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HomeMy WebLinkAboutResolution No. 04-60 CITY OF THE COLONY, TEXAS RESOLUTION NO. 04- ~ O A RESOLUTION OF THE CITY OF THE COLONY, TEXAS, AUTHORIZING THE CITY MANAGER TO EXECUTE A THREE YEAR MEDICAL CONTROL CONTRACT BETWEEN THE CITY OF THE COLONY AND METROCREST MEDICAL SERVICES FOR THE PURPOSE OF ESTABLISHING THE RIGHTS, DUTIES, AND RESPONSIBILITIES OF THE COLONY FIRE DEPARTMENT AND METROCREST MEDICAL SERVICES, AND TO PROVIDE MEDICAL CONTROL TO THE EMS PERSONNEL OF THE CITY; PROVIDING AN EFFECTIVE DATE. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF THE COLONY, TEXAS: Section 1. That the City Manager of the City of The Colony, Texas, is hereby authorized and empowered to execute a three-year Medical Control Contract with Metrocrest Medical Services for the purpose of establishing the rights, duties, and responsibilities o£ The Colony Fire Depar~ent and Metrocrest Medical Services, and to provide medical control to the EMS personnel o£the City. Section 2. That a true and correct copy o£ the Agreement is attached hereto and incorporated herein. Section 3. That this resolution shall take effect immediately from and a~ter its passage. PASSED AND APPROVED by the City Council of the City o£ The Colony, Texas, this 16th day o£August, 2004. Jo~n Dillard, Mayor Ci~of The Colony, Texas Christie Wilson, TRMC, City Secretary MMS Medical Contxol Contract for City of The Colony, Texas Fire Department Page 1 THE STATE OF TEXAS) MEDICAL CONTROL CONTRACT COUNTY OF DALLAS) WHEREAS, The Colony, Texas (the "City") is a duly incorporated municipality pursuant to the laws oftbe State of Texas; and WHEREAS, the City provides Emergency Medical Service ("EMS") solely by and through its Fire Department; and WHEREAS, Metrocrest Medical Service ("MMS"), a nonprofit corporation organized pursuant to the laws of the State of Texas, is providing Medical Control to The Colony Fire Department EMS personnel; and WHEREAS, the City and MMS desire to enter into this Contract for the purpose of establishing the rights, duties, and responsibilities of The Colony Fire Department and MMS in providing Medical Control to the EMS personnel of the City, NOW, THEREFORE, for and in the consideration of the mutual promises and covenants herein contained and other good and valuable consideration, the City and MMS do hereby CONTRACT, COVENANT, WARRANT, AND AGREE as follows: I. GENERAL AGREEMENTS A. The City agrees that any personnel receiving Medical Control under this contract shall be certified by the Texas Department of Health and hold cun'ent EMS status. In addition, personnel shall be authorized by MMS, as specified in the appropriate MMS protocol and Medical Control policies. B. The City agrees if requested to provide to MMS with a written detailed description of its EMS District, including names, counties, towns, cities, or other areas. The City agrees to furnish other reports listed in attachment A. Upon request, the City will furnish additional reports to MMS. C. The City agrees if necessary to provide MMS or it's medical control entity with written permission to operate on the City's radio frequencies. Additionally, the City agrees to provide MMS with the fxequency and PL/CTCSS information for radio channels used by the City's ambulance. The City will furnish and MMS agrees to abide by the City's rules/policies regarding radio usage. D. The City agrees that it will provide, maintain, and operate all necessary, radio, cellular telephones, and associated equipment of the City in order to maintain communications with medical control during periods when such communication is necessary. MMS Medical Control Contract for City of The Colony, Texas Fire Depar~nent Page 2 E. The City and MMS agree that MMS's medical control policy and procedures manual, including any additions or deletions during the contract period, shall be incorporated as a part of this agreement. F. The City agrees that any use of MMS materials (i.e. Policies & Procedures, Protocols, evaluation forms, etc.) outside of its normal intended use will require permission from MMS prior to use. Outside the normal intended use includes, but is not limited to, use of materials as examples of continuous quality improvement used by the City for proposals, information reports, etc. G. All MMS documentation, Policies & Procedures, Protocols, and other materials used by the City remain the property of MMS, and must be returned should the contractual relationship between MMS and the City terminate. Completed run forms with quality improvement evaluations attached are exempt from being returned. The City agrees that any part which is kept by the City is considered part of the quality improvement process, and must remain confidential to the extent permitted by law. II. MEDICAL CONTROL A. MMS will provide Medical Control through a Medical Director and Emergency Department physicians, who are licensed to practice medicine in the State of Texas. B. The City recognizes that the Texas State Board of Medical Examiners EMS Chapter 197 (22 Texas Administrative Code 197), as amended (which regulations are incorporated herein and made a part hereof for all