007.00.20 Ark. Code R. 001
Current through Register Vol. 49, No. 10, October, 2024
RULES PERTAINING TO EMERGENCY MEDICAL SERVICES
AUTHORITY
The following Rules pertaining to Emergency Medical Services are duly adopted and promulgated by the Arkansas State Board of Health pursuant to the authority expressly conferred by the Laws of the state of Arkansas in Ark. Code Ann. § 20-13-201 et.seq., and other laws of the state of Arkansas.
For the purpose of these rules the following terms are defined:
The purpose of these Rules is to provide a framework to enhance care provided to the ill or injured by Emergency Medical Services Personnel.
No person shall furnish, operate, maintain, conduct, advertise or in any way engage in or profess to engage in the business of providing transport of patients upon the streets and highways of Arkansas unless that person holds a valid ambulance service license issued by the Department of Health. This section shall not operate to alter the application of the Good Samaritan Act under Arkansas Code 17-95-101.
An application for the issuance or annual renewal of an ambulance service license shall be made to the Department and shall be accompanied by an applicable fee. All documentation and fees must be submitted to the Department prior to an EMS service or vehicle permit being issued. No license shall be issued until all licensure requirements have been met.
A licensed ambulance service may transport any patient to the care facility of the patient's choice if the licensee considers service area limitations and subject to applicable federal law and the licensee's local protocol. If the patient is unable to make a choice, and if the attending physician is present and has expressed a choice of care facility, the licensee may comply with the attending physician's choice if the licensee considers service area limitations and subject to applicable federal law. If the patient is unable to make a choice, or if the attending physician is not present or has not expressed a choice of facility the licensee may transport the patient to the nearest appropriate care facility subject to applicable federal law,
Each ground & air ambulance service shall notify the receiving medical facility by radio or by a means agreed upon by the receiving facility in the event the radio is unavailable. The notification shall include at minimum impending arrival, patient condition and care rendered to the patient.
The ambulance service shall at the time of transfer of care leave a completed encounter form or a completed Department approved short form. If a short form is left with the medical facility, the ambulance service shall submit a completed encounter form to the medical facility within twenty-four (24) hours from transfer of care. Ambulance services shall comply with all official requests for patient care records from medical facilities for patients that were transported to that medical facility. The Department may inspect the patient encounter forms of any service covered by these Rules.
Each licensee shall report EMS data, as required by the Department for every request that results in the dispatch of a vehicle. All submissions shall be complete, reflect accurate information and submitted to the Department within fifteen (15) days of the dispatch of the call. All services shall have a quality improvement process to ensure that each run has been submitted and that the data being submitted are complete and accurate.
Each licensee shall have in force and effect general liability insurance coverage, and liability insurance coverage for each vehicle owned and operated by or for the applicant or licensee. All policies shall be issued by an insurance company licensed to do business in the state of Arkansas. Proof of current general liability insurance and coverage for each vehicle shall be submitted to the Department on initial application or renewal of service license. Each air ambulance service shall have in force and effect liability insurance coverage for each aircraft owned and operated by or for the applicant or licensee as required by the FAA. The service shall maintain evidence of proof of current liability insurance coverage for each aircraft. A license holder shall immediately notify the Department and cease operations if the coverage required by this section is cancelled or suspended.
Each service shall be issued a license in at least one (I) of the classifications set forth by the Department.
Each licensee, including air ambulance services, shall be required to obtain a separate service license in each county the ambulance service has an operational base.
Each service shall display a copy of the ambulance service license in a prominent location on the premises of the ambulance service's operational base at all times
All documentation and applicable fees must be submitted to the Department prior to any license being issued. No license shall be issued until all licensure requirements have been met.
Service licenses shall only be transferable if all initial licensure paperwork fees are submitted to the Department prior to operation, unless otherwise approved by the Department.
Service licenses holders shall notify the Department by certified mail within ten (10) days after any of the information contained in the application changes or becomes inaccurate.
An ambulance service shall not advertise to the general public, skills, procedures, staffing or personnel licensure levels which cannot be provided on every emergency request, twenty-four (24) hours a day, seven (7) days a week.
