ARM 37.98.10

ARM 37.98.10 Program Emergency and Health Provisions

This section establishes emergency, health, safety, and transportation requirements for programs serving youth in residential outdoor and expedition settings in Montana. Operators must maintain written emergency and evacuation plans, provide medical and dental care, implement infection control procedures, manage medications safely, and ensure vehicles and equipment meet safety standards. These requirements apply to programs licensed under ARM 37.98, which governs residential outdoor and high-adventure youth programs.

37.98.1001
 EMERGENCY AND EVACUATION PLANS 

(1)
 
A program shall have and follow a written emergency plan developed in conjunction with emergency services in the community which provides specific procedures for evacuations, disasters, medical emergencies, hostage situations, casualties, missing youth and other serious incidents identified by the program. 

(2)
 
The emergency plan must, at a minimum, include: 

(a)
 
designation of authority and staff assignment; 

(b)
 
a specific evacuation plan; 

(c)
 
provisions for transportation and relocation of program participants when necessary; 

(d)
 
provisions for supervision of youth after an evacuation or a relocation; 

(e)
 
provisions for the instruction of all participants on how to respond in the case of an emergency; and 

(f)
 
provisions for arranging medical care and notifying a youth's physician and parent or guardian. 

(3)
 
When youth are on an expedition: 

(a)
 
Emergency plan drills must be practiced with youth and staff immediately upon entering the outdoor location and monthly thereafter. Results of the drill must be recorded, showing date, time, staff and youth present with problem areas noted in the log. 

(b)
 
A program shall have support vehicles for transport of youth from expedition sites during emergencies. The support vehicles and field office must be equipped with first aid equipment. 

(c)
 
A program shall have provisions for notifying the field office about the nature of the emergency and an accounting of each participant's location and status. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.1003
 HEALTH CARE 

(1)
 
Medical, dental, psychiatric, psychological, chemical dependency care and counseling must be obtained for the youth as needed. 

(2)
 
Each youth in care must receive an annual physical examination. 

(3)
 
Each youth in care must receive an annual dental examination. 

(4)
 
Provisions for treatment of diseases, remedial defects or deformities, and malnutrition must be made by the program immediately upon the physician's recommendation with notification of the placing agency and parent or legal guardian. 

(5)
 
The program shall develop and follow written policies and procedures to keep youth healthy while in the program. Medical care must be provided to all youth as needed and must be documented in the youth's case records. A signed release for emergency medical treatment from the parent or guardian must be documented in the youth's file. 

(6)
 
First aid treatment must be provided in as prompt a manner as the location and circumstances allow. 

(7)
 
The program shall transport any youth with an illness or physical complaint that needs immediate care or treatment to appropriate medical care. 

(8)
 
Complaints or reports by a youth of illness and injuries must be documented in a daily log along with any treatment provided. 

(9)
 
There may not be any negative consequence imposed on a youth for reporting an injury or illness or for requesting to see a health care professional. 

(10)
 
Youth must be instructed and monitored regularly by staff in matters of personal hygiene. 

(11)
 
The program shall develop and follow written policies and procedures governing emergency medical and dental care. 

(12)
 
The program shall develop a written plan to prohibit: 

(a)
 
the use of tobacco, alcohol or illegal drugs by youth; and 

(b)
 
all use of tobacco, alcohol or illegal drugs by employees, volunteers and visitors in any program building or vehicle used by youth and in the presence of youth. 

(13)
 
A program shall develop and follow written policies and procedures governing all aspects of suicide prevention and intervention, which must meet the following criteria: 

(a)
 
The suicide prevention and intervention policies must be reviewed and approved by professional staff members. 

(b)
 
All staff with responsibility for the supervision of youth must be trained in the implementation of the policies. Documentation of training must be in the staff personnel file. 

(14)
 
Depending on the length of the program and/or whether these needs have been documented to have been met elsewhere, youth must receive age-appropriate health education and instruction regarding teen pregnancy prevention, HIV education and prevention and general information about the prevention and treatment of sexually transmitted diseases. The program shall be in compliance with federal and state guidelines governing sexually transmitted diseases. 

(15)
 
Staff must be trained to recognize eating disorders. This training must be documented in staff records. If the staff suspects the youth has an eating disorder, staff shall report the suspicions immediately to the appropriate program professional staff members. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.1004
 INFECTION CONTROL 

(1)
 
Each program shall provide, develop and implement an effective infection prevention and control program. The program must develop policies and procedures to evaluate all factors, including, although not limited to, risk evaluations, education and TB screening of employees and residents. The decision to perform regular repeat testing of some employees or residents must be based on data from within the facility, the risk associated with certain procedures performed and the number of infectious cases reported within the county and state. 

(2)
 
A program shall provide a sanitary environment to avoid sources and transmission of infections which must include: 

(a)
 
separation of infected individuals from other group members; 

(b)
 
notification of a parent or legal guardian; 

(c)
 
consultation with a doctor or medical facility, if appropriate for the youth's treatment; 

(d)
 
notification or consultation with the program's medical director; and 

(e)
 
proper disinfection of all items used by the infected individual before use by any other person. 

(3)
 
A program shall maintain a record of incidents and corrective actions related to infections. 