purposes), shall govern the obligations of the Medical Director in regard to Services provided, which includes, but is not limited to, the MMS Medical Control System authorization of all EMS personnel within the City. C. The Medical Director will provide pre hospital protocols, including standing orders for treatment of patients by the EMS personnel under his/her medical direction. D. MMS will make available an on-line medical control source, which will be available 24 hours a day, 7 days a week to provide medical direction and consultation to the Cit2/s EMS personnel. E. The City agrees to participate in, and follow the recommendations of, MMS's Quality Improvement (QI) Program. MMS Medical Control Contract for City of The Colony, Texas Fire Department Page 3 F. The City agrees to appoint one supervisor to represent the City for the Quality Improvement Manager committee. This appointment is subject to approval of MMS. III. New Personnel A. The City agrees to report newly certified and/or new EMS personnel to MMS prior to permitting them to provide out of hospital care. The City also agrees to send one copy of each new EMS personnel's Texas Department of Health's EMS certification and, for paramedic-level personnel, a "current" (dated within 2 years of submission) Advanced Cardiac Life Support course completion card to MMS in order to receive authorization to provide patient care in the MMS Medical Control System. New EMS personnel who do not have a "current" ACLS course completion card will have a period of no greater than 120 days to complete the required ACLS training. MMS will assisted the City to facilitate ACLS training for personnel not processing a current ACLS completion card. All new EMS personnel will be issued a medical control number after MMS receives proper notification of new EMS personnel. The City agrees that personnel hired cannot provide patient care under the authority of the MMS Medical Control System until a medical control number has been issued. B. New personnel will be required to successfully complete the MMS New Employee Training and Testing Course (NETTC) which will train and test skills and introduce policies and procedures utilized in the MMS Medical Control System. The new personnel will take a written exam covering the protocols applicable to the personnel's certification within the time frame established by the medical control policies. NETTC training will be completed with 120 days new personnel being authorized to function in the medical control system unless scheduled NETTC classes to provide for this time. Successful completion of this exam will result in full protocol privileges up to the personnel's state certification level. A fee of $25.00 per ½ day will be charged for attendance to the NETTC class. The fees for the attendance for the NETTC training are included in the Contract fees for up to a maximum of (6) six personnel per contract year. For any additional personnel to attend NETTC training over the maximum number of (6) paramedic MMS's current NETTC class fee will be charged C. If the City does not require the need of (6) personnel to attend NETTC, the City may substitute the balance of non-utilized positions in any other specialized training classes MMS offers. These may include RSI, PHTLS, ACLS, PALS, FTO, or PEPP. D. Individuals not completing the MMS NETTC class after being hired may be subject to having their medical control authorization revoked, at the discretion of the Medical Director IV. CONTINUING EDUCATION MMS Medical Control Contract for City of The Colony, Texas Fire DeparUnent Page 4 A. Personnel receiving Medical Control under this contract shall comply with the MMS CE requirements. MMS will provide Continuing Education ("CE") hours, which are approved by the Texas Depathnent of Health for credit towards m-certification of the City's EMS personnel. The CE will also meet the educational needs of the City's EMS personnel as determined by the QI program. All EMS personnel CE records will be maintained by MMS. Other CE, which is pm-approved by MMS, will be accepted for record keeping by MMS. B. CE will be provided by MMS approved CE Instructors, under the direction of the Medical Control Services ("MCS") Manager, a Certified Course Coordinator, and the MMS Medical Director. CE evaluation forms will be available at all CE offerings to give EMS personnel the opportunity to provide MMS with feedback concerning the instructor and class. C. The CE provided by MMS will consist of lecture and practice on the skills required for certification. MMS will design the skills practice so that over a four-year re-certification period, all skills will be evaluated. D. Mandatory attendance by the City's EMS personnel is required and is covered in the appropriate policy. E. Missed CE can be made up (within 30 days of the missed CE offering) by successfully completing the CE makeup packet (provided by MMS's CE Coordinator) and passing the written exam covering the material. The appropriate amount of CE credit will be awarded upon successful completion of the makeup packet. F. MMS is not responsible for fees required for the EMS personnel's m-certification (for the skills exam, written