Arkansas Administrative Code
Agency 007 - Arkansas Department of Health
Division 03 - Emergency Health Services
Rule 007.03.15-001 - Rules and Regulations for Emergency Medical Services

1. Patient's choice of nearest appropriate medical facility

A licensed ambulance service may transport any patient to the care facility of the patient's choice if the licensee considers service area limitations and subject to applicable federal law and the licensee's local protocol. If the patient is unable to make a choice, and if the attending physician is present and has expressed a choice of care facility, the licensee may comply with the attending physician's choice if the licensee considers service area limitations and subject to applicable federal law. If the patient is unable to make a choice, or if the attending physician is not present or has not expressed a choice of facility the licensee may transport the patient to the nearest appropriate care facility subject to applicable federal law.

2. Reports to the Medical Health Care Facility or Emergency Medical Receiving Facility

Each ground & air ambulance service shall notify the receiving Medical Health Care Facility or Emergency Medical Receiving Facility by radio or by a means agreed upon by the receiving facility in the event the radio is unavailable. The notification shall include at minimum impending arrival, patient condition and care rendered to the patient.

The ambulance service shall at the time of transfer of care leave a completed Encounter Form or a completed Short Form. If a Short Form is left with the

Receiving Facility the ambulance service shall submit a completed Encounter Form to the receiving facility within twenty-four (24) hours from transfer of care. The Department may inspect the patient encounter forms of any Service covered by these rules.

3. Reports to the Department

Each licensee shall report EMS data, as required by the Department for every request that results in the dispatch of a vehicle. All submissions shall be complete, reflect accurate information and submitted to the Department by the last day of the subsequent month following the dispatch date. All Services shall have an audit process to ensure that each run has been submitted and that data being submitted is complete and accurate.

4. Insurance Requirements

Each licensee shall have in force and effect general liability insurance coverage, and liability insurance coverage for each vehicle owned and operated by or for the applicant or licensee. All policies shall be issued by an insurance company licensed to do business in the State of Arkansas. Proof of current general liability insurance and coverage for each vehicle shall be submitted to the Department on initial application or renewal of Service license. Each air ambulance service shall have in force and effect liability insurance coverage for each aircraft owned and operated by or for the applicant or licensee as required by the FAA. The Service shall maintain evidence of proof of current liability insurance coverage for each aircraft. A license holder shall immediately notify the Department and cease operations if the coverage required by this section is cancelled or suspended.

5. Service License

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

Each licensee, including air ambulance services, shall be required to obtain a separate service license in each county the ambulance service has an operational base.

Each Service shall display a copy of the ambulance service license in a prominent location on the premises of the ambulance services operational base at all times

6. Issuance of licenses

All documentation and applicable fees must be submitted to the Department prior to any license being issued. No license shall be issued until all licensure requirements have been met.

7. Transferability of License

Service licenses shall only be transferable if all initial licensure paperwork fees are submitted to the Section prior to operation, unless otherwise approved by the Department.

8. Change in Information

Service licenses holders shall notify the Department by certified mail within ten (10) days after any of the information contained in the application changes or becomes inaccurate.

9. Advertising

An ambulance service shall not advertise to the general public, skills, procedures, staffing or personnel licensure levels which cannot be provided on every emergency request, twenty-four (24) hours a day, seven (7) days a week.

10. Service Area

The service area of each licensed ambulance service shall be clearly identified on a map provided by the Department and submitted annually to the Department. A licensed Service may cross county lines to serve a portion of an adjoining county with an agreement with the licensed

Service(s) in the adjoining county, and in accordance with written contracts or agreements between the ambulance service and city/county governments as they may exist. This agreement shall be submitted to the Department annually with the service area map. This excludes Air Ambulance Services.

11. Securing Patients

An ambulance service shall only transport patients who are properly secured based upon the ambulance manufactures' recommendations.

12. Intercepts

An Intercept can be requested by the in-charge lead emergency medical services personnel of the transporting ambulance if the patient's condition dictates.

13. Patient Consent

14. Prohibition

Ambulance services shall not carry nor dispense any drugs or medications or perform any procedure that is outside of the EMSP's Scope of Practice.

