Section 515.300  Approval of New EMS Systems

 

a)         The Department shall approve the development of a new EMS System only when a local or Regional need for establishing such System has been identified  (Section 3.20(c)(1) of the Act).  The applicant shall submit documentation addressing the following:

 

1)         A clear description of its current role and status within the existing System;

 

2)         Its rationale for separating from the existing System and developing its own program;

 

3)         A description of the methods to be used for ensuring the coordination of emergency services with adjacent Systems, including the System that it proposes to leave;

 

4)         A statement detailing the effect that the proposed change will have on the area's pre-hospital services and patient referral patterns;

 

5)         A statement summarizing the steps to be taken to ensure that the necessary quality and level of care will be maintained during the implementation phase of the proposed System; and

 

6)         A letter of support from the Regional Advisory Committee.

 

b)         In the event of a denial letter from the Regional Advisory Committee, the Department may approve the establishment of a new System based upon any of the following criteria:

 

1)         Unavailability or inaccessibility of primary or continuing education to current providers that participate in the area;

 

2)         Discrepancy between the level of pre-hospital emergency care of the EMS System and the level of the provider; or

 

3)         Documentation of extenuating circumstances, to be reviewed by the Department on an individual basis, where a special need exists and/or a special population is not serviced by an existing EMS System.

 

(Source:  Amended at 25 Ill. Reg. 16386, effective December 20, 2001)

 

Section 515.310  Approval and Renewal of EMS Systems

 

a)         All applicants for EMS System approval shall submit to the Department one copy of a written EMS System Program Plan in a format approved by the Department that complies with Section 515.330 and is authorized by the EMS MD.

 

1)         The Plan shall clearly identify any portion or item that is not expected to be fully operational by the date of Department approval, and shall specify the expected date for full operation of such portion or item, which shall not exceed one year after Department approval has been issued.

 

2)         The Department will expect all portions of the proposed Plan to be fully operational upon Department approval unless otherwise identified pursuant to this Section.

 

b)         The Department will review a submitted Program Plan and notify the applicant of any corrections that must be submitted in order to complete the Plan.  The Department will also require the applicant to submit a formal waiver request for any item or portion identified as having a delayed operational date, if the Department finds that:

 

1)         The item or length of operational delay has not previously been authorized by the Department for other EMS Systems;

 

2)         The delay would appear to prevent the System from operating in substantial compliance with the Act or this Part upon approval; or

 

3)         The delay would appear potentially to reduce the quality of medical/EMS care established by the Act and this Part.

 

c)         The Department will conduct an on-site inspection of the applicant Resource Hospital within 90 days after a Program Plan has been accepted as complete.

 

d)         The Department will issue a letter of approval to the applicant EMS System if the inspection indicates compliance with the approved Program Plan, the Act and this Part.  The letter will indicate the level or levels of service that the System is authorized to provide (CCT, ALS, ILS, BLS).

 

e)         A System approval shall be valid for a period of four years, except as allowed in subsection (l).

 

f)         A System seeking renewal of approval shall submit a written request to the Department at least 90 days prior to its renewal date.  The request shall include any proposed revisions to the Program Plan and updates of all letters of commitment required by Section 515.330.

 

g)         The Department will review the request for renewal and notify the System of any corrections that must be submitted to complete the update of the Program Plan.

 

h)         The Department will conduct an on-site renewal inspection of the Resource Hospital during each four-year approval period, and will conduct additional inspections of any System hospital or vehicle provider as necessary to ensure compliance with the Program Plan, the Act and this Part.

 

i)          The Department will issue a letter of renewal approval to the EMS System if the Program Plan is complete, the inspection indicated substantial compliance with the approved Program Plan, the Act and this Part, and there is no Department legal action pending against the System.  The letter will indicate the level or levels of service that the System is authorized to provide (CCT, ALS, ILS, BLS).

 

j)          An approved EMS System shall amend its Program Plan by submitting to the Department the portion or Section in which the change is proposed, along with a letter authorized by the EMS MD that describes the reason or reasons for the change.  The amendment shall not be implemented until approval has been granted by the Department.

 

k)         Changes in any of the following shall be considered modifications of a System Program Plan requiring submission of a proposed amendment:

 

1)         EMS MD;

 

2)         Resource, Associate or Participating Hospital, or their specific roles;

 

3)         System service area;

 

4)         Written standing orders and policies;

 

5)         Method or methods of providing EMS services;

 

6)         Additional vehicle service providers, or changes in their levels of service, specific roles or response areas;

 

7)         Access and dispatch procedures and mechanisms;

 

8)         Communications plan;

 

9)         Equipment and drug requirements;

 

10)         Education, continuing education and/or examination requirements;

 

11)         Quality assurance policies;

 

12)         Data collection and evaluation policies;

 

13)         Override or bypass/diversion policies;

 

14)         Disciplinary or suspension policies or procedures.

 

l)          All EMS Systems shall submit to the Department a revised Program Plan that conforms to the requirements of this Part.  The Department will approve Program Plans that meet the requirements of this Part and will establish renewal dates for EMS System approval.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.315  Bypass or Resource Limitation Status Review

 

a)         The Department shall investigate the circumstances that caused a hospital in an EMS System to go on bypass status to determine whether that hospital's decision to go on bypass status was reasonable.  (Section 3.20(c) of the Act)

 

b)         The hospital shall notify the Illinois Department of Public Health, Division of Emergency Medical Services, of any bypass/resource limitation decision, at both the time of its initiation and the time of its termination, through status change updates entered into the Illinois EMResource application, accessed at https://emresource.juvare.com/login.  The hospital shall document any inability to access EMResource by contacting IDPH Division of EMS during normal business hours.

 

c)         In determining whether a hospital's decision to go on bypass/resource limitation status was reasonable, the Department shall consider the following:

 

1)         The number of critical or monitored beds available in the hospital at the time that the decision to go on bypass status was made;

 

2)         Whether an internal disaster, including, but not limited to, a power failure, had occurred in the hospital at the time that the decision to go on bypass status was made;

 

3)         The number of staff after attempts have been made to call in additional staff, in accordance with facility policy; and

 

4)         The approved hospital protocols for peak census, surge, and bypass and diversion at the time that the decision to go on bypass status was made, provided that the Protocols include subsections (c)(1), (2) and (3).

 

5)         Bypass status may not be honored or deemed reasonable if three or more hospitals in a geographic area are on bypass status and/or transport time by an ambulance to the nearest facility is identified in the regional bypass plan to exceed 15 minutes.

 

d)         Hospital diversion should be based on a significant resource limitation and may be categorized as a System of Care (STEMI or Stroke), or other EMS transports.  The decision to go on bypass (or resource limitation) status shall be based on meeting the following two criteria, and compliance with subsection (c)(3).

 

1)         Lack of an essential resource for a given type or class of patient (i.e. Stroke, STEMI, etc.) Examples include, but are not limited to:

 

A)        No available or monitored beds within traditional patient care and surge patient care areas with appropriate monitoring for patient needs;

 

B)        Unavailability of trained staff appropriate for patient needs; and/or

 

C)        No available essential diagnostic and/or intervention equipment or facilities essential for patient needs.

 

2)         All reasonable efforts to resolve the essential resource limitations have been exhausted including, but not limited to:

 

A)        Consideration for using appropriately monitored beds in other areas of the hospital;

 

B)        Limitation or cancellation of elective patient procedures and admissions to make available surge patient care space and redeploy clinical staff to surge patients;

 

C)        Actual and substantial efforts to call in appropriately trained off-duty staff; and

 

D)        Urgent and priority efforts have been undertaken to restore existing diagnostic and/or interventional equipment or backup equipment and/or facilities to availability, including but not limited to seeking emergency repair from outside vendors if in house capability is not rapidly available.

 

3)         The hospital will do constant monitoring to determine when the bypass condition can be lifted.  Such monitoring and decision making shall include clinical and administrative personnel with adequate hospital authority.  Efforts to resolve issues in subsection (d)(1) using all available resource under subsection (d)(2) to come off bypass as soon as such patients can be safely accommodated.

 

e)         For Trauma Centers only, the following situations would constitute a reasonable decision to go on bypass status:

 

1)         All staffed operating suites are in use or fully implemented with on-call teams, and at least one or more of the procedures is an operative trauma case;

 

2)         The CAT scan is not working; or

 

3)         The general bypass criteria in subsection (c).

 

f)         During a declared local or state disaster, hospitals may only go on bypass status if they have received prior approval from IDPH. Hospitals must complete or submit the following prior to seeking approval from IDPH for bypass status:

 

1)         EMResource must reflect current bed status;

 

2)         Peak census policy must have been implemented 3 hours prior to the request of bypass;

 

3)         Hospital and staff surge plans must be implemented;

 

4)         The following hospital information shall be provided to IDPH:

 

A)        Number of hours for in-patient holds waiting for bed assignment;

 

B)        Longest number of hours wait time in Emergency Department;

 

C)        Number of patients in waiting area waiting to be seen;

 

D)        In-house open beds that are not able to be staffed;

 

E)        Percent of beds occupied by in-patient holds;

 

F)         Number of potential in-patient discharges; and

 

G)        Number of open ICU beds.

 

5)         The IDPH Regional EMS Coordinator will review the above information along with hospital status in the region and determine whether to approve bypass for 2 hours, 4 hours, or an appropriate length of time as determined by the DPH Regional EMS Coordinator, or to deny the bypass request.  A by pass request may be extended based on continued assessment of the situation, including status of surrounding hospitals, with the DPH Regional EMS Coordinator and communication with the requesting hospital.  A hospital may be denied bypass based on regional status or told to come off bypass if an additional hospital in the geographic area requests bypass.

 

g)         The Department may impose sanctions, as set forth in Section 3.140 of the Act, upon a Department determination that the hospital unreasonably went on bypass status in violation of the Act.  (Section 3.20(c) of the Act)

 

h)         Each EMS System shall develop a policy addressing response to a system-wide crisis.

 

(Source:  Amended at 46 Ill. Reg. 20898, effective December 16, 2022)

 

Section 515.320  Scope of EMS Service

 

a)         All BLS, ILS, and ALS services, and CCT, as defined in the Act, shall be provided through EMS Systems.  An individual System shall operate at one or more of those levels of service, as specified in its Program Plan and the Department's letter of approval, using vehicles licensed by the Department pursuant to the Act and this Part.

 

b)         All pre-hospital, inter-hospital and non-emergency medical care, as defined in the Act, shall be provided through EMS Systems, using the levels of Department licensed or approved personnel required by the Act and this Part.

 

c)         An EMS System shall designate a Resource Hospital, which shall have the authority and responsibility for the System, through the EMS MD, as described in the Act, this Part and the System Program Plan.

 

d)         All other hospitals that are located within the geographic boundaries of a System and that have standby, basic or comprehensive level emergency departments must function in that System as either an Associate Hospital or Participating Hospital and follow all System policies specified in the System Program Plan, including, but not limited to, the replacement of drugs and equipment used by providers who have delivered patients to their emergency departments. (Section 3.20(b) of the Act)

 

1)         All hospitals shall be formally affiliated with a System.  A hospital may have a secondary affiliation with another System or may request a waiver to participate in a System other than that in which the hospital is geographically located.  (See Section 515.150(d)(5).)

 

2)         Every System Hospital shall identify the level of its emergency department services in its letter of commitment, which is part of the EMS System Program Plan to be submitted to the Department.

 

3)         An "Associate Hospital" shall provide the same clinical and communications services as the Resource Hospital, but shall not have the primary responsibility for personnel education and System operations.  It shall have a basic or comprehensive emergency department with 24-hour physician coverage and a functioning intensive care and/or cardiac care unit.

 

4)         All "Participating Hospitals" shall maintain ambulance to hospital communications capabilities that, at a minimum, include MERCI radio and comply with the Resource Hospital's communication plan.

 

5)         All System Hospitals shall agree to replace medical supplies and provide for equipment exchange for System vehicles.

 

6)         All Resource and Associate Hospitals monitoring telecommunications from EMS field personnel shall provide voice orders by the EMS MD, a physician appointed by the EMS MD, or an ECRN.

 

7)         All System Hospitals shall allow the Department, EMS MD and EMS System Coordinator access to all records, equipment, vehicles and personnel during their activities evaluating the Act and this Part.

 

e)         The Resource Hospital shall appoint an EMS MD. The EMS MD for an ILS or ALS or CCT level EMS System shall be a physician licensed to practice medicine in all of its branches in Illinois, and shall be certified by the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine, and, for a BLS level EMS System, the EMS MD shall be a physician licensed to practice medicine in all of its branches in Illinois, with regular and frequent involvement in pre-hospital emergency medical services.  In addition, all EMS MDs shall:

 

1)         Have experience on an EMS vehicle at the highest level available within the System, or make provision to gain such experience within 12 months prior to the date responsibility for the System is assumed or within 90 days after assuming the position;

 

2)         Be thoroughly knowledgeable of all skills included in the scope of practices of all levels of EMS Personnel within the System; and

 

3)         Have or make provision to gain experience instructing students at a level similar to that of the levels of EMS Personnel within the System; and

 

4)         For ILS and ALS EMS MDs, successfully complete a Department-approved EMS MD's Course.  (Section 3.20(c)(1 through 6) of the Act)

 

f)         The EMS MD shall appoint an alternate EMS MD and establish a written protocol addressing the functions to be carried out in his or her absence. (Section 3.35(b) of the Act)

 

g)         An EMS System utilizing SEMSVs shall appoint and approve SEMSV Medical Directors to manage and direct the use of SEMSVs and their personnel within the System.  He or she shall be a physician who has met at least the following qualifications:

 

1)         One or more of the following:

 

A)        Certified by the American Board of Emergency Medicine (ABEM) or American Osteopathic Board of Emergency Medicine (AOBEM) through the American Osteopathic Association (AOA);

 

B)        Completion of a residency in emergency or osteopathic emergency medicine as prescribed by one of the Boards listed in subsection (g)(1)(A); or

 

C)        Completion of a 12-month internship followed by 60 months plus 7,000 hours of hospital based emergency or osteopathic emergency medicine (2,800 of the 7,000 hours must be completed within one 24-month period), and documentation of 50 hours of related continuing education for each complete year of practice; and

 

2)         Completion of advanced cardiac life support and advanced trauma life support courses;

 

3)         For aircraft programs, completion of education covering inflight treatment modalities, altitude physiology, and infection; and

 

4)         For watercraft programs, completion of education covering diving accident physiology and treatment and drowning in cold, warm, fresh and salt water.

 

h)         The Resource Hospital shall appoint a full-time EMS System Coordinator, who shall be responsible for coordinating the educational and functional aspects of the System, as described in the Program Plan.  He or she shall be an RN or Paramedic licensed in the State of Illinois, and meet at least the following qualifications:

 

1)         Be educated and knowledgeable in all principles of the National EMS Education Standards;

 

2)         Have a diverse background in emergency care.  For EMS Systems with CCT program plans, the System Coordinator shall have knowledge of or obtain education regarding critical care standards within six months; and

 

3)         Within one year after being appointed, complete in-field observation and/or participation on at least 10 ambulance runs at the highest level of service provided by the System.

 

i)          The Resource Hospital shall appoint an EMS Administrative Director, who shall be responsible for administrative leadership of the System as described in the Program Plan.

 

j)          To avoid any conflict of interest, the EMS MD, EMS System Coordinator and EMS Administrative Director shall notify the Department in writing of any association with an ambulance service provider through employment, contract, ownership, or otherwise specifying how he or she is answerable to or directed by the ambulance service provider concerning any matter falling within the scope of the Act or this Part.  The Department shall review and address potential or actual conflicts of interest on a case-by-case basis.

 

k)         The Resource Hospital must identify the EMS System in the facility's budget, with sufficient funds to support the EMS MD, EMS Administrative Director, EMS System Coordinator, and support staff and to provide for the operation of the EMS System.

 

l)          All EMS Resource Hospitals shall obtain recognition as an SEDP, EDAP or PCCC.  All Illinois hospitals are encouraged to obtain and maintain SEDP or EDAP status.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.330  EMS System Program Plan

 

An EMS System Program Plan shall contain the following information:

 

a)         The name, address and fax number of the Resource Hospital;

 

b)         The names and resumes, and contact information that includes address, phone, and email addresses of the following persons:

 

1)         The EMS MD;

 

2)         The Alternate EMS MD;

 

3)         The EMS Administrative Director;

 

4)         The EMS System Coordinator;

 

c)         The name, address and fax number of each Associate or Participating Hospital (see subsection (i));

 

d)         The name, email, and primary address of each transport and non-transport provider, as well as vehicle locations participating within the EMS System;

 

e)         A map of the EMS System's service area indicating the location of all hospitals, healthcare facilities, and transport and non-transport providers participating in the System;

 

f)         Current letters of commitment from the following persons at the Resource Hospital that describe the commitment of the writer and his or her office to the development and ongoing operation of the EMS System, and that state the writer's understanding of and commitment to any necessary changes, such as emergency department staffing and educational requirements:

 

1)         The Chief Executive Officer of the hospital;

 

2)         The Chief of the Medical Staff; and

 

3)         The Director of the Nursing Services;

 

g)         A letter of commitment from the EMS MD that describes the EMS MD's agreement to:

 

1)         Be responsible for the ongoing education of all System personnel, including didactic and clinical experience;

 

2)         Develop and authorize written standing orders (treatment protocols, standard operating procedures) and certify that all involved personnel will be knowledgeable and competent in emergency care;

 

3)         Be responsible for supervising all personnel participating within the System, as described in the System Program Plan;

 

4)         Be responsible for developing or approving a system form and submitting the following to the Department on a monthly basis:

 

A)        Number of EMS patient care complaints, including a brief synopsis of the issue;

 

B)        Outcome of the system investigation; and

 

C)        Names and licenses of the EMS personnel involved in sustained allegations.

 

5)         Develop or approve one or more patient care reports covering all types of patient care responses performed by System providers;

 

6)         Pursuant to Sec. 515.310(k), EMS Systems utilizing an approved EMS provider short patient care report form will require, at a minimum, the following data elements to be left at the receiving hospital:

 

A)        Name of patient;

 

B)        Age;

 

C)        Vital Signs;

 

D)        Chief complaint;

 

E)        List of current medications;

 

F)         List of allergies;

 

G)        All treatment rendered;

 

H)        Date; and

 

I)         Time.

 

7)         Develop a policy to ensure that patient care reports are filed or either faxed or dropped off at the receiving hospital within 2 hours of patient being brought to the receiving hospital;

 

8)         Ensure that the Department has access to all records, equipment and vehicles under the authority of the EMS MD during any Department inspection, investigation or site survey;

 

9)         Notify the Department of any changes in personnel providing pre-hospital care in accordance with the EMS System Program Plan approved by the Department;

 

10)       Be responsible for the total management of the System, including the enforcement of compliance with the System Program Plan by all participants within the System;

 

11)       Direct the applicant to the IDPH EMS website for access to an independent renewal form for EMS Personnel within the System who have not been recommended for relicensure by the EMS MD; and

 

12)       Be responsible for compliance with the provisions of Sections 515.400 and 515.410;

 

h)         A description of the method of providing EMS services, which includes:

 

1)         Single vehicle response and transport;

 

2)         Dual vehicle response;

 

3)         Level of first response vehicle;

 

4)         Level of transport vehicle;

 

5)         A policy identifying when and how a patient may be transported directly to an EMS-System-approved mental health facility if that patient.

 

A)        has no immediate life-threatening injuries or illness;

 

B)        is not under the influence of drugs or alcohol;

 

C)        has no immediate or obvious need for transport to an emergency department; and

 

D)        has an immediate need for transport to an EMS-approved mental health facility.  (Sec. 3.155(i) of the EMS System Act)

 

6)         A policy identifying when a patient may be transported to an EMS-System-approved urgent care or immediate care facility that meets the proper criteria and is approved by Online Medical Control or the EMS Medical Director or Emergency Communications Registered Nurse. (Sec. 3.155(i) of the Act)

 

7)         A policy that describes in-field service level upgrade, using advanced level EMS vehicle service providers;

 

8)         A policy that describes ambulance service provider and vehicle service provider upgrade – rural population (optional);

 

9)         A policy for Alternative Staffing Models for private ambulance providers consistent with Section 515.830(k);

 

10)       Use of mutual aid agreements; and

 

11)       Informing the caller requesting an emergency vehicle of the estimated time of arrival when this information is requested by the caller;

 

i)          A letter of commitment from each Associate Hospital, Participating Hospital or Veterans Health Administration facility within the System that includes the following:

 

1)         Signed statements by the hospital's Chief Executive Officer, Chief of the Medical Staff and Director of the Nursing Service describing their commitments to the standards and procedures of the System;

 

2)         A description of how the hospital will relate to the EMS System Resource Hospital, its involvement in the ongoing planning and development of the program, and its use of the education and continuing education aspects of the program;

 

3)         Only at an Associate Hospital, a commitment to meet the System's educational standards for ECRNs;

 

4)         An agreement to abide by the system policy regarding the exchange of all drugs and equipment with all pre-hospital providers participating in the System or other EMS System whose ambulances transport to them;

 

5)         An agreement to use the standard treatment orders as established by the Resource Hospital;

 

6)         An agreement to follow the operational policies and protocols of the System;

 

7)         A description of the level of participation in the education and continuing education of EMS Personnel;

 

8)         An agreement to collect and provide relevant data as determined by the Resource Hospital;

 

9)         A description of the hospital's or facility’s data collection and reporting methods and the personnel responsible for maintaining all data;

 

10)         An agreement to allow the Department access to all records, equipment and vehicles relating to the System during any Department inspection, investigation or site survey;

 

11)         If the hospital is a participant in another System, a description of how it will interact within both Systems and how it will ensure that communications interference as a result of this dual participation will be minimized; and

 

12)         The names, email addresses, and resumes of the Associate Hospital EMS MD and Associate Hospital EMS Coordinator;

 

j)          A letter of commitment from each ambulance provider participating within the System that indicates compliance with Section 515.810;

 

k)         Descriptions and documentation of each communications requirement provided in Section 515.400;

 

l)          The Program Plan shall consist of the EMS System Manual, which shall be made accessible to all System Participants and shall include the following Sections:

 

1)         Education

 

A)        Curricula and standards for all education programs for EMS Personnel offered or authorized within the System shall be consistent with national EMS education standards, including any necessary transitional or bridge education to align System personnel with the current national EMS education standards.

 

B)        Education, testing and credentialing requirements for ECRN, PHRN, PHPA, and APRN.

 

C)        Continuing education for EMS Personnel, including:

 

i)          System requirements (hours, types of content, etc.);

 

ii)         A plan for measurement of ongoing competency for all System Participants (i.e., quality assurance);

 

iii)        Requirements for approval of academic course work;

 

iv)        Didactic programs offered by the System;

 

v)         Clinical opportunities available within the System; and

 

vi)        Recordkeeping requirements for participants, which must be maintained at the Resource Hospital.

 

D)        Renewal Protocols

 

i)          System examination requirements for EMS Personnel;

 

ii)         Procedures for approval and the renewal of EMS Personnel;

 

iii)        Requirements for submission of transaction cards for EMS Personnel meeting renewal requirements; and

 

iv)        Department renewal application forms for EMS Personnel who have not met renewal requirements according to System records.

 

E)        System Participant education and information, including:

 

i)          Distribution of System Manual amendments;

 

ii)         In-services for policy and protocol changes;

 

iii)        Methods for communicating updates on System and regional activities, and other matters of medical, legal and/or professional interest; and

 

iv)        Locations of library/resource materials, forms, schedules, etc.

 

F)         A plan that describes how Emergency Medical dispatch agencies and EMRs participate within the EMS System Program Plan (see Sections 515.710 and 515.725).

 

G)        A System may require that up to one-half of the continuing education hours that are required toward relicensure, as determined by the Department, be earned through attendance at System-required courses.

 

H)        A didactic continuing education offering or course that has received a State site code or has been approved by other Department-approved national accrediting bodies shall be accepted by the System, subject only to the requirements of subsection (l)(1)(C).

 

2)         Drugs and Equipment

 

A)        A list of all drugs and equipment required for each type of System vehicle;

 

B)        Procedures for obtaining replacements at System hospitals; and

 

C)        Policies for appropriate storage and security of medications.

 

3)         Personnel Requirements for EMS Personnel

 

A)        Minimum staffing for each type and level of vehicle; and

 

B)        Guidelines for EMS Personnel patient interaction.

 

4)         EMS Protocols, including medical-legal policies, but not limited to:

 

A)        The Regional Standing Medical Orders;

 

B)        Administrative, Legal and EMS Protocols and Guidelines (Appendix D).

 

5)         Communications standards and protocols, including:

 

A)        The information contained in the System Program Plan relating to the requirements of Sections 515.410(a)(1), (2), (3) and (4) and 515.390(b) and (c);

 

B)        Protocols ensuring that physician direction and voice orders to EMS vehicle personnel and other hospitals participating in the System are provided from the operational control point of the Resource or Associate Hospital;

 

C)        Protocols ensuring that the voice orders via radio and using telemetry shall be given by or under the direction of the EMS MD or the EMS MD's designee, who shall be either an ECRN or physician;

 

D)        Protocols defining when an ECRN should contact a physician; and

 

E)        A policy requiring that all on-line medical direction calls are to be recorded for retrospective review for a minimum of 365 days, or consistent with the hospital's record retention policy, whichever is longer.

 

6)         The EMS System shall have a quality improvement plan which describes how quality indicators and quality benchmarks are selected and how results and improved processes are communicated to the system participants.

 

7)         The plan shall also include quality improvement measures for both adult and pediatric patient care shall be performed on a quarterly basis and be available upon Department request; ambulance operation and System educational activities, including, but not limited to, monitoring educational activities to ensure that the instructions and materials are consistent with national EMS education standards for EMTs and Section 3.50 of the Act; unannounced inspections of pre-hospital services; and peer review.

 

8)         Data collection and evaluation methods that include:

 

A)        The process that will facilitate problem identification, evaluation, patient care gaps, disease/injury surveillance, and monitoring in reference to patient care and/or reporting discrepancies from hospital and pre-hospital providers;

 

B)        A policy identifying any additional required data elements that the EMS provider shall include in their patient care report;

 

C)        Identified benchmarks or thresholds that should be met;

 

D)        A copy of the evaluation tool for the short reporting form, if used, pre-hospital reporting form; and

 

E)        A sample of the required information and data submitted by the provider to be reported to the Department summarizing System activity (see Section 515.350).

 

9)         Operational policies that delineate the respective roles and responsibilities of all providers in the System regarding the provision of emergency service, including policies identified in Appendix D.

 

10)         Each EMS System shall develop an administrative policy that provides the IDPH Division of EMS and Highway Safety and its State Regional EMS Coordinator with notification the next business day when an Illinois licensed EMS crew member is killed in the line of duty.

 

11)         The responsibilities of the EMS MD.

 

12)         The responsibilities of the Alternate EMS MD.

 

13)         The responsibilities of the EMS Administrative Director.

 

14)         The responsibilities of the EMS System Coordinator, as designated by the EMS MD and Resource Hospital, including, but not limited to, data evaluation, quality management, complaint investigation, supervision of all didactic education, clinical and field experiences, and physician and nurse education as required by Section 515.320(h);

 

m)        Written protocols for the bypassing of or diversion to any hospital, trauma center or regional trauma center, STEMI center, Comprehensive Stroke Center, Primary Stroke Center, Acute Stroke-Ready Hospital or Emergent Stroke Ready Hospital, which provide that a person shall not be transported to a facility other than the nearest hospital, regional trauma center or trauma center, STEMI center, Comprehensive Stroke Center, Primary Stroke Center, Acute Stroke-Ready Hospital or Emergent Stroke Ready Hospital unless the medical benefits to the patient reasonably expected from the provision of appropriate medical treatment at a more distant facility outweigh the increased risks to the patient from transport to the more distant facility, or the transport is in accordance with the System's protocols for patient choice or refusal. (Section 3.20(c)(5) of the Act)  The bypass status policy shall include criteria to address how the hospital will manage pre-hospital patients with life threatening conditions within the hospital's then-current capabilities while the hospital is on bypass status.  In addition, a hospital can declare a resource limitation, which is further outlined in the System Plan, for the following conditions:

 

1)         There are no critical or monitored beds available in the hospital; or

 

2)         An internal disaster occurs in the hospital;

 

n)         Bypass status may not be honored or deemed reasonable if multiple hospitals in a geographic area are on bypass status and transport time by an ambulance to the nearest facility identified in the regional bypass plan exceeds 15 minutes;

 

o)         Each hospital shall have a policy addressing peak census procedures and a surge capacity plan.

 

(Source:  Amended at 46 Ill. Reg. 20898, effective December 16, 2022)

 

Section 515.340  EMS Medical Director's Course

 

a)         An EMS Medical Director for an ILS or ALS level System who is appointed after the adoption of this Section shall submit to the Department proof of completion of a Department-approved EMS Medical Director's Course within six months after his or her date of appointment.

 

b)         The following courses are approved by the Department:

 

1)         American College of Emergency Physicians (ACEP) Principles of EMS Systems - A Course for Medical Directors.

 

2)         Base Station Course National Association of Emergency Medical Services Physicians (NAEMSP).

 

c)         The Department shall review requests for approval of other courses upon submission of the curriculum, along with the name, address and telephone number of the person or entity conducting the course.  The Department shall approve the course if it meets the following criteria:

 

1)         The course objectives are the same as the courses recommended in subsection (b) above; and

 

2)         The course is taught by Board Certified emergency department physicians.

 

(Source:  Added at 21 Ill. Reg. 5170, effective April 15, 1997)

 

Section 515.350  Data Collection and Submission

 

a)         A patient care run report shall be completed by each Illinois-licensed transport vehicle service provider for every inter-hospital transport and pre-hospital emergency call, regardless of the ultimate outcome or disposition of the call.

 

1)         One patient care report shall be provided (paper or electronic) to the receiving hospital emergency department or health care facility before leaving this facility.

 

2)         Each EMS System shall designate or approve the patient care report to be used by all of its transport vehicle providers.  The report shall contain the minimum requirements listed in Appendix E.

 

b)         All non-transport vehicle providers shall document all medical care provided and shall submit the documentation to the EMS System within 24 hours. The EMS System shall review all medical care provided by non-transport vehicles and shall provide a report to the Department upon request.

 

c)         The transport vehicle provider shall submit patient care report data to the EMS System.  When an EMS System is unable to import data from one or more providers, those providers may, with EMS System approval, submit their patient care report data directly to the Department.  The Department will make the patient care report data available to the EMS System upon request.  Every EMS System and EMS provider approved to submit data directly shall electronically submit all patient care report data to the Department by the 15^th day of each month.  The monthly report shall contain the previous month's patient care report data.  Third party software shall be validated by the Department to ensure compatibility with the Department's data specifications.  Third party software shall not be used until the Department's validation is complete.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.360  Approval of Additional Drugs and Equipment

 

a)         All drugs and equipment, other than those covered by the national EMS education standards, as modified by the Department, for each level of licensure, must be approved by the Department in accordance with subsections (b), (c) and (d) before being used in a System.

 

b)         To apply for approval to add drugs and/or equipment, the EMS MD shall submit to the Department documentation covering the following:

 

1)         The education program for all additional psychomotor skills and the number of continuing education hours;

 

2)         A curriculum for each additional drug, psychomotor skill, equipment or device, which includes at least the following (as applicable):

 

A)        Objectives;

 

B)        Methods and materials;

 

C)        Content, which shall include, but not be limited to, usage, complications, adverse reactions, and equipment maintenance and use;

 

D)        Evidence-based standards and guidelines relevant to the proposal; and

 

E)        Evaluation of learning; and

 

3)         New written standing orders.

 

c)         Upon receipt of the application from the System, the Director or his or her designee shall either approve the drug or equipment, approve the drug or equipment on a conditional basis, or disapprove the drug or equipment. The Director's or designee's decision shall be based on a review and evaluation of the documentation submitted under subsection (b); the application of technical and medical knowledge and expertise; consideration of relevant literature and published studies on the subject; and whether the drug or equipment has been reviewed or tested in the field. The Director may seek the recommendations of medical specialists or other professional consultants to determine whether to approve or disapprove the specific drug or drugs or equipment.

 

d)         The Director or designee shall consider whether the drugs and equipment may be used safely and with proper education by the pre-hospital care provider and shall disapprove any drugs or equipment that he or she finds are generally unsafe or dangerous in the pre-hospital care setting.

 

e)         When a drug or equipment is approved on a conditional basis, the System shall submit to the Department, on a quarterly basis (January 1, April 1, July 1 and October 1) the following information:

 

1)         Indications for use;

 

2)         Number of times used;

 

3)         Number and types of complications that occurred;

 

4)         Outcome of patient after use of drug or equipment; and

 

5)         Description of follow-up actions taken by the System on each case in which complications occurred.

 

f)         When a death or complication that results in a deterioration of a patient's condition occurs, involving a drug or equipment approved on a conditional basis, the System shall notify the Department within three business days, followed by a written report of the situation submitted to the Department within 10 business days.

 

g)         Failure of the System to submit the information required under subsection (e) shall be considered as a basis for withdrawal of approval of the drug or equipment on a conditional basis. Failure of the System to notify the Department as required under subsection (f) shall be considered as a basis for withdrawal of approval of the drug or equipment on a conditional basis.

 

h)         The Director or designee shall evaluate the information submitted under subsection (e) and any notification required under subsection (f). The Department will notify the System that a drug or equipment is disapproved and may no longer be performed on a conditional basis when the evaluation of the information submitted pursuant to this subsection (h) indicates that the safety of the drug or equipment has not been established for use in the pre-hospital setting.

 

i)          An EMS MD shall not approve EMS Personnel to use new drugs or equipment unless that individual has completed the Department- and System-approved education program and examination, and has demonstrated the required knowledge and skill to use that intervention safely and effectively.

 

j)          An EMS MD shall not be required to provide education on new interventions to EMS Personnel who will not be using the new interventions.

 

k)         The Department may share best practice models with proven efficacy with the EMS System EMS MDs.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.370  Automated Defibrillation (Repealed)

 

                                                           

(Source:  Repealed at 27 Ill. Reg. 13507, effective July 25, 2003)

 

Section 515.380  Do Not Resuscitate (DNR) and Practitioner Orders for Life-Sustaining Treatment (POLST) Policy

 

a)         A System shall adopt a Regional standardized DNR and POLST policy for use by System personnel.  The policy shall be implemented only after it has been reviewed and approved by the Department, in accordance with the requirements of this Section.  For purposes of this Section, DNR refers to the withholding of cardiopulmonary resuscitation (CPR) and cardiocerebral resuscitation (CCR); electrical therapy to include pacing, cardioversion and defibrillation; invasive airway management and manually or mechanically assisted ventilations, unless otherwise stated on the IDPH Uniform POLST Advance Directive.  POLST refers to the recording of a person's desires for life-sustaining treatment and palliative care.

 

b)         The policy shall include, but not be limited to, specific procedures and protocols for cardiac arrest/DNR situations arising in long-term care facilities, with hospice and home care patients, and with patients who arrest during inter-hospital transfers or transportation to or from home.

 

c)         The policy shall include specific procedures and protocols for withholding CPR and CCR in situations where explicit signs of biological death are present (e.g., decapitation, rigor mortis without profound hypothermia, profound dependent lividity), or the patient has been declared dead by a coroner/medical examiner or the patient's physician.  The policy shall include recording such information on the patient care report.

 

d)         The policy shall include specific procedures and protocols for a person's desire for life-sustaining treatment and palliative care.

 

e)         For situations not covered by subsection (c), the policy shall require that resuscitative procedures be followed unless a valid IDPH Uniform POLST advance directive is present.

 

f)         The Department of Public Health Uniform POLST form, or a copy of that form, shall be honored.  (Section 3.57 of the Act)  Systems shall also have a policy in place concerning recognition of other DNR and POLST advance directives.  The information required on the Department Uniform POLST advance directive includes, but is not limited to, the following items:

 

1)         Name of the patient;

 

2)         Name and signature of authorized practitioner;

 

3)         Effective date;

 

4)         The phrase "Do Not Resuscitate" or "Practitioner Orders for Life-Sustaining Treatment" or both;

 

5)         Evidence of consent:

 

A)        signature of patient;

 

B)        signature of legal guardian;

 

C)        signature of durable power of attorney for health care agent; or

 

D)        signature of surrogate decision-maker.

 

g)         A living will by itself cannot be recognized by pre-hospital care providers.

 

h)         Revocation of a written DNR or POLST Advance Directive shall be made only in one or more of the following ways:

 

1)         The advance directive is physically destroyed by the authorized practitioner who signed the advance directive or by the person who gave written consent to the advance directive; or

 

2)         The advance directive is verbally rescinded by the authorized practitioner who signed the advance directive or by the person who gave written consent to the advance directive, the word "VOID" is written in large letters across the front of the advance directive, and the advance directive is signed and dated by the authorized practitioner who signed the advance directive or by the person who gave written consent to the advance directive.

 

i)          A System's DNR and POLST policy shall require System personnel to make a reasonable attempt to verify the identity of the patient (for example, identification by another person or an identifying bracelet) named in a valid DNR or POLST advance directive.

 

j)          The policy shall describe the roles of the on-line medical control physician and ECRN in DNR or POLST situations.

 

k)         The policy shall state which System EMS Personnel are authorized to respond to a valid DNR or POLST advance directive (Paramedic, PHRN, A-EMT, EMT-I, EMT, EMR).

 

l)          The policy shall cross-reference the System's coroner/medical examiner notification policy.

 

m)        The policy shall describe the System's program for educating System personnel concerning the DNR or POLST policy.

 

n)         The policy shall identify the quality assurance measures specific to this policy, including the methods and periods of review.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.390  Minimum Standards for Continuing Operation

 

a)         The Resource Hospital and all System Participants shall comply with the terms of the EMS System Program Plan, the System Manual, their respective letters of commitment, and any applicable provisions of the Act or this Part.

 

b)         All System EMS personnel, provider agencies and licensed vehicle owners are responsible for and shall maintain current certifications, licenses and approvals.

 

c)         In accordance with Section 515.160, the Department may suspend, revoke or refuse to issue or renew the approval of any EMS System when its findings show that the System is in violation of one or more of the requirements of the Act and this Part.

 

1)         Suspension, revocation or refusal to renew shall be preceded by notice and an opportunity for a hearing served upon the EMS MD by certified mail, personal service or confirmed facsimile.

 

2)         The notice shall set forth the reasons for the proposed suspension or revocation and shall afford the EMS MD 15 days from the date of receipt to make a written request for an administrative hearing. The EMS MD's failure to file a written request for a hearing within 15 days shall be considered a waiver of the System's right to a hearing on the proposed suspension, revocation or refusal.

 

3)         All hearings shall be conducted in accordance with the Department's Rules of Practice and Procedure for Administrative Hearings (77 Ill. Adm. Code 100).

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.400  General Communications

 

a)         All radios used by ambulance services shall:

 

1)         Have two-way ambulance-to-hospital communications capability on frequencies assigned by the Department;

 

2)         Use channel and tones assigned by the Department; and

 

3)         Use unit identifier numbers or other descriptive means of identification locally acceptable.

 

b)         All radio communications systems will require preliminary coordination with and recommendations from the Department's communication personnel.

 

c)         All pre-hospital care providers must provide information relative to the mechanism used for consumer access and dispatch of emergency vehicles within their respective service area.

 

d)         All hospitals participating in an EMS Plan or receiving emergency patients by ambulances must:

 

1)         Have two-way ambulance-to-hospital communications capability on a frequency determined and assigned by the Department; and

 

2)         Have two-way hospital-to-hospital communications capability.

 

e)         The use of cellular telephone technology is permitted provided that:

 

1)         The ambulance also has VHF or UHF radio back-up on a frequency assigned by the Department; and

 

2)         The permission of the EMS Resource Hospital is obtained.

 

(Source:  Added at 21 Ill. Reg. 5170, effective April 15, 1997)

 

Section 515.410  EMS System Communications

 

a)         The System's communications plan shall be submitted for approval to the Department's EMS Communications staff, and shall include the following in accordance with 47 CFR 90 (1994):

 

1)         A listing of access numbers of Emergency Medical Services, including a description of plans to use or to implement a "911" System or Central Medical Emergency Dispatch (CMED) if or when available and a list of agencies involved;

 

2)         A description of communications interface with existing Systems;

 

3)         A description of plans to handle hospital-to-hospital communications;

 

4)         A complete and detailed communications equipment description;

 

5)         A general description of ultra-high frequency (UHF) or cellular telephone and back-up radio capabilities, such as very high frequency (VHF) or UHF radio, including Resource and Associate Hospital interconnections and control functions if any exist;

 

6)         A general description of paramedic input telephones, including Resource and Associate Hospital interconnections if any exist;

 

7)         A general description of EMS vehicle dispatch communications, including areas covered, mutual aid agreements, radio and telephone capabilities, including radio channels used (i.e., 155.220 MHz) and present and future 911 involvement;

 

8)         All mobile and portable communications equipment to be used by EMS System personnel;

 

9)         A detailed block diagram sketch or sketches showing all transmitters, receivers, antennas, control consoles, electrocardiogram (EKG) demodulators, patient monitor equipment, recorders, telephones, and couplers, with signal flow lines;

 

10)       Radio equipment specifications, including effective radiated power (ERP), antenna height, ground heights, antenna pattern, antenna direction, channels used, continuous tone-controlled squelch system tones, and digital dial numbers;

 

11)       Modes of operation such as half-duplex and multiplex;

 

12)       Radio coverage maps showing locations of all transmitting and receiving equipment and control points;

 

13)       A general discussion concerning radio interference and steps taken to minimize it (i.e., the use of only short EKG transmission, thus allowing several EMS units to use one channel, minimizing ERP and antenna height);

 

14)       Copies of Federal Communications Commission (FCC) licenses or application; and

 

15)       A narrative description of the System's plans for informing the community of the EMS System program development, how citizens can gain access, and the ongoing operation of the System.

