007.28.08 Ark. Code R. 001

Current through Register Vol. 49, No. 10, October, 2024

Rule 007.28.08-001 - Rules for Emergency Medical Services

AUTHORITY

The following Rules and Regulations Pertaining to Emergency Medical Services are duly adopted and promulgated by the Arkansas State Board of Health pursuant to the authority expressly conferred by Act 435 of 1975, Act 293 of 1981, Act 345 ofl987_L_Act 1255 of 1997, Act 38 of 1999, Act 60 of 1999, Act 666 of 1999, Arkansas Code 20-13-200, and the Laws of the State of Arkansas including without limitation, Act 96 of 1913 {Arkansas Statutes, 1947, Section 82-110).

SECTION I. DEFINITIONS

For the purpose of these regulations the following terms are defined:

A. Advanced Life Support (ALS) Medical Director: An Arkansas licensed physician who provides medical oversight for any licensed ALS EMS entity, is either Board Certified in Emergency Medicine or holds a current ACLS card, and is identified with the Department as the medical director.

B. Advanced Response Service: A licensed non-transporting service that is requested to respond to the scene of an emergency and provides Advanced Life Support care to ill or injured patients prior to the arrival of a licensed transporting ambulance service, subject to compliance with the EMS Rules and Regulations relating to the level of care available from the responding personnel.

C. Aeromedical Crew Members: Personnel responsible for patient care on an air ambulance.

D. Aeromedical Training Requirements: Minimum training requirements recommended by the Governor's Advisory Council on EMS and approved by the Department.

E. Air Ambulance: Any privately or publicly owned helicopter or fixed wing aircraft specially designed, constructed or modified, maintained or equipped to be used for the transportation of patients.

F. Air Ambulance Operation: One aircraft making one flight in response to a patient transport request.

G. Air Ambulance Service: An entity operating an aircraft used for air transportation that is specifically designed to accommodate the aeromedical needs of persons who are ill, injured, wounded, or otherwise mentally or physically incapacitated or helpless; who may require emergency medical care in-flight, and who, in a physician's opinion, cannot be safely transported on a standard commercial or charter flight. Such a service includes suitable aircraft, flight crews, and aircraft maintenance in accordance with Federal Aviation Administration (FAA) Regulation (FAR 135), adequate aeromedical crewmembers, aircraft fittings and equipment, and provision for medical control of aeromedical crewmembers.

H. Ambulance: Those vehicles used for transporting any person by stretcher or gurney upon the streets or highways of Arkansas, excluding vehicles intended solely for personal use by immediate family members.

I. Ambulance Service: Those services authorized and licensed by the Department to provide care and transportation of patients upon the streets and highways of Arkansas.

J. Ambulance Service Encounter Form: A patient data form, which has been approved by the Department, that describes the EMS encounter and is left with the care facility at time of service or within a reasonable time after service. This form must include a patient narrative.

K. Arkansas Code 20-13-200: Arkansas Code Title 20 (Public Health and Welfare). Subtitle 2 (Health and Safety). Chapter 13 (Emergency Medical Services).

L. Basic Life Support (BLS) Medical Director: An Arkansas licensed physician who provides medical oversight for any licensed BLS EMS entity, holds a current American Heart Association Healthcare Provider card or the American Red Cross CPR for the Professional Rescuer, and is identified with the Department as the medical director.

M. Certification: Official acknowledgment by the Department that an individual has demonstrated competence to perform the emergency medical services required for certification as provided by these Rules and Regulations.

N. Charter Flight: The utilization of an aircraft that is not registered to a scheduled air carrier.

O. Controlled Drugs: Those drugs identified as Schedule II-V as designated by federal law

P. Coordination Point: A fixed location(s) where information about the air ambulance service may be obtained and where the activities of dispatch, resource allocation, and flight operations are conducted.

Q. Department: The Arkansas Department of Health.

R. Office of EMS and Trauma Systems (Office): The organization within the Department responsible for the enforcement of EMS legislation within the State of Arkansas.

S. Emergency Medical Services: The transportation and medical care provided the ill or injured prior to arrival at a medical facility by a certified emergency medical technician (EMT) or other healthcare provider and continuation of the initial emergency care within a medical facility subject to the approval of the medical staff and governing board of that facility.

T. Emergency Medical Services Advisory Council: Those persons appointed by the Governor to assist and advise the Department concerning matters dealing with emergency medical services.

U. Emergency Medical Service Communication Network: A system of both telephone and radio that is utilized in the delivery of pre-hospital care to the victims of illness or injury.

V. Emergency Medical Technician: A person who has been certified as an EMT, EMT-Ambulance, EMT-Intermediate or EMT-Paramedic and who may perform those services equivalent to level of certification.

W. Emergency Medical Technician - Instructor: A person who has been certified to teach EMT courses after completing an approved DOT EMT-Instructor course and completion of all of the instructor requirements.

X. Emergency Medical Technician-Intermediate: A person who has successfully completed an approved DOT training course that includes formal course work, practical instruction, clinical and field experience and who is certified to perform those skills and/or services set forth in SECTION III.C.2 and SECTION III.D and functions in accordance with the requirements set forth throughout these regulations.

Y. Emergency Medical Technician-Paramedic: A person who has successfully completed an approved DOT training course that includes formal course work, practical instruction, clinical and field experience and who is certified to perform those skills and/or services set forth in SECTION III.C.l and SECTION III.C.2 and functions in accordance with the requirements set forth throughout these regulations.

Z. Emergency Request: A call for assistance to an incident or condition which is perceived by the caller to have created an actual threat to human life or physical well being of such magnitude and character that immediate medical intervention by any Emergency Medical Technician or other health professional is appropriate and necessary for medical reasons.

AA. Enrolled student: An enrolled student is one who attends at least three (3) out of the first five (5) sessions of an EMT course at an approved EMT Training Site.

BB. Extrication Services: The services provided by the use of equipment for the purpose of gaining access and entry to entrapped patients.

CC. FAA FAR Part 135- Federal Aviation Administration Regulations governing air taxi operations and commercial operation of small aircraft.

DD. Flight Nurse: A registered nurse licensed in Arkansas who completes the required aeromedical crew member training requirements recommended by the Governor's Advisory Council on EMS and approved by the Department.

EE. Flight Physician: A physician with a current valid license to practice medicine in Arkansas or in the state of primary operation of the air ambulance service, and who is certified in Advanced Cardiac Life Support.

FF. In-charge Member: The individual designated by the licensed service who is responsible for patient care.

GG. Intercept: Instances where a transporting service requests assistance from a service better able to provide the necessary patient care and/or transport.

HH. Intravenous Fluid: A solution used for the purpose of a volume replacement fluid or to establish and maintain intravenous cannulation.

II. Lapsed EMT: An Emergency Medical Technician (any level) that does not complete recertification requirements prior to their expiration date as issued by the Office.

JJ. Lay Evaluator: An individual approved by the Office to evaluate the practical portion of the Arkansas EMT Certification exam.

KK. Legend Drug: Any drug which requires a prescription by a licensed physician as required by federal law.

LL. Medical Facility: Any hospital, medical clinic, physician's office, nursing home or other health care facility.

MM. National Registry of Emergency Medical Technicians (NREMT): A not-for-profit, independent, non-governmental agency that functions as a registration agency which issues certificates of competency verified by achievement of minimal competencies of EMTs (Basic, Intermediate and Paramedic) through establishment and implementation of uniform requirements of EMT training, examination, and continuing education.(NREMT Brochure B-50/10-94/10M).

NN. Office: Office of Emergency Medical Services & Trauma Systems.

OO. Out of State Transfer (OST): Any person certified in another state or in the military and are seeking Arkansas certification are referred to as out-of-state transfers (OST's)

PP. Permit: An authorization by the Department for the purpose of vehicle registration.

QQ. Person: Any individual, corporation, partnership, firm, association, trust, estate, public or private institution, group, agency, political subOffice of this State or any other state or political subOffice or agency thereof, and any legal successor, representative, agent or agency of the foregoing. Federal government agencies are excluded from this definition.

RR. Policy and Procedure: Any policy, procedure, training requirement or equipment list related to these rules and regulations as recommended by the Governor's Advisory Council on EMS and approved by the Department. However, no policy or procedure shall supercede these rules and regulations.

SS. Probation: An administrative action imposed on an EMS service, EMT certification, EMT-Instructor certification or authorized and accredited training site for violations of EMS Rules and Regulations. The term of Probation will be for no less than six (6) months and no more than two (2) years unless otherwise covered in Section VII.A.4.

TT. Protocols: Standing orders authorized by each licensee provided they are written or adopted by the Medical Director of that licensed ambulance service, approved by the Department.

UU. Provisional Instructor: An EMT who has completed initial instructor training but is in the process of finishing their teaching requirements, with appropriate recommendation from the Instructor-Trainer, before becoming a certified EMT Instructor.

VV. Reaction Time: The time between the responding services' dispatch receives adequate information from the caller and the time the vehicle and personnel initiate response.

WW. Revocation: An administrative action imposed by the Department that terminates an EMS service license, EMT certification, EMT-Instructor certification or authorized training site for violating EMS Rules and Regulations.

XX. Service Area: The primary area of operation within a county for a licensed ambulance service as defined by that service and on file with the Office of EMS and Trauma Systems.

YY. Service License: Authorization issued by the Department to a person, firm, corporation, association, county, municipality or other legal entity for the purpose of engaging in care and/or transport of patients in the State of Arkansas.

ZZ. Suspension: An administrative action imposed by the Department that temporarily removes an EMS service license, EMT certification, EMT-Instructor certification or training site authorization and accreditation for violating EMS Rules and Regulations for a time to be determined by the Department.

AAA. Training Site: Those organizations authorized and accredited by the Department to provide EMS education.

BBB. Training Site Authorization and Accreditation: Authorization and accreditation issued by the Department to an organization for the purpose of engaging in EMS education in the state of Arkansas.

CCC. Training Site Representative: Individual responsible for the organization, coordination, and day-to-day operations of the EMS training programs.

DDD. Unsound Mind: means and includes the inability to perceive all relevant facts related to one's condition and proposed treatment so as to make an intelligent decision based thereon, regardless of whether the inability is only temporary or has existed for an extended period of time or occurs or has occurred only intermittently and whether or not it is due to natural state, age, shock or anxiety, illness, injury, drugs or sedation, intoxication, or other cause of whatever nature.

EEE. Volunteer Ambulance Service: An ambulance service operating a I-B registered ambulance that is staffed by personnel who perform and give their services of there own free will without expecting any compensation.

FFF. Words implying the masculine gender may be applied to both males and females.

GGG. Written Warning: An administrative action imposed on an EMS service, EMT certification, EMT-Instructor certification or authorized training-site for first-time or minor offenses unless otherwise stated.

SECTION II. ADMINISTRATIVE

A. All communications concerning these Rules and Regulations shall be addressed to the Arkansas Department of Health, Office of EMS and Trauma Systems, 4815 West Markham Street, Slot 38, Little Rock, Arkansas, 72205-3867.

B. The purpose of these Rules and Regulations is to provide a framework to enhance the emergency medical care of people in Arkansas. It shall be departmental policy to encourage and assist all services to upgrade their equipment and personnel.

C. All specific lists and information will be managed and kept on file at the Office of EMS & Trauma Systems. Examples include current Drug Lists (Required and Optional), Approved EMT Skills Lists (BLS and ALS), etc.

SECTION III. LICENSURE OF AMBULANCE SERVICES

Those services authorized and licensed by the Department to provide care and transportation of patients.

A. Purpose

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.

