202 KAR 7:510. Air
ambulance services.
RELATES TO: KRS
311A.030, 311A.190, 14 C.F.R. Parts 91, 135
STATUTORY AUTHORITY: KRS
311A.020, 311A.025, 311A.030, 311A.190
NECESSITY, FUNCTION, AND
CONFORMITY: KRS 311A.020 requires the board to exercise all administrative
functions in the regulation of air ambulance services the EMS system and the
licensing of air ambulance services. KRS 311A.030 requires the board to
promulgate administrative regulations for the licensing, inspection, and
regulation of air ambulance providers. This administrative regulation
establishes minimum licensing requirements for air ambulance providers.
Section 1. Provider
Licensing Requirements. (1) A person or entity shall not provide, advertise, or
profess to engage in the provision of air ambulance service originating in
Kentucky without having first obtained a license from the board pursuant to
this administrative regulation.
(2) A provider shall
comply with local ordinances, state and federal statutes and administrative
regulations.
(3) A provider shall
display its license in a prominent public area at the service base station and
all satellite locations. The following information shall be included on the license:
(a) Operating name of
the provider;
(b) Physical location of
the base station;
(c) The number and
physical location of satellite stations, if any, operated by the licensee;
(d) The license
classification;
(e) The level of service
provided;
(f) The number of rotor
and fixed-wing aircraft operated by the provider; and
(g) The specific
geographic area to be served by the licensee.
(4) Providers shall
provide the KBEMS Office with an accurate map and a written description of its
geographic service area within the commonwealth, which shall identify with specificity
the complete boundary of the area served by the provider when applying for
initial licensure or if the service area has changed since the last map was provided
to the KBEMS Office.
(5) A licensed provider
may respond to emergency calls outside of its geographic service area only if
the provider is providing:
(a) Mutual aid under an
existing agreement with another licensed provider whose geographic service area
includes the area in which the emergency call is made;
(b) Disaster assistance;
or
(c) Nonemergency
transfers from damaged or closed health facilities.
Section 2. Licensing,
Inspection and Change of Ownership. (1) To obtain a license, an air ambulance
provider shall file an "Kentucky Application for Ambulance Service
Licensing", Form EMS-1 (6/96), with the KBEMS Office.
(2) An applicant for a
license or a licensee shall, as a condition precedent to licensing or
relicensing, be in compliance with all applicable sections of this
administrative regulation as determined through means including a physical
inspection process, subject to subsection (4)(b)2 of this section.
(3) A license shall
expire on December 31 following the original date of issue and shall
subsequently expire annually on December 31 of each year.
(4) A license may be
renewed upon:
(a) Payment of the
prescribed fee; and
(b) Action by the board,
based upon recommendation of staff following the physical inspection of the
provider.
(5) A license to operate
shall be issued only for the person or entity, service area, and premises,
including the number of aircraft, named in the application, and shall not be
transferable.
(6) A new application
shall be filed if a change of ownership of an air ambulance service occurs. A
change of ownership for licenses shall be deemed to occur if more than fifty
(50) percent of the assets, capital stock, or voting rights of a corporation or
provider operating an air ambulance is purchased, transferred, leased, or
acquired by comparable arrangement by one (1) person or entity from another.
(7) If a new application
for a license is filed due to change of ownership, the new license shall be
issued for the remainder of the current licensure period.
(8) There shall be full
disclosure to the board of the changes in ownership, such as name and address,
of:
(a) Each person having
direct or indirect ownership interest of ten (10) percent or more in the
service;
(b) Officers and
directors of the corporation, if a service is organized as a corporation; or
(c) Partners, if a
provider is organized as a partnership.
(9) Representatives of
the board shall have access to the service during hours that the service
operates.
(10) A regulatory
violation identified during an inspection shall be transmitted in writing by
the board and given to the provider.
(11) The provider shall
submit a written plan for the elimination or correction of a regulatory
violation to the KBEMS Office within ten (10) working days after receipt of the
statement of violation and shall include the specific date by which the violation
may be corrected.
(12) Within ten (10)
working days following a review of the plan, the KBEMS Office shall notify the
provider in writing whether or not the plan is accepted as providing for the
elimination or correction of the violation.
(13) The KBEMS Office
may conduct a follow-up visit to verify compliance with the plan.
(14) If a portion or all
of the plan is insufficient:
(a) The KBEMS Office
shall specify the reasons why the plan cannot be accepted; and
(b) The provider shall
modify or amend the plan and resubmit it to the KBEMS Office within ten (10)
days after receipt of notice that the plan is insufficient.