 

b)         EMS telecommunications equipment shall be configured to allow the EMS Medical Director, or designee, to monitor all vehicle to hospital transmissions and hospital-to-vehicle transmissions within the System.

 

c)         Resource and Associate Hospitals shall have an operational control point for a Medical Emergency Communications of Illinois (MERCI) VHF/UHF base station, telemetry receiving and monitoring and any Associate to Resource Hospital intercom lines.

 

d)         Physician direction shall be provided from the operational control point of an approved Resource or Associate Hospital.  All medical orders/direction given shall be taped.

 

e)         Telecommunications equipment necessary to fulfill the requirements of this Part shall be staffed and maintained 24 hours every day, including VHF and UHF base stations and their required telephone equipment.

 

f)         EMS System personnel shall be capable of properly operating their respective communications equipment.

 

g)         All telecommunications equipment shall be maintained to minimize breakdowns.  Procedures shall be established to provide immediate action to be taken by operating personnel to ensure rapid restoration in case breakdowns do occur.

 

h)         Written protocols shall describe communications procedures for operation of the System, all base station control points, and field units. These protocols shall contain provisions for limiting the time of individual radio transmissions to include only necessary information transfer (i.e., short telemetry strips).  Mobile base control points and mobile units shall have an easily accessible copy of the protocols pertaining to their stations.

 

i)          Written protocols shall include a requirement that before terminating communications with medical control, pre-hospital personnel must notify medical control of a method by which the ambulance can be re-contacted, and must set its communications equipment so as to be able to receive a call from medical control.

 

j)          The Department shall approve channel assignments, ERP, antenna height and locations, and tones in new Systems to ensure radio coverage in approved program service areas without causing interference in existing Systems.

 

k)         The Department shall monitor and may require modifications in channel assignments, tones, antenna height and locations, and ERP to correct documented radio interference problems.

 

(Source:  Added at 21 Ill. Reg. 5170, effective April 15, 1997)

 

Section 515.420  System Participation Suspensions

 

a)         An EMS MD may suspend from participation within the System any EMS Personnel, EMS Lead Instructor (LI), individual, individual provider or other participant considered not to be meeting the requirements of the Program Plan of that approved EMS System. (Section 3.40(a) of the Act)

 

b)         Except as allowed in subsection (l), the EMS MD shall provide the individual, individual provider or other participant with a written explanation of the reason for the suspension; the terms, length and condition of the suspension; and the date the suspension will commence, unless a hearing is requested.  The procedure for requesting a hearing within 15 days through the Local System Review Board shall be provided.

 

c)         Failure to request a hearing within 15 days shall constitute a waiver of the right to a Local System Review Board hearing.

 

d)         The Resource Hospital shall designate the local System review board, for the purpose of providing a hearing to any individual or entity participating within the System who is suspended from participation by the EMS MD.  (Section 3.40(e) of the Act)  The review board will consist of at least three members, one of whom is an emergency department physician with knowledge of EMS, one of whom is an EMT and one of whom is of the same professional category as the individual, individual provider or other participant requesting the hearing.  The EMS MD shall prepare and post, in a 24-hour accessible location at the Resource Hospital, the System Review Board List.

 

e)         The hearing shall commence as soon as possible, but at least within 21 days after receipt of a written request.  The EMS MD shall arrange for a certified shorthand reporter to make a stenographic record of that hearing and thereafter prepare a transcript of the proceedings.  The transcript, all documents or materials received as evidence during the hearing and the local System review board's written decision shall be retained in the custody of the EMS System.  The System shall implement a decision of the local System review board unless that decision has been appealed to the State Emergency Medical Services Disciplinary Review Board in accordance with the Act and this Part.  (Section 3.40(e) of the Act)

 

f)         The local System review board shall state in writing its decision to affirm, modify or reverse the suspension order.  That decision shall be sent via certified mail or personal service to the EMS MD and the individual, individual provider or other participant who requested the hearing within five business days after the conclusion of the hearing.

 

g)         The EMS MD shall notify the Department, in writing, within five business days after the Board's decision to either uphold, modify or reverse the EMS MD's suspension of an individual, individual provider or participant.  The notice shall include a statement detailing the duration and grounds for the suspension.

 

h)         If the local System review board affirms or modifies the EMS MD's suspension order, the individual, individual provider or other participant shall have the opportunity for a review of the local board's decision of the State EMS Disciplinary Review Board.  (Section 3.40(b)(1) of the Act)

 

i)          If the local System review board reverses or modifies the EMS MD's suspension order, the EMS MD shall have the opportunity for review of the local board's decision by the State EMS Disciplinary Review Board.  (Section 3.40(b)(2) of the Act)

 

j)          Requests for review by the State EMS Disciplinary Review Board shall be submitted in writing to the Chief of the Department's Division of Emergency Medical Services and Highway Safety, within 10 days after receiving the local board's decision or the EMS MD's suspension order, whichever is applicable.  A copy of the Board's decision or the suspension order shall be enclosed.  (Section 3.45(h) of the Act)

 

k)         An EMS MD may immediately suspend an EMR, EMD, EMT, EMT-I, A-EMT, Paramedic, ECRN, PHRN, LI, or other individual or entity if he or she finds that the continuation in practice by the individual or entity would constitute an imminent danger to the public.  The suspended individual or entity shall be issued an immediate verbal notification, followed by a written suspension order by the EMS MD that states the length, terms and basis for the suspension.  (Section 3.40(c) of the Act)

 

1)         Within 24 hours following the commencement of the suspension, the EMS MD shall deliver to the Department, by messenger, telefax, or other Department-approved electronic communication, a copy of the suspension order and copies of any written materials that relate to the EMS MD's decision to suspend the individual or entity.

 

2)         Within 24 hours following the commencement of the suspension, the suspended individual or entity may deliver to the Department, by messenger, telefax, or other Department-approved electronic communication, a written response to the suspension order and copies of any written materials that the individual or entity feels are appropriate.

 

3)         Within 24 hours following receipt of the EMS MD's suspension order or the individual's or entity's written response, whichever is later, the Director or the Director's designee shall determine whether the suspension should be stayed pending an opportunity for a hearing or review in accordance with the Act, or whether the suspension should continue during the course of that hearing or review.  The Director or the Director's designee shall issue this determination to the EMS MD, who shall immediately notify the suspended individual or entity.  The suspension shall remain in effect during this period of review by the Director or the Director's designee.  (Section 3.40(c) of the Act)

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.430  Suspension, Revocation and Denial of Licensure of EMTs (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 9053, effective April 9, 2014)

 

Section 515.440  State Emergency Medical Services Disciplinary Review Board

 

a)         The Governor shall appoint a State Emergency Medical Service Disciplinary Review Board in accordance with Section 3.45 of the Act. (Section 3.45(a) of the Act)

 

b)         The Board shall regularly meet on the first Tuesday of every month, unless no requests for review have been submitted.  Additional meetings of the Board shall be scheduled as necessary to insure that a request for direct review of an immediate suspension order is scheduled within 14 days after the Department receives the request for review or as soon thereafter as a quorum is available.  The Board shall meet in Springfield or Chicago, whichever location is closer to the majority of the members or alternates attending the meeting.  (Section 3.45(g) of the Act)

 

c)         At its regularly scheduled meetings, the Board shall review requests which have been received by the Department at least 10 working days prior to the Board's meeting date.  Requests for review which are received less than 10 working days prior to a scheduled meeting shall be considered at the Board's next scheduled meeting, except that requests for direct review of an immediate suspension order may be scheduled up to 3 working days prior to the Board's meeting date.  (Section 3.45(i) of the Act)

 

d)         A quorum shall be required for the Board to meet, which shall consist of 3 members or alternates, including the EMS Medical Director or alternate and the member or alternate from the same professional category as the subject of the suspension order.  At each meeting of the Board, the members or alternates present shall select a Chairperson to conduct the meeting.  (Section 3.45(j) of the Act)

 

e)         Deliberations for decisions of the State EMS Disciplinary Review Board shall be conducted in closed session.  Department staff may attend for the purpose of providing clerical assistance,  but no other persons may be in attendance except for the parties to the dispute being reviewed by the Board and their attorneys, unless by request of the Board.   (Section 3.45(k) of the Act)

 

f)         The Board shall review the transcript, evidence and written decision of the local review board or the written decision and supporting documentation of the EMS Medical Director, whichever is applicable, along with any additional written or verbal testimony or argument offered by the parties to the dispute.  (Section 3.45(l) of the Act)

 

g)         At the conclusion of its review, the Board shall issue its decision and the basis for its decision on a form provided by the Department, and shall submit to the Department its written decision together with the record of the Local System Review Board.  The Department shall promptly issue a copy of the Board's decision to all affected parties.  The Board's decision shall be binding on all parties.  (Section 3.45(m) of the Act)

 

(Source:  Amended at 22 Ill. Reg. 11835, effective June 25, 1998)

 

Section 515.445  Pediatric Care

 

a)         Upon the availability of federal funds for development of an emergency medical services for children (EMSC) program, the Department shall appoint an Advisory Board to advise the Department on all matters concerning emergency medical service for children and to develop and implement a plan to address identified pediatric areas of need.  The Advisory Board shall advise the Department in the formulation of policy that reflects the purposes of the Act and this Part.  The Advisory Board shall consist of 26 members to be appointed by the Director for a term of three years.  Membership of the Advisory Board shall include:

 

1)         One practicing pediatrician, one pediatric critical care physician and one board certified pediatric emergency physician, to be recommended by the Illinois Chapter of the American Academy of Pediatrics;

 

2)         One pediatric surgeon, to be recommended by the Illinois Chapter of the American College of Surgeons, or a trauma nurse manager/coordinator recommended by the Illinois Trauma Coordinators Coalition;

 

3)         Two emergency physicians, one to be recommended by the Illinois Chapter of the American College of Emergency Physicians and one to be recommended by the National Association of EMS Physicians;

 

4)         One family medicine physician, to be recommended by the Illinois Chapter of the American Academy of Family Physicians;

 

5)         Two RNs, one to be appointed upon recommendation of the American Nurses Association-Illinois (ANA-Illinois) and one to be appointed upon recommendation of the Illinois State Council, Emergency Nurses Association (ENA);

 

6)         Two EMS Personnel of differing levels, to be appointed, one each, upon recommendation of the Illinois EMT Association and Illinois Fire Fighters Association;

 

7)         An EMS Coordinator;

 

8)         A representative from each of the following:  Division of Specialized Care for Children; Illinois Fire Chiefs Association; Illinois State Ambulance Association; Illinois State Medical Society; Illinois Department of Transportation; SAFEKIDS Coalition; Illinois Health and Hospital Association; Illinois Critical Access Hospital Network; Illinois Department of Children and Family Services; Illinois Poison Center; a pediatric rehabilitation representative; a community organization; a child advocate group; and a parent representative;

 

9)         A non-voting member from the Department's Division of Emergency Medical Systems and Highway Safety and the Office of Women's Health, Division of Maternal, Child and Family Health Services.  EMS Regional representation shall be through board members who serve as representatives of other designated constituencies.  The members shall have dual representation status in advising the Department, but shall retain one vote.  The Department shall consider Regional representation when making advisory board appointments.

 

b)         The Advisory Board members with medical backgrounds shall have expertise and interest in emergency or critical care medical services for children. Vacancies on the Advisory Board shall be filled for the unexpired term by appointment of the Director in the same manner as originally filled.  The members of the Advisory Board shall serve without compensation, but shall be reimbursed for necessary expenses incurred in the performance of their duties, including travel expenses.  A majority of the members of the Advisory Board shall constitute a quorum for the conduct of business of the advisory committee.  A majority vote of the members present at a meeting at which a quorum is established shall be necessary to validate any action of the committee.

 

c)         A majority of the members of the Advisory Board shall constitute a quorum for the conduct of the Board's business.  A majority vote of the members present at a meeting at which a quorum is established shall be necessary to validate any action.

 

d)         The Advisory Board shall act pursuant to bylaws that it adopts, which shall include the annual election of a Chair and Vice-Chair.

 

e)         The Department, with the advice of the Advisory Board, shall address and establish through the EMSC program at least the following:

 

1)         Initial and continuing education programs for emergency medical services personnel, which shall include training in the emergency care of infants and children;

 

2)         Guidelines for referring children to the appropriate emergency or critical care medical facilities;

 

3)         Guidelines for pre-hospital, hospital and other pediatric emergency or critical care medical service equipment;

 

4)         Guidelines and protocols for pre-hospital and hospital facilities encompassing all levels of pediatric emergency medical services, hospital and pediatric critical care services, including, but not limited to, triage, stabilization, treatment, transfers and referrals;

 

5)         Guidelines for hospital-based emergency departments appropriate for pediatric care to assess, stabilize, and treat critically ill infants and children and if necessary to prepare the child for transfer to a pediatric intensive care unit or pediatric trauma center;

 

6)         Guidelines for pediatric intensive care units, pediatric trauma centers and intermediate care units fully equipped and staffed by appropriately trained critical care pediatric physicians, surgeons, nurses and therapists;

 

7)         An inter-facility transfer system for critically ill or injured children;

 

8)         Guidelines for pediatric rehabilitation units to ensure staffing by rehabilitation specialists and capabilities to provide any service required to assure maximum recovery from the physical, emotional and cognitive effects of critical illness and severe trauma;

 

9)         Guidelines for the implementation of public education and injury prevention programs throughout the State in conjunction with local fire, public safety and school personnel;

 

10)         Guidelines for the collection, analysis and dissemination of pediatric quality improvement information regarding ongoing improvements in the EMSC program;

 

11)         Guidelines and protocols for pre-hospital providers and hospital facilities for the treatment, documentation, reporting and professional interactions with family members, and for referrals to social, psychological and rehabilitation services in suspected cases of child maltreatment; and

 

12)         Guidelines addressing pediatric disaster/all-hazards preparedness.

 

(Source:  Amended at 44 Ill. Reg. 15619, effective September 4, 2020)

 

Section 515.450  Complaints

 

a)         For the purposes of this Section, "complaint" means a report of an alleged violation of the Act or this Part by any System Participants or providers covered under the Act, or members of the public.  Complaints shall be defined as problems related to the care and treatment of a patient.

 

b)         A person who believes that the Act or this Part may have been violated may submit a complaint by means of a telephone call, letter, fax, or in person.  An oral complaint will be reduced to writing by the Department.  The complainant is requested to supply the following information concerning the allegation:

 

1)         Date and time or shift of occurrence;

 

2)         Names of the patient, EMS Personnel, entities, family members, and other persons involved;

 

3)         Relationship of the complainant to the patient or to the provider;

 

4)         Condition and status of the patient;

 

5)         Details of the situation; and

 

6)         The name of the facility where the patient was taken.

 

c)         All complaints shall be submitted to the Department's Central Complaint Registry or to the EMS MD.  Complaints received by the EMS MD or Trauma Center MD shall be forwarded to the Department's Central Complaint Registry within five working days after receipt of the complaint.  The substance of the complaint shall be provided in writing to the System participant or provider no earlier than at the commencement of an on-site investigation pursuant to subsection (e).

 

d)         The Department and the EMS MD or Trauma Center MD shall not disclose the name of the complainant unless the complainant consents in writing to the disclosure.

 

e)         The Department may conduct a joint investigation with the EMS MD, EMS Coordinator or Trauma Center MD if a death or serious injury has occurred or there is imminent risk of death or serious injury,  or if the complaint alleges action or conditions that could result in a denial, non-renewal, suspension, or revocation of licensure or designation.  If the complaint alleges a violation by the EMS MD, EMS Coordinator or Trauma Center MD, the Department shall conduct the investigation.  If the complaint alleges a violation that would not result in licensure or designation action, the Department shall forward the complaint to the EMS MD or Trauma Center MD for review and investigation.  The EMS MD or Trauma Center MD may request the Department's assistance at any time during an investigation.  In the case of a complaint between EMS Systems, the Department will be involved as mediator or lead investigator.

 

f)         The EMS MD or Trauma Center Director shall forward the results of the investigation and any disciplinary action resulting from a complaint to the Department. Documentation of the investigation shall be retained at the hospital in accordance with EMS System improvement policies and shall be available to the Department upon request.  The investigation file shall be considered privileged and confidential in accordance with the Medical Studies Act [735 ILCS 5/8-2101].

 

g)         Based on the information submitted by the complainant and the results of the investigation conducted in accordance with subsection (e), the Department will determine whether the Act or this Part is being or has been violated. The Department will review and consider any information submitted by the System participant or provider in response to an investigation.

 

h)         The Department will have final authority in the disposition of a complaint. Complaints shall be classified as "violation", "no violation", or "undetermined".

 

i)         The Department will inform the complainant and the System Participant or provider of the complaint results (i.e., whether the complaint was found to be a violation, no violation, or undetermined) within 20 days after its determination.

 

j)         The EMS System shall have a policy in place requiring compliance with this Section.

 

k)        An EMS System Participantparticipant or provider who is dissatisfied with the determination or investigation by the Department may request reconsideration by the Department.

 

l)          The investigative files of the EMS System and the Department shall be privileged and confidential in accordance with the Medical Studies Act [735 ILCS 5/8-2101], except that the Department and the involved EMS System may share information.  The Department's final determination shall be public information subject to FOIA.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.455  Intra- and Inter-System Dispute Resolution

 

a)         If the Director determines that a dispute  exists between an EMS System, Vehicle Service Provider, Advisory Committee, hospital, or EMS MD or between any combination of any elements of these entities and the dispute causes an imminent threat to the availability or quality of emergency pre-hospital care within the State, then the Director or designee shall have the authority to resolve those disputes, if one party to the dispute requests the Director's intervention in writing. If the Director receives and approves such a request, then each entity's duly authorized representative shall be given the opportunity to submit written arguments and evidence in support of any potential resolution.  The Director or designee shall have the authority to hear oral arguments and testimony based upon the written submissions.  Any decision by the Director or designee shall be issued in writing and state the basis for the decision, which shall be final and binding upon all parties to the dispute.  The Director or designee will endeavor to issue a written decision within 30 days after receipt of all written submissions and verbal testimony, if verbal testimony is permitted.

 

b)         This dispute resolution procedure shall not be available to any EMS Personnel or a member of the public. This procedure shall not be applicable to any EMS System Suspension, Local Board of Review, action by the State EMS Disciplinary Review Board or the Department.  

 

c)         The Department's Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100) shall govern all proceedings.

 

d)         All final administrative decisions of the Department hereunder shall be subject to judicial review pursuant to the provisions of the Administrative Review Law [35 ILCS 5/Art. III] . (Section 3.145 of the Act) A decision by the Director in accordance with this Section shall be considered an administrative review decision under Section 3.145 of the Act and shall be subject to judicial review.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.460  Fees

 

a)         The following fees shall be submitted to the Department at the time of application for examination, initial licensure, licensure renewal, duplicate license, or reciprocity:

 

1)         EMT licensure:  $45

 

2)         EMT renewal:  $20

 

3)         EMT examination:  $20

 

4)         A-EMT or EMT-I licensure:  $45

 

5)         A-EMT or EMT-I renewal:  $30

 

6)         A-EMT or EMT-I examination:  $30

 

7)         Paramedic licensure:  $60

 

8)         Paramedic renewal:  $40

 

9)         Paramedic examination:  $40

 

10)         Trauma Nurse Specialist licensure:  $50

 

11)         Trauma Nurse Specialist renewal: $25

 

12)         Trauma Nurse Specialist examination:  $25 (see Section 515.750(f))

 

13)         Emergency Communications Registered Nurse licensure: $55

 

14)         Emergency Communications Registered Nurse renewal:  $20

 

15)         Emergency Medical Dispatcher licensure:  $30

 

16)         Emergency Medical Dispatcher renewal:  $20

 

17)         Pre-Hospital RN licensure:  $30

 

18)         Pre-Hospital RN renewal:  $20

 

19)         Pre-Hospital PA licensure:  $30

 

20)         Pre-Hospital PA renewal:  $20

 

21)         Pre-Hospital APRN licensure:  $30

 

22)         Pre-Hospital APRN renewal:  $20

 

23)         Lead Instructor licensure: $40

 

24)         Lead Instructor renewal:  $20

 

25)         EMR licensure:  $55

 

26)         EMR renewal:  $20

 

27)         Duplicate license:  $10

 

28)         Reciprocity application processing fee:  $50

 

29)         Fees for a reciprocity license or reinstatement of a license will be equal to the amount of the initial license fee.

 

30)         License status verification documentation for out-of-state or organizational requests:  $25

 

31)         License renewal late fee during lapse period:  $50

 

b)         An EMR, EMD, EMT, EMT-I, A-EMT, Paramedic, ECRN or PHRN who is a member of the Illinois National Guard or an Illinois State Trooper or who exclusively serves as a volunteer for units of local government with a population base of less than 5,000 or as a volunteer for a not-for-profit organization that serves a service area with a population base of less than 5,000 in this State may submit an application to the Department for a waiver of the fees for the EMS Personnel examination, licensure and license renewal on a form prescribed by the Department.  (Section 3.50(d-5) of the Act)  The fee waiver application shall be submitted to the Department and approved prior to examination, licensure or renewal.  No fees will be refunded.

 

c)         Fees shall be paid on-line or by certified check or money order made payable to the Department.  Personal checks or cash will not be accepted.

 

d)         If a candidate does not achieve a passing grade on the written examination, the fee for the retest is the same as for initial examination.

 

e)         All fees submitted for licensure examinations are not refundable.

 

(Source:  Amended at 44 Ill. Reg. 15619, effective September 4, 2020)

 

Section 515.470  Participation by Veterans Health Administration Facilities

 

a)         Subject to patient preference, Illinois EMS vehicle service providers may transport patients to Veterans Health Administration facilities that voluntarily participate in an EMS System. (Section 3.20(c)(11) of the Act)

 

b)         Any Veterans Health Administration facility seeking limited participation in an EMS System shall agree to comply with the emergency department requirements set forth in the Hospital Licensing Requirements and with the requirements of this Section.  (Section 3.20(c)(11) of the Act)

 

c)         The types of Veterans Health Administration facilities that may participate in an EMS System (Section 3.20(c)(11) of the Act):  A Veterans Health Administration (VA) facility that meets the minimum standards for a basic or comprehensive emergency department as established by the Hospital Licensing Requirements (77 Ill. Adm. Code 250) that has the ability to promptly evaluate, treat, stabilize, admit or transfer patients to an appropriate hospital capable of providing the appropriate level of care based upon individual patient needs.

 

d)         A VA facility seeking to participate in an EMS System shall apply in writing to the EMS MD of the System for approval.  The facility shall indicate the level at which it seeks to participate (i.e., participating, associate or resource hospital), in accordance with Section 515.320 and, in the case of a resource hospital, Section 515.300. Approval shall be based on the facility's demonstration that it can provide care at the level of participation being sought, in accordance with the requirements of the Act and this Part.

 

e)         The EMS MD shall notify the facility and the Department of the approval and the type of patients for which care is approved.  If the EMS MD denies the approval, the denial shall be issued in writing and shall include the reasons for denial. 

 

f)         The EMS System shall submit a revised System Program Plan to the Department providing for participation of the facility at the level approved by the EMS MD.

 

g)         Participating facilities shall agree to comply with the requirements of the EMS System Plan as set forth in Section 515.330 of this Part, System protocols established by the System, and any other applicable requirements of this Part, unless waived by the Department in accordance with Section 3.185 of the Act and Section 515.150 of this Part.

 

h)         VA facilities participating in an EMS System shall maintain operational two-way radio communication equipment pursuant to Section 515.400 (General Communications) and any additional communications equipment required by the EMS System in which they participate.

 

i)          VA facilities participating in an EMS System shall accept all patients within the facility's capability in a disaster, overload or bypass situation.

 

j)          If at any time the Director or his or her designee has determined that an immediate and serious danger to the public health, safety and welfare exists, the Department will issue an emergency order in accordance with Section 3.85(b)(7) of the Act to prevent licensed vehicle providers from transporting patients to the facility's emergency department.  (Section 3.85(b)(7) of the Act)

 

(Source:  Amended at 37 Ill. Reg. 7128, effective May 13, 2013)

SUBPART D: EDUCATION OF EMERGENCY MEDICAL TECHNICIANS, ADVANCED EMERGENCY MEDICAL TECHNICIANS, EMERGENCY MEDICAL TECHNICIANS-INTERMEDIATE, PARAMEDICS AND EMS PERSONNEL

 

Section 515.500  EMS System Education Program-Emergency Medical Technician

 

a)         An EMS education program shall only be conducted by an EMS System or an academic institution under the direction of the EMS System.

 

b)         Applications for pre-approval of EMS education programs shall be filed with the Department on forms prescribed by the Department.  The applications shall contain, at a minimum:

 

1)         Name of the applicant, agency and address;

 

2)         Lead Instructor's name, license number, address and contact information;

 

3)         Name and signature of the EMS MD and EMS System Coordinator;

 

4)         Type of education program;

 

5)         Dates, times and location of the education program, including course schedule;

 

6)         Goals, objectives and course outline;

 

7)         Methods, materials and text books;

 

8)         Content and time consistent with the national EMS education standards and additional course curricula required by the Department.  Initial or modified course syllabi shall be approved by the Department;

 

9)         Description of the clinical and field requirements;

 

10)         Description of evaluation tools (student, clinical units, faculty and programs); and

 

11)         Requirements for successful completion.

 

c)         Applications for pre-approval, including a copy of the course schedule and syllabus, shall be submitted no less than 60 days before the first scheduled class.

 

1)         Initial or revised education programs require full submission of all curriculum related educational documents for Department pre-approval (see Section 515.520(b)(1 through 11)).

 

2)         Education programs previously approved by the Department without changes to curricula or content require submission of the course schedule and syllabus only.

 

d)         The EMS MD shall attest on the application form that the education program will be conducted according to the national EMS education standards, including modifications required by the Department.  The course hours shall include, at a minimum, 125 hours of didactic education and 25 hours of clinical experience, which includes hospital or alternate health care facility and field internship experience.  The clinical experience shall include minimum patient care contacts, competency evaluation, and measurement, as defined in the standards and approved by the EMS MD.

 

e)         The EMS MD and the EMS System Coordinator, in cooperation with the educational institution, shall be responsible for oversight, quality assurance and outcome measurement for the EMT education program.

 

f)         The Lead Instructor for the course shall be responsible for ensuring that no EMT course begins until after the Department issues its formal, written pre-approval, which shall be in the form of a numeric site code.

 

g)         The Lead Instructor for the course shall be responsible for ensuring that all materials presented to EMT students conform to all curriculum requirements of both the Department and the EMS System granting its approval.  Methods of assessment or intervention that are not approved by both the Department and the EMS System shall not be taught or presented.  All LIs for courses shall be approved by the EMS MD.

 

h)         Any change in the EMT program's EMS MD, EMS System Coordinator or Lead Instructor, or change in the minimum approved program, shall require an amendment to be filed with the Department by the EMS System.

 

i)          Before a candidate is accepted into the program, documentation shall be submitted that a BLS EMS System vehicle will be available to accommodate field internship needs.

 

j)          Each EMS Lead Instructor shall verify a student's qualification to take a Department-approved licensure examination upon the successful completion of the education program and shall submit a student roster on a form approved by the Department.  The EMS MD or designee may approve students through an on-line verification system.

 

k)         EMT candidates may test for licensure through the Illinois State examination or the NREMT examination.  For EMT candidates who have completed and passed components of the program, and passed the NREMT examination, the EMS MD shall submit to the Department an electronic transaction provided by the Department.  No electronic transaction form is necessary for candidates taking the State licensing examination.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.510  Advanced Emergency Medical Technician and Emergency Medical Technician-Intermediate Education

 

a)         An A-EMT or EMT-I course shall be conducted only by an EMS System or an academic institution whose curriculum has been approved by the EMS System.

 

b)         Applications for pre-approval of A-EMT or EMT-I education programs shall be filed with the Department on forms prescribed by the Department.  The application shall contain, at a minimum:.

 

1)         Name of the applicant, agency and address;

 

2)         Lead Instructor's name, license number, address and contact information;

 

3)         Name and signature of EMS MD and EMS System Coordinator;

 

4)         Type of education program;

 

5)         Dates, times and location of the education program, including course schedule;

 

6)         Goals, objectives and course outline;

 

7)         Methods, materials and text books;

 

8)         Content and time consistent with the national EMS education standards and additional course curricula required by the Department.  Initial or modified course syllabi shall be approved by the Department;

 

9)         Description of the clinical and field requirements;

 

10)         Description of evaluation tools (student, clinical units, faculty and programs); and

 

11)         Requirements for successful completion.

 

c)         Applications for pre-approval, including a copy of the course schedule and syllabus, shall be submitted at least 60 days before the first scheduled class.

 

1)         Initial or revised education programs require full submission of all curriculum related educational documents for Department pre-approval (see Section 515.520(b)(1) through (11)).

 

2)         Education programs previously approved by the Department without changes to curricula or content require submission of the course schedule and syllabus only.

 

d)         The EMS MD shall attest on the application form that the A-EMT or EMT-I education program shall be conducted according to the national EMS education standards for an A-EMT, including modifications required by the Department.  The course hours shall minimally include 200 hours of didactic education and at least 150 hours of clinical experience. Clinical experience shall include hospital, alternate care facility, and field internship experience, including minimum patient care contacts, competency evaluation and measurement, as defined in the standards and approved by the EMS MD.

 

e)         Oversight, quality assurance and outcome measurement for the A-EMT and EMT-I education program shall be the responsibility of the EMS MD and the EMS System Coordinator, with cooperation of the educational institution.

 

f)         The Lead Instructor shall be responsible for ensuring that no A-EMT or EMT-I course begins before the Department issues its formal written pre-approval, which will be in the form of a numeric site code.

 

g)         The Lead Instructor for the course shall be responsible for ensuring that all materials presented to A-EMT or EMT-I students conform to all curriculum requirements of both the Department and the EMS System granting its approval.  Methods of assessment or intervention that are not approved by both the Department and the EMS System shall not be taught or presented.  All LIs for courses must be approved by the EMS MD.

 

h)         Any change in the A-EMT or EMT-I program's EMS MD, EMS System Coordinator or Lead Instructor, or change in the minimum approved program, requires an amendment to be filed with the Department.

 

i)          A candidate for an A-EMT or EMT-I education program shall have a current Illinois EMT license.  All program participants shall maintain their qualifying license throughout completion of the program and successful completion of the licensure examination.

 

j)          Before a candidate is accepted into the program, documentation shall be submitted that an ILS or ALS EMS System vehicle will be available to accommodate field internship needs.

 

k)         Each education program shall verify a student's qualification to attempt a Department-approved licensure examination upon the successful completion of the education program and shall submit a student roster on a form approved by the Department.  The EMS MD or designee may approve students through an on-line verification system.

 

l)          A-EMT and EMT-I candidates who have completed and passed all components of the program may test for licensure through the Illinois State examination.  No electronic transaction form is necessary for candidates taking the State licensing examination.  An A-EMT candidate may choose to test with the NREMT examination.  For candidates successfully passing the NREMT examination and applying for Illinois licensure, the EMS MD shall submit to the Department an electronic transaction form provided by the Department.

 

m)        All approved programs shall maintain course and student records, for a minimum of seven years, in compliance with affiliated academic institution requirements as applicable.  The course and student records shall be made available to the EMS System or Department upon demand.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.520  Paramedic Education

 

a)         A Paramedic course shall be conducted only by an EMS System or an academic institution whose curriculum has been approved by the EMS System.

 

b)         Applications for pre-approval of Paramedic education programs shall be filed with the Department on forms prescribed by the Department.  The application shall contain, at a minimum:

 

1)         Name of the applicant, agency and address;

 

2)         Lead Instructor's name, license number, address and contact information;

 

3)         Name and signature of EMS MD and EMS System Coordinator;

 

4)         Type of education program;

 

5)         Dates, times and location of the education program, including course schedule;

 

6)         Goals, objectives and course outline;

 

7)         Methods, materials and text books;

 

8)         Content and time, consistent with the national EMS education standards and additional course curricula required by the Department.  Initial or modified course syllabi shall be approved by the Department;

 

9)         Description of the clinical and field requirements;

 

10)         Description of evaluation tools (student, clinical units, faculty and programs); and

 

11)         Requirements for successful completion.

 

c)         Applications for pre-approval, including a copy of the course schedule and syllabus, shall be submitted at least 60 days before the first scheduled class.

 

1)         Initial or revised education programs require full submission of all curriculum related educational documents for Department pre-approval (see Section 515.520(b)(1 through 11)).

 

2)         Education programs previously approved by the Department without changes to curricula or content will require submission of the course schedule and syllabus only.

 

d)         The EMS MD of the EMS System shall attest on the application form that the education program will be conducted according to the national EMS education standards, including all modifications required by the Department.  The course hours shall minimally include 500 hours of didactic education and 500 hours of clinical experience, which includes hospitals plus alternate care facilities and field internship experience, including minimum patient care contacts and competency evaluation and measurement as defined in the standards and approved by the EMS MD.  

 

e)         Oversight, quality assurance and outcome measurement for the Paramedic education program shall be the responsibility of the EMS MD and the EMS System Coordinator, with cooperation of the educational institution.

 

f)         The Lead Instructor for the course shall be responsible for ensuring that no Paramedic class begins until after the Department issues its formal written pre-approval, which shall be in the form of a numeric site code.

 

g)         The Lead Instructor for the course shall be responsible for ensuring that all materials presented to Paramedic students conform to all curriculum requirements of both the Department and the EMS System granting its approval. Methods of assessment or intervention that are not approved by both the Department and the EMS System shall not be taught or presented.  All LIs for courses must be approved by the EMS MD.

 

h)         Any change in the Paramedic program's EMS MD, EMS System Coordinator or Lead Instructor, or change in the minimum approved program, shall require an amendment to be filed with the Department.

 

i)          A candidate for a Paramedic education program shall have a current Illinois EMT, A-EMT or EMT-I license. All program participants shall maintain their qualifying license throughout completion of the program and successful completion of the licensure examination.

 

j)          Before a candidate is accepted into the program, documentation shall be submitted that an ALS or CCT EMS System vehicle will be available to accommodate field internship needs.

 

k)         Each education program shall verify a student's qualification to attempt a Department-approved licensure examination upon the successful completion of the education program and shall submit a student roster on a form approved by the Department.  The EMS MD or designee may approve students through an on-line verification system.

 

l)          Paramedic candidates may test for licensure through the Illinois State examination or the NREMT examination (NREMT requires successful completion from an accredited academic institution recognized by NREMT).  For Paramedic candidates who have completed and passed all components of the program, and passed the NREMT examination, and who are applying for Illinois licensure, the EMS MD shall submit to the Department an electronic transaction form provided by the Department.  No electronic transaction form is required for candidates taking the State licensure examination.

 

m)        All approved programs shall maintain course and student records for seven years, in compliance with the affiliated academic institution requirements as applicable.  The course and student records shall be made available to the EMS System or Department upon request.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.530  EMT, A-EMT, EMT-I and Paramedic Testing

 

a)         All candidates shall hold a high school diploma or high school equivalency certificate and be 18 years of age or older to be licensed. Candidates who meet all of the requirements of this Part may test after attaining 17 years of age and may apply for licensure upon attaining 18 years of age.

 

b)         After completion of an approved education program and a recommendation to test by the EMS MD or designee, candidates shall take a written licensure examination. Candidates shall have the choice of taking either the NREMT written and psychomotor examination or the Department's examination if eligible and available.  The Department's written examinations shall be based on the national EMS education standards and practice analysis and are equivalent to the NREMT written examinations as modified by the Department.

 

c)         Candidates qualifying for licensure examinations may register for examinations through either the State of Illinois testing vendor or the NREMT. Application information may be found at the Department's website (http://www. continentaltesting.net/) or the NREMT website (https://www.nremt.org/nremt/ about/apply_for_assess_exam.asp).  All candidates for licensure examinations shall be approved by the EMS System.  Candidates shall register to take a licensure examination within 90 days after course completion, including all clinical and field requirements.

 

d)         A failure rate per course of 30 percent or greater on the licensure examination will subject the particular education program to review by the EMS System or the Department.

 

e)         Candidates shall have three attempts to pass the licensure examination within 12 months after initial authorizations to test.  Candidates who fail all three initial examination attempts shall take a refresher course in alignment with the NREMT Cognitive Examination Retest policy.  Candidates shall be granted up to three additional licensure examination attempts only upon EMS MD authorization.

 

f)         When a candidate elects to take the State examination or the NREMT examination, the candidate shall pass that particular testing procedure or exhaust all three test attempts with the initial testing agency.  Any candidate may request a waiver from the Department to change the examination testing venue after three unsuccessful testing attempts.

 

g)         Failure to appear for the examination on the scheduled date, at the time and place specified, shall result in the forfeiture of the examination fee.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.540  EMT, A-EMT, EMT-I and Paramedic Licensure

 

a)         To be licensed by the Department as an EMT, A-EMT, EMT-I or Paramedic, an individual must pass either the NREMT examination or the Department's licensure examination based on a final composite score of  70.

 

b)         Upon successful completion of the NREMT written and psychomotor examinations, the applicant shall apply to the Department through the affiliated EMS System, using forms specified by the Department. The application will include demographic information, social security number, child support statement, felony conviction statement, and applicable fees, and will require EMS System authorization. Upon successful completion of the State examination, the applicant will be required to pay the applicable fees (see Section 515.460(a)).

 

c)         An EMS license will specify the level of licensure, i.e., EMT, A-EMT, EMT-I or Paramedic, and will be effective for a period of four years.

 

d)         An EMT, A-EMT, EMT-I or Paramedic shall notify the Department within 30 days after any change in name or address.  Notification may be in person or by mail, phone, fax or electronic mail. Addresses may be changed through the Department's on-line system.  Name and gender changes require certified copies of court orders, i.e., marriage license or court documents.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.550  Scope of Practice − Licensed EMT and Paramedic

 

a)         Any person currently licensed as an EMT, EMT-I, A-EMT or Paramedic may only perform emergency and non-emergency medical services in accordance with his or her level of education, training and licensure, the standards of performance and conduct prescribed in this Part, and the requirements of the EMS System in which he or she practices, as contained in the approved Program Plan for that System.  The Director may, by written order, temporarily modify individual scopes of practice in response to public health emergencies for periods not to exceed 180 days. (Section 3.55(a) of the Act)

 

b)         EMS Personnel who have successfully completed a Department-approved course in automated external defibrillator operation and who are functioning within a Department-approved EMS System may use an automated external defibrillator according to the standards of performance and conduct prescribed by the Department in this Part, and the requirements of the EMS System in which they practice, as contained in the approved Program Plan for that System.  (Section 3.55(a-5) of the Act)

 

c)         An EMT, EMT-I, A-EMT or Paramedic who has successfully completed a Department-approved course in the administration of epinephrine shall be required to carry epinephrine with him or her as part of the EMS Personnel medical supplies whenever he or she is performing official duties, as determined by the EMS System. (Section 3.55 (a-7) of the Act)

 

d)         An EMR, EMT, EMT-I, A-EMT or Paramedic may only practice as an EMR, EMT, EMT-I, A-EMT or Paramedic or utilize his or her EMR, EMT, EMT-I, A-EMT or Paramedic license in pre-hospital or inter-hospital emergency care settings or non-emergency medical transport situations, under the written or verbal direction of the EMS MD. For purposes of this Section, a "pre-hospital emergency care setting" may include a location, that is not a health care facility, which utilizes EMS Personnel to render pre-hospital emergency care prior to the arrival of a transport vehicle. The location shall include communication equipment and all of the portable equipment and drugs appropriate for the EMT, EMT-I, A-EMT or Paramedic's level of care, and the protocols of the EMS Systems, and shall operate only with the approval and under the direction of the EMS MD.

 

e)         This does not prohibit an EMR, EMT, EMT-I, A-EMT or Paramedic from practicing within an emergency department or other health care setting for the purpose of receiving continuing education or training approved by the EMS MD.  This also does not prohibit an EMT, EMT-I, A-EMT or Paramedic from seeking credentials other than his or her EMT, EMT-I, A-EMT or Paramedic license and utilizing such credentials to work in emergency departments or other health care settings under the jurisdiction of that employer.  (Section 3.55(b) of the Act)

 

f)         A student enrolled in a Department-approved EMS Personnel program, while fulfilling the clinical training and in-field supervised experience requirements mandated for licensure or approval by the System and the Department, may perform prescribed procedures under the direct supervision of a physician licensed to practice medicine in all of its branches, a qualified RN or a qualified EMS Personnel, only when authorized by the EMS MD.  (Section 3.55(d) of the Act)

 

g)         An EMR, EMT, EMT-I, A-EMT or Paramedic may transport a police dog injured in the line of duty to a veterinary clinic or similar facility if there are no persons requiring any medical attention or transport at that time. (Section 3.55(e) of the Act) EMS Systems that choose to transport police dogs injured in the line of duty shall develop written policies or procedures for all of the following:

 

1)         Basic level first aid and safe handling procedures for injured police dogs, including the use of a box muzzle, developed in consultation with a local veterinarian.  The provision of Intermediate and Advanced Life Support care is not authorized and shall not be permitted unless the individual EMS provider is also appropriately licensed under the Illinois Veterinary Medicine and Surgery Practice Act [225 ILCS 115];

 

2)         Identification of local veterinary facilities that will provide emergency treatment of injured police dogs on short notice;

 

3)         Proper and complete decontamination of stretchers, the patient compartment, and all contaminated medical equipment, when a police dog has been transported by ambulance or other EMS vehicle; and

 

4)         The sterilization of the interior of an ambulance, including complete sanitizing of all allergens and disinfecting to a standard safe for human transport before being returned to human service.