B. General Standards

An application for the issuance or renewal of an ambulance service license shall be made on forms provided by the Department of Health and shall be accompanied by any fee as required by law or by regulations promulgated by the Department of Health. Each license shall be renewed annually.

All ambulances operating in this State must meet all standards prescribed by and under Arkansas Code 20-13-200 and be licensed under this subchapter and all personnel operating ambulances in this State must meet the standards prescribed by and under Arkansas Code 20-13-200.

1. Patient's choice of nearest appropriate medical facility

A licensee under this act shall transport any patient to the care facility of the patient's choice within the service area of the ambulance. If the patient is unable to make a choice, and the attending physician is present and has expressed a choice of care facility within the service area, the licensee shall comply with the attending physician's choice. If the licensee is unable to make a choice, the attending physician is not present or has not expressed a choice of facility, or there is no hospital in the service area of the ambulance, the licensee shall transport the patient to the nearest appropriate care facility.

2. Reports to the Health Care Facility

The licensee shall provide the care facility where the patient was transported with a copy of an ambulance service encounter form prescribed or approved by the Department of Health, which shall become part of the patient's medical records.

3. Reports to the Department

Each licensee shall report, in a format approved by the Department of Health, every request that results in the dispatch of a vehicle with the exception of calls cancelled enroute or responses made where no patient contact was made.

4. Each licensee shall have in force and effect liability insurance coverage, issued by an insurance company licensed to do business in the State of Arkansas, for each vehicle owned and operated by or for the applicant or licensee. The Department of Health shall maintain evidence of proof of current liability insurance coverage for each vehicle of each licensee.

5. Each licensee shall be issued a service license in at least one (1) of the classifications set forth by the Department of Health.

6. 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.

7. Three (3) formal citations (i.e. administrative actions administered by the Office) during the license term for failure to comply with Arkansas Code 20-13-200 and any regulations promulgated by the Department of Health in regard to ambulance services shall result in administrative action including revocation of the service license.

8. All documentation and fees must be submitted to the Office prior to EMS License being issued. NO license shall be issued until ALL licensure requirements have been met.

9 An ambulance service shall not, in any way, advertise to the general public the service areas, skills, procedures, or personnel certification levels which they cannot provide on every emergency request, twenty-four (24) hours a day, seven (7) days a week.

10. The service area shall be clearly identified on a map and in writing annually, and shall be on file with the Department of Health.

11. An ambulance service shall only transport patients who are properly secured. No other device (i.e. wheelchair, incubator, etc.) may be used to transport patients, unless there is adequate equipment that will secure the device in the back of the ambulance based upon the manufactures' recommendations.

12. In mass casualty incidents, please reference the MCI Rules and Regulations.

13. In instances in which patients are being transported, an Intercept can be requested by the in-charge member of the transporting service if the patient's condition dictates. It shall be the decision of the in-charge crewmember of the intercepting service to either transfer the patient to the Intercept unit or to move the equipment and continue care in the transporting unit.

14. Patient Consent

a. It is recognized and established that, in addition to such other persons as may be so authorized and empowered, any one (1) of the following persons is authorized and empowered to consent, either orally or otherwise, to any surgical or medical treatment or procedures not prohibited by law which may be suggested, recommended, prescribed, or directed by a licensed physician:

1) Any adult, for himself;

2) Any parent, whether an adult or a minor, for his minor child or for his adult child of unsound mind whether the child is of the parent's blood, is an adopted child, is a stepchild, or is a foster child; provided, however, the father of an illegitimate child cannot consent for the child solely on the basis of parenthood;

3) Any married person, whether an adult or a minor, for himself;

4) Any female, regardless of age or marital status, for herself when given in connection with pregnancy or childbirth, except the unnatural interruption of a pregnancy;

5) Any person standing in loco parentis, whether formally serving or not, and any guardian, conservator, or custodian, for his ward or other charge under disability;

6) Any emancipated minor, for himself;

7) Any unemancipated minor of sufficient intelligence to understand and appreciate the consequences of the proposed surgical or medical treatment or procedures, for himself;

8) Any adult, for his minor sibling or his adult sibling of unsound mind;

9) During the absence of a parent so authorized and empowered, any maternal grandparent and, if the father is so authorized and empowered, any paternal grandparent, for his minor grandchild or for his adult grandchild of unsound mind;

10) Any married person, for a spouse of unsound mind;

11) Any adult child, for his mother or father of unsound mind;

b. An individual shall not be considered to be "of unsound mind" for the purposes of this subchapter based solely upon the fact of his refusal of medical care or treatment.

c. In addition to any other instances in which consent is excused or implied at law, consent to surgical or medical treatment or procedures suggested, recommended, prescribed, or directed by a licensed physician will be implied in the following circumstances:

1) Where an emergency exists and there is no one immediately available who is authorized, empowered to, or capable of consent. 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;

2) Where any emergency exists, there has been a protest or refusal of consent by a person authorized and empowered to do so, and there is no other person immediately available who is authorized, empowered, or capable to consent but there has been a subsequent material and morbid change in the condition of the affected person

15. Clinical Investigations

Clinical Investigations may be recommended by the Governor's EMS Advisory Council and approved by the Department and the Board of Health. Test periods will be temporary in nature, and will be determined on an individual basis for each procedure and technique tested. A written request to enroll in a Clinical Investigation must be submitted to the Governor's Advisory Council on EMS and approved by the Department. Clinical Investigations beyond the scope of the EMS Rules and Regulations are to be evaluated in a carefully controlled study under appropriate medical control. At the completion of the evaluation period, the test results will be forwarded to the Board of Health for review. Permission for Clinical Investigations will be granted only to determine if the procedure or technique should be added to the existing EMS Rules and Regulations and must follow the clinical investigations guidelines recommended by the Governor's Advisory Council on EMS and approved by the Department.

16. Basic medical and extrication equipment

Each vehicle shall meet the basic medical and extrication equipment requirements recommended by the Governor's Advisory Council on EMS and approved by the Department.

17. Prohibitions

Licensees shall not carry nor dispense any drugs or medications or perform any procedure not specifically recommended by the Governor's EMS Advisory Council and approved by the Department.

18. Out-of-State Ambulance Contracts for Disaster Assistance

Licensee shall contact the Department prior to deploying/sending any Arkansas permitted ambulance to another state(s) to fulfill obligations of a state/federal/private contract or agreement for a disaster. Licensee shall contact the Department at 501-661-2262 during regular scheduled office hours or 501-661-2136 after office hours.

C. Ambulance Service Licensure

1. The Office of EMS & Trauma Systems shall issue a Paramedic Service License to those EMS services that have fifty percent (50%) or more of their ambulances registered at the Paramedic level.

2. The Office of EMS & Trauma Systems shall issue an Intermediate Service License to those EMS services that have fifty percent (50%) or more of their ambulances registered at the Intermediate level.

3. The Office of EMS & Trauma Systems shall issue a Basic Life Support (BLS)

Service License to those EMS services that have their ambulances registered at one of the following levels:

a. I-A

b. I-B*

*Volunteer Ambulance Services will be issued a BLS License and must meet the I-B vehicle requirements.

D. Licensed ambulance services at the Paramedic or Intermediate level {Advanced Life Support (ALS) level) shall be required to meet the following:

1. Twenty-four hour coverage

Each licensee shall provide 24-hour continuous service.

3. Two minute reaction time

Each licensee shall comply with a two-minute reaction time for each emergency request.

4. Multiple License

The issuance of multiple levels of license to the same ambulance service is acceptable. All qualifications for the particular service license must be met. The service will be required to provide the highest level of response to all emergency requests, until those resources are depleted or are not available. The caller will determine the emergency.

5. Multiple Vehicle Registration

The issuance of multiple levels of registered vehicles to the same ambulance service is acceptable. However, the service will be required to respond to all emergency requests with the highest registered vehicle until those resources are depleted or are not available. The caller will determine the emergency.

6. Legend Drugs Register

Each licensee shall maintain a register of legend drugs to include type, quantity, date received, and physician authorizing purchase and usage.

7. Drug Enforcement Agency (DEA) License

Each licensee shall submit to the Office of EMS and Trauma Systems a copy of the DEA license to be utilized in acquiring controlled drugs.

8. Hospital notification

Each licensee shall notify the receiving hospital of impending arrival, patient condition and care rendered to the patient.

9. Medical Director

Each licensee shall have an Arkansas licensed physician to serve as the Advanced Life Support Medical Director who will provide medical oversight pursuant to Arkansas statutes and meets the requirements of Section LA. Lhis shall be the same physician providing the DEA number if required (6 above).

10. Protocols

Standing orders are authorized for use by each licensee provided they are written or adopted by the Medical Director of that licensed ambulance service, reviewed by the Department and Office of Pharmacy and on file with the Office.

E. Licensed ambulance services at the Basic Life Support (BLS) level shall be required to meet the following:

1. Twenty-four hour coverage

Each licensee shall provide 24-hour continuous service except Volunteer organizations that use volunteer staff to provide service to the general public.

2. Two minute reaction time

Each licensee shall comply with a 2-minute reaction time for each emergency request except Volunteer Ambulance Services.

3. Hospital notification

Each licensee shall notify the receiving hospital of impending arrival, patient condition and care rendered to the patient.

F. Special Purpose Services:

1. Definition of license

A Special Purpose License shall be issued to an applicant who provides a specific medical service to a limited population group and emergency evacuation services only, and does not participate in the business of providing continuous general population response for emergency medical services.

2. Appropriate vehicle and equipment required

Each licensee shall ensure that the appropriate vehicle and equipment be available to perform the services set forth in SECTION VII.

SECTION IV. LICENSURE OF RESPONSE SERVICES

Those services authorized and licensed by the Department to provide emergency care to critically ill or injured patients prior to the arrival of a licensed transporting ambulance service.

An application for the issuance or renewal of an advanced response service license shall be made on forms provided by the Department of Health and shall be accompanied by any fee as required by law or by regulations promulgated by the Department of Health. Each license shall be renewed annually.

Advanced Response Service

A non-transporting service that is dispatched to respond to the scene of an emergency and provides ALS care to ill or injured patients prior to the arrival of a licensed transporting ambulance service is subject to compliance with the EMS Rules and Regulations.

1. Purpose

No person shall furnish, operate, maintain, conduct, advertise or in any way engage in or profess to engage in the business of providing Advanced Life Support Response Services upon the streets and highways of Arkansas unless that person holds a valid service license issued by the Department. This provision shall not in any way operate to alter the application of the Arkansas Good Samaritan Act {Arkansas Statutes 72-624).

2. General Standards

a. Each licensee shall report, in a format approved by the Department, every request, which results in the dispatch of a vehicle.

b. Each licensee shall have in force and effect liability insurance coverage, issued by an insurance company licensed to do business in the State of Arkansas, for each vehicle owned and operated by or for the applicant or licensee. The Department of Health shall maintain evidence of proof of current liability insurance coverage for each vehicle of each licensee.

c. Three citations during the license term for failure to comply with these standards shall result in revocation of the service license.

d. Each licensee shall be an entity that chooses to provide Advanced Life Support to the General Public, but does not transport patients except in mass casualty incidents.

