202 KAR 7:510. Air ambulance services

Link to law: http://www.lrc.ky.gov/kar/202/007/510.htm
Published: 2015

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      202 KAR 7:510. Air

ambulance services.



311A.030, 311A.190, 14 C.F.R. Parts 91, 135


311A.020, 311A.025, 311A.030, 311A.190


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


      (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


      (e) The level of service


      (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;


      (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


      (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


      (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,


      (a) Each person having

direct or indirect ownership interest of ten (10) percent or more in the


      (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


      (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;


      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


      3. A governmental agency;


      (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;


      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


      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


      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


      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


      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


      (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;


      (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


      (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


      (c) Medical terminology;

      (d) Flight coordination

and utilization;

      (e) Navigation and

weather interpretation;

      (f) Flight following;


      (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


      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;


      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


      c. A certified or registered

respiratory therapist;

      d. A nurse practitioner;


      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;


      (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


      (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


      (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;


      (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


      (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


      6. Two (2) eye protector

pads and shields or an approved substitute;

      7. Two (2) occlusive


      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


      (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


      (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


      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


      (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



      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



      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


      (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


      (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.