Chapter 5 - Medical Control

California Health and Safety Code — §§ 1798-1798.8

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Sections (38)

Amended by Stats. 1988, Ch. 1390, Sec. 6.

(a)The medical direction and management of an emergency medical services system shall be under the medical control of the medical director of the local EMS agency. This medical control shall be maintained in accordance with standards for medical control established by the authority.

(b)Medical control shall be within an EMS system which complies with the minimum standards adopted by the authority, and which is established and implemented by the local EMS agency.

(c)In the event a medical director of a base station questions the medical effect of a policy of a local EMS agency, the medical director of the base station shall submit a written statement to the medical director of the local EMS agency requesting a review by a panel of medical directors of other base stations. Upon receipt of the request, the medical director of a local EMS agency shall promptly convene a panel of medical directors of base stations to evaluate the written statement. The panel shall be composed of all the medical directors of the base stations in the region, except that the local EMS medical director may limit the panel to five members.

This subdivision shall remain in effect only until the authority adopts more comprehensive regulations that supersede this subdivision.

§ 1798.100

Amended by Stats. 1988, Ch. 1390, Sec. 10.

In administering the EMS system, the local EMS agency, with the approval of its medical director, may designate and contract with hospitals or other entities approved by the medical director of the local EMS agency pursuant to Section 1798.105 to provide medical direction of prehospital emergency medical care personnel, within its area of jurisdiction, as either base hospitals or alternative base stations, respectively. Hospitals or other entities so designated and contracted with as base hospitals or alternative base stations shall provide medical direction of prehospital emergency medical care provided for the area defined by the local EMS agency in accordance with policies and procedures established by the local EMS agency and approved by the medical director of the local EMS agency pursuant to Sections 1797.220 and 1798.

§ 1798.101

Amended by Stats. 1988, Ch. 1390, Sec. 11.

(a)In rural areas, as determined by the authority, where the use of a base hospital having a basic emergency medical service special permit pursuant to subdivision (c) of Section 1277 is precluded because of geographic or other extenuating circumstances, a local EMS agency, in order to assure medical direction to prehospital emergency medical care personnel, may utilize other hospitals which do not have a basic emergency medical service permit but which have been approved by the medical director of the local EMS agency for utilization as a base hospital, if both of the following apply:

(1)Medical control is maintained in accordance with policies and procedures established by the local EMS agency, with the approval of the medical director of the local EMS agency.

(2)Approval is secured from the authority.

(b)(1)

In rural areas, as determined by the authority, when the use of a hospital having a basic emergency medical service special permit is precluded because of geographic or other extenuating circumstances, as determined by the authority, the medical director of the local EMS agency may authorize another facility which does not have this special permit to receive patients requiring emergency medical services if the facility has adequate staff and equipment to provide these services, as determined by the medical director of the local EMS agency.

(2)A local EMS agency which utilizes in its EMS system any facility which does not have a special permit to receive patients requiring emergency medical care pursuant to paragraph (1) shall submit to the authority, as part of the plan required by Section 1797.254, protocols approved by the medical director of the local EMS agency to ensure that the use of that facility is in the best interests of patient care. The protocols addressing patient safety and the use of the nonpermit facility shall take into account, but not be limited to, the following:

(A)The medical staff, and the availability of the staff at various times to care for patients requiring emergency medical services.

(B)The ability of staff to care for the degree and severity of patient injuries.

(C)The equipment and services available at the facility necessary to care for patients requiring emergency medical services and the severity of their injuries.

(D)The availability of more comprehensive emergency medical services and the distance and travel time necessary to make the alternative emergency medical services available.

(E)The time of day and any limitations which may apply for a nonpermit facility to treat patients requiring emergency medical services.

(3)Any change in the status of a nonpermit facility, authorized pursuant to this subdivision to care for patients requiring emergency medical services, with respect to protocols and the facility’s ability to care for the patients shall be reported by the facility to the local EMS agency.

§ 1798.102

Amended by Stats. 1984, Ch. 1391, Sec. 17.

