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

      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.)

Notation

      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.