The service area of each licensed ambulance service shall be clearly identified on a map provided by the Department and submitted annually to the Department. A licensed service may cross county lines to serve a portion of an adjoining county with an agreement with the licensed service(s) in the adjoining county, and in accordance with written contracts or agreements between the ambulance service and city/county governments as they may exist. This agreement shall be submitted to the Department annually with the service area map. This excludes air ambulance services.
An ambulance service shall only transport patients who are properly secured based upon the ambulance manufacture's recommendations and/or federal requirements.
An emergency is defined as a situation wherein, in competent medical judgment, the proposed surgical or medical treatment or procedures are immediately or imminently necessary and any delay occasioned by an attempt to obtain a consent would reasonably be expected to jeopardize the life, health, or safety of the person affected or would reasonably be expected to result in disfigurement or impaired faculties;
Ambulance services shall not carry nor dispense any drugs or medications or perform any procedure that is outside of the EMSP's scope of practice.
Ambulance services shall contact the Department prior to deploying or sending any Arkansas permitted ambulances to another state(s) to fulfill obligations of a state/federal/private contract or agreement for a disaster. The ambulance service shall contact the Department during regular business hours or the Department Emergency Communication Center after hours.
A pre-arranged mutual aid agreement with another Arkansas licensed service shall be in place or by activation of a mass casualty incident through the Department.
Ground ambulance services are the primary pre-hospital emergency responder for each emergency scene request within their service area. Air ambulance services are considered secondary emergency responders when requested by a patient, bystander, or responders at the scene. In the event of a mass casualty incident or an extenuating circumstance, an air ambulance service may be considered a primary responder if access to patients is delayed or inaccessible by ground ambulances. If an air ambulance service is notified by a patient, bystander, responder prior to arrival of ground ambulance service, the air ambulance service shall immediately activate the ground ambulance service within that service area.
Items not related to patient care may only be transported in an ambulance that is considered out of service, this excludes service / guide dogs as defined by Arkansas Code Annotated § 20-14-308.
*Paramedic. A EMT and EMT services may not license EMT-specialty, EMT-volunteer or stretcher Ambulances
Physicians acting as medical directors for EMS education programs recognized by the Department that require clinical and field internship performance by students shall be permitted to delegate authority to a student-in-training during their performance of program-required medical acts and only while under the control of the education program.
Services utilizing a tiered response dispatch process shall met the following provisions:
An application for the issuance or renewal of an emergency vehicle permit shall be made on forms provided by the Department.
The following identifiers may also be displayed in contrasting color(s):
* Community paramedic and stretcher ambulances may not be equipped with warning lights.
155.280 MHz
155.235 MHz
155.340 MHz
All permitted ambulances of licensed services that are participating in the Trauma System must have a Trauma AWFN radio that is in operating condition.
*Does not apply to Stretcher Ambulances
Documentation for the quality assurance program and review shall include the following:
Documentation of such flight following must be maintained during all phases of flight.
An application for the issuance or renewal of an air ambulance vehicle permit shall be made to the Department.
Minimum Experience for paramedics Conducting Air Ambulance Transport:
Minimum Experience for Paramedics
Minimum Training Requirements for Specialty Care Air Medical Personnel
Minimum Experience for Paramedics Conducting Fixed-Wing Transport
Minimum Experience for Specialty Care Fixed-Wing Personnel
* Advanced life support equipment cannot be stored on a licensed EMT ambulance.
ALS Services approved to provide Rapid Sequence Induction (RSI) must first meet all RSI requirements and be approved by the Department. Paramedics are allowed to use paralytics to maintain the paralysis of an already intubated patient, if approved by medical direction.
An application for the initial issuance of a license shall be submitted to the Department, and shall be accompanied by the fee set forth by Arkansas Code Ann. § 20-13-211. An application for the emergency vehicle operator (EVO) certification and community paramedic licensure shall be submitted to the Department with the application fee waived.
Each EMSP shall have the Arkansas EMSP licensure card issued by the Department on their person at all times while on duty or have the ability to contact their EMS service for licensure verification.
Each Service shall have readily available a copy of all current licensure and certification cards for all employees.
