202 KAR 7:501.
Ambulance providers and medical first response agencies.
RELATES TO: KRS
311A.030, 311A.190
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 the EMS system and the licensing of ambulance
services and medical first response agencies. KRS 311A.030 requires the board
to promulgate administrative regulations for the licensing, inspection, and
regulation of ambulance providers and medical first response agencies. This
administrative regulation establishes minimum licensing requirements.
Section 1. License
Classifications. (1) The following classifications of licensure are established
for ambulance providers:
(a) Class I ground
ambulance services shall operate at the ALS or BLS level to provide emergency
and nonemergency transportation;
(b) Class II ground
ambulance services shall operate at the BLS level only to provide nonemergency
transportation;
(c) Class III ground
ambulance services shall operate at the ALS level only to provide critical
care, emergency or nonemergency transportation between health care facilities;
(d) Class IV ground
ambulance services shall operate at the ALS or BLS level to provide emergency
and nonemergency transportation for restricted locations such as industrial
sites and other sites that do not provide services outside a designated site;
(e) Class VI services
provide ALS medical first response without patient transport; and
(f) Class VII rotor wing
air ambulance services may provide ALS emergency or nonemergency
transportation. Fixed wing class VII services may provide ALS or BLS emergency
or nonemergency transportation.
(2) The KBEMS office
shall determine the appropriate classification for licensing all providers.
Section 2. Provider
Licensing Requirements. (1) A person or entity shall not provide, advertise, or
profess to engage in the provision of ambulance service or ALS medical first
response originating in Kentucky without having first obtained a license from
the board pursuant to this administrative regulation and certificate of need if
appropriate.
(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.
(4) 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
vehicles operated by the provider; and
(g) The specific
geographic area to be served by the licensee.
(5) 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. The map shall accurately reflect the
service area as identified by the providers certificate of need, if appropriate.
(6) A licensed provider
may respond to 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; or
(d) Interfacility care
to residents of its service area, who are patients in facilities outside of its
service area, for the purpose of returning the patients to their home service
area or transporting them to another health facility.
Section 3. Licensing,
Inspection and Change of Ownership. (1) To obtain a license, an ambulance
provider shall file an "Application for Ambulance Provider Licensing",
Form EMS-1 (6/96), with the Office of the Kentucky Board of Emergency Medical
Services, 2545 Lawrenceburg Road, Frankfort, Kentucky 40601.
(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 that include a physical
inspection process.
(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) Recommendation of
staff following the physical inspection of the provider; and
(b) Payment of the
prescribed fee.
(5) A license to operate
shall be issued only for the person, service area, and premises, including the
number of ambulances, named in the application, and shall not be transferable.
(6) A new application
shall be filed if a change of ownership 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 is
purchased, transferred, leased, or acquired by comparable arrangement by one
(1) person 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, 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) Compliance with
licensing under this administrative regulation may be ascertained through
on-site inspections of the provider by representatives or employees of the
KBEMS Office.
(10) Representatives or
employees of the KBEMS Office shall have access to the service during hours
that the service operates.
(11) A regulatory
violation identified during an inspection shall be transmitted in writing to
the provider by the KBEMS office.
(12) 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 of receipt of the
statement of violation.
(13) The plan shall
specify the date by which the violation shall be corrected.
(14) 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.
(15) The KBEMS office
shall conduct a follow-up visit to verify compliance with the plan.
(16) If a portion or all
of the plan is unacceptable:
(a) The KBEMS office
shall specify 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 unacceptable.
(17) Unannounced
inspections may be conducted for a:
(a) Complaint
allegation;
(b) Follow-up visit; or
(c) Relicensing
inspection.
(18) Any licensed
provider may be recommended for discipline based upon the following:
(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 obtains a license by:
1. Fraud;
2. Forgery;
3. Deception;
4. Misrepresentation; or
5. Subterfuge;
(f) Providing false or
misleading advertising;
(g) Falsifying, or
causes 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
specified fees; or
(l) Submitting
fraudulent or misleading claims for reimbursement to:
1. An individual;
2. A private insurance
company; or
3. A governmental
agency.
