(a) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise.
  (1) Advanced life support--Health care provided to sustain life in an emergency, life-threatening situation. The term includes the initiation of intravenous therapy, endotracheal or esophageal intubation, electrical cardiac defibrillation or cardioversion, and drug therapy procedures.
  (2) Direct supervision--Supervision by a licensed physician who is present in the same area or an area adjacent to the area where an emergency medical technician-paramedic or licensed paramedic performs a procedure and who is immediately available to provide assistance and direction during the performance of the procedure.
  (3) Emergency medical technician-paramedic (EMT-P) or licensed paramedic (LP)--An individual who is certified by the Department of State Health Services (DSHS) as minimally proficient to provide advanced life support that includes initiation and maintenance of certain procedures under a physician's supervision, including intravenous therapy, endotracheal or esophageal intubation or both, electrical cardiac defibrillation or cardioversion, and drug therapy.
  (4) Protocols--Written instructions providing EMT-Ps or LPs with a standardized approach to commonly encountered problems in a health care facility-based setting, typically in regard to patient care.
  (5) Standing delegation orders--Instructions or orders provided by a supervising physician to EMT-Ps or LPs, directing them to perform certain medical care, as allowed by law.
(b) Notwithstanding other law, a person who is certified as an EMT-P or a LP, is acting under the delegation and direct supervision of a licensed physician, and is authorized to provide advanced life support by a health care facility, may in accordance with DSHS rules provide advanced life support in the facility's emergency or urgent care clinical setting, including a hospital emergency room and a freestanding emergency medical care facility.
(c) The supervising physician may use protocols, which may include standing delegation orders. Such instructions may not be used in lieu of communication with the supervising physician or of obtaining the physician's physical assistance and direction during the performance of a procedure.
(d) The physician who delegates to and directly supervises advanced life support in a healthcare facility as authorized in this section remains professionally and legally responsible for the patient care provided by the EMT-P or LP.
(e) The physician who delegates to and directly supervises an EMT-P or LP providing advanced life support must ensure that the EMT-P or LP meets all requirements under the law related to creating and maintaining a medical record documenting the patient encounter.

Source Note: The provisions of this §197.7 adopted to be effective April 3, 2016, 41 TexReg 2315