216 R.I. Code R. 216-RICR-20-10-2.7

Current through December 26, 2024

Section 216-RICR-20-10-2.7 - Ambulance Services

A. Ambulance services shall be licensed at the following levels:

1. Class A: Advanced life support (ALS)

2. Class B: Basic life support only (BLS)

3. Class C: EMR

B. Requirements for initial and renewal licensure of ambulance services:

1. The applicant for an ambulance service license must be the entity responsible for its governance, and the license is not transferable among entities.

2. A license will immediately become null and void and must be returned to RIDOH when service is discontinued or when any changes in ownership occur pursuant to R.I. Gen. Laws § 23-4.1-6(f).

3. The license must be posted in a conspicuous place in the ambulance service central office.

4. Identify the individual or individuals, which may include existing staff, who fulfill the following functions:

a. Emergency Medical Services Chief of Service: the individual who is the lead administrator of the ambulance service

b. Emergency Medical Services Communications Coordinator: the individual who ensures that all communications equipment is functional and meets RIDOH standards

c. Emergency Medical Services Continuous Quality Improvement Coordinator: the individual who oversees the quality improvement program in conjunction with the Medical Director of the service

d. Emergency Medical Services Coordinator: the individual who directs and coordinates all EMS activities within an ambulance service. This function must be staffed by an emergency medical services practitioner or practitioners in accordance with the level of Emergency Medical Services (pursuant to § 2.8(A) of this Part) provided.

e. Emergency Medical Services Data Manager: the individual who reviews the EMS data for completeness and accuracy, and submits data to RI EMS Information System within the required timeframe

f. Emergency Medical Services Inspection Contact: the individual who ensures compliance with inspection requirements

g. Emergency Medical Service Pediatric Emergency Care Coordinator (PECC): the individual who ensures that the ambulance service and its providers are prepared to care for ill and injured children

h. Emergency Medical Services Training Coordinator: the individual who ensures that all RIDOH, NREMT, and ambulance service training requirements are met

i. Emergency Medical Service Medical Director: the individual who is a physician board-certified or board-eligible in emergency medicine and/or EMS

5. Each ambulance service must have written policies and procedures that are consistent with accepted standards of EMS care and standing orders, guidelines for the operation of the service, and the maintenance of the ambulances. These policies must be comprehensive in nature, must reflect day-to-day operations, and must address subjects to include, but not be limited to:

a. The service's responsibility to ensure all personnel maintain licensure

b. An orientation and training plan for all new ambulance service personnel

c. Assurance of compliance with pre-employment immunization and testing requirements

d. Agreements for mutual aid, including policies for when mutual aid is to be used

e. Procedures for dispatching ambulances and related communications including pre-arrival instructions when applicable

f. Procedures for stocking medications, supplies, and equipment

g. Policies for use of lights and sirens

h. Adherence to minimum staffing requirements and duties

i. Addressing mechanical failure of vehicles or equipment

j. Cooperation with inspection authorities

k. Policies for infection control

l. Maintenance of mechanical and biomedical equipment and devices in accordance with manufacturers' recommendations

m. Acquisition, security and disposal of controlled substances and other drugs in accordance with applicable Federal and State Regulations

n. Resolution of complaints

o. Media relations

p. Utilization of the National Incident Management System (NIMS)

6. Private ground ambulance services must have the following minimum insurance coverage types and limit requirements at all times.

a. General liability insurance with limits of not less than one million dollars ($1,000,000.00) per each occurrence and two million dollars ($2,000,000.00) in the aggregate.

b. Automobile liability insurance with limits of not less than one million dollars ($1,000,000.00) per each accident, and must include all vehicles used by the applicant.

c. Professional liability insurance covering errors and omissions with limits of not less than one million dollars ($1,000,000.00) per each claim and two million dollars ($2,000,000.00) in the aggregate.

d. Workers compensation insurance with statutory limits of coverage with employer liability limits of five hundred thousand dollars ($500,000.00) per each accident, disease limits of five hundred thousand dollars ($500,000.00) per each employee, and disease policy limit of five hundred thousand dollars ($500,000.00).

7. Ground ambulance services must have a secure, temperature-controlled garage to house all ambulance vehicles when not in use.

8. Each licensed ambulance service must implement a continuous quality improvement program to assess, monitor, and evaluate the quality of patient care.