3. Specific Standards

Each Advanced Response licensee shall, when appropriate, provide the following skills with Medical Director oversight:

a. Advanced life support (ALS) skills

Each Advanced Response licensee shall, when appropriate, perform those services set forth in SECTION VII.

b. Basic life support (BLS) skills

Each Advanced Response licensee shall, when appropriate, perform those services set forth in SECTION VII.

c. Each licensee shall provide 24-hour continuous service within its designated service area.

d. Each Advanced Response vehicle, when responding to an emergency request, shall be attended by at least a licensed physician, or an Emergency Medical Technician-Paramedic.

e. Each licensee shall comply with a two-minute reaction time for each emergency request.

f. Each licensee shall have its vehicles registered as Advanced Response.

g. Each licensee shall submit to the Department a copy of the DEA license to be utilized in acquiring drugs and medications.

h. Each licensee shall obtain, from the local ambulance service, a written agreement that the care begun by the Advanced Response personnel will be maintained during transport. This agreement will include the allowance of ALS skills, by appropriate personnel to be continued when a Basic Life Support licensee makes transport.

i. Each licensee shall have an Arkansas licensed physician to serve as

Medical Director who will provide medical oversight pursuant to Arkansas statutes and meets the requirements of Section LA. This shall be the same physician providing the DEA number if required (above).

j. Each licensee shall provide the responding transport service patient condition, care rendered to the patient and any information requested by the service.

SECTION V. REGISTRATION OF EMERGENCY VEHICLES

A. Purpose

An application for the issuance or renewal of an emergency vehicle permit shall be made on forms provided by the Department. The Department, upon satisfactory completion of an annual inspection by the Department, shall issue a vehicle permit.

B. General Standards

1. Vehicle permits

Each vehicle of a licensee shall be issued a permit in one of the classifications set forth below.

1. Each emergency ambulance vehicle will comply with Federal Ambulance Specifications, KKK-A-1822C, in regard to vehicle exhaust system and tires.

2. Additional Equipment

Any equipment a licensed EMS service wants to routinely carry that is not on the approved equipment list must have written approval by the Office to carry the equipment.

3. ALS Equipment Carried on BLS Registered Vehicles

For ALS Licensed Services registering I-A vehicles, ALS equipment and skills may only be permitted when appropriate ALS personnel are present. This does NOT permit the service to routinely carry ALS equipment on a I-A vehicle.

C. Specific Standards

1. Paramedic

a. Vehicle specifications

Each licensee shall ensure that each vehicle to be registered meets the following vehicle and on-board medical equipment specifications as follows:

Minimum dimensions for patient compartment

a). Height - 54"

b). Length- 116"

b. Two-way communication

Each registered vehicle shall have two-way direct communication with dispatch centers and/or base stations, other emergency medical service vehicles and receiving hospitals.

c. Paramedic medical equipment and drugs

Each vehicle shall meet the Paramedic drug and equipment specifications recommended by the Governor's Advisory Council on EMS and approved by the Department.

d. Each vehicle attended by two (2) individuals

Each Paramedic registered vehicle shall be attended at the scene and while enroute to the medical facility, by a minimum of two certified individuals, who shall be an Emergency Medical Technician-Paramedic, Emergency Medical Technician-Intermediate, or Emergency Medical Technician-Ambulance, with the ""Emergency Medical Technician-Paramedic staffing the vehicle at all times and in the patient compartment at all times during patient transport.

*Note: This does not preclude allowing a licensed physician or nurse from providing care in the back of the ambulance in addition to the certified EMT-Paramedic

e. This permit is available only to ALS Licensed services.

2. Intermediate

a. Vehicle specifications

Each licensee shall ensure that each vehicle to be registered meets the following vehicle and on-board medical equipment specifications as follows:

Minimum dimensions for patient compartment

a). Height - 54"

b). Length- 116"

b. Two-way communication

Each registered vehicle shall have two-way direct communication with dispatch centers and/or base stations, other emergency medical service vehicles and receiving hospitals.

c. Intermediate medical equipment and supplies

Each vehicle shall meet the Intermediate supplies and equipment specifications recommended by the Governor's Advisory Council on EMS and approved by the Department.

d. Each vehicle attended by two (2) individuals

Each Intermediate registered vehicle shall be attended at the scene and while enroute to the medical facility, by a minimum of two certified individuals, who shall be an Emergency Medical Technician-Paramedic, Emergency Medical Technician-Intermediate, or Emergency Medical Technician-Ambulance, with the ""Emergency Medical Technician-Intermediate or Emergency Medical Technician-Paramedic staffing the vehicle at all times and in the patient compartment at all times during patient transport.

*Note: This does not preclude allowing a licensed physician or nurse from providing care in the back of the ambulance in addition to the certified EMT-Intermediate or Paramedic

e. This permit is available only to ALS Licensed services.

3. ClassI-A

a. Vehicle specifications

Each licensee shall ensure that each vehicle to be registered meets the following vehicle and on-board medical equipment specifications as follows:

Minimum dimensions for patient compartment

a). Height - 54"

b). Length- 116"

b. Two-way communication

Each registered vehicle shall have two-way direct communication with dispatch centers and/or base stations, other emergency medical service vehicles and receiving hospitals.

c. Basic Medical equipment and supplies

Each vehicle shall meet the I-A supplies and equipment specifications recommended by the Governor's Advisory Council on EMS and approved by the Department.

d. Each vehicle attended by two (2) individuals

Each I-A registered vehicle shall be attended at the scene and while enroute to the medical facility, by a minimum of two certified individuals, who shall be an Emergency Medical Technician-Paramedic, Emergency Medical Technician-Intermediate, or Emergency Medical Technician-Ambulance, with the ""Emergency Medical Technician-Ambulance, Emergency Medical Technician-Intermediate or Emergency Medical Technician-Paramedic staffing the vehicle at all times and in the patient compartment at all times during patient transport.

*Note: This does not preclude allowing a licensed physician or nurse from providing care in the back of the ambulance in addition to the certified EMT.

e. This permit is available for both BLS and ALS Licensed services.

4. ClassI-B

a. Minimum dimensions for patient compartment

1) . Height - 50"

2) . Length- 110"

b. Two-way communications

Each registered vehicle shall have two-way communication with dispatch centers and/or base stations, other emergency medical service vehicles and receiving hospitals.

c. Medical equipment

Each vehicle shall meet the I-B supplies and equipment specifications recommended by the Governor's Advisory Council on EMS and approved by the Department.

d. Each vehicle attended by two (2) individuals

Each I-B registered vehicle shall be attended at the scene and while enroute to the medical facility, by a minimum of two individuals, one of whom shall be a licensed physician, Emergency Medical Technician-Paramedic, Emergency Medical Technician-Intermediate, licensed nurse, or Emergency Medical Technician-Ambulance, with any of the above in the patient compartment at all times during patient transport.

e. This permit is available for both BLS and ALS Licensed services.

5. Special Purpose

This permit shall be issued to only those emergency vehicles that are operated by a Special Purpose Licensee.

6. Advanced Response

a. Two-way communications

Each registered vehicle shall have two-way direct communications with dispatch centers and base stations, other emergency medical service vehicles and medical control.

b. Advanced life support medical equipment and drugs

Each vehicle shall meet the Advanced Response drug and equipment specifications recommended by the Governor's Advisory Council on EMS and approved by the Department.

c. Basic medical equipment

Each vehicle shall meet the basic medical and extrication equipment requirements recommended by the Governor's Advisory Council on EMS and approved by the Department.

d. This permit is available only to services licensed as Advanced Response.

SECTION VI. ADVANCED LIFE SUPPORT SKILLS BY QUALIFIED PERSONNEL

A. To allow EMT-Paramedics and EMT-Intermediates to perform in the following manner, written approval, as well as a copy of the current protocols, must be obtained and kept on file by the Department, the individual service, and the service Medical Director.

1. Within the service area of the service with whom he is affiliated, the EMT-I or EMT-P, with written approval from the ambulance service management, and written protocols from the service medical director, can perform Advanced Life Support procedures at his level of certification as recommended by the Governor's EMS Advisory Council and approved by the Department, prior to the arrival of the ambulance from his service.

2. An EMT-I or EMT-P, with written approval from all services involved and the ALS service medical director, and with approved written protocols may perform Advanced Life Support (ALS) procedures at their level of certification as recommended by the Governor's EMS Advisory Council and approved by the Department.

3. An EMT-I or EMT-P who is solely employed in industry and serves on the facility's emergency response team, or an emergency response team affiliated with or sponsored by a governmental entity, can, while on duty, perform any skill which is listed in their approved protocols as long as they meet ALL of the following requirements:

a. Written approval is received from the team's medical director

b. Individual is certified by the Department to perform the skills

c. The guidelines recommended by the Governor's EMS Advisory Council and approved by the Department are adhered to

d. Individual's performance is not tied to a licensed ambulance service at the time they are performing skills for the response team

B. In all cases, where advanced care is provided, provision for the continuity of level of care initiated must be maintained enroute to the hospital.

SECTION VII. CERTIFICATION OF PERSONNEL

A. Purpose

1. Types of certificates

The Department shall issue the following types of certificates:

a. Advanced Life Support

1). Emergency Medical Technician-Paramedic

2). Emergency Medical Technician-Intermediate

b. Basic Life Support

Emergency Medical Technician-Ambulance c. Instructor

1). Emergency Medical Technician-Instructor

2). Emergency Medical Technician-Instructor Trainer

2. Initial and renewal fees

An application for the initial issuance of a certification shall be made on forms provided by the Department, and shall be accompanied by a fee set forth by current EMS statute. Each certificate shall be renewed biennially and shall be accompanied by a fee set forth by current Arkansas Code 20-13-200.

3. Certification Card

Each Arkansas Certified EMT shall carry at all times the Arkansas Certification Card issued by the Office or have the ability to contact their EMS service or the Office for EMT certification verification when providing patient care if level of certification is questioned.

4. Criminal History Form

Any applicant applying for certification shall complete one time only a criminal history check form and shall request the Identification Bureau of the Department of the Arkansas State Police to conduct a state and/or national criminal history check on the applicant as required by Arkansas Code 20-13-200.

5. Approved Skills for Emergency Medical Technicians

a. Emergency Medical Technician-Paramedic when appropriate, may perform the following skills with Medical Director oversight:

1) . Advanced life support (ALS) skills:

a) . Administration of approved intravenous fluids

b). Airway maintenance and ventilatory support including endotracheal intubation, nasotracheal intubation, cricothyroidotomy, and needle thoracostomy

c). Administration of approved drugs

d). Electrocardiogram monitoring and interpretation

e). Defibrillation and synchronized cardioversion

f). Oralgastric and nasogastric insertion, lavage and suction

g). Additional procedures and skills as recommended by the Governor's EMS Advisory Council and approved by the Department.

2). Basic Life Support (BLS) skills:

a). Airway maintenance and ventilatory support

b). Obtaining and monitoring vital signs

c). Cardiopulmonary resuscitation (CPR)

d). Defibrillation with an Automated External Defibrillator (AED)

e). Performing scene assessment, patient assessment and triage

f). Bleeding control, wound care, and treatment for shock

g). Fracture immobilization

h). Management of medical, traumatic, and behavioral emergencies

i). Gaining access to patients and extricate for treatment and transport

j). Use of emergency medical services communication equipment

k). Provide verbal patient reports and written run documentation to the care facility as required

l). Additional procedures and skills as recommended by the Governor's EMS Advisory Council and approved by the Department.

b. Emergency Medical Technician-Intermediate when appropriate, may perform the following skills with Medical Director oversight:

1) . Advanced Life Support (ALS) skills:

a) . Administration of approved intravenous fluids

b). Airway maintenance and ventilatory support as recommended by the Governor's EMS Advisory Council and approved by the Department.

c). Administration of approved drugs

d). Additional procedures and skills as recommended by the Governor's EMS Advisory Council and approved by the Department.