(15) Unannounced
inspections may be conducted at the discretion of the board or its representative.
(16) Any licensed
provider may be recommended for discipline based upon:
(a) Failure to submit,
amend, or modify a plan of correction in order to eliminate or correct
regulatory violations;
(b) Failure to eliminate
or correct regulatory violations;
(c) Falsifying an
application for licensing;
(d) Changing a license
issued by the board;
(e) Attempting to obtain
or obtaining a license by:
1. Fraud;
2. Forgery;
3. Deception;
4. Misrepresentation; or
5. Subterfuge;
(f) Providing false or
misleading advertising;
(g) Falsifying, or
causing to be falsified a:
1. Patient record;
2. Service run report;
or
3. Other reports
provided to the KBEMS Office;
(h) Providing an
unauthorized level of service;
(i) Demonstrating a
history of staff violations that have resulted in disciplinary action;
(j) Failing to provide
the board or its representative with information upon request, or obstructing
an investigation regarding alleged or confirmed violations of statutes or
administrative regulations;
(k) Issuing a check for
a license on an invalid account or an account with insufficient funds to pay
fees to KBEMS; or
(l) Submitting
fraudulent or misleading claims for reimbursement to:
1. An individual;
2. A private insurance
company;
3. A governmental agency;
or
(m) Any violation of KRS
Chapter 311A or 202 KAR Chapter 7.
Section 3. Utilization
of Aircraft by Licensed Providers. (1) At the time of initial inspection, each
provider shall inform the KBEMS Office of the make, model, year, serial number,
and FAA identification number for each aircraft it uses.
(2) Except as provided
by this administrative regulation, an aircraft shall not be placed into
operation until after the board has been notified and has verified through a
physical inspection that the aircraft meets the requirements of this
administrative regulation.
(3) Each provider shall
notify the KBEMS Office via U.S. mail, email, or fax, no later than the next
board business day, of the permanent removal of any licensed aircraft from
service by the license holder.
(4) A licensed provider
may use a replacement aircraft on a temporary basis if an approved aircraft is
out of service, if:
(a) The KBEMS Office
receives notice within twenty-four (24) hours or on the next business day by
fax or email of the need for the provider to place an aircraft into service on
a temporary basis; and
(b) Within five (5)
business days, the provider provides the board written notice identifying:
1. The make, model,
year, serial number, and FAA identification number for the aircraft being
removed from service and for the aircraft being placed into temporary service;
and
2. The temporary
replacement aircraft meets the requirements of this administrative regulation.
(5) A temporary
replacement aircraft shall not be used for more than sixty (60) days, unless
the KBEMS Office has verified through a physical inspection that it meets the
requirements of this administrative regulation.
(6) The KBEMS Office
shall be notified by email or fax within twenty-four (24) hours or on the next
business day when a temporary aircraft is removed from service and the original
licensed aircraft is returned to service.
(7) A provider that
fails to meet the reporting requirements for use of a temporary aircraft may be
required to immediately cease use of the replacement aircraft until the reporting
requirements are met.
(8) A provider that
fails to remove a temporary aircraft from service upon written order may be
fined an amount not to exceed $1,000 per day for each day or partial day the
aircraft is in service and the reporting requirements are not met.
(9) This administrative
regulation shall not prevent a provider from utilizing other means of
transporting patients in:
(a) Disasters;
(b) Mass casualty
incidents; or
(c) Extraordinary scene
conditions that may impair the safety of the patient or personnel operating at
the scene.