 

(Source:  Amended at 43 Ill. Reg. 4145, effective March 19, 2019)

 

Section 515.560  EMT Continuing Education

 

a)         Continuing education classes, seminars, clinical time, workshops or other types of programs shall be approved by the Department before being offered to EMTs.  An application for approval shall be submitted to the Department on a form prescribed, prepared and furnished by the Department, at least 60 days prior to the scheduled event. The application will include, but not be limited to, the following:

 

1)         Name of applicant, agency and address;

 

2)         Lead Instructor's name, license number, address and contact information;

 

3)         Name and signature of the EMS MD and the EMS System Coordinator;

 

4)         Type of education program;

 

5)         Dates, times and location of the education program (submit course schedule);

 

6)         Goals and objectives;

 

7)         Methods and materials, text books, and resources, when applicable;

 

8)         Content consistent with the national EMS education standards;

 

9)         Description of evaluation instruments; and

 

10)        Requirements for successful completion, when applicable.

 

b)         Approval will be granted provided the application is complete and the content of the program is based on topics or materials from the national EMS education standards, as modified by the Department. Upon approval, the Department will issue a site code to the course, seminar, workshop or program.

 

c)         An EMS System may apply to the Department for a single System site code to cover CE activities conducted or approved by the System for System EMTs when an urgent education need arises that requires immediate attention or when other appropriate education opportunities present outside of the scheduled approved offerings.  Activities conducted under the System site code shall not require individual approval by the Department.  The single System site code is not intended to replace the routine CE pre-approvals required by this Section and Sections 515.570 and 515.580.

 

d)         An EMT functioning within an EMS System shall submit written proof of CE attendance to the EMS System Coordinator pursuant to System policy.  An EMT not functioning within an EMS System shall submit written proof of CE attendance to the Department Regional EMS Coordinator upon licensure renewal request.

 

e)         The EMS MD or designee of the EMS System of the EMT's primary affiliation or Department's designee for independent EMTs shall verify whether specific CE hours meet requirements for educational credit towards active status or renewal purposes outlined in Section 515.590(a)(2)(B).

 

f)         An EMS System that requires clinical CE shall specify in the System Program Plan the number of hours required and the manner in which those hours shall be earned, submitted and verified.

 

g)         An EMT shall maintain copies of all documentation concerning CE programs that he or she has completed for a period of not less than four years.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.570  A-EMT and EMT-I Continuing Education

 

a)         Continuing education classes, seminars or other types of programs shall be approved by the Department before being offered to A-EMTs or EMT-Is.  An application for approval shall be submitted to the Department by an EMS MD, on a form prescribed and furnished by the Department, at least 60 days prior to the scheduled event.  The application will include, but not be limited to, the following:

 

1)         Name of applicant, agency and address;

 

2)         Lead Instructor's name, license number, address and contact information;

 

3)         Name and signature of the EMS MD and the EMS System Coordinator;

 

4)         Type of education program;

 

5)         Dates, times and location of the education program (submit course schedule);

 

6)         Goals and objectives;

 

7)         Methods and materials, text books, and resources, when applicable;

 

8)         Content consistent with the national EMS education standards;

 

9)         Description of evaluation instruments; and

 

10)         Requirements for successful completion, when applicable.

 

b)         Approval will be granted provided the application is complete and the content of the program is based on topics or materials from the national EMS education standards for an A-EMT, as modified by the Department.  Upon approval, the Department will issue a site code to the course, seminar or program.

 

c)         An EMS System may apply to the Department for a single System site code to cover CEactivities conducted or approved by the System for System A-EMTs and EMT-Is when an urgent education need arises that requires immediate attention or when other appropriate education opportunities present outside of the scheduled approved offerings.  Activities conducted under the System site code shall not require individual approval by the Department. The single System site code is not intended to replace the routine CE pre-approvals required by this Section and Sections 515.560 and 515.580.

 

d)         A-EMTs and EMT-Is functioning within an EMS System shall submit written proof of CE attendance to the EMS System Coordinator pursuant to System policy.  A-EMTs and EMT-Is not functioning within an EMS System shall submit written proof of CE attendance to the Department Regional EMS Coordinator upon licensure renewal request.

 

e)         The EMS MD or designee of the EMS System of the A-EMT's or EMT-I's primary affiliation or the Department's designee for independent A-EMTs or EMT-Is shall verify whether specific CE hours meet criteria for educational credit towards active status or renewal purposes as required by Section 515.590(a)(2)(B).

 

f)         An EMS System that requires clinical CE shall specify in the System Program Plan the number of hours required, and the manner in which those hours must be earned, submitted and verified.

 

g)         A-EMTs and EMT-Is shall maintain copies of all documentation concerning CE programs or activities that they have completed for a period of not less than four years.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.580  Paramedic Continuing Education

 

a)         Continuing education classes, seminars or other types of programs shall be approved by the Department before being offered to Paramedics.  An application for approval shall be submitted to the Department by an EMS Medical Director, on a form prescribed, prepared and furnished by the Department, at least 60 days prior to the scheduled event. The application will include, but not be limited to, the following:

 

1)         Name of applicant, agency and address;

 

2)         Lead Instructor's name, license number, address and contact information;

 

3)         Name and signature of the EMS MD and the EMS System Coordinator;

 

4)         Type of education program;

 

5)         Dates, times and location of the education program (submit course schedule);

 

6)         Goals and objectives;

 

7)         Methods and materials, text books, and resources, when applicable;

 

8)         Content consistent with the national EMS education standards;

 

9)         Description of evaluation instruments; and

 

10)         Requirements for successful completion, when applicable.

 

b)         Approval will be granted provided the application is complete and the content of the program is based on topics or materials from the national EMS education standards, as modified by the Department.  Upon approval, the Department will issue a site code to the course, seminar or program.

 

c)         An EMS System may apply to the Department for a single System site code to cover CE activities conducted or approved by the System solely for System Paramedics when an urgent education need arises that requires immediate attention or when other appropriate education opportunities present outside of the scheduled approved offerings.  Activities conducted under the System site code shall not require individual approval by the Department. The single System site code is not intended to replace routine CE pre-approvals required by this Section and Sections 515.560 and 515.570.

 

d)         A Paramedic functioning within an EMS System shall submit written proof of CE attendance to the EMS System Coordinator pursuant to System policy.  A Paramedic not functioning within an EMS System shall submit written proof of CE attendance to the Department Regional EMS Coordinator upon licensure renewal request.

 

e)         The EMS MD or designee of the EMS System Paramedic's primary affiliation shall verify whether specific CE hours meet the criteria for educational credit towards active status or renewal purposes required by Section 515.590(a)(2)(B).

 

f)         An EMS System that requires clinical CE shall specify in the System Program Plan the number of hours required, and the manner in which those hours must be earned, submitted and verified.

 

g)         A Paramedic shall maintain copies of all documentation concerning CE programs or activities that he or she has completed for a period of not less than four years.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.590  EMS Personnel License Renewals

 

a)         To be relicensed:

 

1)         The licensee shall file an application for renewal, either written or on-line, with the Department, using the format prescribed by the Department, at least 30 days prior to the license expiration date. Incomplete license applications submitted to the Department less than 30 days before the expiration may not be processed by the expiration date and may be subject to a late fee.

 

A)        In addition to completion of the renewal application and payment of the renewal fee, a licensee who functions within an EMS System shall submit documentation of completion of CE requirements to his or her EMS System of primary affiliation at least 30 days before the expiration of his or her license.  A licensee who does not function within an EMS System, and who seeks independent renewal, shall submit documentation of completion of CE requirements to the Department at least 30 days before the expiration of his or her license.

 

B)        A licensee who has not been recommended for relicensure by the EMS MD shall independently submit an application for renewal to the Department.  The EMS MD shall provide a written statement stating the reason for the denial of relicensure to the licensee and the Department.  The application for independent renewal may be found on the Department's website: http://dph.illinois.gov/sites/ default/files/forms/emsindependentrenewal-040317.pdf.

 

2)         The EMS MD or designee shall provide an electronic authorization to the Department regarding completion of the following minimum requirements:

 

A)        Paramedics and PHRNs shall have a minimum of 100 approved CE hours. A-EMTs and EMT-Is shall have a minimum of 80 approved CE hours.  EMTs shall have a minimum of 60 approved CE hours.

 

B)        CE hours shall consist of EMS System-approved in-services, Department-recognized college health care courses, online CE courses, seminars and workshops, addressing both adult and pediatric care.  The System shall define in the Program Plan the number of CE hours to be accrued for relicensure.  No more than 20 percent of those hours may be in the same subject.

 

C)        Any System CE requirements for EMS Personnel approved to operate an automated external defibrillator shall be included in the required CE hours.

 

D)        The licensee shall have a current CPR for Healthcare Providers card that covers didactic and psychomotor skills that meet or exceed American Heart Association guidelines.

 

b)         The license of EMS Personnel who has failed to file a completed application for renewal on time shall be invalid on the day following the expiration date shown on the license. EMS Personnel shall not function on an expired license.

 

c)         At any time prior to the expiration of the current license, an EMT, A-EMT, EMT-I or Paramedic may downgrade to EMT or EMR status for the remainder of the license period.  The EMT, A-EMT, EMT-I or Paramedic shall make this request in writing to the EMS MD of his or her System of primary affiliation along with a signed renewal notice and his or her original EMS license and duplicate license fee.  The EMS MD or designee shall verify that the license is current with CE hours and forward the approved applications to the Department.  To relicense at the EMT or EMR level, the individual must meet the relicensure requirements for that downgraded level.

 

d)         EMS Personnel who have downgraded to EMT, A-EMT or EMT-I status may subsequently upgrade to his or her original level of licensure held at the time of the downgrade upon the recommendation of an EMS MD who has verified that the individual's knowledge and psychomotor skills are at the level of the licensure being requested.  The individual shall complete any education or testing deemed necessary by the EMS MD for resuming A-EMT, EMT-I or Paramedic activities and submit a duplicate license fee.  EMS Personnel cannot upgrade from the EMR level.

 

e)         EMS Personnel whose licenses have expired may, within 60 days after license expiration, submit all relicensure requirements and submit the required relicensure fees (see Section 515.460), including a late fee, online or by certified check or money order.  Cash or personal check will not be accepted.  If all relicensure requirements have been met, and no disciplinary actions are pending against the EMS Personnel, the Department will relicense the EMS Personnel.

 

f)         EMS Personnel whose licenses have  expired for a period of more than 60 days shall be required to reapply for licensure, complete the education program, pass a Department-approved licensure examination, and pay the fees as required for initial licensure (see Section 515.460). Within 36 months after expiration of a license, an individual may quality for reinstatement under Section 515.640.

 

g)         The Department shall require the licensee to certify on the renewal application form, under penalty of perjury, that he or she is not more than 30 days delinquent in complying with a child support order.  (Section 10-65(c) of the Illinois Administrative Procedure Act)

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.600  EMS Personnel Inactive Status

 

a)         Prior to the expiration of the current license, EMS Personnel may request to be placed on inactive status on a form prescribed by the Department available on the Department's website: http://dph.illinois.gov/sites/default/files/forms/ems-inactive-request-062116.pdf.  The application shall contain the following information:

 

1)         Name of individual and contact information;

 

2)         Applicant's current original license;

 

3)         Level of licensure;

 

4)         License number;

 

5)         Circumstances requiring inactive status; and

 

6)         Confirmation from the EMS MD of the System of primary affiliation or the Department for independent licensees that relicensure requirements have been met by the date of the application for inactive status.

 

b)         The Department will review requests for inactive status. The Department will notify the EMS MD in writing of its decision based on subsection (a).

 

c)         For EMS Personnel to return to active status, the EMS MD shall make application to the Department on a form prescribed by the Department available on the Department's website: http://dph.illinois.gov/sites/ default/files/forms/ems-reactivation-request-061416.pdf.  The EMS MD shall confirm that the applicant has been examined (physically and mentally) and found capable of functioning within the EMS System; that the applicant's knowledge and psychomotor skills are at the active EMT level for that individual's license; and that the applicant has completed any education and evaluation deemed necessary by the EMS MD and approved by the Department.  If the inactive status was based on a disability, the EMS MD shall also verify that the applicant can perform all critical functions of the requested license level.

 

d)         During inactive status, the individual shall not perform at the level of any EMS provider.

 

e)         EMS Personnel whose inactive status period exceeds 48 months shall pass a Department-approved licensure examination for the requested level of license upon recommendation of an EMS MD.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.610  EMT, A-EMT, EMT-I and Paramedic Reciprocity

 

a)         An EMT, A-EMT, EMT-I or Paramedic licensed or certified in another state, territory or jurisdiction of the United States who seeks licensure in Illinois may apply to the Department for licensure by reciprocity on a form prescribed by the Department available on the Department's website:  http://dph.illinois.gov/sites/ default/files/forms/emsreciprocityapplication.pdf.

 

b)         The reciprocity application shall contain the following information:

 

1)         Verifiable proof of current state, territory or jurisdiction licensure or certification, or current registration with NREMT;

 

2)         A written statement of satisfactory completion of an education program that meets or exceeds the requirements of the Department as set forth in this Subpart;

 

3)         A letter of recommendation from the EMS MD of the EMS System in the state, territory or jurisdiction from which the individual is licensed. The letter should include a statement that the applicant is currently in good standing and up to date with CE hours; and

 

4)         A current CPR for Healthcare Providers card that covers didactic and psychomotor skills that meet or exceed American Heart Association guidelines.

 

c)         The Department will review requests for reciprocity to determine compliance with the applicable provisions of this Part.  CE hours from the state of current licensure will be prorated based on the expiration date of the current license.

 

d)         Individuals who meet the requirements for licensure by reciprocity will be State licensed consistent with the expiration date of their current license but not to exceed a period of four years.

 

e)         Following licensure by reciprocity, the individual must comply with the requirements of this Part for relicensure.

 

f)         IDPH shall permit immediate reciprocity to all EMS personnel who hold an unencumbered National Registry of Emergency Medical Technicians certification for EMTs, AEMTs, or Paramedics, allowing such individuals to operate in an EMS System under a provisional system status until an Illinois license is issued:

 

1)         To operate on an EMS System transport or non-transport IDPH licensed Vehicle under provisional system status, an individual must have applied for licensure with the Department and meet all requirements under the Act. All Department-required application materials for submission must be provided to the EMS System for review prior to system provisional reciprocity approval.

 

2)         The EMS System has the responsibility for validating National Registry Certification of each individual.

 

3)         An individual with a Class X, Class 1 or Class 2 felony conviction or out-of-state equivalent offense, as described in Section 515.190, is not eligible for provisional system status.

 

(Source:  Amended at 46 Ill. Reg. 20898, effective December 16, 2022)

 

Section 515.620  Felony Convictions (Renumbered)

 

(Source:  Section 515.620 renumbered to Section 515.190 at 38 Ill. Reg. 9053, effective April 9, 2014)

 

Section 515.630  Evaluation and Recognition of Military Experience and Education

 

a)         In prescribing licensure testing requirements for honorably discharged members of the armed forces of the United States under this Part, the Department shall ensure that a candidate's military emergency medical training, emergency  medical curriculum completed, and clinical experience, as described in this Section, are recognized. (Section 3.50(d)(2) of the Act)

 

b)         The Department will review applications for EMS Personnel licensure from honorably discharged members of the armed forces of the United States with military emergency medical training.

 

c)         The Department will provide application forms.  Applications shall be filed with the Department within one year after military discharge and shall contain the following:

 

1)         Documentation that the application is being filed within one year after military discharge;

 

2)         Proof of successful completion of military emergency medical training;

 

3)         A detailed description of the emergency medical curriculum completed, including official documentation demonstrating basic coursework and curriculum; and

 

4)         A detailed description and official documentation of the applicant's clinical experience.

 

d)         The Department may request additional and clarifying information and supporting documentation, if necessary, to verify the information provided in subsection (c).

 

e)         The Department shall evaluate the application, including the applicant's training and experience, consistent with the standards set forth under Section 3.10(a), (b), (c) or (d) of the Act and this Part, to determine if the applicant qualifies for the licensure level for which the applicant has applied.

 

f)         If the application clearly demonstrates that the training and experience meets the standards of subsection (e), the Department shall offer the applicant the opportunity to successfully complete a Department-approved EMS Personnel examination for the level of license for which the applicant is qualified, in accordance with Section 515.530.

 

g)         Upon the applicant's passage of an examination and having paid all required fees, as set forth in Sections 515.530 and 515.460, the Department shall issue a license that shall be subject to all provisions of the Act and this Part that are otherwise applicable to the class of EMS Personnel license issued, as set forth in Section 515.590. (Section 3.50(d)(2.5) of the Act)

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.640  Reinstatement

 

a)         An Illinois licensed EMR, EMD, EMT, EMT-I, A-EMT, Paramedic, ECRN or PHRN whose license has been expired for less than 36 consecutive months may apply for reinstatement by the Department. (Section 3.50(d)(5) of the Act)

 

b)         Reinstatement shall require all of the following:

 

1)         The applicant shall submit satisfactory proof of completion of continuing medical education and clinical requirements in accordance with the following:

 

A)        Continuing education in accordance with Sections 515.560, 515.565, 515.570, 515.580, 515.710, 515.715, 515.725, 515.730 and 515.740.

 

B)        EMS Personnel education in accordance with Sections 515.500, 515.505, 515.510, 515.520, 515.710, 515.715, 515.725, 515.730 and 515.740.

 

2)         The applicant shall submit a positive recommendation in writing from an Illinois EMS MD attesting to the applicant's clinical qualifications for retesting.  The EMS MD shall verify that the applicant has demonstrated competency of all skills at the level of EMS Personnel license to be reinstated.

 

3)         The applicant shall pass a Department-approved test for the level of EMS Personnel license sought to be reinstated, in accordance with Section 515.530. (Section 3.50(d)(5) of the Act)

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

SUBPART E: EMS LEAD INSTRUCTOR, EMERGENCY MEDICAL DISPATCHER, EMERGENCY MEDICAL RESPONDER, PRE-HOSPITAL REGISTERED NURSE, EMERGENCY COMMUNICATIONS REGISTERED NURSE, AND TRAUMA NURSE SPECIALIST

 

Section 515.700  EMS Lead Instructor

 

a)         All education, training and CE courses for EMT, EMT-I, A-EMT, Paramedic, PHRN, ECRN, EMR and EMD shall be coordinated by at least one approved Illinois EMS Lead Instructor.  A program that includes education, training or CE for more than one type of EMS Personnel may use one EMS LI to coordinate the program. A single EMS LI may simultaneously coordinate more than one program or course.  (Section 3.65(b)(5) of the Act)

 

b)         To be eligible for an Illinois EMS LI license, the applicant shall meet at least the following minimum experience and education requirements and shall provide a written recommendation from the EMS MD of the primary EMS System affiliation:

 

1)         A current Illinois license as an EMT, EMT-I, A-EMT, Paramedic, RN or physician;

 

2)         A minimum of four years of experience in EMS or emergency care;

 

3)         At least two years of documented teaching experience;

 

4)         Documented EMS classroom teaching experience with a recommendation for LI licensure by an EMS MD or licensed LI;

 

5)         Documented successful completion of the Illinois EMS Instructor Education Course or equivalent to the National Standard Curriculum for EMS Instructors as approved by the Department.

 

c)         Upon successful course completion, the applicant may apply to the Department through the affiliated EMS System using the child support form available on the Department's website (http://dph.illinois.gov/sites/default/files/forms/ems-renewal-notice.pdf) and an application form provided by the local EMS System. The application will include demographic information, social security number, child support statement, felony conviction statement, applicable fees, and EMS System authorization.

 

d)         All EMS LIs shall attend a Department-approved review course whenever revisions are made to the national EMS education standards.

 

e)         Relicensure Application

 

1)         To apply for relicensure, the EMS LI shall submit the following to the Department at least 60 days, but not more than 90 days, prior to the LI's license expiration:

 

A)        A letter of support or electronic authorization from an EMS MD indicating that the EMS LI has satisfactorily coordinated programs for the EMS System at any time during the four-year period;

 

B)        Documentation of at least 40 hours of continuing education, of which 20 hours shall be related to the development, delivery and evaluation of education programs; and

 

C)        Documentation of attendance at a Department-approved national EMS education standards update course, if applicable, in accordance with subsection (d).

 

2)         The EMS LI shall file a written or electronic application for renewal with the Department no less than 30 days before the license expiration date.  Incomplete license applications submitted less than 30 days before the expiration may not be processed by the expiration date and will be subject to a late fee once the license has expired.

 

A)        In addition to submission of the renewal application and renewal fee, an LI functioning within an EMS System shall submit documentation of completion of all CE requirements of the EMS System or primary affiliation no less than 30 days before the expiration of his or her license.

 

B)        An LI who has not been recommended for relicensure shall be provided with a written statement from the EMS MD stating the reason for the withholding of the endorsement.

 

C)        The license of an LI who has failed to complete the renewal application requirements for the EMS System and the Department shall be invalid on the expiration of the license.  An individual shall not function as an EMS LI on an expired license.

 

D)        An LI whose license has expired may, within 60 days after the expiration of the license, submit all relicensure requirements and submit the fees required by Section 575.460, including a late fee, online or by certified check or money order.  Cash or personal check will not be accepted.  If all relicensure requirements have been met, and there are no pending or sustained disciplinary actions against the LI, the Department will relicense the LI.

 

f)         The Department will, in accordance with Section 515.160, suspend, revoke or refuse to issue or renew the approval of an EMS Lead Instructor, after an opportunity for a hearing, when findings show one or more of the following:

 

1)         The EMS LI has failed to conduct a course in accordance with the curriculum prescribed by the Act and this Part and the System sponsoring the course; or

 

2)         The EMS LI has failed to comply with protocols prescribed by this Part and the System sponsoring the course.  (Section 3.65(b)(7) of the Act)

 

g)         The EMS LI shall be responsible for the following:

 

1)         Ensuring that no EMS education course begins until after the Department issues its formal written pre-approval, which shall be in the form of a numeric site approval code; and

 

2)         Ensuring that all materials presented to participants comply with the national EMS education standards, as modified by the Department, and are approved by the EMS System and the Department. Methods of assessment or intervention that are not approved byboth the EMS System and the Department shall not be  presented.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.710  Emergency Medical Dispatcher

 

a)         EMD Licensure

 

1)         To apply for licensure as an EMD, the individual shall request that the EMS System submit the following to the Department:

 

A)        A completed electronic transaction form recommending initial licensure as an EMD; and

 

B)        Documentation of successful completion of a training course in emergency medical dispatching that meets or exceeds the national curriculum of the United States Department of Transportation for EMS Dispatchers or its equivalent.  (Section 3.70(a) of the Act)

 

2)         Reciprocity shall be granted to an individual who is licensed as an EMD in another state and who meets the requirements of this Section.

 

3)         An individual who is certified or recertified by a national certification agency shall be licensed as an EMD if he or she meets the requirements of this Section.

 

4)         The license shall be valid for a period of four years.

 

5)         A licensed EMD shall notify the Department within 30 days after any changes in name or address.  Notification may be in person or by mail, phone, fax or electronic mail. Addresses may be changed through the Department's online system. Name and gender changes require legal documents, i.e., marriage license or court documents.

 

6)         A person may not represent himself or herself, nor may an agency or business represent an agent or employee of that agency or business, as an EMD unless licensed by the Department as an EMD.  (Section 3.70(b)(11) of the Act)

 

b)         EMD Protocols

 

1)         The EMD shall use the Department-approved emergency medical dispatch priority reference system (EMDPRS) protocol selected for use by his or her agency and approved by the EMS MD.  Prearrival support instructions shall be provided in a non-discriminatory manner and shall be provided in accordance with the EMDPRS established by the EMS MD of the EMS System in which the EMD operates.  (Section 3.70(a) of the Act)

 

2)         EMD protocols shall include:

 

A)        Complaint-related question sets that query the caller in a standardized manner;

 

B)        Pre-arrival instructions associated with all question sets;

 

C)        Dispatch determinants consistent with the design and configuration of the EMS System and the severity of the event as determined by the question sets; and

 

D)        Post-dispatch instructions with all question sets.

 

3)         If the dispatcher operates under the authority of an Emergency Telephone System Board established under the Emergency Telephone System Act, the protocols shall be established by the Board in consultation with the EMS MD. (Section 3.70(a) of the Act)

 

4)         The EMD shall provide prearrival instructions in compliance with protocols selected and approved by the System's EMS MD and approved by the Department.  (Section 3.70(b) of the Act)

 

5)         The Department and the EMS MD shall approve EMDPRS protocols that meet or exceed the requirements of subsection (b)(2) and the National Highway Traffic Safety Administration (NHTSA) Emergency Medical Dispatch:  National Standard Curriculum (1996); available from the U.S. Government Printing Office, P.O. Box 371954, Pittsburgh, Pennsylvania 15250-7954; no later editions or amendments are included.

 

c)         EMD Relicensure

 

1)         To apply for relicensure, the EMD shall submit the following to the Department no less than 30 days before the licensure expiration date:

 

A)        An approval signed by the EMS MD recommending recertification;

 

B)        Proof of completion of at least 12 hours annually of medical dispatch CE.

 

2)         The EMD shall file a written or electronic application for renewal with the Department no less than 30 days before the license expiration data.  Incomplete license applications submitted less than 30 days before the expiration of the license may not be processed by the expiration date and will be subject to a late fee.

 

3)         An EMD whose license has expired may, within 60 days after the license expiration date, complete all relicensure requirements, and submit relicensure fees (see Section 515.460), including a late fee, online or by certified check or money order.  Cash or personal check will not be accepted.  If all relicensure requirements have been met and there are no pending or sustained disciplinary action against the EMD, the Department will relicense the EMD.

 

4)         An EMD who has not been recommended for relicensure by the EMS MD shall independently submit to the Department an application for recertification.  The EMS MD shall provide the EMD with a copy of the appropriate form to be completed.

 

d)         EMD Education Program

 

1)         Department-approved emergency medical dispatch training programs shall be conducted in accordance with the standards of the National Highway Traffic Safety Administration Emergency Medical Dispatch:  National Standard Curriculum or equivalent.  (Section 3.70(b)(9) of the Act)

 

2)         Applications for approval of EMD education programs shall be filed with the Department on forms prescribed by the Department.  The application shall contain, at a minimum, the name of the applicant, agency and address, type of education program, Lead Instructor's name and address, and dates of the education program.

 

3)         Applications for approval, including a copy of the course schedule and syllabus, shall be submitted at least 60 days in advance of the first scheduled class.  A description of the text book being used and passing score for the course shall be included with the application. The application shall be made on a form provided by the Department and will include, but not be limited to, the following:

 

            A)        Name of applicant, agency and address:

 

B)        Lead Instructor's name, license number, address and contact information;

 

C)        Name and signature of the EMS MD and the EMS System Coordinator;

 

            D)        Type of education program;

 

E)        Dates, times and location of the education program (submit course schedule);

 

            F)         Goals, objectives and course outline;

 

G)        Methods, materials and text books;

 

H)        Content and time consistent with the National Highway Traffic Safety Administration Emergency Medical Dispatch: National Standard Curriculum and additional course curricula required by the Department.  Initial or modified course syllabi shall be approved by the Department;

 

I)         Description of evaluation instruments (student, clinical units, faculty and programs); and

 

J)         Requirements for successful completion, when applicable.

 

4)         All education, training, and CE courses for EMD shall be coordinated by at least one approved EMS Lead Instructor.  (Section 3.65(b)(5) of the Act)  The EMS LI shall be approved by the Department based on the requirements of Section 515.700.

 

5)         EMD training programs shall be conducted by instructors licensed by the Department as an EMT, EMT-I, A-EMT or Paramedic who:

 

A)        are, at a minimum, licensed as emergency medical dispatchers;

 

B)        have completed a Department-approved course on methods of instruction;

 

C)        have previous experience in a medical dispatch agency; and

 

D)        have demonstrated experience as an EMS instructor.  (Section 3.70(b)(14) of the Act)

 

6)         Any change in the EMD education program's EMS LI shall require that an amendment to the application be filed with the Department.

 

7)         Questions for all quizzes and tests to be given during the EMD education program shall be prepared by the EMS LI and available for review by the Department upon the Department's request.

 

8)         All approved programs shall maintain course and student records for seven years. The records shall be made available to the Department for review upon request.

 

e)         Emergency Medical Dispatch Agency Certification

 

1)         To apply for certification as an emergency medical dispatch agency, the person, organization or government agency that operates an emergency medical dispatch agency shall submit the following to the Department:

 

A)        A completed emergency medical dispatch agency certification form that includes name and address;

 

B)        Documentation of the use on every request for medical assistance of an emergency medical dispatch priority reference system (EMDPRS) that complies with this Section and is approved by the EMS MD (Section 3.70(b)(10) of the Act); and

 

C)        Documentation of the establishment of a continuous quality improvement (CQI) program under the approval and supervision of the EMS MD.  (Section 3.70(b)(10) of the Act)  The CQI program shall include, at a minimum, the following:

 

i)          A quality assistance review process used by the agency to identify EMD compliance with the protocol;

 

            ii)         Random case review;

 

            iii)        Regular feedback of performance results to all EMDs;

 

iv)        Availability of CQI reports to the Department upon request; and

 

v)         Compliance with the confidentiality provisions of the Medical Studies Act.

 

2)         A person, organization, or government agency shall not represent itself as an emergency medical dispatch agency unless the person, organization, or government agency is certified by the Department as an emergency medical dispatch agency.  (Section 3.70(b)(12) of the Act)

 

f)         Emergency Medical Dispatch Agency Recertification

To apply for recertification, the emergency medical dispatch agency shall submit an application to the Department at least 30 days prior to the certification expiration date.  The application shall document continued compliance with subsection (e).

 

g)         Revocation or Suspension of EMD or Emergency Medical Dispatch Agency Certification

 

1)         The EMS MD shall report to the Department whenever an action has taken place that may require the revocation or suspension of a license issued by the Department.  (Section 3.70(b)(4) of the Act)

 

2)         Revocation or suspension of an EMD license or emergency medical dispatch agency certification shall be in accordance with Section 515.165.

 

h)         Waiver of Emergency Medical Dispatch Requirements

 

1)         The Department may modify or waive emergency medical dispatch requirements based on:

 

A)        The scope and frequency of dispatch activities and the dispatcher's access to training; or

 

B)        Whether the previously attended dispatcher training program merits automatic relicensure for the dispatcher.  (Section 3.70(b)(15) of the Act)

 

2)         The following individuals are exempt from the requirements of this Section:

 

A)        Public safety dispatchers who only transfer calls to another answering point that is responsible for dispatching of fire or EMS Personnel;

 

B)        Dispatchers for volunteer or rural ambulance companies providing only one level of care, whose dispatchers are employed by the ambulance service and are not performing call triage, answering 911 calls or providing pre-arrival instructions.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.715  Provisional Licensure for Emergency Medical Responders

 

a)         A person under the age of 18 shall not be issued an EMR  license.  A person between the ages of 16 and 18 who has successfully completed a Department-approved EMR course may apply to the Department for a provisional EMR license. Upon satisfaction of all other applicable requirements, the Department will issue a provisional license, subject to the following limitations:

 

1)         A person with a provisional license shall not use his or her provisional license except when affiliated with a recognized Illinois EMS System and with the written authorization of that System's EMS MD;

 

2)         A provisional licensee shall not be placed in a position of primary response to emergencies by any licensee of the Department, unless the assignment satisfies all other provisions of this Part; 

 

3)         A provisional licensee shall function as an EMR  only while under the direct, personal and continuous supervision of at least one other non-provisional EMR, EMT, A-EMT, EMT-I, Paramedic or PHRN licensed at or above the level of the provider's license. Nothing in this Part shall preclude a provisionally licensed EMR from providing nationally recognized basic first aid when not participating as part of the emergency medical response of his or her affiliated agency;

 

4)         A provisional licensee shall not be involved in the transport of a patient unless he or she is under the direct, personal and continuous supervision of at least two other non-provisional EMRs, EMTs, A-EMTs, EMT-Is, Paramedics or PHRNs licensed at or above the level of the transport provider's license.  A provisional licensee shall not be used to satisfy the staffing requirements of this Part;

 

5)         A provisional licensee shall not operate, drive or maneuver a Department licensed transport vehicle, rescue vehicle or non-transport agency owned vehicle in connection with an emergency response or the transportation of any patient; and

 

6)         A provisional licensee will be recognized by the Department as an unrestricted EMR upon turning 18 years of age as required in Section 515.725.

 

b)         The EMS provider agency and the supervising licensee shall be jointly responsible for assuring that no provisional licensee violates rules applicable to the provisional licensee and shall jointly report, in writing, the nature and details of any violations of this Section to the EMS MD within 48 hours after the occurrence. A failure to make written reports as required shall be grounds for disciplinary action as authorized by this Part.

 

c)         Violation of provisions applicable to provisional licensees shall be grounds for any form of disciplinary action authorized by this Part, up to and including license suspension and revocation.

 

d)         Applicants for Provisional EMR shall verify compliance with Section 10-65(c) of the Illinois Administrative Procedure Act and Section 515.620 of this Part on a form prescribed by the Department.

 

e)         The Provisional EMR license fee is the same fee prescribed in the schedule for EMRs (see Section 575.460). The license fee shall be in effect for four years.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.720  First Responder (Repealed)

 

(Source:  Repealed at 37 Ill. Reg. 10683, effective June 25, 2013)

 

Section 515.725  Emergency Medical Responder

 

a)         An EMR education program shall be pre-approved by the Department and conducted only by an EMS System or a community college under the direction of the EMS System.

 

b)         Applications for approval of EMR education programs shall be filed with the Department on forms prescribed by the Department. The application shall contain, at a minimum, name of applicant, agency and address, type of training program, dates of training program, and names and signatures of the EMS MD and EMS System Coordinator.

 

c)         Applications for approval, including a copy of the course schedule and syllabus, shall be submitted at least 60 days in advance of the first scheduled class.

 

d)         The EMS MD of the EMS System shall attest on the application form that the education program will be conducted according to the national EMS education standards. The EMR education program shall include all components of the national EMS education standards, including all modifications required by the Department. The course hours shall minimally include 52 hours of didactic education.

 

e)         The EMR education program shall designate an EMS Lead Instructor who shall be responsible for the overall management of the education program and shall be approved by the Department based on requirements of Section 515.700.

 

f)         The EMS MD shall electronically submit to the Department approval for licensure for an EMR candidate who is at least 18 years of age and has completed and passed all components of the education program, has passed the final examination, and has paid the appropriate initial licensure fee (see Section 515.460).  The initial licensure fee may be waived pursuant to Section 515.460(c).

 

g)         All approved programs shall maintain course and student records for seven years, which shall be made available to the Department upon request.

 

h)         CE classes, seminars, workshops, or other types of programs shall be approved by the Department before being offered to EMR candidates. An application for approval shall be submitted to the Department on a form prescribed, prepared and furnished by the Department at least 60 days prior to the scheduled event.

 

i)          Approval will be granted provided that the application is complete and the content of the program is based on topics or materials from the national EMS education standards for the EMR.

 

j)          EMRs shall be responsible for submitting written proof of CE attendance to the EMS System Coordinator or, for independent renewals, to the Department Regional EMS Coordinator. The EMS System Coordinator or Department Regional EMS Coordinator shall verify whether specific CE hours submitted by the EMR qualify for renewal.

 

k)         EMRs shall maintain copies of all documentation concerning CE programs that he or she has completed.

 

l)          To renew an EMR license, the applicant shall submit the following to the Department at least 60 days, but no more than 90 days, before the license expiration. The renewal licensure fee may be waived pursuant to Section 515.460(c).

 

1)         The submission of an electronic transaction by the EMS MD will satisfy the renewal application requirement for an EMR who has been recommended for re-licensure by the EMS MD.

 

2)         The licensee shall file a written or electronic application for renewal with the Department no less than 30 days before the license expiration date.  Incomplete license applications submitted less than 30 days before the license expiration may not be processed by the expiration date and will be subject to a late fee.

 

3)         EMRs whose licenses have expired may, within 60 days after license expiration, submit all relicensure requirements and submit the required relicensure fees, including a late fee, online or by certified check or money order.  Cash or personal check will not be accepted.  If all relicensure requirements have been met, and there are no pending disciplinary actions against the EMR, the Department will relicense the EMR.

 

4)         An EMR who has not been recommended for relicensure by the EMS MD shall independently submit to the Department an application for renewal. The EMS MD shall provide the EMR with a copy of the application form.

 

m)        A written recommendation signed by the EMS MD shall be provided to the Department regarding completion of the following requirements:

 

1)         24 hours of CE every four years.  The System shall define in the EMS Program Plan the number of CE hours to be accrued each year for re-licensure; and

 

2)         The licensee shall have a current CPR for Healthcare Providers card that covers didactic and psychomotor skills that meet or exceed American Heart Association guidelines.

 

n)         EMRs whose licenses have expired may, within 60 days after license expiration, submit all relicensure requirements and submit the required relicensure fees, including a late fee, online or in the form of a certified check or money order.  Cash or personal check will not be accepted.  If all relicensure requirements have been met, and there are no pending disciplinary actions against the EMR, the Department will relicense the EMR.

 

o)         EMRs who are not affiliated with an EMS System shall have equipment immediately available to provide the standard of care established by the national EMS education standards for the EMR.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.730  Pre-Hospital Registered Nurse, Pre-Hospital Physician Assistant, Pre-Hospital Advanced Practice Registered Nurse

 

a)         To be approved and licensed as a PHRN, PHPA, PHAPRN:

 

1)         An individual shall:

 

A)        Be a licensed RN, PA or APRN in good standing and in accordance with all requirements of the Illinois Department of Financial and Professional Regulation;

 

B)        Complete a supplemental education curriculum, formulated by an EMS System and approved by the Department, that consists of:

 

i)          at least 40 hours of classroom and psychomotor education and measurement of competency equivalent to the entry level Paramedic program;

 

ii)         practical education, including, but not limited to, advanced airway techniques, ambulance operations, extrication, telecommunications, and pre-hospital cardiac and trauma care of both the adult and pediatric population (Section 3.80(c)(1)(A) of the Act); and

 

iii)        the EMS System's policies, protocols and standing orders; and

 

C)        Complete a minimum of 10 ALS runs supervised by a licensed EMS System, physician, an approved System PHRN, PHPA, PHAPN or a Paramedic, only as authorized by the EMS MD, and shall successfully complete a Paramedic examination approved by the Department.

 

2)         New applicants completing course work after January 1, 2018 and before September 1, 2020 shall successfully pass the State of Illinois Paramedic licensure examination.  New applicants completing course work after September 1, 2020 shall successfully pass the National Registry of EMT's Paramedic cognitive assessment exam; and

 

3)         The EMS MD shall electronically submit to the Department, using the Department's Electronic Transaction Form, a recommendation for licensure for a PHRN, PHPA, PHAPN candidate who has completed and passed all components of the PHRN, PHPA, PHAPN education program and passed the final examination.  The application will include demographic information, social security number, child support statement, felony conviction statement, and applicable fees and shall require EMS System authorization.

 

b)         To apply for a four year renewal, the PHRN, PHPA, PHAPN shall comply with Section 515.590.

 

c)         Inactive Status

 

1)         Prior to the expiration of the current license, a PHRN, PHPA, PHAPN may request to be placed on inactive status as outlined in Section 515.600.  The request shall be made in writing to the EMS MD.

 

2)         A PHRN, PHPA, PHAPN who wants to restore his or her license to active status shall follow the requirements set forth in Section 515.600.

 

3)         If the PHRN, PHPA, PHAPN inactive status period exceeds 48 months, the licensee shall redemonstrate competencies and successfully pass the State Paramedic examination.

 

4)         The EMS MD shall notify the Department in writing of a PHRN's, PHPA's, PHAPN's approval, reapproval, or granting or denying of inactive status within 10 days after any change in a PHRN's, PHPA's, PHAPN's approval status.

 

d)         A PHRN, PHPA, PHAPN shall notify the Department within 30 days after any change in name or address.  Notification may be in person, or by mail, phone, fax, or electronic mail.  Addresses may be changed through the Department's online system:  https://emslicensing.dph.illinois.gov/Clients/ILDOHEMS/Private/

AddressChange/AddressLogin.aspx.  Names and gender changes require legal documents, i.e., marriage license or court documents.

 

(Source:  Amended at 44 Ill. Reg. 15619, effective September 4, 2020)

 

Section 515.740  Emergency Communications Registered Nurse

 

a)         To be licensed as an ECRN, an individual shall:

 

1)         Be an RN in accordance with the Nurse Practice Act;

 

2)         Complete an education curriculum formulated by an EMS System and approved by the Department, which consists of at least 40 hours of classroom and practical education for both the adult and pediatric population, including telecommunications, System standing medical orders, and the procedures and protocols established by the EMS MD (Section 3.80(c)(1)(B) of the Act);

 

3)         Complete eight hours of field experience supervised by a Paramedic, only as authorized by the EMS MD.

