reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1029 - MEDICAL COMMAND FACILITIES AND RECEIVING FACILITIES › Subchapter A - MEDICAL COMMAND FACILITIES › Section 1029.6 - Discontinuation of service

Current through Register Vol. 54, No. 28, July 13, 2024
A medical command facility may not discontinue medical
						command operations without providing 90 days advance written notice to the
						Department, regional EMS councils responsible for regions in which the medical
						command facility routinely provides medical command and EMS agencies for which
						it routinely provides medical command. A medical command facility shall
						advertise notice of its intent to discontinue service as a medical command
						facility in a newspaper of general circulation in its service area at least 90
						days in advance of discontinuing service as a medical command
						facility.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1029 - MEDICAL COMMAND FACILITIES AND RECEIVING FACILITIES › Subchapter B - RECEIVING FACILITIES › Section 1029.21 - Receiving facilities

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
General requirements.
A receiving facility shall include a
					 fixed location, with an organized emergency department, including a physician
					 educated to manage cardiac, trauma, pediatric, obstetrics, medical behavioral
					 and all-hazards emergencies. A physician who satisfies these requirements shall
					 be present in the facility and available to the emergency department 24
					 hours-a-day, 7 days-a-week.
(b)
Patients with special needs.
Patients with special needs,
					 particularly those with time-sensitive illnesses, who need to be transported to
					 a receiving facility shall be transported to a specialty receiving facility
					 consistent with the Statewide EMS protocols.
(c)
Transports to receiving
					 facilities.
Unless directed otherwise by a medical command physician,
					 if patient transport by ambulance is required for additional care that has not
					 been prearranged, an ambulance must transport the patient to a receiving
					 facility or other facility as the Department has designated in the Statewide
					 EMS protocols.
(d)
Confirmation of receiving patient.
When a patient has been
					 transported to a receiving facility, the receiving facility shall acknowledge
					 in writing that it has received the patient if the transporting ambulance crew
					 requests that acknowledgement.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.1 - Administrative and appellate procedure

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Administrative
				  proceedings.
Except as otherwise provided in this chapter, the
				  Department will hold hearings and issue adjudications for proceedings conducted
				  under the act and this subpart in accordance with 2 Pa.C.S. (relating to
				  administrative law and procedure) and will conduct those proceedings under 1
				  Pa. Code Part II (relating to General Rules of Administrative Practice and
				  Procedure).
(b)
Judicial
				  appeals.
Department adjudications issued under the act and this
				  chapter may be appealed to the Commonwealth Court under
				  42 Pa.C.S. §
											763
				  (relating to direct appeals from government agencies).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.4 - Petition for certification after revocation

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Petition for certification after
				  revocation.
A person whose certification has been revoked may not
				  apply for reinstatement of that certification. A person whose EMS provider
				  certification has been revoked may petition the Department for allowance to
				  apply for a new certification no earlier than 5 years after the effective date
				  of the revocation. The petition must aver facts to establish that the
				  petitioner has been rehabilitated to the extent that issuing that person a
				  certification would not be detrimental to the public interest. In assessing the
				  public interest, the Department will weigh the facts that tend to show that the
				  petitioner has been rehabilitated against the Department's duty to maintain
				  public confidence in its ability to regulate EMS providers, deter other EMS
				  providers from engaging in conduct similar to that which resulted in the
				  revocation and protect persons who may require EMS.
(b)
Department action on the
				  petition.
(1) The Department will
				  deny a petition for allowance to apply for a new certification, without
				  conducting a hearing, if it accepts as true all facts averred and it concludes
				  that those facts fail to establish that the petitioner has been rehabilitated
				  to the extent that certification would not be detrimental to the public
				  interest.
(2) The Department may
				  grant or hold a hearing on a petition for a new certification if it concludes
				  that the facts averred in the petition, if true, establish a prima facie case
				  that the petitioner has been rehabilitated to the extent that certification
				  would not be detrimental to the public interest.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.5 - Discipline of EMS vehicle operators

