77 Ill. Adm. Code 515.860
ALS Expanded Scope and Critical Care Transport
Section
515.860Â ALS Expanded Scope and Critical Care Transport
a)Â Â Â Â Â Â Â Â Critical care transport
may be provided by:
1)
Department-approved
critical care transport providers, not owned or operated by a hospital,
utilizing EMT-Paramedics with additional training, nurses, or other qualified
health professionals; or
2)
Hospitals, when
utilizing any vehicle service provider or any hospital-owned or operated
vehicle service provider. Nothing in
the
Act requires a hospital to use,
or to be, a Department-approved critical care transport provider when
transporting patients, including those critically injured or ill. Nothing in
the
Act shall restrict or prohibit a hospital from providing, or arranging for, the
medically appropriate transport of any patient, as determined by a physician
licensed to practice
medicine
in all of its branches, an APRN, or a PA.
(Section
3.10(f-5) of the Act)
3)Â Â Â Â Â Â Â Â Physician
medical direction for critical care, approved by the EMS MD, shall have the
qualifications consistent with the acuity and conditions of the critical care
patients transported. Such medical direction includes an Illinois licensed
practicing physician with competency in critical care transport medicine and
board certification in a specialty relevant to the provider agency mission or
experience in critical care transport medicine consistent with the types,
acuity and severity of patients transported.
b)
All critical care
transport providers must function within a Department-approved EMS
System. Nothing in
this Part
shall restrict a hospital's ability to
furnish personnel, equipment, and medical supplies to any vehicle service
provider, including a critical care transport provider.
(Section 3.10(g-5)
of the Act)
c)Â Â Â Â Â Â Â Â For the purposes of this
Section, "expanded scope of practice" includes the accepted national
curriculum plus additional education, experience and equipment (see Section
515.360) as approved by the Department pursuant to Section 3.55 of the Act.Â
Tier I transports are considered "expanded scope of practice".
d)Â Â Â Â Â Â Â Â For the purposes of this
Section, CCT plans are defined in three tiers of care. Tier II and Tier III
are considered Critical Care Transports.
e)Â Â Â Â Â Â Â Â Tier
I (Expanded Scope ALS)
Tier
I provides a level of care for patients who require care beyond the Department-approved
Paramedic scope of practice, up to but not including the requirements of Tiers
II and III. Tier I transport may include the use of a ventilator, the use of
infusion pumps with administration of medication drips, and maintenance of
chest tubes.
1)Â Â Â Â Â Â Â Â Personnel Staffing and
Licensure
A)Â Â Â Â Â Â Â Licensure
i)Â Â Â Â Â Â Â Â Â Licensed Illinois
Paramedic, PHRN, PHPA or PHAPRN;
ii)Â Â Â Â Â Â Â Â Scope of practice more
comprehensive than the national EMS scope of practice model approved by the
Department in accordance with the EMS System plan (see Sections 515.310 and
515.330); and
iii)Â Â Â Â Â Â Â Approved to practice by
the Department in accordance with the EMS System plan.
B)Â Â Â Â Â Â Â Minimum Staffing
i)Â Â Â Â Â Â Â Â Â System authorized EMT,
A-EMT, EMT-I, Paramedic, PHRN, PHPA or PHAPRN as driver; and
ii)Â Â Â Â Â Â Â Â System authorized
expanded scope of practice Paramedic, PHRN, PHPA, PHAPRN or physician who shall
remain with the patient at all times.
2)Â Â Â Â Â Â Â Â Education, Certification
and Experience
A)Â Â Â Â Â Â Â Initial Education.Â
Documentation of initial education and demonstrated competencies of expanded
scope of practice knowledge and skills as required by Tier I Level of Care and
approved by the Department in accordance with
the
EMS System plan.
B)Â Â Â Â Â Â Â CE Requirements
i)Â Â Â Â Â Â Â Â Â Annual competencies of
expanded scope of practice knowledge, equipment and procedures shall be
completed; and
ii)Â Â Â Â Â Â Â Â The EMS vehicle service
provider shall maintain documentation of competencies and provide documentation
to the EMS System upon request.