(4)
 
A program shall prohibit staff with symptoms or signs of a communicable disease from direct contact with the youth and their food. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.1005
 MEDICATION STORAGE AND ADMINISTRATION 

(1)
 
A program shall have and follow policies and procedures regarding the storage, administration and disposal of prescription and nonprescription medication. 

(2)
 
Prescription and nonprescription medication must be stored under lock and key and safeguarded from youth in their original containers, labeled with the original prescription label. For medications taken on field outings, all medication must be in the possession of a staff member qualified to assist with the self administration of medications. 

(3)
 
Staff who assist with self administration must be trained in proper medication procedures. Training must be documented in each staff member's personnel file. 

(4)
 
All prescription medications must be ordered by licensed health care professionals working within the scope of their practice. All prescription orders must contain the dosage to be given. 

(5)
 
Psychotropic medication is prohibited unless a licensed health care professional working within the scope of his or her practice determines that the medications are clinically indicated. Under no circumstances may psychotropic medication be given for disciplinary purposes, for the convenience of the staff, or as a substitute for appropriate treatment services. 

(6)
 
There must be a written record of all medications self administered by a youth. The record must include: 

(a)
 
youth's name; 

(b)
 
name and dosage of the medication; 

(c)
 
the date and time the medication was taken or was refused by youth; 

(d)
 
name of the staff member who assisted in self administration of the medication; and 

(e)
 
documentation of any medication errors, results of errors and any effects observed. 

(7)
 
Prescribed medication may not be stopped or changed in dosage or administration without first consulting with the prescribing licensed health care professional. Results of the consultation must be recorded in the youth's record. The licensed health care professional shall document in writing any changes to medication. This documentation must be kept as part of the youth's case record. 

(8)
 
All unused and expired medication must be disposed of. The disposal of unused medication must be done by two licensed health care professionals, and the disposal must be recorded in a medication destruction log. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.1010
 SAFETY POLICY 

(1)
 
A program shall have appropriate written safety procedures and equipment. 

(2)
 
Each youth must have instruction on environmental hazards and precautions. 

(3)
 
There must be a first aid kit with sufficient supplies available at all times. A kit must: 

(a)
 
be readily available on site as well as in all vehicles; 

(b)
 
meet the standards of an appropriate national organization for the activity being conducted and the location and environment being used; 

(c)
 
be reviewed by the field director with new staff for contents and use; 

(d)
 
be reviewed at least annually by the field director with all staff for contents and use; and 

(e)
 
be inventoried by the field director after each expedition and restocked as needed. 

(4)
 
Policies and procedures must be in place for the safe use and storage of fuels and all heat sources, including inaccessibility to youth when not being used under the direct supervision of staff. 

(5)
 
Policies and procedures must be in place for the safe use and storage of poisons and toxins as follows: 

(a)
 
All medicines, alcohol, detergents, chemical sanitizers and related cleaning compounds and other chemicals must be stored in a safe location that is inaccessible to youth. 

(b)
 
Combustible and flammable materials and liquids must be properly stored so as not to create a fire hazard. 

(c)
 
Poisonous compounds such as insecticide, rodenticide, and other chemicals bearing the EPA toxicity labels "warning" or "danger" must be kept under lock and key. 

(d)
 
Poisonous or toxic chemicals may not be stored above or adjacent to food, dishes or utensils or food contact surfaces. They may not be used in such a manner that they could contaminate these articles. 

(6)
 
Emergency information for youth must be easily accessible at the field office and on an expedition. Emergency information for each youth must include: 

(a)
 
the name, address, telephone number and relationship of a designated person to be contacted in case of an emergency; 

(b)
 
the name, address, telephone number of the youth's licensed health care professional or source of health care; 

(c)
 
the name, address, telephone number and relationship of the person able to give consent for emergency medical treatment; 

(d)
 
a copy of the youth's most recent health examination; 

(e)
 
a signed release for emergency medical treatment from the parent or legal guardian; and 

(f)
 
a copy of the youth's current medical insurance card. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.

37.98.1016
 TRANSPORTATION 

(1)
 
Any person transporting youth must possess a valid Montana driver's license for the type of vehicle used in transporting the youth. 

(2)
 
Any person transporting youth must comply with applicable traffic laws while transporting youth. 

(3)
 
The vehicle used in transporting youth must at a minimum: 

(a)
 
have proper Montana registration; 

(b)
 
have insurance coverage; 

(c)
 
be maintained in a safe condition; 

(d)
 
be equipped with a red triangle reflector device for use in a emergency; and 

(e)
 
be equipped with a first aid kit. 

(4)
 
The driver and all of the passengers must ride in a vehicle manufactured seat. Each person shall use a seat belt. 

(5)
 
No person can ride in the bed of or on the back of a truck. 

(6)
 
Youth may ride in a snowmobile or on a sled pulled by a snowmobile driven by a staff member. The youth must wear a helmet and be instructed on safety procedures. 

Authorizing statute(s):
 Sec. 
50-5-220
, MCA

Implementing statute(s):
 Sec. 
50-5-220
, MCA

History: 
NEW, 2004 MAR p. 1960, Eff. 8/6/04.