| (ii) be from the commissioner's court of the county
in which the applicant is located and is applying to provide EMS,
if the applicant is not located in a municipality;
(iii) include the attestation that the addition of
another licensed EMS provider will not interfere with or adversely
affect the provision of EMS by the licensed EMS providers operating
in the municipality or county;
(iv) include the attestation that the addition of another
licensed EMS provider will remedy an existing provider shortage that
cannot be resolved through the use of the licensed EMS providers operating
in the municipality or county; and
(v) include the attestation that the addition of another
licensed EMS provider will not cause an oversupply of licensed EMS
providers in the municipality or county.
(8) Paragraph (7)(CC) of this subsection does not apply
to renewal of an EMS provider license or a municipality, county, emergency
services district, hospital, or EMS volunteer provider organization
in this state that applies for an EMS provider license.
(9) An EMS provider is prohibited from expanding operations
to or stationing any EMS vehicles in a municipality or county other
than the municipality or county from which the provider obtained the
letter of approval under this subsection until after the second anniversary
of the date the provider's initial license was issued, unless the
expansion or stationing occurs in connection with:
(A) a contract awarded by another municipality or county
for the provision of EMS;
(B) an emergency response made in connection with an
existing mutual aid agreement; or
(C) an activation of a statewide emergency or disaster
response by the department.
(10) Paragraph (9) of this subsection does not apply
to renewal of an EMS provider license or a municipality, county, emergency
services district, hospital, or EMS volunteer provider organization
in this state that applies for an EMS provider license.
(11) Paragraph (9) of this subsection does not apply
to fixed or rotor wing EMS providers.
(d) EMS Provider License.
(1) License.
(A) Applicants who have submitted all required documents
and who have met all the criteria for licensure will be issued a provider
license to be effective for a period of two years from the date of
issuance.
(B) Licenses shall be issued in the name of the applicant.
(C) License expiration dates may be adjusted by the
department to create licensing periods less than two years for administrative
purposes.
(D) An application for an initial license or for the
renewal of a license may be denied to a person or legal entity who
owns or who has owned any portion of an EMS provider service or who
operates/manages or who/which has operated/managed any portion of
an EMS provider service which has been sanctioned by or which has
a proposed disciplinary action/sanction pending against it by the
department or any other local, state or federal agency.
(E) The license will be issued in the form of a certificate
which shall be prominently displayed in a public area of the provider's
primary place of business.
(F) An EMS Provider License issued by the department
shall not be transferable to another person or entity.
(2) Vehicle Authorization.
(A) The department will issue an authorization for
each vehicle to be operated by the applicant which meets all criteria
for approval as defined in subsection (d) of this section.
(B) A vehicle authorization 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. A vehicle authorization 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
(viii) Specialized.
(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
level.
(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
providers.
(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 Operational Name and Administration.
(A) The applicant shall submit a list of all business
operational 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.
(B) A change in the operational 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 of Record 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.
(e) Vehicles.
(1) All EMS vehicles must be adequately constructed,
equipped, maintained and operated to render patient care, comfort
and transportation of adult, pediatric, and neonatal patients safely
and efficiently. A pediatric and neonatal equipment list should be
based on endorsed pediatric equipment national standards within the
approved equipment list required by the medical director.
(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
manner.
(3) As approved by the department, EMS vehicles must
meet a practical efficient minimum national ambulance vehicle body
type, dimension and safety criteria standards.
(4) All vehicles shall have an environmental system
capable of heating or cooling the patient(s) and staff, 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) EMS vehicles shall have operational two-way communication
capable of contacting appropriate medical resources and as outlined
in the current Texas interoperability plan unless the vehicle is designated
as being out of service using the form provided by the department.
(6) EMS vehicles shall be in compliance with all applicable
federal, state and local requirements unless the vehicle is designated
out of service with the form provided by the department.
(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
and in contrasting color. The license number shall have the letters
TX prior to the license number. This requirement does not apply to
fixed or rotor wing aircraft.
(f) Substitution, replacement and additional EMS vehicles.
(1) The EMS provider shall notify the department within
five business days if the EMS provider substitutes or replaces a vehicle.
No fee is required for a vehicle substitution or replacement.
(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.
Cont'd... |