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

Ambulances service shall contact the Department prior to deploying or sending any Arkansas permitted ambulances to another state(s) to fulfill obligations of a state/federal/private contract or agreement for a disaster. Ambulance service shall contact the Department during regular business hours or the Department Emergency Communication Center after hours.

16. Mutual Aid

A pre-arranged mutual aid agreement with another Arkansas Licensed Service shall be in place or by activation of a mass casualty incident through the Department.

17. Primary Responder(s)

Ground ambulance services are the primary pre-hospital emergency responder for each emergency scene request within their service area. Air ambulance services are considered secondary emergency responders when requested by a patient, bystander, or responders at the scene. If an air ambulance service is notified by a patient, bystander, or responder prior to arrival of ground ambulance service, the air ambulance service shall immediately activate the ground ambulance service within that service area.

18. Transportation of non-patient care equipment

Items not related to patient care may only be transported in an ambulance that is considered out of service, this excludes service / guide dogs as defined by Arkansas Code Annotated § 20-14-308.

1. Licensed Paramedic Services shall have fifty percent (50%) or more ambulances permitted at the Paramedic level. Only licensed Paramedic Services may operate Paramedic ambulances.

2. Licensed Advanced EMT Services shall have fifty percent (50%) or more ambulances permitted at the Advanced EMT level. Only Advanced EMT and Paramedic Services may operate Advanced EMT ambulances.

3. Licensed EMT Services shall have ambulances permitted only at the EMT level. Paramedic and Advanced EMT Services may also operate EMT ambulances.

4. Licensed Advanced Response Services shall only have vehicles permitted at the Advanced Response level.

4. Licensed EMT Specialty Services shall only have ambulances permitted at the EMT Specialty Level.

5. Licensed EMT Volunteer Services shall only have ambulances permitted at the EMT Volunteer Level.

6. Licensed Medical Facility Transport Services shall have ambulances permitted as a Stretcher ambulance.

*Paramedic. Advanced EMT and EMT Services max not license EMT-Specialtv. EMT-Volunteer or Stretcher Ambulances

1. A licensed ambulance service with multiple levels of permitted vehicles shall respond to each emergency requests with the highest permitted vehicle at the time of the request until those resources are depleted or are not available.

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

3. Each licensed EMS service shall have a Medical Director. This Medical Director must provide the Drug Enforcement Agency license for the service.

EMT, EMT-Specialty and EMT-Volunteer licensed services administering or carrying medications will be granted six months from the effective date of this Rules to comply with the Medical Director requirements. The medical director shall:

4. Written protocols shall be reviewed annually by the services Medical Director (if applicable) and prior to implementation of new protocols.

5. EMS Services participating in EMSP field/clinical times shall ensure that students are at all times under the direct supervision of an Arkansas licensed EMSP at or above the level of the EMSP's course of training.

6. Each licensed emergency medical services personnel shall conduct a quality assurance program. The quality assurance program shall evaluate patient care and personnel performance for compliance with the current standards of practice as set forth in the services medical protocols, regulations, and standards of Emergency Medical Services scope of practice. Reviews should be conducted at least quarterly, to assess, monitor, and evaluate the quality of patient care provided. Documentation for the quality assurance program and review shall include the following:

7. Any authorized representative of the Department shall have the right to enter the premises of any service or permitted ambulance at any time in order to make whatever inspection necessary in accordance with the minimum standards and regulations prescribed herein. Each service shall maintain and make available (during normal business hours) to the Department for inspection records including, but not limited to:

1. Licensed Paramedic Services shall:

2. Licensed Advanced EMT Services shall:

3. Licensed EMT Services shall:

4. Licensed Advanced Response Services shall:

5. Licensed EMT Specialty Service:

6. Licensed EMT Volunteer Service:

7. Licensed Medical Facility Transport Service

1. Each vehicle of a licensed ground ambulance service shall be issued a permit in one of the classifications set forth below.

2. A vehicle may not be permitted by the Department or operated as an ambulance prior to the submission and approval of all required documentation, fees and a Department inspection.