Any applicant applying for initial licensure or emergency vehicle operator certification shall complete a state and/or federal criminal history check.
One (1) Continuing Education (CE) Hour is defined as every fifty (50) minutes of approved classroom or skills laboratory activities, or each hour of media based/serial production. Continuing Education courses or activities shall not be approved or accepted for less than one half hour of credit. CE hours shall not be awarded until all requirements have been met and the EMSP attended the complete training. Credit can be applied for college courses that relate to your role as an EMS professional. Hour-for-hour credit can be applied for nationally standardized courses (including, but not limited to, ABLS, ACLS, AMLS, EMPACT, EPC, ITLS, PHTLS, PALS, PEPP, etc.) The following cannot be applied towards the National Continued Competency Program Topic Hours (NCCR, LCCR and ICCR):
Initial and renewal applications are randomly selected for audit. If a licensee's EMSP's application is randomly selected, the licensee EMSP must provide documentation for all hours used for their renewal, or information included on their initial application within fifteen (15) business days from notification. Documentation may consist of course completion certificates, training rosters, written verification from the training officer, or other proof as approved by the Department.
EMTs who have never held national certification shall document completion of all education requirements outlined in 1) a.-c. above prior to their state license expiration date to obtain state EMT license.
AEMTs who have never held national certification shall document completion of all education requirements outlined in 1) a.-c. above prior to their state license expiration date to obtain state AEMT license.
EMSP instructor licensure is for a two (2) year period to run concurrently with the current EMSP level of licensure.
The following must be completed and submitted for ALL Instructors:
No EMSP may provide patient care until a license has been issued.
Individuals who do not complete their educational and training requirements for renewal prior to their expiration date will be considered lapsed and will have to complete the following requirements for their licensure level prior to receiving their new licensure card.
No EMSP that is lapsed shall provide patient care until a license has been issued:
As used in this subsection "automatic licensure" means granting the occupational licensure without an individual having met occupational licensure requirements provided under this title or by the rules of the occupational licensing entity.
In order for an Arkansas Licensed EMSP to perform skills for which they are licensed within a hospital, the EMSP shall ensure that the following actions have been taken by the hospital:
The following section pertains to all EMSP training sites
Or
Or
Full accreditation by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) and Committee on Allied Health Education and Accreditation (CAHEA) shall be attained or be in the process of accreditation as documented by a letter from CoAEMSP prior to authorization of the subsequent class.
Internship must be completed with an Arkansas licensed paramedic ambulance service or a service that meets the requirements of the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) and approved by the Department. There shall be a written agreement allowing students to actively participate in patient care. The student must be in the patient compartment during transport and have direct supervision by a licensed paramedic at all times.
* Emergency department services;
* Home health services;
* Hospital case management;
* Public health agencies services
No person is eligible to provide care, as defined in these Rules, without a current Arkansas EMSP License. Requirements for licensure include:
Investigators and inspectors for Pharmacy Services and Drug Control, and Arkansas Department of Health, are directed to make investigations, inspections and, make copies of the records and orders, wherever located, of all services licensed by the Department in order to determine whether or not said licensed ambulance services have violated the laws of the state of Arkansas respecting prescribing and using of narcotics and other drugs and whether or not said services have violated the provisions of the law.
A separate registration in the name of the medical director (physician) is required for each service license place of business at one general physical location where controlled substances are maintained or distributed to ambulances specifically licensed to maintain drugs.
Must be in accordance with the Office of Drug Enforcement Agency's Regulations regarding all controlled substances no longer usable due to deterioration, expired dating, or no longer used by the service.
A policies and procedures manual pertaining to drug handling shall be developed and submitted to the Office of Pharmacy Services and Drug Control for approval. This manual shall also be submitted to the Department. The manual shall include at a minimum the following:
All additions to the Optional Drug List will be approved by the medical director, and approved by the Department, prior to implementing the drug.
The policy of purchasing small quantities of legend drugs from hospital pharmacies by the supervising physician of non-hospital based ambulance services or EMS systems is acceptable. There is no requirement for hospitals to participate in this sale.