2). Basic Life Support (BLS) skills

a). Airway maintenance and ventilatory support

b). Obtaining and monitoring vital signs

c). Cardiopulmonary resuscitation (CPR)

d). Defibrillation with an Automated External Defibrillator (AED)

e). Performing scene assessment, patient assessment and triage

f). Bleeding control, wound care, and treatment for shock

g). Fracture immobilization

h). Management of medical, traumatic, and behavioral emergencies

i). Gaining access to patients and extricate for treatment and transport

j). Use of emergency medical services communication equipment

k). Provide verbal patient reports and written run documentation to the care facility as required

c. Emergency Medical Technician-Ambulance when appropriate, may perform the following skills Basic Life Support (BLS) skills:

1.) Airway maintenance and ventilatory support

2.) Obtaining and monitoring vital signs

3.) Cardiopulmonary resuscitation (CPR)

4.) Defibrillation with an Automated External Defibrillator (AED)

5.) Performing scene assessment, patient assessment and triage

6.) Bleeding control, wound care, and treatment for shock

7.) Fracture immobilization

8.) Management of medical, traumatic, and behavioral emergencies

9.) Gaining access to patients and extricate for treatment and transport

10.) Use of emergency medical services communication equipment

11.) Provide verbal patient reports and written run documentation to the care facility as required

B. Certification Standards

1. No person is eligible to provide care, as defined in these Rules and Regulations, without a Current Arkansas EMT Certification. Requirements for certification includes:

a. Emergency Medical Technician-Paramedic

1). Pre-requisites for training

a) Successful completion of an Arkansas EMT Basic Course, or hold a current State EMT or Intermediate certification, or Military and Federal Employees who have a current National Registry card.

b) Current CPR card (AHA or ARC) documenting completion of a CPR course designed specifically for healthcare providers, or a copy of an official American Heart Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster.

2). Pre-requisites for testing

a)Currently certified as an Arkansas EMT.

(Note: Any person not holding Arkansas Certification must comply with the requirements for a State and/or National Criminal History check as required by Act 666 of 1999.)

b) Successful completion of a Department approved Department of Transportation (DOT)- National Standard Curriculum EMT-Paramedic program including all didactic, clinical and field internship requirements or be accepted for reciprocity from another state.

c) Current AHA ACLS card or official AHA roster, and current CPR Card (AHA or ARC) documenting completion of a CPR course designed specifically for healthcare providers, or a copy of an official American Heart Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster.

3). Certification requirements

Successfully complete the Arkansas EMT-Paramedic Examination

b. Emergency Medical Technician-Intermediate

1). Pre-requisites for training

a) Successful completion of an Arkansas EMT Basic Course, or hold a current State EMT certification, or Military and Federal Employees who have a current National Registry card.

2). Pre-requisites for testing

a). Currently certified as an Arkansas EMT.

(Note: Any person not holding Arkansas Certification must comply with the requirements for a State and/or National Criminal History check as required by Act 666 of 1999.)

b). Successful completion of a Department-approved DOT National Standard Curriculum EMT-I training course including all didactic, clinical and field internship requirements or be accepted for reciprocity from another state.

3). Certification Requirements

Successfully complete the Arkansas EMT-Intermediate Examination.

c. Emergency Medical Technician-Ambulance

1). The Department shall base certification on successful completion of the DOT- National Standard Curriculum EMT training course including all didactic, clinical and field internship requirements or successful completion of other courses approved. Also, as part of the course completion requirements, ALL students taking a basic EMT Course must complete a minimum eight (8) hour Extrication Course. Students with training and certification in other states without documented extrication must complete the eight (8) hours of required extrication in order to be eligible for testing. The Extrication Course can be conducted in one (1) of the following manners, or a combination of the following methods:

a) Videos

b) Classroom lectures

c) Skills practice

d) Any combination of the above

2). Certification shall be based on a successful completion of both the Arkansas practical skills examination and the National Registry of EMTs written examination.

d. Emergency Medical Technician-Instructor

1) Instructor certification will run concurrent with the current EMT expiration date.

2) Upon completion of the Instructor requirements listed below, the Instructor Candidates will be placed on PROVISIONAL status. PROVISIONAL Instructors must complete the following within twelve (12) months of completion of the Instructor course:

a) Instruct a 120-hour EMT-Basic course or an approved EMT Refresher Program at any level that follows current Department of Transportation-National Standard Curriculum Guidelines and sponsored by an Arkansas approved Training Site as long as ALL of the following requirements have been met:

1. If the Provisional Instructor chooses to teach a refresher program to meet this requirement, they MUST be certified for a minimum of two (2) consecutive years at the level they will teach.

2. All courses must be sponsored by an Arkansas approved Training Site.

3. Applications for all courses must be approved by the Office of EMS prior to starting (Instructor/Site Representative must receive approval letter from the Office prior to starting)

4. All courses must follow the current Department of Transportation National Standard Curriculum guidelines.

b) First course must be monitored, using a Office of EMS & Trauma Systems approved evaluation tool, by one (1) of the following (minimum of three (3) hours):

1. The Candidate's Instructor Trainer

2. Another Instructor approved by the EMS Specialist or Certification Administrator and the candidates Instructor Trainer

3. An EMS Specialist or Certification Administrator.

c) Complete Lay Evaluator Training d) The Office will notify the candidate when they have successfully completed all requirements to be placed on full Instructor status (removed from PROVISIONAL status).

3) Instructor Candidate Training Requirements

a) Certified Arkansas EMT (Ambulance, Intermediate or Paramedic level)

b) Certified continuously for a minimum of two (2) years as an EMT

c) Current Basic Life Support Instructor course completion (American Heart Association OR American Red Cross-ONLY)

d) Successfully complete a Office of EMS approved forty (40) hour Department of Transportation-National Standard Curriculum EMT-Instructor Course. For successful completion, students must complete the end of course written with a minimum score 80%, and meet all other course requirements.

e. EMT Instructor Teaching Advanced Courses

1). EMT- Intermediate who applies to teach an EMT-Intermediate course must complete the following:

a) Have received full EMT-Instructor status.

b) Have been certified as an EMT-Intermediate for a minimum of two (2) years.

2). EMT-Paramedic who applies to teach an EMT-Intermediate or EMT-Paramedic course must complete the following:

a) Have received full EMT-Instructor status

b) Copy of current ACLS Instructor card

c) Have been certified as a Paramedic for a minimum of two (2) years

f. Emergency Medical Technician-Instructor Trainer

1). All of the following eligibility requirements must be met for Instructors to become an EMT-Instructor Trainer:

a) Arkansas certification at the EMT-Intermediate or EMT-Paramedic level

b) Certified continuously for two (2) years in EMS as an EMT-Instructor

c) Current Basic Life Support Instructor Trainer course completion (American Heart Association OR American Red Cross - ONLY)

e) Sponsored by an Arkansas approved Training Site.

f) Completed Lay Evaluator Training.

g) Document minimum of an Associate Degree or a Senior of Vocational Instruction rating.

C. Recertification Standards

Arkansas EMT recertification is required every two (2) years in order to ensure EMTs maintain the ability, skills and knowledge needed to properly perform prehospital medical patient care. It is based on a combination of training programs and testing of basic critical skills. Individuals will not be authorized to provide care as EMTs from their expiration date until they receive their new identification card. EMT-Instructor recertification requirements must be completed to maintain Instructor status, but does not affect Arkansas EMT certification. An individual can lose their Instructor status, but still be recertified at their EMT level.

Any currently certified EMT applying for recertification shall complete one time only a criminal history check form and shall request the Identification Bureau of the Department of the Arkansas State Police to conduct a state and/or national criminal history check on the applicant.

1. Emergency Medical Technician - Basic and Ambulance

a. Completed Application Form signed in ink (available from the Office).

b. A $10.00 certification fee payable to the Arkansas Department of Health.

c. Current CPR card (AHA or ARC) documenting completion of a CPR course designed specifically for healthcare providers, or a copy of an official American Heart Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster.

d. Complete and document one (1) of the following:

1.) An approved EMT Basic Refresher Program (a minimum of twenty-four (24) hours) including an end-of-course written and practical skills exam, documented by a letter from a certified Arkansas EMT Instructor on approved Training Site letterhead

2.) Complete Forty-eight (48) hours of Continuing Education pre-approved by the Office (with a minimum of three (3) areas, maximum of sixteen (16) hours per area).

2. EMT - Intermediate

a. Completed Application Form signed in ink (available from the Office of EMS).

b. A $10.00 certification fee payable to the Arkansas Department of Health.

d. Documentation signed and dated by the Medical Director verifying competency in the following skills: Patient Assessment, Airway Management with appropriate device(s), IV Therapy, MAST and D50W Administration.

e. Complete and document ALL of the following:

1). An approved EMT Basic Refresher Program (a minimum of twenty-four (24) hours) including an end-of-course written and practical skills exam, documented by a letter from a certified Arkansas EMT Instructor on approved Training Site letterhead

2). Twelve (12) hours of Intermediate level Refresher training pre-approved by the Office.

3). Thirty-six (36) Hours of Continuing Education pre-approved by the Office (with a minimum of three (3) areas, maximum of sixteen (16) hours per area.)

3. EMT - Paramedic

a. Completed Application Form signed in ink (available from the Office).

b. A $10.00 certification fee payable to the Arkansas Department of Health.

d. A copy (front and back) of your current American Heart Association ACLS Provider card or official AHA course roster (valid past your current EMT-P expiration date).

e. Documentation signed and dated by the Medical Director verifying competency in the following skills: Patient Assessment, Endotracheal Intubation, IV Therapy, Drug Therapy and MAST.

f. Twenty-four (24) hours of Continuing Education pre-approved by the Office (with a minimum of three (3) areas, maximum of sixteen (16) hours per area).

g. In addition to the above, complete and document one of the following:

1) An approved forty-eight (48) hour EMT-Paramedic Refresher course, including an end-of-course written and practical skills exam, documented by a letter from the certified EMT-Paramedic instructor on approved Training Site letterhead.

2) Forty-eight (48) hours Refresher Training/Continuing Education pre-approved by the Office adhering to and including the content of the EMT-Paramedic Refresher National Standard Curriculum.

4. EMT - Instructor

Instructor Certification is for a two (2) year period to run concurrent with your current EMT level of certification.

The following must be completed and submitted for ALL Instructors:

a. Completed Application Form signed in ink (available from the Office of EMS).

b. A copy (front and back) of your current CPR Instructor card or official course roster, either:

1) American Heart Association

2) American Red Cross

c. Complete eight (8) hours of Continuing Education at the Instructor level pre-approved by the Office.

d. Meet the recertification requirements for your level of certification (EMT-A, EMT-Intermediate, or EMT-Paramedic)

e. Document the following requirements for your level of certification:

1). EMT-Ambulance certified as an EMT-Instructor, must complete one of the following:

a) One (1) full EMT course teaching more than 50% of the course materials

b) Two (2) EMT courses as co-instructor teaching

c) Two (2) Refresher courses

d) Forty-eight (48) hours of classroom instruction with prior approval by ADH, or with a letter from the lead instructor or training site representative verifying hours and topics of instruction taught at an approved EMT course.

2). EMT-Intermediate certified as an EMT-Instructor, must complete one of the following:

a) One (1) EMT course teaching more than 50% of the course material

b) Two (2) EMT courses as co-instructor

c) Two (2) Refresher courses

d) One (1) EMT-Intermediate course teaching more than 50%> of the course material

e) Forty-eight (48) hours of classroom instruction with prior approval by ADH, or with a letter from the lead instructor or training site representative verifying hours and topics of instruction taught at an approved EMT course.

3). EMT-Paramedic certified as an EMT-Instructor, must complete one of the following:

a) One (1) EMT course teaching more than 50% of the course material

b) Two (2) EMT courses as co-instructor

c) Two (2) Refresher Courses

d) One (1) EMT-Intermediate course

e) One (1) EMT-Paramedic course teaching more than 50% of the course material

f) One (1) forty-eight (48) hour Paramedic refresher course with a letter from the lead instructor or training site representative verifying hours and topics of instruction taught at an approved EMT course.

