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RULE §157.12Rotor-wing Air Ambulance Operations

(a) Rotary wing aircraft (helicopters) operated by a licensed emergency medical services (EMS) provider shall be at the mobile intensive care level. Persons or entities operating rotary wing air ambulances must direct and control the integrated activities of both the medical and aviation components. Although the aircraft operator is directly responsible to the Federal Aviation Administration (FAA) for the operation of the aircraft, typically the organization in charge of the medical functions directs the combined efforts of the aviation and medical components during patient transport operations. Licensed rotary wing aircraft must also meet the requirements of §157.11 of this title (relating to Requirements for an EMS Provider License) as long as the Airline Deregulation Act of 1978, 49 U.S.C. §41713 (b)(1) et seq. is not violated.

(b) When being used as an ambulance, the helicopter shall:

  (1) be configured so that the medical personnel have adequate access to the patient in order to begin and maintain basic and advanced life support treatment;

  (2) have an entry that allows loading and unloading of a patient without excessive maneuvering (no more than 45 degrees about the lateral axis and 30 degrees about the longitudinal axis); and does not compromise functioning of monitoring systems, intravenous (IV) lines, or manual or mechanical ventilation;

  (3) have a supplemental lighting system in the event standard lighting is insufficient for patient care that includes:

    (A) a self-contained lighting system powered by a battery pack or a portable light with a battery source; and

    (B) a means to protect the pilot's night adaptation vision. (Use of red lighting or low intensity lighting in the patient care area is acceptable if not able to isolate the patient care area);

  (4) have an electric power outlet with an inverter or appropriate power source of sufficient output to meet the requirements of the complete specialized equipment package without compromising the operation of any electrical aircraft equipment;

  (5) have protection of the pilot's flight controls, throttles and radios from any intended or accidental interference by the patient, air medical personnel or equipment and supplies; and

  (6) have an internal medical configuration located so that air medical personnel can provide patient care consistent with the scope of care of the air medical service, to include:

    (A) the space necessary to ensure the patient's airway is maintained and to provide adequate ventilatory support from the secured, seat-belted position of the air medical personnel;

    (B) those aircraft with gaseous oxygen systems have equipment installed so that medical personnel can determine if oxygen is on by in-line pressure gauges mounted in the patient care area. Aircraft using liquid or gaseous oxygen should have equipment installed:

      (i) with each gas outlet clearly marked for identification;

      (ii) with oxygen flow capable of being stopped at the oxygen source from inside the aircraft; and

      (iii) so that the measurement of the liter flow and quantity of oxygen remaining is accessible to air medical personnel while in flight. All flow meters and outlets must be padded, flush mounted, or so located as to prevent injury to air medical personnel; or there shall be an operational policy stating that attendants wear helmets;

    (C) hangers/hooks available to secure (IV) solutions in place or a mechanism to provide high flow fluids if needed:

      (i) all IV hooks shall be padded, flush mounted, or so located as to prevent head trauma to the air medical personnel in the event of a hard landing or emergency with the aircraft; or an operational policy stating that attendants wear helmets; and

      (ii) glass containers shall not be used unless required by medication specifications and properly vented;

    (D) provision for medication which allows for protection from extreme temperatures if it becomes environmentally necessary;

    (E) secure positioning of cardiac monitors, defibrillators, and external pacers so that displays are visible to medical personnel; and

    (F) shall assure that all specialized medical equipment is secured throughout transport with adequately engineered designated mounts as approved by FAA.

(c) An air ambulance provider shall meet the responsibilities of EMS providers as in §157.11 of this title (relating to Requirements for an EMS Provider License) and in addition shall:

  (1) submit proof that the rotor-wing aircraft provider carries bodily injury and property damage insurance with a company licensed to do business in Texas in order to secure payment for any loss or damage resulting from any occurrence arising out of or caused by the operation or use of any of the certificate holder's aircraft.

  (2) submit proof that the air ambulance provider carries professional liability insurance coverage in the minimum amount of $500,000 per occurrence, with a company licensed to do business in Texas in order to secure payment for any loss or damage resulting from any occurrence arising out of or caused by the care or lack of care of a patient;

  (3) submit a list of all aircraft with the registration number or "N" number for the helicopters in the possession of the provider.

  (4) submit a letter of agreement that all helicopters shall meet the specifications of subsection (b) of this section, if the aircraft is leased from a pool;

  (5) allow visual and physical inspection of each aircraft and of the equipment to be used on each vehicle for the purpose of determining compliance with the vehicle and equipment specifications within this section; and

  (6) submit a copy of current Federal Aviation Administration (FAA) carrier, operational, and airworthiness certification, as per U.S, Code of Federal Regulations, Title 14, Subchapter G, Part 135).

(d) The air ambulance provider shall employ a medical director who shall meet the following qualifications:

  (1) be a physician approved by the department and in practice;

  (2) have knowledge and experience consistent with the transport of patients by air;

  (3) be knowledgeable in aeromedical physiology, stresses of flight, aircraft safety, patient care, and resource limitations of the aircraft, medical staff and equipment;

  (4) have access to consult with medical specialists for patient(s) whose illness and care needs are outside the medical director's area of practice;

  (5) shall comply with the requirements in the Medical Practice Act, Occupations Code, Chapters 151 - 168, and 22 Texas Administrative Code, Chapter 197; and

  (6) have knowledge on Texas EMS laws and regulations affecting local, regional and state operations.

(e) The physician shall fulfill the following responsibilities:

  (1) ensure that there is a comprehensive plan/policy to address selection of appropriate aircraft, staffing and equipment;

  (2) be involved in the selection, hiring, educating, training and continuing education of all medical personnel;

  (3) be responsible for overseeing the development and maintenance of a continuous quality improvement program;

  (4) ensure that there is a plan to provide direction of patient care to the air medical personnel during transport. The system shall include on-line (radio/telephone) medical control, and/or an appropriate system for off-line medical control such as written guidelines, protocols, procedures, patient specific written orders or standing orders;

  (5) participate in any administrative decision making processes that affect patient care;

  (6) ensure that there is an adequate method for on-line medical control, and that there is a defined plan or procedure and resources in place to allow off-line medical control;

  (7) oversee the review, revision and validation of written medical policies and protocols annually for the treatment and transportation of adult, pediatric, and neonatal patients; and

  (8) attest to the following capabilities:

    (A) experience consistent with the transport of patients by air;

    (B) knowledge of aeromedical physiology, stresses of flight, aircraft safety, resources limitations of the aircraft;

    (C) knowledge on Texas EMS laws and regulations affecting local, regional and state operations; and


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