3. Vehicles must meet applicable requirements set forth in these Rules prior to receiving or retaining a vehicle permit.

4. Permits shall be for a period not to exceed one (1) year.

5. New ambulances replacing a permitted vehicle or being added to an existing service license must be inspected and permitted prior to being placed in service.

6. Any medical equipment carried on an ambulance outside the approved equipment list, shall have prior written approval by the Department. No equipment or supplies shall be carried on an ambulance which would permit an EMSP to render care beyond the scope of practice and/or violate these Rules.

7. Ambulances used for the transportation of patients must have supplies and equipment for the protection of personnel and patients from infectious diseases and for personal safety.

8. Ambulances shall be equipped with fasteners of the quick-release type to secure the cot to the floor or side walls that meet Ambulance Manufacturing Division (AMD) standard 004. Stretcher mounts must be capable of fastening the stretcher to the vehicle to prevent any movement of the stretcher when in its fastened position.

9. Only ambulances of a Paramedic or Advanced EMT Service shall be equipped with ALS Equipment unless a prior request for an upgrade has been made and approved by the department.

10. Temporary upgrades and downgrades of permitted ambulances are for mechanical reasons only and must be for a temporary period of time. Notice shall be made in writing on approved forms to the Department prior to any changes in equipment or staffing of permitted ambulances. Upgrades and downgrades are not permitted for the purposes of staffing. Permanent upgrades and downgrades shall follow the same guidelines as a new vehicle permit.

11. Each permitted ambulance must have the ambulance service name clearly displayed in contrasting color(s) on each side and rear of the ambulance such that it is easily identifiable by the general public. The following identifiers shall also be displayed in contrasting color(s)*:

The following identifiers may also be displayed in contrasting color(s):

12. Each ambulance shall be equipped with a siren capable of emitting sound audible under normal conditions from a distance of not less than five hundred feet (500'). The warning device shall not be used except when the ambulance is operated in response to an emergency call. (Reference Arkansas Code Annotated § 27-37-202) * Stretcher ambulances may not be equipped with audible warning devices.

13. Each ambulance shall be equipped with an emergency lighting system that shall provide 360 degrees of conspicuity for safety during all missions. This includes at a minimum, a flashing emergency light bar, two (2) alternating flashing red lights located at the same level on the front and sides and to the rear two (2) alternating flashing red lights located at the same level. These lights shall have sufficient intensity to be visible at five hundred feet (500') in normal sunlight.

* Stretcher ambulances may not be equipped with warning lights.

14. All lighting, both interior and exterior, shall be fully operational, including lens caps.

15. Electrically powered suction aspirator systems shall be installed and fully functional.

16. Each ambulance shall be equipped with a minimum of one (1) fire extinguisher.

17. Each ambulance shall be equipped with a backup alert alarm, (audible warning device) activated when the vehicle is shifted into reverse and a load management system to ensure power to essential patient care equipment is protected.

18. All designated seating positions in the patient compartment shall be equipped with safety restraint systems appropriate for each type of seating configuration and shall be fully operational. There shall be no less than 43" of seat to ceiling space for all personnel sitting positions.

19. All oxygen tanks shall be secured, with the main oxygen tanks regulator indicating the cylinder pressure visible from within the patient compartment. The O2 tank retention system shall meet AMD standard 003. Oxygen must be medical grade and contain at least 500 PSI at all times.

20. Each permitted ambulance shall have two-way direct communication with dispatch centers and/or base stations, other emergency medical service vehicles and receiving hospitals. The following frequencies are mandated:

155.280 MHz

155.235 MHz

155.340 MHz

All permitted ambulances of licensed services that are participating in the Trauma System must have a Trauma AWIN radio that is in operating condition.

21. All ambulances permitted by the Department shall carry the minimum approved supplies and equipment for the level of licensure of the ambulance. All equipment and supplies shall be clean, sanitary and in good working order. *See Appendix 1

22. Each ambulance shall have no structural or functional defects that may adversely affect the patient, EMS personnel, or the safe operation of the vehicle to include steering systems, brakes and seatbelts.

23. Tires shall be appropriate for the gross vehicle weight of the vehicle and shall not be damaged or have excessive tread wear.

24. The ambulance exhaust system, as well as the gaskets surrounding the vehicles exterior doors and windows shall be in good condition and free of leaks and the vehicle exhaust system shall extend beyond the sides of the patient compartment and away from doors.

