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RULE §197.5Authority for Control of Medical Services at the Scene of a Medical Emergency

(a) Control at the scene of a medical emergency shall be the responsibility of the individual in attendance who is most appropriately trained and knowledgeable in providing pre-hospital emergency stabilization and transport.

(b) The prehospital provider on the scene is responsible for the management of the patient(s) and acts as the agent of the physician providing medical direction.

(c) If the patient's personal physician is present and assumes responsibility for the patient's care, the prehospital provider should defer to the orders of said physician unless those orders conflict with established protocols. The patient's personal physician shall document in his or her orders in a manner acceptable to the EMS system. The physician providing on-line medical direction shall be notified of the participation of the patient's personal physician.

(d) If the medical orders of the patient's personal physician conflict with system protocols, the personal physician shall be placed in communication with the physician providing on-line medical direction. If the personal physician and the on-line medical director cannot agree on treatment, the personal physician must either continue to provide direct patient care and accompany the patient to the hospital or must defer all remaining care to the on-line medical director.

(e) The system's medical director or on-line medical control shall assume responsibility for directing the activities of prehospital providers at any time the patient's personal physician is not in attendance.

(f) If an intervenor physician is present at the scene and has been satisfactorily identified as a licensed physician and has expressed his or her willingness to assume responsibility for care of the patient, the on-line physician should be contacted. Once the on-line physician is contacted, he or she is ultimately responsible for the care of the patient unless or until the on-line physician allows the intervenor physician to assume responsibility for the patient.

(g) The on-line physician has the option of managing the case exclusively, working with the intervenor physician, or allowing the intervenor physician to assume complete responsibility for the patient.

(h) If there is any disagreement between the intervenor physician and the on-line physician, the prehospital provider shall be responsible to the on-line physician and shall place the intervenor physician in contact with the on-line physician.

(i) If the intervenor physician is authorized to assume responsibility, all orders to the prehospital provider by the intervenor physician shall also be repeated to medical control for recordkeeping purposes.

(j) The intervenor physician must document his or her intervention in a manner acceptable to the local EMS.

(k) The decision of the intervenor physician not to accompany the patient to the hospital shall be made with the approval of the on-line physician.

(l) Nothing in this section implies that the prehospital provider can be required to deviate from standard protocols.

Source Note: The provisions of this §197.5 adopted to be effective February 28, 1999, 24 TexReg 1157; amended to be effective January 20, 2014, 39 TexReg 298

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