4). EMT-Instructor Trainer must complete all of the following:

a) Maintain current Arkansas EMT-Intermediate or EMT-Paramedic certification

b) Maintain current EMT-Instructor certification

5. Late EMT Recertification Applications

a. Recertification will be allowed for those who submit their documentation after their expiration date IF:

1) All required educational hours were completed PRIOR to the expiration date;

2) All specific training (i.e, Refresher, ACLS, CPR, etc.) was completed PRIOR to the expiration date; AND

3) All documentation was submitted PRIOR to the next recertification period.

b. Persons who have NOT submitted the documentation PRIOR to their expiration date will be considered lapsed BEGINNING with the expiration date and will remain lapsed until the paperwork is submitted, reviewed by the Office, meets the above criteria, and documentation of recertification is issued (current wallet ID card).

D. Lapsed Emergency Medical Technicians

Individuals who do not complete their educational and training requirements for recertification prior to their expiration date will be considered lapsed and will have to complete the following requirements for their certification level prior to receiving their new State Certification card:

1. EMT-Ambulance

a.LAPSED TWO (2) YEARS OR LESS:

1) Document successful completion of an approved Basic EMT Refresher Course (minimum 24 hours);

2) Document current CPR card (AHA or ARC) documenting completion of a CPR course designed specifically for healthcare providers, or a copy of an official American Heart Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster;

3) Submit Arkansas application form, completely filled out with signature, and a $10.00 certification fee payable to the Arkansas Department of Health.

4) Challenge and pass the Arkansas Basic EMT written and practical examination.

b.LAPSED MORE THAN TWO (2) YEARS:

1) Document successful completion of an approved Basic EMT Course following the Department of Transportation National Standard Curriculum (NSC) for EMT Training, minimum 120 hours;

2) Submit Arkansas application form, completely filled out with signature, and a $10.00 certification fee payable to the Arkansas Department of Health;

3) Mail copy of National Registry application and testing fee (money order payable to National Registry) directly to National Registry office, and mail original National Registry application to the Office of EMS & TS;

4) Challenge and pass the Arkansas Basic EMT Certification examination (written and practical for EMT-A).

2. EMT- Intermediate

a.LAPSED TWO (2) YEARS OR LESS:

1) Document successful completion of an approved Basic EMT Refresher Course (minimum 24 hours) and twelve (12) hours of Intermediate level continuing education (prior approval by the Office of EMS & TS is needed for credit to be given);

3) Submit Arkansas application form, completely filled out with signature, and a $10.00 certification fee payable to the Arkansas Department of Health;

4) Submit a letter from an Arkansas licensed ambulance service or training site medical director verifying skills;

5) Challenge and pass the Arkansas/National Registry EMT-Intermediate written and practical examination.

b.LAPSED MORE THAN TWO (2) YEARS:

1) Document successful completion of an approved Basic EMT Course following the Department of Transportation National Standard Curriculum (NSC) for EMT Training, minimum 120 hours;

2) Submit Arkansas application form, completely filled out with signature, and a $10.00 certification fee payable to the Arkansas Department of Health;

4) Challenge and pass the Arkansas Basic EMT Certification examination (written and practical for EMT-A);

5) Document successful completion of an approved Arkansas EMT-Intermediate Course following the Department of Transportation National Standard Curriculum (NSC) for EMT Training;

6) Submit Arkansas application form, completely filled out with signature, and a $10.00 certification fee payable to the Arkansas Department of Health;

7) Mail National Registry application and testing fee (money order payable to National Registry) for the Intermediate exam directly to National Registry office;

8) Challenge and pass the Arkansas/National Registry EMT-Intermediate Certification examination (written and practical).

3. EMT-Paramedic

a.LAPSED TWO (2) YEARS OR LESS:

1) Document successful completion of an approved forty-eight (48) hour Paramedic Refresher Course;

2) Current CPR card (AHA or ARC) documenting completion of a CPR course designed specifically for healthcare providers, or a copy of an official American Heart Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster;

3) Submit copy of current American Heart Association ACLS card or official course roster;

4) Submit Arkansas application form, completely filled out with signature, and a $10.00 certification fee payable to the Arkansas Department of Health;

5) Submit a letter from an Arkansas licensed ambulance service or training site medical director verifying skills;

6) Challenge and pass the Arkansas/National Registry EMT-Paramedic written and practical examination.

b.LAPSED MORE THAN TWO (2) YEARS:

1) Document successful completion an approved Basic EMT Course following the Department of Transportation National Standard Curriculum (NSC) for EMT Training, minimum 120 hours;

2) Submit Arkansas application form, completely filled out with signature, and a $10.00 certification fee payable to the Arkansas Department of Health;

4) Challenge and pass the Arkansas Basic EMT Certification examination (written and practical for EMT-A).

5) Document successful completion of an approved Arkansas EMT-Paramedic Course following the Department of Transportation National Standard Curriculum (NSC) for EMT Training;

6) Submit Arkansas application form, completely filled out with signature, and a $10.00 certification fee payable to the Arkansas Department of Health;

7) Mail National Registry application and testing fee (money order payable to National Registry) for the Paramedic exam directly to National Registry office;

8) Challenge and pass the Arkansas/National Registry EMT-Paramedic Certification examination (written and practical).

E. Request for Extension to complete EMT Recertification Requirements

1. Submit a letter to the Office of EMS & Trauma Systems no later than thirty (30) days prior to the expiration date requesting an extension. The letter must include the reason(s) the extension is being requested (what circumstances have occurred during the past two (2) years that requires an extension). Include information to substantiate the need for an extension (i.e. Military Orders, medical documentation from a physician, etc)

2. Office of EMS & Trauma Systems will review each letter of request AND all supporting documents separately and make a decision on a case by case basis by the expiration date.

3. If the Office of EMS & Trauma Systems receives the request or documentation after their expiration date, the EMT will be considered LAPSED and the request will not be accepted or reviewed. However, requests from EMTs on active duty with the military and stationed overseas will be reviewed as long as a copy of their orders are attached to the request.

4. After all of the information is reviewed, a letter will be sent to the applicant explaining the Office of EMS & Trauma Systems decision.

5. If an individual is found to be providing care while certification is lapsed, they will be subject to Disciplinary Action. In addition, the licensed ambulance service, if applicable, will be notified of Disciplinary Actions (See Section XIII) taken against them for allowing a non-certified EMT to operate on an ambulance.

6.If your request is granted and you receive an extension, you are NOT eligible to provide patient care, as an Arkansas certified EMT, past your expiration date UNTIL you complete all of your recertification requirements!

F. Reciprocity

The Department is authorized to approve Arkansas certification testing for individuals who hold certifications or licenses issued by other states. In addition, military, ex-military and federal employees who hold a current National Registry of EMTs card will be eligible for Arkansas certification testing. Certification will be equal to their preexisting certification, not to exceed two (2) years. The Department shall require any person seeking reciprocity to comply with the following requirements:

1. Certification in another state and/or National Registration does not authorize you to function as an EMT in Arkansas. Presenting yourself as an EMT in this state prior to certification could jeopardize your chance to become an Arkansas EMT. Also, any service employing an EMT not Arkansas certified is risking disciplinary action.

2. Applicants must be within their original certification period or have recertified in the state the EMT is transferring from prior to applying to Arkansas. Applicants must also challenge and successfully complete the Arkansas certification requirements prior to their out-of-state expiration date.

3. All state certified and Nationally Registered Basic EMTs seeking Arkansas certification must complete and submit the following documentation to the Office:

a. A completed Verification of EMT Status Form (obtained from the Office).

b. A completed Arkansas application signed and dated in INK, for EMT certification form (obtained from the Office).

c. A $10.00 certification fee payable to the Arkansas Department of Health. Note: certification fees are not refundable.

d. Arkansas Criminal Background Check form, which includes a State and FBI check, (form(s) obtained from the Office).

e. Document Current CPR course (AHA or ARC) documenting completion of a CPR class designed specifically for healthcare providers, or a copy of an official American Heart Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster.

f. Copies of your current State certification and National Registry cards.

Note: If you are not currently a National Registry cardholder, you must acquire one before being Arkansas certified. Contact the Office of EMS & Trauma Systems to obtain the procedures you must follow to acquire National Registry

status.

g. Successfully complete the Arkansas Practical Skills Exam if you have a current National Registry card. If not, successfully complete National Registry Written Exam and the Arkansas Practical Skills Exam.

4. All state certified and Nationally Registered EMT-Intermediates seeking Arkansas certification must complete and submit the following documentation to the Office:

a. A completed Verification of EMT Status Form (obtained from the Office).

b. A completed Arkansas application signed and dated in INK, for EMT certification form (obtained from the Office).

c. A $10.00 certification fee payable to the Arkansas Department of Health. Note: certification fees are not refundable.

d. Arkansas Criminal Background Check form, which includes a State and FBI check. (Form(s) obtained from the Office).

e. Document Current CPR card (AHA or ARC) documenting completion of a CPR course designed specifically for healthcare providers, or a copy of an official American Heart Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster.

f. Copies of your current State certification and National Registry cards.

status.

g. Verification of the following skills within the past two (2) years:

1) Three (3) Esophageal Obturator Airway (EOA) / Esophageal Gastric Tube Airway (EGTA) intubations which were conducted under the supervision of the Medical Director of an approved training site, Medical Director of a Licensed Advanced Life Support ambulance service or any person qualified/approved as an instructor for Intermediate and Paramedic training courses (Verification can be accomplished by using an Intubation Manikin).

2) Three (3) each intravenous cannulation starts verified by a physician, registered nurse or any person qualified/approved as an instructor for Intermediate and Paramedic training courses (Verification can be accomplished using an IV Manikin).

5. All state certified and Nationally Registered EMT-Paramedics seeking Arkansas certification must complete and submit the following documentation to the Office:

a. A completed Verification of EMT Status Form (obtained from the Office).

b. A completed Arkansas application signed and dated in INK, for EMT certification form (obtained from the Office).

c. A $10.00 certification fee payable to the Arkansas Department of Health. Note: certification fees are not refundable.

d. Arkansas Criminal Background Check form, which includes a State and FBI check. (Form(s) obtained from the Office).

e. Current CPR card (AHA or ARC) documenting completion of a CPR course designed specifically for healthcare providers, or a copy of an official American Heart Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster.

f. Submit copy of current AHA ACLS card or course roster documenting successful completion within the previous 24 months.

g. Copies of your Current State certification and National Registry cards.

status.

h. Verification of the following skills within the past two (2) years:

1) Three (3) each endotracheal intubations verified by a physician, anesthesiologist, CRNA, or any person qualified/approved as an instructor for Paramedic training courses (Verification can be accomplished by using an Intubation Manikin).

2) Three (3) each intravenous cannulation starts verified by a physician, registered nurse or any person qualified/approved as an instructor for Paramedic training courses (Verification can be accomplished using an IV Manikin).

6. Military trained personnel will be eligible for EMT-Basic/Ambulance Certification ONLY, unless documentation of completion of a State Approved Department of Transportation National Standard Curriculum EMT-I or EMT-P course can be provided. A DD Form 214 listing a medical MOS, AFSC, or NEC must be submitted. The applicant must not have been separated from the Military (Personnel stationed in the Continental United States or overseas) for more than twelve (12) months, and must have been active in the job description within the previous twelve (12) months.

a. Military Personnel seeking Basic certification must complete the following requirements:

1) . Submit a copy of DD Form 214 (reserve personnel must submit a copy of training information from their 201 file).

2) . A completed Verification of EMT Status Form (obtained from the Office).