C)Â Â Â Â Â Â Â Certifications. Â Tier I
personnel shall maintain all of the following renewable certifications and
credentials in active status:
i)Â Â Â Â Â Â Â Â Â Advanced Cardiac Life
Support (ACLS);
ii)Â Â Â Â Â Â Â Â Pediatric Education for
Pre-Hospital Professionals (PEPP) or Pediatric Advance Life Support (PALS);
iii)Â Â Â Â Â Â Â International Trauma
Life Support (ITLS) or Pre-Hospital Trauma Life Support (PHTLS); and
iv)Â Â Â Â Â Â Â Any additional
educational course work or certifications required by the EMS MD.
D)Â Â Â Â Â Â Â Experience
i)Â Â Â Â Â Â Â Â Â Minimum of 6 months of
experience functioning in the field at an ALS level or as a physician in an
emergency department; and
ii)Â Â Â Â Â Â Â Â Documentation of education
and demonstrated competencies of expanded scope of practice knowledge and skills
required for Tier I Level of Care, approved by the Department and included in
the EMS System plan.
3)Â Â Â Â Â Â Â Â Medical Equipment and
Supplies
Authorized
equipment as approved by the EMS MD and the Department and included in the
system plan.
4)Â Â Â Â Â Â Â Â Vehicle Standards
Any
vehicle used for providing expanded scope of practice care shall comply at a
minimum with Section 515.830 (Ambulance Licensing Requirements) or Sections 515.900
(Licensure of SEMSV Programs –General) and 515.920 (SEMSV Program Licensure
Requirements for Air Medical Transport Programs) regarding licensure of SEMSV Programs
and SEMSV vehicle requirements, including additional medical equipment and
ambulance equipment as defined in the EMS system plan. Any vehicle used for
expanded scope of practice transport shall be equipped with an onboard
alternating current (AC) supply capable of operating and maintaining the AC
current needs of the required medical devices used in providing care during the
transport of a patient.
5)Â Â Â Â Â Â Â Â Treatment and Transport
Protocols shall address the following:
A)Â Â Â Â Â Â Â Written operating
procedures and protocols signed by the EMS MD and approved for use by the
Department in accordance with the System plan; and
B)Â Â Â Â Â Â Â Use of authorized
equipment as approved by the EMS MD.
6)Â Â Â Â Â Â Â Â Quality Assurance
Program
A)Â Â Â Â Â Â Â The Tier I transport
provider shall develop a written Quality Assurance (QA) plan approved by the
EMS System and the Department in accordance with subsection (e)(6)(D). The
provider shall provide quarterly QA reports to the EMS Systems and to the
Department upon request for the first 12 months of operation.
B)Â Â Â Â Â Â Â The EMS System shall
establish the frequency of quality reports after the first year if the System
has not identified any deficiencies or adverse outcomes.
C)Â Â Â Â Â Â Â An EMS MD or a SEMSV MD shall
oversee the QA program.
D)Â Â Â Â Â Â Â The QA plan shall
evaluate all expanded scope of practice activity. The review shall include at a
minimum:
i)Â Â Â Â Â Â Â Â Â Review of transferring
physician orders and evidence of compliance with those orders;
ii)Â Â Â Â Â Â Â Â Documentation of vital
signs and frequency and evidence that abnormal vital signs or trends suggesting
an unstable patient were appropriately detected and managed;
iii)Â Â Â Â Â Â Â Documentation of any
side effects/complications, including hypotension, extreme bradycardia or
tachycardia, increasing chest pain, dysrhythmia, altered mental status and/or
changes in neurological examination, and evidence that interventions were
appropriate for those events;
iv)Â Â Â Â Â Â Â Documentation of any
unanticipated discontinuation of a catheter or rate adjustments of infusions,
along with rationale and outcome;
v)Â Â Â Â Â Â Â Â Documentation that any
unusual occurrences were promptly communicated to the EMS System; and
vi)Â Â Â Â Â Â Â A root cause analysis of
any event or care inconsistent with standards.
E)Â Â Â Â Â Â Â The QA plan shall be
subject to review as part of an EMS System site survey and as deemed necessary
by the Department (e.g., in response to a complaint).
f)Â Â Â Â Â Â Â Â Tier
II (Critical Care)
Tier
II provides an expanded scope of practice more comprehensive than Tier I and
approved by the EMS MD and the Department in accordance with the system plan.