The base hospital shall supervise prehospital treatment, triage, and transport, advanced life support or limited advanced life support, and monitor personnel program compliance by direct medical supervision.

§ 1798.104

Amended by Stats. 1984, Ch. 1391, Sec. 18.

The base hospital shall provide, or cause to be provided, EMS prehospital personnel training and continuing education in accordance with local EMS policies and procedures.

§ 1798.105

Added by Stats. 1988, Ch. 1390, Sec. 12.

The medical director of the local EMS agency may approve an alternative base station, as defined in Section 1798.53, to provide medical direction to advanced life support or limited advanced life support personnel for an area of the local EMS system for which no qualified base hospital is available, to provide that medical direction, providing that both the following conditions are met:

(a)Medical control is maintained in accordance with policies and procedures established by the local EMS agency, with the approval of the medical director of the local EMS agency.

(b)Any responsibilities of a base station hospital, including review of run reports or provision of continuing education, which are not assigned to the alternative base station, are assigned to either the local EMS agency, a base hospital for another area of the local EMS system, or a receiving hospital which has been approved by the medical director to, and has agreed to, assume the responsibilities.

§ 1798.150

Added by Stats. 1980, Ch. 1260.

The authority may establish, in cooperation with affected medical organizations, guidelines for hospital facilities according to critical care capabilities.

§ 1798.160

Amended by Stats. 1984, Ch. 1735, Sec. 5. Effective September 30, 1984.

Except where the context otherwise requires, the following definitions govern the construction of this article:

(a)“Trauma case” means any injured person who has been evaluated by prehospital personnel according to policies and procedures established by the local EMS agency pursuant to Section 1798.163 and who has been found to require transportation to a trauma facility.

(b)“Trauma facility” means a health facility, as defined by regulation, which is capable of treating one or more types of potentially seriously injured persons and which has been designated as part of the regional trauma care system by the local EMS agency. A facility may be a trauma facility for one or more services, as designated by the local EMS agency.

(c)“Trauma care system” means an arrangement under which trauma cases are transported to, and treated by, the appropriate trauma facility.

§ 1798.161

Amended by Stats. 1984, Ch. 1735, Sec. 6. Effective September 30, 1984.

(a)The authority shall submit draft regulations specifying minimum standards for the implementation of trauma care systems to the commission on or before July 1, 1984, and shall adopt the regulations on or before July 1, 1985. These regulations shall provide specific requirements for the care of trauma cases and shall ensure that the trauma care system is fully coordinated with all elements of the existing emergency medical services system. The regulations shall be adopted as provided in Section 1799.50, and shall include, but not be limited to, all of the following:

(1)Prehospital care management guidelines for triage and transportation of trauma cases.

(2)Flow patterns of trauma cases and geographic boundaries regarding trauma and nontrauma cases.

(3)The number and type of trauma cases necessary to assure that trauma facilities will provide quality care to trauma cases referred to them.

(4)The resources and equipment needed by trauma facilities to treat trauma cases.

(5)The availability and qualifications of the health care personnel, including physicians and surgeons, treating trauma cases within a trauma facility.

(6)Data collection regarding system operation and patient outcome.

(7)Periodic performance evaluation of the trauma system and its components.

(b)The authority may grant an exception to a portion of the regulations adopted pursuant to subdivision (a) upon substantiation of need by a local EMS agency that, as defined in the regulations, compliance with that requirement would not be in the best interests of the persons served within the affected local EMS area.

§ 1798.162

Amended by Stats. 1984, Ch. 1735, Sec. 7. Effective September 30, 1984.

(a)A local emergency medical services agency may implement a trauma care system only if the system meets the minimum standards set forth in the regulations for implementation established by the authority and the plan required by Section 1797.257 has been submitted to, and approved by, the authority. Prior to submitting the plan for the trauma care system to the authority, a local emergency medical services agency shall hold a public hearing and shall give adequate notice of the public hearing to all hospitals and other interested parties in the area proposed to be included in the system. This subdivision does not preclude a local EMS agency from adopting trauma care system standards which are more stringent than those established by the regulations.