CE evaluation, and/or any other fees). State fees will be the sole responsibility of the EMS personnel, City, or both (as defined by the City's own policies/procedures). G. MMS may, at their discretion, evaluate EMS personnel during emergency runs and may credit the personnel CE credit hours for those runs. Continuing education credit hours will be awarded based upon TDH rules in effect at the time of EMS personnel evaluation. H. Additional CE credit hours may be certified through MMS by attending outside courses or seminars approved in advance by MMS if required verification and/or course information is provided to MMS. I. MMS will provide the City, upon written request, with a regular report indicating individuals who are nearing their re-certification date. However, the information will be based upon data received fxom the City and MMS will not be responsible for errors. The MMS Medical Contxol Contract for City of The Colony, Texas Fire Department gage 5 City further understands the ultimate responsibility of EMS certification rests at the with the individual EMS personnel. J. The City will be responsible for notifying the MMS CE Coordinator of the need for CE reports, which will allow the City to complete the appropriate State required paperwork for that City's EMS personnel needing to re-certify. The responsibility for re-certification of the City's EMS personnel rests with the City. K. MMS will keep track of all CE hours accrued through MMS CE classes. MMS will also keep records of re-certification dates of all personnel. Responsibility for timely re- certification of the City's EMS personnel rests entirely with the City and the individual. V. COSTS A The costs for Medical Control and Continuing Education per month during this contract period will be: Period Medical Control Continuing Education Total Per Month 10/04-9/05 $1320.00 $615.00 $1935.00 10/05-9/06 $1345.00 $625.00 $1970.00 10/06-9/07 $1370.00 $635.00 $2005.00 Payment may be made on an annual, semiannual, quarterly, or monthly basis at the City's election. Payment shall be made on or in advance with the first payment due October 1, 2004. B. Three (3) 4 credit-hour Continuing Education classes will be scheduled and provided per month during the term of this contract. The cost for providing continuing education classes to the City is based upon $65.00 per class hour for up to ten students. The City agrees to pay MMS $30.00 per class for the each additional group of ten students or fraction thereof in any class. For example, a CE class of 35 or 40 would cost the City an additional $90.00 per class hour. Charges for additional instructors are payable in arrears Net 15 following receipt of invoice from MMS. C. If, during this Contract, any EMS personnel need additional CE hours or training as determined by the QI Program, the City must pay a fee to MMS of $65.00 per training hour (for up to 10 students in one class) or $87.00 (for 11-20 students in one class) provided by MMS to make up the deficiency. However, deficient training hours may also be made up through other sources of certified CE instruction, which is pre-approved by MMS. MMS will offer the necessary training to keep all EMS personnel current in their CE requirements. MMS Medical Control Contract for City of The Colony, Texas Fire Department Pa~e 6 D. Any increase in cost of providing services hereunder occasioned by changes in applicable laws or regulations from or after the date hereof shall be paid by the City. The fees to be paid hereunder pertain to the scope of services to be provided hereunder, to-wit, medical control of a transport City and continuing education classes. Supplemental Service as defined below, fail outside the scope of services of this Contract, and are charged and to be paid as follows: Medical Director $125.00 per hour Other MMS personnel $ 65.00 per hour Supplemental services are defined as: 1. Pre scheduled standby events at which medical control personnel are requested to be present by the City or required to be present by law 2. Consultations with the City, or on behalf of the City, beyond the normal and customary scope of medical control 3. Appearances and presentation on behalf of the City, beyond the normal and customary scope of medical control and, 4. The commitment of man-hours by MMS in excess of 120% of those occasioned by providing normal and customary medical control (the "Standard") to the City. For purposes hereof, the standard is determined to be 37 hours per month. VI. INDEMNIFICATION A. The City agrees to indemnify MMS against and hold MMS harmless from any and all actions, damages, injuries, claims, lawsuits, judgments, or causes of action of any nature alleged or sustained by any person arising out of or occasioned negligent acts of the City, its agents or employees, in the execution and performance of this contract. B. MMS agrees to indemnify the City against and hold the harmless from any and all actions, damages, injuries, claims, lawsuits, judgments or causes of action of any nature alleged or sustained by any person arising out of or occasioned negligent acts of the MMS, its agents or employees, in the execution and performance of this contract. MMS