202 KAR 7:501 Ambulance providers and medical first response agencies

Link to law: http://www.lrc.ky.gov/kar/202/007/501.htm
Published: 2015

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      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.)