| (B) Vehicle Authorizations shall be issued for the
following levels of service, and a provider may operate at a higher
level of service based on appropriate staffing, equipment and medical
direction for that level. Vehicle authorizations will include a level
of care designation at one of the following levels:
(i) Basic Life Support (BLS);
(ii) BLS with Advanced Life Support (ALS) capability;
(iii) BLS with Mobile Intensive Care Unit (MICU) capability;
(iv) Advanced Life Support (ALS);
(v) ALS with MICU capability;
(vi) Mobile Intensive Care Unit (MICU);
(vii) Air Medical:
(I) Rotor wing; or
(II) Fixed wing; and
(C) Change of Vehicle Authorization. To change an authorization
to a different level the provider shall submit a request with appropriate
documentation to the department verifying the provider's ability to
perform at the requested level. A fee of $30 shall be required for
each new authorization requested. The provider shall allow sufficient
time for the department to verify the documentation and conduct necessary
inspections before implementing service at the requested authorization
(D) Vehicle Authorizations are not required to be specific
to particular vehicles and may be interchangeably placed in other
vehicles as necessary. The original Vehicle Authorization for the
appropriate level of service shall be prominently displayed in the
patient compartment of each vehicle:
(E) Vehicle Authorizations are not transferable between
(F) A replacement of a lost or damaged license or authorization
may be issued if requested with a nonrefundable fee of $10.
(3) Declaration of Business Names and Administration.
(A) The applicant shall submit a list of all business
names under which the service is operated. If the applicant intends
to operate the service under a name or names different from the name
for which the license is issued, the applicant shall submit certified
copies of assumed name certificates. The Department shall not issue
licenses with an identical name.
(B) A change in the name which the service is operated
will require a new application and a prorated fee as determined by
the department. A new provider number will be issued.
(C) Name of Administrator must be declared. The applicant
shall submit a notarized document declaring the full name of the chief
administrator, his/her mailing address and telephone number to whom
the department shall address all official communications in regard
to the license.
(1) All EMS vehicles must be adequately constructed,
equipped, maintained and operated to render patient care, comfort
and transportation safely and efficiently.
(2) EMS vehicles must allow the proper and safe storage
and use of all required equipment, supplies and medications and must
allow all required procedures to be carried out in a safe and effective
(3) Unless otherwise approved by the department, EMS
vehicles must meet the minimum ambulance vehicle body type, dimension
and safety criteria as specified in the "Federal Specification for
ambulances," KKK-A-1822, published by the U.S. General Services Administration.
(4) All vehicles shall have an environmental system
capable of heating or cooling, in accordance with the manufacturer
specifications, within the patient compartment at all times when in
service and which allows for protection of medication, according to
manufacturer specifications, from extreme temperatures if it becomes
environmentally necessary. The provider shall provide evidence of
an operational policy which shall list the parenteral pharmaceuticals
authorized by the medical director and which shall define the storage
and/or FDA recommendations. Compliance with the policy shall be incorporated
into the provider's Quality Assurance process and shall be documented
on unit readiness reports.
(5) When response-ready or in-service, EMS vehicles
shall have operational two-way communication capable of contacting
appropriate medical resources.
(6) When response-ready or in-service, EMS vehicles
shall be in compliance with all applicable federal, state and local
(7) All EMS vehicles shall have the name of the provider
and a current department issued EMS provider license number prominently
displayed on both sides of the vehicle in at least 2 inch lettering.
The license number should have the letters TX prior to the license
number. This requirement does not apply to fixed wing aircraft.
(e) Substitution, replacement and additional vehicles.
(1) The provider shall notify the department within
five business days if the provider substitutes or replaces a vehicle.
No fee is required for a vehicle substitution or replacement.
(2) The provider shall notify the department if the
provider adds a vehicle to the provider's operational fleet. A vehicle
authorization request shall be submitted with a nonrefundable vehicle
fee prior to the vehicle being placed into service.
(f) Staffing Plan Required.
(1) The applicant shall submit a completed EMS Personnel
Form listing each response person assigned to staff EMS vehicles by
name, certification level, and department issued certification/license
(2) An EMS provider responsible for an emergency response
area that is unable to provide continuous coverage within the declared
service areas shall publish public notices in local media of its inability
to provide continuous response capability and shall include the days
and hours of its operation. The EMS provider shall notify all the
public safety-answering points and all dispatch centers of the days
and hours when unable to provide coverage. The EMS provider shall
submit evidence that reasonable attempts to secure coverage from other
EMS providers have been made.
(g) Minimum Staffing Required.
(1) BLS--When response-ready or in-service, authorized
EMS vehicles operating at the BLS level shall be staffed at a minimum
with two emergency care attendants (ECAs).
(2) BLS with ALS capability--When response-ready or
in-service below ALS two ECAs. Full ALS status becomes active when
staffed by at least an emergency medical technician (EMT)-Intermediate
and at least an EMT.
(3) BLS with MICU capability--When response-ready or
in-service below MICU two ECAs. Full MICU status becomes active when
staffed by at least a certified or licensed paramedic and at least
(4) ALS--When response-ready or in-service, authorized
EMS vehicles operating at the ALS level shall be staffed at a minimum
with one EMT Basic and one EMT-Intermediate.
