (Medical Anti-Shock Trousers) are no longer required for carriage on ambulances in Massachusetts and may be removed.

Q: How long are continuing education approval numbers good for? Do they expire?

A: Continuing education approval numbers are effective for the date of the program unless the training coordinator applies for an "open" date for the year, and then they are effective until the end of the calendar year.

Q: Do you have to be an Instructor/ Coordinator to submit for credit and teach a BLS refresher?

A: One does not need to be an Instructor/Coordinator to teach a BLS refresher, but there are instructor requirements as outlined on page 10 of the state training manual available at: http://www.cmemsc.org/training/AHAinstructors/OEMSTrainingManual.pdf

Q: Will AHA CPR rosters suffice as proof of certification of training while awaiting cards?

A: A fully completed AHA roster with the signature of a valid AHA instructor is sufficient to provide evidence that the course was completed while awaiting cards except for EMTs who are required to hold a current training card at all times while operating on an ambulance.

Q: Is there a state entity that provides training related to the how to and reasons for a clinical investigation?

A:  There are no clinical investigation "training programs" but the process is as follows:

1. Investigations are usually initiated after a report is made to OEMS in the form of a complaint against a service, EMS provider, or both. These complaints may be submitted by a patient, family member, bystander, first responder, hospital staff, or other pre-hospital provider. Each Region is also bound by regulation to report any violation of 105 CMR 170.000 (these are the EMS regulations which cover everything from ambulance licensing requirements to adherence to protocols). Sometimes, these reports are made by the service itself since they have a duty to report serious incidents.  Such reportable incidents include, but are not limited to:

   • Medication errors resulting in serious injury;

   • Failure to provide treatment in accordance with the Statewide Treatment Protocols resulting in serious injury; or

   • Major medical or communications device failure, or other equipment failure or user error resulting in serious injury or delay in response or treatment.
      

2. When OEMS receives a complaint, it determines first whether the issue is within its jurisdiction; second, whether an investigation is warranted, or whether the issue is one that is more appropriately handled as an ambulance licensure matter by the OEMS ambulance inspector for that service. Investigations are coordinated and in most cases conducted by the OEMS Compliance Coordinator, Michael Clapp, EMT-Paramedic. Once an investigation is completed, the investigator presents a summary of findings and recommendations to a team that reviews all OEMS compliance cases (the team includes the OEMS Director or Acting Director, Medical Director, Clinical Coordinator and the Policy and Regulatory Specialist).

In all cases, an investigation report is drafted which contains a summary of the facts, investigation, findings, and a resolution plan if needed. When there is a valid finding, most result in some sort of letter (e.g., Advisory Letter, Letter of Clinical Deficiency, Letter of Reprimand, Notice of Serious Deficiency) and a resolution plan that involves remediation, as overseen by a medical director. In very few cases where the findings are of a serious nature, or in which the EMT or service has a repeated compliance history with the Department, the OEMS team may propose Department agency action for suspension or revocation of an EMT's certification and the case file is forwarded to the Department's Office of General Counsel. The Office of General Counsel will review the case file and the OEMS recommendation, and if it believes an agency action is defensible, will manage the agency action. Additional information regarding complaints is available at the OEMS website.

Q: If a town has decided to change its EMS provider does that town have to continue the previous level of care? For example, if a town has a private ALS service and that town wants to take over the ambulance, does the town have to staff the ambulance at the ALS level or can the town reduce the care being provided by making the service BLS or ILS?

A:  A town determines what level of service will be provided within its community (BLS or ALS- there is no such thing as "ILS"). A town may choose not to renew their contract with an ALS service, or if provided by a municipal service, not renew their license at the ALS level. This determination should be made after careful consideration of all factors contributing to providing optimal pre-hospital care and examining alternative options such as regionalized ALS.

Q: When do CPR cards actually expire? Is there such a thing as "a 30 day grace period" to recertify?

A: American Heart Association CPR cards are valid for two years from training and expire the last day of the month indicated on the card's expiration date. Instructors aligned with the CMEMSC AHA Training Center may use their own discretion to allow a thirty day "grace period" for individuals taking the Healthcare Provider Renewal course rather than mandating the Healthcare Provider Initial course. There are no other AHA courses available in the "renewal" format.

Q: Where are the Regional Guidelines and Protocols the State EMS Pre-Hospital Treatment Protocols make reference to? I would like to suggest a link to them be put on the side bar index so they all may be viewed on line. Thank you

A: Your suggestion has been implemented.  For Region II Guidelines click here.