25. The patient compartment of all ambulances shall be adequately heated, air-conditioned, and ventilated.

26. The interior of the ambulance and the equipment therein shall be maintained in a manner that is safe, clean, and in good working order at all times.

27. Each ambulance shall be equipped with functioning windshield wipers.

28. All doors and door latches both inside and outside of the vehicle shall be fully functional.

29. Licensed services shall ensure that all outdated, misbranded, adulterated or deteriorated fluids, supplies and medications are removed from an ambulance immediately.

30. The interior of the ambulance, including all storage areas, must be kept clean so as to be free from dirt, grease, and other offensive or contaminated matter.

31. The Department may, at its sole discretion, inspect each licensed ambulance subject to the requirements of these rules and regulations. The Department may inspect an ambulance or its maintenance records at any time or place to determine if the ambulance is being operated safely and in compliance with these regulations.

32. Each vehicle shall meet the basic medical and extrication equipment requirements. If an ambulance service does not provide extrication services a letter shall be submitted to the Department from an agency that provides extrication capabilities within the service area of the ambulance service. The letter shall be submitted with the ambulance services initial and annual renewal application.

33. Each permitted vehicle shall keep a current copy of the services approved offline medical control protocols in the ambulance at all times.

34. Licensee shall perform only those skills at the level of the permitted vehicle.

1. Paramedic Permitted Ambulances

2. Advanced EMT Permitted Ambulances

3. EMT Permitted Ambulances

4. Advanced Response Permitted Vehicles

5. EMT-Volunteer Permitted Ambulances

6. EMT-Specialty Permitted Ambulances

7. Permitted Stretcher Ambulances

1. Each vehicle of a licensed air ambulance service shall be issued a permit in one of the classifications set forth below.

1. A vehicle may not be operated as an ambulance prior to the application and receipt of a permit issued by the Department

2. Permits shall be for a period not to exceed one (1) year.

3. Each licensee shall have a current Federal Aviation Administration (FAA) FAR Part 135 Air Carrier Certificate.

4. 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.

5. Air ambulance services based outside of Arkansas that do hospital to hospital transports (including emergency scene flights and hospital to hospital transfers within the State of Arkansas) shall be subject to the requirements of these regulations, in conjunction with other state's applicable rules when appropriate.

6. Each air ambulance service shall have and maintain a coordination point, 24 hours a day, 7 days a week.

7. Each air ambulance must have radio capability to communicate air-to-air and air-to-ground and the ability to communications with physicians who are responsible for directing patient care in transit, and with ground personnel who coordinate the transfer of the patient.

8. Each air ambulance shall contact the referring and receiving medical facilities or ground scene personnel, when within radio range, giving them the estimated time of arrival and when on final approach. Otherwise, the coordination point shall have this responsibility.

9. The following information shall be logged for all flights:

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

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

12. Each Air Ambulance Service shall have a Medical Director. This Medical Director shall provide the Drug Enforcement Agency registration for the service. The Medical Director shall:

13. Each Service shall maintain a register of legend drugs to include type, quantity, date received, date of expiration and physician authorizing purchase and usage. See Section XIV. E.

14. Each Service shall maintain a copy of the Department approved Medication Policy and Procedure which meets the requirements of the Arkansas Department of Health Pharmacy Services and Drug Control.

15. Each permitted aircraft shall keep a current copy of the services approved offline medical control protocols in the aircraft at all times.

16. Quality Assurance Program for Licensed Ambulance Services

All licensed emergency medical services personnel shall conduct a quality assurance program. The quality assurance program shall evaluate patient care and personnel performance for compliance with the current standards of practice as set forth in the services medical protocols, regulations, and standards of Emergency Medical Services scope of practice. Reviews should be conducted at least quarterly, to assess, monitor, and evaluate the quality of patient care provided. Documentation for the quality assurance program and review shall include the following:

17. Any authorized representative of the Department shall have the right to enter the premises of any service or permitted ambulance at any time in order to make whatever inspection necessary in accordance with the minimum standards and regulations prescribed herein. Each service shall maintain and make available to the Department for inspection records including, but not limited to:

