| (2) The EMS provider shall notify the department if
the EMS provider adds a vehicle to the provider's operational fleet
prior to making the vehicle response-ready. A vehicle authorization
request shall be submitted with a nonrefundable vehicle fee prior
to the vehicle being placed into service.
(g) 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
identification number.
(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.
(3) The applicant must provide proof at initial and
renewal of license that all licensed or certified personnel have completed
a jurisprudence examination approved by the department on state and
federal laws and rules that affect EMS.
(h) 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
or AEMT 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
an EMT.
(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 AEMT or EMT- Intermediate.
(5) ALS with MICU capability--When response-ready or
in-service below MICU shall require one EMT-Intermediate or AEMT 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 certified or licensed 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
department.
(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) When response-ready or in-service, authorized EMS
vehicles may operate at a lower level than licensed by the department.
When operating at the BLS level with an ALS/MICU ambulance, the EMS
provider must have an approved security plan for the ALS/MICU medication
as approved by the EMS provider medical director's protocol and/or
policy.
(10) 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.
(i) Treatment and Transport Protocols Required.
(1) The applicant shall submit written delegated standing
orders for patient treatment and transport protocols and policies
related to patient care which have been approved and signed by the
provider's medical director.
(2) The protocols shall have an effective date.
(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.
(j) EMS Equipment, supplies, medical devices, parenteral
solutions and pharmaceuticals.
(1) The EMS provider shall submit a list, approved
and signed 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 patient care equipment, and medical devices
must be operational, appropriately secured in the vehicle at the time
of providing patient care and response ready, and supplies shall be
clean and fully operational. All patient care powered equipment shall
have manual mechanical, spare batteries or an alternative power source,
if applicable.
(3) All solutions and pharmaceuticals shall be up to
date and shall be stored and maintained in accordance with the manufacturer's
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.
(k) The following equipment shall be present on each
EMS in-service vehicle and on, or immediately available for, each
response-ready vehicle as specified in the equipment list as required
by the medical director's approved equipment list to include all state
required equipment. The equipment list shall include equipment required
for treatment and transport of adult, pediatric, and neonatal patients.
(1) Basic Life Support (BLS):
(A) Equipment required to administer the BLS scope
of practice and incorporates the knowledge, competencies and basic
skills of an EMT/ECA and additional skills as authorized by the EMS
provider medical director. All BLS ambulances shall be able to perform
treatment and transport patients receiving the following skills:
(i) airway/ventilation/oxygenation;
(ii) cardiovascular circulation;
(iii) immobilization;
(iv) medication administration - routes; and
(v) single and multi-system trauma patients.
(B) oropharyngeal airways;
(C) portable and vehicle mounted suction;
(D) bag valve mask units, oxygen capable;
(E) portable and vehicle mounted oxygen;
(F) oxygen delivery devices;
(G) dressing and bandaging materials;
(H) commercial tourniquet;
(I) rigid cervical immobilization devices;
(J) spinal immobilization devices;
(K) extremity splints;
(L) equipment to meet special patient needs;
(M) equipment for determining and monitoring patient
vital signs, condition or response to treatment;
(N) pharmaceuticals, as required by the medical director's
protocols;
(O) an external cardiac defibrillator appropriate to
the staffing level with two sets of adult and two sets of pediatric
pads;
(P) a patient-transport device capable of being secured
to the vehicle, and the patient must be fully restrained per manufacturer
recommendations; and
(Q) an epinephrine auto injector or similar device
capable of treating anaphylaxis.
(2) Advanced Life Support (ALS):
(A) equipment required to administer the ALS scope
of practice and incorporates the knowledge, competencies and basic
and advanced skills of an AEMT and additional skills as authorized
by the EMS provider medical director. All ALS ambulances shall be
able to perform treatment and transport patients receiving the following
skills, including all required BLS equipment to perform treatment
and transport patients receiving the following skills:
Cont'd... |