Section 4. Utilization
of Vehicles by Licensed Providers. (1) At the time of initial inspection, each
provider shall inform the KBEMS office of the make, model, year, vehicle
identification number or serial number, and license tag number for each vehicle
it uses.
(2) Except as provided
by this administrative regulation, a vehicle shall not be placed into operation
until after the board has been notified and has verified, through a physical
inspection, that the vehicle 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 vehicle from
service by the license holder.
(4) A licensed provider
may use a replacement vehicle on a temporary basis if an approved vehicle is
out of service, and if 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 a vehicle into service on a temporary basis. A temporary replacement
vehicle shall not be used for more than thirty (30) days unless the KBEMS
office has verified, through a physical inspection, that it meets the
requirements of this administrative regulation.
(5) The KBEMS office
shall be notified by email or fax within twenty-four (24) hours or on the next
business day when a temporary vehicle is removed from service and the original
licensed vehicle is returned to service.
(6) A provider that
fails to meet the reporting requirements for use of a temporary vehicle may be
required to immediately cease use of the replacement vehicle until the
reporting requirements are met.
(7) A provider that
fails to remove a temporary vehicle from service upon written order may be
fined an amount not to exceed $1,000 per day for each day or partial day the
vehicle is in service and the reporting requirements are not met.
(8) 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 would impair the safety of the patient or personnel operating
at the scene.
Section 5. 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 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 which shall be 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 a vehicle. 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 vehicle;
2. A preemployment
criminal and Department of Transportation driver's records check for each
individual added to the service; and
3. Health records, 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 shall 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, ambulances, 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. Employee health and
safety;
2. Compliance with
protocols and operating procedures;
3. Assessment of
dispatch procedures;
4. Vehicle operations
and vehicle safety;
5. Equipment selection
processes;
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 establish:
1. Casualty collection
sites;
2. Casualty evacuation
sites;
3. Training and
education for personnel; and
4. The organizational
structure that shall outline an internal incident command structure and how it
integrates into a community response plan;
(j) Maintain an
orientation program for all personnel related to:
1. Communication
equipment at the base station and on each vehicle;
2. Vehicle fire extinguishers;
3. Response standards;
4. Map reading and
geographic orientation;
5. Mutual aid
agreements;
6. Cleaning of equipment
including vehicles;
7. Stretcher operations
and use;
8. Completion of run
reports; and
9. Other standard
operating procedures that have been established by the provider;
(k) Maintain and provide
proof of professional liability malpractice insurance;
(l) Maintain and provide
proof of vehicular liability insurance; and
(m) Notify the board
immediately upon transfer of coverage, cancellation, lapse, or other cessation
or change in professional liability malpractice insurance or vehicular
liability insurance.
(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.
(3) Diversion plans
shall meet the following requirements:
(a) A provider shall
maintain a diversion plan if physicians, hospitals, and ambulance providers
within a county or group of counties identify the need for a local diversion
plan;
(b) If it is determined
a plan is needed, a committee comprised of equal representation of physicians,
hospitals, and ambulance providers shall be formed to:
1. Develop and implement
a diversion plan;
2. Monitor
implementation of the diversion plan;
3. Meet at least
quarterly to discuss operation of the plan and any concerns of providers
covered by the plan;
4. Collect and review
data on diversion, evaluate the need for revisions, and update the plan as
needed; and
5. Communicate to the
chief executive officer of any health care provider covered under the plan if
there is a reported perceived breach of the plan;
(c) Diversion plans
shall address:
1. Patient and physician
preference;
2. The patient's medical
needs; and
3. Availability and
capacity of hospital resources; and
(d) Ambulance providers
licensed in any county where the diversion plan is established shall follow the
plan.
(4) Copies of all
documents required by this regulation need not be stored at the ambulance
service location but shall be accessible so as to be immediately available to
the board, KBEMS office or representatives upon request.
Section 6. Operating
Requirements. (1) All providers, except Class IV shall provide service
twenty-four (24) hours, a day, seven (7) days a week. Class IV providers shall
operate during the hours of operation for their licensed location. These
provisions may be met through a call system or through mutual aid agreements.
(2) A provider shall
have a written plan to assure all requests for service are promptly answered.