1. Each Rotor-Wing and Rotor-Wing Specialty ambulances shall have:

2. Each Fixed-Wing ambulance shall have:

1. Air Ambulance Vehicles Shall:

1. Rotor-Wing and Rotor-Wing Specialty Vehicles Shall:

2. Fixed-Wing Vehicles Shall:

1. Rotor-Wing

2. Rotor-Wing Specialty

3. Fixed-Wing

1. Minimum Orientation and Recurrent Training in the Following Areas:

1. High Risk Obstetrical

2. Neonatal Transport

1. Minimum Orientation and Recurrent Training in the Following Areas:

1. Minimum Orientation and Recurrent Training in the following areas:

1. Minimum Initial and Recurrent Training in the Following Areas:

1. Documentation showing completion of all recurrent training as outlined in Section VII. E. -I shall be submitted to the Department annually with the Air Ambulance Service license renewal for all licensed EMT and Communication Specialists.

1. The following must be submitted to the Section for review and approval prior to implementation of this practice:

2. An Advanced EMT or Paramedic 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:

1. Procedures and skills for all EMSP licensure levels

2. The following are procedures and skills for Only Advanced EMTs and Paramedics

3. The following are procedures and skills for Only Paramedics

1. The Department shall issue the following types of licenses:

2. Fees

An application for the initial issuance of a license shall be made on forms provided by the Department, and shall be accompanied by a $20 fee set forth by Arkansas Code Ann. § 20-13-211.

3. Certification and Licensure Cards

Each EMSP shall have the Arkansas EMSP licensure card issued by the Department on their person at all times while on duty or have the ability to contact their EMS service for licensure verification. All paramedics shall maintain ACLS certification throughout their licensure period. All licensure levels shall maintain current CPR certification during their license period. Each Service shall have readily available a copy of all current licensure and certification cards for all employees.

4. Criminal History Form

Any applicant applying for initial licensure shall complete a State and/or Federal criminal history check.

1. Paramedic

2. Advanced Emergency Medical Technician

3. Emergency Medical Technician

1. All individuals applying for renewal of a license shall submit the following to the Department:

2. Specific Renewal Requirements by EMS Level

3. EMSP - Instructor Renewal Requirements:

EMSP Instructor licensure is for a two (2) year period to run concurrent with the current EMSP level of licensure.

The following must be completed and submitted for ALL Instructors:

4. EMSP relicensure applications submitted after expiration date

1. EMT

2. Advanced EMT

3. Paramedic

4. All licensed EMSP levels

1. Extensions will only be considered if the licensee submits a letter and documentation to the Department no later than thirty (30) days prior to the EMSP's expiration date requesting an extension. The letter must include the reason(s) the extension is being requested. Extensions will be considered for the following reasons:

2. Extension Decisions:

1. General Standards for reciprocity:

2. Military Personnel

Military trained personnel will be eligible for EMT Licensure ONLY, unless documentation is submitted showing completion of an accredited AEMT or Paramedic course including all didactic, clinical and field internship requirements.

3. EMSP's previously licensed in Arkansas that hold a current NREMT Card

1. All instructor requirements remain the same as if the course is conducted at the EMS Education Program.

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

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

1. Meet Arkansas requirements as listed in the Arkansas Site Accreditation Manual

2. Submit their application and site review to the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP), and

3. Be awaiting the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) site visit.

Full accreditation by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) and Committee on Allied Health Education and Accreditation (CAHEA) shall be attained or be in the process of accreditation as documented by a letter from CoAEMSP prior to authorization of the subsequent class.

1. be sponsored by an EMS Education Program

2. be approved prior to starting any training

3. have an agenda/course outline submitted with the course approval application

1. Advanced EMT and Paramedic psychomotor testing will follow the guidelines outlined in the National Registry Exam Coordinator Manuals. Any deviation from these requirements must be approved by the National Registry in writing prior to the exam.

2. EMT psychomotor testing will follow all guidelines outlined in the Sections Psychomotor Skills Exam Coordinator Manual. Any deviation from these requirements must be approved by the department in writing prior to the exam.

