Emergency Medical Dispatch Services Requirements

PURPOSE: This rule prescribes requirements for the provision of Emergency Medical Dispatch Services, including training requirements consistent with changes to section 650.340, RSMo, that became effective August 28, 2023. (1) For purposes of this rule, the following terms mean— (A) “Board,” the Missouri 911 service board established in section 650.325, RSMo; (B) “Call routing,” the reception of emergency calls where the only purpose is to determine the course of direction of routing (police, fire, medical) resulting in rapid transfer of medical callers to the appropriate agency; (C) “Dispatch agency,” any person or organization that receives requests for emergency medical services from the public, by telephone or other means, and is responsible for dispatching emergency medical services; (D) “EMD agency,” any business, organization, or government agency, including a dispatch agency and Public Safety Answering Points (PSAP), that is tasked with gathering information related to medical emergencies and the delivery of medical instructions by voice before the arrival of emergency medical services and that is recognized by the board as an emergency medical dispatch agency; (E) “EMD medical director,” a licensed physician under Chapter 334, RSMo, who provides EMD medical direction to a dispatch agency, PSAP, or a dispatch agency and PSAP, and works with the local EMS medical director if another person holds that position; (F) “Emergency,” the sudden and, at the time, unexpected onset of a health condition that manifests itself by symptoms of sufficient severity that would lead to a prudent layperson, possessing an average knowledge of health and medicine, to believe that the absence of immediate medical care could result in— 1. Placing the person’s health, or with respect to a pregnant woman, the health of the woman or her unborn child, in significant jeopardy; 2. Serious impairment to a bodily function; 3. Serious dysfunction of any bodily organ or part; and 4. Inadequately controlled pain; (G) “Emergency medical dispatcher (EMD),” a person who receives emergency calls from the public and is certified or recertified to have successfully completed an approved emergency dispatch course and Continuing Dispatch Education requirements prescribed by this regulation; (H) “Emergency medical dispatching,” the reception, evaluation, processing, provision of dispatch life support, management of requests for emergency medical assistance, and participation in ongoing evaluation and improvement of the emergency medical dispatch process. This process includes identifying the nature of the request, prioritizing the severity of the request, dispatching the necessary resources, providing instructions to callers, and coordinating the responding resources as needed but does not include call routing per se; (I) “Emergency Medical Dispatch Priority Reference System (EMDPRS),” a board approved and EMD medical director approved system that includes the protocol used by an EMD in a dispatch agency, PSAP, or dispatch agency and PSAP to dispatch aid to medical emergencies that includes systematized caller interrogation questions, systematized instructions, and systematized coding protocols that match the EMD’s evaluation of the injury or illness severity with the vehicle response mode and vehicle response configuration; continuous quality improvement program that measures compliance to protocol through ongoing random case review for each EMD; and a training curriculum and testing process consistent with the specific EMDPRS protocol used by the dispatch agency, PSAP, or dispatch agency and PSAP; (J) “Instructions,” the scripted medical aid and safety instructions provided in response to critical medical situations; (K) “National standards,” the following standards related to emergency medical dispatch programs and EMDs— 1. “ASTM F1258-95 (2022) Standard Practice for Emergency Medical Dispatch,” published by ASTM International, 100 Barr Harbor Dr., West Conshohocken, PA 19428-2959, last updated September 7, 2022; 2. “ASTM F1552-94 (2016) Standard Practice for Training Instructor Qualification and Certification Eligibility of Emergency Medical Dispatchers,” published by ASTM International, 100 Barr Harbor Dr., West Conshohocken, PA 19428-2959, last updated December 27, 2016; 3. “ASTM F1560-00 (2022) Standard Practice for Emergency Medical Dispatch Management,” published by ASTM International, 100 Barr Harbor Dr., West Conshohocken, PA 19428-2959, last updated September 7, 2022; 4. “Emergency Medical Dispatch. National Standard Curriculum. Instructor Guide. Trainee Guide,” of the National Highway Traffic Safety Administration (DOT), Washington, DC; Health Resources and Services Administration (DHHS/PHS), Washington, DC, Maternal and Child Health Bureau. Published in February 1996 by the U.S. Government Publishing Office, Superintendent of Documents, Mail Stop: SSOP, Washington DC 20402-9328. Available at https://files.eric.ed.gov/fulltext/ ED425308.pdf; 5. “2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,” republished on December 4, 2018, by the American Heart Association, 7272 Greenville Ave., Dallas, TX 75231. Available at https://www. ahajournals.org/doi/full/10.1161/CIR.0000000000000613; 6. “Highlights of the 2020 American Heart Association Guidelines for CPR and ECC,” published in 2020 by the American Heart Association, 7272 Greenville Ave., Dallas, TX 75231; and 7. “2020 American Heart Association Guidelines for CPR and ECC,” published in 2020 by the American Heart Association, 7272 Greenville Ave., Dallas, TX 75231; (L) “Public Safety Answering Points (PSAP),” the location at which 911 calls are answered, including primary and secondary Public Safety Answering Points, also known as Emergency Communication Centers; (M) “Quality Assurance and Improvement Program (QAAIP),” a program approved by the EMD Medical Director and administered by the dispatch agency, PSAP, or dispatch agency and PSAP for the purpose of ensuring safe, efficient, and effective performance of EMDs in regard to their use of the EMDPRS and patient care advice provided. This program shall include, at a minimum, the random case review evaluating EMD performance, feedback of EMDPRS compliance levels to EMDs, related Continuing Dispatch Education, and submission of compliance data to the EMD medical director. (2) The board’s authority and responsibilities shall include— (A) Determining acceptable EMD training programs to be used to certify and recertify EMDs; (B) Setting minimum training and Continuing Dispatch Education requirements that meet national standards for EMD certification and recertification; and (C) Evaluating and approving EMD training and Continuing Dispatch Education programs based on national standards. (3) All EMD agencies shall have an EMD medical director, utilize a EMDPRS and have a QAAIP. The board shall identify preapproved, standardized EMDPRS’s for selection and use by local EMD agencies. The board shall recognize all dispatch agencies and PSAPs that meet these requirements as EMD agencies. (4) EMD training programs shall be based on an EMDPRS and a board-approved curriculum that includes a board-approved examination which tests for competency in the specific EMDPRS taught in the program. All such programs shall be conducted in accordance with national standards. (5) A business, organization, or government agency, including a dispatch agency or PSAP, may not represent itself as an EMD agency unless it is recognized by the board as an EMD agency. AUTHORITY: sections 650.330 and 650.340, RSMo Supp. 2024.* Original rule filed May 1, 2024, effective Nov. 30, 2024. *Original authority: 650.330, RSMo 1997, amended 1999, 2017, 2018, 2019, 2023, and 650.340, RSMo 1999, amended 2007, 2017, 2018, 2023.