(3) Requests for
emergency service shall be dispatched or notified within two (2) minutes of the
call taker determining the correct address or location of the emergency
incident site.
(4) Any provider that
determines it is unable to have a vehicle responding within ten (10) minutes
from the initial time an emergency call is received from the dispatch center
shall notify the next closest appropriate vehicle to respond. The next closest
vehicle shall be considered to be the vehicle that potentially has the quickest
response time to the address requesting service regardless of service
ownership. The provider shall notify the dispatch center and the source of the
emergency call immediately that it is unable respond to the call and inform the
dispatch center and the source of whom the provider dispatched to the emergency
scene.
(5) A provider shall
enter into mutual aid agreements with another Kentucky licensed provider or
fire department, rescue squad, or other organizations operating within the same
or contiguous counties, that provide response to medical emergencies. These
agreements shall be in writing and address:
(a) The type of mutual
aid assistance to be provided, including ALS or BLS medical care, ALS medical
first response, or extrication;
(b) Response personnel,
including levels of training or education and provisions for joint in-service
training or education if appropriate;
(c) Response vehicles,
including unit identifiers and the station or location from which the vehicles
shall be operated;
(d) A plan of action for
the mutual aid agreement, including dispatch and notification procedures;
(e) Radio and other
communications procedures between the ambulance provider and other response
agencies with which the provider has mutual aid agreements;
(f) On-scene
coordination and scene control including medical direction if several agencies
respond to the same incident;
(g) Exchange of patient
information, records, and reports as allowed by law; and
(h) The effective dates
and process for amendment or termination.
(6) If a local or
regional dispatch center or 911 arrangement exists for all or part of the service
area of a ground provider, the ground provider shall have a signed affiliation
agreement with the dispatch center for coordination of emergency calls. If a
ground provider is unable to secure a written affiliation agreement with the dispatch
center, the ground provider shall have on file proof of a good faith attempt to
obtain an affiliation agreement.
(7) A provider may
accept a request to provide service outside of its service area if it requires
documentation from the requesting facility or provider that a good faith effort
was made to utilize a provider licensed for the area, except as provided for in
Section 2(6) of this administrative regulation.
(8) A provider shall not
refuse a request for emergency service if a unit is available in the service
area.
(9) The provider shall
establish written policies and procedures regarding the criteria used by the
ambulance service or dispatch center for determining what constitutes a request
for emergency service.
(10) A provider licensed
to provide emergency service shall not exhaust their resources by answering a
nonemergency call.
(11) A preventive
maintenance program shall be maintained for each vehicle and its equipment to
keep them in optimum working order to protect the health and safety of the
patient and ambulance personnel.
(12) Documentation shall
be maintained by the provider to support evidence of periodic inspections or
calibrations required for maintenance and operation of the vehicle and its
equipment.
(13) Each vehicle 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.
(14) This administrative
regulation shall not be construed to prevent a licensed provider from providing
medical first response emergency prehospital care at or below the level for
which they are licensed through the utilization of:
(a) Designated,
provider-owned response vehicles;
(b) Provider or
personally-owned supervisor vehicles; or
(c) Employee
personally-owned vehicles.
(15) The licensed
provider shall determine in writing the minimum equipment required for tiered
response vehicles operating under their license.
(16) Vehicles used to
provide medical first response services shall be insured by the employee or
through the insurance policies of the provider.
(17) 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 vehicles shall be appropriately licensed through
the FCC. Copies of the current FCC licenses shall be on file in the provider’s
office;
(b) Vehicles shall be
equipped with two (2) way radio communication equipment capable, under normal
conditions, of contacting dispatch centers and hospitals; and
(c) Each vehicle shall
have a minimum of one (1) portable communication device capable of operating on
the provider or hospital frequency, that shall be provided for personnel if
away from the vehicle.