3) . A completed Arkansas application signed and dated in INK, for EMT certification form (obtained from the Office).

4) . A $10.00 certification fee payable to the Arkansas Department of Health. Note: certification fees are not refundable.

5) . Arkansas Criminal Background Check form, which includes a State and FBI check, (form(s) obtained from the Office).

6) . Document Current CPR card (AHA or ARC) documenting completion of a CPR course designed specifically for healthcare providers, or a copy of an official American Heart Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster.

7) . A copy of your current National Registry card.

8) . Verification of an eight (8) hour extrication course.

9) . Successfully complete the Arkansas Practical Skills Exam.

b. Military Personnel seeking Emergency Medical Technician-Intermediate certification must complete the requirements listed in Section VII.F.4 above.

c. Military Personnel seeking Emergency Medical Technician-Paramedic certification must complete the requirements listed in Section VII.F.5 above.

7. Federal Employees

a. Federal Employees seeking Basic Emergency Medical Technician certification must complete the following requirements:

1) A completed Verification of EMT Status Form (obtained from the Office).

2) A completed Arkansas application signed and dated in INK, for EMT certification form (obtained from the Office).

3) A $10.00 certification fee payable to the Arkansas Department of Health. Note: certification fees are not refundable.

4) Arkansas Criminal Background Check form, which includes a State and FBI check, (form(s) obtained from the Office).

5) Document Current CPR card (AHA or ARC) documenting completion of a CPR course designed specifically for healthcare providers, or a copy of an official American Heart Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster.

6) A copy of your current National Registry card.

7) Verification of an eight (8) hour extrication course.

8) Successfully complete the Arkansas Practical Skills Exam

b. Federal Employees seeking Emergency Medical Technician-Intermediate certification must complete the requirements listed in Section VII.F.4 above.

c. Federal Employees Emergency Medical Technician-Paramedic certification must complete the requirements listed in Section VII.F.5 above.

SECTION VIII. HOSPITAL STAFFING

Pursuant to ACT 293 of 1981, if a hospital wishes to permit an Arkansas Certified Emergency Medical Technician to perform specified procedures within the Emergency Department or as a member of an emergency code team functioning elsewhere in the hospital, the following action must be taken:

A. The medical staff must approve the privileges granted to the individual functioning as an EMT with the concurrence of the hospital's governing body. Specific policies governing the supervision and the procedures to be performed by the EMT must be developed by the medical staff and also approved by the hospital's governing body. In no event, however, may an EMT perform a procedure on a patient in a hospital that he or she is not certified to do by the Office of EMS and Trauma Systems, Arkansas Department of Health.

B. Approved EMTs in a hospital setting must function in accordance with physician's orders and under the direct supervision of either the physician or the Registered Nurse responsible for emergency services within a hospital.

C. In addition, with hospital concurrence, students in EMT training programs approved by the Office of Emergency Medical Services and Trauma Systems of the Arkansas Department of Health must be trained by qualified personnel within the hospital under guidelines established by the medical staff and approved by the hospital governing body.

D. A roster with the delineation of privileges will be maintained in the files of the supervisor for the respective department of employment and in the files of the administrator.

SECTION IX. GENERAL TRAINING SITE REQUIREMENTS

The following sections pertain to training at all three levels of EMS Instruction in Arkansas.

A. All Arkansas approved Training Sites must be accredited by the Department using the current Accreditation Standards.

B. The Department shall approve all EMT courses and training sites prior to the beginning of any period of instruction.

C. There shall be an academic as well as clinical atmosphere. Trainees must be in uniform with a standard means of identification when engaged in the patient care and clinical or field internship portions of the program.

D. The course of instruction and minimum number of hours of total instruction will be set by the Department.

E. The course instructor must be an Arkansas Licensed Physician or a certified EMT-Instructor as set forth in SECTION VII.B.l.d.

F. Off-Site Courses

1. All instructor requirements remain the same as if the course is conducted at the training site.

2. The facility where the class is located must meet with the approval of both the sponsoring institution and the Department.

3. Written documentation should verify one of the following concerning equipment.

a. All equipment needed for the course (i.e. Health Department list) is available at the course location without removing any equipment from a licensed ambulance. Health Department Office of EMS can inspect at anytime during the course if they so desire. Or

b. The training site sponsor provides all equipment. For off site courses, due to loading/transport/use time, that set of equipment cannot be considered available for any other course unless a specific policy exists requiring return in a certain time span. Or

c. Equipment used for the course may be provided as a combined effort by the training site and the location where the course is offered. Such an agreement must be signed prior to submission of the course request form, and must be submitted with it.

G. Sponsorship of Multiple Courses

Any training site may offer concurrent courses providing the following criterion has been met.

There must be adequate equipment available for each course offered to insure that each student has appropriate access to each needed item. In the case of concurrent courses, a training site must be able to demonstrate that no conflict in equipment availability exists.

SECTION X. BASIC AND ADVANCED TRAINING SITE REQUIREMENTS

A. Paramedic Training Sites

1. By July 1, 2003 all current Arkansas Paramedic Training Sites must complete one of the following:

a. Have achieved accreditation by a National Accrediting Organization as recognized by the Office.

b. Have submitted all required paperwork, including the self-study and be awaiting a site visit.

2. Any potential site wishing to apply to be a Paramedic Training Site after July 1, 2003 must have been awarded national accreditation as a Paramedic Training Site, as recognized by the Office, and met Arkansas requirements as listed in the Arkansas Site Accreditation Manual.

B. Emergency Medical Technician-Paramedic Training

1. The Department shall approve all EMT-P courses and training sites prior to the beginning of any period of instruction.

2. Training sites must meet and maintain the standards set forth in the Training Site Accreditation Standards as recommended by the Governor's EMS Advisory Council and approved by the Department.

3. Primary Instructors must be either Arkansas licensed physicians, registered nurse/EMT Instructor, or EMT-Paramedic/EMT-Instructor. A paramedic who is an EMT-Instructor will teach at least fifty (50) percent of each course.

4. In-Hospital training

a. Clinical phases of training will be conducted within a medical facility with hospital concurrence.

b. EMT-Paramedic students will be trained, within the hospital, by qualified personnel under guidelines and requirements stated in the curriculum and approved by the medical staff and the hospital's governing body during clinical phases of training.

c. All requirements for hours, hospital, ambulance, patient contact and training set forth in the 1999 ALS Implementation Plan must be met by all classes beginning after July 1, 2001.

5. Field Internship

a. Internship must be completed with a paramedic licensed ambulance service with which there is an agreement allowing students to actively participate in patient care. The student must be in the patient compartment during transport

b. All requirements for both field internships set forth in the current ALS Implementation Plan must be met for all classes after July 1, 2001.

6. Only those students from approved courses and recommended by their instructor and medical director will be allowed to challenge the State of Arkansas certification examination.

7. There must be a Medical Director designated, having emergency department experience, who meets the requirements in Section 1 .A. and documents current Advanced Cardiac Life Support credentials or is Board Certified in Emergency Medicine.

C. Emergency Medical Technician-Intermediate Training

1. The Department shall approve all EMT-Intermediate courses and training sites prior to the beginning of any periods of instruction.

2. EMT-Intermediate training may be sponsored only by a higher education institution that has affiliation with an Arkansas licensed hospital or EMT-Paramedic training site.

3. Primary Instructors must be either Arkansas licensed physicians, registered nurses/EMT Instructor, EMT-Paramedic/EMT Instructor, or EMT-Intermediate/EMT-Instructor (applies only to EMT-Intermediates completing the 1999 EMT-Intermediate DOT-NSC).

4. The Department will set the course of instruction and minimum number of hours of total instruction.

5. There shall be an academic as well as a clinical atmosphere. Trainees must be in uniform with a standard means of identification when engaged in the patient care and clinical portions of the program.

6. Only those students from approved courses and recommended by their instructor and medical director will be allowed to challenge the State of Arkansas certification examination.

7. There must be a Medical Director designated, having emergency department experience, who meets the requirements in Section 1 .F. and documents Advanced Cardiac Life Support certification current within one year of becoming a Medical Director or is Board Certified in Emergency Medicine.

8. In-Hospital Training

a. Clinical phases of training will be conducted within a medical facility with hospital concurrence.

b. EMT-Intermediate students will be trained, within the hospital, by qualified personnel under guidelines and requirements stated in the curriculum and approved by the medical staff and the hospital's governing body during clinical phases of training.

c. All requirements for hours, hospital, ambulance, patient contact and training set forth in the 1999 ALS Implementation Plan must be met by all classes beginning after July 1, 2001.

9. Field Internship

a. Internship must be completed with a Paramedic or Intermediate licensed ambulance service with which there is an agreement allowing students to actively participate in patient care. The student must be in the patient compartment during transport.

b. All requirements for both field internships set forth in the 1999 ALS Implementation Plan must be met for all classes after July 1, 2001.

D. Emergency Medical Technician-Ambulance Training

1. The Department shall approve all EMT-Basic courses and training sites prior to the beginning of any periods of instruction.

2. Basic EMT training may be sponsored only by a higher education institution that is affiliated with an Arkansas licensed hospital or an approved training site.

3. Primary Instructors must be either Arkansas licensed physicians, registered nurses/EMT Instructor, EMT-Paramedic/EMT Instructor, EMT-Intermediate/EMT-Instructor or EMT-Ambulance/EMT Instructor.

4. The Department will set the course of instruction and minimum number of hours of total instruction.

6. Only those students from approved courses that have successfully completed all course requirements as documented by the instructor and medical director will be allowed to challenge the State of Arkansas certification examination.

7. There must be a Medical Director designated, having provided care in an emergency room, meets the requirements in Section I.F. and documents ACLS certification current within one year of becoming a Medical Director or be Board Certified in Emergency Medicine.

8. In-Hospital Training

a. Clinical phases of training will be conducted within a medical facility with hospital concurrence.

b. Basic EMT students will be trained, within the hospital, by qualified personnel under guidelines and requirements stated in the curriculum and approved by the medical staff and the hospital's governing body during clinical phases of training.

9. Field Internship

a. Internship must be completed with a Paramedic, Intermediate or Basic licensed ambulance service with which there is an agreement allowing students to actively participate in patient care. The student must be in the patient compartment during transport.

E. Emergency Medical Technician-Instructor Training

1. Requirements to conduct an EMT-Instructor Course are as follows:

a. The course must be sponsored by an Arkansas approved EMT Training site in affiliation with an educational institution (Vo-Tech School, Technical College, Community College, four year college or university).

b. All courses must be approved prior to starting by the Office of EMS.

c. All courses must follow the current Department of Transportation National Standard Curriculum guidelines.

d. All courses must conduct a practical skills exam (those skills on which students test for certification) with a performance of 80% or above.

e. An individual who holds a Bachelor's Degree, or higher, in education, or adult education must assist with the course.

2. The EMT-Instructor Trainer must submit the following information to the Office of EMS:

a. A curriculum vitae of all instructional staff

b. Copy of course curriculum

c. Copy of current Basic Life Support (BLS) Instructor card

d. Application/written request to conduct an Instructor course (Instructor/Site Representative must receive approval letter from the Office prior to starting course).

e. List of applicants for verification/approval of EMT status by Office of EMS

3. Upon completion of EMT-Instructor course, the Instructor Trainer must submit end of course documentation including a list of students who successfully completed the course.

4. Each student successfully completing the EMT-Instructor course will be responsible for completing the requirements outlined in the Requirements for Arkansas EMT-Instructor Certification (Section VII.B.l.d.) for their level of EMT certification.

