Effective - 28 Aug 2022, 5 histories
190.103. Regional EMS medical director, powers, duties — considered public official, when — online telecommunication medical direction permitted — treatment protocols for special needs patients. — 1. One physician with expertise in emergency medical services from each of the EMS regions shall be elected by that region's EMS medical directors to serve as a regional EMS medical director. The regional EMS medical directors shall constitute the state EMS medical director's advisory committee and shall advise the department and their region's ambulance services on matters relating to medical control and medical direction in accordance with sections 190.001 to 190.245 and rules adopted by the department pursuant to sections 190.001 to 190.245. The regional EMS medical director shall serve a term of four years. The southwest, northwest, and Kansas City regional EMS medical directors shall be elected to an initial two-year term. The central, east central, and southeast regional EMS medical directors shall be elected to an initial four-year term. All subsequent terms following the initial terms shall be four years. The state EMS medical director shall be the chair of the state EMS medical director's advisory committee, and shall be elected by the members of the regional EMS medical director's advisory committee, shall serve a term of four years, and shall seek to coordinate EMS services between the EMS regions, promote educational efforts for agency medical directors, represent Missouri EMS nationally in the role of the state EMS medical director, and seek to incorporate the EMS system into the health care system serving Missouri.
2. A medical director is required for all ambulance services and emergency medical response agencies that provide: advanced life support services; basic life support services utilizing medications or providing assistance with patients' medications; or basic life support services performing invasive procedures including invasive airway procedures. The medical director shall provide medical direction to these services and agencies in these instances.
3. The medical director, in cooperation with the ambulance service or emergency medical response agency administrator, shall have the responsibility and the authority to ensure that the personnel working under their supervision are able to provide care meeting established standards of care with consideration for state and national standards as well as local area needs and resources. The medical director, in cooperation with the ambulance service or emergency medical response agency administrator, shall establish and develop triage, treatment and transport protocols, which may include authorization for standing orders. Emergency medical technicians shall only perform those medical procedures as directed by treatment protocols approved by the local medical director or when authorized through direct communication with online medical control.
4. All ambulance services and emergency medical response agencies that are required to have a medical director shall establish an agreement between the service or agency and their medical director. The agreement will include the roles, responsibilities and authority of the medical director beyond what is granted in accordance with sections 190.001 to 190.245 and rules adopted by the department pursuant to sections 190.001 to 190.245. The agreement shall also include grievance procedures regarding the emergency medical response agency or ambulance service, personnel and the medical director.
5. Regional EMS medical directors and the state EMS medical director elected as provided under subsection 1 of this section shall be considered public officials for purposes of sovereign immunity, official immunity, and the Missouri public duty doctrine defenses.
6. The state EMS medical director's advisory committee shall be considered a peer review committee under section 537.035.
7. Regional EMS medical directors may act to provide online telecommunication medical direction to AEMTs, EMT-Bs, EMT-Ps, and community paramedics and provide offline medical direction per standardized treatment, triage, and transport protocols when EMS personnel, including AEMTs, EMT-Bs, EMT-Ps, and community paramedics, are providing care to special needs patients or at the request of a local EMS agency or medical director.
8. When developing treatment protocols for special needs patients, regional EMS medical directors may promulgate such protocols on a regional basis across multiple political subdivisions' jurisdictional boundaries, and such protocols may be used by multiple agencies including, but not limited to, ambulance services, emergency response agencies, and public health departments. Treatment protocols shall include steps to ensure the receiving hospital is informed of the pending arrival of the special needs patient, the condition of the patient, and the treatment instituted.
9. Multiple EMS agencies including, but not limited to, ambulance services, emergency response agencies, and public health departments shall take necessary steps to follow the regional EMS protocols established as provided under subsection 8 of this section in cases of mass casualty or state-declared disaster incidents.
10. When regional EMS medical directors develop and implement treatment protocols for patients or provide online medical direction for patients, such activity shall not be construed as having usurped local medical direction authority in any manner.
11. The state EMS medical directors advisory committee shall review and make recommendations regarding all proposed community and regional time-critical diagnosis plans.
12. Notwithstanding any other provision of law to the contrary, when regional EMS medical directors are providing either online telecommunication medical direction to AEMTs, EMT-Bs, EMT-Ps, and community paramedics, or offline medical direction per standardized EMS treatment, triage, and transport protocols for patients, those medical directions or treatment protocols may include the administration of the patient's own prescription medications.
--------
(L. 1998 S.B. 743, A.L. 2016 S.B. 732, A.L. 2017 S.B. 503, A.L. 2018 H.B. 1355 merged with S.B. 870, A.L. 2022 H.B. 2331)
Structure Missouri Revised Statutes
Title XII - Public Health and Welfare
Chapter 190 - Emergency Services
Section 190.020 - Public hearing, notice — costs, how paid.
Section 190.025 - Petitions — consolidation, when — amended, how.
Section 190.030 - Sufficiency of petition, county commission to determine.
Section 190.035 - Notice of election, contents.
Section 190.040 - Form of ballot — effect of passage on tax rate — fund created — refunds, when.
Section 190.041 - Tax levy for central dispatching service, when, amount — funds kept separate.
Section 190.043 - Increase in tax rate without voter approval, when, amount.
Section 190.045 - Returns of election, where filed — effect of.
Section 190.051 - Change in number of board members, when — ballot language.