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Grounds for discipline.
The Department may discipline or impose corrective measures on an EMSVO or an
				  applicant for EMSVO certification for one or more of the following reasons:
(1) Having a lack of physical or mental
				  ability to operate an EMS vehicle, with reasonable accommodations if the person
				  has a disability.
(2) Deceptively
				  or fraudulently procuring or representing certification or registration
				  credentials, or making misleading, deceptive or untrue representations to
				  secure a certification or registration.
(3) Operating an emergency vehicle in a
				  reckless manner or while under the influence of alcohol, illegal drugs or the
				  knowing abuse of legal drugs.
(4)
				  Having a driver's license suspended in any jurisdiction due to the use of
				  alcohol or drugs or a moving traffic violation.
(5) Operating a ground EMS vehicle without a
				  driver's license or while a driver's license is suspended.
(6) Being convicted of a felony or a crime
				  involving moral turpitude.
(7)
				  Failing to report a criminal conviction that the applicant or EMSVO is required
				  to report or failing to report the suspension of a driver's license due to the
				  use of alcohol or drugs or a moving traffic violation.
(8) Any other reason as determined by the
				  Department that poses a threat to the health and safety of the
				  public.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.6 - Temporary suspension of EMS provider and EMS vehicle operator certifications

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Issuance of temporary suspension.
The Department will issue an
				  order temporarily suspending an EMS provider or EMS vehicle operator
				  certification, without a hearing, if based upon evidence received that appears
				  to be credible the Department determines that the person is a clear and
				  immediate danger to the public health and safety.
(b)
Notice and preliminary
				  hearing.
Notice of the temporary suspension will include a written
				  statement of the factual allegations upon which the determination is based.
				  Unless an extension of time is requested by the EMS provider or EMS vehicle
				  operator, within 30 days after an order under subsection (a) is issued, the
				  Department shall conduct a preliminary hearing to determine whether there is a
				  prima facie case supporting the temporary suspension. The EMS provider or EMS
				  vehicle operator may be present at the preliminary hearing and may be
				  represented by counsel, cross-examine witnesses, inspect physical evidence,
				  call witnesses and offer testimony and other evidence to rebut the prima facie
				  case. If and when the Department determines that the evidence does not
				  establish a prima facie case that the EMS provider or EMS vehicle operator is a
				  clear and immediate danger to the public health and safety, the Department will
				  immediately issue an order lifting the suspension.
(c)
Beginning of formal disciplinary
				  proceedings.
After issuing an order under subsection (a), the
				  Department shall begin formal disciplinary action under §
										1031.3 or §
										1031.5 (relating to discipline of
				  EMS providers; and discipline of EMS vehicle operators).
(d)
Duration of temporary suspension
				  if prima facie case is established.
If the Department determines that
				  a prima facie case supporting the temporary suspension is established at the
				  preliminary hearing, the temporary suspension shall remain in effect, but no
				  longer than 180 days unless agreed upon by the parties.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.7 - Discipline of EMS instructors

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Grounds for discipline.
The Department may discipline or
				  impose corrective measures on a certified EMS instructor, or an applicant for
				  certification as an EMS instructor, for one or more of the following reasons:
(1) Any reason an EMS provider may be
				  disciplined under §
											1031.3 (relating to discipline of
				  EMS providers).
(2) Providing
				  instruction while under the influence of alcohol or illegal drugs or the
				  knowing abuse of legal drugs.
(3)
				  Failing to perform a duty imposed upon an EMS instructor under this
				  subpart.
(4) Any other reason as
				  determined by the Department that poses a threat to the health and safety of
				  students.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.8 - Discipline of medical command physicians and medical command facility medical directors

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Grounds for discipline.
The Department may discipline or
				  impose corrective measures on a medical command physician or medical command
				  facility medical director for the following reasons:
(1) Violating a responsibility imposed on the
				  physician by §
											1023.2 or §
											1023.3 (relating to medical
				  command physician; and medical command facility medical director).
(2) Without good cause, failing to comply
				  with an EMS protocol established or approved by the
				  Department.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.9 - Automatic suspension for incapacity