 

b)         The EMS MD shall electronically submit to the Department, using the Department's Electronic Transaction Form, a recommendation for licensure for an ECRN candidate who has completed and passed all components of the education program and passed the final examination.  The application will include demographic information, social security number, child support statement, felony conviction statement, applicable fees, and EMS System authorization.

 

c)         To apply for a four year renewal:

 

1)         The ECRN shall submit proof of the following no less than 60 days, but not more than 90 days, before the license expiration:

 

A)        Is an RN with an unencumbered license in the state in which he or she practices; and

 

B)        Has completed 32 hours of continuing education in a four-year period.

 

2)         The ECRN shall submit a written or electronic application for renewal with the Department no less than 30 days before the license expiration.  Incomplete license applications submitted less than 30 days before the expiration may not be processed by the expiration date and shall be subject to a late fee.

 

3)         An ECRN whose license has expired may, within 60 days after the license expiration, submit all relicensure requirements and submit the required relicensure fees, including a late fee, online or by a certified check or money order.  Cash or personal check will not be accepted.  If all relicensure requirements have been met, and there are no pending disciplinary actions against the ECRN, the Department will relicense the ECRN.

 

d)         Inactive Status

 

1)         Prior to the expiration of the current ECRN license, the ECRN may request to be placed on inactive status.  The request shall be made in writing to the EMS MD and shall contain the following information:

 

A)        Name of individual;

 

B)        Date of approval;

 

C)        Circumstances requiring inactive status;

 

D)        A statement that recertification requirements have been met by the date of the application for inactive status.

 

2)         The EMS MD shall review and grant or deny requests for inactive status.

 

3)         For the ECRN to return to active status, the EMS MD shall document that the ECRN has been examined (physically and mentally) and found capable of functioning within the EMS System, that the ECRN's knowledge and clinical skills are at the active ECRN level, and that the ECRN has completed any refresher education deemed necessary by the EMS System. If the inactive status was based on a temporary disability, the EMS System shall also verify that the disability has ceased.

 

4)         During inactive status, the individual shall not function as an ECRN at any level.

 

5)         The EMS MD shall notify the Department in writing of the ECRN's approval, reapproval or granting or denying inactive status within 10 days after any change in an ECRN's approval status.

 

e)         An ECRN shall notify the Department within 30 days after any change in name or address.  Notification may be in person, or by mail, phone, fax or electronic mail. Addresses may be changed through the Department's online system: https://emslicensing.dph.illinois.gov/Clients/ILDOHEMS/Private/AddressChange/AddressLogin.aspx.  Name and gender changes require legal documents, i.e., marriage license or court documents.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.750  Trauma Nurse Specialist

 

a)         TNS Education Sites

 

1)         TNS courses shall be conducted only at hospitals that have been designated by the Department as TNS education sites.

 

2)         The Department shall designate TNS education sites based upon regional needs, the educational capabilities of interested hospitals to provide advanced trauma education to nurses, and participation in an EMS System.

 

3)         The TNS Program Plan (see Section 515.760) shall serve as a standard TNS program plan.  The Department will approve program plans based on compliance with Section 515.760.

 

4)         The Chief Executive Officer of the hospital designated as a TNS education site shall appoint, and endorse in writing to the Department, a TNSCC to plan, coordinate, implement and evaluate the TNS course and TNS program activities, who meets the following requirements:

 

A)        Is an RN with an unencumbered license in the state in which he or she practices;

 

B)        Is employed by the TNS education site;

 

C)        Has at least three years of experience as an RN in an emergency department or critical care setting in a trauma center;

 

D)        Holds a certificate of TNS course completion issued by the Department as provided in this Section; and

 

E)        Has a minimum of 50 hours of teaching experience in emergency/critical care nursing courses.

 

b)         The TNSCC shall admit to the TNS course only those individuals who have met the following requirements:

 

1)         Are currently licensed as an RN in the state in which they are practicing, as verified by the submission of a photocopy of the official license showing the license number and expiration date; and

 

2)         Have at least 1500 hours of clinical care experience in an emergency department or critical care unit (preferred) as an RN, with successful completion of a unit orientation.

 

c)         The TNS course shall reflect evidence-based content as created by the TNSCC and approved by the Department as being in compliance with the TNS program (see Section 515.760).

 

d)         Testing

 

1)         A standardized practical examination shall be administered.  The practical examination shall include an assessment station at which the student will evaluate and stabilize a simulated critically injured trauma patient.

 

A)        The student shall have a maximum of 10 minutes to evaluate and stabilize the patient.

 

B)        The TNSCC shall develop the passing criteria, which shall be included in the program plan developed in accordance with Section 515.760.

 

C)        A student shall be given three attempts to successfully complete the practical examination. 

 

2)         A student who has successfully completed course requirements per procedure and paid all fees shall be eligible to take the final written examination. The TNSCC shall develop the final examination and shall provide the examination to the Department.  The TNSCC shall develop passing criteria, which shall be included in the Program Plan developed in accordance with Section 515.760.

 

A)        A student shall be given three attempts to successfully complete the final written examination.

 

B)        The candidate shall successfully achieve a passing score on the State examination within 12 months after completing the education program. 

 

3)         Examination Application

 

A)        Candidates for the TNS examination shall apply to take the examination using the Department form. Information is available on the Department's website:  http://www.continentaltesting.net/ProfDetail.aspx?Entity=5&ProfID=73.

 

B)        A roster of examination candidates from each TNS education site is created by the TNSCC who approves the candidate's application and is submitted to the Department.

 

C)        The candidate shall submit a fee for each written examination attempt (see Section 515.460).

 

e)         Failure to appear for the examination on the scheduled date, at the time and place specified, shall result in forfeiture of the examination fee.

 

f)         If a candidate does not achieve a passing grade on the written examination, the fee for the re-test is the same as for initial examination.

 

g)         All fees submitted for licensure examination are nonrefundable.

 

h)         Testing Option − Challenge

Any individual who has met the admission requirements provided in subsection (b) has the option of taking the TNS practical examination and final examination without having completed the didactic sessions (referred to as "challenging" the examination). The individual shall file a request to challenge the examination with the TNS education site at least 30 days prior to the scheduled practical examination.  Candidates who elect to challenge the examination will have only one attempt to successfully complete the written and practical examinations to demonstrate proficiency.

 

i)          Licensure as a TNS

 

1)         The Department will license a student or candidate after the student or candidate has achieved a passing score on the final written and practical examinations and has paid any required fees (see Section 515.460).

 

2)         Licensure is effective for four years.

 

j)          TNS Relicensure

 

1)         A TNS may be relicensed by either submitting approved trauma-specific CE or taking the current TNS final written examination as provided in this Section.

 

2)         A TNS may apply for relicensure by submitting the following to a TNSCC at least 40 days, but no more than 90 days, prior to license expiration:

 

A)        Documentation of 64 hours of approved trauma-specific CE/activities for nursing or CME acquired over four years, using the TNS CE Summary Submission form.  CE approval will be granted, provided that the application is complete and the content of the program educational activity is based on topics listed in the TNS program in place at the time the CE is acquired;

 

B)        Completed Child Support form supplied by the Department; and

 

C)        Relicensure fee (see Section 515.460).

 

3)         The TNS final written examination is an alternative option for relicensure.  A total of three attempts are allowed for the relicensure candidate to achieve a successful examination score prior to the lapse date.  The process used in subsection (d)(3) is used for the application, assignment to an examination site, and fee submission.

 

4)         The candidate applying for license renewal is responsible for his/her record keeping and timely submission of CE documentation.

 

5)         The license of a TNS who has failed to file an application for recertification or an application for an extension prior to the lapse date shall terminate on the day following the expiration date shown on the certificate.

 

k)         Inactive Status

 

1)         Prior to the expiration of the current license, a TNS may request to be placed on inactive status.  The request shall be in writing, on a form prescribed by the Department, and shall contain the following information:

 

A)        Name of individual;

 

B)        Date of certification;

 

C)        Circumstances requiring inactive status; and

 

D)        A statement that relicensure requirements have been met by the date of the application for inactive status. CE hours shall be current at the prorated rate of 1.3 hours per month for the current licensure period.

 

2)         The Department will review requests for inactive status.  The Department will notify the individual TNS in writing of its decision based on subsection (k)(1).

 

3)         To return to active status, the TNS shall apply in writing within 36 months after being placed on inactive status. The application shall include a current unencumbered RN license and a fee (see Section 515.460).

 

4)         Inactive status is valid for only 36 months.  If status is not reactivated, the individual shall successfully complete the examination or retake the course (see subsection (h)).

 

5)         During inactive status, the individual shall not function as a TNS.

 

l)          A TNS whose license has expired may, within 60 days after expiration, submit all relicensure material required by this Section and a fee (see Section 515.460), in the form of an organization's payment, a certified check, or a money order (cash or personal check will not be accepted).  If the application for license renewal meets the requirements of this Section and there is no disciplinary action pending against the TNS, the Department will renew the TNS license.

 

m)        A TNS shall notify the Department within 30 days after any change in name or address.  Notification may be in person or by mail, phone, fax or electronic mail. Addresses may be changed through the Department's online system: https://emslicensing.dph.illinois.gov/Clients/ILDOHEMS/Private/AddressChange/AddressLogin.aspx. Name and gender changes require legal documents, i.e., marriage licenses or court documents.

 

n)         The Department shall have the authority and responsibility to suspend, revoke or renew the license of a TNS, after an opportunity for hearing by the Department, if findings show that the TNS has failed to maintain proficiency in the level of skills for which the TNS is licensed or has failed to comply with relicensure requirements.  (Section 3.75(b)(8) of the Act)  Hearings shall be conducted in accordance with Practice and Procedure in Administrative Hearings.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.760  Trauma Nurse Specialist Program Plan

 

A TNS program plan shall contain the following information:

 

a)         The name, address and fax number of the TNS site hospital;

 

b)         The names and resumes of the TNSCCs;

 

c)         Current letters of commitment from the following persons at the TNS site hospital that describe the commitment of the writer and his or her office to the development and ongoing operation of the TNS program and that state the writer's understanding of and commitment to TNS program staffing and educational requirements:

 

1)         The Chief Executive Officer of the hospital; and

 

2)         The administrative representative responsible for the TNS program;

 

d)         A letter of commitment from the above administrator that describes the TNS site's agreement to:

 

1)         Be responsible for providing initial TNS education and CE based on region needs, including coordinating didactic and clinical experiences;

 

2)         Provide travel and meeting time and expenses; clerical support including access to a computer with word processing and data base management capabilities; audiovisual equipment; printing; and education aides;

 

3)         Ensure that the Department has access to all TNS program records under the authority of the TNS site during any Department inspection, investigation or site survey;

 

4)         Notify the Department of any known changes in TNS personnel;

 

5)         Be responsible for the total management of the TNS program at that site and collaborative management of the TNS program with all TNSCCs and the Department;

 

6)         Ensure that a copy of the application for renewal (a form supplied by the Department) is provided to every  TNS within the region (in collaboration with TNSCCs); and

 

7)         Be responsible for compliance with the provisions of Section 515.750.

 

e)         The TNS program manual maintained at each TNS site shall include the following:

 

1)         Education

 

A)        Content and curricula of the TNS educational or certification program including:

 

i)          Entrance and completion requirements;

 

ii)         Program schedules;

 

iii)        Goals and objectives;

 

iv)        Subject areas;

 

v)         Didactic requirements, including skills laboratories;

 

vi)        Clinical requirements;

 

vii)       Testing formats.

 

B)        CE for TNSs, including:

 

i)          Relicensure requirements (hours, types of programs, etc.);

 

ii)         Site program for TNS participants: types of activities covered (e.g., trauma case review, morbidity and mortality conferences, grand rounds, etc.);

 

iii)        Requirements for approval of academic course work;

 

iv)        Didactic programs offered by the site;

 

v)         Clinical opportunities available within the region;

 

vi)        Record-keeping requirements for the individual.

 

C)        Renewal Protocols

 

i)          Examination requirements for TNSs;

 

ii)         Procedures for renewal of TNSs;

 

iii)        Submission of transaction cards for TNSs meeting renewal requirements;

 

iv)        Providing Department renewal application forms to TNSs who have not met renewal requirements according to region records.

 

D)        TNS education and information, including:

 

i)          Distribution of policy and protocol changes;

 

ii)         Methods for communicating updates on site and regional activities, and other matters of medical, legal and/or professional interest;

 

iii)        Locations of resource materials, forms, schedules, etc.

 

2)         Quality improvement measures should be performed on a semiannual basis and be available upon Department request.

 

3)         Any procedures regarding disciplinary or suspension decisions and the review of those decisions that the site has elected to follow in addition to those required by the Act.

 

4)         The responsibilities of the TNSCC, as designated by the Department, including:

 

A)        Curriculum development and maintenance;

 

B)        Creation and maintenance of the program policies and procedures;

 

C)        Planning, organizing, implementing and evaluating  the TNS course at that site;

 

D)        Planning, organizing, implementing and evaluating CE offerings in their regions;

 

E)        Maintenance of a TNS database within the region to facilitate TNS relicensure;

 

F)         Archive TNS education records, including: curriculum, handouts, and participant information for minimum of 7 years;

 

G)        Attend not less than 75 percent of bimonthly scheduled meetings.

 

5)         All TNS sites in existence upon adoption of this Section shall submit to the Department a revised program plan that conforms to requirements of this Part.  The Department will approve program plans that meet the requirements of this Part.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

SUBPART F: VEHICLE SERVICE PROVIDERS

 

Section 515.800  Vehicle Service Provider Licensure

 

a)         An application for a Vehicle Service Provider license shall be submitted on a form prescribed by the Department.  The application shall include, but not be limited to, licensee name, address and telephone number; and, for each vehicle to be covered by the license, make, model, year, vehicle identification number (VIN), State vehicle license number and level of service (BLS, ILS or ALS).

 

b)         Each application shall be accompanied by a fee of $25 for each vehicle included in the initial license application and due at the time of each annual inspection for up to 100 individual vehicles.  A fee of $2500 shall be submitted for initial applications and due at annual inspections for providers with 100 or more vehicles.

 

c)         An application for license renewal shall be submitted to the Department in accordance with subsections (a) and (b) at least 60 days but no more than 90 days prior to license expiration.

 

d)         The Department shall issue a license valid for four years.  The license will remain valid if, after annual inspection, all fee requirements are paid and the Department finds that the vehicle service provider is in full compliance with the Act and this Part.  If the Department finds that the vehicle service provider is not in full compliance, in addition to all other actions authorized by the Act and this Part, the Department may issue a license for a shorter interval.

 

e)         The Department shall have the right to make inspections and investigations as necessary to determine compliance with the Act and this Part. Pursuant to any inspection or investigation, a licensee shall allow the Department access to all records, equipment and vehicles relating to activities addressed by the Act and this Part.

 

f)         Each license is issued to the licensee for the vehicles identified in the application.  The licensee shall notify the Department, in writing, within 10 days after any changes in the information on the application.  Additional vehicles shall not be put in service until an application is submitted with the proper fee and an inspection is conducted.  The licensee shall notify the Department, in accordance with subsection (g), to change a vehicle's level of service.

 

g)         The Department will approve each vehicle covered by an ambulance service provider license to operate at a specific level of service (BLS, ILS or ALS).  To change the level of service for a specific vehicle:

 

1)         The licensee shall submit a written request to the EMS MD.

 

2)         The EMS MD shall submit a copy of that request to the Department, along with written verification that the licensee meets the equipment and staffing requirements of this Part and the EMS System Plan for the requested level of service.

 

3)         The Department will then amend the provider license and vehicle certificate to reflect the new level of service.

 

h)         All Vehicle Service Providers shall function within an EMS System.  (Section 3.85(b)(1) of the Act)

 

i)          A Vehicle Service Provider utilizing ambulances shall have a primary affiliation with an EMS System within the EMS Region in which its Primary Service Area is located.  This does not apply to Vehicle Service Providers that exclusively utilize Limited Operation Vehicles. (Section 3.85(b)(2) of the Act)

 

j)          A Vehicle Service Provider is prohibited from advertising, identifying its vehicles, or disseminating information in a false or misleading manner concerning the Provider's type and level of vehicles, location, primary service area, response times, level of personnel, licensure status or System participation.  (Section 3.85(b)(10) of the Act)

 

k)         A vehicle service provider, whether municipal, private, or hospital owned, is prohibited from advertising itself as a critical care transport provider unless it participates in a Department-approved EMS System critical care transport plan and provides critical care transport services at a Tier II or Tier III level of care. (Section 3.85(b)(10.5) of the Act)

 

(Source:  Amended at 38 Ill. Reg. 9053, effective April 9, 2014)

 

Section 515.810  EMS Vehicle System Participation

 

For each EMS vehicle participating within the System, the following documentation shall be provided:

 

a)         A list of the following:

 

1)         The year, model, make and vehicle identification number;

 

2)         The license plate number;

 

3)         The Department license number;

 

4)         The base location address; and

 

5)         The level of service (advanced, intermediate or basic);

 

b)         A description of the vehicle's role in providing advanced life support, intermediate life support, basic life support and patient transport services within the System;

 

c)         Definitions of the primary, secondary and outlying areas of response for each EMS vehicle used within the System;

 

d)         A map or maps indicating the base locations of each EMS vehicle, the primary, secondary and outlying areas of response for each EMS vehicle, the population base of each service area and the square mileage of each service area;

 

e)         A commitment to optimum response times up to six minutes in primary coverage areas, six to 15 minutes in secondary coverage areas, and 15 to 20 minutes in outlying coverage areas;

 

f)         A commitment to 24-hour coverage;

 

g)         A commitment that within one year after Department approval of a new or upgraded vehicle service, each ambulance at the scene of an emergency and during transport of emergency patients to and between hospitals will be staffed in accordance with the requirements of Section 515.830(f)(1) and (2);

 

h)         Copies of written mutual aid agreements with other providers and a description of the provider's own back-up system, which detail how adequate coverage will be ensured when an EMS vehicle is responding to a call and a simultaneous call is received for service within that vehicle's coverage area;

 

i)          A statement that emergency services that an EMS vehicle is authorized to provide shall not be denied on the basis of the patient's inability to pay for such services;

 

j)          An agreement to file an appropriate EMS run sheet or form for each emergency call, as required by the System;

 

k)         An agreement to maintain the equipment required by Section 515.830 and by the System in working order at all times, and to carry the medication as required by the System;

 

l)          An agreement to notify the EMS MD of any changes in personnel providing pre-hospital care in the System in accordance with the policies in the System manual;

 

m)        A copy of its current FCC licenses;

 

n)         A description of the mechanism and specific procedures used to access and dispatch the EMS vehicles within their respective service areas;

 

o)         A list of all personnel who will provide care, their license numbers, expiration dates and levels of licensure (EMT, EMT-I, A-EMT, Paramedic), and their PHRN or physician;

 

p)         An agreement to allow the Department access to all records, equipment and vehicles relating to the System during any Department inspection, investigation or site survey;

 

q)         An agreement to allow the EMS MD or designee access to all records, equipment and vehicles relating to the System during any inspection or investigation by the EMS MD or designee to determine compliance with the System program plan;

 

r)          Documentation that its communications capabilities meet the requirements of Section 515.410;

 

s)         Documentation that each EMS vehicle participating in the System complies with the vehicle design, equipment and extrication criteria as provided in Section 515.830(a)(1) and (b); and

 

t)          An agreement to follow the approved EMS policies and protocols of the System.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.820  Denial, Nonrenewal, Suspension and Revocation of a Vehicle Service Provider License

 

a)         The Director shall, in accordance with Section 515.160 of this Part and after providing notice and an opportunity for an administrative hearing to the applicant or licensee, deny, suspend, revoke or refuse to renew a vehicle service provider license in any case in which it is found that the applicant, licensee or vehicles fail to comply with the requirements of the Act or this Part.

 

b)         If the failure to comply relates only to one or more specific vehicles operated by the applicant or licensee, and the applicant or licensee has one or more vehicles that are in compliance, the Director's action shall be limited to those vehicles which fail to comply with the Act or this Part.

 

c)         If the failure to comply concerns all of the provider's vehicles or the provider's operation as a whole, the Director's action shall cover the entire vehicle service provider license.

 

d)         In the event that an immediate and serious danger to the public health, safety or welfare exists, the Director shall issue an emergency suspension order for any provider or vehicle licensed under the Act and this Part.  (Section 3-85(b)(7) of the Act)  Subsequent to the emergency suspension order, the Director shall promptly initiate proceedings to revoke or suspend the license or portion thereof and provide the licensee with an opportunity for an administrative hearing. The emergency suspension shall remain in effect throughout the course of such proceedings, unless the Director lifts the suspension order after determining that the emergency situation has been corrected or remedied.  In determining whether to lift the suspension, the Director will consider whether patient care is compromised.

 

e)         All administrative hearings conducted pursuant to this Section shall be governed by the Department's Rules of Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100).

 

(Source:  Added at 21 Ill. Reg. 5170, effective April 15, 1997)

 

Section 515.825  Alternate Response Vehicle

 

a)         Ambulance Assistance Vehicles

Ambulance assistance vehicles are dispatched simultaneously with an ambulance and assist with patient care prior to the arrival of the ambulance.  Ambulance assistance vehicles include fire engines, trucks, squad cars or chief's cars that contain the staff and equipment required by this Section.  Ambulance assistance vehicles shall not function as assist vehicles if staff and equipment required by this Section are not available.  The agency shall identify ambulance assistance vehicles as a program plan amendment outlining the type and level of response that is planned.  The ambulance assistance vehicle shall not transport or be a primary response vehicle but a supplementary vehicle to support EMS services.  The ambulance assistance vehicle shall be dispatched only if needed.  Ambulance assistance vehicles shall be classified as either:

 

1)         Advanced ambulance assistance vehicles shall be staffed with a minimum of one Paramedic, PHRN or physician and shall have all of the required equipment;

 

2)         Intermediate ambulance assistance vehicles shall be staffed with a minimum of one EMT, EMT-I, A-EMT, Paramedic, PHRN or physician and shall have all of the required equipment;

 

3)         Basic ambulance assistance vehicles shall be staffed with a minimum of one EMT, EMT-I, A-EMT, Paramedic, PHRN or physician and shall have all of the required equipment; or

 

4)         First Responder assistance vehicles shall be staffed with a minimum of one EMR, EMT, EMT-I, A-EMT, Paramedic, PHRN or physician  and shall have all of the required equipment.

 

b)         Non-Transport Vehicles

Non-Transport Vehicles are dispatched prior to dispatch of a transporting ambulance and include ambulances and fire engines that contain the staff and equipment required by this Section.  The vehicle service provider shall identify non-transport vehicles as a program plan amendment outlining the type and level of response that is planned.  Non-transport vehicles shall be staffed 24 hours per day, every day of the year.

 

1)         ALS Non-Transport Vehicles shall have a minimum of either one System authorized Paramedic or one PHRN and one additional System authorized A-EMT, EMT-I, EMT or physician, and shall have all of the required equipment.

 

2)         ILS Non-Transport Vehicles shall have a minimum of either one System authorized A-EMT, EMT-I, Paramedic or PHRN and one additional System authorized EMT, A-EMT, EMT-I, Paramedic, PHRN or physician and shall have the required equipment.

 

3)         BLS Non-Transport vehicles shall be staffed by one System authorized EMT, A-EMT, EMT-I, Paramedic or physician on all responses and shall have all of the required equipment.

 

c)         Equipment Requirements

Each vehicle used as an alternate response vehicle shall meet the following equipment requirements, as determined by the Department by an inspection.

 

1)         Functional portable oxygen cylinder, with a capacity of not less than 350 liters

 

2)         Dial flowmeter/regulator for 15 liters per minute

 

3)         Delivery tubes

 

4)         Adult, child and infant masks

 

5)         Adult squeeze bag and valve, with adult and child masks

 

6)         Child squeeze bag and valve, with child, infant and newborn size masks

 

7)         Airways, oropharyngeal − adult, child and infant (sizes 00-5)

 

8)         Airways, nasopharyngeal with lubrication (sizes 12-30F)

 

9)         Manually operated suction device

 

10)         Triangular bandages or slings

 

11)         Roller bandages, self-adhering (4" by 5 yds)

 

12)         Trauma dressings

 

13)         Sterile gauze pads (4" by 4")

 

14)         Vaseline gauze (3" by 8")

 

15)         Bandage shears

 

16)         Adhesive tape rolls

 

17)         Blanket

 

18)         Long backboard (if required by the EMS System protocols)

 

19)         Cervical collars − adult, child and infant

 

20)         Extremity splints − adult/child, long/short

 

21)         Adult/child/infant blood pressure cuffs and gauge

 

22)         Stethoscope

 

23)         Burn sheet, individually wrapped

 

24)         Sterile saline or water solution (1,000ml), plastic bottles or bags

 

25)         Obstetrical kit, sterile − minimum one, pre-packaged with instruments, bulb syringe and cord clamps

 

26)         Thermal absorbent blanket and head cover, aluminum foil roll or appropriate heat reflective material – minimum one

 

27)         Cold packs

 

28)         EMS run reports

 

29)         Nonporous disposable gloves

 

30)         Personal protective equipment (PPE), including gowns, eye/nose/mouth protection or face shields

 

31)         Flashlight

 

32)         Equipment to allow reliable communications with hospital

 

33)         ILS/ALS System-approved equipment

 

A)        Drug box

 

B)        Airway equipment, including laryngoscope and assorted blades

 

C)        Monitor/defibrillator, equipped with pediatric size defibrillation pads or paddles

 

34)        Opioid antagonist, including, but not limited to, Naloxone, with administration equipment appropriate for the licensed level of care

 

35)        Automated external defibrillator (AED) that includes pediatric capabilities

 

e)         Registration of Non-transport Provider Agencies

            Each non-transport provider shall complete and submit to the Department either the EMS non-transport provider application or EMS non-transport application for an existing transport provider, available on the Department's website: http://dph.illinois.gov/topics-services/emergency-preparedness-response/ems/prov-vehLic.

 

f)         Inspection of Non-transport EMS Providers

            The Department will schedule initial inspections.  Thereafter, non-transport ambulance assist providers shall perform annual self-inspections, using forms provided by the Department, and shall submit the form to the EMS System for submission to the Department upon completion of the inspection.  The Department will perform inspections randomly or as the result of a complaint.

 

g)         Issuance and Renewal of License

            Upon payment of the appropriate fee, qualifying non-transport providers shall be issued a provider license that lists a number for each level of care approved.  Licenses will not be issued for individual Non-Transport Vehicles. Providers shall inform the EMS System and the Department of any modifications to the application, using the System Modification forms (sys-mod).  Licenses will be issued for one year and will be renewed upon completion of the self-inspection.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.827  Ambulance Assistance Vehicle Provider Upgrades

 

a)         An ambulance assistance vehicle provider may submit a written proposal to the EMS Medical Director requesting approval of an ambulance assistance vehicle provider in-field service level upgrade. (Section 3.88(b) of the Act)

 

b)         An ambulance assistance vehicle provider may be upgraded, as defined by the EMS Medical Director in a written policy or procedure, as long as the EMS Medical Director and the Department have approved the proposal, to the highest level of EMT license (advanced life support/paramedic, intermediate life support, or basic life support) or Pre-Hospital RN certification held by any person staffing that provider's ambulance assistance vehicle. The ambulance assistance vehicle provider's proposal for an upgrade must include all of the following (Section 3.88(b-1) of the Act):

 

1)         The manner in which the provider will secure and store all advanced life support equipment, supplies, and medications. (Section 3.88(b-1)(A) of the Act)

 

2)         The type of quality assurance the provider will perform. (Section 3.88(b-1)(B) of the Act)

 

3)         An assurance that the provider will advertise only the level of care that can be provided 24 hours a day. (Section 3.88(b-1)(C) of the Act)

 

4)         A statement that the provider will have that vehicle inspected by the Department annually. (Section 3.88(b-1)(D) of the Act)

 

c)         If an ambulance assistance vehicle provider is approved to provide an in-field service level upgrade based on the licensed personnel on the vehicle, all the advanced life support medical supplies, durable medical equipment, and medications must be environmentally controlled, secured, and locked with access by only the personnel who have been authorized by the EMS Medical Director to utilize those supplies. (Section 3.88(b-2) of the Act)

 

d)         The EMS System shall routinely perform quality assurance, in compliance with the EMS System's quality assurance plan approved by the Department, on in-field service level upgrades authorized under this Section to ensure compliance with the EMS System plan. (Section 3.88(b-3) of the Act)

 

e)         The EMS Medical Director may define what constitutes an in-field service level upgrade through a written EMS System policy or procedure. An in-field service level upgrade may include, but need not be limited to, an upgrade to a licensed ambulance, alternate response vehicle, or specialized emergency medical services vehicle. (Section 3.88(b-3) of the Act)

 

f)         If the EMS Medical Director approves a written proposal for an ambulance assistance vehicle provider's in-field service level upgrade under this Section, he or she shall submit the proposal to the Department along with a statement of approval signed by him or her. Once the Department has approved the proposal, the ambulance assistance vehicle provider shall be authorized to function at the highest level of EMT license (advanced life support/paramedic, intermediate life support, or basic life support) or Pre-Hospital RN certification held by any person physically staffing the provider's ambulance assistance vehicle. (Section 3.88(c) of the Act)

 

g)         Nothing in this Section shall allow for the approval of a request to downgrade the service level licensure for an ambulance assistance vehicle provider. (Section 3.88(d) of the Act) 

 

h)         The Department will approve or deny the request based on the Department's review and determination of the provider's ability to comply with all requirements outlined in this Part. Any application found deficient or incomplete will be returned to the EMS System with a request for additional information, modification or clarification.

 

(Source:  Added at 43 Ill. Reg. 4145, effective March 19, 2019)

 

Section 515.830  Ambulance Licensing Requirements

 

a)         Vehicle Design

 

1)         Each new vehicle used as an ambulance shall comply with the current criteria established by nationally recognized standards such as National Fire Protection Association, Ground Vehicle Standards for Ambulances, the Federal Specifications for the Star of Life Ambulance, or the Commission on Accreditation of Ambulance Services (CAAS) Ground Vehicle Standard for Ambulances.

 

2)         A licensed vehicle shall be exempt from subsequent vehicle design standards or specifications required by the Department in this Part, as long as the vehicle is continuously in compliance with the vehicle design standards and specifications originally applicable to that vehicle, or until the vehicle's title of ownership is transferred. (Section 3.85(b)(8) of the Act)

 

b)         Equipment Requirements – Basic Life Support Vehicles Each ambulance used as a Basic Life Support vehicle shall meet the following equipment requirements, as determined by the Department by an inspection:

 

1)         Stretchers, Cots, and/or Litters

 

A)        Primary Patient Cot

 

B)        Secondary Patient Stretcher

 

2)         Oxygen, Portable

Shall be secured.

 

3)         Suction, Portable

 

A manually operated suction device is acceptable if approved by the Department.

 

4)         Medical Equipment

 

A)        Squeeze bag-valve-mask ventilation unit with adult size transparent mask, and child size bag-valve-mask ventilation unit with child, infant and newborn size transparent masks

 

B)        Lower-extremity traction splint, adult and pediatric sizes

 

C)        Blood pressure cuff, one each, adult, child and infant sizes and gauge

 

D)        Stethoscopes, two per vehicle

 

E)        Long spine board with three sets of torso straps, 72" x 16" minimum

 

F)         Short spine board (32" x 16" minimum) with two 9-foot torso straps, one chin and head strap or equivalent vest type (wrap around) per vehicle; extrication device optional

 

G)        Airway, oropharyngeal – adult, child, and infant, sizes 0-5

 

H)        Airway, nasopharyngeal with lubrication, sizes 14-34F

 

I)         Two adult and two pediatric sized non-rebreather oxygen masks per vehicle 

 

J)         Two infant partial re-breather, or equivalent oxygen masks per vehicle

 

K)        Three nasal cannulas, adult and child size, per vehicle

 

L)        Bandage shears, one per vehicle

 

M)       Extremity splints, adult, two long and short per vehicle

 

N)        Extremity splints, pediatric, two long and short per vehicle

 

O)        Rigid cervical collars – one pediatric, small, medium, and large sizes or adjustable size collars, or equivalent per vehicle.  Shall be made of rigid material to minimize flexion, extension, and lateral rotation of the head and cervical spine when spine injury is suspected

 

P)         Medical grade patient restraints, arm and leg, sets

 

Q)        Pulse oximeter with pediatric and adult sensors 

 

R)        AED or defibrillator that includes pediatric capability

 

5)         Medical Supplies

 

A)        Trauma dressing – six per vehicle

 

B)        Sterile gauze pads – 20 per vehicle, 4 inches by 4 inches

 

C)        Bandages, soft roller, self-adhering type, 10 per vehicle, 4 inches by 5 yards

 

D)        Vaseline gauze – two per vehicle, 3 inches by 8 inches

 

E)        Adhesive tape rolls – two per vehicle

 

F)         Triangular bandages or slings – five per vehicle

 

G)        Burn sheets – two per vehicle, clean, individually wrapped

 

H)        Sterile solution (normal saline) – four per vehicle, 500 cc or two per vehicle, 1,000 cc plastic bottles or bags

 

I)         Material or device intended to maintain body temperature

 

J)         Obstetrical kit, sterile – minimum one, pre-packaged with instruments and bulb syringe

 

K)        Cold packs, three per vehicle

 

L)        Hot packs, three per vehicle, optional

 

M)       Emesis basin – one per vehicle

 

N)        Drinking water – one quart, in non-breakable container; sterile water may be substituted

 

O)        Ambulance emergency run reports – 10 per vehicle, on a form prescribed by the Department or one that contains the data elements from the Department-prescribed form as described in Section 515.Appendix E or electronic documentation with paper backup

 

P)         Sheets – two per vehicle, for ambulance cot

 

Q)        Blankets – two per vehicle, for ambulance cot

 

R)        Opioid antagonist, including, but not limited to, Naloxone, with administration equipment appropriate for the licensed level of care

 

S)         Urinal

 

T)         Bedpan

 

U)        Remains bag, optional

 

V)        Nonporous disposable gloves

 

W)       Impermeable red biohazard-labeled isolation bag

 

X)        Face protection through any combination of masks and eye protection and face shields

 

Y)        Suction catheters – sterile, single use, two each, 6, 8, 10, 12, 14 and 18F, plus three tonsil tip semi-rigid pharyngeal suction tip catheters per vehicle; all shall have a thumb suction control port

 

Z)        Pediatric specific restraint systems or age/size appropriate car safety seats

 

AA)       Current equipment/drug dosage sizing tape or pediatric equipment/drug age/weight chart

 

BB)        Flashlight, two per vehicle, for patient assessment

 

CC)        Current Illinois Department of Transportation Safety Inspection sticker in accordance with Section 13-101 of the Illinois Vehicle Code

 

DD)       Illinois Poison Center telephone number

 

EE)        Department of Public Health Central Complaint Registry telephone number posted where visible to the patient

 

FF)         Medical Grade Oxygen

 

GG)       Ten disaster triage tags

 

HH)       State-approved Mass Casualty Incident (MCI) triage algorithms (START/JumpSTART)

 

c)         Equipment Requirements – Intermediate and Advanced Life Support Vehicles

Each ambulance used as an Intermediate Life Support vehicle or as an Advanced Life Support vehicle shall meet the requirements in subsections (b) and (d) and shall also comply with the equipment and supply requirements as determined by the EMS MD in the System in which the ambulance and its crew participate.  Drugs shall include both adult and pediatric dosages. These vehicles shall have a current pediatric equipment/drug dosage sizing tape or pediatric equipment/drug dosage age/weight chart.

 

d)         Equipment Requirements – Rescue and/or Extrication

The following equipment shall be carried on the ambulance, unless the ambulance is routinely accompanied by a rescue vehicle:

 

1)         Wrecking bar, 24"

 

2)         Goggles for eye safety

 

3)         Flashlight – one per vehicle, portable, battery operated

 

4)         Fire Extinguisher – two per vehicle, ABC dry chemical, minimum 5-pound unit with quick release brackets.  One mounted in driver compartment and one in patient compartment

 

e)         Equipment Requirements – Communications Capability

Each ambulance shall have reliable ambulance-to-hospital radio communications capability and meet the requirements provided in Section 515.400.

 

f)         Equipment Requirements – Epinephrine

An EMT, EMT-I, A-EMT or Paramedic who has successfully completed a Department-approved course in the administration of epinephrine shall be required to carry epinephrine (both adult and pediatric doses) with him or her in the ambulance or drug box as part of the EMS Personnel medical supplies whenever he or she is performing official duties, as determined by the EMS System within the context of the EMS System plan.  (Section 3.55(a-7) of the Act)

 

g)         Personnel Requirements

 

1)         Each Basic Life Support ambulance shall be staffed by a minimum of one System authorized EMT, A-EMT, EMT-I, Paramedic or PHRN, PHPA, PHAPN and one other System authorized EMT, A-EMT, EMT-I, Paramedic, PHRN ,PHPA, PHAPN or physician on all responses.

 

2)         Each ambulance used as an Intermediate Life Support vehicle shall be staffed by a minimum of one System authorized A-EMT, EMT-I, Paramedic or PHRN, PHPA, PHAPN and one other System authorized EMT, A-EMT, EMT-I, Paramedic, PHRN, PHPA, PHAPN or physician on all responses.

 

3)         Each ambulance used as an Advanced Life Support vehicle shall be staffed by a minimum of one System authorized Paramedic or PHRN, PHPA, PHAPN and one other System authorized EMT, A-EMT, EMT-I, Paramedic, PHRN, PHPA, PHAPN or physician on all responses.

 

h)         Alternate Rural Staffing Authorization  

 

1)         A Vehicle Service Provider that serves a rural or semi-rural population of 10,000 or fewer inhabitants and exclusively uses volunteers, paid-on-call personnel or a combination to provide patient care may apply for alternate rural staffing authorization to authorize the ambulance, Non-Transport Vehicle, Special-Use Vehicle, or Limited Operation Vehicle to be staffed by one EMS Personnel licensed at or above the level at which the vehicle is licensed, plus one EMR when two licensed EMTs, A-EMTs, EMT-Is, Paramedics, PHRNs, PHPAs, PHAPNs or physicians are not available to respond. (Section 3.85(b)(3) of the Act)

 

2)         The EMS Personnel licensed at or above the level at which the ambulance is licensed shall be the primary patient care provider in route to the health care facility.

 

3)         The Vehicle Service Provider shall obtain the prior written approval for alternate rural staffing from the EMS MD.  The EMS MD shall submit to the Department a request for an amendment to the existing EMS System plan that clearly demonstrates the need for alternate rural staffing in accordance with subsection (h)(4) and that the alternate rural staffing will not reduce the quality of medical care established by the Act and this Part.

 

4)         A Vehicle Service Provider requesting alternate rural staffing authorization shall clearly demonstrate all of the following:

 

A)        That it has undertaken extensive efforts to recruit and educatelicensed EMTs, A-EMTs, EMT-Is, Paramedics, or PHRNs, PHPAs, PHAPNs;

 

B)        That, despite its exhaustive efforts, licensed EMTs, A-EMTs, EMT-Is, Paramedics or PHRNs, PHPAs, PHAPNs are not available; and

 

C)        That, without alternate rural staffing authorization, the rural or semi-rural population of 10,000 or fewer inhabitants served will be unable to meet staffing requirements as specified in subsection (g).

 

5)         The alternate rural staffing authorization and subsequent authorizations shall include beginning and termination dates not to exceed 48 months. The EMS MD shall re-evaluate subsequent requests for authorization for compliance with subsections (h)(4)(A) through (C).  Subsequent requests for authorization shall be submitted to the Department for approval in accordance with this Section.

 

6)         Alternate rural staffing authorization may be suspended or revoked, after an opportunity for hearing, if the Department determines that a violation of this Part has occurred. Alternate rural staffing authorization may be summarily suspended by written order of the Director, served on the Vehicle Service Provider, if the Director determines that continued operation under the alternate rural staffing authorization presents an immediate threat to the health or safety of the public.  After summary suspension, the Vehicle Service Provider shall have the opportunity for an expedited hearing.

 

7)         Vehicle Service Providers that cannot meet the alternate rural staffing authorization requirements of this Section may apply through the EMS MD to the Department for a staffing waiver pursuant to Section 515.150.

 

i)          Alternate Response Authorization 

 

1)         A Vehicle Service Provider that exclusively uses volunteers or paid-on-call personnel or a combination to provide patient care who are not required to be stationed with the vehicle may apply to the Department for alternate response authorization to authorize the ambulance, Non-Transport Vehicle, Special-Use Vehicle, or Limited Operation Vehicle licensed by the Department to travel to the scene of an emergency staffed by at least one licensed EMT, A-EMT, EMT-I, Paramedic, PHRN, PHPA, PHAPN or physician.

 

2)         A Vehicle Service Provider operating under alternate response authorization shall ensure that a second licensed EMS Personnel is on scene or in route to the emergency response location.

 

3)         Unless the Vehicle Service Provider is approved for alternate rural staffing authorization under subsection (h), the Vehicle Service Provider shall demonstrate to the Department that it has written safeguards to ensure that no patient will be transported with:

 

A)        fewer than two EMTs, Paramedics or PHRNs, PHPAs, PHAPNs;

 

B)        a physician; or

 

C)        a combination, at least one of whom shall be licensed at or above the level of the license for the vehicle.

 

4)         Alternate response authorization may be suspended or revoked, after an opportunity for hearing, if the Department determines that a violation of this Part has occurred. Alternate response authorization may be summarily suspended by written order of the Director, served on the Vehicle Service Provider, if the Director determines that continued operation under the alternate response authorization presents an immediate threat to the health or safety of the public.  After summary suspension, the licensee shall have the opportunity for an expedited hearing (see Section 515.180).