Section 190.052 - Board member must live in his district — vacancies, how filled.
Section 190.053 - Educational training required for board of directors — failure to attend.
Section 190.056 - Recall of directors, procedure.
Section 190.060 - Powers of district.
Section 190.065 - Bonds, issuance of — election, form of ballot.
Section 190.070 - Annexation, petition for — hearing — election, form of ballot.
Section 190.074 - Collection of taxes — levy — procedure.
Section 190.075 - Records, what and how kept.
Section 190.080 - Donated property — title, how taken.
Section 190.085 - Failure to approve bonds, effect of — dissolution — funds, how rebated.
Section 190.094 - Minimum ambulance staffing — volunteer defined.
Section 190.100 - Definitions.
Section 190.102 - Regional EMS advisory committees.
Section 190.104 - Pediatric emergency medical services system.
Section 190.107 - Contracts for mutual aid services.
Section 190.108 - Air ambulance licenses — sale or transfer of ownership, notice required.
Section 190.109 - Ground ambulance license.
Section 190.111 - Inspection limitation — effect of sale or transfer on a license.
Section 190.120 - Insurance, what coverage required — policy provisions required — term of policy.
Section 190.131 - Certification of training entities.
Section 190.133 - Emergency medical response agency license.
Section 190.134 - Dispatch agency, requirements.
Section 190.142 - Emergency medical technician license — rules.
Section 190.144 - Immunity from liability, when.
Section 190.146 - Lapse of license, request to return to active status, procedure.
Section 190.160 - Renewals of licenses, requirements.
Section 190.165 - Suspension or revocation of licenses, grounds for — procedure.
Section 190.171 - Aggrieved party may seek review by administrative hearing commission.
Section 190.173 - Confidentiality of information.
Section 190.175 - Records to be maintained by licensee.
Section 190.176 - Data collection system.
Section 190.180 - Penalty for violation.
Section 190.185 - Rules and regulations, department to adopt — procedure.
Section 190.190 - Time to comply granted existing equipment and personnel.
Section 190.200 - Public information and education.
Section 190.205 - Insurers' duties.
Section 190.243 - Transportation to trauma, STEMI, or stroke centers or hospitals, how authorized.
Section 190.248 - Investigations of allegations of violations, completed when — access to records.
Section 190.255 - Naloxone, first responder may administer, when — definition.
Section 190.265 - Helipads, hospitals not required to have fencing or barriers.
Section 190.270 - Citation of law.
Section 190.275 - Definitions.
Section 190.286 - Inapplicability to certain out-of-state businesses.
Section 190.290 - Definitions.
Section 190.300 - Definitions.
Section 190.306 - Dissolution of emergency telephone service not required, when (Christian County).
Section 190.315 - Contract for service authorized.
Section 190.320 - Election — ballot form.
Section 190.328 - Election of board, Christian and Scott counties, when — terms.
Section 190.329 - Election of board, exceptions, when — terms.
Section 190.334 - Performance and fiscal audits authorized.
Section 190.336 - Recall, board members subject to — procedure.
Section 190.340 - Emergency services board, officers duties, rules and regulations.
Section 190.355 - Use of existing resources required.
Section 190.400 - Definitions — interoperability service agreements, what agencies.
Section 190.420 - Fund established.
Section 190.470 - Alternate consolidation — petition, election — board appointed, requirements.
Section 190.475 - Centralized database to be maintained, updates.
Section 190.500 - Temporary license — qualified health care professions — declared emergency.
Section 190.525 - Definitions.
Section 190.534 - Violations, penalty — attorney general to have concurrent jurisdiction.
Section 190.537 - Rulemaking authority.
Section 190.550 - Schedule of fees established, rules — collection and deposit.
Section 190.600 - Citation of act — definitions.
Section 190.606 - Immunity from liability, what persons and entities.
Section 190.609 - Order effective, when — limitations of order.
Section 190.618 - Rules — rulemaking authority.
Section 190.621 - Penalty for concealing or falsifying an order.
Section 190.800 - Imposition of tax — definitions.
Section 190.803 - Formula for tax based on gross receipts — challenge of validity of rules.
Section 190.806 - Record-keeping requirements, confidentiality.
Section 190.812 - Determination of tax final, when — timely protest permitted.
Section 190.815 - Rulemaking authority.
Section 190.818 - Remittance of tax — fund created, use of moneys.
Section 190.821 - Tax period — failure to pay, delinquency, enforcement procedures.
Section 190.824 - Tax-exempt status of ambulance service not affected.
Section 190.827 - Payments to ambulance services, when.
Section 190.830 - Federal financial participation required.
Section 190.833 - No tax imposed prior to effective date.
Section 190.836 - Rules requirements, authority.
Section 190.839 - Expiration date.
Section 190.840 - Nonseverability clause.
Section 190.900 - REPLICA enacted — definitions.
Section 190.903 - Home state licensure.
Section 190.906 - Compact privilege to practice.
Section 190.909 - Conditions of practice in a remote state.
Section 190.912 - Relationship to emergency management assistance compact.
Section 190.915 - Veterans, service members separating from active duty military, and their spouses.
Section 190.918 - Adverse actions.
Section 190.921 - Additional powers invested in a member state's EMS authority.
Section 190.924 - Establishment of the interstate commission for EMS personnel practice.
Section 190.927 - Coordinated database.
Section 190.933 - Oversight, dispute resolution, and enforcement.