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will automatically suspend a certification
					 issued under this subpart upon receiving a certified copy of court records
					 establishing that the person has been adjudicated as incapacitated under
					 20 Pa.C.S. §
											5511
					 (relating to petition and hearing; independent evaluation) or an equivalent
					 statutory provision, and will lift the suspension upon receiving a certified
					 copy of court records establishing that the person has regained capacity under
					 20 Pa.C.S. §
											5517
					 (relating to adjudication of capacity and modification of existing orders) or
					 an equivalent statutory provision.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.10 - Discipline of EMS agencies

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Grounds for discipline.
The Department may discipline an EMS
				  agency or an applicant for an EMS agency license for one or more of the
				  following reasons:
(1) Violating a
				  requirement of the act or a regulation adopted under the act.
(2) Failing to submit a plan of correction
				  acceptable to the Department to correct a violation cited by the Department or
				  failing to comply with a plan of correction accepted by the
				  Department.
(3) Refusing to accept
				  a conditional temporary license properly sought by the Department or to abide
				  by its terms.
(4) Engaging in fraud
				  or deceit in obtaining or attempting to obtain a license.
(5) Lending its license or, except as
				  authorized by the Department in acting upon the license application or an
				  application to amend the license, enabling another person to manage or operate
				  the EMS agency or any service the EMS agency is licensed to provide.
(6) Engaging in incompetence, negligence or
				  misconduct in operating the EMS agency or in providing EMS to
				  patients.
(7) Using the license of
				  another or in any way knowingly aiding or abetting the improper granting of a
				  license, certification, accreditation or other authorization issued under the
				  act.
(8) Failing to meet or
				  continue to meet applicable licensure standards.
(9) The EMS agency is not a responsible
				  person or is not staffed by responsible persons and refuses to remove from its
				  staff the irresponsible person or persons when directed to do so by the
				  Department.
(10) Being convicted of
				  a felony or a crime involving moral turpitude or related to the practice of the
				  EMS agency.
(11) Making
				  misrepresentations in seeking funds made available through the
				  Department.
(12) Refusing to render
				  EMS because of a patient's race, sex, creed, national origin, sexual
				  preference, age, handicap, medical problem or refusing to respond to an
				  emergency and render EMS because of a patient's financial inability to
				  pay.
(13) Violating an order
				  previously issued by the Department in a disciplinary matter.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.11 - Discipline of medical command facilities

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Grounds for discipline.
The Department may discipline a medical command facility or an applicant for a
				  medical command facility certification for one or more of the following
				  reasons:
(1) Submitting a fraudulent or
				  deceptive application for certification or registration of the
				  certification.
(2) Violating a
				  requirement in §
											1029.1 or §
											1029.2 (relating to general
				  provisions; and operational requirements).
(3) Refusing to permit an inspection or to
				  respond to an inquiry as required under §
											1029.4 (relating to inspections
				  and investigations).
(4) Failing to
				  comply, without just cause, with an EMS protocol approved by the
				  Department.
(5) Failing to submit a
				  plan of correction acceptable to the Department to correct a violation cited by
				  the Department or failing to comply with a plan of correction accepted by the
				  Department.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.12 - Discipline of EMS educational institutes

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Grounds for discipline.
The Department may discipline an EMS educational institute or an applicant for
				  an EMS educational institute certification for one or more of the following
				  reasons:
(1) Failure to satisfy the
				  responsibilities imposed upon it under §§
											1025.1-1025.3 (relating to accreditation
				  and operational requirements of EMS educational institutes; accreditation
				  process; and advertising).
(2) An
				  absence of students in the program for 2 consecutive years.
(3) Submission of a fraudulent or deceptive
				  application for accreditation.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.13 - Discipline of providers of EMS continuing education

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Grounds for discipline.
The Department may discipline a continuing education sponsor or an applicant
				  for accreditation or reaccreditation as a continuing education sponsor for one
				  or both of the following reasons:
(1) Failure
				  to satisfy the requirements in Chapter 1025, Subchapter B (relating to EMS
				  continuing education courses).
(2)
				  Submission of a fraudulent or deceptive application for accreditation or
				  reaccreditation.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.14 - Civil money penalty for practicing without a license or certification