(5) ALS with MICU capability--When response-ready or
in-service below MICU shall require one EMT-Intermediate and one EMT.
Full MICU status becomes active when staffed by at least a certified
or licensed paramedic and at least an EMT.
(6) MICU--When response-ready or in-service, authorized
EMS vehicles operating at the MICU level shall be staffed at a minimum
with one EMT Basic and one EMT-Paramedic.
(7) Specialized--When response-ready or in-service,
EMS vehicles authorized to operate for a specialized purpose shall
be staffed with a minimum of two personnel appropriately licensed
and/or certified as determined by the type and application of the
specialized purpose and as approved by the medical director and the
(8) For air ambulance staffing requirements refer to §157.12(f)
of this title (relating to Rotor-wing Air Ambulance Operations) or §157.13(g)
of this title (relating to Fixed-wing Air Ambulance Operations).
(9) As justified by patient needs, providers may utilize
appropriately certified and/or licensed medical personnel in addition
to those which are required by their designation levels. In addition
to the care rendered by the required staff, the provider shall be
accountable for care rendered by any additional personnel.
(h) Treatment and Transport Protocols Required.
(1) The applicant shall submit written delegated standing
orders for patient treatment and transport (protocols) which have
been approved and signed by the provider's medical director.
(2) The protocols shall have an effective date and
an expiration date which correspond to the inclusive dates of the
provider's EMS license.
(3) The protocols shall address the use of non-EMS
certified or licensed medical personnel who, in addition to the EMS
staff, may provide patient care on behalf of the provider and/or in
the provider's EMS vehicles.
(4) The protocols shall address the use of all required,
additional, and/or specialized medical equipment, supplies, and pharmaceuticals
carried on each EMS vehicle in the provider's fleet.
(5) The protocols shall identify delegated procedures
for each EMS Certification or license level utilized by the provider.
(6) The protocols shall indicate specific applications,
including geographical area and duty status of personnel.
(i) EMS Equipment, supplies, medical devices, parenteral
solutions and pharmaceuticals.
(1) The EMS provider shall submit a list, approved
by the medical director and fully supportive of and consistent with
the protocols, of all medical equipment, supplies, medical devices,
parenteral solutions and pharmaceuticals to be carried. The list shall
specify the quantities of each item to be carried and shall specify
the sizes and types of each item necessary to provide appropriate
care for all age ranges appropriate to the needs of their patients.
The quantities listed shall be appropriate to the provider's call
volume, transport times and restocking capabilities.
(2) All critical patient care equipment, medical devices,
and supplies shall be clean and fully operational. All critical patient
care battery powered equipment shall have spare batteries or an alternative
power source, if applicable.
(3) All solutions and pharmaceuticals shall be in date
and shall be stored and maintained in accordance with the manufacturers
and/or U.S. Federal Drug Administration (FDA) recommendations.
(4) The requirements for air ambulance equipment and
supplies are listed in §157.12(h) of this title or §157.13(h)
of this title.
(j) The following items shall be present on each EMS
in-service vehicle and on, or immediately available for, each response-ready
vehicle in quantities, sizes and types as specified in the equipment
list as required in subsection (i) of this section:
(1) Basic Life Support:
(A) oropharyngeal airways;
(B) portable and vehicle mounted suction;
(C) bag valve mask units, oxygen capable;
(D) portable and vehicle mounted oxygen;
(E) oxygen delivery devices;
(F) dressing and bandaging materials;
(G) rigid cervical immobilization devices;
(H) spinal immobilization devices;
(I) extremity splints;
(J) equipment to meet special patient needs;
(K) equipment for determining and monitoring patient
vital signs, condition or response to treatment;
(L) pharmaceuticals, as required by medical director
(M) An External Cardiac Defibrillator appropriate to
the staffing level;
(N) A patient-transport device capable of being secured
to the vehicle; and
(O) An epinephrine auto injector or similar device
capable of treating anaphylaxis.
(2) Advanced Life Support:
(A) all required BLS equipment;
(B) advanced airway equipment;
(C) IV equipment and supplies; and
(D) pharmaceuticals as required by medical director
(A) all required BLS and ALS equipment;
(B) cardiac monitor/defibrillator; and
(C) pharmaceuticals as required by medical director
(4) BLS with ALS Capability:
(A) all required BLS equipment, even when in service
or response ready at the ALS level; and
(B) all required ALS equipment, when in service or
response ready at the ALS level.
(5) BLS with MICU Capability:
(A) all required BLS equipment, even when in service
or response ready at the MICU level; and
(B) all required MICU equipment, when in service or
response ready at the either the MICU level.
(6) ALS with MICU Capability:
(A) all required ALS equipment, even when in service
or response ready at the MICU level; and
(B) all MICU equipment, when in service or response
ready at the MICU level.
(7) In addition to medical supplies and equipment:
(A) a complete and current copy of written protocols
approved by the medical director; with a current and complete equipment,
supply, and medication list;