1)Â Â Â Â Â Â Â Â Licensure and Personnel
Staffing
A)       Licensure − Licensed
Illinois Paramedic, PHRN, PHPA or PHAPRN:
B)Â Â Â Â Â Â Â Minimum Staffing:
i)Â Â Â Â Â Â Â Â Â System authorized Paramedic,
PHRN, PHPA or PHAPRN; and
ii)Â Â Â Â Â Â Â Â System authorized Paramedic,
PHRN, PHPA, PHAPRN or physician who is critical care prepared and who shall
remain with the patient at all times.
2)Â Â Â Â Â Â Â Â Education, Certification
and Experience
A)Â Â Â Â Â Â Â Initial Advanced Formal
Education.
i)Â Â Â Â Â Â Â Â Â At a minimum, 80 didactic
hours of established higher collegiate critical care education nationally
recognized; or two years of experience in critical care or emergency care with
completion of an EMS MD or SEMSV MD approved critical care training program
(consisting of, at minimum, 80 didactic hours) and obtaining a nationally
recognized advanced certification within two years; and
ii)Â Â Â Â Â Â Â Â Demonstrated
competencies, as documented by the EMS MD or SEMSV MD and approved by the
Department.
B)Â Â Â Â Â Â Â CE Requirements
i)Â Â Â Â Â Â Â Â Â The EMS System shall
document and maintain annual competencies of expanded scope of practice knowledge,
equipment and procedures;
ii)Â Â Â Â Â Â Â Â The following current
credentials, as a minimum, shall be maintained: ACLS, PEPP or PALS, ITLS or
PHTLS
,
TPATC or ATLS
;
iii)Â Â Â Â Â Â Â A minimum of 40 hours
of critical care level education shall be completed every four years;
iv)Â Â Â Â Â Â Â The EMS provider shall
maintain documentation of compliance with subsections (f)(2)(B)(i) through (iii)
and shall provide documentation to the EMS System upon request; and
v)Â Â Â Â Â Â Â Â Nationally recognized
critical care certifications shall be maintained and renewed based on national
recertification criteria.
C)Â Â Â Â Â Â Â Experience. Â Minimum of one
year experience functioning in the field at an ALS level for Paramedics, PHRNs,
PHPAs, and PHAPRNs and one year experience in an emergency department for
physicians.
3)Â Â Â Â Â Â Â Â Medical Equipment and
Supplies
A)Â Â Â Â Â Â Â Infusion pumps; and
B)Â Â Â Â Â Â Â Other authorized
equipment as approved by the SEMSV MD and the Department and included in the
system plan.
4)Â Â Â Â Â Â Â Â Vehicle Standards
Any
vehicle used for providing critical care transport shall comply at a minimum
with Section 515.830 (Ambulance Licensing Requirements) or Sections 515.900
(Licensure of SEMSV Programs – General) and 515.920 (SEMSV Program Licensure
Requirements for Air Medical Transport Programs) regarding licensure of SEMSV Programs
and SEMSV vehicle requirements, including additional medical equipment and
ambulance equipment as defined in the EMS System Plan. Any vehicle used for CCT
 shall be equipped with an onboard AC supply capable of operating and
maintaining the AC current needs of the required medical devices used in
providing care during the transport of a patient.
5)Â Â Â Â Â Â Â Â Treatment and Transport
Protocols shall address equipment and medications used on Tier II transport.
6)Â Â Â Â Â Â Â Â Quality Assurance
Program
A)Â Â Â Â Â Â Â The EMS Systems and
providers shall have a quality improvement program, approved by the Department,
that uses national standards performance indicators to evaluate the
appropriateness and quality of patient care. The method and results of the
quality improvement projects shall be available to the Department upon request.
B)Â Â Â Â Â Â Â An EMS MD or SEMSV MD
shall oversee the QA program.
g)Â Â Â Â Â Â Â Â Tier
III (Critical Care)
Tier
III provides the highest level of transport care for patients who require advanced
level treatment modalities and interventions as approved by the EMS MD and the
Department and identified in the system plan.
1)Â Â Â Â Â Â Â Â Minimum Personnel
Staffing and Licensure
A)Â Â Â Â Â Â Â One driver holding a
current Illinois EMS license; and
B)Â Â Â Â Â Â Â Two critical care
prepared providers, who shall remain with the patient at all times:
i)Â Â Â Â Â Â Â Â Â Paramedic, PHRN, PHPA
or PHAPRN; and
ii)Â Â Â Â Â Â Â Â RN, PHRN, PHPA or PHAPRN.