Q: When staffing the Ambulance at the PB level is there any special requirements for the Medic or Basic?

A: When operating under a PB waiver, the ambulance service must meet the requirements of AR 5-256.

Part of these requirements includes ensuring that all EMTs, at all levels of certification, who work under P/B waivers complete required, Department approved training for P/B waivers (i.e., Paramedic Assistant course).
 

Q: Do Clinical Laboratory Improvement Amendments (CLIA) apply to ambulance companies? Do they have to apply for this certification to use glucometers? A/R 5-520 is not very clear on this.

A: CLIA, a federal regulation, does apply to ambulance services. A certificate of waiver is required to carry glucometers on ambulances. Download the application at our webpage: http://www.cmemsc.org/protocols-state/glucometer.shtml

Q: Can magazine articles such as those printed in JEMS or EMS be submitted to OEMS for continuing education credit, and what is the process for applying for a con-ed number for these articles? Ex. JEMS charges to submit these for credit through them. Is there a loop-hole so I do not have to pay a fee and can offer it to other EMTs and Paramedics for con-ed hours?

A: JEMS prints some very good CE courses in their journal each month. You may submit them (to the appropriate region) with a continuing education application to request OEMS continuing education credits. Be sure to credit JEMS for the program. (You may even want to create a PowerPoint presentation to enhance the delivery of the course and add supporting videos, practical activities, and group discussions to make the most of the program). The quiz at the end of each CE program does not include the answer key. Be sure you know the material well enough to complete the quiz accurately to avoid relaying the wrong information to your students.

Q: If 2 EMT-B's are on the bus with a child birth, do both  Emts get a Stork pin or only the Emt with PT. care?

A: There is no set rule about the stork pin. Since both EMTs are responsible for patient care, both can wear the pin.

Q: Is a paramedic, who is credentialled in Region II only but has taken an interfacility transfer class, able to attend a transfer that originates outside of Region II or in another state (ex: call coming out of Boston or Rhode Island)? (The medic is not nationally certified).

A: Any paramedic certified in Massachusetts who has successfully completed the latest Inter-facility Transfer training program may transfer any patient within the Commonwealth or any patient originating outside the Commonwealth. At all times the scope of practice is limited to the IFT guidelines found in Appendix N of the Mass EMS Pre-hospital Treatment Protocols.

Q: Can first responders (not certified EMT's) obtain refusals from patients at an emergency scene? Example- Fire Dept. running a Class 5 ambulance not fully staffed by EMTs, but required to document every EMS run, including patient refusals not obtained by the private EMS provider.

A:  First Responders may cancel an incoming ambulance for “no EMS” calls (e.g., 9-1-1 call for an MVA which is then determined to be just a disabled motorist). First Responders are not prohibited from obtaining a patient refusal but there should be a policy in place between the First Responder service (e.g., police or fire department) and the ambulance service, since ultimately; the ambulance crew is responsible for the response to the patient. First Responders should receive the appropriate training in dealing with patient refusals and continue ambulance response for any patient that a refusal of care may not be prudent.

Q: How much training does it take to become a paramedic?

A: You can review requirements on the Massachusetts Paramedic Training Programs web page.

Q: If a Paramedic is working for a service licensed at the Basic or Intermediate level is the medic at all responsible for the care of the patient or actions of the other technician?

A: The care of a patient is the responsibility of BOTH EMTs since they are considered working together as a team.

An EMT (no matter what level; paramedic, intermediate, or basic), may only perform duties to the LICENSURE LEVEL OF THE SERVICE. An EMT (no matter what level) working for a First Responder service (e.g., police department, on-call fire department that is NOT licensed as an ambulance service) may only perform duties to the First Responder level.

Q: If a competent patient initially refuses care but goes unconscious while crew is in process of informing patient of possible consequences of refusing care: does the crew then operate under implied consent?

A: Yes they do !

Q: Which are the level 1 and trauma centers in Region 2? According to OEMS web site, there are none, or UMASS is the only one, depending on where you look.

UMass is the only ACS (American College of Surgeons) verified Level 1 Trauma Center in Region II and is identified as the only Trauma Center in the Region II Trauma Point of Entry Designation:  http://www.cmemsc.org/cmed/point_of_entry.htm [answer updated July 6, 2006]

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