(1) Qualifications - Applicants for certification as a medical program director (MPD) must:
(a) Hold and maintain a current and valid license to practice medicine and surgery under chapter
18.71 RCW or osteopathic medicine and surgery under chapter
18.57 RCW; and
(b) Be qualified and knowledgeable in the administration and management of emergency medical care and services; and
(c) Complete a medical director training course approved by the department; and
(d) Be recommended for certification by the local medical community and local emergency medical services and trauma care council.
(2) MPD certification process. In certifying the MPD, the department will:
(a) Work with the local EMSTC council to identify physicians interested in serving as the MPD;
(b) Receive a letter of interest and curriculum vitae from the MPD candidate;
(c) Perform required background checks identified in RCW
18.130.064;
(d) Work with and provide technical assistance to local EMSTC councils on evaluating MPD candidates;
(e) Obtain letters of recommendation from the local EMSTC council and local medical community;
(f) Make final appointment of the MPD.
(3) The certified MPD must:
(a) Provide medical control and direction of EMS certified personnel in their medical duties. This is done by oral or written communication;
(b) Develop and adopt written prehospital patient care protocols to direct EMS certified personnel in patient care. These protocols may not conflict with regional patient care procedures. Protocols may not exceed the authorized care of the certified prehospital personnel as described in WAC
246-976-182;
(c) Establish policies for storing, dispensing, and administering controlled substances. Policies must be in accordance with state and federal regulations and guidelines;
(d) Participate with local and regional EMS/TC councils to develop and revise:
(i) Regional patient care procedures;
(ii) County operating procedures when applicable. COPS do not conflict with regional patient care procedures; and
(iii) Participate with the local and regional EMS/TC councils to develop and revise regional plans;
(e) Work within the parameters of the approved regional patient care procedures and the regional plan;
(f) Supervise training of all EMS certified personnel;
(g) Develop protocols for special training described in WAC
246-976-023(4);
(h) Periodically audit the medical care performance of EMS certified personnel;
(i) Recommend to the secretary certification, recertification, or denial of certification of EMS personnel;
(j) Recommend to the secretary disciplinary action to be taken against EMS personnel, which may include modification, suspension, or revocation of certification; and
(k) Recommend to the department individuals applying for recognition as senior EMS instructors.
(4) In accordance with department policies and procedures, the MPD may:
(a) Delegate duties to other physicians, except for duties described in subsection (3)(b), (i), (j), and (k) of this section. The delegation must be in writing;
(i) The MPD must notify the department in writing of the names and duties of individuals so delegated, within fourteen days of appointment;
(ii) The MPD may remove delegated authority at any time, which shall be effective upon written notice to the delegate and the department.
(b) Delegate duties relating to training, evaluation, or examination of certified EMS personnel, to qualified nonphysicians. The delegation must be in writing;
(c) Enter into EMS medical control agreements with other MPDs;
(d) Recommend denial of certification to the secretary for any applicant the MPD can document is unable to function as an EMS provider, regardless of successful completion of training, evaluation, or examinations; and
(e) Utilize examinations to determine the knowledge and abilities of certified EMS personnel prior to recommending applicants for certification or recertification.
(5) The secretary may withdraw the certification of an MPD for failure to comply with the Uniform Disciplinary Act (chapter
18.130 RCW) and other applicable statutes and regulations.
(1) Qualifications - Applicants for certification as a county medical program director (MPD) must:
(a) Hold and maintain a current and valid license to practice medicine and surgery under chapter
18.71 RCW or osteopathic medicine and surgery under chapter
18.57 RCW; and
(b) Be qualified and knowledgeable in the administration and management of emergency medical care and services; and
(c) Complete a medical director training course approved by the department within the first two years of initial certification as an MPD unless an EMS fellowship has already been completed or a board certification in EMS is held; and
(d) Be recommended for certification by the local medical community and local emergency medical services and trauma care council (EMS/TC).
(2) MPD certification process. In certifying the MPD, the department will:
(a) Notify the local EMS/TC of a vacancy for an MPD and work with the local EMS/TC council and medical community to identify physicians interested in serving as the MPD;
(b) Receive a letter of interest and curriculum vitae from MPD candidates;
(c) Perform required background checks identified in RCW
18.130.064;
(d) Work with and provide technical assistance to local EMS/TC councils on evaluating MPD candidates;
(e) Obtain letters of recommendation from the local EMS/TC council and local medical community; and
(f) Make final determination to certify the MPD.
(3) Medical control and direction. The certified MPD must:
(a) Provide medical control and direction of EMS certified personnel in their medical duties. This is done by oral or written communication; and
(b) Develop and adopt written prehospital patient care protocols for specialized training and to direct EMS certified personnel in patient care. Protocols must:
(i) Meet the minimum standards of the department;
(ii) Not conflict with county operating procedures or regional patient care procedures;
(iii) Not exceed the authorized care of the certified prehospital personnel as described in WAC 246-976-182;
(iv) Be relevant and meet current nationally recognized and state approved EMS practices;
(v) Be approved by the department. The department may consult with MPDs and other technical advisory groups for input prior to approval of protocols;
(vi) Develop and keep updated a mechanism to familiarize and assess competency of EMS providers with the protocols, county operating procedures, and MPD policies; and
(vii) With approval from the department, may enter into medical control agreements with other MPDs to clarify medical oversight for EMS providers to support the continuity of patient care.
