Medical Command

Medical Command and Medical Command Authorization

Authority to grant medical command.

The ALS service medical director has the authority to grant, deny, or restrict as provided, medical command authorization to an EMT-paramedic or prehospital registered nurse who seeks to provide EMS on behalf of the ALS ambulance service. The ALS service medical director shall document the medical command authorization decision and how that decision was made. The decision of the ALS service medical director shall affect the medical command authorization status of the EMT-paramedic or prehospital registered nurse for that ALS ambulance service only.

Prerequisites to initial determination regarding medical command authorization.

  • (1) Prior to making the initial determination whether to grant or deny medical command authorization, the ALS service medical director shall:
    • (i) Require the individual seeking medical command authorization to complete an application for medical command authorization on a form prescribed by the Department.
    • (ii) Verify with the Department the individual’s certification or recognition status.
    • (iii) Inquire of the Department whether disciplinary action under section 11(j.1) of the act (35 P. S. § 6931(j.1)) and § 1003.27 (relating to disciplinary and corrective action) has been or is currently being imposed against the individual.
  • (2) The ALS service medical director shall deny medical command authorization to an individual who is not certified or recognized by the Department, who is currently subject to a disciplinary or corrective measure imposed by the Department which prevents the individual from having medical command authorization, or who has not complied with the applicable continuing education in § 1003.29 (relating to continuing education requirements).
  • (3) Before the ALS service medical director may grant medical command authorization to an individual, the ALS service medical director shall verify that the individual can competently perform each of the services set forth within the scope of practice authorized by the individual’s certification or recognition. The ALS service medical director may only grant medical command authorization to permit practice in accordance with the medical treatment protocols in the region or regions in which ambulances of the ALS ambulance service, out of which the individual will function, are stationed. If the individual had not previously been granted medical command authorization for any ALS ambulance service in this Commonwealth, the ALS service medical director shall determine the individual’s competence to perform those services by direct observation. Alternatively, the ALS service medical director may determine the individual’s competence by consulting with a physician, EMT-paramedic or prehospital registered nurse who has directly observed the individual’s performance of those services, and who the ALS service medical director has determined to be qualified to make the assessment. If the individual had previously been granted medical command authorization, the ALS service medical director shall verify that the individual can competently perform each of those services by either directly observing the individual’s performance of those services; or by consulting with a physician, EMT-paramedic or prehospital registered nurse who has directly observed the individual’s performance of those services, and who the ALS service medical director has determined to be qualified to make the assessment; or doing the following for services not directly observed:
    • (i) Consulting with one or more medical command physicians who have given the individual medical command.
    • (ii) Consulting with emergency department physicians who have received patients to whom the individual has provided prehospital emergency care.
    • (iii) Performing a medical audit of records of services provided by the individual seeking medical command authorization, for patients attended to by that individual for the ALS ambulance for which the ALS service medical director is making the medical command authorization decision.
    • (iv) Consulting with one or more ALS service medical directors who has granted, denied or restricted the individual’s medical command status.
  • (4) If the ALS service medical director determines that the individual applying for medical command authorization cannot competently perform one or more of those services, the ALS service medical director shall either deny, or restrict as provided in subsection (c)(3), the individual’s medical command authorization in a written document provided to the individual.

Review of medical command authorization.

At least annually, and more often as circumstances warrant, the ALS service medical director shall review the medical command authorization status of each EMT-paramedic and prehospital registered nurse providing services on behalf of the ALS ambulance service. In reviewing medical command authorization, the ALS service medical director shall ensure that the individual has completed or is completing the applicable continuing education requirements in § 1003.29 and has demonstrated competence, as verified by the ALS service medical director, in performing each of the services that fall within the scope of the individual’s medical command authorization. The ALS service medical director, upon review of medical command authorization, may:

  • (1) Renew medical command authorization.
  • (2) Renew medical command authorization and require continuing education courses in any field the ALS service medical director deems appropriate. The ALS service medical director may require an individual to secure more continuing education credit than generally required for personnel operating under medical command authorization for the ALS ambulance service, only if the ALS service medical director determines that the following conditions are satisfied:
    • (i) The individual does not demonstrate sufficient competence in performing a service.
    • (ii) The continuing education is prescribed to address that deficiency.
    • (iii) The number of continuing education hours generally required are not sufficient to provide the education the individual needs to remedy the problem.
  • (3) Restrict medical command authorization, if the restriction does not preclude the individual from performing the services specified within the scope of the individual’s certification or recognition as permitted by the medical treatment protocols for the region. This permits imposing a restriction such as requiring on scene supervision when the individual performs a specified service or services, or permitting a specified service or services to be performed only when the individual is receiving online medical command.
  • (4) Withdraw medical command authorization.

Medical Command Facilities and Physicians

To qualify for the civil immunity protection afforded by section 11(j)(4) of the act (35 P. S. § 6931(j)(4)), a facility shall secure recognition as a medical command facility from the Department. To secure recognition as a medical command facility, a facility shall submit an application to the Department through EMSI. Application for medical command facility recognition shall be made on forms prescribed by the Department.

Forms can be obtained via https://ems.health.state.pa.us/EMSO/QRSVRSRMEDCOApp.html or below

Recognition as a medical command facility shall be valid for 3 years. A facility shall file an application for renewal of its recognition as a medical command facility 60 days prior to expiration of the medical command facility’s recognition from the Department. Failure to apply for renewal of recognition in a timely manner may result in the facility having a lapse in the civil immunity protection afforded by section 11(j)(4) of the act.

 

 

 

AttachmentDateSize
[file] MEDCO Facility App.pdf04/15/13 2:16 pm729.88 KB
[file] MEDCO Facility Director APP.pdf04/15/13 2:16 pm657.98 KB
[file] MEDCO Physician App.pdf04/15/13 2:16 pm688.71 KB
[file] MedicalCommAuthForm.pdf05/01/13 2:32 pm117.19 KB