(b)Notwithstanding subdivision (a) or any other provision of this article, the Santa Clara County Emergency Medical Services Agency may implement a trauma care system prior to the adoption of regulations by the authority pursuant to Section 1798.161. If the Santa Clara County Emergency Medical Services Agency implements a trauma care system pursuant to this subdivision prior to the adoption of those regulations by the authority, the agency shall prepare and submit to the authority a trauma care system plan which conforms to any regulations subsequently adopted by the authority.

§ 1798.163

Amended by Stats. 1984, Ch. 1735, Sec. 8. Effective September 30, 1984.

A local emergency medical services agency implementing a trauma care system shall establish policies and procedures which are concordant and consistent with the minimum standards set forth in the regulations adopted by the authority. This section does not preclude a local EMS agency from adopting trauma care system standards which are more stringent than those established by the regulations.

§ 1798.164

Amended by Stats. 1988, Ch. 768, Sec. 1.

(a)A local emergency medical services agency may charge a fee to an applicant seeking initial or continuing designation as a trauma facility in an amount sufficient to cover the costs directly related to the designation of trauma facilities pursuant to Section 1798.165 and to the development of the plans prepared pursuant to Sections 1797.257 and 1797.258, and subdivision (b) of Section 1798.162.

(b)Each local emergency medical services agency charging fees pursuant to subdivision (a) shall annually provide a report to the authority and to each trauma facility having paid a fee to the agency. The report shall contain sufficient detail to apprise facilities of the specific application of fees collected and to assure the authority that fees collected were expended in compliance with subdivision (a).

(c)The authority may establish a prescribed format for the report required in subdivision (b).

§ 1798.165

Amended by Stats. 1985, Ch. 570, Sec. 1.

(a)Local emergency medical services agencies may designate trauma facilities as part of their trauma care system pursuant to the regulations promulgated by the authority.

(b)The health facility shall only be designated to provide the level of trauma care and service for which it is qualified and which is included within the system implemented by the agency.

(c)No health care provider shall use the terms “trauma facility,” “trauma hospital,” “trauma center,” “trauma care provider,” “trauma vehicle,” or similar terminology in its signs or advertisements, or in printed materials and information it furnishes to the general public, unless the use is authorized by the local EMS agency.

§ 1798.166

Added by Stats. 1983, Ch. 1067, Sec. 2.

A local emergency medical services agency which elects to implement a trauma care system on or after January 1, 1984, shall develop and submit a plan to the authority according to the regulations established prior to the implementation.

§ 1798.167

Added by Stats. 1983, Ch. 1067, Sec. 2.

Nothing in this article shall be construed to restrict the authority of a health care facility to provide a service for which it has received a license pursuant to Chapter 2 (commencing with Section 1250) of Division 2.

§ 1798.168

Added by Stats. 1983, Ch. 1067, Sec. 2.

Nothing in this article shall be construed as changing the boundaries of any local emergency medical services agency in existence on January 1, 1984.

§ 1798.169

Added by Stats. 1983, Ch. 1067, Sec. 2.

Nothing in this article shall be construed as restricting the use of a helicopter of the Department of the California Highway Patrol from performing missions which the department determines are in the best interests of the people of the State of California.

§ 1798.170

Amended by Stats. 1987, Ch. 1240, Sec. 16.

A local EMS agency may develop triage and transfer protocols to facilitate prompt delivery of patients to appropriate designated facilities within and without its area of jurisdiction. Considerations in designating a facility shall include, but shall not be limited to, the following:

(a)A general acute care hospital’s consistent ability to provide on-call physicians and services for all emergency patients regardless of ability to pay.

(b)The sufficiency of hospital procedures to ensure that all patients who come to the emergency department are examined and evaluated to determine whether or not an emergency condition exists.

(c)The hospital’s compliance with local EMS protocols, guidelines, and transfer agreement requirements.

§ 1798.172

Amended by Stats. 1988, Ch. 888, Sec. 6. Effective September 14, 1988.