Section 4. Provider
Management Requirements. (1) All providers shall:
(a) Maintain an
organizational chart that establishes lines of authority, including the designation
of:
1. An administrator
responsible for assuring compliance with this administrative regulation during
the daily operation of the service; and
2. A designee who shall
serve in the absence of the administrator;
(b) Maintain records and
reports at the ambulance service base station or at a location where the
records can be made readily available to KBEMS staff including an original,
microfilm, electronic equivalent, or copy of all run reports whether reported
on:
1. The EMS-8A and EMS-8B
"Kentucky Emergency Medical Ambulance Run Report" (9/98), with all
nonshaded portions of the run report completed as appropriate for each patient
and each run; or
2. A paper or electronic
run form developed by the provider that contains all of the data components of
the nonshaded areas of the EMS-8A and EMS-8B (9/98);
(c) Maintain a copy of
all completed run report forms, maintained to ensure confidentiality and
safekeeping, for a minimum of five (5) years from the date on which the service
was rendered, or in the case of a minor, until five (5) years after the minor
reaches eighteen (18) years of age. Copies of run reports shall be accessible
so as to be immediately available to the board, KBEMS Office or representatives
upon request;
(d) Maintain personnel
files for each employee or volunteer who staffs an aircraft. Personnel files
shall be maintained for a minimum of five (5) years following separation from
employment. As a minimum, personnel files shall contain:
1. Current certification
or licensure with corresponding numbers and expiration dates for the position
that the individual fulfills on the aircraft;
2. Proof that the
provider has conducted a pre-employment criminal background check; and
3. Health records,
maintained in accordance with state and federal laws and administrative
regulations, in a separate secure file, that include:
a. A post-offer of
employment health assessment;
b. Annual tuberculin skin testing or other method of evaluation;
c. Hepatitis-B
vaccinations and seroconversion testing unless exempted by the employees’
physician, or an employee signed waiver; and
d. A record of all
work-related illnesses or injuries;
(e) Maintain a plan and
records for the provision of continuing education for staff and volunteers
including a written plan for the method of assessment of staff continuing
education needs and a coordinated plan to meet those needs including:
1. Training or
continuing education rosters that include the printed name, signature, and
certification or license number of those in attendance;
2. A curriculum vitae
for the instructor; and
3. A brief outline of
the presentation including the educational objective for the offering and the
method of presentation used for the presentation;
(f) Maintain an
infection control plan in accordance with KyOSHA guidelines;
(g) Maintain a written
plan for training or educating personnel for responding to hazardous materials,
criminal, and potential terrorist incidents, including plans for the protection
and decontamination of patients, aircraft, equipment, and staff;
(h) Maintain a written plan
for the quality assessment of patient care and provider quality improvement
including a periodic review of ambulance run report forms, and evaluation of
staff performance related to patient care. This plan shall address as a
minimum:
1. Aircraft maintenance
as it impacts the clinical aspects of patient care delivery, employee health
and safety;
2. Compliance with
protocols and operating procedures;
3. Transport response
and transport limitations;
4. Assessment of
dispatch procedures;
5. Aircraft operations
and safety;
6. Equipment preventive
maintenance programs; and
7. A process for the
resolution of customer complaints;
(i) Maintain a written
plan for training personnel and responding to mass casualty incidents and
disasters, which shall include an internal incident command structure and how
it will integrate into a community response plan;
(j) Maintain an
orientation program for all personnel related to:
1. Aircraft, scene,
ground and base safety;
2. Communication
equipment at the base station and on each aircraft;
3. The location and use
of fire extinguishers;
4. Transport response
and transport limitation standards;
5. Map reading and
geographic orientation;
6. Mutual aid
agreements;
7. Cleaning of equipment
including aircraft;
8. Stretcher operations
and use;
9. Completion of run
reports; and
10. Other standard
operating procedures that have been established by the provider;
(k) Maintain proof of
professional liability malpractice insurance; and
(l) Maintain proof of
aircraft liability insurance.
(m) Provide a copy of
the current FAA Air Carrier Certificate; and
(n) Maintain a written
policy regarding patient criteria for interfacility transfers including a
written statement of medical necessity signed by a physician for each patient
transferred.
(2) Each provider shall,
in the county in which their base station or a substation is located;
(a) Document evidence of
participation in county emergency management disaster exercises, if conducted;
(b) Coordinate with the
county emergency management director plans for the possible utilization of a
provider's personnel for use in the emergency operations center in a disaster;
and
(c) Maintain a copy of
the county and state emergency management agency's emergency operations plan at
the ambulance base station.
Section 5. Operating
Requirements. (1) All air ambulance providers shall provide service twenty-four
(24) hours a day, seven (7) days a week, subject to safety issues and weather
conditions established in Part 135 of the FAR. These provisions may be met
through a call system or through mutual aid agreements.
(2) A provider shall
have a written plan, developed in consultation with the air ambulance
provider's medical director that requires:
(a) Utilization of the air
medical intake flow chart;
(b) Dispatch of requests
for emergency service within two (2) minutes of the call taker's determination
of the correct address or location of the emergency incident site and completion
of a weather check;
(c) Disclosure of the
accurate availability of provider's aircraft, including the estimated time of arrival
to the requesting agency. If the provider's closest aircraft is not available,
and so requested by the requesting agency, the provider shall attempt to
contact the closest known aircraft to the scene; and
(d) The air ambulance
provider to share current aircraft position data, through computer interface
with other air ambulance providers, if the air ambulance provider utilizes a
satellite tracking position mechanism.
(3) A provider may enter
into mutual aid agreements with other Kentucky licensed air ambulance services
operating within the same geographic area.