 

j)          Alternate Response Authorization – Secondary Response Vehicles

 

1)         A Vehicle Service Provider that uses volunteers or paid-on-call personnel or a combination to provide patient care, and staffs its primary response vehicle with personnel stationed with the vehicle, may apply for alternate response authorization for its secondary response vehicles. The secondary or subsequent ambulance, Non-Transport Vehicle, Special-Use Vehicle, or Limited Operation Vehicle licensed by the Department at the BLS, ILS or ALS level, when personnel are not stationed with the vehicle, may respond to the scene of an emergency when the primary vehicle is on another response. The vehicle shall be staffed by at least one System authorized licensed EMT, A-EMT, EMT-I, PHRN, PHPA, PHAPN or physician.

 

2)         A Vehicle Service Provider operating under the alternate response authorization shall ensure that a second System authorized licensed EMT, A-EMT, EMT-I, Paramedic, PHRN, PHPA, PHAPN or physician is on the scene or in route to the emergency response location, unless the Vehicle Service Provider is approved for alternate rural staffing authorization, in which case the second individual may be an EMR or First Responder.

 

3)         Unless the Vehicle Service Provider is approved for alternate rural staffing authorization under subsection (h), the Vehicle Service Provider shall demonstrate to the Department that it has written safeguards to ensure that no patient will be transported without at least one EMT who is licensed at or above the level of ambulance, plus at least one of the following:  EMT, Paramedic, PHRN, PHPA, PHAPN or physician.

 

4)         Alternate response authorization for secondary response vehicles may be suspended or revoked, after an opportunity for hearing, if the Department determines that a violation of this Part has occurred. Alternate response authorization for secondary response vehicles may be summarily suspended by written order of the Director, served on the Vehicle Service Provider, if the Director determines that continued operation under the alternate response authorization for secondary vehicles presents an immediate threat to the health or safety of the public.  After summary suspension, the Vehicle Service Provider shall have the opportunity for an expedited hearing (see Section 515.180).

 

k)         Alternative Staffing for Private Ambulance Providers, Excluding Local Government Employers

An ambulance provider may request approval from IDPH to use an alternative staffing model for interfacility transfers for a maximum of one year in accordance with the requirements for Vehicle Service Providers in 210 ILCS 50/3.85 of the Act and may be renewed annually.

 

1)         An ambulance provider requesting alternative staffing for BLS ambulances for interfacility transfers will provide the following to IDPH:

 

A)        Assurance that an EMT will remain with the patient at all times and an EMR will act as driver.

 

B)        Certificate of completion of a defensive driver course for the EMR and validation that the EMT has one year of pre-hospital experience.

 

C)        A system plan modification form stating this type of transport will only be for identified interfacility transports or medical appointments excluding dialysis.

 

D)        Dispatch protocols for properly screening and assessing patients appropriate for transports utilizing the alternative staffing models.

 

E)        A quality assurance plan which must include monthly review of dispatch screening and outcome.

 

2)         The System modification form and program plan shall be submitted to the EMSMD for approval and forwarded to the REMSC for review and approval.  The provider shall not implement the alternative staffing plan until approval by the EMSMD and the Department. 

 

3)         Each EMS System must develop an EMS Workforce Development and Retention Committee.

 

A)        The Committee shall be representative of the following:

 

i)          At least one individual representing each private ambulance provider;

 

ii)         At least one individual representing each municipal provider;

 

iii)        Two individuals representing the Associate Hospitals;

 

iv)        Two individuals representing the Participating Hospitals;

 

v)         One individual representing the Resource Hospital; and

 

vi)        The EMS System Medical Director.

 

B)        The Committee shall:

 

i)          Assess whether there are EMS staffing shortages within the System and the impact of any staffing shortage on response times and other relevant metrics.

 

ii)         Develop recommendations to address such staffing shortages, including, but not limited to, alternative staffing models including the use of EMRs.

 

C)        No later than 1/31/22, the EMSMD shall submit a final report of the Committee to the Department along with any proposed system modifications to address the staffing shortages of the System. 

 

D)        Under the approval of the EMSMD, private ambulance providers may submit a plan for alternative staffing models.

 

i)          The alternative staffing model would include expanded scopes of practice as determined by the EMSMD and approved by the Department.

 

ii)         This may include the use of an EMR at the BLS, AEMT/ILS, or ALS levels of care.

 

iii)        If an EMSMD proposes an expansion of the scope of practice for EMRs, such expansion shall not exceed the education standards prescribed by IDPH.

 

E)        The alternative staffing plan shall be renewed annually if the following criteria are met:

 

i)          All system modification forms and supportive planning documentation are submitted, validated, and approved by the EMSMD who shall submit to the Department for final approval.

 

ii)         All plans must demonstrate that personnel will meet the training and education requirements as determined by IDPH for expanding the scope of practice for EMRs, testing to assure knowledge and skill validation, and a quality assurance plan for monitoring transports utilizing alternative staffing models that include EMRs. 

 

iii)        This plan shall be submitted to the REMSC for review and approval. 

 

iv)        This plan shall not be implemented without Department approval, which shall not be unreasonably withheld.  Deference shall be given to the EMSMD’s approval of the plan.

 

l)          Rural population staffing credentialing exemption (5000 or fewer inhabitants) for volunteer EMS agencies:

 

1)         An EMSMD may create an exception to the credentialing process to allow registered nurses, physician assistants and advanced practice nurses to apply to serve as volunteers who perform the same work as EMTs after completion of the following:

 

A)        Assurance by the EMSMD that the registered nurse, physician assistant or advance practice nurse has a valid license.

 

B)        20 hours of continuing education for each individual to include at a minimum: airway management, ambulance operation, ambulance equipment, extrication, telecommunication, prehospital cardiac, and trauma care. (Section 3.89 of the Act)

 

C)        8 hours of observation riding time for each individual. (Section 3.89 of the Act)

 

D)        Policy outlining requirements for credentialing, additional CME; requirements and rejecting of a volunteer.

 

E)        The plan for system level recognition will be submitted to the Department for approval and once approved, will be for a period of one year.

 

m)        Operational Requirements

 

1)         An ambulance that is transporting a patient to a hospital shall be operated in accordance with the requirements of the Act and this Part.

 

2)         A licensee shall operate its ambulance service in compliance with this Part, 24 hours a day, every day of the year.  Except as required in this subsection (k), each individual vehicle within the ambulance service shall not be required to operate 24 hours a day, as long as at least one vehicle for each level of service covered by the license is in operation at all times.  An ALS vehicle can be used to provide coverage at either an ALS, ILS or BLS level, and the coverage shall meet the requirements of this Section.

 

A)        At the time of application for initial or renewal licensure, and upon annual inspection, the applicant or licensee shall submit to the Department for approval a list containing the anticipated hours of operation for each vehicle covered by the license.

 

i)          A current roster shall also be submitted that lists the System authorized EMTs, A-EMTs, EMT-Is, Paramedics, PHRNs, PHPAs, PHAPNs or physicians who are employed or available to staff each vehicle during its hours of operation.  The roster shall include each staff person's name, license number, license expiration date and telephone number, and shall state whether the person is scheduled to be on site or on call.

 

ii)         An actual or proposed four-week staffing schedule shall also be submitted that covers all vehicles, includes staff names from the submitted roster, and states whether each staff member is scheduled to be on site or on call during each work shift.

 

B)        Licensees shall obtain the EMS MD's approval of their vehicles' hours of operation prior to submitting an application to the Department.  An EMS MD may require specific hours of operation for individual vehicles to assure appropriate coverage within the System.

 

C)        A Vehicle Service Provider that advertises its service as operating a specific number of vehicles or more than one vehicle shall state in the advertisement the hours of operation for those vehicles, if individual vehicles are not available 24 hours a day.  Any advertised vehicle for which hours of operation are not stated shall be required to operate 24 hours a day. (See Section 515.800(j).)

 

3)         For each patient transported to a hospital, the ambulance staff shall, at a minimum, measure and record the information required in Appendix E.

 

4)         A Vehicle Service Provider shall provide emergency service within the service area on a per-need basis without regard to the patient's ability to pay for the service.

 

5)         A Vehicle Service Provider shall provide documentation of procedures to be followed when a call for service is received and a vehicle is not available, including copies of mutual aid agreements with other ambulance providers.  (See Section 515.810(h).)

 

6)         A Vehicle Service Provider shall not operate its ambulance at a level exceeding the level for which it is licensed (basic life support, intermediate life support, advanced life support), unless the vehicle is operated pursuant to an EMS System-approved in-field service level upgrade or ambulance service upgrades – rural population.

 

7)         The Department will inspect ambulances each year.  If the Vehicle Service Provider has no violations of this Section that threaten the health of safety of patients or the public for the previous five years and has no substantiated complaints against it, the Department will inspect the Vehicle Service Provider's ambulances in alternate years, and the Vehicle Service Provider may, with the Department's prior approval, self-inspect its ambulances in the other years.  The Vehicle Service Provider shall use the Department's inspection form for self-inspection.  Nothing contained in this subsection (k)(7) shall prevent the Department from conducting unannounced inspections.

 

n)         A licensee may use a replacement vehicle for up to 10 days without a Department inspection, provided that the EMS System and the Department are notified of the use of the vehicle by the second working day.

 

o)         Patients, individuals who accompany a patient, and EMS Personnel may not smoke while inside an ambulance or SEMSV.  The Department of Public Health shall impose a civil penalty on an individual who violates this subsection (m) in the amount of $100.  (Section 3.155(h) of the Act)

 

p)         Any provider may request a waiver of any requirements in this Section under the provisions of Section 515.150.

 

(Source:  Amended at 46 Ill. Reg. 20898, effective December 16, 2022)

 

Section 515.833  In-Field Service Level Upgrade – Rural Population

 

a)         Ambulance Service Provider and Vehicle Service Provider Upgrades – Rural Population

 

1)         An ambulance operated by a rural ambulance service provider or a specialized emergency medical services vehicle or alternate response vehicle operated by a rural vehicle service provider may be upgraded, as defined by the EMS System Medical Director in a policy or procedure, as long as the EMS System Medical Director and the Department have approved the proposal, to the highest level of EMT license (advanced life support/paramedic, intermediate life support, advanced EMT or basic life support) or Pre-Hospital RN held by any person staffing that ambulance, specialized emergency medical services vehicle, or alternate response vehicle. The ambulance service provider's proposal or rural services vehicle provider's proposal for an upgrade must include all of the following:

 

A)        The manner in which the provider will secure and store advanced life support equipment, supplies and medications.

 

B)        The type of quality assurance the provider will perform.

 

C)        An assurance that the provider will advertise only the level of care that can be provided 24 hours a day.

 

D)        A statement that the provider will have that vehicle inspected by the Department annually.

 

2)         If a rural ambulance service provider or rural vehicle service provider is approved to provide an in-field service level upgrade based on the licensed personnel on the vehicle, all the advanced life support medical supplies, durable medical equipment, and medications must be environmentally controlled, secured, and locked with access by only the personnel who have been authorized by the EMS System Medical Director to utilize those supplies.

 

3)         The EMS System shall routinely perform quality assurance, in compliance with the EMS System's quality assurance plan approved by the Department, on in-field service level upgrades authorized under this Section to ensure compliance with the EMS System plan.

 

4)         The EMS System Medical Director may define what constitutes an in-field service level upgrade through an EMS System policy or procedure.  An in‑field service level upgrade may include, but need not be limited to, an upgrade to a licensed ambulance, alternate response vehicle or specialized emergency medical services vehicle.

 

b)         If the EMS System Medical Director approves a proposal for a rural in-field service level upgrade under this Section, he or she shall submit the proposal to the Department along with a statement of approval signed by him or her. Once the Department has approved the proposal, the rural ambulance service provider or rural vehicle service provider will be authorized to function at the highest level of EMT license (advanced life support/paramedic, advanced EMT, intermediate life support, or basic life support) or Pre-Hospital RN held by any person staffing the vehicle. (Section 3.87 of the Act)

 

c)         The Department will approve or deny the request based on the Department's review          and determination of the provider's ability to comply with requirements as outlined in the Act and this Part. Any application found deficient will be returned to the provider with a request for additional information or clarification.

 

(Source:  Added at 39 Ill. Reg. 13075, effective September 8, 2015)

 

Section 515.835  Stretcher Van Provider Licensing Requirements

 

a)         An application for a stretcher van provider license shall be submitted on a form prescribed by the Department.  The application shall include, but not be limited to:

 

1)         Applicant's and registered agent's name and permanent business addresses and telephone numbers; and

 

2)         For each vehicle to be covered by the license, the make, model, year, vehicle identification number, State vehicle license number and proof of liability insurance.

 

b)         The application shall be accompanied by a fee of $25 for each vehicle included in the license application, up to 100 vehicles.  A fee of $2500 shall be submitted for applications for 100 or more vehicles.

 

c)         An application for license renewal shall be submitted to the Department in accordance with subsections (a) and (b) of this Section at least 60 days, but no more than 90 days, prior to license expiration.

 

d)         The Department shall issue a license that is valid for one year if, after inspection, the Department finds that the stretcher van provider and each vehicle identified in the application are in compliance with the Act and this Part.

 

e)         The Department is authorized to make inspections and make investigations as it deems necessary to determine compliance with the Act and this Part. Advance notice shall not be required.  Pursuant to any inspection or investigation, a licensee shall allow the Department full access to all records, equipment, personnel and vehicles relating to activities addressed in the Act or this Part.

 

f)         Each license is issued to the licensee for the vehicles identified in the application and is not transferrable.  The licensee shall notify the Department, in writing, within 10 days after any changes in the information on the application.  Additional vehicles shall not be put into service until an application is submitted with the required fee and an inspection is conducted.

 

g)         A stretcher van provider is prohibited from advertising, identifying its vehicles, or disseminating information in a false or misleading manner concerning the provider's type and level of vehicles, location, response times, level of personnel, licensure status, or EMS System participation. (Section 3.86 of the Act)

 

(Source:  Added at 35 Ill. Reg. 18331, effective October 21, 2011)

 

Section 515.840  Stretcher Van Requirements

 

a)         A stretcher van shall not be a passenger sedan, limousine, or recreational vehicle.  Sport utility vehicles with fewer than three passenger doors and a wheelbase of less than 100 inches are not permitted to be licensed as stretcher vans.

 

b)         A stretcher van shall have the capability for continuous and reliable voice communication with staffed dispatch bases and receiving facilities, and the ability to contact emergency services as necessary.

 

c)         A stretcher van shall have sufficient room for two attendants and appropriate equipment to secure all passengers and the stretcher to prevent injury or aggravation of an existing medical condition and to allow for direct observation of the stretcher passenger.

 

d)         A stretcher van shall be in good operating condition and equipped with seat belts for each passenger, one working 5-pound ABC fire extinguisher, and one working battery-operated flashlight.  A stretcher van shall not be equipped with emergency (red or blue) lights or other emergency warning devices.

 

e)         A stretcher van shall have accommodation for a primary wheeled litter, which shall be at least 75 inches long and 22 inches wide and fastened securely with a crash-stable quick-release three-point fastener (i.e., Ferno Type 175 fastener or equivalent); in addition, passengers on the primary wheeled litter shall be secured with three sets of straps and over-shoulder straps.

 

f)         A stretcher van shall have a flat and unencumbered floor with a non-skid surface that is easily cleaned. The patient area of the stretcher van shall be constructed of surfaces that are non-porous and easily sanitized.

 

g)         A stretcher van shall have a loading light capable of illuminating the area around the stretcher van.

 

h)         A stretcher van shall be equipped with a crash-stable quick-release mounting bracket for each oxygen cylinder transported.

 

i)          A stretcher van shall have provisions for continuous visual and voice communication between the driver and the passenger.

 

j)          A stretcher van shall have heating, cooling and ventilation systems in good working condition.  The passenger area shall be clear and designed to ensure that there are no sharp projections that could injure the passenger.

 

k)         Smoking or use of smoking materials or devices shall not be permitted in stretcher vans licensed under this Part. A stretcher van shall include "No Smoking" and "Fasten Seat Belt" signs conspicuously posted in the driver and passenger compartments.

 

l)          A stretcher van shall provide either:

 

1)         A 24-hour written agreement to have emergency road service; or

 

2)         One spare wheel and tire, one with a jack with the capacity to raise a wheel of the stretcher van, and one wheel lug wrench.

 

m)        A stretcher van shall be equipped with:

 

1)         Two each: pillows, sheets and blankets;

 

2)         CPR mask with safety valve;

 

3)         Red bio-hazard labeled isolation bags; and

 

4)         A box of disposable gloves.

 

n)         All equipment and supplies in a stretcher van shall be properly secured, so as to be crash safe.

 

o)         A stretcher van shall not transport more than one stretcher passenger at any one time.

 

(Source:  Added at 35 Ill. Reg. 18331, effective October 21, 2011)

 

Section 515.845  Operation of Stretcher Vans

 

a)         No stretcher van may be operated with a crew of fewer than two trained attendants. One trained attendant shall remain with the passenger.

 

b)         All stretcher van attendants shall be CPR certified and have received basic training in the operation of stretchers.

 

c)         A stretcher van provider may provide transport of a passenger on stretcher provided the passenger meets all of the following requirements:

 

1)         He or she needs no medical monitoring or clinical observation;

 

2)         He or she needs routine non-emergent transportation to or from a medical appointment or service if he or she is convalescent or otherwise bed confined and does not require clinical observation, aid, care, or treatment during transport. (Section 3.86(c) of the Act)

 

d)         Examples of appropriate stretcher van transport include, but are not limited to, transport from a passenger's home to another residential setting, a medical appointment or a therapy session.

 

e)         A stretcher van provider shall not transport a passenger who meets any of the following conditions:

 

1)         He or she is being transported to a hospital for emergency medical treatment;

 

2)         He or she is experiencing an emergency medical condition or needs active medical monitoring, including isolation precautions, supplemental oxygen that is not self-administered, continuous airway management, suctioning during transport, or the administration of intravenous fluids during transport.  (Section 3.86(d) of the Act)

                                   

f)         Examples of inappropriate transports by stretcher vans include:

 

1)         Passengers who, by nature of their illness or injury, are likely to encounter complications and are likely to require medical care in route;

 

2)         Passengers whose physical or mental state prevents them from cooperating with the stretcher van operators (e.g., senile dementia/Alzheimer's, mentally unstable individuals or passengers who present a risk of elopement).

 

(Source:  Amended at 37 Ill. Reg. 18883, effective November 12, 2013)

 

Section 515.850  Reserve Ambulances

 

a)         For the purposes of this Section, "reserve ambulance" means a vehicle that meets all criteria set forth in Section 515.830 of this Part, except for the required inventory of medical supplies and durable medical equipment, which may be rapidly transferred from a fully functional ambulance to a reserve ambulance without the use of tools or special mechanical expertise. (Section 3.85(a)(3)(C) of the Act)

 

b)         No changes to the vehicular operating systems, such as the electrical, plumbing, lighting, emergency warning or dispatch and hospital communication systems, shall be permitted.

 

c)         The vehicle service provider shall complete a vehicle inventory of equipment and supplies as required by Section 515.830 of this Part and any system specific requirements each time a reserve vehicle is placed into service.

 

d)         The vehicle provider shall notify the EMS System within 48 hours after a reserve ambulance is placed into service. A copy of the vehicle inventory form shall be provided to the EMS System.

 

e)         Any reserve ambulance placed into service for 10 days or more shall be inspected by the EMS System, and the System shall provide notification to the Department on a Department prescribed form.

 

f)         Reserve ambulances shall be identified on the vehicle provider license in accordance with Section 515.800 of this Part.

 

(Source:  Added at 35 Ill. Reg. 16697, effective September 29, 2011)

 

Section 515.860  Critical Care Transport

 

a)         Critical care transport may be provided by:

 

1)         Department-approved critical care transport providers, not owned or operated by a hospital, utilizing EMT-Paramedics with additional training, nurses, or other qualified health professionals; or

 

2)         Hospitals, when utilizing any vehicle service provider or any hospital-owned or operated vehicle service provider. Nothing in the Act requires a hospital to use, or to be, a Department-approved critical care transport provider when transporting patients, including those critically injured or ill. Nothing in the Act shall restrict or prohibit a hospital from providing, or arranging for, the medically appropriate transport of any patient, as determined by a physician licensed to practice medicine in all of its branches, an APRN, or a PA. (Section 3.10(f-5) of the Act)

 

b)         All critical care transport providers must function within a Department-approved EMS System. Nothing in this Part shall restrict a hospital's ability to furnish personnel, equipment, and medical supplies to any vehicle service provider, including a critical care transport provider. (Section 3.10(g-5) of the Act)

 

c)         For the purposes of this Section, "expanded scope of practice" includes the accepted national curriculum plus additional education, experience and equipment (see Section 515.360) as approved by the Department pursuant to Section 3.55 of the Act.  Tier I transports are considered "expanded scope of practice".

 

d)         For the purposes of this Section, CCT plans are defined in three tiers of care.  Tier II and Tier III are considered Critical Care Transports.

 

e)         Tier I

Tier I provides a level of care for patients who require care beyond the Department-approved Paramedic scope of practice, up to but not including the requirements of Tiers II and III.  Tier I transport includes the use of a ventilator, the use of infusion pumps with administration of medication drips, and maintenance of chest tubes.

 

1)         Personnel Staffing and Licensure

 

A)        Licensure

 

i)          Licensed Illinois Paramedic, PHRN, PHPA or PHAPN;

 

ii)         Scope of practice more comprehensive than the national EMS scope of practice model  approved by the Department in accordance with the EMS System plan (see Sections 515.310 and 515.330); and

 

iii)        Approved to practice by the Department in accordance with the EMS System plan.

 

B)        Minimum Staffing

 

i)          System authorized EMT, A-EMT, EMT-I, Paramedic, PHRN, PHPA or PHAPN as driver; and

 

ii)         System authorized expanded scope of practice Paramedic, PHRN, PHPA, PHAPN or physician who shall remain with the patient at all times.

 

2)         Education, Certification and Experience

 

A)        Initial Education.  Documentation of initial education and demonstrated competencies of expanded scope of practice knowledge and skills as required by Tier I Level of Care and approved by the Department in accordance with the EMS System plan.

 

B)        CE Requirements

 

i)          Annual competencies of expanded scope of practice knowledge, equipment and procedures shall be completed; and

 

ii)         The EMS vehicle service provider shall maintain documentation of competencies and provide documentation to the EMS Resource Hospital upon request.

 

C)        Certifications.  Tier I personnel shall maintain all of the following renewable certifications and credentials in active status:

 

i)          Advanced Cardiac Life Support (ACLS);

 

ii)         Pediatric Education for Pre-Hospital Professionals (PEPP) or Pediatric Advance Life Support (PALS);

 

iii)        International Trauma Life Support (ITLS) or Pre-Hospital Trauma Life Support (PHTLS); and

 

iv)        Any additional educational course work or certifications required by the EMS MD.

 

D)        Experience

 

i)          Minimum of one year of experience functioning in the field at an ALS level or as a physician in an emergency department; and

 

ii)         Documentation of education and demonstrated competencies of expanded scope of practice knowledge and skills required for Tier I Level of Care, approved by the Department and included in the EMS System plan.

 

3)         Medical Equipment and Supplies

 

A)        Ventilator; and

 

B)        Infusion pumps.

 

4)         Vehicle Standards

Any vehicle used for providing expanded scope of practice care shall comply at a minimum with Section 515.830 (Ambulance Licensing Requirements) or Sections 515.900 (Licensure of SEMSV Programs –General) and 515.920 (SEMSV Program Licensure Requirements for All Vehicles) regarding licensure of SEMSV Programs and SEMSV vehicle requirements, including additional medical equipment and ambulance equipment as defined in this Section. Any vehicle used for expanded scope of practice transport shall be equipped with an onboard alternating current (AC) supply capable of operating and maintaining the AC current needs of the required medical devices used in providing care during the transport of a patient.

 

5)         Treatment and Transport Protocols shall address the following:

 

A)        EMS MD or designee present at established Medical Control;

 

B)        Communication points for contacting System authorized Medical Control and a written Expanded Scope of Practice Standard;

 

C)        Written operating procedures and protocols signed by the EMS MD and approved for use by the Department in accordance with the System plan; and

 

D)        Use of a ventilator, infusion pumps with administration of medication drips, and maintenance of chest tubes.

 

6)         Quality Assurance Program

 

A)        The Tier I transport provider shall develop a written Quality Assurance (QA) plan approved by the EMS System and the Department in accordance with subsection (e)(6)(D).  The provider shall provide quarterly QA reports to the assigned EMS Resource Hospitals for the first 12 months of operation.

 

B)        The EMS System shall establish the frequency of quality reports after the first year if the System has not identified any deficiencies or adverse outcomes.

 

C)        An EMS MD or a SEMSV shall oversee the QA program.

 

D)        The QA plan shall evaluate all expanded scope of practice activity for medical appropriateness and thoroughness of documentation. The review shall include:

 

i)          Review of transferring physician orders and evidence of compliance with those orders;

 

ii)         Documentation of vital signs and frequency and evidence that abnormal vital signs or trends suggesting an unstable patient were appropriately detected and managed;

 

iii)        Documentation of any side effects/complications, including hypotension, extreme bradycardia or tachycardia, increasing chest pain, dysrhythmia, altered mental status and/or changes in neurological examination, and evidence that interventions were appropriate for those events;

 

iv)        Documentation of any unanticipated discontinuation of a catheter or rate adjustments of infusions, along with rationale and outcome;

 

v)         Review of any Medical Control contact for further direction;

 

vi)        Documentation that any unusual occurrences were promptly communicated to the EMS System; and

 

vii)       A root cause analysis of any event or care inconsistent with standards. The EMS System educator shall assess and carry out a corrective action plan.

 

E)        The QA plan shall be subject to review as part of an EMS System site survey and as deemed necessary by the Department (e.g., in response to a complaint).

 

f)         Tier II

Tier II provides a level of care for patients who require care beyond the Department-approved national EMS scope of practice model  and expanded scope of practice ALS (Paramedic) transport program, and who require formal advanced education for ALS Paramedic staff. Tier II transport includes the use of a ventilator, infusion pumps with administration of medication drips, maintenance of chest tubes, and other equipment and treatment, such as, but not limited to: arterial lines; accessing central lines; medication-assisted intubation; patient assessment and titration of IV pump medications, including additional active interventions necessary in providing care to the patient receiving treatment with advanced equipment and medications.

 

1)         Personnel Staffing and Licensure

 

A)        Licensure − Licensed Illinois Paramedic, PHRN, PHPA or PHAPN:

 

i)          Expanded scope of practice more comprehensive than the national EMS scope of practice model and Tier I Level as approved by the Department; and

 

ii)         Approved to practice by the EMS System and the Department in accordance with the EMS System plan.

 

B)        Minimum Staffing:

 

i)          System authorized Paramedic, PHRN, PHPA or PHAPN; and

 

ii)         System authorized Paramedic, PHRN, PHPA, PHAPN or physician who is critical care prepared and who shall remain with the patient at all times.

 

2)         Education, Certification and Experience

 

A)        Initial Advanced Formal Education.

 

i)          At a minimum, 80 didactic hours of established higher collegiate education or equivalent critical care education based on nationally recognized program models; and

 

ii)         Demonstrated competencies, as documented by the EMS MD or SEMSV MD and approved by the Department.

 

B)        CE Requirements

 

i)          The EMS System shall document and maintain annual competencies of expanded scope of practice knowledge, equipment and procedures;

 

ii)         The following current credentials, as a minimum, shall be maintained: ACLS, PEPP or PALS, ITLS or PHTLS;

 

iii)        A minimum of 40 hours of critical care level education shall be completed every four years;

 

iv)        The EMS provider shall maintain documentation of compliance with subsections (f)(2)(B)(i) through (iii) and shall provide documentation to the EMS Resource Hospital upon request; and

 

v)         Nationally recognized critical care certifications shall be maintained and renewed based on national recertification criteria.

 

C)        Experience.  Minimum of two years experience functioning in the field at an ALS level for Paramedics and PHRNs and one year experience in an emergency department for physicians.

 

3)         Medical Equipment and Supplies

 

A)        Ventilator; and

 

B)        Infusion pumps.

 

4)         Vehicle Standards

Any vehicle used for providing critical care transport shall comply at a minimum with Section 515.830 (Ambulance Licensing Requirements) or Sections 515.900 (Licensure of SEMSV Programs – General) and 515.920 (SEMSV Program Licensure Requirements for All Vehicles) regarding licensure of SEMSV Programs and SEMSV vehicle requirements, including additional medical equipment and ambulance equipment as defined in this Section. Any vehicle used for CCT  shall be equipped with an onboard AC supply capable of operating and maintaining the AC current needs of the required medical devices used in providing care during the transport of a patient.

 

5)         Treatment and Transport Protocols shall address the following:

 

A)        EMS MD or designee present at established Medical Control communication points and a written Expanded Scope of Practice Standard Operating Procedure signed by the EMS MD and approved for use by the Department in accordance with the System plan;

 

B)        The use of a ventilator, infusion pumps with administration of medication drips, maintenance of chest tubes, and other equipment and treatment, such as, but not limited to: arterial lines, accessing central lines, and medication-assisted intubation; and

 

C)        Patient assessment and titration of IV pump medications, including additional active interventions necessary in providing care to the patient receiving treatment with advanced equipment and medications.

 

6)         Quality Assurance Program

 

A)        The Tier II transport provider shall develop a written QA plan approved by the EMS System and the Department in accordance with subsection (f)(6)(D).  The participating provider shall provide quarterly reports to the assigned EMS Resource Hospitals for the first 12 months of operation.

 

B)        The EMS System shall establish the frequency of quality reports after the first year if the System has not identified any deficiencies or adverse outcomes.

 

C)        An EMS MD or SEMSV MD shall oversee the QA program.

 

D)        The QA plan shall evaluate all expanded scope of practice activity for medical appropriateness and thoroughness of documentation. The review shall include:

 

i)          Review of transferring physician orders and evidence of compliance with those orders;

 

ii)         Documentation of vital signs and frequency, and evidence that abnormal vital signs or trends suggesting an unstable patient were appropriately detected and managed;

 

iii)        Documentation of any side effects or complications, including, but not limited to, hypotension, extreme bradycardia or tachycardia, increasing chest pain, dysrhythmia, altered mental status and/or changes in neurological examination, and evidence that interventions were appropriate for those events;

 

iv)        Documentation of any unanticipated discontinuation of a catheter or rate adjustments of infusions, along with rationale and outcome;

 

v)         Review of any Medical Control contact for further direction;

 

vi)        Documentation that unusual occurrences were promptly communicated to the EMS System; and

 

vii)       A root cause analysis shall be completed for any event or care inconsistent with standards. The EMS MD or the SEMSV MD shall recommend and implement a corrective action plan.

 

E)        The QA plan shall be subject to review as part of an EMS System site survey and as deemed necessary by the Department (e.g., in response to a complaint).

 

g)         Tier III

Tier III provides the highest level of ground transport care for patients who require nursing level treatment modalities and interventions.

 

1)         Minimum Personnel Staffing and Licensure

 

A)        EMT, A-EMT, EMT-I or Paramedic (as driver); and

 

B)        Two critical care prepared providers, who shall remain with the patient at all times:

 

i)          Paramedic, PHRN, PHPA or PHAPN; and

 

ii)         RN, PHRN, PHPA or PHAPN.

 

2)         Education, Certification, and Experience: Paramedic, PHRN, PHPA or PHAPN

 

A)        Initial Advanced Formal Education

 

i)          Approval to practice by EMS System and the Department in accordance with the EMS program plan;

 

ii)         At a minimum, 80 didactic hours of established higher collegiate education or equivalent critical care education nationally recognized program models;

 

iii)        Demonstrated competencies, as documented by EMS MD and SEMSV MD and approved by the Department; and

 

iv)        Expanded scope of practice more comprehensive than the national EMS scope of practice model and Tier II level as approved by the Department.

 

B)        CE Requirements

 

i)          The EMS System shall document and maintain annual competencies of expanded scope of practice knowledge, equipment and procedures;

 

ii)         The following valid credentials, at a minimum, shall be maintained:  ACLS, PEPP or PALS, ITLS or PHTLS;

 

iii)        A minimum of 40 hours of critical care level CE shall be completed every four years;

 

iv)        The EMS provider shall maintain documentation of compliance with subsection (g)(2)(B)(i) and shall provide documentation to the EMS Resource Hospital upon request; and

 

v)         Nationally recognized critical certifications shall be maintained and renewed based on national recertification criteria.

 

C)        Experience

 

i)          Minimum of two years experience functioning in the field at an ALS Level;

 

ii)         Documented demonstrated competencies; and

 

iii)        Completion of annual competencies of expanded scope knowledge, equipment and procedures.

 

3)         Education, Certification and Experience − Registered Professional Nurse

 

A)        CE Requirements

 

i)          A minimum of 48 hours of critical care level education shall be completed every four years;

 

ii)         The EMS provider shall maintain documentation of compliance with subsection (g)(3)(A)(i) and shall provide documentation to the EMS Resource Hospital upon request; and

 

iii)        Annual competencies of expanded scope of practice knowledge, equipment and procedures shall be completed.

 

B)        Certifications

Tier III personnel shall maintain the following valid critical care certifications and credentials:

 

i)          ACLS;

 

ii)         PALS, PEPP or ENPC;

 

iii)        ITLS, PHTLS, TNCC or TNS; and

 

iv)        ECRN or equivalent.

 

C)        Advanced Certifications Preferred but not Required

 

i)          Certified Emergency Nurse (CEN);

 

ii)         Critical Care Registered Nurse (CCRN);

 

iii)        Critical Care Emergency Medical Technician-Paramedic (CCEMT-P);

 

iv)        Certified Registered Flight Nurse (CFRN); and

 

v)         Certified Transport Registered Nurse (CTRN).

 

D)        Experience

 

i)          Two years of experience with demonstrated competency in a critical care setting; and

 

ii)         Documented demonstrated EMT System competencies.

 

4)         Medical Equipment and Supplies

Tier III transport requires nursing level treatment modalities and interventions as agreed upon by the sending physician and the accepting physician at the receiving facility. If either physician is not available for consult, the EMS MD or SEMSV MD or designee shall direct care.

 

5)         Vehicular Standards

Any vehicle used for providing CCT shall comply, at a minimum, with Section 515.830 (Ambulance Licensing Requirements) or Sections 515.900 (Licensure of SEMSV Programs – General) and 515.920 (SEMSV Program Licensure Requirements for All Vehicles) regarding licensure of SEMSV Programs and SEMSV vehicle requirements, including additional medical equipment and ambulance equipment as defined in this Section. Any vehicle used for CCT shall be equipped with an onboard AC supply capable of operating and maintaining the AC current needs of the required medical devices used in providing care during the transport of a patient.

 

6)         Treatment and Transport Protocols shall address the following:

 

A)        Paramedic, PHRN, PHPA or PHAPN:  EMS MD or designee present at established Medical Control communication points and written Critical Care Standard Operating procedure signed by the EMS MD and approved for use by the Department in accordance with the System plan;

 

B)        Registered Professional Nurse: The provider's EMS MD or SEMSV Critical Care MD may establish standing medical orders for nursing personnel, or the RN may be approved to accept orders from the sending physician or receiving physician.

 

7)         Quality Assurance Program

 

A)        The Tier III transport provider shall have a written QA plan approved by the EMS System and the Department, in accordance with subsection (g)(7)(D). The provider shall provide quarterly reports to the assigned EMS Resource Hospitals for the first 12 months of operation.

 

B)        The EMS System shall establish the frequency of quality reports after the first year if the System has not identified any deficiencies or adverse outcomes.

 

C)        An EMS MD or SEMSV MD shall oversee the QA program.

 

D)        The QA plan shall evaluate all expanded scope of practice activity for medical appropriateness and thoroughness of documentation. The review shall include:

 

i)          Review of transferring physician orders and evidence of

compliance with those orders;

 

ii)         Documentation of vital signs and frequency and evidence that abnormal vital signs or trends suggesting an unstable patient were appropriately detected and managed;

 

iii)        Documentation of any side effects or complications, including, but not limited to, hypotension, extreme bradycardia or tachycardia, increasing chest pain, dysrhythmia, altered mental status or changes in neurological examination, and evidence that interventions were appropriate for those events;

 

iv)        Documentation of any unanticipated discontinuation of a catheter or rate adjustments of infusions, along with rationale and outcome;

 

v)         Review of any medical control contact for further direction;

 

vi)        Prompt communication of unusual occurrences to the EMS System;

 

vii)       A root cause analysis shall be completed for any event or care inconsistent with standards. The  EMS MD or the SEMSV MD shall recommend and implement a corrective action plan.

 

E)        The QA plan will be subject to review as part of an EMS System site survey and as deemed necessary by the Department (e.g., in response to a complaint).

 

h)         The Department will approve vehicle service providers for CCT when the provider demonstrates compliance with an approved EMS System's CCT program plan for Tier II or Tier III transports.  Only Department-approved agencies may advertise as CCT providers.

 

i)          The Department will suspend a vehicle service provider's approval for critical care transport if any part of the provider's QA plan is not followed or if a situation exists that poses a threat to the public health and safety.  The Department will provide a notice of suspension of CCT approval and an opportunity for hearing.  If the vehicle service provider does not respond to the notice within 10 days after receipt, approval will be revoked.

 

j)          The Director may summarily suspend any licensed provider's authorization to perform CCT under this Part if the Director or designee determines that continued CCT by the provider poses an imminent threat to the health or safety of the public.  Any order for suspension will be in writing and effective immediately upon service of the provider or its lawful agent.  Any provider served with an order of suspension shall immediately cease accepting all CCT cases and shall have the right to request a hearing if a written request is delivered to the Department within 15 days after receipt of the order of suspension.  If a timely request is delivered to the Department, then the Department will endeavor to schedule a hearing in an expedited manor, taking into account equity and the need for evidence and live witnesses at the hearing.  The Department is authorized to seek injunctive relief in the circuit court if the Director's order is violated.

 

(Source:  Amended at 44 Ill. Reg. 15619, effective September 4, 2020)

SUBPART G: LICENSURE OF SPECIALIZED EMERGENCY MEDICAL SERVICES VEHICLE (SEMSV) PROGRAMS

 

Section 515.900  Licensure of SEMSV Programs −  General

 

a)         No person, either as owner, agent or otherwise, shall furnish, operate, conduct, maintain, advertise or otherwise be engaged in the provision of emergency medical care or transportation to a sick or injured patient using a Specialized Emergency Medical Services Vehicle (SEMSV), unless currently licensed by the Department pursuant to this Subpart.  This requirement applies to:

 

1)         Any air medical service that may pick up a patient within the State of Illinois; and

 

2)         Any provider that advertises that it provides air medical transport services, regardless of its base of operation, location of vehicle registration, or percentage of vehicle use for air medical transport.

 

b)         An application for licensure shall be filed with the Department by submitting a Program Plan that includes the information required in this Part. The Program Plan shall be signed by the SEMSV Medical Director and the EMS Medical Director of the EMS System of which the SEMSV Program is a part.  (See Section 515.920(a) of this Part.)

 

c)         Each license shall be valid for a period of one year from the date of issuance, unless suspended or revoked.

 

d)         Each license shall be issued to the program named in the application for the specific vehicle or vehicles identified in the application and shall not be assignable or transferable.

 

e)         Section 515.800 regarding application and renewal of licensure shall apply.

 

f)         The Department shall inspect any vehicles, equipment, records or other documents covered by the licensed or applicant SEMSV Program annually to determine initial or continued compliance with the requirements of the Act andthis Part.

 

(Source:  Amended at 38 Ill. Reg. 16304, effective July 18, 2014)

 

Section 515.910  Denial, Nonrenewal, Suspension or Revocation of SEMSV Licensure

 

a)         The Director may issue an Emergency Suspension Order for any provider or vehicle licensed under this Part or the Act, when the Director or his or her designee has determined that an immediate and serious danger to the public health, safety and welfare exists.  Suspension or revocation proceedings which offer an opportunity for hearing shall be promptly initiated after the emergency suspension order has been issued.  (Section 3.85(b)(7) of the Act)

 

b)         The Department, in accordance with Section 515.160, after notice and an opportunity for hearing, shall deny an application for licensure or renewal, suspend or revoke a license when:

 

1)       the applicant or license holder has failed to meet or has violated any of the requirements of the Act or this Part; or

 

2)       any SEMSV personnel, during the provision of emergency services, have engaged in dishonorable, unethical or unprofessional conduct of a character likely to deceive, defraud or harm the public, such as not meeting the requirements of the Act, charging for services or equipment not provided or used, or using unqualified personnel as provided in Section 515.940.

 

c)         All hearings shall be governed by the Department's Practice and Procedure in Administrative Hearings and Section 3.135(a) and (b) of the Act.  Upon receipt of a notice of denial, nonrenewal, suspension or revocation, the applicant or certificate holder shall have 15 days in which to request a hearing.

 

(Source:  Amended at 38 Ill. Reg. 16304, effective July 18, 2014)

 

Section 515.920  SEMSV Program Licensure Requirements for All Vehicles

 

a)         The SEMSV Program shall be part of a Department-approved EMS System.

 

b)         The SEMSV Program shall meet and comply with all State and federal requirements governing the specific vehicles employed in the program.  (See Section 515.930, 515.945 or 515.970.)