(4) MPD policies. The MPD must:
(a) Establish policies as directed by the department to include a policy for storing, dispensing, and administering controlled substances. Policies must be in accordance with state and federal regulations and guidelines;
(b) Work within the parameters of department policies, regional EMS and trauma care plans, and patient care procedures;
(c) Participate with local and regional EMS/TC councils to develop and revise:
(i) Regional EMS and trauma care plans;
(ii) Regional patient care procedures;
(iii) County operating procedures when applicable. COPs must not conflict with regional patient care procedures or other state standards; and
(iv) Recommendations for improvements in medical control communications and EMS system coordination; and
(d) MPDs must work within the parameters of the approved regional patient care procedures and the regional plan.
(5) MPD oversight of training and education. The MPD:
(a) Must provide oversight of instructors and supervise training of all EMS providers. MPDs may conduct these activities remotely;
(b) Must recommend to the department approval of individuals applying for recognition as senior EMS instructors candidates, senior EMS instructors, EMS evaluators, and locally approve all guest instructors for any EMS education and training;
(c) Must recommend to the department approval of training programs, courses, ongoing education and training plans (OTEP), and content for continuing medical education (CME) and ongoing training;
(d) May develop or approve an intensive airway management program and approve providers to take the program if live intubations cannot be obtained;
(e) May approve providers to perform IV and IO starts on artificial training aids; and
(f) May develop an evaluation form for a procedure or skill if one is not provided by the department.
(6) Certification of EMS providers. The MPD:
(a) Must recommend to the secretary certification, recertification, reciprocity, challenge, reinstatement, reissuance of expired certification or denial of certification of EMS personnel and sign applications; and
(b) May develop an integration process to evaluate and determine competency of an applicant's knowledge and skills in accordance with department policies. The MPD may:
(i) Use examinations to determine competency on department-approved MPD protocols prior to making a recommendation;
(ii) Use examinations to determine knowledge and abilities for personnel prior to recommending applicants for certification or recertification;
(iii) Prescribe additional required refresher training for expired providers;
(iv) Request, review and evaluate an EMS providers training records, skills, and documentation of prehospital medical care provided by the person, to determine proficiency and competency in the application of prehospital care prior to making a recommendation;
(v) Prescribe and review clinical and field evaluations; and
(vi) An MPD integration process must be approved by the department and may not take more than 90 days to complete unless unusual or extenuating circumstances exist;
(c) An MPD may recommend denial of certification to the secretary for any applicant the MPD can document is unable to function as an EMS provider, regardless of successful completion of training, evaluation, or examinations;
(d) An MPD must recommend certified providers to be approved or denied endorsements for specialized skills; and
(e) An MPD may approve a certified advanced emergency medical technician or a paramedic to function at a lower level of certification.
(7) Quality improvement and assurance activities. The MPD:
(a) Must adopt an MPD quality improvement plan that describes how quality improvement activities are conducted by the MPD. The plan must meet the minimum standards of the department;
(b) May access patient care records and reports in the statewide electronic EMS data system for EMS services under their oversight;
(c) May audit the medical care performance of EMS providers in accordance with the MPD quality improvement plan. The audit may include a review of documentation of patient care, training, and skills maintenance of EMS personnel;
(d) May perform counseling and assign remediation regarding the clinical practice of EMS providers;
(e) May recommend to the secretary disciplinary action to be taken against EMS personnel, which may include modification, suspension, or revocation of certification; and
(f) Must participate in regional quality improvement activities.
(8) Oversight of licensed, verified, or recognized EMS services. The MPD:
(a) Must review and make a recommendation to the department for applications for services applying for recognition as an emergency services supervisory organization (ESSO);
(b) Must approve equipment and medications used to provide medical care by EMS personnel; and
(c) May make recommendations for corrections for EMS services that are out of compliance with the regional plan to the department in accordance with WAC 246-976-400.
(9) Delegation of duties. In accordance with department policies and procedures, the MPD may appoint a qualified physician to be an MPD delegate as defined in WAC 246-976-010. The MPD:
(a) May delegate duties to other physicians, except for duties described in subsections (3)(b), (4)(c)(i), (5) (b) and (c), (6)(a), (d), and (e), (7)(e), and (8)(a) of this section.
(i) The MPD must notify the department in writing of the names and duties of individuals so delegated, within 14 days of appointment; and
(ii) The MPD may recommend to the secretary removal of a delegate's authority.
(b) The MPD may delegate duties relating to training, evaluation, or examination of certified or recognized EMS personnel, to qualified nonphysicians.
(10) The secretary may withdraw the certification of an MPD when it finds that the MPD:
(a) Failed to comply with the Uniform Disciplinary Act (chapter
18.130 RCW) and other applicable statutes and regulations;
(b) Is not performing the duties required in applicable statutes and regulations;
(c) Has been recommended for termination by the local EMST council; or
(d) Is no longer authorized to practice within the local medical community.
(11) Modification, suspension, revocation, or denial of certification will be consistent with the requirements of the Administrative Procedure Act (chapter
34.05 RCW), the Uniform Disciplinary Act (chapter
18.130 RCW), and chapter 246-10 WAC.
(12) The department will make the final determination on termination of the MPD.