Section 7. Ground
Vehicle Specifications. (1) Vehicles used by ground providers shall:
(a) Have the name of the
provider appearing on both sides of the exterior surface of the vehicle subject
to the following:
1. The name shall be the
incorporated name or the name under which the provider does business and as it
appears on the provider's license;
2. The service may
request approval from the board to display an abbreviated or shortened version
of its name to serve as a unique identifier;
3. This requirement
shall not preclude a provider from adding additional names from another entity
on the vehicle due to a joint venture, if the name as licensed by the board is
the larger, and visible and readable by the public; and
4. A vehicle operated by
a provider shall not be marked with the words "advanced life
support", "paramedic", or similar words which convey essentially
the same meaning on its exterior surface visible to the public unless the
provider is licensed to provide ALS services;
(b) Be maintained in good
operating condition and in full repair without obvious apparent problems
relating to tires, exhaust, body integrity, warning devices, or mechanical
reliability, which would be recognized by the average lay person who is not an
automotive mechanic;
(c) Be designed to
provide for the medical care or transportation of patients; and
(d) Have tires that meet
the manufacturer's standards for the gross vehicle weight of the vehicle. A
tire shall not display exposed tire cord or have tread depth less than 2/32 on
back tires and 4/32 on front tires if measured in any two (2) adjacent grooves
at three (3) locations spaced equally around the tire. Retread tires shall not
be used on ground vehicles.
(2) All ground
ambulances shall meet or exceed the following minimum physical characteristics:
(a) A ground ambulance
shall comply fully with the ambulance design criteria contained in
"Federal Specifications for Ambulances", KKK-1822, in effect when the
ambulance is manufactured, except for color and provider identification;
(b) The ambulance
provider shall require that a certification decal or sticker be supplied by the
manufacturer of newly-purchased ambulances, indicating that the ambulance met
KKK-1822 specifications on the date it was manufactured. The certification
decal shall be located on a permanent surface, such as in the ambulance oxygen
tank compartment; and
(c) The ambulance
provider shall require, for units that are later modified, the conversion
company to supply a letter to verify the modification meets or exceeds the
KKK-1822 specification requirements, except for color or provider
identification, as incorporated in the KKK-1822 specifications on the
ambulance's original date of manufacture.
(3) In addition to the
KKK-1822 specifications, the following state licensing requirements shall be
maintained:
(a) The heating system
shall maintain a temperature of not less than sixty-five (65) degrees
Fahrenheit in the driver and patient compartments in winter weather conditions
as determined by a standard automotive testing thermometer;
(b) The air-conditioning
system shall maintain a temperature of not more than eighty-five (85) degrees
Fahrenheit in the driver and patient compartments in summer weather conditions
as determined by a standard automotive testing thermometer; and
(c) There shall be no
more patients, personnel, and other persons than can be safely secured by means
of seat safety belts or similar devices in the vehicle while the vehicle is in
motion.
Section 8. Ground
Vehicle Routine Staffing Requirements. (1) A Class I service operating a BLS
ambulance shall assure that it is minimally staffed by:
(a) A driver certified
as a first responder; and
(b) An attendant
certified as an EMT.
(2) A Class I service
operating an ALS ambulance that is providing an ALS level of care shall assure
that it is minimally staffed by:
(a) A driver certified
as first responder; and
(b) An attendant
licensed as a paramedic.
(3) A Class I service
operating an ALS ambulance that is providing a BLS level of care shall assure
that it is minimally staffed by:
(a) A driver certified
as a first responder; and
(b) An attendant
certified as an EMT.
(4) A Class II service
shall be minimally staffed by:
(a) A driver certified
as a first responder; and
(b) An attendant certified
as an EMT.
(5) A Class III service
shall be minimally staffed by:
(a) A driver certified
as an EMT; and
(b) An attendant
licensed as a paramedic.
(6) A Class IV service
operating a BLS ambulance shall assure that it is minimally staffed by:
(a) A driver certified
as a first responder; and
(b) An attendant
certified as an EMT.
(7) A Class IV service
operating an ALS ambulance shall assure that it is minimally staffed by:
(a) A driver certified
as an EMT; and
(b) An attendant
licensed as a paramedic.
(8) A Class V service
shall be minimally staffed by:
(a) A driver certified
as an EMT; and
(b) An attendant
licensed as a paramedic.
(9) Class I ALS, Class
III, Class IV ALS, and Class V ALS services shall have a licensed paramedic on
duty at all times.