 

c)         The SEMSV Program shall comply with this Part during its hours of operation.  The SEMSV Program shall operate 24 hours per day, every day of the year, in accordance with weather conditions, except when the service is committed to another medical emergency request, or is unavailable due to maintenance requirements.

 

d)         The SEMSV Program shall provide pre-hospital emergency services within its service area on a per-need basis without regard to the patient's ability to pay for the service.

 

e)         The SEMSV Program shall be supervised and managed by a Medical Director, who shall be a physician who has met at least the following requirements:

 

1)         Educational experience in those areas of medicine that are commensurate with the mission statement of the medical service (e.g., trauma, pediatric, neonatal, obstetrics) or utilize specialty physicians as consultants when appropriate;

 

2)         Valid certification and experience in Advanced Cardiac Life Support (ACLS), such as the American Heart Association's ACLS course or equivalent education;

 

3)         Valid certification and experience in Pediatric Advanced Life Support (PALS), such as the American Heart Association PALS course or PEPP/American Academy of Pediatrics Advanced Pediatric Life Support Course or equivalent education;

 

4)         Valid certification and experience in Advanced Trauma Life Support (ATLS), such as the American College of Surgeons' ATLS course or equivalent education;

 

5)         In programs using air vehicles, documentation, such as certificates or proof of completion in course work designed to bring about:

 

A)        Experience and knowledge in in-flight treatment modalities;

 

B)        Experience and knowledge in altitude physiology;

 

C)        Experience and knowledge in infection control as it relates to airborne and intra-facility transportation; and

 

D)        Experience and knowledge in stress management techniques;

 

6)         In programs using watercraft, documentation, such as certificates of completion in course work designed to bring about:

 

A)        Experience and knowledge in treating persons suffering from submersion incidents (cold, warm, fresh and salt water); and

 

B)        Experience and knowledge in diving accident physiology and treatment.

 

7)         In programs using air vehicles, the SESMV MD shall be knowledgeable and involved in the establishment of flight safety and weather-related parameters.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.930  Helicopter and Fixed-Wing Aircraft Requirements

 

In addition to the requirements specified in Sections 515.900 and 515.920, an SEMSV Program using helicopters or fixed-wing aircraft shall submit a program plan that includes the following:

 

a)         Documentation of the SEMSV MD's credentials as required by Section 515.920(e), and a statement signed by the MD containing his or her commitment to the following duties and responsibilities:

 

1)       Supervising and managing the program;

 

2)       Supervising and evaluating the quality of patient care provided by the aeromedical crew;

 

3)       Developing written treatment protocols and standard operating procedures to be used by the aeromedical crew during flight;

 

4)       Developing and approving a list of equipment and drugs to be available on the SEMSV during patient transfer;

 

5)       Providing periodic review, at least monthly, of patient care provided by the aeromedical crew;

 

6)       Providing for the CE of the aeromedical team (see Section 515.940(a)(2));

 

7)       Providing medical advice and expertise on the use, need and special requirements of aeromedical transfer;

 

8)       Submitting documentation assuring the qualifications of the aeromedical crew;

 

9)       Notifying the Department when the primary SEMSV is unavailable in excess of 24 hours, stating the reason for unavailability, the expected date of return to service, and the provisions made, if any, for replacement vehicles;

 

10)       Assuring appropriate staffing of the SEMSV, with a minimum of one EMS pilot and one aeromedical crew member for BLS  missions.  There shall be two aeromedical crew members for ALS and CCT, one of which must be an RN or physician with completion of education required by Section 515.940.  Two EMS pilots shall be used for fixed-wing aircraft or helicopters when required by the Federal Aviation Administration (FAA) requiring that staffing.  Additional aeromedical personnel may be required at the discretion of the SEMSV MD.  The SEMSV MD shall provide the Department with a list of all approved pilots and aeromedical crew members, and shall update the list whenever a change in those personnel is made;

 

b)         The SEMSV MD's list of required medical equipment and drugs for use on the aircraft (see Section 515.950);

 

c)         The SEMSV MD's treatment protocols and standard operating procedures;

 

d)         The curriculum and requirements for orientation and education (see Section 515.940(a)(2), (3) and (4)), including mandatory CE for all aeromedical crew members consisting of at least 16 hours in specialized aeromedical transportation topics, eight hours of which may include quality assurance reviews; operational safety standards; and weather related parameters;

 

e)         A description of the communications system accessing the aeromedical dispatch center, the medical control point, receiving and referring agencies (see Section 515.960);

 

f)         A description and map of the service area for each vehicle;

 

g)         A description of the EMS System's method of providing emergency medical services using the SEMSV Program; and

 

h)         The identification number and description of all vehicles used in the program.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.935  EMS Pilot Specifications

 

a)         Approval for EMS System participation for a pilot shall be valid for a period of one year and may be renewed by the SEMSV MD if the pilot has completed renewal education, which shall include, but is not limited to, the requirements of subsections (b)(1) and (5)(A) through (H) or subsections (c)(1) and (3)(A) through (F).

 

1)         For helicopter programs only:

 

A)        Four EMS pilots per helicopter, excluding relief support, shall be dedicated to the SEMSV Program.  Temporary staffing by three full-time pilots is permitted for no more than six months while finding and educating a replacement pilot.

 

B)        An EMS pilot assigned to SEMSV duty shall be physically present at the aircraft base to assure timely response.

 

C)        An EMS pilot assigned to SEMSV duty shall be provided with work space to carry out assigned duties.  If duty time exceeds 12 continuous hours, separate sleeping quarters shall be provided to assure physical rest.

 

2)         For fixed-wing programs only:  One EMS pilot per aircraft who will respond within one-half hour from the receipt of the request.

 

b)         Each EMS pilot assigned to a helicopter shall be approved for participation in an EMS System by the EMS MD and shall meet the following requirements:

 

1)         Compliance with subparts E and F of Air Taxi Operations and Commercial Operators (14 CFR 135).

 

2)         A minimum of 2000 flight hours with a minimum of 1500 rotorcraft flight hours and the following stipulations:

 

A)        Factory school or equivalent (ground and flight);

 

B)        A minimum of 1000 hours as the pilot in command (PIC) in a rotorcraft;

 

C)        100 flight hours at night, unaided; and

 

            D)        A minimum of 500 hours of turbine time.

 

3)         A minimum of five hours day/night area flight orientation, of which two hours must be at night, and, in the judgment of the SEMSV MD, special terrain flight orientation.

 

4)         Instrument Flight Rules (IFR) certification by the Federal Aviation Administration (IFR Currency is recommended).

 

5)         Documentation of completion of education that includes, but is not limited to, the following:

 

A)        Judgment and decision making;

 

B)        Local routine operating procedures, including day and night operations;

 

C)        Flight by reference to instruments, including Instrument Meteorological Conditions (IMC) recovery;

 

D)        Regional area weather phenomena;

 

E)        Area terrain hazards;

 

F)         Scene procedures;

 

G)        EMS System and SEMSV Program communications requirements;

 

H)        Orientation to each hospital/pre-hospital health care system affiliated with the SEMSV Program; and

 

I)         Crew resource management education.

 

c)         Each pilot assigned to a fixed-wing aircraft shall be approved by the EMS MD for participation in an EMS System and shall meet the following requirements:

 

1)         Compliance with subparts E and F of Air Taxi Operations and Commercial Operators (14 CFR 135);

 

2)         The pilot shall have a minimum of 2000 flight hours; a minimum of 1000 flight hours as PIC in a fixed wing aircraft; 100 night flight hours and 25 hours in the specific make and model of aircraft before flying as the PIC on patient missions; or completion of a commercially established education program for the specific make and model air craft and the successful completion of the check ride;

 

3)         Provide documentation of completion of education that includes, but is not limited to, the following:

 

A)        Judgment and decision making;

 

B)        Local routine operating procedures, including day and night operations;

 

C)        Flight by reference to instruments, including Instrument Meteorological Conditions (IMC) recovery;

 

D)        Regional area weather phenomena;

 

E)        Area terrain hazards;

 

F)         EMS System and SEMSV Program communications requirements; and

 

G)        Crew resource management education.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.940  Aeromedical Crew Member Education Requirements

 

a)         Except as provided for by subsection (b), each aeromedical crew member assigned to a helicopter or fixed-wing aircraft shall be approved by the SEMSV MD and shall meet the following requirements:

 

1)         Be a Paramedic, RN or a physician.

 

2)         Each crew member shall be current in, or obtain within six months of hire:

 

A)        Advanced Cardiac Life Support (ACLS);

 

B)        Pre-Hospital Trauma Life Support (PHTLS) or International Trauma Life Support (ITLS);

 

C)        Pediatric Advanced Life Support (PALS) or Emergency Nursing Pediatric Course (ENPC) or Pediatric Education for Prehospital Professionals (PEPP) Advanced;

 

D)        TNS or Trauma Nurse Core Course (TNCC);

 

E)        Neonatal Resuscitation Program (NRP) or an equivalent as approved by the EMS MD.

 

3)         Initial education program requirements for full-time and part-time critical care and ALS providers.  Each critical care and ALS provider shall successfully complete a comprehensive education program or show proof of recent experience, education and competency in the categories listed in subsections (a)(3)(A) and (B) prior to assuming independent responsibility.

 

A)        Didactic Component − Shall be specified and appropriate for the mission statement and scope of the medical transport service:

 

i)          Advanced airway management;

 

ii)         Altitude physiology/stressors of flight if involved in rotor wing or fixed wing operations;

 

iii)        Anatomy, physiology and assessment for adult, pediatric and neonatal patients;

 

iv)        Aviation − aircraft orientation/safety and in-flight procedures/general aircraft safety, including depressurization procedures for fixed wing (as appropriate). Ambulance orientation/safety and procedures as appropriate;

 

v)         Cardiac emergencies and advanced cardiac critical care;

 

vi)        Hemodynamic monitoring, pacemakers, implantable cardiac defibrillator (ICD), intra-aortic balloon pump, and central lines, pulmonary artery and arterial catheters;

 

vii)       Multiple patient incidents;

 

viii)      EMS radio communications;

 

ix)        Environmental emergencies;

 

x)         Hazardous materials recognition and response (all hazards recognition and response);

 

xi)        High risk obstetric emergencies (bleeding, medical, and trauma);

 

xii)       Infectious disease prevention, mitigation and treatment;

 

xiii)      Metabolic/endocrine emergencies;

 

xiv)      Multi-trauma (chest, abdomen, facial);

 

xv)       Neonatal emergencies (respiratory distress, surgical, cardiac);

 

xvi)      Oxygen therapy in the medical transport environment −  mechanical ventilation and respiratory physiology for adult, pediatric and neonatal patients as appropriate to the mission statement and scope of care of the medical transport service;

 

xvii)     Pediatric medical emergencies;

 

xviii)    Pediatric trauma;

 

xix)      Pharmacology;

 

xx)       Quality Management −  didactic education that supports the medical transport service mission statement and scope of care (e.g., adult, pediatric, neonatal);

 

xxi)      Respiratory emergencies;

 

xxii)     Scene management/rescue/extrication (rotor wing and ground ambulance);

 

xxiii)    Stress recognition and management;

 

xxiv)    Survival education;

 

xxv)     Record keeping;

 

xxvi)    Thermal, chemical, inhalation, radiation and electrical burns;

 

xxvii)   Legal aspects; and

 

xxviii)  Toxicology.

 

B)        Clinical Component − clinical experiences shall include, but not be limited to, the following (experiences shall be specific and appropriate for the mission statement and scope of care of the medical transport service):

 

i)          Critical care;

 

ii)         Emergency care;

 

iii)        Invasive procedures or simulations equivalent for practicing invasive procedures;

 

iv)        Neonatal intensive care;

 

v)         Obstetrics − five deliveries;

 

vi)        Pediatric critical care;

 

vii)       Pre-hospital care, for rotor wing programs only; and

 

viii)      Tracheal intubations − 10 performed on live patients either in the field or in the hospital setting when in the presence of and under the direct supervision of a licensed physician or Certified Registered Nurse Anesthetist (CRNA); or performed on cadavers or a human patient simulator (HPS) while under direct supervision; or when in the presence of and under the direct and immediate supervision of the EMS MD or SEMSV MD or designee.

 

4)         CE /staff development shall be provided and documented for all full-time and part-time critical care and ALS providers. These shall be specific and appropriate for the mission statement and scope of care of the medical transport service.

 

A)        Didactic CE shall include:

 

i)          Aviation − safety issues (if involved in rotor wing or fixed wing operations);

 

ii)         Requirements of this Part regarding ground and air transport;

 

iii)        Altitude physiology/stressors of flight (if involved in both rotor wing and fixed wing operations);

 

iv)        Critical care courses;

 

v)         Emergency care courses;

 

vi)        Hazardous materials recognition and response;

 

vii)       Infection control;

 

viii)      Stress recognition and management;

 

ix)        Survival education; and

 

x)         Equipment reviews consistent with program scope and mission.

 

B)        Clinical and laboratory CE shall include:

 

i)          Emergency/trauma care;

 

ii)         Critical care (adult, pediatric, neonatal);

 

iii)        Invasive procedure labs;

 

iv)        Labor and delivery;

 

v)         Pre-hospital experience, for rotor wing programs only;

 

vi)        Skills maintenance program documented to comply with number of skills required in a set period of time according to policy of the medical transport service (i.e., endotracheal intubations, chest tubes);

 

vii)       No fewer than five successful intubations per year are required for each Critical Care or ALS provider.  These intubations may be on live patients, either in the field or in the hospital setting, when in the presence of and under the direct supervision of a licensed physician or CRNA; or cadavers or HPS while under direct supervision; or when in the presence of and under the direct and immediate supervision of the EMS MD or SEMSV MD.  Success rates for all live intubations are documented and monitored through the quality management process; and

 

viii)      Live, HPS or cadaver intubation experience within the following age ranges if served by the air medical/ground inter-facility service: birth to 28 days; 28 days to 12 months; 12 months to 2 years; 2 years to 8 years; and 8 years and older.

 

5)         Yearly completion of the CE requirements as described in Section 515.930(d).

 

b)         In addition to at least one aeromedical crew member for BLS  who has met the requirements of subsection (a), and two aeromedical crew members, one of whom must be an RN or licensed physician, for ALS or CCT missions who have met the requirements of subsection (a), the EMS MD or SEMSV MD  may approve and assign additional crew members to a helicopter or fixed-wing aircraft.  The additional crew members shall meet the following requirements:

 

1)         Provide documentation of completion of education that includes, but is not limited to, the following:

 

A)        General patient care in-flight;

 

B)        Aircraft emergencies;

 

C)        Flight safety;

 

D)        EMS System and SEMSV Program communications;

 

E)        Use of all patient care equipment and

 

F)         Rescue and survival techniques.

 

2)         Yearly completion of the CE requirements as described in Section 515.930(d).

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.945  Aircraft Vehicle Specifications and Operation

 

a)         All vehicles shall meet the requirements of subparts A, B, C, and D of Air Taxi Operations and Commercial Operators (14 CFR 135).

 

b)         All vehicles shall have communication equipment to permit both internal crew and air-to-ground exchange of information between individuals and agencies, including at least those involved in SEMSV medical control within the EMS System, the flight operations center, air traffic control and law enforcement agencies.  Helicopters must be able to communicate with law enforcement agencies, EMS providers, fire agencies, and referring and receiving facilities.

 

c)         Rotor wing vehicles shall be equipped with a Medical Emergency Radio Communications for Illinois (MERCI) radio.

 

d)         All vehicles shall be designed to allow the loading and unloading of the patient without rotating the patient more than 30 degrees along the longitudinal axis or 45 degrees along the lateral axis.

 

e)         All vehicles shall be climate controlled to prevent temperature extremes that would adversely affect patient care in the judgment of the EMS MD or SEMSV MD.

 

f)         All vehicles shall have interior lighting to permit patient care to be given and patient status to be monitored without interfering with the pilot's vision.

 

g)         All vehicles shall carry survival equipment including but not limited to:

 

1)         Two sources of heat or fire;

 

2)         Two forms of signaling device;

 

3)         Equipment to provide shelter:  blanket, nylon cord and adhesive tape;

 

4)         Knife; and

 

5)         Food and water supply.

 

h)         All patients shall be restrained to the helicopter or fixed-wing aircraft litter to assure the safety of the patient and crew.

 

i)          For helicopter programs:

 

1)         Each rotorcraft shall be powered by at least one turbine engine.  There shall be at least one dedicated turbine powered rotorcraft.

 

2)         Each vehicle shall be staffed with at least one EMS pilot and at least one aeromedical crew member for BLS missions. There shall be two aeromedical crew members for ALS  and CCT, one of whom shall be an RN or licensed physician.

 

3)         Each vehicle shall be equipped with flight reference instruments to allow recovery from inadvertent Instrument Flight Rules (IFR) situations.

 

4)         Each vehicle shall be equipped with a searchlight pivoting at least 180 degrees horizontal and 90 degrees vertical, controlled by the pilot without removing hands from the flight controls.  The searchlight shall be at least 400,000 candlepower, mounted and operated in accordance with requirements of the Federal Aviation Administration (14 CFR 135).

 

5)         The cockpit shall be isolated by a protective barrier to minimize in-flight distraction or interference.

 

6)         All medical equipment, supplies and personnel shall be secured or restrained.

 

7)         All equipment, litters/stretchers and seating shall be arranged so as not to block rapid egress by personnel or patient from the aircraft and shall be affixed or secured in racks or compartments approved by the Federal Aviation Administration (14 CFR 135) or by straps.

 

j)          For fixed-wing aircraft programs:

 

1)         All single engine fixed-wing aircraft shall be powered by a turbine engine. There shall be at least one dedicated fixed-wing aircraft.

 

2)         Each vehicle shall be staffed with at least one EMS pilot and at least one aeromedical crew member for BLS missions.  There shall be two aeromedical crew members for ALS  and CCT.

 

3)         The aircraft shall be IFR equipped and certified.

 

4)         All equipment, litters/stretchers and seating shall be arranged so as not to block rapid egress by personnel or patient from the aircraft and shall be affixed or secured in approved racks or compartments or by strap restraint.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.950  Aircraft Medical Equipment and Drugs

 

a)         Each helicopter or fixed-wing aircraft shall be equipped with medical equipment and drugs that are appropriate for the various types of missions to which it will be responding, as specified by the SEMSV MD.

 

b)         The SEMSV MD shall submit for approval to the Department a list of medical equipment and drugs to be taken on any particular mission based on patient type (adult, child, infant), medical condition (high risk infant, cardiac, burn, etc.) and anticipated treatment needs en route.  This shall include, but not be limited to:

 

1)       Cardiac monitor with extra battery;

 

2)       Defibrillator that is adjustable for all age groups;

 

3)       External pacemaker;

 

4)       Advanced airway equipment, including, but not limited to, laryngoscope and tracheal intubation supplies for all age ranges;

 

5)       Mechanical ventilator available;

 

6)       Two suction sources; one must be portable;

 

7)       Pulse oximeter; central and peripheral sensors, adult and pediatric;

 

8)       End tidal CO₂ − quantitative wave form capnography;

 

9)       Automatic blood pressure monitor;

 

10)       Doppler with dual capacity to obtain fetal heart tones as well as systolic blood pressure;

 

11)       Invasive pressure monitor;

 

12)       Intravenous pumps with adjustable rates for appropriate age groups;

 

13)       Two sources of oxygen; one must be portable;

 

14)       A stretcher that is large enough to carry the 95^th percentile adult, full length in supine position, and that is rigid enough to support effective cardiopulmonary resuscitation and has the capability of raising the head 30°;

 

15)         Electrical power source provided by an inverter or appropriate power source of sufficient output to meet the requirements of the complete specialized equipment package without compromising the operation of any electrical aircraft equipment;

 

16)         If the patient weighs less than 60 lbs. (27 kg.), an appropriate (for height and weight) restraint device shall be used, which shall be secured by a devise approved by the Federal Aviation Administration (14 CFR 135);

 

17)         An isolette if the service mission profile includes neonate transports; and

 

18)         Opioid antagonist, including, but not limited to, Naloxone, with administration equipment appropriate for the licensed level of care of the SEMSV.

 

c)         The Department's approval shall be based on, but not limited to:

 

1)         Length of time of the mission;

 

2)         Possible environmental or weather hazards;

 

3)         Number of individuals served; and

 

4)         Medical condition of individuals served.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.955  Vehicle Maintenance for Helicopter and Fixed-wing Aircraft Programs

 

a)         For helicopter programs:

 

1)         The maintenance program shall meet the requirements of subpart J of Air Taxi Operations and Commercial Operators (14 CFR 135).

 

2)         One certified airframe and power plant (A & P) mechanic with two years experience for each helicopter shall be available and dedicated to the program 24 hours per day.

 

3)         Mechanics shall have completed factory-approved education for the makes and models of aircraft used in the SEMSV Program.

 

4)         Back-up maintenance support shall be available when the primary mechanic is unavailable or during times of extensive maintenance needs.

 

5)         Hangar facilities shall be available for major maintenance activities, as specified in manufacturer's requirements.  These facilities need not be located at the base of operations.

 

6)         Progressive maintenance on aircraft used by the SEMSV Program is recommended, including routine daily inspections, as required by the aircraft manufacturer.

 

b)         For fixed-wing aircraft programs:

 

1)         The maintenance program shall meet the requirements of subpart J of Air Taxi Operations and Commercial Operators (14 CFR 135).

 

2)         Mechanics shall be certified A & P with two years experience, and shall have completed education for the make and model of aircraft used by the SEMSV Program.

 

3)         Hangar facilities shall be available for major maintenance activities as specified in manufacturer's requirements.

 

4)         Progressive maintenance on aircraft used by the SEMSV Program is recommended, including routine daily inspections, as required by the aircraft manufacturer.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.960  Aircraft Communications and Dispatch Center

 

a)         The SEMSV Program shall have a designated person assigned and available 24 hours per day every day of the year to receive and dispatch all requests for aeromedical services.  For fixed-wing aircraft programs, a telephone answering service may be used.

 

b)         Education of the designated person shall be commensurate with the scope of responsibility of the communications center and pertinent to the air medical service, including:

 

1)         Knowledge of EMS roles and responsibilities of the various levels of education;

 

2)         Knowledge of Federal Aviation Administration and Federal Communications Commission regulations;

 

3)         General safety rules, emergency procedures and flight following procedures;

 

4)         Navigation techniques/terminology and understanding weather interpretation;

 

5)         Types of radio frequency bands used;

 

6)         Stress recognition and management;

 

7)         Medical terminology and obtaining patient information;

 

8)         Assistance with all hazards response and recognition procedure using appropriate reference materials; and

 

9)         Crew resource management.

 

c)         The dispatch center shall have at least one dedicated telephone number for the SEMSV Program.

 

d)         A pre-arranged emergency plan shall be in place to cover situations in which an aircraft is overdue, radio communication cannot be established, or an aircraft location cannot be verified.

 

e)         A back-up power source shall be available for all communications equipment used at the SEMSV medical control point.

 

f)         The dispatch center shall have a system for recording all incoming and outgoing telephone and radio transmissions with time recording and playback capabilities.  Recordings shall be kept for 30 days.

 

g)         In addition, for helicopter programs:

 

1)         The dispatch center shall have the capability to communicate with the aircraft pilot and aeromedical crew for nonmedical purposes on a separate designated frequency.

 

2)         Continuous flight following every 15 minutes shall be maintained and documented.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.963  Flight Program Safety Standards

 

For rotor-wing and fixed-wing programs:

 

a)         Flight crews shall wear the following protective clothing:

 

1)         Reflective material or striping on uniforms during night operations;

 

2)         Flame-retardant clothing;

 

3)         Flight helmets for all rotorcraft crews, including specialty teams; and

 

4)         Boots or sturdy footwear for on-scene operations.

 

b)         Safety and Environment

 

1)         Oxygen storage shall be 10 feet from any heat source and 20 feet from any open flame.

 

2)         All crews shall carry a photo ID with first and last names while on duty.

 

3)         Family members or other passengers who accompany patients shall be identified and listed in the communications center.

 

4)         A policy shall address the security of the aircraft and physical

environment (i.e., hangar, fuel farm), including: 

 

A)        Security of the aircraft or ambulance if left unattended on a helipad, hospital ramp or unsecured airport or parking lot;

 

B)        Education for pilots, mechanics and medical personnel to recognize signs of aircraft tampering; and

 

C)        A plan to address aircraft or ambulance tampering.

 

c)         Completion of all of the following educational components shall be documented for each of the flight medical personnel:  

 

1)         General aircraft safety:

 

A)        Aircraft evacuation procedures (exits and emergency release  mechanisms), including emergency shutdown − engines, radios,  fuel switches, and electrical and oxygen shutdown;

 

B)        Aviation terminology and communication procedures, including knowledge of emergency communications and knowledge of emergency communications frequency;

 

C)        In-flight and ground fire suppression procedures (use of fire extinguishers);

 

D)        In-flight emergency and emergency landing procedures (i.e., position, oxygen, securing equipment);

 

E)        Safety in and around the aircraft, including national aviation regulations pertinent to medical team members, landing zone personnel when possible, patients, and lay individuals;

 

F)         Specific capabilities, limitations and safety measures for each aircraft used, including specific education for backup or  occasionally used aircraft;

 

G)        Use of emergency locator transmitter (ELT); and

 

H)        All ground support ambulances used for fixed wing operations shall meet minimal State ambulance licensing requirements located in Section 515.830.

 

2)         Ground operations rotor wing (RW)

 

A)        Landing site policies consistent with Federal Aviation Administration Helicopter Emergency Medical Services (HEMS) requirements;

 

B)        Patient loading and unloading – policy for rapid loading/unloading procedures;

 

C)        Refueling policy for normal and emergency situations;

 

D)        Hazardous materials recognition, response and training policy consistent with 2014 Aeronautical Information Manual, Chapter 10 (2014, US Department of Transportation); 

 

E)        Highway scene safety management policy that demonstrates coordination with local emergency response personnel;

 

F)         Survival education/techniques/equipment that are pertinent to the environment/geographic coverage area of the medical service based on the program risk assessment;

 

G)        Smoke in the cockpit/cabin, firefighting in the cockpit/cabin; and 

 

H)        Emergency evacuation of crew and patients.

 

d)         A planned and structured safety program shall be provided to public safety/law enforcement agencies and hospital personnel who interface with the medical service that includes:

 

1)          Identifying, designating and preparing an appropriate landing zone (LZ).

 

2)          Personal safety in and around the helicopter for all ground personnel.

 

3)          Procedures for day/night operations, conducted by the medical team, specific to the aircraft, including:

 

A)        High and low reconnaissance;

 

B)        Two-way communications between helicopter and ground personnel to identify approach and departure obstacles and wind  direction;

 

C)        Approach and departure path selection; and

 

D)        Procedures for the pilot to ensure safety during ground operations in an LZ with or without engines running.   

 

4)         Crash recovery procedures specific to the aircraft make and model shall minimally include:

 

A)        Location of fuel tanks;

 

B)        Oxygen shut-offs in cockpit and cabin;

 

C)        Emergency egress procedures;

 

D)        Aircraft batteries; and

 

E)        Emergency shut-down procedures.

 

5)         Education regarding "helicopter shopping" shall be included.

 

6)         Records shall be kept of initial and recurrent safety education of pre-hospital, referring and receiving ground support personnel.

 

e)         The program shall maintain a safety management system that is proactive in identifying risks and eliminating injuries to personnel and patients and damage to equipment.

 

f)         Special requirements for night operations; SEMSV rotorcraft programs shall incorporate use of night vision goggles (NVG) and shall be compliant by December 31, 2018:

 

1)         Pilot required; and

 

2)         Medical crew recommended.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.965  Watercraft Requirements

 

In addition to the requirements specified in Sections 515.900 and 515.920, an SEMSV Program using watercraft shall submit a program plan that includes the following:

 

a)         Documentation of the EMS MD's or SEMSV MD's credentials as required by Section 515.920(e), and a statement signed by the EMS MD or SEMSV MD committing to the following duties and responsibilities:

 

1)         Supervising and managing of the program;

 

2)         Supervising and evaluating the quality of patient care provided by the watercraft crew;

 

3)         Developing written treatment protocols and standard operating procedures to be used by the watercraft crew during vehicle operation;

 

4)         Developing and approving a list of equipment and drugs to be available on the SEMSV during patient transfer;

 

5)         Providing periodic review, at least quarterly, of patient care provided by the watercraft crew;

 

6)         Providing medical advice/expertise on the use, need and special requirements of watercraft transfer;

 

7)         Submitting documentation assuring the qualifications of the watercraft crew;

 

8)         Assuring appropriate staffing of the SEMSV:

 

A)        Each watercraft crew member assigned to a watercraft shall be approved by the EMS MD or SEMSV MD, who shall provide the Department with a list of all approved crew members and watercraft operators and update the list whenever a change in such personnel is made.

 

B)        For ALS operations, the watercraft shall be staffed by a crew of at least one Paramedic, RN or physician, and one other EMT, A-EMT, EMT-I, Paramedic, RN or physician, in addition to the watercraft operator.

 

C)        For BLS operations, the watercraft shall be staffed by a crew of at least two of the following: EMT, A-EMT, EMT-I, Paramedic, RN  or physician, one of whom may also be the watercraft operator.

 

D)        Except as provided for by subsection (a)(8)(E) of this Section, each watercraft crew member shall document, appropriate to their scope of practice, completion of education that includes, but is not limited, to the following:

 

i)          Advanced life support;

 

ii)         Cardiac support;

 

iii)        Traumatic emergencies;

 

iv)        Pediatric emergencies;

 

v)         Psychiatric emergencies;

 

vi)        Crisis intervention;

 

vii)       Infection control;

 

viii)      Advanced airway management techniques;

 

ix)        Environmental emergencies;

 

x)         Radio or other EMS communications;

 

xi)        Rescue and survival techniques;

 

xii)       Record keeping;

 

xiii)      Legal aspects;

 

xiv)      Certification in Advanced Life Saving by the American Red Cross; and

 

xv)       Completion of a boat safety course conducted pursuant to Section 5-18 of the Boat Registration and Safety Act [625 ILCS 45].

 

E)        In addition to at least two watercraft crew members who have met the requirements of subsections (a)(8)(B) through (D), the EMS MD or SEMSV MD may approve and assign additional watercraft crew members to a watercraft.  Such additional watercraft crew members shall document the completion of training that includes but is not limited to the following:

 

i)          General patient care;

 

ii)         Watercraft emergencies;

 

iii)        Completion of a boat safety course conducted pursuant to Section 5-18 of the Boat Registration and Safety Act;

 

iv)        EMS System and SEMSV Program communications;

 

v)         Use of all patient care equipment;

 

vi)        Rescue and survival techniques; and

 

vii)       Certification in Advanced Life Saving by the American Red Cross.

 

F)         Watercraft operators shall be at least 21 years of age and shall meet the following requirements:

 

i)          Certification in Advanced Life Saving by the American Red Cross; and

 

ii)         Completion of a boat safety course conducted pursuant to Section 5-18 of the Boat Registration and Safety Act;

 

b)         The EMS MD's or the SEMSV MD's list of required medical equipment and drugs for use on the watercraft (see Section 515.975);

 

c)         The EMS MD's or the SEMSV MD's standing orders (treatment protocols, standard operating procedures);

 

d)         A description of the communications system linking the watercraft with the SEMSV medical control point;

 

e)         A description of the EMS System's method of providing emergency medical services using the SEMSV Program;

 

f)         A description and map of the service area for each vehicle; and

 

g)         The identification number and description of all vehicles used in the program.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.970  Watercraft Vehicle Specifications and Operation

 

a)         All watercraft shall meet the requirements of Article IV of the Boat Registration and Safety Act.

 

b)         All watercraft shall carry equipment including but not limited to the following:

 

1)         One anchor with line attached that is three times the maximum depth of water in the areas of usual operation;

 

2)         Two docking fenders;

 

3)         Two mooring lines;

 

4)         Self or mechanical bailer;

 

5)         Search light with a minimum of 200,000 candle power;

 

6)         Swim harness attached to 75 feet of tethering line;

 

7)         Waterproof flashlight capable of operating for more than two hours;

 

8)         Basic tool kit, to include at least:

 

A)        Wrench, 12 inch with adjustable open end;

 

B)        Screw driver, 12 inch with straight blade;

 

C)        Locking pliers, minimum length, 10 inches;

 

9)         One life jacket for each member of the watercraft crew and two extra adult life jackets (Type I, II or III);

 

10)         Two child life jackets (Type I or II);

 

11)         Any watercraft 16 feet or more in length, except a canoe or kayak, shall have a least one Type IV (throwable) U.S. Coast Guard approved personal floatation device (PFD) or its equivalent on board, in addition to the PFDs required in subsections (b)(9) and (10);

 

12)         Knife, 6-inch blade, with sheath;

 

13)         Boat hook, extendable to at least 10 feet;

 

14)         A locking mechanism to secure a stretcher or litter below the gunwale level;

 

15)         Lanyard or engine cut-off device;

 

16)         Lights (operational between the hours of sunset and sunrise);

 

17)         Mufflers;

 

18)         Whistle or electric or air powered horn;

 

19)         Fire extinguisher;

 

20)         Carburetor arrestors (except for outboard motors);

 

21)         Ventilators (except for open boats);

 

22)         Battery covers to prevent accidental shorting;

 

23)         For watercraft operating on Lake Michigan:

 

A)        A VHF/FM marine radio with at least 25 watts of power;

 

B)        Navigational charts for service area and navigational aids, including compass or Global Positioning System (GPS);

 

C)        Speed capability of 20 knots per hour;

 

D)        Visual distress signal; and

 

E)        Sealing of marine heads.

 

c)         All watercraft shall have communication equipment to assure exchange of information between individuals and agencies, including at least those involved at the SEMSV medical control point within the EMS System, and law enforcement agencies.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.975  Watercraft Medical Equipment and Drugs

 

a)         Each watercraft shall be equipped with medical equipment and drugs that are appropriate for the various types of missions to which it will be responding, as specified by the EMS MD or the SEMSV MD.

 

b)         Opioid antagonist, including, but not limited to, Naloxone, appropriate for the licensed level of care of the SEMSV.

 

c)         For ALS operations, the EMD MD or the SEMSV MD shall submit for approval a list of supplies available for each mission used.  The EMS MD or the SEMSV MD shall decide on the medical equipment and drugs taken on any particular mission based on patient type (adult, child, infant), medical condition (high risk infant, cardiac, burn, etc.) and anticipated treatment needs en route.

 

d)         The Department's approval shall be based on, but not limited to:

 

1)         length of time of the mission;

 

2)         possible environmental or weather hazards;

 

3)         number of individuals served; and

 

4)         medical condition of individuals served.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.980  Watercraft Communications and Dispatch Center

 

a)         The SEMSV Program shall have a designated dispatch center assigned and available 24 hours per day every day of the year to receive and dispatch all requests for watercraft services.

 

b)         The communications and dispatch center shall have the ability to communicate with the watercraft for nonmedical purposes through approved telecommunications or on a separate designated radio frequency.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.985  Off-Road SEMSV Requirements

 

In addition to the requirements specified in Sections 515.900 and 515.920, an SEMSV Program utilizing off-road SEMSV vehicles shall submit a program plan that includes the following:

 

a)         Documentation of the EMS MD's or the SEMSV MD's  credentials as required by Section 515.920(e), and a statement signed by the EMS MD or the SEMSV MD containing his or her commitment to the following duties and responsibilities:

 

1)         The supervision and management of the program;

 

2)         Supervising and evaluating the quality of patient care provided by the off-road SEMSV crew;

 

3)         Providing medical advice and expertise on the use, need and special requirements of off-road SEMSV transfer;

 

4)         Submitting documentation assuring the qualifications of the off-road SEMSV crew; and

 

5)         Assuring appropriate staffing of the off-road SEMS vehicle:

 

A)        For ALS operations, the vehicle shall be staffed by a minimum of one Paramedic, RN or physician and one other EMT, A-EMT, EMT-I, Paramedic, RN or physician, one of whom may also be the driver of the off-road SEMSV; and

 

B)        For BLS operations, the vehicle shall be staffed by a minimum of two of the following: EMTs, A-EMTs, EMT-Is, Paramedics, RNs or physicians, one of whom may also be the driver of the off-road SEMSV;

 

b)         The EMS MD's or the SEMSV MD's list of required medical equipment and drugs for use on the off-road SEMSV (see Section 515.995 of this Part);

 

c)         The EMS MD's or the SEMSV MD's standing orders (treatment protocols, standard operating procedures);

 

d)         A description of the communications system linking the off-road SEMSV with the SEMSV medical control point;

 

e)         A description and map of the service area for each vehicle;

 

f)         The identification number and description of all vehicles used in the program;

 

g)         An agreement/contract with a licensed ground provider for transportation of patients; and

 

h)         A description of the EMS System's method of providing emergency medical services using the SEMSV Program.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.990  Off-Road Vehicle Specifications and Operation

 

a)         The off-road SEMSV shall have sufficient space for the vehicle operator, a patient in a supine position, and personnel rendering medical care alongside the patient.

 

b)         Each vehicle shall have a locking mechanism to secure the patient transport litter/stretcher to the off-road SEMSV.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.995  Off-Road Medical Equipment and Drugs

 

a)         Each off-road SEMSV shall be equipped with medical equipment and drugs for the various types of missions to which it will be responding, as specified by the EMS MD or the SEMSV MD.

 

b)         Opioid antagonist, including, but not limited to, Naloxone, appropriate for the licensed level of care of the SEMSV.

 

c)         For ALS operations, the EMS MD or the SEMSV MD shall submit for approval a list of supplies available for each mission.  The SEMSV MD shall decide what medical equipment and drugs are taken on any particular mission based on patient type (adult, child, infant), medical condition (high risk infant, cardiac, burn, etc.) and anticipated treatment needs en route.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

 

Section 515.1000  Off-Road Communications and Dispatch Center

 

a)         The SEMSV Program shall have a designated dispatch center assigned and available 24 hours per day every day of the year to receive and dispatch all requests for off-road SEMSV services.

 

b)         The communications and dispatch center shall have the ability to communicate with the off-road SEMSV for nonmedical purposes through approved telecommunications or on a separate designated radio frequency.

 

(Source:  Amended at 42 Ill. Reg. 17632, effective September 20, 2018)

SUBPART H: TRAUMA CENTERS

 

Section 515.2000  Trauma Center Designation

 

a)         The Department shall attempt to designate trauma centers in all areas of the State.  There shall be at least one Level I Trauma Center serving each EMS Region, unless waived by the Department.  Level I Trauma Centers shall serve as resources for Level II Trauma Centers in the EMS Regions.  The extent of such relationships shall be defined in the EMS Region plan.  (Section 3.90(b)(5) of the Act)

 

b)         Any hospital seeking designation as a Level I or Level II Trauma Center shall submit an application form (see Section 515.Appendix A of this Part) as prescribed by the Department.

 

c)         Upon receipt of a completed application, the Department shall conduct a site visit to determine compliance with the Act and this Part.  A report of the inspection shall be provided to the Director within 30 days of the completion of the site visit.  (Section 3.90(b)(3) of the Act) The applicant hospital shall be operational for designation within six months after the application and site survey are approved.

 

d)         The Department shall designate those applicant hospitals as Level I or Level II Trauma Centers which meet the requirements established by the Act and this Part.

 

e)         Beginning September 1, 1997 the Department shall designate a new Trauma Center only when a local or Regional need for such a Trauma Center has been identified by the applicable EMS Region's Trauma Center Medical Directors Committee, with advice from the Regional Trauma Advisory Committee.  (Section 3.90(b)(4) of the Act) Department designation shall be based upon any of the following criteria justifying a need for designation of a new Trauma Center:

 

1)         Number of expected trauma cases;

 

2)         An estimated time of arrival to existing Trauma Centers greater than 25 minutes;

 

3)         The number of times that surrounding Trauma Centers went on bypass status within the preceding year;

 

4)         A recommendation by the Trauma Regional Advisory Board or Regional EMS Advisory Committee that there is an indentifiable need for additional Trauma Centers since the trauma system was implemented; and

 

5)         Documentation of extenuating circumstances, which will be reviewed by the Department on an individual basis, where a special need exists and/or a population is not serviced by an existing Trauma Center.

 

f)         A Trauma Center designation shall be for two years.

 

g)         All requests for renewal of Trauma Center designations shall be filed in writing (see Section 515.Appendix B of this Part) with the Department before the designation expiration date.  If the renewal request meets the requirements of this Part, the existing designation shall continue in full force and effect until a final Department decision on the renewal request has been issued.

 

h)         Any level Trauma Center may voluntarily terminate its designation prior to its expiration date by notifying the Department in writing.  Such notification shall include the anticipated date of termination, which shall not exceed 60 days after notice is received by the Department, and shall describe the procedures taken by the Trauma Center to notify the providers, hospitals, EMS systems and other Trauma Centers in the EMS Region.

 

i)          No facility shall use the phrase "Trauma Center" or words of similar meaning in relation to itself or hold itself out as a Trauma Center without first obtaining designation pursuant to the Act and this Part.  (Section 3.105 of the Act)

 

(Source:  Amended at 22 Ill. Reg. 16543, effective September 8, 1998)

 

Section 515.2010  Denial of Application for Designation or Request for Renewal

 

a)         The Department shall deny an application for designation or a request for renewal of a designation when its findings show failure to substantially comply with the Act or this Part.

 

b)         The Department shall provide written notice, via certified mail, of its decision to deny an application for designation or a request for renewal of a designation.  The applicant shall have 15 days after receipt of the written notice to make a written request for an administrative hearing to contest the Department's decision.  All administrative hearings shall be conducted in accordance with the Department's Rules of Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100).