Licensed ambulance services shall appropriately triage all traumatically injured patients using the Field Triage Decision Scheme: The Arkansas Trauma Triage Protocol identified as Appendix 2. The Lead EMSP will make the destination decision considering the ATCC recommendation, patient's condition, distance of travel, patient preference, and system status.
The following rules regarding the process for inter-facility trauma transfers applies to those services participating in the states trauma system. Services not participating shall have written protocols addressing procedures for the timely inter-facility transfer of urgent trauma patients as defined below to appropriate adult or pediatric trauma centers based on a patient's medical needs. Any deviation from the services protocol shall be reviewed by the services medical director.
The need for an urgent trauma transfer exists when, in the opinion of the treating physician, two conditions are met:
and
The hospital seeking the urgent trauma transfer shall contact the ATCC to provide patient condition information and to obtain concurrence with the urgent trauma transfer classification. All urgent trauma transfers shall prompt involvement of the medical director of ATCC in real time. The medical director shall verify the urgent nature of the transfer and concur there is reasonable evidence the two conditions of an urgent trauma transfer are met. If the above conditions are met and concurrence from ATCC is obtained, this transfer qualifies as an urgent trauma transfer.
Once the ATCC confirms the patient meets the criteria for urgent trauma transfer, the ATCC shall contact the EMS service identified by the transferring hospital to coordinate pick up. The ATCC shall confirm with the transferring hospital the time the patient will be ready for pick-up and communicate that to the EMS service. The sending hospital should contact the EMS service designated on the ATCC dashboard early in the process to allow the service as much advance notice as possible of the impending urgent transfer.
If the EMS service cannot be at the transferring hospital by the agreed upon time, a backfill service shall be contacted by the EMS Service. Service area coverage is considered in place at the time the backfill agreement request is accepted. If the service is unable to secure a backfill agreement acceptance, the ATCC shall be available to assist with the backfill, but not assume responsibility. The EMS service shall have ten minutes to accept the transfer request and shall arrive at the hospital at time agreed upon between the transferring hospital and the EMS service. The patient and paperwork should be ready for transfer at that time.
All urgent trauma transfer requests shall prompt a review at the local TRAC PI Subcommittee to ensure that the system is being used appropriately, the urgent trauma transfer is accomplished in a timely manner, and that each segment of the system performed its responsibilities. Potential abuses of the system shall be elevated to the State TRAC/PI Subcommittee of the TAC for adjudication and recommendation of action steps to the ADH in order to prevent future abuses.
Offenses:
* Conviction, pleading guilty, or nolo contender to any criminal offense listed in Arkansas Code Ann § 20-13-1106
* Demonstration of incompetence, knowingly or willfully violating these Rules or other inability to provide adequate service.
* Violating any, as well as federal, state, or local laws, rules affecting, but not limited to, the practice of EMS.
* Any conduct which is in violation of any criminal, civil and/or administrative code or statute.
* Falsifying, destroying or failing to make accurate, complete and/or clearly written or oral patient care reports documenting a patient's condition upon arrival at the scene, the prehospital care provided, and patient's status during transport, including signs, symptoms, and responses during duration of transport as per EMS provider's approved policy.
* Disclosing confidential information or knowledge concerning a patient except where required or allowed by law.
* Causing or permitting physical or emotional abuse or injury to a patient or the public, and/or failing to report such abuse or injury to the Department, appropriate legal authority and/or the Department within twenty-four (24) hours after the event occurs.
* Failing to report to the employer, appropriate legal authority or the Department, an event of abuse or injury to a patient or the public within twenty-four (24) hours (or the next business day within twenty-four (24) hours) after the event.
* Failure to follow the medical director's protocol, performing advanced level or invasive treatment without medical direction or supervision, or practicing beyond the scope of certification or licensure.
* Failing to respond to a call while on duty and/or leaving duty assignment without proper authority.
* Abandoning a patient.
* Failing to comply with the terms of a Department ordered probation or suspension.
* Misrepresenting level of any certification or licensure.
* Misappropriating or failure to take precautions to prevent misappropriation of medications, supplies, equipment, personal items, or money belonging to the patient, employer or any other person or entity.