(10) An attendant shall
remain with the patient, in the patient compartment, at all times during
transport.
(11) A provider that has
documented an insufficient number of EMTs or first responders available to
staff its vehicles may request a waiver of minimum requirements for drivers
only. The waiver request shall be accompanied by an acceptable plan to address
the shortage of certified or licensed staff in the area served by the provider.
If a waiver is approved by the board, an individual with drivers training as
defined by this administrative regulation, and current first aid and CPR
certification and HIV/AIDS training as required by KRS 311A.110 may serve as
the driver of a provider's vehicle. The driver shall be enrolled in an first
responder or EMT course within three (3) months of the hire date and become
certified within six (6) months of enrolling in the first responder or EMT
course.
(12) 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 would impair the safety of the patient or personnel operating
at the scene.
Section 9. Motor Vehicle
Operator Requirements. (1) Staff members or volunteers who operate a vehicle,
as a part of their job duties shall:
(a) Be at least eighteen
(18) years of age;
(b) Hold a valid
Kentucky driver's license; and
(c) Complete an initial
drivers training and education program that is a minimum of eight (8) hours
long, developed by the provider or provided for the provider in conjunction
with another agency or organization.
(2) Documentation shall
be available to support that the driving training program consisted of:
(a) Review of driving a
vehicle under emergency conditions;
(b) Review of Kentucky
Revised Statutes regarding operation of emergency vehicles;
(c) Performing forward
and back-up driving maneuvers in a controlled situation, such as in an obstacle
course designed specifically for this purpose; and
(d) Review of defensive
driving techniques and procedures with hands-on experience or exposure by
visual aids, such as videotapes, slides, or planned demonstrations.
(3) All personnel,
certified or licensed by the board, who operate a provider's motor vehicle
shall repeat a refresher driver's training and education program at least once
every two (2) years, which is a minimum of four (4) hours in duration. The
course shall consist of:
(a) A review of driving
a vehicle under emergency conditions;
(b) A review of Kentucky
Revised Statutes regarding operation of emergency vehicles;
(c) A review of forward
and back-up driving maneuvers in a controlled situation, such as in an obstacle
course designed specifically for this purpose; and,
(d) A review of
defensive driving techniques and procedures by with hands-on experience or
exposure by visual aids, such as videotapes, slides, or planned demonstrations.
(4) Provider personnel
who may serve as an attendant or a driver shall meet the qualifications for
both roles. Documentation shall be required in personnel files for personnel
who:
(a) Serve as drivers
only in a three (3) person crew and do not render any type of first aid or
medical treatment; or
(b) Serve as patient care
providers only.
Section 10. Basic Life
Support Equipment and Supplies. (1) All providers shall carry and maintain, in
full operational order, the following minimum basic life support equipment and
supplies:
(a) Suction,
ventilation, and blood pressure equipment, which shall include:
1. Two (2) sources of
suction apparatus, one (1) of which shall be mechanically operated;
2. Rigid catheters;
3. Flexible catheters in
adult, pediatric and infant sizes;
4. Bulb syringe or
meconium aspiration device for infant and neonate suction;
5. Disposable adult,
pediatric and infant bag-valve-mask ventilation units with oxygen reservoir,
oxygen tubing and masks;
6. Nasopharyngeal and
oropharyngeal airway kits in sizes for adult and children with water soluble lubricant;
and
7. Adult, obese adult,
child, and infant sphygmomanometer cuffs with stethoscope. A
permanently-mounted sphygmomanometer shall not satisfy this requirement;
(b) Oxygen equipment,
including:
1. A fixed oxygen system
for each ambulance;
2. Portable oxygen tanks
that are minimum size D, with a filled secured spare portable tank, minimum
size D;
3. Pressure gauge and
flow rate regulator for fixed and portable units with a range of zero to
fifteen (15) liters per minute;
4. Disposable oxygen humidifier
and attachment for use on the fixed oxygen tank;
5. Oxygen supply tubing;
6. Transparent
nonrebreather oxygen masks for adults and children; and
7. Nasal cannulas for
adults and children;
(c) Bandages, bandaging
supplies and tape, including:
1. Two (2) sterile
universal dressings at least ten (10) inches by thirty (30) inches, compactly