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Operating an EMS agency without a license.
The Department may
				  impose a civil money penalty of up to $5,000 per day upon a person who owns or
				  operates an EMS agency in this Commonwealth without having a license to operate
				  that EMS agency.
(b)
Practicing as an EMS provider without a certification.
The
				  Department may impose a civil money penalty of up to $1,000 per day upon a
				  person who provides EMS without an EMS provider's certification or other legal
				  authority to provide EMS.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.15 - Discipline of vendors of EMS PCR software

Current through Register Vol. 54, No. 28, July 13, 2024
The Department may assess a vendor of EMS PCR software a
					 civil money penalty of up to $5,000 for each day a vendor violates a duty
					 imposed by §
										1021.43(b) or (d)
					 (relating to vendors of EMS patient care reports).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1031 - COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS › Section 1031.16 - Discipline of management companies

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  The Department may deny, withdraw or condition the approval of an entity to
				  offer management services for one or more of the following reasons:
(1) The entity is not a responsible
				  person.
(2) Persons having a
				  substantial ownership interest in the entity are not responsible
				  persons.
(3) The entity will not be
				  staffed by or conduct its activities through responsible persons.
(4) The entity refuses to provide the
				  Department with records or information reasonably requested by the Department
				  to make a determination regarding paragraphs (1)-(3).
(5) The entity conducts the operation or
				  managerial control of an EMS agency, or conducts the day-to-day operations of
				  the EMS agency, in a manner that subjects the EMS agency to possible
				  disciplinary action under §
											1031.10 (relating to discipline of
				  EMS agencies).
(6) The entity
				  violates a requirement of the act or a regulation adopted under the act that is
				  applicable to the entity.
(7)
				  Engaging in fraud or deceit in obtaining or attempting to obtain or maintain
				  Department approval.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1033 - SPECIAL EVENT EMS › Section 1033.1 - Special event EMS planning requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Procedure for obtaining required
				  plan approval.
The entity responsible for the management and
				  administration of a special event may submit a special event EMS plan to the
				  Department, through the regional EMS council assigned responsibility for the
				  region in which the special event is to occur, to secure a determination from
				  the Department as to whether the plan is adequate to address the EMS needs
				  presented by a special event or a series of special events conducted at the
				  same location.
(1) The applicant shall submit
				  its plan at least 90 days prior to the date of the first day of the
				  event.
(2) The Department will
				  approve or disapprove a special event EMS plan within 60 days after a complete
				  plan is filed with the regional EMS council.
(3) The Department's approval of a special
				  event EMS plan will be for the special event or series of special events in a
				  calendar year, as identified in the plan. The entity shall submit a new special
				  event EMS plan to secure Department approval of a plan for a special event or
				  series of special events in a subsequent calendar year.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1033 - SPECIAL EVENT EMS › Section 1033.2 - Administration, management and medical direction requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Special event EMS
				  director.
EMS provided at a special event shall be supervised by a
				  special event EMS director.
(1)
Responsibilities.
The responsibilities of the special event
				  EMS director include:
(i) Preparing a plan
				  under §
												1033.1 (relating to special event
				  EMS planning requirements).
(ii)
				  Managing the delivery of special event EMS.
(iii) Ensuring implementation of the EMS
				  coordination measures contained in the special event EMS plan.
(iv) Ensuring that a record is kept that
				  lists the individuals that requested or received EMS and the disposition of
				  each case, including identification of the transporting EMS agency and
				  ambulance, and the receiving facility, if the individual was transported to a
				  receiving facility.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1033 - SPECIAL EVENT EMS › Section 1033.3 - Special event EMS personnel and capability requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Special event EMS providers shall be
				  certified at appropriate levels based on the level of EMS approved by the
				  Department in the special event EMS plan.
(b) One ambulance shall be stationed onsite
				  at a special event if the event is expected to involve the presence of between
				  5,000 and 25,000 persons at any one time.
(c) Two ambulances shall be stationed onsite
				  at a special event if the event is expected to involve the presence of more
				  than 25,000 but less than 55,000 persons at any one time.
(d) Three ambulances shall be stationed
				  onsite at a special event if the event is expected to involve the presence of
				  more than 55,000 persons at any one time.
(e) Sufficient EMS providers shall be
				  available to enssure the availability of EMS to persons present at the special
				  event.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1033 - SPECIAL EVENT EMS › Section 1033.4 - Onsite facility requirements