(4) A provider may
accept a request to provide service outside of its service area except it shall
require documentation from the requesting facility or provider that a good
faith effort was made to utilize a provider licensed for the area.
(5) A preventive
maintenance program shall be maintained that complies with Part 135 FAR or Part
92 FAR.
(6) Minimally,
documentation of annual inspections or annual preventative maintenance records
in addition to any records of maintenance performed shall be maintained by the
provider to support evidence of periodic inspections or calibrations required
for maintenance and operation of medical equipment utilized on the aircraft.
(7) Each aircraft and
its equipment shall be checked after each use to ensure that it is in a clean
and sanitary condition, unless precluded by emergency conditions. Minimally,
documentation shall be maintained by the provider to support the evidence of a
daily medical equipment checklist.
(8) A communications
system shall be developed, coordinated, and maintained by each ambulance
provider. The communication system shall meet the following requirements:
(a) Radio equipment used
in emergency medical services aircraft shall be appropriately licensed through
the FCC. Copies of the current FCC licenses shall be on file in the provider’s
office;
(b) Aircraft shall be
equipped with two (2) way radio communication equipment capable, under normal
conditions, of contacting dispatch centers and hospitals;
(c) Aircraft shall have
air-to-air, ground-to-air, and air-to-ground communication capabilities and
shall be capable of communicating with ground personnel to properly coordinate
the landing and primary medical responders on the ground who may be caring for
the patient;
(d) Aircraft shall have
a minimum of two (2) portable communication devices capable of operating on the
provider frequency that shall be provided for personnel when away from the
aircraft; and
(e) All aircraft when
approaching and departing a landing zone in uncontrolled airspace shall
announce their intentions to other aircraft via 123.025 MHz.
(9) Air ambulance
providers shall comply with FAR specifications for flight following and
position plotting by a provider based or maintained communication center. The
communication center shall be equipped with communications equipment and
staffed by a properly trained ACS to receive and coordinate all calls as provided
for by FAR. If providing fixed-wing service, this requirement may be met by
filing an FAA flight plan.
(10) An ACS shall have
documented training appropriate to the transport of the provider that shall as
a minimum address the following areas:
(a) FAA and FCC
regulations pertinent to air ambulance operations;
(b) Air medical radio
communications;
(c) Medical terminology;
(d) Flight coordination
and utilization;
(e) Navigation and
weather interpretation;
(f) Flight following;
and
(g) Emergency procedures.
(11) An air ambulance
provider shall provide proof that it:
(a) Complies with FAR
pertaining to maintenance inspections, flight, and duty time;
(b) Complies with FAA
and FAR required maintenance activities; and
(c) Holds FAR required
air ambulance operations specifications.
Section 6. Aircraft
Requirements. (1) Fixed and rotor-wing air ambulance aircraft shall:
(a) Have an entry that
allows patient loading and unloading without tilting the patient greater than
thirty (30) degrees from the horizontal axis;
(b) Be climate
controlled and maintain a temperature of not less than sixty-five (65) degrees
nor more than eighty-five (85) degrees Fahrenheit in the patient compartment
during patient transport or demonstrate a procedure for maintaining patient
temperature sufficient to prevent hypothermia and hyperthermia;
(c) All pharmaceuticals
shall be kept within the recommended temperature range as established by the
manufacturer or as otherwise established by FDA standards;
(d) Utilize an alternate
aircraft or alternate mode of transportation, if the environment within the
aircraft is such that it would be detrimental to the staff’s physical welfare
or the patient’s condition, until those conditions are alleviated;
(e) Be configured in
such a way that air medical personnel shall have access to the patient in order
to begin and maintain both basic and advanced life support;
(f) Have interior
lighting adequate to ensure complete observation of the patient;
(g) Have a procedure in
place to limit light in the cockpit area during night operation;
(h) Have an electric
inverter, with two (2) outlets, to convert direct current (DC) to alternating
current (AC) for operation of specialized equipment, such as an isolette or
intra-aortic balloon pump;
(i) Have equipment,
stretchers, and seating:
1. Arranged so as not to
block rapid egress by air ambulance personnel or patients; and
2. Affixed or secured in
FAA approved racks, compartments, or strap restraints which meet FAR
"G" loading requirements;
(j) Have a patient
stretcher or litter which:
1. Has the capability to
raise the head of the patient; and
2. Has appropriate
devices to secure the patient to the stretcher.
(k) Provide proof of an
FAR Part 135 certificate with an FAR required air ambulance specification; and
(l) Not transport more
patients, personnel, and other persons than can be safely secured by means of
seat safety belts or similar devices in the aircraft during flight.