 

(Source:  Added at 21 Ill. Reg. 5170, effective April 15, 1997)

 

Section 515.2020  Inspection and Revocation of Designation

 

a)         The Department shall have the authority to inspect designated trauma centers to assure compliance with the provisions of the Act and this Part.  Information received by the Department through filed reports, inspection or as otherwise authorized under the Act shall not be disclosed publicly in such a manner as to identify individuals or hospitals, except in a proceeding involving the denial, suspension or revocation of a trauma center designation or imposition of a fine on a trauma center.  (Section 3.90(b)(6) of the Act)

 

b)         The Department shall have the authority to take the following action, as appropriate, after determining that a trauma center is in violation of the Act or this Part:

 

1)         If the Director determines that the violation presents a substantial probability that death or serious physical harm will result and if the trauma center fails to eliminate the violation immediately or within a fixed period of time, not exceeding 10 days, as determined by the Director, the Director may immediately revoke the trauma center designation.  The trauma center may appeal the revocation within 15 days after receiving the Director's revocation order, by requesting a hearing as provided by Section 3.135 of the Act.  The Director shall notify the chair of the Region's Trauma Center Medical Directors Committee and EMS Medical Directors for the appropriate EMS Systems of such a trauma center designation revocation.

 

2)         If the Director determines that the violation does not present a substantial probability that death or serious physical harm will result, the Director shall issue a notice of violation and request a plan of correction which shall be subject to the Department's approval.  The trauma center shall have 10 days after the receipt of the notice of violation in which to submit a plan of correction.  The Department may extend this period for up to 30 days.  (Section 3.90(b)(10)(B) of the Act)

 

A)        The Department will consider the following factors in determining whether or not to extend the period for submission of the plan of correction to a maximum of 30 days:  whether a substantial probability that death or serious physical harm will result still exists, and whether the delay could lead to physical harm.

 

B)        The plan shall include a fixed time period not in excess of 90 days within which violations are to be corrected. The plan of correction and the status of its implementation by the trauma center shall be provided, as appropriate, to the EMS Medical Directors for the appropriate EMS Systems.  If the Department rejects a plan of correction, it shall send notice of the rejection and the reason for the rejection to the trauma center.  The trauma center shall have 10 days after receipt of the notice of rejection in which to submit a modified plan.  If the modified plan is not timely submitted, or if the modified plan is rejected, the trauma center shall follow an approved plan of correction imposed by the Department.  If, after notice and opportunity for hearing, the Director determines that a trauma center has failed to comply with an approved plan of correction, the Director may revoke the trauma center designation. The trauma center shall have 15 days after receiving the Director's notice in which to request a hearing.  Such hearing shall conform to the provisions of Section 3.135 of the Act.  (Section 3.90(b)(10)(B) of the Act)

 

C)        Each plan of correction shall be based on an assessment by the facility of the conditions or occurrences which are the basis of the violation and an evaluation of the practices, policies, and procedures which have caused or contributed to the conditions or occurrences.  Evidence of such assessment and evaluation shall be maintained by the facility.  Each plan shall include:

 

i)          A description of the specific corrective action the facility is taking, or plans to take, to abate, eliminate, or correct the violation cited in the notice;

 

ii)         A description of the steps that will be taken to avoid future occurrences of the same or similar violations.

 

D)        The Department shall review each plan of correction to ensure that it provides for the abatement, elimination, or correction of the violation.  The Department shall reject a submitted plan if it finds any of the following deficiencies:

 

i)          The plan does not address the conditions or occurrences that are the basis of the violation and an evaluation of the practices, policies, and procedures that have caused or contributed to the conditions or occurrences.

 

ii)         The plan is not specific or does not provide measures to indicate the actual actions the facility will be taking to abate, eliminate, or correct the violation(s).

 

iii)        The plan does not provide steps that will avoid future occurrences of the same and similar violations.

 

iv)        The plan does not provide for timely completion of the corrective action, considering the seriousness of the violation, any possible harm to patients, and the extent and complexity of the corrective action.

 

E)        The Department shall verify the completion of the corrective action:

 

i)          By requiring the trauma center to submit monthly reports to the Department for up to one year, which consists of current hospital trauma plan (first month only); trauma quality monitoring plan and indicators (first month only); minutes of all meetings pertaining to trauma, including but not limited to Trauma Service Committee, Department of Surgery, and Morbidity and Mortality Review Committee; a list of all Category I and II trauma patients treated in the previous month, which includes but is not limited to medical record number, date and time of arrival at the trauma center, sex, mechanism of injury, trauma category classification and time; trauma surgeon and surgical specialty; time of notification and arrival time; and

 

ii)         Through subsequent investigations, surveys and evaluations of the trauma center.

 

(Source:  Added at 21 Ill. Reg. 5170, effective April 15, 1997)

 

Section 515.2030  Level I Trauma Center Designation Criteria

 

a)         Level I Trauma Centers, under the direction of Level I Trauma Center Medical Directors, shall be responsible for coordinating and managing trauma care in the EMS Region.  This responsibility includes obtaining the cooperation of all Level II Trauma Centers, Participating Hospitals, and EMS Systems in the EMS Region.  A Level I Trauma Center Medical Director shall be the chairperson of the Regional Trauma Advisory Committee.

 

b)         The Trauma Center Medical Director shall be a trauma surgeon, board certified in surgery, with at least two years of post-residency experience in trauma care and with 24-hour independent operating privileges.

 

c)         The trauma center shall provide a trauma service, separate from the general surgery service, that is an identified hospital service functioning under the designated director and staffed by trauma surgeons with one year of experience in trauma, and who are available in-house 24 hours a day for immediate response.

 

1)         Trauma surgeons shall have 10 hours of trauma-related CME every two years.

 

2)         The trauma surgeon requirement may be fulfilled by residents with a minimum of four years of general surgery residency training with independent operating room privileges and who have current Advanced Trauma Life Support (ATLS) verification.

 

3)         If the resident is fulfilling the trauma surgeon requirement, the attending physician must be consulted within 30 minutes after the patient's being classified as Category I or II.

 

4)         If the resident is fulfilling the trauma surgeon requirement, it is mandatory that an attending be present 30 minutes after the decision to operate is made.

 

5)         The trauma surgeon, resident or surgical subspecialist shall be consulted when the decision is made to admit a Category II patient. The trauma surgeon or appropriate subspecialist shall see the patient within 12 hours after Emergency Department (ED) arrival.

 

6)         A physician with current ATLS verification or who has current competency in the initial resuscitation of the trauma patient as verified by the professional staff competency plan must be present 24 hours per day in the Level I Trauma Center to treat the trauma patient.

 

7)         The hospital's quality improvement program shall monitor compliance with this subsection (c).

 

8)         The trauma center shall have the option of allowing the ED personnel to determine that a trauma patient with an isolated injury may be treated by one of the services listed in subsection (d) of this Section.  An isolated injury refers to the transfer of energy to a single specific anatomic body region with no potential for multisystem involvement.  The subspecialist is to arrive within the designated time listed in subsection (d) after notification that his or her services are needed at the hospital.  When the need for neurosurgical intervention has been identified, the neurosurgeon must arrive and be available in a fully staffed operating room within 60 minutes after the identification of need for operative intervention.

 

d)         The trauma center shall have the following surgical services within the designated times listed below:

 

1)         On call to arrive at the hospital to treat the patient within 30 minutes after notification that their services are needed at the hospital:

 

A)        Cardiothoracic; this requirement may be fulfilled by a cardiothoracic surgeon or a trauma/general surgeon with experience in cardiothoracic surgery for lifesaving procedures; the surgeon must have cardiothoracic privileges;

 

B)        Obstetrics; and

 

C)        Pediatric surgery as designated by Section 515.2035 of this Part or by transfer agreement.

 

2)         On call to arrive at the hospital to treat the patient within 60 minutes after notification that their services are needed at the hospital:

 

A)        Orthopedic;

 

B)        Vascular;

 

C)        Ophthalmologic;

 

D)        Oral-Dental;

 

E)        Otorhinolaryngologic;

 

F)         Plastic/maxillofacial;

 

G)        Urologic;

 

H)        Reimplantation service, or a transfer agreement; and

 

I)         Neurosurgical.  When the need for neurosurgical intervention has been identified, the neurosurgeon must arrive and be available in a fully staffed operating room within 60 minutes after the identification of the need for operative intervention.

 

3)         Twenty-four hours a day, or a transfer agreement:

 

A)        Burn center staffed by Registered Nurses trained in burn care; and

 

B)        Acute spinal cord injury management.

 

e)         The trauma center shall provide the following nonsurgical services within the designated times:

 

1)         Emergency Medicine staffed 24 hours a day in the ED by:

 

A)        A physician who has competency in trauma as demonstrated by:

 

i)          Board certification or board eligibility by the American Board of Emergency Medicine (ABEM) or the American Osteopathic Board of Emergency  Medicine (AOBEM) of the American Osteopathic Association (AOA); and

 

ii)         Ten hours per year of American Medical Association (AMA) or AOA-approved Category I or II trauma-related CME; or

 

B)        A physician who was working in the emergency department of a trauma center prior to January 1, 2000, and who had completed 12 months of internship, followed by at least 7000 hours of hospital-based Emergency Medicine over at least a 60-month period (including 2800 hours within one 24-month period), and CME totaling 50 hours, 10 of which are trauma related, for each post-internship year in which the physician completed any hospital-based Emergency Medicine hours.

 

2)         Anesthesiology Services:

 

A)        The anesthesiology service or department shall be supervised by anesthesiologists.  "Supervise", for the purposes of this subsection, means to manage, control and direct the services performed, including being present in the trauma center and immediately available for consultation while the services are being performed.

 

B)        Anesthesiology services shall be available 24 hours a day in-house.

 

C)        Direct patient care services may be performed by an anesthesiologist or a certified registered nurse anesthetist (CRNA) acting under the direct supervision of an anesthesiologist.

 

3)         Radiology staffed by:

 

A)        A technician with the ability to perform a computerized axial tomography (CAT) scan in-house, 24 hours a day.

 

B)        A radiologist with the ability to read CAT scans and perform angiography available within 30 minutes.  This requirement may be met by a Post Graduate Year (PGY) II radiology resident with six months experience in CAT and angiography.  Teleradiographic equipment may be used to transmit CAT scans to radiologists off site in lieu of the radiologists' response to the trauma center to read CAT scans.  The radiology department shall provide a quality monitoring process to validate the resident's compliance with the time requirements and competency to read CAT scans and perform angiography.

 

4)         Intensive Care Medicine Unit (ICU) having available 24 hours a day in-house:

 

A)        A physician credentialed by the hospital.  This requirement may be fulfilled by second and third year residents who have had intensive care training and are under the supervision of a staff physician possessing full intensive care privileges;

 

B)        One Registered Professional Nurse per shift with two years of ICU or critical care experience and four hours of trauma-related critical care  continuing education per year; and

 

C)        The following equipment:

 

i)          Airway control and ventilation devices;

 

ii)         Oxygen source with concentration controls;

 

iii)        Cardiac emergency cart;

 

iv)        Electrocardiograph-oscilloscope-defibrillator;

 

v)         Cardiac output monitoring;

 

vi)        Electronic pressure monitoring;

 

vii)       Mechanical ventilator-respirators;

 

viii)      Pulmonary function measuring devices, i.e., pulse oximeter and CO₂ monitoring;

 

ix)        Temperature control devices;

 

x)         Drugs, intravenous fluids, and supplies in accordance with the Hospital Licensing Requirements (77 Ill. Adm. Code 250.1050, 250.2140, and 250.2710);

 

xi)        Intracranial pressure monitoring devices; and

 

xii)       Intra-aortic balloon pump capability.

 

5)         Laboratory 24 hours a day in-house, providing the following:

 

A)        Standard analysis of blood, urine, and other body fluids;

 

B)        Blood typing and cross-matching;

 

C)        Coagulation studies;

 

D)        Comprehensive blood bank or access to a community central blood bank and adequate hospital storage facilities (see Hospital Licensing Requirements (77 Ill. Adm. Code 250.520));

 

E)        Blood gases and pH determinations;

 

F)         Microbiology, to include the ability to initiate aerobic and anaerobic cultures on a 24 hour per day basis; and

 

G)        Drug and alcohol screening.

 

6)         Cardiology -- 60 minutes.

 

7)         Internal Medicine -- 60 minutes.

 

8)         Pediatrics -- 60 minutes.

 

9)         Postanesthetic recovery capabilities 24 hours a day (may be fulfilled by ICU).

 

10)       Acute hemodialysis capability 24 hours a day.

 

11)       The trauma center shall demonstrate an ongoing relationship with its designated organ procurement agency (OPA).

 

f)         The trauma center shall meet the following professional staff requirements:

 

1)         The ED Director shall be a physician board certified by the ABEM or certified by the AOBEM of the AOA;

 

2)         The ED treating the Category I or Category II trauma patient shall be cared for by at least one RN who holds a current nationally recognized trauma nursing certification such as Trauma Certified Registered Nurse (TCRN), Advanced Trauma Certified Nurse (ATCN), or Trauma Nursing Core Course (TNCC); or is currently recognized as a Trauma Nurse Specialist (TNS);

 

3)         A full-time Trauma Coordinator shall be dedicated solely to the Trauma Program;

 

4)         An operating room shall be staffed in-house and available 24 hours a day; and

 

5)         Staff shall include occupational therapy, speech therapy, physical therapy, social work, dietary, and psychiatry.

 

g)         The trauma center shall develop a professional staff competency plan, including but not limited to trauma surgeons and emergency medicine physicians treating the trauma patients.  Physicians caring for trauma patients in the Level I Trauma Center must demonstrate the following:

 

1)         Board certification/Board eligibility in their specialty;

 

2)         Successful completion of trauma-related CME requirements as specified in this Section;

 

3)         Ongoing clinical involvement in the care of the trauma patient as evidenced by the routine participation in one or more of the following:  trauma call rosters, trauma teams, and attendance at trauma rounds/trauma meetings;

 

4)         Physician specific outcome measurements for high volume/high acuity procedures;

 

5)         For trauma surgeons and emergency medicine physicians only, the successful completion of an ATLS provider course.

 

h)         The trauma center shall provide and maintain the following equipment:

 

1)         Airway control and ventilation equipment including laryngoscopes and endotracheal tubes of appropriate sizes, bag-mask, resuscitator, sources of oxygen, mechanical ventilator, pulse oximetry and CO₂ monitoring;

 

2)         Suction devices and equipment (pulmonary and gastric);

 

3)         Electrocardiograph-oscilloscope-defibrillator;

 

4)         Apparatus to establish central venous pressure monitoring;

 

5)         All standard intravenous fluids and administration devices;

 

6)         Sterile surgical instruments or sets for emergency care, such as cricothyrotomy, tracheostomy, thoracotomy, thoracostomy, cut down, peritoneal lavage, and intraosseous;

 

7)         Drugs and supplies necessary for emergency care;

 

8)         X-ray and CAT scan capability;

 

9)         Spinal immobilization equipment;

 

10)       Temporary pacemaker;

 

11)       Temperature control device; and

 

12)       Specialized pediatric resuscitation cart with measuring device in the emergency area.

AGENCY NOTE:  Broselow(TM) Pediatric Tape will meet this requirement.

 

i)          The trauma center must have helicopter landing capabilities approved by State and federal authorities.  (Section 3.95(i) of the Act) The helicopter landing capabilities shall:

 

1)         Comply with the Aviation Safety Rules of the Illinois Department of Transportation (92 Ill. Adm. Code 14, specifically 14.790, 14.792, and 14.795);

 

2)         Be covered by a favorable airspace determination letter issued by the Federal Aeronautics Administration pursuant to Sections 307 and 309 of the Federal Aviation Act of 1958, and 14 CFR 157 and 14 CFR 77, Subpart D;

 

3)         Be provided on the campus of the trauma center; and

 

4)         Out-of-state trauma centers are exempt from this subsection but must provide proof of compliance with their state's rules that govern aviation safety.

 

j)          The trauma center shall perform focused outcome analyses of its trauma services on a quarterly basis, and shall provide on site or upon request all minutes related to these reviews to the Department.  The analyses shall consist of at least:

 

1)         Review of all patient deaths, excluding dead on arrival (DOA).  Patients must be assigned a status of non-preventable death, potentially preventable death, preventable death, or cannot be determined, using the American College of Surgeons "Performance Improvement" (Chapter 16, from "Resources for Optimal Care of the Injured Patient, 1999").  Factors contributing to the death must be included in the review.  A cumulative report of these findings should be kept on site and available to the Department upon request.

 

2)         Review of all morbidities.  A morbidity is a negative outcome that is the result of the original trauma and/or treatment rendered or omitted.  Factors contributing to the morbidity must be included in the review.  A cumulative report of these findings must be presented quarterly to the Region.

 

3)         Review of audit filters.  An audit filter is a clinical and/or internal resource indicator used to examine the process of care and to identify potential patient care and/or internal resource problems.

 

4)         All information contained in or relating to any medical audit performed of a trauma center's trauma services pursuant to the Act or by an EMSMD or his designee of medical care rendered by system personnel, shall be afforded the same status as is provided information concerning medical studies in Article VIII, Part 21 of the Code of Civil Procedure.  (Section 3.110(a) of the Act)

 

k)         Every two years the trauma center shall provide written protocols with the redesignation packet, which shall include the following:

 

1)         Policies for treating patients in the Level I Trauma Center, which include Trauma Category I and Trauma Category II criteria as required in Section 515.Appendices C and F of this Part;

 

2)         Clinical protocols for the management of the trauma patient in basic resuscitation and management of specific injuries, kept on site and available to the Department upon request;

 

3)         The protocols for transferring trauma patients to more specialized care;

 

4)         A policy that a blood alcohol test will be drawn on any motor vehicle crash victim who is believed to have been the driver of the vehicle;

 

5)         A suspension policy for trauma nurse specialists, meeting due process requirements (see Section 515.2200); and

 

6)         A professional staff competency plan in accordance with subsection (g) of this Section.

 

l)          Changes to the Trauma Center Plan must be approved by the Department prior to implementation.

 

m)        The practices of the trauma center shall reflect the protocols and policies of the EMS Region and Trauma Center plan.

 

n)         The resuscitation care of a Trauma Category I or Trauma Category II patient must be documented on a Trauma Flow Sheet, which at minimum contains trauma category classification; time and place of classification (field or in-house); time of arrival of patient to trauma center; notification of surgical specialties and time of arrival to see patient (may exclude isolated injuries for Category II patients).

 

o)         The trauma center shall maintain a job description for the Trauma Center Medical Director that details his/her responsibility and authority for the coordination and management of trauma services.

 

p)         The trauma center shall maintain a job description for the Trauma Coordinator that details his/her responsibility and authority for the coordination and management of trauma services.

 

q)         The trauma service must be identified in the facility's budget, with sufficient funds dedicated to support the trauma director and trauma coordinator's positions and to provide for the operation of the trauma registry.

 

r)          The trauma center shall develop a policy that identifies resource limitations that would result in the diversion of a trauma patient to another facility.  The hospital shall also develop a policy that identifies what measures will be taken to avoid requesting a resource limitation/bypass (see Section 515.315).

 

1)         Such diversion must be reported to the Department by telephone if it occurs during business hours or written notification by fax of diversion must be sent within 24 hours following the diversion.

 

2)         Both forms of notification shall include at minimum:

 

A)        The name of the trauma center;

 

B)        Date and time of resource limitation; and

 

C)        The reason for resource limitation.

 

s)         The trauma center shall develop a plan for implementing a program of public information and education concerning trauma care for adult and pediatric patients.

 

(Source:  Amended at 46 Ill. Reg. 20898, effective December 16, 2022)

 

Section 515.2035  Level I Pediatric Trauma Center

 

a)         The Level I Pediatric Trauma Center Director shall advise the Trauma Center Medical Director and shall be a member of the Regional Trauma Advisory Board.

 

b)         The Pediatric Trauma Center Medical Director shall be board certified in pediatric surgery or be a general surgeon, with at least two years of experience in pediatric trauma care, 10 hours per year of trauma-related continuing medical education (CME), and 24-hour independent operating privileges, as evidenced by:

 

1)         care and supervision for 50 pediatric trauma cases per year; and

 

2)         ongoing involvement in pediatric trauma care.

 

c)         The trauma center shall provide a pediatric trauma service separate from the general surgery service.  The pediatric trauma service shall be staffed by pediatric trauma surgeons with one year of experience in pediatric trauma or general surgeons with two years of pediatric trauma care experience, who are available in-house 24 hours a day for immediate response.

 

1)         The pediatric trauma surgeon requirement may be fulfilled by residents with a minimum of four years of general surgery residency training with independent operating room privileges for pediatric surgery and who have current Advanced Trauma Life Support (ATLS) verification.

 

2)         If the resident is fulfilling the pediatric trauma surgeon requirement, the attending pediatric trauma surgeon must be consulted within 30 minutes after the patient's being classified as Category I or II.

 

3)         If the resident is fulfilling the pediatric trauma surgeon requirement, it is mandatory that the attending pediatric trauma surgeon be present for patients undergoing operative procedures by the time the surgery begins.

 

4)         The pediatric trauma surgeon, pediatric surgery resident or surgical subspecialist shall be consulted when the decision is made to admit a Category II patient.  The pediatric trauma surgeon or appropriate subspecialist shall see the patient within 12 hours after the patient arrives in the Emergency Department (ED).

 

5)         A physician with current ATLS verification or who has current competency in the initial resuscitation of the trauma patient as verified by the professional staff competency plan must be present 24 hours per day in the Level I Pediatric Trauma Center to treat the trauma patient.

 

6)         The hospital's quality improvement program shall monitor compliance with this subsection (c).

 

7)         The trauma center shall have the option of allowing the ED personnel to determine that a trauma patient with an isolated injury may be treated by one of the services listed in subsection (d) of this Section.  Any patient meeting the definition of isolated injury requires consultation with the appropriate subspecialist.  That subspecialist is to arrive within the time designated in subsection (d) after the notification that his or her services are needed at the hospital.  When the need for neurosurgical intervention has been identified, the neurosurgeon must arrive and be available in a fully staffed operating room within 60 minutes after the identification of need for operative intervention.  An isolated injury refers to the transfer of energy to a single specific anatomic body region with no potential for multisystem involvement.

 

d)         The trauma center shall provide the following surgical services within the designated times, by physicians credentialed by the hospital to provide pediatric care:

 

1)         On call to arrive at the hospital to treat the patient within 30 minutes after notification that their services are needed at the hospital:

 

A)        Cardiothoracic; this requirement may be fulfilled by a cardiothoracic surgeon or a pediatric trauma/general surgeon with experience in pediatric cardiothoracic surgery for lifesaving procedures; the surgeon must have pediatric cardiothoracic privileges; and

 

B)        Obstetrics, or a transfer agreement.

 

2)         On call to arrive at the hospital to treat the patient within 60 minutes after notification that their services are needed at the hospital:

 

A)        Orthopedic;

 

B)        Vascular;

 

C)        Ophthalmologic;

 

D)        Oral-dental;

 

E)        Otorhinolaryngologic;

 

F)         Plastic/maxillofacial;

 

G)        Urologic;

 

H)        Reimplantation service, or a transfer agreement;

 

I)         Neurosurgery.

 

3)         Twenty-four hours a day, or a transfer agreement:

 

A)        Burn center staffed by registered nurses trained in burn care; and

 

B)        Acute spinal cord injury management.

 

e)         The pediatric trauma center shall provide the following nonsurgical services:

 

1)         Department of Pediatrics with a designated Board certified pediatrician in the role of chairman.

 

2)         Emergency Medicine staffed 24 hours a day in the ED by a physician who is board prepared or certified by the ABEM or by the American Board of Pediatrics and Pediatric Emergency Medicine (ABP/PEM) or AOBEM with two year ongoing involvement in daily pediatric trauma care and 10 hours per year of trauma-related CME.

 

3)         Anesthesiology Services:

 

A)        The anesthesiology service or department shall be supervised by pediatric anesthesiologists.  "Supervise," for the purposes of this subsection (e)(3)(A), means to manage, control and direct the services performed, including being present in the trauma center and immediately available for consultation while the services are being performed.

 

B)        Pediatric anesthesiology services as credentialed by the hospital available 24 hours a day in-house.

 

C)        Direct patient care services may be performed by a pediatric anesthesiologist or a certified registered nurse anesthetist (CRNA) with experience in pediatric anesthesia acting under the direct supervision of a pediatric anesthesiologist.

 

4)         Radiology staffed by:

 

A)        A technician with the ability to perform a computerized axial tomography (CAT) scan in-house, 24 hours a day.

 

B)        A radiologist with the ability to read CAT scans and perform angiography available within 30 minutes.  This requirement may be met by a Post Graduate Year (PGY) II radiology resident with six months experience in CAT and angiography.  Teleradiographic equipment may be used to transmit CAT scans to radiologists off site in lieu of the radiologists' response to the trauma center to read CAT scans.  The radiology department shall provide a quality monitoring process to validate the resident's compliance with the time requirements and competency to read CAT scans and perform angiography.

 

C)        A pediatric radiologist on staff to provide a quality improvement process to validate interpretation of pediatric films.

 

5)         Pediatric intensive care unit having available 24 hours a day:

 

A)        A physician credentialed by the hospital.  This requirement may be fulfilled by pediatric or general surgery residents at the second or third year level or by pediatric or surgical critical care fellows who have had pediatric intensive care training and are under the supervision of a staff physician possessing full pediatric intensive care privileges;

 

B)        One Registered Professional Nurse per shift  with two years of pediatric intensive care or critical care experience and four hours of trauma-related pediatric critical care continuing education per year; and

 

C)        The following pediatric equipment:

 

i)          Airway control and ventilation devices;

 

ii)         Oxygen source with concentration controls;

 

iii)        Cardiac emergency cart;

 

iv)        Electrocardiograph-oscilloscope-defibrillator;

 

v)         Cardiac output monitoring;

 

vi)        Electronic pressure monitoring;

 

vii)       Mechanical ventilator-respirators;

 

viii)      Pulmonary function measuring devices, i.e., pulse oximeter and CO[2] monitoring;

 

ix)        Temperature control devices;

 

x)         Drugs, intravenous fluids, and supplies in accordance with the Hospital Licensing Requirements (77 Ill. Adm. Code 250.1050, 250.2140, and 250.2710); and

 

xi)        Intracranial pressure monitoring devices.

 

6)         Laboratory 24 hours a day in-house, providing the following:

 

A)        Standard analysis of blood and urine, and other body fluids using micro-sampling techniques;

 

B)        Blood typing and cross-matching;

 

C)        Coagulation studies;

 

D)        Comprehensive blood bank or access to a community central blood bank and adequate hospital storage facilities (see Hospital Licensing Requirements (77 Ill. Adm. Code 250.520));

 

E)        Blood gases and pH determinations;

 

F)         Microbiology, to include the ability to initiate aerobic and anaerobic cultures on a 24 hour per day basis; and

 

G)        Toxicology screening.

 

7)         A board-certified pediatrician shall be available within 60 minutes after notification.

 

8)         Pediatric cardiology 60 minutes after notification.

 

9)         Postanesthetic recovery capabilities 24 hours a day (may be fulfilled by a pediatric ICU).

 

10)       Acute hemodialysis capability 24 hours a day.

 

11)       Open heart capability.

 

f)         The trauma center shall meet the following professional staff requirements:

 

1)         The ED Director shall be a physician board certified by the ABEM or ABP/PEM or certified by the AOBEM;

 

2)         The Emergency Department treating the Category I or Category II trauma patient shall be cared for by at least one RN who holds a current nationally recognized trauma nursing certification such as Trauma Certified Registered Nurse (TCRN) or Trauma Nursing Core Course (TNCC); or is currently recognized as a Trauma Nurse Specialist (TNS);

 

3)         A full-time Trauma Coordinator dedicated solely to the Trauma Program;

 

4)         An operating room shall be staffed in-house and available 24 hours a day; and

 

5)         Staff shall include occupational therapy, speech therapy, physical therapy, social work, child protective services, dietary and pediatric psychiatry.

 

g)         The Trauma Center shall develop a professional staff competency plan including but not limited to trauma surgeons and emergency medicine physicians treating the trauma patients.  Physicians caring for trauma patients in the Level I Pediatric Trauma Center must demonstrate the following:

 

1)         Board certification/Board eligibility in their specialty;

 

2)         Successful completion of trauma-related CME requirements as specified in this Section;

 

3)         Ongoing clinical involvement in the care of the trauma patient as evidenced by routine participation in one or more of the following: trauma call rosters, trauma teams, and attendance at trauma rounds/trauma meetings;

 

4)         Physician specific outcome measurements for high volume/high acuity procedures;

 

5)         For trauma surgeons and emergency medicine physicians only, the successful completion of an ATLS provider course.

 

h)         The trauma center shall provide and maintain the following equipment:

 

1)         Airway control and ventilation equipment including laryngoscopes and endotracheal tubes of appropriate sizes, bag-mask, resuscitator, sources of oxygen, mechanical ventilator, CO₂ monitoring and pulse oximeter;

 

2)         Suction devices and equipment (pulmonary and gastric);

 

3)         Electrocardiograph-oscilloscope-defibrillator, pacemaker;

 

4)         Apparatus to establish central venous pressure monitoring;

 

5)         All standard intravenous fluids and administration devices;

 

6)         Sterile surgical instruments or sets for emergency care, such as cricothyrotomy, tracheostomy, thoracotomy, thoracostomy, cut down, peritoneal lavage, intraosseous;

 

7)         Drugs and supplies necessary for emergency care;

 

8)         X-ray and CAT scan capability;

 

9)         Spinal immobilization equipment;

 

10)       Temperature control devices;

 

11)       Pediatric measuring device;

 

12)       Scale; and

 

13)       Specialized pediatric resuscitation cart with measuring device in the emergency area.

AGENCY NOTE:  Broselow(TM) Pediatric Tape will meet this requirement.

 

i)          The trauma service must be identified in the facility's budget, with sufficient funds dedicated to support the trauma director and trauma coordinator positions and to provide for the operation of the trauma registry.

 

j)          A level I Pediatric Trauma Center shall meet the requirements of Section 515.2030(i)-(s) of this Part.

 

(Source:  Amended at 46 Ill. Reg. 20898, effective December 16, 2022)

 

Section 515.2040  Level II Trauma Center Designation Criteria

 

a)         A Level II Trauma Center, under the direction of a Level II Trauma Center Medical Director, shall be responsible for providing trauma care in accordance with the EMS System Program Plan.

 

b)         The Trauma Center Medical Director shall be a trauma surgeon, board certified in surgery, with at least two years of post-residency experience in trauma care and with 24-hour independent operating privileges.

 

c)         The trauma center shall provide a trauma service, separate from the general surgery service, that is an identified hospital service functioning under the designated director and staffed by trauma surgeons with one year of experience in trauma, and who will arrive at the hospital to treat the trauma patient within 30 minutes after the patient's being classified as a Category I trauma patient.

 

1)         The trauma surgeons shall have 20 hours of trauma-related CME every two years.

 

2)         The trauma surgeon requirement may be fulfilled by residents with a minimum of four years of general surgery residency training and current ATLS verification.

 

3)         If the resident is fulfilling the trauma surgeon requirement, the attending physician must be consulted within 30 minutes after the patient's being classified as Category I or II.

 

4)         If the resident is fulfilling the trauma surgeon requirement, it is mandatory that an attending be present for patients undergoing operative procedures by the time the surgery begins.

 

5)         The trauma surgeon, resident or surgical subspecialist shall be consulted when the decision is made to admit a Category II patient.  The trauma surgeon or appropriate subspecialist shall see the patient within 12 hours after ED arrival.

 

6)         A physician with current ATLS verification or who has current competency in the initial resuscitation of the trauma patient as verified by the professional staff competency plan must be present 24 hours per day in the Level II Trauma Center to treat the trauma patient.

 

7)         The hospital's quality improvement program shall monitor compliance with this subsection (c).

 

8)         The trauma center shall maintain a call schedule that identifies at least a primary and back-up surgeon, each listed by surgeon's name.

 

9)         The trauma center shall have the option of allowing the ED personnel to determine that a trauma patient with an isolated injury may be treated by one of the services listed in subsection (d) or (e) of this Section. An isolated injury refers to the transfer of energy to a single specific anatomic body region with no potential for multisystem involvement. The subspecialist must arrive within the time frame listed in subsection (d) or (e) after notification that his or her services are needed at the hospital.  When the need for neurosurgical intervention has been identified, the neurosurgeon must arrive and be available in a fully staffed operating room within 60 minutes after the identification of need for operative intervention.

 

d)         The trauma center shall have the following surgical services on call to arrive at the hospital to treat the patient within 60 minutes after notification that their services are needed:

 

1)         Cardiothoracic; this requirement may be fulfilled by a cardiothoracic surgeon or a trauma/general surgeon with experience in cardiothoracic surgery for lifesaving procedures; the surgeon must have cardiothoracic privileges;

 

2)         Orthopedic;

 

3)         Urologic; and

 

4)         Obstetrics.

 

e)         The trauma center shall have the following surgical specialties on call to arrive at the hospital to treat the patient within 60 minutes after notification that their services are needed.  When the need for neurosurgical intervention has been identified, the neurosurgeon must arrive and be available in a fully staffed operating room within 60 minutes after the identification of the need for operative intervention.  The following services may be provided by written transfer agreement.  These services must be provided according to subsection (c)(9) of this Section for isolated injuries when the trauma surgeon is not required to respond:

 

1)         Neurosurgical;

 

2)         Ophthalmologic;

 

3)         Oral-Dental;

 

4)         Otorhinolaryngologic;

 

5)         Reimplantation;

 

6)         Plastic/Maxillofacial;

 

7)         Burn center staffed by Registered Professional Nurses trained in burn care;

 

8)         Acute spinal cord injury management; and

 

9)         Pediatric surgery as designated by Section 515.2045 of this Part.

 

f)         The trauma center shall provide the following nonsurgical services within the designated times:

 

1)         Emergency Medicine staffed 24 hours a day in the ED by:

 

A)        A physician who has competency in trauma as demonstrated by:

 

i)          Board certification or board eligibility by the ABEM or the AOBEM; and

 

ii)         Ten hours per year of AMA or AOA-approved Category I or II trauma-related CME; or

 

B)        A physician who was working in the emergency department of a trauma center prior to January 1, 2000, and who had completed 12 months of internship, followed by at least 7000 hours of hospital-based Emergency Medicine over at least a 60-month period (including 2800 hours within one 24-month period), and CME totaling 50 hours, 10 of which are trauma related for each post-internship year in which the physician completed any hospital-based Emergency Medicine Hours.

 

2)         Anesthesiology Services:

 

A)        Anesthesiology services shall be in compliance with the Hospital Licensing Act and the Hospital Licensing Requirements, 77 Ill. Adm. Code 250.1410.  Staff shall be on call to arrive at the hospital to administer anesthesia within 30 minutes after notification that their services are needed at the hospital.

 

B)        Direct patient care services may be performed by an anesthesiologist or a CRNA.

 

3)         Laboratory – 24 hours a day in-house, providing the following:

 

A)        Standard analysis of blood, urine, and other body fluids;

 

B)        Blood typing and cross-matching;

 

C)        Coagulation studies;

 

D)        Comprehensive blood bank or access to a community central blood bank and adequate hospital storage facilities (see Hospital Licensing Requirements (77 Ill. Adm. Code 250.520));

 

E)        Blood gases and pH determinations;

 

F)         Microbiology, to include the ability to initiate aerobic and anaerobic cultures on a 24 hour per day basis; and

 

G)        Drug and alcohol screening.

 

4)         Radiology staffed by:

 

A)        A technician with the ability to perform a CAT scan available within 30 minutes; and

 

B)        A radiologist with the ability to read CAT scans and perform angiography available within 60 minutes.  This requirement may be met by a PGY II radiology resident with six months experience in CAT and angiography.  The radiology department shall provide a quality monitoring process to validate the resident's compliance with the time requirements and competency to read CAT scans and perform angiography.  Teleradiographic equipment may be used to transmit CAT scans off site in lieu of the radiologist's response to the trauma center to read CAT scans.

 

5)         Cardiology – 60 minutes.

 

6)         Internal Medicine – 60 minutes.

 

7)         Postanesthetic recovery capability staffed and available within 30 minutes may be fulfilled by ICU.

 

8)         Intensive Care Medicine Unit having available the following:

 

A)        A physician credentialed by the hospital and available within 30 minutes. This requirement may be fulfilled by second and third year residents who have had intensive care training and are under the supervision of a staff physician possessing full intensive care privileges;

 

B)        One Registered Professional Nurse per shift with two years of ICU experience and four hours of trauma-related critical care continuing education per year.

 

C)        The following equipment:

 

i)          Airway control and ventilation devices;

 

ii)         Oxygen source with concentration controls;

 

iii)        Cardiac emergency cart;

 

iv)        Electrocardiograph-oscilloscope-defibrillator;

 

v)         Temperature control devices;

 

vi)        Drugs, intravenous fluids, and supplies in accordance with the Hospital Licensing Requirements (77 Ill. Adm. Code 250.1050, 250.2140, and 250.2710);

 

vii)       Mechanical ventilator-respirators;

 

viii)      Pulmonary function measuring devices (i.e., pulse oximeter, CO₂ monitoring); and

 

ix)        Drugs, intravenous fluids and supplies in accordance with Hospital Licensing Requirements (77 Ill. Adm. Code 250.1050, 250.2140 and 250.2710).

 

9)         Pediatrics – 60 minutes.

 

10)       Acute hemodialysis capability 24 hours a day or a transfer agreement.

 

g)         The trauma center shall meet the following professional staff requirements:

 

1)         The ED Director shall be a physician board certified by the ABEM, or certified by the AOBEM of the AOA;

 

2)         The Emergency Department treating the Category I or Category II trauma patient shall be cared for by at least one RN who holds a current nationally recognized trauma nursing certification such as Trauma Certified Registered Nurse (TCRN) or Trauma Nursing Core Course (TNCC); or is currently recognized as a Trauma Nurse Specialist (TNS);

 

3)         A full-time Trauma Coordinator dedicated solely to the Trauma program;

 

4)         An operating room shall be staffed and available within 30 minutes 24 hours a day; and

 

5)         Staff shall include occupational therapy, speech therapy, physical therapy, social work, dietary, and psychiatry.

 

h)         The trauma center shall develop a professional staff competency plan including but not limited to trauma surgeons and emergency medicine physicians treating the trauma patients.  Physicians caring for trauma patients in the Level II Trauma Center must demonstrate the following:

 

1)         Board certification/Board eligibility in their specialty;

 

2)         Successful completion of trauma-related continuing medical education (CME) requirements as specified in this Section;

 

3)         Ongoing clinical involvement in the care of the trauma patient as evidenced by routine participation in one or more of the following: trauma call rosters, trauma teams, and attendance at trauma rounds/trauma meetings;

 

4)         Physician specific outcome measurements based on the frequency and acuity of procedures or other peer review measures pertinent to the facility trauma patient volume;

 

5)         For trauma surgeons and emergency medicine physicians only, the successful completion of an ATLS provider course.

 

i)          The trauma center shall provide and maintain the following equipment:

 

1)         Airway control and ventilation equipment including laryngoscopes and endotracheal tubes of appropriate sizes, bag-mask, resuscitator, sources of oxygen, mechanical ventilator, pulse oximeter and CO₂ monitoring;

 

2)         Suction device;

 

3)         Electrocardiograph-oscilloscope-defibrillator;

 

4)         Apparatus to establish central venous pressure monitoring;

 

5)         All standard intravenous fluids and administration devices;

 

6)         Sterile surgical sets of procedures standard for ED, such as cricothyrotomy, tracheostomy, thoracotomy, cut down, peritoneal lavage, and intraosseous;

 

7)         Drugs and supplies necessary for emergency care;

 

8)         X-ray and CAT scan capability, available within 30 minutes;

 

9)         Spinal immobilization equipment;

 

10)       Temporary pacemaker;

 

11)       Temperature control device; and

 

12)       Specialized pediatric resuscitation with measuring device cart in the emergency area.

AGENCY NOTE:  Broselow(TM) Tape will meet this requirement.

 

j)          The trauma center must have helicopter landing capabilities approved by State and federal authorities.  (Section 3.100(j) of the Act) The helicopter landing capabilities shall:

 

1)         Comply with the Aviation Safety Rules of the Illinois Department of Transportation (92 Ill. Adm. Code 14.790, 14.792 and 14.795);

 

2)         Be covered by a favorable airspace determination letter issued by the Federal Aeronautics Administration pursuant to Sections 307 and 309 of the Federal Aviation Act of 1958, and 14 CFR 157 and 14 CFR 77, Subpart D; and

 

3)         Be provided on the campus of the trauma center.

 

Out-of-state trauma centers are exempted from this subsection (j) but must comply with their state's rules that govern aviation safety.

 

k)         The trauma center shall perform focused outcome analyses of its trauma services on a quarterly basis and shall provide all minutes related to these reviews on site or at the request of the Department.  The analyses shall consist of at least:

 

1)         Review of all patient deaths, excluding dead on arrival (DOA).  Patients must be assigned a status of non-preventable death, potentially preventable death, or preventable death, or cannot be determined, using the American College of Surgeons "Performance Improvement" (Chapter 19, from "Resources for the Optimal Care of the Injured Patient, 1999").  Factors contributing to the death must be included in the review.  A cumulative report of these findings shall be available on site and upon request by the Department.