Current through Register Vol. 54, No. 28, July 13, 2024
A special event expected to involve the presence of more
					 than 25,000 persons at any one time shall require the use of onsite treatment
					 facilities. The onsite treatment facilities shall provide:
(1) Environmental control, providing
				  protection from weather elements to ensure patient safety and
				  comfort.
(2) Sufficient beds, cots
				  and equipment to provide for evaluation and treatment of at least four
				  simultaneous patients.
(3) Adequate
				  lighting and ventilation to allow for patient evaluation and
				  treatment.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1033 - SPECIAL EVENT EMS › Section 1033.5 - Communications system requirements

Current through Register Vol. 54, No. 28, July 13, 2024
A special event EMS system shall have onsite communications
					 capabilities to ensure:
(1) Uniform
				  access to care for patients in need of EMS.
(2) Onsite coordination of the activities of
				  EMS providers, including capability for interoperable communication with all
				  EMS agencies involved in the plan and with EMS agencies local to the event site
				  that are not involved in the special event EMS plan.
(3) Communication with existing community
				  PSAPs.
(4) Communication interface
				  with other involved public safety agencies.
(5) Communication with receiving
				  facilities.
(6) Communication with
				  ambulances providing emergency transportation.
(7) Communication with medical command
				  physicians.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1033 - SPECIAL EVENT EMS › Section 1033.6 - Requirements for educating event attendees regarding access to EMS

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The entity
				  responsible for the management and administration of a special event shall
				  develop and implement a plan to educate special event participants and
				  spectators about the following:
(1) The
				  presence and location of EMS at the special event.
(2) The methods of obtaining EMS at the
				  special event.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1033 - SPECIAL EVENT EMS › Section 1033.7 - Special event report

Current through Register Vol. 54, No. 28, July 13, 2024
An entity for which the Department has approved a special
					 event EMS plan shall complete a special event report form prepared by the
					 Department and provided to it by the relevant regional EMS council and file the
					 completed report with that regional EMS council within 30 days following the
					 last day of a special event. Among other matters, the report shall provide a
					 summary of the patient information required to be kept under §
										1033.2(a)(1)(iv)
					 (relating to administration, management and medical direction
					 requirements).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › GENERAL PROVISIONS › Section 1051.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter provides standards for the issuance and
						revocation of out-of-hospital DNR orders and compliance with those orders. An
						additional purpose of this chapter is to address how health care providers are
						to deal with orders or directions to not provide life-sustaining treatment,
						CPR, nutrition or hydration to a pregnant woman.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › GENERAL PROVISIONS › Section 1051.3 - Applicability

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This chapter
					 applies to the following:
(1) Health care
					 providers.
(2) Attending
					 physicians.
(3) Patients.
(4) Surrogates.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › PATIENT AND SURROGATE RIGHTS AND RESPONSIBILITIES › Section 1051.11 - Patient qualifications to request and revoke out-of-hospital DNR order

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Patient
					 requesting an out-of-hospital DNR order.
A patient may request and
					 receive an out-of-hospital DNR order from the patient's attending physician if
					 the patient has a terminal condition and the patient is at least 18 years of
					 age, has graduated from high school, has married or is emancipated.
(b)
Patient revoking an
					 out-of-hospital DNR order.
An out-of-hospital DNR patient, regardless
					 of age or physical or mental condition, may revoke an out-of-hospital DNR order
					 issued for the out-of-hospital DNR patient whether the order was issued
					 pursuant to the request of the patient or the patient's surrogate.
This section cited in 28 Pa. Code §
													1051.22 (relating to issuance of
						  out-of-hospital DNR order); 28 Pa. Code §
													1051.23 (relating to disclosure to
						  patient requesting out-of-hospital DNR order); and 28 Pa. Code §
													1051.26 (relating to physician
						  refusal to issue an out-of-hospital DNR
						  order).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › PATIENT AND SURROGATE RIGHTS AND RESPONSIBILITIES › Section 1051.12 - Surrogate's authority to request and revoke out-of-hospital DNR order

