The panel closes its report by advocating that all of the recommendations that CDPHE approves and implements should be set forth in regulation or policy to ensure transparency, consistency, and accountability.
The legal authority for CDPHE to oversee certain components of the EMS system is set forth in Colorado Revised Statutes, Section 25-3.5-101, et seq. Based on these statutes, CDPHE has developed regulations, promulgated by either the state Board of Health or CDPHE’s Executive Director (if a physician, if not, by the Chief Medical Officer,) for the certification, licensure and education of EMS providers (see 6 CCR 1015-3, Chapter 1), for EMS providers’ scopes of practice (see 6 CCR 1015-3, Chapter 2), and for EMS agency data collection and reporting (see 6 CCR 1015-3, Chapter 3). Statutes set forth the law and regulations have the force and effect of law. Policies often provide additional details that interpret and explain the statutes and regulations.
Regulations are revised and updated when laws are changed. Additionally, Colorado law requires that every state department develop a schedule to review all of its rules to assess the continuing need for and the appropriateness and cost-effectiveness of its rules to determine if they should be continued in their current form, modified, or repealed.[78] The regulations regarding EMS providers’ scopes of practice in particular are reviewed by staff and the EMPAC at least every two years to reflect changes in medical practice and technology.
The panel’s recommendation comports with CDPHE statutory duties to promulgate regulations, its obligation to revise and update regulations as necessary, and its commitment to clarifying laws and regulations for the benefit of its stakeholders and the public. In this case, the panel recommends that CDPHE amend its EMS regulations to incorporate all panel recommendations that CDPHE’s Executive Director accepts, including requirements for a waiver for ketamine as a chemical restraint, investigation of complaints received for alleged waiver violations, and enforcement actions that may be imposed for violations. The panel notes that, in some respects, its recommendation echoes that of the Colorado Society of Anesthesiologists, which urges CDPHE to “establish standardized and published policies and procedures that will make instances where pharmacologic incapacitation of EMS patients with extreme agitation are rare.”