folded and packaged;
2. Fifty (50) sterile
four-by-four (4x4) gauze pads;
3. Ten (10) soft roller
self-adhering bandages, various sizes;
4. Four (4) rolls of
adhesive tape, minimum of two (2) sizes;
5. Ten (10) triangular
bandages with large safety pins;
6. Two (2) sterile burn
sheets;
7. Two (2) eye protector
pads and shields or an approved substitute;
8. Two (2) occlusive
dressings; and
9. Shears for bandages;
(d) Miscellaneous
supplies, including:
1. Hand held flashlight,
at a minimum two (2) "C" cell or greater, capable of providing
adequate lighting to assess a scene or a patient away from the vehicle;
2. One (1) penlight;
3. Two (2) sterile obstetrical
kits;
4. One (1) bottle of
activated charcoal;
5. Sterile irrigation
fluids;
6. Instant glucose;
7. Cold packs;
8. Bite stick; and
9. An AED with a minimum
of two (2) complete sets of pads for all non-ALS vehicles;
(e) Splints, including:
1. Lower extremity
mechanical traction splint in adult and pediatric sizes; and
2. Splints for arm, full
leg, and foot including padded boards, ladder splints, air splints, or vacuum
splints;
(f) Immobilization
devices, including:
1. Short spine board with
straps or other acceptable extrication device;
2. Adult, and pediatric
long spine boards or other full body immobilization device with straps and
cervical immobilization accessories;
3. Five (5) rigid, stiff
cervical collars in four (4) different sizes including pediatric sizes;
4. Towel rolls or other
bulk dressings to be used for cervical immobilization for infants; and
5. An orthopedic
"scoop" stretcher or an additional full-body immobilization device
shall be maintained by all ground providers; and
(g) Two (2) five (5)
pound size or larger, ABC multipurpose fire extinguishers, approved by
Underwriters Laboratory, Coast Guard, or Factory Mutual. One (1) shall be
accessible to the driver and the other to the attendant or attendants in the
patient compartment in the ambulance or in the rear of the ALS medical first
response vehicle.
(2) All ground
ambulances shall have a multi-position stretcher with wheels and a minimum of
three (3) straps that shall include shoulder straps for securing the patient to
the stretcher, and a mechanism to secure the stretcher while in transit.
(3) Personal protective
equipment shall be available to each staff member responding on the vehicle,
including:
(a) One (1) pocket mask
with an isolation valve;
(b) One (1) clean scrub
gown (or substitute, such as disposable coveralls);
(c) Simple disposable
face mask;
(d) Clear protective
goggles or safety glasses;
(e) Disposable gloves;
(f) One (1) particulate
filter mask rated at N95 or better without an exhaust port for patient use;
(g) One (1) particulate
filter mask rated at N95 or better with or without an exhaust port for
protection of crew members; and
(h) A means of cleansing
the hands, such disposable towlettes or other solutions.
(4) Cleaning materials
shall be available including:
(a) 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) Puncture resistant
containers for disposal of sharp objects.
(5) Patient comfort
items including:
(a) Two (2) clean
blankets, sheets, pillows, and pillowcases;
(b) Tissues;
(c) A disposable urinal;
(d) A disposable bed
pan; and
(e) An emesis container
or similar substitute.
(6) Current expiration
dates are required for any item that carries an expiration date.
Section 11. 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 10 of this administrative regulation, an ALS
provider shall carry on each vehicle and maintain in fully operational order,
supplies and equipment required by the providers protocols, including as a minimum
of:
(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. An end tidal carbon
dioxide detection device;
7. Stylettes in adult
and pediatric sizes;
8. Magill forceps in
adult and pediatric sizes;
9. One-half (1/2) inch
wide twill tape or equivalent for securing endotracheal tubes; and
10. 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) Sterile, disposable
needles, in types and sizes sufficient for personnel to administer medications
and perform procedures allowed by the providers' patient treatment protocols;
(d) Disposable syringes
in types and sizes sufficient for personnel to administer medications and
perform procedures allowed by the providers' patient treatment protocols;
(e) Restriction band
appropriate for use with venipuncture procedure;
(f) Dextrostix or
equivalent for the measure of blood glucose levels;
(g) Disposable,
individually-packaged antiseptic wipes;
(h) 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;
(i) Intraosseous
needles; and
(j) 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 vehicle.