 

2)         Review of all morbidities.  A morbidity is a negative outcome that is the result of the original trauma and/or treatment rendered or omitted. Factors contributing to the morbidity must be included in the review.  A cumulative report of these findings must be presented quarterly to the Region.

 

3)         Review of audit filters.  An audit filter is a clinical and/or internal resource indicator used to examine the process of care and to identify potential patient care and/or internal resource problems.

 

4)         All information contained in or relating to any medical audit performed of a trauma center's trauma services pursuant to the Act, or by an EMSMD or his designee of medical care rendered by system personnel, shall be afforded the same status as is provided information concerning medical studies in Article VIII, Part 21 of the Code of Civil Procedure.  (Section 3.110(a) of the Act)

 

l)          Every two years the trauma center shall provide to the Department written protocols concerning the following:

 

1)         Policies for treating patients in the trauma center, which includes Trauma Category I and Trauma Category II criteria as required in Section 515.Appendices C and F of this Part;

 

2)         Clinical protocols for management of the trauma patient in basic resuscitation and management of specific injuries.  Protocols are to be kept on site and available to the Department upon request;

 

3)         The transfer of trauma patients to the Level I Trauma Center serving the EMS Region or a more specialized level of care;

 

4)         A policy that blood alcohol will be drawn on a motor vehicle crash victim who is believed to have been the driver of the vehicle;

 

5)         A suspension policy for trauma nurse specialists meeting due process requirements (see Section 515.2200).

 

6)         A professional staff competency plan in accordance with subsection (k) of this Section.

 

m)        Changes to the Trauma Center Plan must be approved by the Department prior to implementation.

 

n)         The practices of the trauma center shall reflect the protocols and policies of the EMS Region and Trauma Center Plan.

 

o)         The resuscitation care of a Trauma Category I or Trauma Category II patient must be documented on a Trauma Flow Sheet, which at minimum contains trauma category classification; time and place of classification (field or in-house); time of arrival of patient to trauma center; notification of surgical specialties and time of arrival to see patient (may exclude isolated injuries for Category II patients).

 

p)         The trauma center shall maintain a job description for the Trauma Center Medical Director, which details his/her responsibility and authority for the coordination and management of trauma services.

 

q)         The trauma center shall maintain a job description for the Trauma Coordinator, which details the responsibility and authority for the coordination and management of trauma services.

 

r)          The trauma service must be identified in the facility's budget with sufficient funds dedicated to support, at a minimum, the trauma director and trauma coordinator positions and to provide for operation of the trauma registry.

 

s)         The trauma center shall develop a policy that identifies situations that would result in trauma bypass.  The hospital shall also develop a policy that identifies what measures will be taken to avoid requesting a resource limitation/bypass (see Section 515.315).

 

1)         Such diversion must be reported to the Department by telephone if it occurs during business hours or written notification by fax of diversion must be sent within 24 hours following the diversion.

 

2)         Both forms of notification shall include at minimum:

 

A)        The name of the trauma center;

 

B)        Date and time of resource limitation; and

 

C)        The reason for resource limitation.

 

t)          The trauma center shall develop a plan for implementing a program of public information and education concerning trauma care for adult and pediatric patients.

 

(Source:  Amended at 46 Ill. Reg. 20898, effective December 16, 2022)

 

Section 515.2045  Level II Pediatric Trauma Center

 

a)         The Level II Pediatric Trauma Director shall advise the Trauma Center Medical Director and shall be a member of the Regional Trauma Advisory Board.

 

b)         The Pediatric Trauma Center Medical Director shall be board certified in pediatric surgery or be a general surgeon, with at least two years of experience in pediatric trauma care, and have 10 hours per year of trauma-related CME, and 24-hour independent operating privileges, as evidenced by either:

 

1)         responsibility for 50 pediatric trauma cases per year; or

 

2)         both:

 

A)        responsibility for 10 percent of the total number of pediatric trauma cases at the trauma center per year; and

 

B)        ongoing involvement in pediatric trauma care.

 

c)         The trauma center shall provide a pediatric trauma service separate from the general surgery service.  The pediatric trauma service shall be staffed by pediatric trauma surgeons who have one year of experience in trauma, who have 24-hour independent operating privileges, and who will arrive at the hospital to treat the trauma patient within 30 minutes after the patient's being classified as a Category I trauma patient.

 

1)         The pediatric trauma surgeon requirement may be fulfilled by residents with a minimum of four years of pediatric surgery residency training and who have current ATLS verification.

 

2)         If the resident is fulfilling the pediatric trauma surgeon requirement, the attending pediatric trauma surgeon must be consulted within 30 minutes after the patient's being classified as Category I or II.

 

3)         If the resident is fulfilling the pediatric trauma surgeon requirement, it is mandatory that the attending pediatric trauma surgeon be present for Category I patients undergoing operative procedures by the time the surgery begins.

 

4)         The pediatric trauma surgeon, pediatric surgery resident or surgical subspecialist shall be consulted when the decision is made to admit a Category II patient.  The pediatric trauma surgeon or appropriate subspecialist shall see the patient within 12 hours after ED arrival.

 

5)         A physician with current ATLS verification or who has current competency in the initial resuscitation of the trauma patient as verified by the professional staff competency plan must be present 24 hours per day in the Level II Pediatric Trauma Center to treat the trauma patient.

 

6)         The hospital's quality improvement program shall monitor compliance with this subsection (c).

 

7)         The trauma center shall maintain a call schedule that identifies at least a primary and back-up pediatric surgeon with each surgeon listed by name.

 

8)         The trauma center shall have the option of allowing the ED personnel to determine that a trauma patient with an isolated injury may be treated by one of the services listed in subsection (d) or (e) of this Section.  Any patient meeting the definition of isolated injury requires consultation with the appropriate subspecialist.  That subspecialist is to arrive within the time designated in subsection (d) after the notification that his or her services are needed at the hospital.  When the need for neurosurgical intervention has been identified, the neurosurgeon must arrive and be available in a fully staffed operating room within 60 minutes after the identification of need for operative intervention.  An isolated injury refers to the transfer of energy to a single specific anatomic body region with no potential for multisystem involvement.

 

d)         The trauma center shall provide the following surgical services by physicians who are credentialed by the hospital to provide pediatric care, and who are on call to arrive at the hospital to treat the patient within 60 minutes after notification that their services are needed:

 

1)         Cardiothoracic; this requirement may be fulfilled by a cardiothoracic surgeon or a pediatric trauma/general surgeon with experience in pediatric cardiothoracic surgery for lifesaving procedures; the surgeon must have pediatric cardiothoracic privileges;

 

2)         Obstetrics;

 

3)         Orthopedic; and

 

4)         Urologic.

 

e)         The trauma center shall have the following surgical specialties by physicians who are credentialed by the hospital to provide pediatric care and who are on call to arrive at the hospital to treat the patient within 60 minutes after notification that their services are needed.  These services may be provided by written transfer agreement.  These services must be provided according to subsection (c)(7) of this Section for isolated injuries when the trauma surgeon is not required to respond:

 

1)         Neurosurgical with two years experience in pediatric neurosurgery;

 

2)         Ophthalmologic;

 

3)         Oral-dental;

 

4)         Otorhinolaryngologic;

 

5)         Reimplantation;

 

6)         Plastic/maxillofacial;

 

7)         Burn center staffed by registered nurses trained in burn care; and

 

8)         Acute spinal cord injury management.

 

f)         The pediatric trauma center shall provide the following nonsurgical services within the designated times:

 

1)         Emergency Medicine staffed 24 hours a day in the ED by a physician who is board prepared or certified by the ABEM, ABP/PEM or AOBEM with two-year ongoing involvement in daily pediatric trauma care, and 10 hours per year of trauma-related CME.

 

2)         Anesthesiology Services:

 

A)        Anesthesiology services shall be in compliance with the Hospital Licensing Act and the Hospital Licensing Requirements (77 Ill. Adm. Code 250.1410).  Staff shall be on call to arrive at the hospital to administer anesthesia within 30 minutes after notification that their services are needed at the hospital.

 

B)        Direct patient care services may be performed by an anesthesiologist or a CRNA with experience in pediatric anesthesia under the direct supervision of an anesthesiologist.

 

3)         Laboratory 24 hours a day in-house, providing the following:

 

A)        Standard analysis of blood, urine, and other body fluids;

 

B)        Blood typing and cross-matching;

 

C)        Coagulation studies;

 

D)        Comprehensive blood bank or access to a community central blood bank and adequate hospital storage facilities (see Hospital Licensing Requirements (77 Ill. Adm. Code 250.520));

 

E)        Blood gases and pH determinations;

 

F)         Microbiology, to include the ability to initiate aerobic and anaerobic cultures on a 24 hour per day basis; and

 

G)        Toxicology screening.

 

4)         Department of Pediatrics with board certified pediatrician in the role of Chairman, and a board certified pediatrician shall be available within 60 minutes after notification that his or her services are needed.

 

5)         Radiology staffed by:

 

A)        A technician with the ability to perform a CAT scan available within 30 minutes after notification;

 

B)        A radiologist with the ability to read CAT scans and perform angiography available within 60 minutes.  This requirement may be met by a PGY II radiology resident with six months experience in CAT and angiography.  The radiology department shall provide a quality monitoring process to validate the resident's compliance with the time requirements and competency to read CAT scans and perform angiography.  Teleradiographic equipment may be used to transmit CAT scans off site in lieu of the radiologist's response to the trauma center to read CAT scans; and

 

C)        A pediatric radiologist on staff to provide a quality improvement process to validate interpretation of pediatric films.

 

6)         Pediatric cardiology 60 minutes after notification.

 

7)         Postanesthetic recovery capability staffed and available within 30 minutes (may be fulfilled by pediatric ICU).

 

8)         ICU having available the following:

 

A)        A physician credentialed by the hospital and available within 30 minutes.  This requirement may be fulfilled by second and third year residents who have had intensive care training and are under the supervision of a staff physician possessing full intensive care privileges;

 

B)        One Registered Professional Nurse per shift in the ICU, with pediatric experience documented by two years in pediatric ICU or critical care and four hours of trauma related pediatric critical care continuing education per year; and

 

C)        The following pediatric equipment 24 hours a day in-house:

 

i)          Airway control and ventilation devices;

 

ii)         Oxygen source with concentration controls;

 

iii)        Pulse oximeter and CO₂ monitoring;

 

iv)        Cardiac emergency cart;

 

v)         Electrocardiograph-oscilloscope-defibrillator;

 

vi)        Temperature control devices;

 

vii)       Drugs, intravenous fluids, and supplies in accordance with the Hospital Licensing Requirements (77 Ill. Adm. Code 250.1050, 250.2140, and 250.2710); and

 

viii)      Mechanical ventilator-respirators.

 

9)         Acute hemodialysis capability 24 hours a day, or a transfer agreement.

 

g)         The trauma center shall meet the following professional staff requirements:

 

1)         The ED Director shall be a physician board certified by the ABEM, AOBEM, or ABP/PEM.

 

2)         The ED treating the Category I or Category II trauma patient shall be cared for by at least one RN who holds a current nationally recognized trauma nursing certification such as Trauma Certified Registered Nurse (TCRN), Advanced Trauma Certified Nurse (ATCN), or Trauma Nursing Core Course (TNCC); or is currently recognized as a Trauma Nurse Specialist (TNS).

 

3)         A full-time Trauma Coordinator dedicated solely to the trauma program.

 

4)         An operating room shall be staffed and available within 30 minutes, 24 hours a day.

 

5)         Staff shall include occupational therapy, speech therapy, social work, child protective services and psychiatry.

 

h)         The trauma center shall develop a professional staff competency plan including but not limited to trauma surgeons and emergency medicine physicians treating the trauma patients.  Physicians caring for trauma patients in the Level II Pediatric Trauma Center must demonstrate the following:

 

1)         Board certification/Board eligibility in their specialty;

 

2)         Successful completion of trauma-related CME requirements as specified in this Section;

 

3)         Ongoing clinical involvement in the care of the trauma patient as evidenced by routine participation on one or more of the following: trauma call rosters, trauma teams, and attendance at trauma rounds/trauma meetings;

 

4)         Physician specific outcome measurements based on the frequency and acuity of procedures or other peer review measures pertinent to the facility trauma patient volume;

 

5)         For trauma surgeons and emergency medicine physicians only, the successful completion of an ATLS provider course.

 

i)          The trauma center shall provide and maintain the following equipment:

 

1)         Airway control and ventilation equipment, including laryngoscopes and endotracheal tubes of appropriate sizes, bag-mask, resuscitator, sources of oxygen, mechanical ventilator, CO₂ monitoring, and pulse oximeter;

 

2)         Suction device;

 

3)         Electrocardiograph-oscilloscope-defibrillator, pacemaker;

 

4)         Apparatus to establish central venous pressure monitoring;

 

5)         All standard intravenous fluids and administration devices;

 

6)         Sterile surgical sets of procedures standard for ED, such as cricothyrotomy, tracheostomy, thoracotomy, cut down, peritoneal lavage, intraosseous;

 

7)         Drugs and supplies necessary for emergency care;

 

8)         X-ray and CAT scan capability, available within 30 minutes;

 

9)         Spinal immobilization equipment;

 

10)       Temperature control devices;

 

11)       Pediatric measuring device;

 

12)       Scale; and

 

13)       Specialized pediatric resuscitation cart with measuring device in the emergency area.

AGENCY NOTE:  Broselow(TM) Pediatric Tape will meet this requirement.

 

j)          The trauma service must be identified in the facility's budget, with sufficient funds dedicated to support the trauma director and trauma coordinator positions and to provide for the operation of the trauma registry.

 

k)         For additional requirements for Level II Pediatric Trauma Centers, see Section 515.2040.

 

l)          A Level II Pediatric Trauma Center shall meet the requirements of Section 515.2030(i)-(s) of this Part.

 

(Source:  Amended at 46 Ill. Reg. 20898, effective December 16, 2022)

 

Section 515.2050  Trauma Center Uniform Reporting Requirements

 

a)         Each trauma center shall have available to the Trauma Service use of an IBM compatible personal computer capable of handling the software contracted by the Department and that meets the following general standards: CPU 80586, 200 MHz, RAM 32Mb, hard drive 1Gb, floppy drive 3 1/2" CD-ROM 20x, color VGA, inkjet or laser printer, 57.6 Baud Modem, software to support the trauma registry program, and backup capability.  The Department shall provide Trauma Registry software for use by the trauma center.  This software shall be used for data collection and shall have a provision to prepare electronic media reports to the Department on a quarterly basis.

 

b)         The trauma center shall provide the following information on each reportable trauma patient:

 

1)         Trauma hospital number

 

2)         Trauma hospital level of care

 

3)         Trauma registry number

 

4)         Crash record number

 

5)         Pre-hospital record number

 

6)         Medical record number

 

7)         Last name

 

8)         First name

 

9)         Middle initial

 

10)       ED arrival date

 

11)       EMS region

 

12)       Birth date

 

13)       Age

 

14)       Sex

 

15)       Race

 

16)       Injury date

 

17)       Injury time

 

18)       Home address

 

19)       Home city

 

20)       Home state

 

21)       Home country

 

22)       Home zip code

 

23)       Federal Information Processing Standard (FIPS) home

 

24)       Scene address

 

25)       Scene city

 

26)       Scene state

 

27)       Scene zip code

 

28)       FIPS scene

 

29)       International Classification of Diseases (ICD)-9CM codes and effective dates, including E-codes, N-codes, P-codes with location date, time and physician (number code) performing procedure, and V-codes

 

30)       School related injury

 

31)       Work related injury

 

32)       Safety equipment

 

33)       Vehicle seat position

 

34)       Date arrived at transferring hospital

 

35)       Time arrived at transferring hospital

 

36)       Initial Glasgow Coma Score (GCS) total at transferring hospital

 

37)       Initial respiration rate at transferring hospital

 

38)       Initial temperature at transferring hospital

 

39)       Initial temperature scale at transferring hospital

 

40)       Initial temperature method at transferring hospital

 

41)       Admission/surgery at transferring hospital

 

42)       Transferring hospital number

 

43)       Transferring vehicle number

 

44)       Transport vehicle highest level of care

 

45)       Date discharged from transferring hospital

 

46)       Time discharged from transferring hospital

 

47)       Pre-hospital dispatch time

 

48)       Pre-hospital scene arrival date

 

49)       Pre-hospital scene arrival time

 

50)       Pre-hospital patient contact time

 

51)       Pre-hospital scene depart time

 

52)       Pre-hospital scene minutes-calculated

 

53)       Pre-hospital transport minutes-calculated

 

54)       Pre-hospital vehicle number

 

55)       Pre-hospital initial GCS total

 

56)       Pre-hospital systolic pressure

 

57)       Pre-hospital pulse

 

58)       Pre-hospital respiratory rate

 

59)       Pre-hospital revised trauma score

 

60)       Pre-hospital pediatric trauma score

 

61)       Pre-hospital triage criteria as referenced in Section 515.Appendix C

 

62)       Pre-hospital run sheet on chart

 

63)       ED arrival date

 

64)       ED arrival time

 

65)       Minimum trauma field triage criteria-in-house assessment as referenced in Section 515.Appendix C

 

66)       Category - level of trauma care activation (I, II, other)

 

67)       Category - location of trauma activation

 

68)       Category - initial time trauma activation declared

 

69)       Category - trauma grade change

 

70)       Category - initial time of trauma category grade change

 

71)       ED physician, trauma surgeon, assistant surgeon, neurosurgeon and consulting physician code numbers, and notification and ED arrival times

 

72)       ED blood alcohol

 

73)       ED drug screen-therapeutic and self-administered

 

74)       ED initial eye, verbal, motor and total Glasgow Coma Scores

 

75)       ED initial systolic pressure

 

76)       ED initial respiratory rate and assessment qualifier

 

77)       ED initial pulse rate

 

78)       ED initial temperature

 

79)       ED initial temperature scale

 

80)       ED initial temperature method/rate

 

81)       ED trauma score revised

 

82)       ED pediatric trauma score

 

83)       Breakdown score for pediatric trauma score

 

84)       Pediatric resuscitation tape-height and weight

 

85)       ED minutes prior to head computerized tomography (CT)

 

86)       ED cervical clearance

 

87)       ED discharge date

 

88)       ED discharge/depart time

 

89)       ED minutes

 

90)       ED disposition

 

91)       ED reason for transfer

 

92)       ED disposition death

 

93)       Admitting service

 

94)       Date of first operation

 

95)       Time of first operation

 

96)       Complications

 

97)       Unanticipated operation

 

98)       Blood products, including auto-transfusion

 

99)       Total ICU days

 

100)     Total monitored bed days

 

101)     Total ventilator days

 

102)     In-patient consult

 

103)     Injury severity score (ISS)

 

104)     ISS calculation

 

105)     Abbreviated injury score for each injury with description and AIS revision and effective year

 

106)     Trauma Score/Injury Severity Score (TRISS) survival probability

 

107)     Discharge disposition

 

108)     Transferred to (facility number)

 

109)     Hospital discharge date

 

110)     Total hospital days

 

111)     Discharge expression, feeding and locomotion capabilities as determined by the functional independence measure (FIM)

 

112)     Organ donor status

 

113)     Hospital charges

 

114)     Hospital payment source

 

115)     Clean/complete record

 

116)     DNR status

 

c)         Reportable trauma patients

 

1)         A reportable trauma patient is one who was involved in a traumatic event and:

 

A)        was transferred to the trauma center from another hospital;

 

B)        was transferred from the trauma center to another hospital;

 

C)        was admitted to the trauma center as an inpatient;

 

D)        was assigned an observation status and had a length of stay greater than 12 hours from time of arrival in the ED;

 

E)        was dead on arrival (DOA);

 

F)         died in the emergency department (DIE); or

 

G)        signed out against medical advice after refusing admission (AMA).

 

2)         A traumatic event is one in which there was a transfer of energy resulting in injury, involving any of the following:

 

A)        aircraft;

 

B)        watercraft;

 

C)        motor vehicles;

 

D)        railway;

 

E)        recreational vehicles;

 

F)         farm machinery;

 

G)        animals, including bites;

 

H)        explosion;

 

I)         falls;

 

J)         thermal (including smoke inhalation)/chemical/radiation injuries;

 

K)        lightning;

 

L)        weather related (tornado, flood, blizzard) injuries;

 

M)       struck by falling object;

 

N)        sports related;

 

O)        caught between objects;

 

P)         cutting or piercing instruments or objects;

 

Q)        firearms;

 

R)        electric current;

 

S)         suicide or self-inflicted injury;

 

T)         homicide;

 

U)        injury inflicted by others;

 

V)        hanging; or

 

W)       strangulation.

 

d)         Illinois trauma registry reporting schedule

 

Patients Discharged	Report Date
January - March	June 30
April - June	September 30
July - September	December 31
October - December	March 31

 

e)         The trauma center shall have a policy to back up and archive data on a regular basis.

 

f)         Data collected from individual trauma centers shall be cross-referenced with Vital Records Death Certificates to confirm accuracy.

 

g)         Annual reports shall be prepared by the Department presenting summary data to allow trauma centers to evaluate performance.  This data shall have all hospital and patient identifiers removed.

 

h)         All data received by the Department shall be kept confidential.  Patient identifiers shall be kept in such a way to assure that confidentiality is maintained and is not available to the public.

 

1)         All reports and records made pursuant to the Head and Spinal Cord Injury Act [410 ILCS 515] and maintained by the Department and other appropriate persons, officials and institutions pursuant to the Head and Spinal Cord Injury Act shall be confidential.  Information shall not be made available to any individual or institution except to:

 

A)        Appropriate staff of the Department;

 

B)        Any person engaged in a bona fide research project, with the permission of the Director of Public Health, except that no information identifying the subjects of the reports or the reporters shall be made available to researchers unless the Department requests and receives consent for such release pursuant to the provisions of this Section; and

 

C)        The Advisory Council on Spinal Cord and Head Injuries, except that no information identifying the subjects of the reports or the reporters shall be made available to the Council unless consent for release is requested and received pursuant to the provisions of this Section.  Only information pertaining to head and spinal cord injuries as defined in Section 1 of the Head and Spinal Cord Injury Act shall be released to the Council.  (Section 3 of the Head and Spinal Cord Injury Act)

 

2)         The Department shall not reveal the identity of a patient, physician or hospital, except that the identity of the patient may be released upon written consent of the patient, parent or guardian, the identity of the physician may be released upon written consent of the physician, and the identity of the hospital may be released upon written consent of the hospital. (Section 3 of the Head and Spinal Cord Injury Act)

 

3)         The Department shall request consent for release from a patient, a physician or hospital only upon a showing by the applicant for such release that obtaining the identities of certain patients, physicians or hospitals is necessary for his bona fide research directly related to the objectives of the Head and Spinal Cord Injury Act. (Section 3 of the Head and Spinal Cord Injury Act)

 

i)          Availability of Registry Information

 

1)         All requests by medical or epidemiologic researchers for confidential registry data must be submitted in writing to the registry.  The request must include a study protocol that contains:  objectives of the research; rationale for the research, including scientific literature justifying current proposal; overall study methods, including copies of forms, questionnaires, and consent forms used to contact facilities, physicians or study subjects, including methods for documenting compliance with 42 CFR 2A, pars. 4 ambulance, 6 a-b, 7 a-b1; methods for the processing of data; storage and security measures taken to ensure confidentiality of patient identifying information; time frame of the study; a description of the funding source of the study (e.g., federal contract); the curriculum vitae of the principal investigator; and a list of collaborators.  In addition, the research request must specify what patient or facility identifying information is needed and how the information will be used.

 

2)         All requests to conduct research and modifications to approved research proposals involving the use of data that includes patient or facility identifying information shall be subject to a review to determine compliance with the following conditions:

 

A)        The request for patient or facility identifying information contains stated goals or objectives;

 

B)        The request documents the feasibility of the study design in achieving the stated goals and objectives;

 

C)        The request documents the need for the requested data to achieve the stated goals and objectives;

 

D)        The requested data can be provided within the time frame set forth in the request;

 

E)        The request documents that the researcher has qualifications relevant to the type of research being conducted;

 

F)         The research will not duplicate other research already underway using the same registry data when both require the contact of a patient, reporting facility or physician about an individual patient involved in the previously approved concurrent research; and

 

G)        Other such conditions relevant to the need for the patient or facility identifying information and the patient's confidentiality rights, because the Department will only release the name of the patient, physician (in accordance with the provisions of this Section) or facility identifying information that is necessary for the research.

 

3)         Research Agreements

 

A)        The Department will enter into research contracts for all approved research requests.  These contracts shall specify exactly what information is being released and how it can be used in accordance with the standards in subsection (c) of this Section.  In addition, the researcher shall include an assurance that:

 

i)          Use of data is restricted to the specifications of the protocol;

 

ii)         Any and all data that may lead to the identity of any patient, research subject, physician, other person, or hospital is strictly privileged and confidential and that such data will be kept strictly confidential at all times;

 

iii)        All officers, agents and employees will keep all such data strictly confidential; will communicate the requirements of this subsection to all officers, agents, and employees; will discipline all persons who may violate the requirements of this Section; and will notify the Department in writing within 48 hours after any violation of this subsection, including full details of the violation and corrective actions to be taken;

 

iv)        All data provided by the Department pursuant to the contract may only be used for the purposes named in the contract and that any other or additional use of the data may result in immediate termination of the contract by the Department; and

 

v)         All data provided by the Department pursuant to the contract is the sole property of the Department and may not be copied or reproduced in any form or manner and that all data and all copies and reproduction of the data will be returned to the Department upon termination of the contract.

 

B)        Any departures from the approved protocol must be submitted in writing and approved by the Director in accordance with subsection (c)(2) of this Section prior to initiation.  No patient or facility identifying information may be released by a researcher to a third party.

 

4)         The Department shall disclose individual patient or facility information to the reporting facility that originally supplied that information to the Department, upon written request of the facility.

 

j)          The patient identifying information submitted to the Department by those entities required to submit information under the Act and this Part is to be used in the course of medical study under Part 21 of Article 8 of the Code of Civil Procedure [735 ILCS 5].  Therefore, this information is privileged from disclosure by Part 21 of Article 8 of the Code of Civil Procedure.

 

k)         The identity of any facility, or any group of facts that tends to lead to the identity of any person whose condition or treatment is submitted to the Department, shall not be open to public inspection or dissemination.  Such information shall not be available for disclosure, inspection or copying under the Freedom of Information Act or the State Records Act.  All information for specific research purposes may be released in accordance with procedures established by the Department in this Section.

 

l)          Every hospital shall provide representatives of the Department with access to information from all medical, pathological, and other pertinent records and logs related to reportable registry information.  The mode of access and the time during which this access will be provided shall be by mutual agreement between the hospital and the Department.  The Department shall not require hospitals to provide information on cases that are dated more than two years before the Department's request for further information.

 

m)        Every hospital shall provide access to information regarding specified patients or other patients specified for research studies, related to reportable registry information, conducted by the Department.  Any disputes as to access shall be resolved by the hospital and the Department within 30 days after requests for access have been denied.

 

(Source:  Amended at 25 Ill. Reg. 16386, effective December 20, 2001)

 

Section 515.2060  Trauma Patient Evaluation and Transfer

 

a)         Patients who are determined in the pre-hospital setting to have sustained hypotension or are victims of cavity penetration of the neck or torso or any other trauma patient as deemed by medical control shall be classified as trauma patients in the field.  The trauma surgeon response time begins at the time of field classification.  The patient shall be immediately evaluated upon arrival at the ED.

 

b)         Patients who are not classified in the field must be evaluated within 10 minutes after arrival at the trauma center.  This evaluation shall be conducted by the attending ED physician or designee.  "Designee", for the purposes of this Section, may refer to ED staff including, but not limited to, a surgeon acting as the ED attending, resident physician, Physician Assistant, or Registered Nurse. By the time the 10 minute evaluation period has elapsed, the patient must be determined to be a Category I trauma patient (Section 515.Appendices C and F of this Part) or Category II (Section 515.Appendix C) or not to have met either Category I or II criteria.  A patient cannot be downgraded once a category has been assigned.  Upgrade to a Category I or II may occur at any time the patient's condition warrants.  The trauma or specialty surgical response time begins at the time of upgrade.

 

c)         EMS Regions or trauma centers may develop triage criteria that expand Category I and II criteria but may not delete any of the minimal criteria in Section 515.Appendix C of this Part.

 

d)         The response period for trauma or specialty surgery for Category I or II patients is as specified in Section 515.2030(c), Section 515.2040(c) and Section 515.Appendix F of this Part.

 

e)         Trauma patients being transferred to a Level I or Level II facility or to more specialized care should be enroute within two hours after arrival when stabilized within the capabilities of the referring institution.

 

f)         The Revised Trauma Score, as specified by the American College of Surgeons, shall be used in all trauma centers.  The Revised Trauma Score is determined by using the following criteria:

 

				Value			Points
1)	Respiratory Rate			10-29/Min			4
				>29/Min			3
				6-9/Min			2
				1-5/Min			1
				0			0
2)	Systolic Blood Pressure			greater than 89mmHg			4
				76-89mmHg			3
				50-75mmHg			2
				1-49mmHg			1
				no pulse			0
3)	Glasgow Coma Scale
	A)	Eye Opening Response					Points
		Spontaneous					4
		To Voice					3
		To Pain					2
		None					1
	B)	Best Verbal Response
		Oriented					5
		Confused					4
		Inappropriate Words					3
		Incomprehensible Sounds					2
		None					1
	C)	Best Motor Response
		Obeys Commands					6
		Localizes (Pain)					5
		Withdraw (Pain)					4
		Flexion (Pain)					3
		Extension (Pain)					1
		None					1
			Total GCS		Revised Trauma
					Points
			13-15		=	4
			9-12		=	3
			6-8		=	2
			4-5		=	1
			<4		=	0
4)	Revised Trauma Score = Total Points 1 + 2 + 3

 

g)         Each EMS Region may include other criteria in addition to the Revised Trauma Score in defining a trauma patient and specifying where trauma patients should be transported according to the severity of the injury.

 

h)         The components of Section 515.Appendix D of this Part shall be included in the trauma center policy.

 

(Source:  Amended at 22 Ill. Reg. 11835, effective June 25, 1998)

 

Section 515.2070  Trauma Center Designation Delegation to Local Health Departments

 

a)         The Department may delegate authority to local health departments in jurisdictions which include a substantial number of trauma centers.  The delegated authority includes, but is not limited to, the authority to designate trauma centers with final approval by the Department, maintain a Regional database with concomitant reporting of trauma registry data, and monitor, inspect and investigate trauma centers within their jurisdiction, in accordance with the requirements of the Act and this Part. (Section 3.90(b)(11) of the Act)

 

b)         The Department shall monitor the performance of local health departments with authority delegated by the Act based upon the following performance criteria.  (Section 3.90(b)(11)(A) of the Act) The local health department shall:

 

1)         Enforce the Act and this Part, consistent with the authority delegated under Section 3.90(b)(11)(A) of the Act.

 

2)         Designate trauma centers consistent with the provisions of the Act and this Part.

 

3)         Upon notification of a trauma center's failure to submit Trauma Registry data to the Department in accordance with Section 515.2050 of this Part take steps to enforce this requirement within 10 working days.

 

4)         Submit a Quarterly Report to the Department specifying all activities conducted under the delegated authority in accordance with the requirements of the Act and this Part.

 

5)         Submit to the Department copies of all complaints within two working days after receipt and copies of all final investigation reports within 10 working days after the completion of the investigation.

 

6)         Submit to the Department copies of quarterly trauma center focused outcome analyses required by Section 515.2030 of this Part.

 

c)         Delegated authority may be revoked for substantial non-compliance with subsection (b) of this Section.  Notice of an intent to revoke shall be served upon the local health department by certified mail, stating the reasons for revocation and offering an opportunity for an administrative hearing to contest the proposed revocation.  The request for a hearing must be received by the Department within 10 working days of the local health department's receipt of notification.  (Section 3.90(b)(11)(B) of the Act)

 

d)         The director of a local health department may relinquish its delegated authority upon 60 days written notification to the Director of Public Health.  (Section 3.90(b)(11)(C) of the Act)

 

(Source:  Added at 21 Ill. Reg. 5170, effective April 15, 1997)

 

Section 515.2080  Trauma Center Confidentiality and Immunity

 

a)         All information contained in or relating to any medical audit performed by a trauma center of a trauma center's trauma services pursuant to the Act, or any medical audit performed by an EMS Medical Director, or his/her designee, of medical care rendered by system personnel, shall be afforded the same status as is provided information concerning medical studies in Article VIII, Part 21 of the Code of Civil Procedure.  Disclosure of such information to the Department pursuant to the Act and this Part shall not be considered a violation of Article VIII, Part 21 of the Code of Civil Procedure. (Section 3.110(a) of the Act)

 

b)         Hospitals, trauma centers and individuals that perform or participate in medical audits pursuant to the Act shall be immune from civil liability to the same extent as provided in Section 10.2 of the Hospital Licensing Act.  (Section 3.110(b) of the Act)

 

(Source:  Added at 21 Ill. Reg. 5170, effective April 15, 1997)

 

Section 515.2090  Trauma Center Fund

 

a)         The Department shall distribute 97.5% of 50% of the moneys deposited into the Trauma Center Fund, a special fund in the State Treasury, to Illinois hospitals that are currently designated as trauma centers.  (Section 3.225(a) of the Act)  The distribution to individual hospitals shall be based on the number of trauma cases, including cases where the hospital provides initial trauma care only, and the average length of stay for trauma cases at each hospital, according to data for the most recently completed State fiscal year.

 

b)         The moneys in the fund shall be allocated proportionally to each EMS Region so that the EMS Region receives the moneys collected from within its Region for violations of laws or ordinances regulating the movement of traffic.  Under no circumstances shall money collected within one EMS Region be redirected to another EMS region.  (Section 3.225(b)(2) of the Act)

 

c)         No moneys may be distributed to a trauma center located outside of the State.  (Section 3.225(b)(3) of the Act)

 

d)         If money collected from an EMS region cannot be distributed to any trauma center in that EMS region because the trauma center is located outside of the State, then the Department shall distribute the money to hospitals in the EMS region for the provision of emergency services related to care of injured patients. (Section 3.225(b)(4) of the Act)

 

e)         The total amount of funds per EMS Region will be based on the moneys received from the counties in that Region.

 

1)         If a county has more than one EMS Region, the moneys received from that county shall be divided among the Regions based on each Region's share of the county's trauma cases.

 

2)         EMS Regions that have developed joint EMS Region Plans to enable them to function as one Region shall be treated as one Region in the calculation.

 

f)         At the beginning of each State fiscal year, the Department shall calculate a per trauma case allocation for each Region, which shall be used to determine each trauma center's share of the funds collected during the previous State fiscal year.

 

g)         To determine the percent of the Trauma Center Fund to be received by each hospital, divide the Hospital Distribution Factor for each trauma center by the Region Distribution Factor.

 

1)         To determine the Region Distribution Factor, add all of the Hospital Distribution Factors for the trauma centers in the Region.

 

2)         To determine the Hospital Distribution Factor, add the hospital's total admission score to the total case value score for the initial trauma care patients treated at the hospital.

 

A)        To determine the hospital's Total Admission Score, multiply the total case value score for admissions by the average length of stay.

 

i)          To determine the total case value score for admissions, assign case values for each patient (one patient may have more than one value, i.e., a person who has an ICU stay after an OR procedure) admitted to the hospital according to the following:

 

Admission	2
Intensive Care Unit Stay	2
Operating Room Procedure	2
Mechanical Ventilation	3
Discharged to a Rehabilitation
Facility	1

 

            The sum of all of the values is the total case value score for the patients admitted to the hospital.

 

ii)         To determine the average length of stay, divide the total length of stay for all patients admitted to the hospital by the total number of patients admitted to the hospital.

 

B)        To determine the total case value score for the initial trauma care patients, assign the case values for each initial trauma care patient treated by the hospital according to the following:

 

Assigned observation status and had length of stay > 12 hours from time of arrival in ED	2
Dead on arrival	0
Dying in emergency (DIE) with a trauma surgeon evaluation (TSE)	1.25
DIE without a TSE	.25
Against medical advice (AMA) with a TSE	1.25
AMA without TSE	.25
Transfer with TSE	1.25
Transfer without TSE	.25

 

            The sum of all of the values is the total case value score for the initial trauma care patients treated by the hospital.

 

h)         In Regions where there are no designated trauma centers within the State boundaries, the monies collected within the Region will be equally distributed to Illinois hospitals providing emergency services. All non-trauma center hospitals receiving equal distribution of trauma center funds shall report all patients meeting inclusion criteria for the Head and Spinal Violent Injury (HSVI) Registry, per 77 Ill. Adm. Code 550.120(d) (Head and Spinal Cord Injury Code), prior to receiving any funds. Hospitals not reporting all such patients shall be precluded from receiving any funds.

 

i)          Hospitals receiving trauma center funds shall demonstrate within the hospital's budget how monies received from the Trauma Center Fund are being used to provide emergency services related to care of injured patients.

 

j)          The Department may request and the hospital shall supply hospital financial records to substantiate that funds are used appropriately for emergency services related to care of injured patients.

 

k)         The hospital shall allocate funds for expenditure within 12 months after funds are received.

 

l)          All funds remaining at the end of the period of time in which trauma center funds are available for expenditure (June 30 of the fiscal year in which the funds were awarded) shall be returned to the State within 45 days.

 

m)        The Department will distribute funds from the Trauma Center Fund within 90 days after July 1 of each year.

 

(Source:  Amended at 36 Ill. Reg. 11196, effective July 3, 2012)

 

Section 515.2100  Pediatric Care (Renumbered)

 

(Source:  Section 515.2100 renumbered to Section 515.445 at 24 Ill. Reg. 9006, effective June 15, 2000)

 

Section 515.2200  Suspension Policy for Trauma Nurse Specialist Certification

 

a)         The responsible nursing administrator may recommend suspension of a TNS certification pending due process or may immediately suspend the TNS certification.

 

b)         Except as allowed in subsection (j) of this Section, the responsible nursing administrator shall provide the TNS with a written explanation of the reason for the suspension; the terms, length, and condition of the suspension; and the date the suspension will commence, unless a hearing is requested.  The procedure for requesting a hearing within 15 days through the Local System Review Board shall be provided to the TNS.

 

c)         Failure to request a hearing within 15 days shall constitute a waiver of the right to a Local System Review Board hearing.

 

d)         The trauma center shall designate the Local Review Board, consisting of at least three members, one of whom is the Trauma Nurse Specialist Course Coordinator (TNSCC) or hospital trauma coordinator, one of whom is a Trauma Nurse Specialist in a staff nurse position, and one of whom is a Registered Professional Nurse in an administrative position.

 

e)         The hearing shall commence as soon as possible but at least within 21 days after receipt of a written request.  The trauma center shall arrange for a certified shorthand reporter to make a stenographic record of that hearing and thereafter prepare a transcript of the proceedings.  The transcript, all documents or materials received as evidence during the hearing and the Local Review Board's written decision shall be retained in the custody of the trauma center.  The trauma center shall implement the decision of the Local Review Board unless that decision has been appealed to the State Emergency Medical Services Disciplinary Review Board.

 

f)         The Local Review Board shall state in writing its decision to affirm, modify or reverse the suspension order.  Such a decision shall be sent via certified mail or personal service to the responsible nursing administrator and the TNS who requested the hearing within five business days after the conclusion of the hearing.

 

g)         The responsible nursing administrator shall notify the Department, in writing, within five business days after the Board's decision to either uphold, modify, or reverse the suspension of the individual.  The notice shall include a statement detailing the duration and grounds for suspension.

 

h)         If the Local Review Board affirms, reverses or modifies the responsible nursing administrator's suspension order, the TNS shall have an opportunity for review of the Local Board's decision by the State Emergency Medical Services Disciplinary Review Board.

 

i)          Requests by the TNS for review by the EMS Disciplinary Review Board shall be submitted in writing to the Chief of the Department's Division of Emergency Medical Services and Highway Safety within 10 days after receiving the Local Review Board's decision or the responsible nursing administrator's suspension order, whichever is applicable.

 

j)          A responsible nursing administrator may immediately suspend an individual if he or she finds that the information in his or her possession indicates that the continuation in practice by the Trauma Nurse Specialist would constitute an imminent danger to the trauma patient.  The suspended Trauma Nurse Specialist shall be issued an immediate verbal notification followed by a written suspension order from the responsible nursing administrator, which states the length, terms and basis for the suspension.

 

1)         Within 24 hours following the commencement of the suspension, the responsible nursing administrator shall deliver to the Department, by messenger or telefax, a copy of the suspension order, including any written materials that relate to the responsible nursing administrator's decision to suspend the Trauma Nurse Specialist.

 

2)         Within 24 hours following commencement of the suspension, the suspended Trauma Nurse Specialist may deliver to the Department, by messenger or telefax, a written response to the suspension order, including any written materials that the Trauma Nurse Specialist believes relate to that response.

 

3)         Within 24 hours following receipt of the responsible nursing administrator's suspension order or the Trauma Nurse Specialist's written response, whichever is later, the Director or Director's designee shall determine whether the suspension should be stayed pending the Trauma Nurse Specialist's opportunity for hearing or review, or whether the suspension should continue during the course of that hearing or review.  The Director or the Director's designee shall issue this determination to the responsible nursing administrator, who shall immediately notify the suspended Trauma Nurse Specialist.  The suspension shall remain in effect during this period of review by the Director or the Director's designee.

 

(Source:  Added at 25 Ill. Reg. 16386, effective December 20, 2001)