641—132.9 (147A) Service program—off-line medical direction.
	   132.9(1) The medical director shall be responsible for providing appropriate medical direction and overall supervision of the medical aspects of the service program and shall ensure that those duties and responsibilities are not relinquished before a new or temporary replacement is functioning in that capacity.
	   132.9(2) The medical director’s duties include, but need not be limited to:
	      a.    	 Developing, approving and updating protocols to be used by service program personnel that meet or exceed the minimum standard protocols developed by the department.
	      b.    	 Developing and maintaining liaisons between the service, other physicians, physician designees, hospitals, and the medical community served by the service program.
	      c.    	 Monitoring and evaluating the activities of the service program and individual personnel performance, including establishment of measurable outcomes that reflect the goals and standards of the EMS system.
	      d.    	 Assessing the continuing education needs of the service and individual service program personnel and assisting them in the planning of appropriate continuing education programs.
	      e.    	 Being available for individual evaluation and consultation to service program personnel.
	      f.    	 Performing or appointing a designee to complete the medical audits required in subrule 132.9(4).
	      g.    	 Developing and approving an applicable continuous quality improvement policy demonstrating type and frequency of review, including an action plan and follow-up.
	      h.    	 Informing the medical community of the emergency medical care being provided according to approved protocols in the service program area.
	      i.    	 Helping to resolve service operational problems.
	      j.    	 Approving or removing an individual from service program participation.
	   132.9(3) Supervising physicians, physician designees, or other appointees as defined in the continuous quality improvement policy referenced in 132.9(2)“g” may assist the medical director by:
	      a.    	 Providing medical direction.
	      b.    	 Reviewing the emergency medical care provided.
	      c.    	 Reviewing and updating protocols.
	      d.    	 Providing and assessing continuing education needs for service program personnel.
	      e.    	 Helping to resolve operational problems.
	   132.9(4) The medical director or other qualified designees shall randomly audit (at least quarterly) documentation of calls where emergency medical care was provided. The medical director shall randomly review audits performed by the qualified appointee. The audit shall be in writing and shall include, but need not be limited to:
	      a.    	 Reviewing the patient care provided by service program personnel and remedying any deficiencies or potential deficiencies that may be identified regarding medical knowledge or skill performance.
	      b.    	 Response time and time spent at the scene.
	      c.    	 Overall EMS system response to ensure that the patient’s needs were matched to available resources including, but not limited to, mutual aid and tiered response.
	      d.    	 Completeness of documentation.
	   132.9(5) Rescinded IAB 2/6/02, effective 3/13/02.
	   132.9(6) On-line medical direction when provided through a hospital.
	      a.    	 The medical director shall designate in writing at least one hospital which has established a written on-line medical direction agreement with the department. It shall be the medical director’s responsibility to notify the department in writing of changes regarding this designation.
	      b.    	 Hospitals signing an on-line medical direction agreement shall:
	       (1)  	 Ensure that the supervising physicians or physician designees will be available to provide on-line medical direction via telecommunications on a 24-hour-per-day basis.
	       (2)  	 Identify the service programs for which on-line medical direction will be provided.
	       (3)  	 Establish written protocols for use by supervising physicians and physician designees who provide on-line medical direction.
	       (4)  	 Administer a quality assurance program to review orders given. The program shall include a mechanism for the hospital and service program medical directors to discuss and resolve any identified problems.
	      c.    	 A hospital which has a written medical direction agreement with the department may provide medical direction for any or all service program authorization levels and may also agree to provide backup on-line medical direction for any other service program when that service program is unable to contact its primary source of on-line medical direction.
	      d.    	 Only supervising physicians or physician designees shall provide on-line medical direction. A physician assistant, registered nurse or emergency medical care provider (of equal or higher level) may relay orders to emergency medical care personnel, without modification, from a supervising physician. A physician designee may not deviate from approved protocols.
	      e.    	 The hospital shall provide, upon request to the department, a list of supervising physicians and physician designees providing on-line medical direction.
	      f.    	 Rescinded IAB 2/6/02, effective 3/13/02.
	      g.    	 The department may verify a hospital’s communications system to ensure compliance with the on-line medical direction agreement.
	      h.    	 A supervising physician or physician designee who gives orders (directly or via communications equipment from some other point) to an emergency medical care provider is not subject to criminal liability by reason of having issued the orders and is not liable for civil damages for acts or omissions relating to the issuance of the orders unless the acts or omissions constitute recklessness.
	      i.    	 Nothing in these rules requires or obligates a hospital, supervising physician or physician designee to approve requests for orders received from emergency medical care personnel.
Note:  Hospitals in other states may participate provided the applicable requirements of this subrule are met.
[ARC 0063C, IAB 4/4/12, effective 5/9/12]