Medical Control Contract for City of The Colony, Texas Fire DeparUnent Page 7 VII. LIABILITY/WORKERS COMPENSATION A. Each party, at its own cost and expense, shall maintain in full fome and effect a policy of general liability, workers compensation and professional liability insurance, protecting itself and its employees against any claim for damages arising by reason of personal injury or death occasioned directly or indirectly in connection with the performance of its Service including those Services which are provided pursuant to this Contract. VIII. TERM of CONTRACT A. Subject to the annual appropriation of funds by the City for the payment of this Contract, the term of this Contract shall be for thirty-six (36) months, commencing at 12:01 a.m. on October 1, 2004 and terminate at midnight, September 30, 2007. B. Either party may initiate a decision regarding possible renewal or m-negotiation of this Contract or any extension thereof; which shall be made at least six (6) months prior to the scheduled termination date of the subject term, unless otherwise agreed in writing by both parties. C. This Contract may be terminated by either party by giving written notice of such termination without cause to the other party. This Contract shall then terminate ninety (90) days after such notice has been received. MMS shall refund a portion of the prepaid fees on a pro-mm basis calculated from the termination date. D. Should MMS fail to provide the contracted services to the City for a period of 60 days (excluding any scheduled period of inactivity), this contract will be considered in default and may be terminated immediately by the City. E. Should payment by the City to MMS fall behind 60 days from date due, this contract will be considered in default and may be terminated immediately by MMS. F. Except as otherwise provided herein, whenever this Contract requires or permits any consent, approval, notice, request, or demand from one party to the other, the consent, approval, notice, request or demand must be in writing to be effective and shall be deemed to have been given when personally delivered to the party to be notified or on the second business day after it is enclosed in an envelope, addressed to the party to be notified at the address set forth below (or at such address as may have been desi~ated by written notice), properly stamped, sealed, and deposited in the United States mail, certified mail, return receipt requested. The address of each party for purposes hereof is as follows: MMS Medical Conlxol Contract for City of The Colony, Texas Fire Depamnent Page MMS: Metrocrest Medical Services, Inc. City: City of The Colony Atm.: Medical Control Manager Atm.: Chief Mike Nolen 1508 E. Beltline Rd #101 4900 Blair Oaks Blvd. Carrollton, Texas 75006 The Colony, TX 75056 Venue for any action under this Contract shall be in Dallas County, Texas. EXECUTED this the /b day of ~ ~ ,2004. The Colony: Signature Printed nan~e and Title J Metrocrest Medical Services, Inc. Chris Cothes Medical Control Manager MMS Medical Control Contract for City of Thc Colony, Texas Fire Department Page 9 ATTACHMENT A The following reports shall be submitted to MMS: A. A monthly activity report in written format, (format provided by MMS), with the following information: 1. Number, type of calls and disposition 2. Number of BLS and ALS incidents 3. Other information determined necessary by the City or MMS B. A copy of each Incident Report shall be forwarded to MMS for review. To be included must be all incident reports where there is no patient transported or found to exist. This form must include type, date, time and personnel responding to incident. C. A copy of each person's current ACLS completion card or training rooster and EMS certification for every EMS personnel working in the MMS Medical Control System for the city of The Colony's Fire Department. D. Monthly Controlled Substance Safe logs, Controlled Substance Use forms, apparatus narcotic accountability logs for each vehicle carrying morphine sulfate and/or Valium, and DEA 222 forms. MMS must receive original, not copy of form. E. A current personnel roster, including the following information: 1. Personnel names 2. TDH certification level 3. Station or post assignment 4. Shift assignment The City will also provide MMS with a revised Personnel Data Form whenever changes are made to field/dispatch staff. F. Information on all EMS personnel, to include: 1. Name 2. Social security number 3. Date of birth 4. Correct address 5. Correct phone number MMS Medical Control ConWact for City of The Colony, Texas Fire Department Page 10 ATTACHMENT B A. The City agrees that ail vehicles used to transport the sick and injured will at all times while being used to provide out of hospital patient care, meet current Texas Department of Heaith standards including equipment and staffing, as well as the equipment and supplies listed in the MMS protocols carried on that particular vehicle. B. The City shall allow and make available at any time, vehicles or equipment for review and inspection by MMS, including non-transport vehicles. C. The City shall allow observation of performance, evaluation and