(2) Fixed-wing aircraft
shall be pressurized if patient flights are to exceed 6000 feet mean sea level.
Section 7. Air Ambulance
Medical Personnel. (1) A rotor-wing air ambulance service operating an ALS
aircraft shall assure that it is minimally staffed by:
(a) A pilot as required
by this administrative regulation; and
(b) Two (2) attendants
that meet one (1) of the following staffing configurations:
1. A Kentucky licensed
paramedic and RN authorized to practice in the state of Kentucky pursuant to
KRS Chapter 314;
2. A RN and RN both of
which are authorized to practice in the state of Kentucky pursuant to KRS
Chapter 314; or
3. A physician
authorized to practice in the state of Kentucky pursuant to KRS Chapter 311 and
RN authorized to practice in the state of Kentucky pursuant to KRS Chapter 314.
(2) Each attendant
required by subsection (1)(a) of this section shall additionally maintain
documentation of current certification or the equivalent thereof as approved by
the board of the following:
(a) ACLS;
(b) BLS;
(c) PALS;
(d)1. PHTLS;
2. ITLS; or
3. TNATC; and
(e) NRP.
(3) BLS fixed-wing
patient transports shall be minimally staffed by:
(a) A pilot as required
by this administrative regulation; and
(b) Two (2) attendants
whom shall be minimally certified as EMT's by the board.
(4) ALS fixed-wing
patient transports shall be minimally staffed by:
(a) A pilot as required
by this administrative regulation; and
(b) Two (2) attendants of
which:
1. The first patient
attendant shall be:
a. A flight nurse; or
b. A RN authorized to
practice in the state of Kentucky pursuant to KRS Chapter 314, qualified by
specific patient population, experience, and current competencies in emergency
and critical care; and
2. The second patient
attendant shall be:
a. A RN authorized to
practice in the state of Kentucky pursuant to KRS Chapter 314, qualified by
specific patient population, experience, and current competency in emergency
and critical care;
b. A licensed paramedic;
c. A certified or
registered respiratory therapist qualified by specific patient population, experience,
and current competency in mission-specific patient care; or
d. A physician authorized
to practice in the state of Kentucky pursuant to KRS Chapter 311 and qualified
by relevant training, experience, and current competency in mission-specific
patient care;
(5) A staffing variance
on an ALS fixed-wing patient mission necessitated by staffing or patient care
requirements shall not be permitted unless prior approval is granted by the
medical director or designee.
(6) ALS specialty care
transport patient transports by rotor or fixed wing air ambulance shall be
minimally staffed by:
(a) A pilot meeting the
requirements of this administrative regulation; and
(b) Two (2) attendants
with relevant training, experience and current competency in transport-specific
patient care as authorized by the medical director or designee of which:
1. The first patient
attendant shall be:
a. A RN authorized to
practice in the state of Kentucky pursuant to KRS Chapter 314;
b. A nurse practitioner;
or
c. A physician authorized
to practice in the state of Kentucky pursuant to KRS Chapter 311; and
2. The second patient
attendant shall be:
a. A RN authorized to
practice in the state of Kentucky pursuant to KRS Chapter 314;
b. A Kentucky licensed
paramedic;
c. A certified or registered
respiratory therapist;
d. A nurse practitioner;
or
e. A physician
authorized to practice in the state of Kentucky pursuant to KRS Chapter 311.
(7) All regular and
specialty care air ambulance patient attendants shall attend and document
flight orientation training Flight orientation training shall include:
(a) Altitude physiology;
(b) Aircraft-specific
operations and in-flight safety;
(c) Emergency egress and
survival training;
(d) Crew resource management;
and
(e) Communication equipment
utilization and emergency procedures.
(8) All regular air
ambulance patient attendants shall complete and document additional flight
orientation training to include:
(a) Scene safety;
(b) Use of extrication
equipment;
(c) Scene triage;
(d) Kentucky EMS
statutes and administrative regulations;
(e) Advanced airway management;
(f) Anatomy, physiology
and assessment of adult, pediatric and neonatal patients as outlined within the
program's scope of care;
(g) Cardiac emergencies
and advanced critical car;
(h) Burns;
(i) Environmental emergencies;
(j) High risk OB;
(k) Multitrauma
emergencies;
(l) Toxicology;
(m) Hazardous materials
awareness level training;
(n) Hemodynamic monitoring;
(o) Mechanical
ventilation and respiratory physiology; and
(p) Pharmacology;
(9) All regular air
ambulance patient attendants shall complete and document annual continuing
education which shall include a review of:
(a) Infection control;
(b) Kentucky EMS
administrative regulations regarding ground and air transport;
(c) Crew resource management;
(d) Stressors of flight
if not included in crew resource management;
(e) Survival training;
and
(f) Skill maintenance
program or competency program for invasive, high risk, or low volume procedures
as outlined in the program's scope of care.