(a)The local EMS agency shall establish guidelines and standards for completion and operation of formal transfer agreements between hospitals with varying levels of care in the area of jurisdiction of the local EMS agency consistent with Sections 1317 to 1317.9a, inclusive, and Chapter 5 (commencing with Section 1798). Each local EMS agency shall solicit and consider public comment in drafting guidelines and standards. These guidelines shall include provision for suggested written agreements for the type of patient, initial patient care treatments, requirements of interhospital care, and associated logistics for transfer, evaluation, and monitoring of the patient.

(b)Notwithstanding subdivision (a), and in addition to Section 1317, a general acute care hospital licensed under Chapter 2 (commencing with Section 1250) of Division 2 shall not transfer a person for nonmedical reasons to another health facility unless that other facility receiving the person agrees in advance of the transfer to accept the transfer.

§ 1798.175

Added by Stats. 1986, Ch. 1377, Sec. 1.

(a)No person or public agency shall advertise itself as, or hold itself out as, providing emergency medical services, by using in its name or advertising the word “emergency,” or any derivation thereof, or any words which suggest that it is staffed and equipped to provide emergency medical services, unless the person or public agency satisfies one of the following requirements:

(1)Is a general acute care hospital providing approved standby, basic, or comprehensive emergency medical services regulated by this chapter.

(2)Meets all of the following minimum standards:

(A)Emergency services are available in the facility seven days a week, 24 hours a day.

(B)Has equipment, medication, and personnel experienced in the provision of services needed to treat life-, limb-, or function-threatening conditions.

(C)Diagnostic radiology and clinical laboratory services are provided by persons on duty or on call and available when needed.

(D)At least one physician who is trained and experienced in the provision of emergency medical care who is on duty or on call so as to be immediately available to the facility.

(E)Medical records document the name of each patient who seeks care, as well as the disposition of each patient upon discharge.

(F)A roster of speciality physicians who are available for referral, consultation, and speciality services is maintained and available.

(G)Policies and procedures define the scope and conduct of treatment provided, including procedures for the management of specific types of emergencies.

(H)The quality and appropriateness of emergency services are evaluated at least annually as part of a quality assurance program.

(I)Provides information to the public that describes the capabilities of the facility, including the scope of services provided, the manner in which the facility complies with the requirements of this section pertaining to the availability and qualifications of personnel or services, and the manner in which the facility cooperates with the patient’s primary care physician in followup care.

(J)Clearly identifies the responsible professional or professionals and the legal owner or owners of the facility in its promotion, advertising, and solicitations.

(K)Transfer agreements are in effect at all times with one or more general acute care hospitals which provide basic or comprehensive emergency medical services wherein patients requiring more definitive care will be expeditiously transferred and receive prompt hospital care. Reasonable care shall be exercised to determine whether an emergency requiring more definitive care exists and the person seeking emergency care shall be assisted in obtaining these services, including transportation services, in every way reasonable under the circumstances.

(b)Nothing in this article shall be construed to require the licensing or certification of any person or public agency meeting the minimum standards of paragraph (2) of subdivision (a), nor to exempt from licensure those health facilities covered by paragraph (1) of subdivision (a).

(c)Nothing in this article shall be construed to:

(1)Prohibit a physician in private practice, an outpatient department of a general acute care hospital whether located on or off the premises of the hospital, or other entity authorized to offer medical services from advertising itself as, or otherwise holding itself out as, providing urgent, immediate, or prompt medical services, or from using in its name or advertising the words “urgent,” “prompt,” “immediate,” any derivative thereof, or other words which suggest that it is staffed and equipped to provide urgent, prompt, or immediate medical services.

(2)Prohibit prehospital emergency medical care personnel certified pursuant to, or any state or local agencies established pursuant to, this division, or any emergency vehicle operating within the emergency medical services system from using the word “emergency” in the title, classification, or designation of the personnel, agency, or vehicle.

(d)Any person or public agency using the word “emergency” or any derivation thereof in its name or advertising on January 1, 1987, but which would be prohibited from using the word or derivation thereof by this article, shall have until January 1, 1988, to comply with this article.

§ 1798.180