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Surrogate requesting an out-of-hospital DNR order.
The
					 surrogate of a patient may request and receive from the patient's attending
					 physician an out-of-hospital DNR order for the patient, regardless of the
					 patient's age or other physical or mental condition.
(b)
Surrogate revoking an
					 out-of-hospital DNR order.
A patient's surrogate may revoke an
					 out-of-hospital DNR order for the patient if the out-of-hospital DNR order was
					 issued at the request of a surrogate.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › PATIENT AND SURROGATE RIGHTS AND RESPONSIBILITIES › Section 1051.13 - Duties when person loses authority to function as a surrogate

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
No
					 authority to revoke out-of-hospital DNR order.
A person who acted as a
					 patient's surrogate when requesting an out-of-hospital DNR order for the
					 patient may not revoke the out-of-hospital DNR order if the person loses the
					 legal authority to serve as the patient's surrogate.
(b)
Duty when person loses surrogate
					 status.
If capable of doing so, a person who loses the authority to
					 act as a patient's surrogate after the person obtained an out-of-hospital DNR
					 order for the patient shall apprise a replacement surrogate, if any, of the
					 patient's out-of-hospital DNR items and of other pertinent information relating
					 to those items. The former surrogate shall also provide to the replacement
					 surrogate or to the patient if the patient is no longer represented by a
					 surrogate, the name of the physician who issued the out-of-hospital DNR order
					 and any information the person has to help the patient or new surrogate locate
					 the physician. The former surrogate, if capable of doing so, shall also make a
					 reasonable effort to apprise the physician who issued the out-of-hospital DNR
					 order of the change in that person's status, as well as the name of the person,
					 if any, who replaced that person as the patient's surrogate and any information
					 the former surrogate has to help the physician locate the patient and the
					 patient's current surrogate.
(c)
Duty when contacted by physician.
If a patient's former
					 surrogate did not attempt to contact the patient's attending physician as
					 required by subsection (b), or made the attempt but was unsuccessful, and is
					 contacted by the patient's attending physician for the purpose of communicating
					 information regarding the patient, the patient's former surrogate shall apprise
					 the physician that the person is no longer the patient's surrogate and provide
					 the physician any information the former surrogate has to help the physician
					 locate the patient or the patient's current surrogate.
(d)
Duty of replacement
					 surrogate.
A person who replaces another person as the patient's
					 surrogate after an out-of-hospital DNR order has been issued for the patient,
					 and who is made aware of the order and given information regarding the
					 attending physician who issued the order, shall make a reasonable effort to
					 contact the physician to apprise the physician of the change in surrogates
					 unless the new surrogate is able to confirm that the former surrogate has
					 already made the disclosure.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › ATTENDING PHYSICIAL RESPONSIBILITIES › Section 1051.21 - Securing out-of-hospital DNR orders, bracelets and necklaces

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Securing order forms.
A physician or the physician's agent may
					 secure out-of-hospital DNR order forms from the Department unless the
					 Department has contracted with a vendor to provide the order forms, in which
					 case the physician shall secure the order forms by purchasing them from the
					 contracted vendor.
(b)
Securing bracelets and necklaces.
A physician may secure
					 out-of-hospital DNR bracelets and necklaces by purchasing them from the vendor
					 with which the Department has contracted to produce the bracelets and
					 necklaces.
(c)
Vendors.
The Department will publish in a
Pennsylvania
					 Bulletin
notice the name and address of the vendors with which it has
					 contracted under this section and publish superseding
Pennsylvania
					 Bulletin
notices when there are vendor changes.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › ATTENDING PHYSICIAL RESPONSIBILITIES › Section 1051.22 - Issuance of out-of-hospital DNR order