(10) An attendant shall
remain with the patient, in the patient compartment, at all times during
transport.
(11) All aircraft,
providing ALS care, that are licensed and based in Kentucky shall have a
Kentucky licensed paramedic on board all aircraft that respond to scene
flights. A variance from the paramedic requirement for all other flights that
is necessitated by patient care requirements, shall be permitted only if the
medical director or designee approves the action. All aircraft responding to
flights originating in Kentucky shall be licensed by the board.
(12) Aircraft that are
licensed in Kentucky but based in contiguous states may use the staffing
requirements of the state in which they are located if they are licensed in
that state and the staffing requirements for that state, at a minimum for scene
flights shall be:
(a) Paramedic and RN;
(b) RN and RN; or
(c) Physician and RN.
(13) This administrative
regulation shall not prevent a provider from utilizing staff other than that
required by this administrative regulation in:
(a) Disasters;
(b) Mass casualty
incidents; or
(c) Extraordinary scene
conditions that may impair the safety of the patient or personnel operating at
the scene.
(14)(a) Staffing
configurations as outlined in this administrative regulation may supplement or
replace the patient care attendants on a ground ambulance licensed in Kentucky
for the purpose of facilitating the care and the transport of a patient if:
1. The aircraft was
unable to complete a patient flight due to deteriorating weather conditions or
other unplanned events; or
2. For the purpose of
providing a continuum of care from the scene to the aircraft or from the
aircraft to the patient destination.
(b) Air ambulance
personnel shall assure the availability of necessary equipment to care for the
patient during transport.
Section 8. Provider
Requirements for Air Ambulance Pilots. The air ambulance provider shall assure
that prior to performing emergency medical service transports the PIC complies
with all requirements as set forth in 14 FAR Part 135.4. All documentation of
having met this requirement shall be provided upon request.
Section 9. Basic Life
Support Equipment and Supplies. (1) All rotor air ambulance providers shall
carry and maintain, in full operational order, the following minimum BLS
equipment and supplies:
(a) Suction equipment,
which shall include:
1. Two (2) sources of
suction apparatus, one (1) of which shall be fixed, and one (1) of which shall
be portable;
2. Rigid catheters;
3. Flexible catheters in
adult, pediatric and infant sizes;
4. Bulb syringe or
meconium aspiration device for infant and neonate suction;
(b) Oxygen and airway
supplies and equipment, including:
1. An installed oxygen
system with a capacity of at least 2,000 liters of oxygen for each aircraft;
2. Portable oxygen system
supplying at least 300 liters;
3. A backup source of
oxygen, which may be the required portable tank if it is carried in the patient
care area during flight in the event the main system fails. The backup source
shall be delivered via a nongravity dependent delivery device;
4. Pressure gauge and
flow rate regulator for fixed and portable units with a range of zero to
fifteen (15) liters per minute;
5. Oxygen supply tubing;
6. Transparent
nonrebreather oxygen masks for adults and pediatrics;
7. Nasal cannulas for
adults and pediatrics;
8. Disposable adult,
pediatric, and infant bag-valve-mask ventilation units with oxygen reservoir,
oxygen tubing and masks;
9. Nasopharyngeal and
oropharyngeal airway kits in sizes for adult and children with water soluble
lubricant; and
10. Bite stick;
(c) Trauma equipment and
supplies including:
1. Two (2) sterile
universal dressings at least 10 in. x 30 in., compactly folded and packaged;
2. Four (4) by four (4)
gauze pads;
3. Soft roller
self-adhering bandages, various sizes;
4. Four (4) rolls of
adhesive tape, minimum of two (2) sizes;
5. Two (2) sterile burn
sheets;
6. Two (2) eye protector
pads and shields or an approved substitute;
7. Two (2) occlusive
dressings;
8. Shears for bandages;
9. Splints, including:
a. Lower extremity
mechanical traction splint in adult and pediatric sizes; and
b. Splints for arm, full
leg and foot using semi-rigid immobilization devices; and
10. Immobilization
devices, including:
a. Lower adult and
pediatric long spine boards or other full body immobilization device with
straps and cervical immobilization accessories;
b. Five (5) rigid, still
cervical collars in four (4) different sizes including pediatric sizes; and
c. Towel rolls or other
bulk dressings to be used for cervical immobilization for infants;
(d) Patient assessment
and management equipment and supplies, including:
1. Adult, obese adult,
pediatric, and infant sphygmomanometer cuffs with stethoscope. A permanently
mounted sphygmomanometer shall not satisfy this requirement;
2. One (1) penlight;
3. An AED with a minimum
of two (2) complete sets of pads for all non-ALS air ambulances;
4. A device for
monitoring pulse oximetry; and
5. Thermometer;
(e) Personal
protective equipment, which shall be available to each staff member responding
on the aircraft, including:
1. One (1) clean scrub
gown or substitute, such as disposable coveralls;
2. Simple disposable
face mask;
3. Clear protective
goggles or safety glasses;
4. Disposable gloves;
5. One (1) particulate
filter mask rated at N95 or better without an exhaust port for patient use;
6. One (1) particulate
filter mask rated at N95 or better with or without an exhaust port for
protection of crew members; and
7. A means of cleansing
the hands, such as disposable towelettes or other solutions;
(f) Patient comfort
items including:
1. Two (2) clean
blankets and sheets; and
2. An emesis container
or similar substitute; and
(g) Miscellaneous
supplies, including:
1. Hand held flashlight
capable of providing adequate lighting to assess a scene or a patient away from
the aircraft;
2. One (1) sterile
obstetrical kit;
3. Instant glucose; and One
(1) multipurpose fire extinguisher which meets FAA requirements for each
specific aircraft and configuration.