participation during runs or other on-site visits as deemed necessary by MMS staff and/or by the Medical Director. D. The City will notify MMS in writing when, and the results of, TDH vehicle inspections. MMS Medical Control Contract for City of The Colony, Texas Fire Department ATTACHMENT C Texas State Board of Medical Examiners EMS Chapter 197 MMS Medical Control Contract for City of The Colony, Texas Fire Deparm~¢nt Page 12 Texas State Board of Medical Examiners Emergency Medical City Chapter 197 Emergency Medical City 197.1-197.6 The following roles are promulgated under the authority of Article 4495b, V.A.C.S. 197.L Purpose. The purpose of this chapter is to facilitate the most appropriate utilization of the skills of physicians who delegate health care tasks to qualified emergency medical City (EMS) technicians. Such delegation shall be consistent with the patient's health and welfare and shall be undertaken pursuant to supervisory guidelines which take into account the skill, training, and experience of both physicians and EMS technicians. This chapter addresses the qualifications, responsibilities, and authority of physicians who provide medical directions and/or supervision of prehospital care by EMS personnel; the qualifications, authority, and responsibilities of physicians who serve as medical directors (off-line); the relationship of EMS providers to the off-line medical director; components of on-line medical direction (direct medical control), including the qualifications an responsibilities of physicians who provide on-line medical direction and the relationship of prehospital providers to those physicians; and, the responsibility of EMS personnel to private and intervenor physicians. This chapter is not intended and shall not be construed to restrict a physician from delegating administrative and technical or clinical tasks not involving the exemise of independent medical judgment to those specially trained individuals instructed and directed by a licensed physician who accepts responsibility for the acts of such allied health personnel. Likewise, nothing in this chapter shall be construed to prohibit a physician from instructing a technician, assistant, or other employee, who is not among the classes of EMS technicians, as defined in section 197.2 of this title (relating to Definitions), to perform delegated tasks so long as the physician retains supervision and control of the technician, assistant, or employee. Nothing in this chapter shall be conslrued to relieve the supervising physician of the professional or legal responsibility for the care and treatment of his or her patients. A physician who, after agreeing to supervise EMS personnel, fails to do so adequately and properly, may be subject to disciplinary action pursuant to the Medical Practice Act. Implementation of this chapter will enhance the ability of EMS systems to assure adequate medical direction of all advanced prehospital providers and many basic level providers, as well as compliance by personnel and facilities with minimum criteria to implement medical direction of prehospital services. A medical director shall not be held responsible for noncompliance with this chapter if the EMS administration fails to provide the necessary administrative support to permit compliance with the provisions of chapter. ' 197.2. Definitions. The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise. Advanced life support -Emergency prehospital care that involves invasive medical procedures. The provision of advanced life support shall be under the medical directions and/or supervision and control of a licensed physician. Texas State Board of Medical Examiners Emergency Medical City Chapter 197 Basic life support -Emergency prehospital care that involves noninvasive medical procedures. The provision of basic life support may be under the medical direction and/or supervision and control of a licensed physician. Board - The Texas State Board of Medical Examiners. Delegated practice - Permission given by a physician either in person or by treatment protocols or standing orders to a specific EMT-I or EMT-P to perform invasive procedures. I)ireet medical control - Provision by a physician designated by the EMS system of immediate medical direction to prehospital providers in out of hospital locations either at the scene or via radio or telephonic communication. This relationship may also be referred to as on- line medical direction. Emergency medical services personnel - (A) Emergency care attendant (ECA) - An individual certified by the Texas Department of Health as able to provide emergency prehospital care in the form of initial aid that promotes comfort and avoids aggravation of an injury or illness; (B) Emergency medical technician (EMT) - An individual certified by the Texas Department of Health as able to provide emergency prehospital care that is necessary for basic life support; (C) Emergency medical technician-intermediate (EMT-I) - An individual certified by the Texas Department of Health as able to provide emergency prehospital care by initiating certain procedures, including intravenous therapy and endotracheal or esophageal intubation, under