by Stephen H. DiNolfo
The Illinois Department of Public Health (“IDPH”) recently adopted a smattering of emergency rules that impact EMS licensure and hospital bypass. 77 Ill. Admin. Code § 515. Below is a roundup of those changes.
First, as of December 27, 2021, EMS personnel with an unencumbered certification in the National Registry of Emergency Medical Technicians as an EMT, Advanced EMT, or Paramedic may serve in an Illinois EMS system under provisional status until they receive an Illinois license. 77 Ill. Admin. Code § 515.610(f).
Second, volunteer EMS agencies in rural populations (i.e., those with 5,000 or fewer inhabitants) can create a credentialing exception to allow registered nurses, physician assistants, and advanced practice nurses with valid licenses to serve as volunteers who perform the same work as EMTs after completing certain requirements like completing twenty hours of continuing education in areas like airway management, prehospital cardiac and trauma care, ambulance equipment and operation, and completing eight hours of observation riding time. 77 Ill. Admin. Code § 515.830(l).
Third, the emergency amendments have changed the procedure for a hospital to go on bypass status. Hospitals must receive prior approval from the IDPH to go on bypass status during a local or state disaster. When seeking approval, a hospital must provide information to the IDPH about current bed status, submit proof that surge plans have been implemented, and show the hospital’s peak census policy have been implemented three hours prior to the request to go on bypass. Hospitals must also supply information pertaining to patient wait times, the number of patients waiting to be seen, the number of beds that cannot be staffed, the percentage of currently occupied beds, the number of potential in-patient discharges, and the number of open ICU beds. The IDPH Regional EMS Coordinator will review requests with respect to the status of other hospitals in the region and approve or deny requests within two to four hours. 77 Ill. Admin. Code § 515.315(f).
A request for bypass status may not be honored if three or more hospitals in the geographic area are also on bypass status or if the transport time for an ambulance to reach the nearest facility in the regional bypass plan will exceed fifteen minutes. The decision to go on bypass status must be based on lack of essential resources for a type or class of patient, such as unavailability of staff or unavailability of essential diagnostic equipment. All reasonable efforts to resolve the limitations on resources must have been exhausted, such as cancellation of elective procedures and unsuccessful efforts to call in off-duty staff. Hospitals must perform constant monitoring to determine when bypass status can be lifted. 77 Ill. Admin Code § 515.315(c-d).
Additionally, trauma centers must now have at least one Registered Professional Nurse with a current trauma nursing certification available to care for trauma patients. These emergency amendments are designed to allow the IDPH to closely monitor bypass status of hospitals and allow EMS staff to be immediately notified of hospital bypass status. This will help ensure patients in critical condition are transported to the closest hospital and that multiple hospitals in the same area are not on bypass simultaneously. These amendments will also address EMS personnel shortages.
Fourth, IDPH has updated the necessary criteria for ambulance design according to the National Fire Protection Association, Ground Vehicle Standards for Ambulances, and/or the Federal Specifications for the Star of Life Ambulance. 77 Ill. Admin. Code § 515.830(a). Furthermore, ambulance providers can request approval from the IDPH to use an alternative staffing model for interfacility transfers for up to one year, according to the requirements for vehicle service providers. 77 Ill. Admin. Code § 515.830(k).
IDPH’s emergency rules are set to expire within 150 days of their effective date, which is approximately May 26, 2022.