(2) All aircraft shall
have a stretcher or litter with:
(a) Head-raising
capabilities;
(b) An FAA approved
aircraft-specific mechanism for securing the stretcher or litter in the
aircraft during transit; and
(c) An FAA approved
aircraft-specific patient to stretcher securing mechanism.
(3) Cleaning materials
shall be available, including:
(a) Hospital type
disinfectants;
(b) Glass or
multisurface cleaner;
(c) Trash bags for
disposal of nonbiohazard waste materials;
(d) Biohazard bags for
the disposable of biohazard waste; and
(e) Environment,
terrain, and mission-specific rescue and survival supplies; and
(4) Current expiration
dates shall be required for any item that carries an expiration date.
Section 10. Advanced
Life Support Equipment and Supplies. (1) All ALS providers shall maintain
evidence in the form of a letter that medical protocols have been reviewed and
approved by the board.
(2) In addition to the BLS
equipment required in Section 9 of this administrative regulation, an ALS
provider shall carry on each aircraft and maintain in fully-operational order,
supplies and equipment required by the providers protocols, including as a minimum:
(a) Endotracheal
intubation equipment consisting of:
1. Laryngoscope handle;
2. Various laryngoscope
blades in adult, pediatric, and infant sizes;
3. Extra batteries and
bulbs for handles or blades;
4. A minimum of seven
(7) different sizes of endotracheal tubes for oral and nasal placement in
adult, pediatric, and infant sizes;
5. Equipment necessary
to perform emergency cricothyrotomy;
6. Alternative airway
device to include at least one (1) of the following:
a. LMA;
b. Combitube;
c. King Airway; or
d. Additional
alternative airway device as approved by the service medical director;
7. End tidal carbon
dioxide detection devices, including:
a. A Capnography device
that provides continuous waveform and digital readout of end tidal CO2; and
b. A disposable colormetric
device;
8. Stylettes in adult
and pediatric sizes;
9. Magill forceps in
adult and pediatric sizes;
10. One-half (1/2) inch
wide twill tape or equivalent for securing endotracheal tubes; and
11. Water soluble
lubricant for lubrication of endotracheal and nasotracheal tubes;
(b) A portable monitor
defibrillator that:
1. Is capable of
displaying a visual display of cardiac electrical activity;
2. Is capable of
providing a hard copy of cardiac electrical activity measure;
3. Is capable of delivering
direct current energy over a variable range, which is suitable for pediatric
and adult usage;
4. Is capable of
providing external cardiac pacing;
5. Has adult and
pediatric external paddle electrodes or pads, capable of utilization for
immediate monitoring of heart activity and delivery of counter shock in both
the adult and pediatric patient;
6. Is capable of being
operated from internal rechargeable batteries;
7. Has synchronized
counter-shock capability for cardioversion; and
8. Has a patient monitoring
cable with:
a. Electrode paste or
gel or equivalent;
b. Electrode pads or
equivalent for use with the patient monitoring cable; and
c. One (1) additional
roll of paper for hard copy printout;
(c) Pulse oximeter;
(d) Mechanical ventilation
device;
(e) Sterile, disposable
needles, in types and sizes sufficient for personnel to administer medications
and perform procedures allowed by the providers' patient treatment protocols;
(f) Disposable syringes
in types and sizes sufficient for personnel to administer medications and
perform procedures allowed by the providers' patient treatment protocols;
(g) Restriction band
appropriate for use with venipuncture procedure;
(h) Dextrostix or
equivalent for the measure of blood glucose levels;
(i) Disposable,
individually-packaged antiseptic wipes;
(j) Intravenous fluids
as required by the provider's protocol, with macrodrip and microdrip fluid
sets, extension sets and accessory items including over-the-needle catheter
devices in sizes fourteen (14) to twenty-four (24) gauge;
(k) Intraosseous
needles; and
(l) Pediatric drug
dosage tape or equivalent that provides easy reference for pediatric and infant
treatment and drug dosages.