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Authority to issue.
A
					 patient's attending physician shall issue an out-of-hospital DNR order for the
					 patient if the patient who is qualified to request the order under §
											1051.11(a)
					 (relating to patient qualifications to request and revoke out-of-hospital DNR
					 order) or the patient's surrogate requests the attending physician to issue an
					 out-of-hospital DNR order for the patient and the attending physician
					 determines that the patient has a terminal condition or is permanently
					 unconscious.
(b)
Review of
					 order before signing.
Before completing, signing and dating an
					 out-of-hospital DNR order, a patient's attending physician shall ensure that
					 the patient is identified in the order, that all other provisions of the order
					 have been completed, and that the patient or the patient's surrogate, as
					 applicable, has signed the order.
(c)
Order form
. A patient's
					 attending physician shall issue an out-of-hospital DNR order for the patient
					 only on a form provided by the Department or its designee.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › ATTENDING PHYSICIAL RESPONSIBILITIES › Section 1051.24 - Disclosures to surrogate requesting out-of-hospital DNR order

Current through Register Vol. 54, No. 28, July 13, 2024
Before issuing an out-of-hospital DNR order for a patient
						that is requested by the patient's surrogate, the attending physician shall
						disclose the following information to the surrogate:
(1) The diagnosed condition is a terminal
					 condition or that the physician has diagnosed the patient to be permanently
					 unconscious.
(2) The disclosures
					 required by §
											1051.23(2), (3), (5), (7) and
					 (8) (relating to disclosures to patient
					 requesting out-of-hospital DNR order).
(3) An out-of-hospital DNR order, bracelet or
					 necklace requested by the surrogate is effective only when the order, bracelet
					 or necklace is displayed with the patient or the surrogate presents the order
					 to the EMS provider at the time the patient experiences cardiac or respiratory
					 arrest.
(4) The patient or
					 surrogate may revoke the out-of-hospital DNR order; the patient or surrogate
					 may do so without the physician's approval or knowledge; revocation may be
					 accomplished by destroying or not displaying the order, bracelet or necklace,
					 or by conveying the decision to revoke the out-of-hospital DNR order verbally
					 or otherwise at the time the patient experiences cardiac or respiratory arrest;
					 and neither the physical nor mental condition of the patient will be considered
					 to void the decision of the patient or surrogate to revoke the out-of-hospital
					 DNR order if that decision is clearly communicated in some manner. The
					 physician shall also apprise the surrogate, if it seems appropriate under the
					 circumstances, that the power of the surrogate to revoke the out-of-hospital
					 DNR order for the patient will terminate if the surrogate loses the legal
					 authority to make that decision.
(5) The physician will make every reasonable
					 effort to contact the surrogate to ask the surrogate to return the
					 out-of-hospital DNR order, bracelet and necklace to the physician, for
					 destruction by the physician, if the physician discovers that the diagnosis of
					 the terminal condition or that the patient is permanently unconscious was in
					 error.
(6) If the patient is
					 female, there are additional procedures that an EMS provider will need to
					 follow to implement an out-of-hospital DNR order if the patient is pregnant at
					 the time of cardiac or respiratory arrest. If the patient is pregnant or the
					 patient's surrogate requests information regarding the additional procedures,
					 the physician shall explain the requirements of §
											1051.61 (relating to pregnant
					 patients).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › ATTENDING PHYSICIAL RESPONSIBILITIES › Section 1051.25 - Disclosures to patient when surrogate requests out-of-hospital DNR order

Current through Register Vol. 54, No. 28, July 13, 2024
Before issuing an out-of-hospital DNR order for a patient
						that is requested by the patient's surrogate, the attending physician shall
						disclose to the patient the information in §
											1051.23 (relating to disclosures
						to patient requesting out-of-hospital DNR order) that the physician in good
						faith believes the patient needs to have to make a future decision to revoke or
						not revoke the order. In making this assessment, the physician shall consult
						with the patient's surrogate and consider factors such as the reason the
						patient is not able to request an out-of-hospital DNR order, the patient's
						ability to comprehend and retain the information, and the patient's age and
						maturity. The attending physician shall refuse to issue the order if the
						physician and surrogate cannot agree to the information that is to be disclosed
						to the patient by the physician.
This section cited in 28 Pa. Code §
													1051.26 (relating to physician
						  refusal to issue an out-of-hospital DNR
						  order).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › ATTENDING PHYSICIAL RESPONSIBILITIES › Section 1051.26 - Physician refusal to issue an out-of-hospital DNR order