medical supervision; and (D) Emergency medical technician-paramedic (EMT-P) - An individual certified by the Texas Department of Health as able to provide emergency prehospital care under medical supervision in the form of advanced life support, which may include initiation of intravenous therapy, endotraeheal or esophageal intubatiun or both, electrical cardiac defibrillation or cardioversion, drug therapy, and other procedures. Emergency medical Services system (EMSS) - All components needed to provide comprehensive prebospital and hospital emergency care including, but not limited to, a medical director, transport vehicles, trained personnel, access and dispatch, communications, and receiving medical facilities. Intervenor physician - A physician licensed by the board, who, without having established a prior physician/patient relationship with the emergency patient, accepts responsibility for the prehospitat care, and can provide proof of a current medical license. Medical Director - A physician responsible for all aspects of the operation of an EMS system concerning provision of medical care. This relationship may also be referred to as off- tine medical direction. Prehospital providers - All personnel providing emergency medical care in a location remote from facilities that are capable of providing definitive medical care. Texas State Board of Medical Examiners Emergency Medical City Chapter 197 Protocols - Guidelines for EMS practice that are used in a variety of situations within the EMS system. Standing delegation ordera - Strictly defmed written orders for actions, techniques, or drag administration that may be implemented when communication has not been or cannot be established with the physician providing on-line medical direction. 197.3. Off-Line Medical Director. (a) An off-line medical director shall be: (1) a physician licensed to practice in Texas; (2) familiar with the design and operation of EMS systems; (3) experienced in prehospital emergency care of acutely ill or injured patients; (4) actively involved in: (A) the emergency management of acutely ill and/or injured patients; (B) the training and/or continuing education of EMS personnel, under his or her direct supervision, at their respective levels of certification; (C) the medical audit, review, and critique of the performance of EMS personnel at all levels of certification; (D) the administrative and legislative environments affecting regional and/or state prehospital EMS organization; (5) knowledgeable about local multi-casualty plans; (6) familiar with dispatch and communications operations ofprehospital emergency units; and (7) knowledgeable about laws and regulations affecting local, regional, and state EMS operation. (b) The medical director shall: (1) approve the level ofprehospital care which may be rendered locally by each of the EMS personnel employed by and/or volunteering with the EMS under the medical director's supervision, regardless of the level of state certification, before the certificant is permitted to provide such care to the public; (2) establish and monitor compliance with field performance guidelines for EMS personnel; (3) establish and monitor compliance with training guidelines which meet or exceed the minimum standards set forth in Texas Department of Health EMS certification regulations; (4) develop, implement, and revise protocols and/or standing delegation orders, if appropriate, governing prehospital care and medical aspects of patient triage, transport, transfer, dispatch, exlricafion, rescue, and radio-telephone-telemetry communication by the EMS; (5) direct an effective system audit and quality assurance program; (6) make formal recommendations on medically related aspects of operation of the EMS including the inspection, evaluation, and approval of the system's Texas State Board of Medical Examiners Emergency Medical City Chapter 197 performance specification; (7) function as the prima~ liaison between the EMS administration and the local medical community, ascertaining and being responsive to the needs of each; (8) develop a letter of agreement between the medical director(s) and the EMS administration outlining the specific responsibilities and authority of each. The agreement should describe the process or procedure by which a medical di~etor may withdraw responsibility for EMS personnel for noncompliance with the Emergency Medical City Act, Health and Safety Code, Chapter 773, the rules adopted in this chapter, and/or accepted medical standards; (9) take or recommend appropriate remedial or corrective measures for EMS personnel, in conjunction with local EMS administration, which may include but are not limited to counseling, retraining, testing, probation, and/or field preceptorship; (10) suspend a certified EMS individual from medical care duties for due cause pending review and evaluation; (11) establish the circumstances under which a patient might not be transported; (12) establish the circumstances under which a patient may be transported against ins or her will in accordance with state law, including approval of appropriate procedures, forms, and a review process; (13) establish criteria for selection of a patient's destination; and (14) develop and implement a comprehensive mechanism for managemem ofpatiem care incidents, including patient complaints, allegations of substandard care, and deviations from established protocols and patient care standards. 