SECTION XI DRUGS AND PHARMACEUTICALS

A.NOTICE OF INSPECTION

Investigators and inspectors for the Office of Pharmacy Services and Drug Control, Arkansas Department of Health, are directed to make investigations and inspections and make copies of the records and orders, wherever located, of all services licensed by the Office of EMS in order to determine whether or not the said services have violated the laws and regulations of the State of Arkansas respecting prescribing and using of narcotics and potentially dangerous drugs and whether or not said services have violated the provisions of the law.

B.REGISTRATION

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.*

C.SECURITY

1. The controlled substances storage area at the ambulance service's physical location shall be accessible only to specifically authorized employees.

2. The Licensee shall provide adequate security for all legend drugs on-board all registered vehicles. Schedule II drugs have a separate requirement for security that also must be complied with by the Licensee.

D.PROCEDURE IN CASE OF LOSS OF CONTROLLED SUBSTANCES

Each Paramedic Licensee or Medical Director shall notify the Office of Pharmacy Services and Drug Control, Arkansas Department of Health (661-2325), immediately upon discovery of any suspected loss, theft and/or other diversion of any controlled substance under their supervision.

E.RECORDS OF CONTROLLED SUBSTANCES

1. The Medical Director (Physician) of the service is responsible for maintaining accurate and complete records of such drugs received and a record of all such drugs administered, or professionally used otherwise.*

2. The basic records are: receipt and disposition of controlled drugs within the service, patient medical records (Encounter Forms), and the controlled drug procurement and disposition records.

3. The record shall in every case show the date of receipt, the name and address of the person or business from whom received and the kind and quantity of drugs received.

4. The record shall show: the drugs administered, date of administration, the name and address of the person to whom or for whose use the drugs were administered, and the kind and quantity of drugs.

* Exception: Hospital based Service (The hospital's DEA Registration allows for the drugs to be supplied to the service through the hospital pharmacy where records of administration and distribution are the responsibility of the hospital).

5. Patient medication records shall consist of at least, (1) physician's order authorizing the dispensing and administration of medications (Standing Orders), (2) medication administration record indicating the date, time and signature of the EMT-Paramedic administering controlled drugs to the patient, and (3) the EMT-Paramedic notes indicating the date, time, method of administration, and condition of the patient before and after the controlled drugs were administered and signature of the EMT-Paramedic administering the drug.

6. In addition to patient's medical records, a record of the procurement and disposition of controlled drug must be maintained.

7. The disposition record must reflect the actual dosage administered to the patient, the patients name, date, time and signature of the EMT-Paramedic administering the controlled drug. Any error of entry on the disposition and procurement record shall follow a policy of correction of errors and accurate accountability. If the person who procures the controlled drug is not the person who administers the drug, then both persons must sign the disposition record.

8. When breakage or wastage of a controlled drug occurs, the amount administered and the amount wasted must be recorded by the EMT-Paramedic who wasted the drug and verified by the signature of a licensed person and/or certified EMT who witnessed the wastage and how it was wasted.

9. Adequate accountability does not require the use of a specific system or form. The system employed must be designed so that all requirements listed are met.

10. Each service shall maintain inventory records in one consolidated record system. Records of Schedule II substances shall be maintained separately from all other records. Inventories of Schedule III, IV and V shall be maintained either separately from all other records or in such form that the information required is readily retrievable from the ordinary business records.

11. Every record shall be kept by the Registrant and be readily retrievable and available for at least two (2) years from the date of the recording for inspection and copying by authorized agents of the Office of Pharmacy Services and Drug Control, Arkansas Department of Health, or the Office of EMS & Trauma Systems, Arkansas Department of Health.

F.SURRENDER OF UNWANTED CONTROLLED SUBSTANCES

All controlled substances no longer usable due to deterioration, expired dating, or no longer used by the service:

1. must be delivered in person or by registered mail or other means of shipment with return receipt and all completed copies of Report of Drugs Surrendered (Form PhA:DC-l) furnished by the Department of Health to: Office of Pharmacy Services and Drug Control, Arkansas Department of Health, 4815 West Markham Street, Little Rock, AR 72205-3867, OR

2. may be destroyed only by authorized agents of the Arkansas Department of Health on site.

G.POLICIES AND PROCEDURES MANUAL

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. The manual shall include at a minimum the following:

1. Detailed job descriptions, duties and responsibilities of each employee handling drugs.

2. Procedures for: registration of the Medical Director, security of drugs and limiting access to one person responsible for the accountability during shift, accurate and complete record keeping of drugs, and availability of records for inspection.

3 Procedures in case of loss of drugs, surrender of unwanted drugs, and wastage.

H.STORAGE OF PHARMACEUTICALS BY LICENSED AMBULANCE SERVICES

1. All pharmaceuticals will be stored in accordance with the instructions included in the package inserts of each drug . Factors such as heat, freezing, susceptibility to light, etc., are described in the insert, and all services will provide suitable storage to comply with the instructions.

2. Freezing is defined as storage at temperatures at or below 32 degrees Fahrenheit (32 F). Excessive heat is defined as temperatures at or above 104 degrees Fahrenheit (104F). The licensee will provide protection of fluids and pharmaceuticals on units.

I.ADDITIONS TO THE REQUIRED AND OPTIONAL DRUG LISTS

All additions to the Optional Drug List will be approved by the Medical Director, recommended by the Governor's Advisory Council on EMS & Trauma Systems and approved by the Office of EMS, prior to implementing the drug.

J.PURCHASING DRUGS FROM HOSPITALS

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.

SECTION XII AIR AMBULANCE OPERATIONS

A. LICENSURE OF AIR AMBULANCE SERVICES

1. Purpose

No person shall furnish, operate, maintain, conduct, advertise or engage in, or profess to engage in, the business of providing air ambulance transport of patients unless that person holds a valid air ambulance service license issued by the Department. This provision shall not in any way operate to alter the application of the Arkansas Good Samaritan Act (Arkansas Statutes 72-624).

2. General Standards

a. An application for the issuance or renewal of an air ambulance service license shall be made on forms provided by the Department and shall be accompanied by all fees as required by law or regulations. Each license shall be renewed annually.

b. Each licensee shall have a current FAA FAR 135 Certificate.

c. Refueling with a patient aboard should be avoided. If fueling operations are necessary, the patient should be temporarily removed from the aircraft if his/her medical condition allows. If a patient is aboard, all fueling procedures must meet FAA Standards given in the Certificate Holder's Operation Manual. During refueling operations, fire control equipment must be in the immediate vicinity and manned.

d. Air Ambulance Services based outside of Arkansas that do intra-Arkansas transfers shall be subject to the requirements of these regulations, in conjunction with other state's applicable rules when appropriate.

e. The aviation crew of an air ambulance shall meet all requirements of FAAFAR135.

f. Each air ambulance service shall have and maintain a coordination point, 24 hours a day.

g. Each air ambulance must have radio capability to communicate air-to-air and air-to-ground.

1) This system should include two-way communications with physicians who are responsible for directing patient care in transit, and with ground personnel who coordinate the transfer of the patient to or from surface transportation.

2) Each aircraft shall have communication capabilities for radio frequencies 123.05 mHz and 155.340 mHz.

h. The pilot may contact the referring and receiving entity, when within radio range, giving them the estimated time of arrival and when on final approach. Otherwise, the coordination point shall have this responsibility.

i. The following information shall be logged for all flights: the time the call was received, time the aircraft was dispatched, time the aircraft departed, name of party requesting the flight with verification telephone number, and pertinent medical and logistical support information.

j. Each air ambulance operator must maintain, for seven years, a record of each air ambulance operation, including but not limited to the following:

1) Patient's name

2) Date of flight

3) Diagnosis

4) Originating and terminating points, and patient's condition upon departure and arrival.

5) An inflight medical attendant's report of the patient's status, including vital signs, level of consciousness, drugs administered, and details of therapeutic intervention.

6) Unusual circumstances encountered during the flight, including inordinate altitudes flown, turbulence, times associated with these abnormal conditions, etc.

k. All Air Ambulance Services must coordinate aircraft departures and arrivals with required surface transportation to avoid delays.

l. Each Air Ambulance Service shall, when appropriate, perform the following services under direction of the ALS Medical Director:

1) Advanced Life Support (ALS) skills-Each air ambulance licensee shall, when appropriate, perform those services set forth in Rules and Regulations Pertaining to Emergency Medical Services, Section III.C.l., and other skills as per protocols and ALS Medical Director approval, Section VII.A.5.a.l.

2) Basic Life Support (BLS) skills-Each air ambulance licensee shall, when appropriate, perform those services set forth in Rules and Regulations Pertaining to Emergency Medical Services, Section VII.A.5.a.2.

3) All aeromedical crewmembers responding to scene flight requests shall be required to have training in extrication, immobilization techniques and scene stabilization.

4) Each licensee shall submit to the Department the DEA number and the person that number is registered to, to be utilized in acquiring drugs and medications. This should be the Medical Director of the service.

5) The ALS Medical Director of an air ambulance service shall be responsible for the following:

a) Ensuring that aeromedical crew and equipment are provided to meet the patient's needs;

b) Ensuring that all aeromedical crew members are minimally trained to perform in-flight duties as recommended by the Governor's Advisory Council on EMS and approved by the department;

c) Supervising and evaluating the quality of care through a written and approved Continuous Quality Improvement program; and d) Determining duty readiness of aeromedical crews.

m. All aeromedical crewmembers will meet minimum training requirements recommended by the Governor's Advisory Council on EMS and approved by the department. All air ambulance services will maintain written documentation of training for each aeromedical crewmember.

B. HELICOPTER AIR AMBULANCE

1. Only helicopter services that possess, or have a contract with operators who possess a current, valid, Federal Aviation Regulation, Part 135 Certificate shall be eligible for an Arkansas Air Ambulance License.

2. Coordination Point

a. Each helicopter air ambulance service shall have the following:

1) Minimum of one (1) incoming telephone line dedicated to emergency requests for the air ambulance service.

2) Personnel assigned to receive all dispatch and flight request information on behalf of the air ambulance service.

b. Each helicopter air ambulance service responding to scene flights shall also provide the following:

1) Personnel assigned to receive all dispatch and flight request information on behalf of the air ambulance service;

2) Communications/dispatch personnel trained commensurate with their responsibilities in the dispatch center, and who have successfully completed Emergency Medical Technician training;

3) Dispatchers with additional training in aircraft capabilities, operational limitations, and navigation and map coordination;

4) A dispatch center with the following:

a) A system to tape-record all incoming and outgoing telephone and radio transmissions pertaining to flight requests, dispatch, and following of aircraft. The system must have time-encoding and playback capabilities. Recordings shall be kept for a minimum of sixty (60) days;

b) Maps of all areas where the service responds to scene flights. Maps must be Arkansas State Highway and Transportation Department General Highway Map for Counties or the equivalent;

c) Personnel available capable of plotting scene coordinates and directing the helicopter to a scene location, 24 hours a day.

3. Flight Following

Each helicopter air ambulance service shall arrange for flight following at least every fifteen (15) minutes. Documentation of such flight following must be maintained. When the aircraft is unable to maintain direct radio contact with the base station, flight following may be maintained through alternative communication links such as hospitals, FAA communications points and EMS agencies.

4. Staffing

All flights must be staffed by a minimum of two (2) aeromedical crewmembers one of who must be either a flight nurse or a flight physician. The medical director may select the second member at his discretion and may designate any additional personnel they choose.

C. FIXED WING-AIR AMBULANCE

1. Only fixed wing air ambulance services that possess, or have a contract with operators who possess, a current, valid Federal Aviation Regulations, Part 135 Certificate shall be eligible for an Arkansas Air Ambulance License.