* Falsifying or altering, or assisting another in falsifying or altering, any Department application, EMS license; or using or possessing any such altered certificate or license.
* Cheating and/or assisting another to cheat on any examination, written or psychomotor, by any provider licensed by the Department or any institution or entity conducting EMS education and/or training or providing an EMS examination leading to obtaining licensure or renewing licensure.
* Obtaining or attempting to obtain and/or assisting another in obtaining or attempting to obtain, any advantage, benefit, favor or gain by fraud, forgery, deception, misrepresentation, untruth or subterfuge.
* I llegally possessing, dispensing, administering or distributing, or attempting to illegally dispense, administer, or distribute controlled substances as defined by the federal or state laws.
* Receiving disciplinary action relating to an EMS certificate or license or another health provider certificate or license issued in another state or in a U.S. Territory or in another nation, or receiving disciplinary action relating to another health provider certificate or license issued in Arkansas.
* Failing or refusing to timely give the Department full and complete information requested by the Department.
* Failing to notify the Department of being convicted or pleading guilty or nolo contendere of a criminal offense within ten (10) business days of the conviction or plea, other than any class C misdemeanor not related to EMS.
* Failing to notify the Department within five (5) business days of his or her being arrested, charged or indicted for any criminal offense, other than any class C misdemeanor not directly related to EMS.
* Engaging in any conduct that jeopardizes or has the potential to jeopardize the health or safety of any person.
* Failure of any drug screening test administered during an EMS work or volunteer shift, or within twelve (12) hours of the beginning or end of any such shift.
* Resigning employment or refusing by the employee, of an employer drug screening test right before, after or during an assigned EMS work or volunteer shift.
* Failing to maintain the requisite of skill, knowledge and/or academic acuity to timely and/or accurately perform the duties or meet the responsibilities required of a licensed EMSP at appropriate licensure level that endangers the safety or welfare of patients and/or EMSP's.
* Delegating medical functions to other personnel without approval from the medical director per approved protocols.
* Behaving in a disruptive manner or exhibiting unprofessional conduct toward other EMS personnel, law enforcement officers, firefighters, hospital personnel, other medical personnel, patients, family members or others on scene.
* Falsifying or altering clinical and/or internship documents for EMS students.
* Falsifying or failing to complete daily readiness checks on EMS vehicles, medical supplies and/or equipment as required by EMS employers.
* Engaging in acts of dishonesty which relate to the EMS profession.
* Behavior that exploits the EMS personnel-patient relationship in a sexual way. This behavior is non-diagnostic and/or non-therapeutic, may be verbal or physical, and may include expressions or gestures that have sexual connotation or that a reasonable person would construe as such.
* Falsifying or making any false statements in any information provided to or by the Department to include misrepresentation, fraud, or concealment including but not limited to applications for licensure, certification, or renewal of a licensure or certification and continuing education requirements.
* Acting negligently, neglectfully, or with intent to cause harm toward a patient or other person
* Reporting to duty or rendering patient care while under the influence of alcohol (According to current Arkansas Legal Code) illegal drugs or illegally obtained drugs concurrent with State Law.
* Use of alcohol or any intoxicating substance (other than as directed by a physician) while on duty.
* Providing false information to regulatory officials or willfully concealing known deficiencies during an inspection.
* Conviction of driving under the influence of alcohol or other intoxicating substance while on duty, on emergency response or during patient transport.
* Failure to report substance abuse of on-duty EMS personnel to the Department.
* Failure to follow accepted standards of care in the management of a patient or in response to a medical emergency.
* Using equipment and/or performing procedures beyond the EMSP's level of licensure, scope of practice, or the level of licensure of the ambulance service.
* Unauthorized release or divulgence of confidential information to an unauthorized person or using confidential patient information for personal or financial benefit.
* Providing care as an Arkansas EMSP independent or with a licensed EMS service while having a lapsed or expired Arkansas EMSP license.
* Failure to respond or accept official Departmental correspondence sent by certified mail.
* Misappropriation, stealing and/or embezzlement of EMS grants or equipment purchased under such grants.
