Hospital Letter of Compliance | Oakland County Medical Control Authority

Fill out the following form in its entirety and hit submit on the final page.

Please contact the OCMCA at (248) 975-9704 if you have any questions.

* Required Field

Hospital/Facility Name:*

1. Licensed by the Michigan Department of Health and Human Services (MDHHS) as:(check one)*

Hospital
Free Standing Facility
Hospital Provider-based ED

2. If a hospital/facility makes a permanent change in their categorization, the facility shall notify the Oakland County Medical Control Authority (OCMCA) 30 days in advance of the change.*

3. Hospital has 24/7 interventional cardiac catheterization capabilities.*

4. TRAUMA LEVELS:

4a. Verified by the American College of Surgeons as a Level 1, 2, or 3 Trauma Center.*

4b. Verified by the State of Michigan as a Level 3 or 4 Trauma Center.*

4c. Designated by MDHHS as a Level 1 through 4 Trauma Center.*

ADULT LEVEL:

Designation Date:

PEDIATRIC TRAUMA LEVEL:

Designation Date:

5. Certified as a Stroke Center.*

5a. Indicate the facility's certifying body:*

5b. Stroke Center Certification*

5c. Please indicate the date of last inspection/verification.*

6. Assure that the emergency facility has a full-time emergency medicine Board Certified/Eligible emergency physician director whose primary clinical responsibility is emergency medicine.*

7. Assure that an emergency medicine Board Certified/Eligible emergency physician be available 24/7 to provide online medical direction and handle ALS runs at all times.*

8. Accept the responsibility for replenishing medication and medical supplies, expended by ALS personnel during treatment of a patient, as per the Regional Drug Box Policy and IV Auxiliary Supply Policy.*

9. This facility designates the OCMCA (including its PSRO) to perform professional practice review functions on behalf of the facility, including review of pre-hospital medical direction furnished in Oakland County and recommendations for improvement of such care.*

10. Facility will participate in the EMS system quality assurance program, and will supply data on outcome of patients as agreed to by the OCMCA.*

11. MEDICAL CONTROL HOSPITALS WITH LSA OVERSIGHT

11a. Facility will provide education activities for LSAs, additional activities agreed upon by the LSA and the facility, activities as directed by the OCMCA PSRO, and activities that may include EMS run report review.*

11b. Facility agrees to allow and encourage the Medical Control Physician the ability to be an advisor to EMS personnel. Educate and communicate with hospital medical staff on issues concerning the EMS community, including all protocols and protocol updates. This may include: auditing the medical direction given by the Medical Control Hospital; and assist in developing EMS educational programs. The Hospital shall report all EMS agency and personnel incidents or concerns to the OCMCA office*

12. Facility follows the OCMCA Medical Control and Participating Hospital Policy, and the Epi-Auto Injectors Exchange Policy.*

13. Hospital/facility will enter CARES data as necessary.*

14. Completion of Addendum Facility Survey (see addendum).*

2023 Hospital Letter of Compliance

Oakland County Medical Control Authority

Medical Control Hospital

2023 Letter of Compliance

Step 1 of 4

Fill out the following form in its entirety and hit submit on the final page.

Please contact the OCMCA at (248) 975-9704 if you have any questions.

* Required Field

Addendum to Letter of Compliance

Facility Survey

OCMCA Hospital Emergency Contact Information

In the event that the Oakland County Emergency Operations Center (EOC) is activated due to disasters/emergencies, additional county resources may be required. Please provide the following information.

It is important to contact the OCMCA immediatley if the hospital ED 24/7 Phone Line, EMS Recorded Line and ePCR Secure Fax change, so that updates can be made to the Oakland County Protocols.

Please let the staff at the OCMCA know of any changes throughout the year.