2. Coordination Point-Each fixed wing air ambulance service shall have the following:

a. Minimum of one (1) incoming telephone line dedicated to emergency requests for the air ambulance service;

b. Personnel assigned to receive all dispatch and flight request information on behalf of the air ambulance service.

3. Staffing

All flights must be staffed by a minimum of one (1) medical crewmember that shall be a critical care nurse, flight physician, or other appropriate personnel selected by the medical director. The medical director may send any additional medical personnel at their discretion.

D. REGISTRATION OF AIR AMBULANCE UNITS

1. Purpose

An application for the issuance or renewal of an air ambulance unit permit shall be made on forms provided by the Department. The Department upon satisfactory completion of an annual inspection by the Department shall issue an air ambulance permit. A fee, as required by law or by regulations promulgated by the Department of Health, shall be required for each unit registered with the service.

2. Structural Requirements

a. Helicopter

1) The aircraft operator must comply with all Federal Aviation Regulations, Part 135, as it pertains to maintenance and inspections.

2) Each helicopter air ambulance must meet the following requirements:

a) The aircraft shall be configured to allow the medical crew to treat the patient including advanced life support procedures.

b) The aircraft shall be equipped with doors that allow safe loading and unloading of the patient without rotating the patient more than 30 degrees about the longitudinal axis or 45 degrees about the lateral axis.

c) The aircraft shall have proper climate control to prevent temperature extremes that would adversely affect patient care.

d) The aircraft must have adequate interior lighting of at least 40-candle power intensity in the patient compartment and must not interfere with the pilot's vision.

e) The patient must be sufficiently isolated from the pilot to minimize in-flight distractions or interference that would affect flight safety.

f) The aircraft must be equipped with appropriate survival equipment.

g) The aircraft must have headset communication between the pilot and each medical crewmember.

h) Litters, equipment, and attendant's seats should be so arranged as not to block rapid egress by personnel or patient from the aircraft.

i) Helicopter air ambulance permits may be issued only to aircraft operated by licensed helicopter air ambulance services.

b. Fixed Wing

1) The aircraft operator must comply with all Federal Aviation Regulations, Part 135, as it pertains to maintenance and inspections.

2) Each fixed wing air ambulance must meet the following structural requirements:

a) The aircraft shall be configured to allow the medical crew to treat the patient, including advanced life support procedures.

c) The upper surface of the litter must be at least 30 inches from the ceiling of the aircraft or the under surface of another litter. A conventional stretcher or litter must be at least 19 inches wide and 56 inches long.

d) The aircraft shall have proper climate control to prevent temperature extremes that would adversely affect patient care.

e) The aircraft must have adequate interior lighting of at least 40-candle power intensity in the patient compartment and without interfering with the pilot's vision.

f) The patient should be sufficiently isolated from the cockpit to minimize in-flight distractions and interference that would affect flight safety.

g) Litters, equipment, and attendant seats should be so arranged as not to block rapid egress by personnel or patient from the aircraft.

h) Fixed wing air ambulance permits may be issued only to aircraft operated by licensed fixed-wing air ambulance services.

3. MINIMUM EQUIPMENT REQUIREMENTS

A. Each air ambulance shall meet the minimum air ambulance equipment and drug specifications as recommended by the Governor's Advisory Council on EMS and approved by the Department.

B. Additional equipment and drugs may be carried at the discretion of the medical director of the service.

SECTION XIII. VIOLATIONS

A. Penalty

1. It shall be Departmental policy to suspend or revoke a service license, EMT certification, vehicle permit, EMT-Instructor status or authorized and accredited training site for failure to comply, maintain compliance with, or violation of any applicable provision, standard or requirement of Act 435 of 1975, as amended, or the rules and regulations promulgated thereunder.

a. Any violation made by a licensed ambulance service will be considered to be done by the organization as a whole and will affect the entire organization holding the license. Any administrative action taken will be taken against the organization, not the individual service license.

b. Any administrative action taken against a certified Emergency Medical Technician for violating these rules and regulations will be based on their EMT certification, relationship with a licensed ambulance service or both.

c. Three (3) formal citations during the license term for failure to comply with Arkansas Code 20-13-200 and any regulations promulgated by the Department of Health in regard to ambulance services shall result in revocation of the ambulance service license.

d. Any administrative action taken that results in the Suspension or Revocation of a Emergency Medical Technicians, ambulance services, EMT-Instructors and EMT training sites shall be reviewed by the Departments legal staff.

e. The following EMS Disciplinary policy is the standard which will be followed for actions against Emergency Medical Technicians, ambulance services, EMT-Instructors and EMT training sites when there have been proven violations of the current EMS Rules and Regulations:

WW - WRITTEN WARNINGP - PROBATIONS - SUSPENSIONR - REVOCATION

EMS PERSONNEL:

OFFENSES:	1st	2nd	3rd
Convicted, plead guilty or nolo contendre to any criminal offense listed in Act 666 of 1999	Concurrent	with	state law
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*.	R
Conviction of driving under the influence of alcohol or illegal drugs* while on duty, on emergency response or during patient transport	R
Misappropriation, stealing and/or embezzlement of EMS grants or equipment purchased under such grants	R
Immediate and intentional refusal to render care to the reasonable level of skill, prudence, caution and competence that could be expected under the circumstances while responding to a formal request for emergency medical care	S	R
Racial, sexual, religious, age, disability, etc. discrimination or harassment during the rendering of patient care, during EMS training or while on duty	S	R

*Includes pharmaceutical, narcotics, stimulants, depressants, prescription drugs, etc. which have been obtained illegally

OFFENSES:	1st	2nd	3rd
Threatening, intimidating or interfering with job performance of other EMS personnel while on an ambulance response or during the rendering of patient care	P	S	R
Failure to report substance abuse of on-duty EMS providers to the Office of EMS & Trauma Systems	P	S	R
Conviction of intentional violation of motor vehicle code while on duty during two (2) year certification period	P	S	R
Intentional falsification of facts on EMT Certification application	P	S	R
Cheating on an EMT Practical and/or Written Exam	P	S	R
Using equipment and/or performing procedures beyond the level of licensure of the ambulance service without medical control	P	S	R
Unauthorized release or divulgence of confidential information	P	S	R
Providing care as an EMT independent or with a licensed EMS service while having a lapsed certification	P	S	R
Fighting or creating a disturbance at the scene of an EMS Response	WW	P	S
Failure to respond or accept official departmental correspondence sent by certified mail except in cases were individual is out-of-state or has prolonged illness.	WW	P	S
AMBULANCE SERVICE:
Misappropriation, stealing and/or embezzlement of EMS grants or equipment purchased under such grants	s	R
Falsification of records related to ambulance service operations	s	R
Requiring EMS Personnel to violate EMT standards	s	R
Racial, sexual, religious, age, disability, etc. discrimination or harassment during the rendering of patient care, during EMS training, or while on duty	s	R
Conviction of violation of State and/or Federal law governing third party reimbursement	s	R
OFFENSES:	1st	2nd	3rd
Unauthorized release or divulgence of confidential information	P	S	R
Neglect of current EMS Rules and Regulations in regards to endangering the safety or welfare of patients and/or EMS Personnel due to failure to maintain compliance with appropriate level of licensure	P	S	R
Carrying and/or using equipment not approved by the Office for the licensure level	P	S	R
The failure to report substance abuse by EMS Providers while on duty to the Office of EMS & Trauma Systems**	P	S	R
Using an EMT who is lapsed or not Arkansas certified to meet the ambulance staffing requirements	WW	P	S
Failure to respond or accept official departmental correspondence sent by certified mail	WW	P	R
Failure to follow the manufacturers recommendations for the use of medical equipment in a manner which causes harm to the patient	WW	P	S
Conviction of violation of Federal Communications Commission (FCC) Rules and Regulations	Concurrent with Federal Laws
INSTRUCTORS:
Falsification by the instructor of facts on student paperwork/applications	S	R
Teaching an EMS related course that requires pre-approval from the Office without having the approval from the Office.	S	R
Abandonment of an approved EMT course	S	R
Failure to teach courses by National Standard Curriculum	P	s	R
Failure to observe recognized professional teaching standards	P	s	R
TRAINING SITES:
Misappropriation, stealing and/or embezzlement of EMS Grants or equipment purchased under such grants	S	R
**Includespharmaceutical, narcotics, stimulants, depressants, prescription drugs, etc.
OFFENSES:	1st	2nd	3rd
Falsification by the training site of records related to courses or training	S	R
Conduct or actions that results in harm to the health and safety of the student	P	S	R
Unauthorized release or divulgence of confidential student Information	P	S	R
Failure to meet and maintain the criteria for program approval as set by the Department	P	s	R
Failure to allow the Department to inspect, observe, or evaluate programs, including program personnel, facilities, classes, and clinical practice sessions	WW	p	S
Use of training personnel not competent for the type of training offered	WW	p	S
Failure to observe recognized professional standards in the course content and operation of the training program	WW	p	s
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	WW	p	s
Failure to offer training consistent with the approved application	WW	p	s

2. Any person who knowingly or willfully violates these rules and regulations may be guilty of a misdemeanor and shall be punished by a fine of not more than $100.00 or by imprisonment for a period not to exceed 30 days in the county jail or both such fine and imprisonment.

3. Any demonstration of incompetence, knowingly or willfully violating these rules and regulations or other inability to provide adequate service shall subject a service licensee or certified EMT, to Departmental corrective action which may result in written warning, probation, suspension or revocation of a service license vehicle permit, EMT certificate, Instructor status or training-site license.

4. Any non-certified person found violating these rules and regulations may be prohibited from obtaining Arkansas State Certification for one (1) year. If such person does obtain Arkansas State certification after one (1) year, they will be placed on Probation for their first two (2) year certification period.

B. Department Hearing and Procedures

1. It shall be Departmental policy to use its discretionary right to consider all available information that is relevant and material.

2. The Office shall reserve the right to refrain from investigating complaints alleging violation until the complaint is reduced in writing and filed with the Department stating the nature of the alleged violation, the date, and the name of the person submitting the complaint.

3. If the Office's investigation concludes that the charges brought against a licensed service or certified EMT are warranted, the matter shall be brought before the Department following the current Administrative Rules Process adopted by the State of Arkanas.

4. In Informal Departmental hearings a person may appear in person and represent himself, or be represented by an Attorney at Law.

5. Two types of hearings

a. Informal - those normally held for the purpose of obtaining necessary or useful information before the Office.

b. Formal - those held for the purpose of adjudication of rights before the Department.

6. Where, in the opinion of the Department, the public's health, interest, or safety is jeopardized, or the failure to be in compliance is willful, the Department may temporarily suspend the license of a service or the certificate of an EMT until the matter is decided by the Department.

7. In all administrative enforcement and appeal procedures thereunder, it shall be in accordance with the Arkansas Administrative Procedures Act and Amendments thereto.

SECTION XIV. SEVERABILITY

If any provision of these Rules and Regulations, or the application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or applications of these Rules and Regulations which can give effect without the invalid provisions or applications, and to this end the provisions hereto are declared to be severable.

SECTION XV. REPEAL

All Regulations and parts of Regulations in conflict herewith are hereby repealed.

CERTIFICATION

This will certify that the foregoing Rules and Regulations Pertaining to Emergency Medical Services were adopted by the Arkansas State Board of Health at a regular board session held in Little Rock, Arkansas, on the 24 th. day of April, 2008.

Paul K. Halverson, DrPH, FACHE Secretary, Arkansas State Board of Health Director, Arkansas Department of Health

The foregoing Rules and Regulations having been filed in my Office are hereby in compliance with the Administrative Procedures Act on this 28 th day of May, 2008.

Mike Beebe Governor

007.28.08 Ark. Code R. 001

6/4/2008