197.4. On-Line Medical Direction. (a) All prehospital providers above the certification level of EMT shall be assigned to a specific on-line communication resource by a predetermined policy. (b) Specific local protocols shall define the circumstances under which on-line medical direction is required. (c) A physician providing or delegating on-line medical direction shall be appropriately trained in the use of prehospital protocols, and shall be familiar with the capabilities of the prehospital providers, as well as local EMS operational policies and regional critical care referral protocols. (d) A physician providing or delegating on-line medical direction shall have demonstrated personal expertise in the prehospital care of critically ill and injured patients. (e) A physician providing or delegating on-line medical direction for particular patients assmnes responsibility for the appropriateness of prehospital care provided under ins or her direction by EMS personnel. 197.5. Authority for Control of Medical Services at the Scene of a Medical Emergency. (a) Control at the scene of a medical emergency scene shall be the responsibility of the individual in attendance who is most appropriately trained and knowledgeable in providing Texas State Board of Medical Examiners Emergency Medical City Chapter 197 prehospital emergency stabilization and transport. (b) When an advanced life support (ALS) team, under medical direction, is requested and dispatched to the scene of an emergency, a physician/patient relationship is thereby established between the patient and the physician designated by the EMS system providing medical direction (either off-line or on-line). (c) The prehospital provider on the scene is responsible for the management of the patient and acts as the agent of the physician providing medical direction. (d) If the patient's private physician is present and assumes responsibility for the patient's care, the prehospital provider should defer to the orders of said physician unless those orders conflict with established protocols. The patient's private physician shall document his or her orders in a manner acceptable to the EMS system. (e) The physician providing on-line medical direction shall be notified of the participation of the patient's private physician. (f) If the medical orders of the patient's private physician conflict with the system protocols, the private physician shall be placed in communication with the physician providing on-line medical direction. If the private physician and the on-line medical director cannot agree on treatment, the private physician must either continue to provide direct the patient to the hospital or must defer all remaining care to the on-line medical director. (g) The system's medical director or on-line medical control shall assume responsibility for directing the activities ofprehospital providers at any time the patient's private physician is not in attendance. (h) If an intervenor physician is present at the scene and has been satisfactorily identified as a licensed physician and has expressed his or her willingness to assume responsibility for care of the patient, the on-line physician should be contacted. The on-line physician is ultimately responsible for the care of the patient unless and/or until the intervenor physician appropriately assumes the responsibility for the patient. (i) The on-line physician has the option of managing the case exclusively, working with the intervenor physician, or allowing the intervenor physician to assume complete responsibility for the patient. (j) If there is any disagreement between the intervenor physician and the on-line physician, the prehospital provider shall be responsible to the on-line physician and shall place the intervenor physician in contact with the on-line physician. (k) If the intervenor physician is authorized to assume responsibility, all orders to the prehospital provider by the intervenor physician shall also be repeated to medical control for record keeping purposes. Texas State Board of Medical Examiners Emergency Medical City Chapter 197 (I) The intervenor physician must document his or her intervention in a manner acceptable to the local EMS. (m) The decision of the intervenor physician not to accompany the patient to the hospital shall be made with the approval of the on-line physician. (n) Nothing in this section implies that the prehospital provider can be required to deviate from system protocols. 197.6. Authority to Conduct Research and/or Educational Studies. (a) The medical director has the authority to design research projects and educational studies. Such studies should be approved by: (1) EMS administrative officials/and (2) an independent review panel if the project/study may have a differential impact on patient care. (b) The results of the study should be made available through publications to the EMS community. Effective January 2, 1991