A provider that stores and utilizes controlled substances shall have protocols
approved by the Cabinet for Health Services' Drug Control Branch.
(5) This administrative
regulation shall not prevent a provider from maintaining 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.
Section 12. Extrication
and Other Rescue Equipment. (1) All ground providers licensed to respond to
emergency calls shall provide and maintain in full operational order the
following minimum light access and extrication equipment on the ambulance:
(a) Two (2) pairs of eye
protection goggles or safety glasses;
(b) Two (2) pairs of
heavy work gloves;
(c) Two (2) hard hats;
and
(d) Three (3) reflective
triangles or strobes, or equivalent warning devices.
(2) For response to
trauma scenes requiring extrication, ground providers licensed to respond to
emergency calls shall provide one (1) vehicle, which need not be an ambulance,
equipped with the following fully-operational, more extensive access and
extrication equipment:
(a) Two (2) fifty (50)
foot long 7/16 or one-half (1/2) inch static or dynamic nylon ropes;
(b) One (1) pair of
pliers or vise grips;
(c) One (1) wrench, with
adjustable, stable open end;
(d) One (1) set of
screwdrivers, four (4) sizes, regular blade;
(e) One (1) set of
screwdrivers, four (4) sizes, Phillips type;
(f) One (1) double
action tin snip;
(g) One (1) crowbar with
pinch point;
(h) One (1) hacksaw with
twelve (12) blades;
(i) One (1) hammer,
three (3) pound size;
(j) One (1) fire axe;
(k) One (1) wrecking
bar;
(l) One (1) bolt cutter,
with one and one-fourth (1 1/4) inch jaw opening;
(m) One (1) four (4) ton
porta-power jack and spreader tool;
(n) One (1) shovel,
short handle, with pointed blade;
(o) One (1) shovel, long
handle, with pointed blade;
(p) One (1) come-along tool
or other acceptable winching device; and
(q) Two (2) fire-proof
blankets.
(3) A ground ambulance
provider may meet the provision of subsection (2) of this section through the
execution of a mutual aid agreement with ALS medical first response providers,
fire departments or rescue squads that provide service to the ambulance service's
licensed response area. The ambulance service shall have mutual aid agreements
that cover all of their licensed response area in order to be exempt from
maintaining the more extensive access and extrication equipment.
Section 13. Medical
Directors. All providers shall have a medical director. Medical directors shall
meet the requirements as set forth in 202 KAR 7:801.
Section 14. 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 15. Exemptions
from Administrative 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) A vehicle serving as
an ambulance during a disaster or major catastrophe; or
(c) A vehicle 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) A vehicle licensed
by another state that is transporting a patient from out of state to a Kentucky
medical facility or other location in Kentucky;
(b) A vehicle licensed
by another state that is transporting a patient from out of state through
Kentucky to another location out-of-state;
(c) A vehicle owned and
operated by a city government which provides services in coterminous cities
outside the ambulance service's designated service area pursuant to KRS
216B.020(7);
(d) A vehicle 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 when
Kentucky licensed providers:
1. Are unavailable;
2. Have already
responded; or
3. Are physically unable
to reach the incident; and
(e) A vehicle licensed
by another state that is providing nonemergency transportation from a Kentucky
health care facility for a patient who is not a Kentucky resident back to their
state of residence.
Section 16. 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 or medical first response agency that is fined,
placed on probationary status, placed on restricted status, suspended, or had a
license revoked.
Section 17.
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) "Federal
Specifications for Ambulances", KKK-A-1822 D, (11/94), General Services
Administration, Federal Supply Service, Washington, D.C. 20406; and
(d) "Application
for Ambulance Provider Licensing", (June 2003).
(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, 2545 Lawrenceburg
Road, Frankfort, Kentucky 40601, Monday through Friday, 8 a.m. to 4:30 p.m. (30
Ky.R. 155; Am. 923; 1221; 1483; eff. 11-19-2003.)