2)Â Â Â Â Â Â Â Â Education,
Certification, and Experience: Paramedic, PHRN, PHPA or PHAPRN
A)Â Â Â Â Â Â Â Initial Advanced Formal
Education
i)Â Â Â Â Â Â Â Â Â At a minimum, 80 didactic
hours of established higher collegiate critical care education nationally
recognized, or two years of experience in critical care or emergency care with
completion of an EMS MD or SEMSV MD approved critical care training program
(consisting of, at minimum, 80 didactic hours) and obtaining a nationally
recognized advanced certification within two years; and; and
ii)Â Â Â Â Â Â Â Â Demonstrated
competencies, as documented by EMS MD and SEMSV MD and approved by the
Department.
B)Â Â Â Â Â Â Â CE Requirements
i)Â Â Â Â Â Â Â Â Â The EMS System shall
document and maintain annual competencies of expanded scope of practice
knowledge, equipment and procedures;
ii)Â Â Â Â Â Â Â Â The following valid
credentials, at a minimum, shall be maintained:Â ACLS, PEPP or PALS and NRP or
system approved equivalent, ITLS or PHTLS;
iii)Â Â Â Â Â Â Â A minimum of 40 hours
of critical care level CE shall be completed every four years;
iv)Â Â Â Â Â Â Â The EMS provider shall
maintain documentation of compliance with subsection (g)(2)(B)(i) and shall
provide documentation to the EMS System upon request; and
v)Â Â Â Â Â Â Â Â Nationally recognized
critical certifications shall be maintained and renewed based on national
recertification criteria.
C)Â Â Â Â Â Â Â Experience
i)Â Â Â Â Â Â Â Â Â Minimum of two years
experience functioning in the field at an ALS Level;
ii)Â Â Â Â Â Â Â Â Documented
demonstrated competencies; and
iii)Â Â Â Â Â Â Â Completion of annual
competencies of expanded scope knowledge, equipment and procedures.
3)Â Â Â Â Â Â Â Â Education, Certification
and Experience − Registered Professional Nurse
A)Â Â Â Â Â Â Â CE Requirements
i)Â Â Â Â Â Â Â Â Â A minimum of 48 hours
of critical care level education shall be completed every four years; and
ii)Â Â Â Â Â Â Â Â The EMS provider shall
maintain documentation of compliance with subsection (g)(3)(A)(i) and shall
provide documentation to the EMS Resource Hospital upon request.
B)Â Â Â Â Â Â Â Certifications
Tier
III personnel shall maintain the following valid critical care certifications and
credentials:
i)Â Â Â Â Â Â Â Â Â ACLS;
ii)Â Â Â Â Â Â Â Â PALS,
PEPP or ENPC;
iii)Â Â Â Â Â Â Â NRP
or system approved equivalent; and
iv)Â Â Â Â Â Â Â ITLS,
PHTLS, TNCC or TNS, TPATC or ATLS.
C)Â Â Â Â Â Â Â Experience
Minimum
of two years full-time critical care experience.
4)Â Â Â Â Â Â Â Â Medical Equipment and
Supplies as approved by the EMS MD and the Department and included in the
system plan.
5)Â Â Â Â Â Â Â Â Vehicular Standards
Any
vehicle used for providing CCT shall comply, at a minimum, with Section 515.830
(Ambulance Licensing Requirements) or Sections 515.900 (Licensure of SEMSV
Programs – General) and 515.920 (SEMSV Program Licensure Requirements for
Air Medical Transport Programs
) regarding licensure of
SEMSV Programs and SEMSV vehicle requirements, including additional medical
equipment and ambulance equipment as defined in the EMS System Plan. Any
vehicle used for CCT shall be equipped with an onboard AC supply capable of
operating and maintaining the AC current needs of the required medical devices
used in providing care during the transport of a patient.
6)Â Â Â Â Â Â Â Â Treatment and Transport
Protocols shall address the equipment and medications used on Tier III
transport.
7)Â Â Â Â Â Â Â Â Quality Assurance Program
A)Â Â Â Â Â Â Â The EMS Systems and
providers shall have a quality improvement program, approved by the Department,
that uses national standards performance indicators to evaluate the
appropriateness and quality of patient care. The method and results of the
quality improvement projects will be available to the Department upon request.
B)Â Â Â Â Â Â Â An EMS MD or SEMSV MD
shall oversee the QA program.