Current through Register Vol. 54, No. 28, July 13, 2024
An attending physician who is not willing to issue an
						out-of-hospital DNR order for a reason other than described in §
											1051.25 (relating to disclosures
						to patient when surrogate requests out-of-hospital DNR order) shall explain the
						reason to the patient or the patient's surrogate, as appropriate. If the
						request is made by a patient's surrogate, or by a patient who qualifies to make
						the request under §
											1051.11 (relating to patient
						qualifications to request and revoke out-of-hospital DNR order), and the
						physician determines that the patient is qualified to receive an
						out-of-hospital DNR order, the physician shall also do the following:
(1) Explain to the patient or surrogate that
					 an out-of-hospital DNR order may be issued only by a physician who has primary
					 responsibility for the treatment and care of a patient.
(2) Make every reasonable effort to assist
					 the patient or surrogate to secure the services of another physician who is
					 willing to issue an out-of-hospital DNR order for the patient and who will
					 undertake primary responsibility for the treatment and care of the patient in
					 addition to or instead of the attending physician, as the patient or surrogate
					 chooses.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › ATTENDING PHYSICIAL RESPONSIBILITIES › Section 1051.27 - Providing out-of-hospital DNR bracelet or necklace

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Bracelet and necklace.
A
					 patient's attending physician may provide to the patient, or to the patient's
					 surrogate for the patient, an out-of-hospital DNR bracelet or necklace, or
					 both, if the physician has issued or is issuing an out-of-hospital DNR order
					 for the patient and the patient or the surrogate requests the item.
(b)
Order also required.
A
					 patient's attending physician may not provide an out-of-hospital DNR bracelet
					 or necklace for the patient without also issuing, or having issued, an
					 out-of-hospital DNR order for the patient.
(c)
Department vendor.
A
					 patient's attending physician may provide to or for the patient only an
					 out-of-hospital DNR bracelet or necklace produced by a vendor with which the
					 Department has contracted to produce the bracelet or necklace.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › ATTENDING PHYSICIAL RESPONSIBILITIES › Section 1051.28 - Documentation

Current through Register Vol. 54, No. 28, July 13, 2024
An attending physician who issues an out-of-hospital DNR
						order for a patient shall maintain a copy of that order in the patient's
						medical record and shall document in that order whether the physician also
						provided an out-of-hospital DNR bracelet or necklace, or both. If the attending
						physician provides an out-of-hospital DNR bracelet or necklace after issuing
						the out-of-hospital DNR order, the physician shall document the patient's
						medical record to reflect that the bracelet or necklace was also provided for
						the patient.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › ATTENDING PHYSICIAL RESPONSIBILITIES › Section 1051.29 - Duty to contact patient or surrogate

Current through Register Vol. 54, No. 28, July 13, 2024
If a physician who issued an out-of-hospital DNR order
						for the patient subsequently determines that the diagnosis that the patient is
						in a terminal condition or is permanently unconscious was in error, the
						physician shall make every reasonable effort to promptly contact the patient or
						the patient's surrogate to disclose the error. The physician shall also request
						the return of the order, and the bracelet and necklace if the physician
						provided those items.
This section cited in 28 Pa. Code §
													1051.30 (relating to physician
						  destruction of out-of-hospital DNR order, bracelet or
						  necklace).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart B - Matters Anciliary to Emergency Medical Services Systems › Chapter 1051 - OUT-OF-HOSPITAL DO-NOT-RECUSCITATE ORDERS › ATTENDING PHYSICIAL RESPONSIBILITIES › Section 1051.30 - Physician destruction of out-of-hospital DNR order, bracelet or necklace

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Destruction of order, bracelet and necklace
. A physician shall
					 destroy an out-of-hospital DNR order, bracelet or necklace returned to the
					 physician under §
											1051.29 (relating to duty to
					 contact patient or surrogate), as follows:
(1) The physician shall shred or otherwise
					 destroy beyond identification the original order and mark all copies of the
					 order in the physician's possession as having been revoked.
(2) The physician shall cut the bracelet or
					 necklace pendant in half or take other action that renders the bracelet or
					 necklace incapable of being used again as an out-of-hospital DNR bracelet or
					 necklace.