(3) An ALS provider
shall stock and maintain drugs and medications as required by the master drug
list contained in protocols established in accordance with this section.
(4) Controlled drugs
shall be stored in a locked storage box in a locked compartment on the
aircraft. A provider that stores and utilizes controlled substances shall show
proof of having submitted the provider's protocols to the Cabinet for Health
Services' Drug Control Branch.
(5) A provider may
maintain other supplies or equipment that are required to carry out its
protocols as approved by the board.
(6) Current expiration
dates shall be required for any item that carries an expiration date.
(7) Drugs and fluids
maintained on the aircraft shall be stored based on manufacturer's
recommendations.
Section 11. Specialty
Care Equipment. A provider may maintain other equipment specified by the
medical director if needed for the transport of neonates or other special needs
patients.
Section 12. Medical
Directors. (1) All providers of air ambulance services shall have a medical director.
(2) Medical directors
shall meet the requirements as set forth in 202 KAR 7:801.
Section 13. Request for
Waiver. (1) A provider licensed or contemplating licensure under this
administrative regulation may make a written request to the board for certain
provisions of this administrative regulation to be waived.
(2) A request shall
justify that a proposed waiver, if approved, shall not jeopardize the quality
of patient care or public safety.
(3) The board may
approve a request based on at least one (1) of the following:
(a) Circumstances where
public health and safety is a factor;
(b) Extenuating or
mitigating circumstances that warrant consideration to assure the delivery of
adequate emergency medical services;
(c) Substitution of
equipment authorized by this administrative regulation; or
(d) Testing of new
procedures, techniques, or equipment in a pilot study authorized by the board.
(4) The board shall
establish time limits and conditions on all waivers.
Section 14. Exemptions
from Regulations. (1) The following situations shall be exempt from the
provisions of this administrative regulation:
(a) First aid or
transportation provided in accordance with KRS 216B.020(2)(f);
(b) An aircraft serving
as an ambulance during a disaster or major catastrophe; or
(c) An aircraft operated
by the United States government on property owned by the United States
government.
(2) In addition, the
following out-of-state providers shall be exempt from the provisions of this
administrative regulation:
(a) An aircraft licensed
by another state that is transporting a patient from out of state to a Kentucky
medical facility or other location in Kentucky;
(b) An aircraft licensed
by another state that is transporting a patient from out of state through
Kentucky to another location out of state; and
(c) An aircraft licensed
in an adjoining state that responds to a mutual aid request from a Kentucky
licensed provider for emergency assistance if the out-of-state service is the
closest service appropriately capable of responding to the request or if
Kentucky licensed providers:
1. Are unavailable;
2. Have already
responded; or
3. Are physically unable
to reach the incident.
Section 15. Public
Notice of Negative Action. The board office shall cause to be published, in the
KBEMS News or similar publication of the board, or otherwise disseminate, the
name of an ambulance provider that is fined, placed on probationary status,
placed on restricted status, suspended, or had a license revoked.
Section 16.
Incorporation by Reference. (1) The following material is incorporated by
reference:
(a) Form EMS-8A,
"Kentucky Emergency Medical Services Ambulance Run Report", 9/98;
(b) Form EMS-8B,
"Kentucky Emergency Medical Services Ambulance Run Report", 9/98;
(c) Form EMS-1,
"Kentucky Application for Ambulance Service Licensing", 6/96; and
(d) "Air Medical
Intake Flow Chart", 10/2008.
(2) This material may be
inspected, copied, or obtained, subject to applicable copyright law, at the
Office of the Kentucky Board of Emergency Medical Services, 300 N. Main Street,
Versailles, Kentucky 40383, Monday through Friday, 8 a.m. to 4:30 p.m. (30
Ky.R. 162; Am. 930; 1228; 1489; eff. 11-19-2003; 35 Ky.R. 328; 1156; eff.
12-5-2008.)