* Falsification of records related to ambulance service operations.
* Failing to provide patient information to a hospital or other health care facility in response to an authorized request.
* Failing to report to the Department actions regarding incompetent, unethical, or illegal practice by any EMSP.
* Requiring EMS Personnel to violate EMS Rules or EMSP standards.
* Engaging in the delivery of emergency medical services on a revoked, suspended, expired, or inactive Arkansas license.
* Alteration of/or transferring a vehicle permit fi-om one vehicle to another. Operating an ambulance or EMS vehicle that is not licensed or insured.
* Failure to follow all requirements concerning drugs and pharmaceuticals
* Carrying and/or using equipment not approved by the Department for the licensure level.
* Using an EMT who is lapsed or not Arkansas licensed to meet ambulance staffing requirements.
* Failure to have all necessary equipment and non-expired supplies in licensed ambulances for the level of licensure.
* Failure to follow the manufacturer's recommendations for the use of medical equipment in a manner which causes harm to the patient.
* Conviction of violation of Federal Communications Commission Concurrent with Federal Laws (FCC) Rules.
* Falsification by the instructor of facts on student paperwork/applications.
* Teaching an EMS related course that requires pre-approval from the Department without having that approval.
* Abandonment of an approved EMT course.
* Failure to complete and submit required documentation for all students.
* Failure to teach courses by National Standard Curriculum.
* Failure to observe recognized professional teaching standards
* Falsification of continuing education documentation
* Falsification by the training site of records related to courses or training
* Conduct or actions by the training site that results in harm to the health and safety of the student
* Failure to meet and maintain the criteria for program approval as set by the Department or accrediting body
* Failure to allow the Department to inspect, observe, or evaluate programs, including program personnel, facilities, classes, and clinical practice sessions
* Use of training personnel not competent for the type of training offered
* Failure to observe recognized professional standards in the course content and operation of the training program
* Failure to keep accurate and adequate records, of the names and addresses and type of training completed of all graduates and attendees for a minimum of two (2) years
* Allowing an AEMT or paramedic student to participate in medical facility or field internship without being a licensed EMT.
* Failure to offer training consistent with the approved application
An EMSP certification/license may be denied for the following reasons:
I f any provision of these Rules, or the application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or applications of these Rules which can give effect without the invalid provisions or applications, and to this end the provisions hereto are declared to be severable.
All Rules and parts of Rules in conflict herewith are hereby repealed.
Detailed Experience
(Clinical phases of the Community Paramedic program shall consist of a minimum of 210 hours to include the following minimum patient contacts listed below)
All experiences within the home health setting must be completed with a Home Health Registered Nurse or other designated provider as outlined below.
* Home Health Patient Assessments - Observe and participate
* Patient Documentation/Charting at home visits
* Medication reconciliation with patient -Observe and participate
* CHF Assess and management plan - Observe and Participate in
* COPD Assess and management plan - Observe and Participate in
* Diabetic related illness issues - Participate in
* Neurologic conditions (CVA, TBI, MS, etc) observe and participate in
* Wound care
* Adult Patients
* Geriatric Patients
* Pediatric patients
* 20 (twenty) lab interpretations
* 5 (five) CT or MRI interpretations
* 5 (five) preparation instructions for CT/MRI
* 10 (ten) Hand Held point of care analyzer testing
* Stitch and Staple removal- Observe and participate in
* Cast Care and assessment - Observe and participate in
* Nursing services
* Social services
* Chaplain services
24 (twenty-four) hours of hospital case management to include but not limited to
* Discharge planning
* Utilization Review
* Case Management
The following can take place in any care setting to include but not limited to Emergency Department, Physical Therapy, Home Health, Public Health Clinic.
10 (ten) patient contacts involving instruction and use of crutches, wheelchairs, walkers, canes, hospital beds, Hoyer lifts, slide boards
10 (ten) uses in the access central lines, ports, ileostomies, Foley catheters, PEG tubes, wound management
* *20% of the patient contacts in each of sections 2, 3, 4, & 5 may be made within an Arkansas licensed community paramedic service**
007.00.20 Ark. Code R. 001