1. All current Arkansas Paramedic EMS Education Programs must complete one of the following prior to starting and Paramedic Education:

1. Paramedic curriculum, evaluations, clinical and field internship will be developed and approved by the accredited EMS education facility

2. The Department shall approve all Paramedic courses and EMS Education Program locations prior to the beginning of any period of instruction.

3. Paramedic programs must obtain and maintain accreditation by the National Accreditation Agency, the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP)

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

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. Medical Facility training

7. Field Internship

8. Only those students from CoAEMSP accredited programs and recommended by their instructor and Medical Director will be allowed to challenge the NREMT certification examination and obtain an Arkansas EMS license.

9. There must be a Medical Director designated, having emergency department experience, who meets the requirements in Section I and documents current Advanced Cardiac Life Support credentials or is Board certified or board eligible by the American Board of Emergency Medicine or by the American Board of Osteopathic Medicine or Licensed in Emergency Medicine.

1. Advanced EMT curriculum, evaluations, clinical and field internships will be developed and approved by the Department accredited EMS education facility.

2. The Department shall approve all Advanced EMT courses and training sites prior to the beginning of any periods of instruction.

3. Advanced EMT training may be sponsored only by a higher education institution that has affiliation with an Arkansas licensed hospital.

4. Primary Instructors must be either Arkansas licensed physicians, or EMS Instructor at the AEMT level or higher.

5. Advanced EMT Training Sites must follow AEMT policies as set forth in the Arkansas Advanced Accreditation Manual

6. The Department will review the course of instruction and minimum recommended number of hours of total instruction.

7. 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.

8. Only those students from an accredited EMS educational facility and recommended by their instructor and Medical Director will be allowed to challenge the NREMT certification examination.

9. There must be a Medical Director designated, having emergency department experience, who meets the requirements in Section I.F..

10. Field Internship

1. The Department shall approve all EMT courses and EMS Education Program locations (not previously approved) prior to the beginning of any periods of instruction.

2. EMT training may be sponsored only by a higher education institution that is affiliated with an Arkansas licensed hospital or a Department approved EMS Education Program.

3. Primary Instructors must be either Arkansas licensed physicians or licensed EMSP Instructors.

4. The Department will review the course of instruction and minimum number of hours of total instruction prior to the course starting.

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 an accredited EMS educational facility that have successfully completed all course requirements as documented by the instructor and Medical Director will be allowed to challenge the NREMT certification examination.

7. There must be a Medical Director designated for the training facility having provided care in an emergency room and meets the requirements in Section I.

8. Medical Facility Training

9. Field Internship

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

2. The EMS-Instructor Trainer must submit the following information to the Department:

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 EMS-Instructor course will be responsible for completing the requirements outlined in the Requirements for Arkansas EMS-Instructor Certification for their level of EMT certification.

1. Pre-requisites for beginning an education program

2. Pre-requisites for field/clinical participation

3. Pre-requisites for testing

4. Licensure requirements

1. Pre-requisites for beginning education program

2. Pre-requisites for field/clinical participation

3. Pre-requisites for testing

4. Licensure requirements

Successfully complete the NREMT Advanced EMT certification examination including both didactic and psychomotor exams.

1. Licensure requirements

1. Instructor licensure will run concurrent with the current EMSP expiration date.

2. Instructor Candidate Education Requirements

3. Upon completion of the Instructor requirements listed above, 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. Failure to complete these requirements within the twelve (12) month period will have to complete the instructor course:

1. Advanced EMTs who apply to teach an Advanced EMT course must complete the following:

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

1. All of the following eligibility requirements must be met for Instructors to become an EMSP Educator Trainer:

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 (prescription) drugs on-board all registered vehicles. Schedule II drugs have a separate requirement for security that also must be complied with by the licensee.

3. All controlled substances shall be stored under a mounted double lock security. All other prescription drugs shall be stored under a single lock security

1. Each Licensed Ambulance Service or Medical Director shall notify the Office of Pharmacy Services and Drug Control, Arkansas Department of Health immediately upon discovery of any suspected loss, theft and/or other diversion of any controlled substance under their supervision. Additionally, 21 CFR Part 1301.74 (c) requires notification of the Field Division Office of the Drug Enforcement Administration (DEA) in writing within one business day of discovery of the theft or loss.