9. Pay the application fee stated in the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health (Part 10-05-2 of this Title), if applicable.

10. Any other information required by RIDOH

C. Availability of Ambulance Services

1. An ambulance service licensed in Rhode Island must be available to provide ambulance services on a twenty-four hour (24) basis, seven (7) days a week.

2. Services must be provided either directly or under a written agreement with other licensed ambulance services. If agreements are made, a copy of the agreement must be submitted to RIDOH.

D. Ambulance Service Reporting Requirements

1. An ambulance service must maintain appropriate personnel and administrative records, and electronic patient care reports. All data must be reported to RIDOH in an electronic format. Records include the following:

a. Evidence of training and continued competency education

b. Maintenance records for each licensed ambulance

c. Record for each licensed ambulance including a list of equipment, and other essential data

d. Maintenance and scheduled service records for medical devices as required by the manufacturer, including cardiac monitors/defibrillators, stretchers, and stair chairs

2. An ambulance service must report changes in administrative staff to RIDOH within five (5) business days.

3. Electronic patient care reports (ePCR)

a. RIDOH-approved electronic patient care reports for all ambulance calls must be completed.

b. All electronic patient care reports must meet the standards of the National Emergency Medical Services Information System (NEMSIS) and the Rhode Island Emergency Medical Services Information System (RIEMSIS). RIDOH will determine the NEMSIS version that is applicable and any State-mandated data fields.

c. Electronic patient care reports must be posted to RIEMSIS within two (2) hours of completion of the incident, i.e. transportation to the destination, by the responding EMS personnel.

d. A digital and paper copy of the completed patient care report for each patient transported to a hospital emergency facility must be left with and promptly available to a designated representative of the receiving facility, who will sign the report upon receipt of the patient, indicating a transfer of care. A copy of the patient care report must be retained by the receiving hospital, the ambulance service, and RIDOH.

4. Reportable Events a. An ambulance service must file a written report with RIDOH within seventy-two hours (72) of the following reportable events involving its service, personnel, or property:

(1) Fire affecting an ambulance or service place of business

(2) Theft of an ambulance

(3) Loss, theft or tampering with any controlled substances, drug delivery devices, or other regulated medical devices and equipment from an agency facility or ambulance

(4) An accident involving personal injury or property damage more than one thousand dollars ($1,000.00) and in which a report is required under the provisions of R.I. Gen. Laws § 31-26-6

(5) Kidnapping or elopement of a patient

(6) More than a thirty minute (30) delay between the time of arrival at a healthcare facility and transfer of care to a healthcare provider at the receiving facility

(7) Pending or actual labor disputes or actions which would impact delivery of EMS services including, but not limited to, strikes, walk-outs and strike notices. Services must provide a plan, acceptable to the RIDOH, for continued operation of the service, suspension of operations, or closure in the event of such actual or potential labor dispute or action.

5. Reportable Incidents

a. An ambulance service must file a written report with RIDOH within five (5) days of the following reportable incidents involving its service, personnel, or property that result in serious injury, illness or death to a patient not ordinarily expected as a result of the patient's condition. These incidents include, but are not limited to, the following:

(1) Medication errors

(2) Deviation from medical standing orders

(3) Major medical device failures

(4) Major communications device failures

6. Ambulance Service Closure

a. An ambulance service must inform RIDOH in writing of its intent to close at least ninety (90) days prior to its closure.

b. The ambulance service must develop a written closure plan to include:

(1) The date the agency will cease operations

(2) Steps to ensure adequate staffing throughout the closure process

(3) A process for the disposition of properties, vehicles, equipment, supplies, and assets

(4) Steps to dispose of any pharmaceutical, biological, and chemical products and waste

(5) A process to assure transfer of any contracts to another ambulance service after closure

E. Controlled substances

1. An ambulance service licensed as Class A-1C, A-1P, A-2C or A-2P Advanced Life Support must maintain current registration with:

a. RIDOH, in accordance with the Rhode Island Uniform Controlled Substances Act, R.I. Gen Laws Chapter 21-28, and

b. U.S. Department of Justice Drug Enforcement Administration.

216 R.I. Code R. 216-RICR-20-10-2.7

Adopted effective 12/27/2018
Amended effective 12/27/2020