| (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:
(i) airway/ventilation/oxygenation;
(ii) cardiovascular circulation;
(iii) immobilization;
(iv) medication administration - routes; and
(v) intravenous (IV) initiation/maintenance fluids.
(B) all required BLS equipment;
(C) advanced airway equipment;
(D) IV equipment and supplies;
(E) pharmaceuticals as required by medical director
protocols; and
(F) wave form capnography or state approved carbon
dioxide detection equipment must be used after January 1, 2018, when
performing or monitoring endotracheal intubation.
(3) MICU:
(A) equipment required to administer the knowledge,
competencies and advanced skills of a paramedic, and additional skills
as authorized by the EMS provider medical director. All MICU 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) intravenous (IV) initiation/maintenance fluids.
(B) all required BLS and ALS equipment;
(C) with transmitting 12-lead capability cardiac monitor/defibrillator
by January 1, 2020; and
(D) pharmaceuticals as required by medical director
protocols.
(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 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 as
defined in subsection (k) of this section, EMS vehicles must also
have:
(A) a complete and current copy of written or electronic
formatted protocols approved and signed by the medical director; with
a current and complete equipment, supply, and medication list available
to the crew;
(B) operable emergency warning devices;
(C) personal protective equipment for the EMS vehicle
staff, including at least:
(i) protective, non-porous gloves;
(ii) medical eye protection;
(iii) medical respiratory protection must be available
per crew member, meeting National Institute for Occupational Safety
and Health (NIOSH) approved N95 or greater standards;
(iv) medical protective gowns or equivalent; and
(v) personal cleansing supplies;
(D) sharps container;
(E) biohazard bags;
(F) portable, battery-powered flashlight (not a pen-light);
(G) a mounted, currently inspected, 5 pound ABC fire
extinguisher (not applicable to air ambulances);
(H) "No Smoking" signs posted in the patient compartment
and cab of vehicle;
(I) a current emergency response guide book, or an
electronic version that is available to the crew (for hazardous materials);
and
(J) each vehicle will carry 25 triage tags in coordination
with the Regional Advisory Council (RAC).
(8) As justified by specific patient needs, and when
qualified personnel are available, EMS providers may appropriately
utilize equipment in addition to that which is required by their authorization
levels. Such equipment must be consistent with protocols and/or patient-
specific orders and must correspond to personnel qualifications.
(l) National accreditation. If a provider has been
accredited through a national accrediting organization approved by
the department and adheres to Texas staffing level requirements, the
department may exempt the provider from portions of the license process.
In addition to other licensing requirements, accredited providers
shall submit:
(1) an accreditation self-study;
(2) a copy of the formal accreditation certificate;
and
(3) any correspondence or updates to or from the accrediting
organization which impact the provider's status.
(m) Subscription or Membership Services. An EMS provider
that operates or intends to operate a subscription or membership program
for the provision of EMS within the provider's service area shall
meet all the requirements for an EMS provider license as established
by the Health and Safety Code, Chapter 773, and the rules adopted
thereunder, and shall obtain department approval prior to soliciting,
advertising or collecting subscription or membership fees. To obtain
department approval for a subscription or membership program, the
EMS provider shall:
(1) Obtain written authorization from the highest elected
official (County Judge or Mayor) of the political subdivision(s) where
subscriptions will be sold. Written authorization must be obtained
from each County Judge if subscriptions are to be sold in multiple
counties.
(A) The County Judge must provide written authorizations,
if subscriptions are to be sold throughout a county.
(B) The Mayor may provide written authorization if
subscriptions are sold exclusively within the boundaries of an incorporated
town or city.
(C) If an EMS provider is not the primary emergency
provider in any area where they are going to sell a subscription plan,
written notification must be provided to the participants receiving
subscription plan stating that the EMS Provider is not the primary
emergency provider in this area. A copy of this documentation should
be provided to the primary emergency provider and the department within
30 days before the beginning of any enrollment period.
(2) Submit a copy of the contract used to enroll participants.
(3) The EMS provider shall maintain a current file
of all advertising for the service. Submit a copy of all advertising
used to promote the subscription service within 30 days before the
beginning of any enrollment period.
(4) Comply with all state and federal regulations regarding
billing and reimbursement for participants in the subscription service.
(5) Provide evidence of financial responsibility by:
(A) obtaining a surety bond payable to the department
in an amount equal to the funds to be subscribed. The surety bond
must be on a department bond form and be issued by a company licensed
by or eligible to do business in the State of Texas; or
(B) submitting satisfactory evidence of self-insurance
an amount equal to the funds to be subscribed if the provider is a
function of a governmental entity.
(6) Not deny emergency medical services to non-subscribers
or subscribers of non-current status.
(7) Be reviewed at least every year; and the subscription
program may be reviewed by the department at any time.
(8) Furnish a list after each enrollment period with
the names, addresses, dates of enrollment of each subscriber, and
subscription fee paid by each subscriber.
(9) Furnish the department beginning and ending dates
of enrollment period(s). Subscription service period shall not exceed
one year. Subscribers shall not be charged more than a prorated fee
for the remaining subscription service period that they subscribe
for.
(10) Furnish the department with the total amount of
funds collected each year.
(11) Not offer membership nor accept members into the
program who are Medicaid clients.
(n) Responsibilities of the EMS provider. During the
license period, the EMS provider's responsibilities shall include:
(1) assuring that all response-ready and in-service
vehicles are available 24 hours a day and seven days a week, maintained,
operated, equipped and staffed in accordance with the requirements
of the provider's license, to include staffing, equipment, supplies,
required insurance and additional requirements per the current EMS
provider's medical director approved protocols and policies;
Cont'd... |