2. The original and one copy of the DEA Form 106 shall be sent to the DEA Resident Office and one copy shall be sent to the Pharmacy Services and Drug Control within seven days.

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

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.

5. Patient medication records shall consist of at least, (a) physician's order authorizing the dispensing and administration of medications (Standing Orders), (b) medication administration record indicating the date, time and signature of the Paramedic or other licensed healthcare provider administering controlled drugs to the patient, and (c) the Paramedic or other licensed healthcare provider 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 Paramedic or other licensed healthcare provider administering the drug.

6. In addition to patient's medical records, a record of the procurement and disposition of controlled drugs 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 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 Paramedic or other licensed healthcare provider who wasted the drug and verified by the signature of a licensed healthcare provider and/or licensed Paramedic 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 licensed ambulance 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 Section of EMS.

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 Slot-25, Little Rock, AR 72205-3867, OR

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

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

2. Procedures for registration of the ambulance service 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.

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.

1. The immediate needs of the patient cannot be met in the sending facility due to lack of capability or capacity;

and

2. The patient's condition is such that failure to meet the immediate needs will likely result in loss of life, limb, fertility or permanent impairment that transfer to a higher level of care could potentially ameliorate.

The hospital seeking the urgent trauma transfer shall contact the ATCC to provide patient condition information and to obtain concurrence with the urgent trauma transfer classification. All urgent trauma transfers shall prompt involvement of the medical director of ATCC in real time. The medical director shall verify the urgent nature of the transfer and concur there is reasonable evidence the two conditions of an urgent trauma transfer are met. If the above conditions are met and concurrence from ATCC is obtained, this transfer qualifies as an urgent trauma transfer.

Once the ATCC confirms the patient meets the criteria for urgent trauma transfer, the ATCC shall contact the EMS Service identified by the transferring hospital to coordinate pick up. The ATCC shall confirm with the transferring hospital the time the patient will be ready for pick-up and communicate that to the EMS Service. The sending hospital should contact the EMS Service designated on the ATCC dashboard early in the process to allow the Service as much advance notice as possible of the impending urgent transfer.

If the EMS Service cannot be at the transferring hospital by the agreed upon time, a backfill Service shall be contacted by the EMS Service. Service area coverage is considered in place at the time the backfill agreement request is accepted. If the service is unable to secure a backfill agreement acceptance, the ATCC shall be available to assist with the backfill, but not assume responsibility. The EMS Service shall have ten minutes to accept the transfer request and shall arrive at the hospital at time agreed upon between the transferring hospital and the EMS agency. The patient and paperwork should be ready for transfer at that time.

All urgent trauma transfer requests shall prompt a review at the local TRAC PI Subcommittee to ensure that the system is being used appropriately, the urgent trauma transfer is accomplished in a timely manner, and that each segment of the system performed its responsibilities. Potential abuses of the system shall be elevated to the State TRAC/PI Subcommittee of the TAC for adjudication and recommendation of action steps to the ADH in order to prevent future abuses.

1. If the transfer request does not meet the two criteria for an urgent transfer, yet the patient's injury requires a higher level of care, the transferring hospital shall call the ATCC to coordinate acceptance with the receiving hospital. The transferring hospital shall notify its EMS service and coordinate an appropriate time for patient pick-up. The EMS Service shall have no less than one hour to arrive at the transferring facility. The transferring hospital shall have the patient ready for pick-up by the agreed upon time.

1. It shall be Departmental policy to suspend or revoke a service license, EMSP

license, vehicle permit, EMSP-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.

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 licensed EMSP, to Departmental corrective action which may result in written warning, probation, suspension or revocation of a service license vehicle permit, EMT certificate, I nstructor status or training-site license.

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

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

2. The Department 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.I f the Department's investigation concludes that the charges brought against a licensed service or licensed EMSP are warranted, the matter shall be brought before the Arkansas Department of Health following the current Administrative Rules Process adopted by the State of Arkansas.

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

5. Two types of hearings

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 licensure of an EMSP 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.

1. Clinical investigations may be recommended by the 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 EMS Advisory Council and approved by the Department.