Current through Register Vol. 49, No. 9, September, 2024
The following Rules pertaining to Emergency Medical Services
are duly adopted and promulgated by the Arkansas State Board of Health pursuant
to the authority expressly conferred by the Laws of the state of Arkansas in
Ark. Code Ann. §
20-13-201 et. seq., and other laws
of the state of Arkansas.
SECTION I.
DEFINITIONS
For the purpose of these rules the following terms are
defined:
A. Advanced Emergency Medical
Technician (AEMT): A person who has successfully completed an advanced EMT
education program approved by the Department and is licensed as an advanced
EMT.
B. Advanced Response Agency: A
licensed non-transporting agency that is requested to respond to the scene of
an emergency.
C. Air Ambulance: A
fixed or rotary-wing aircraft, utilized for on-scene responses or transports
deemed necessary by a physician and licensed by the Department.
D. Air Ambulance Communication Specialist:
Personnel assigned to receive and coordinate all requests for the air ambulance
service.
E. Air Ambulance Service
Emergency: An air ambulance service that provides emergency scene flights that
can also provide inter-facility transports.
F. Air Ambulance Service: An entity operating
an aircraft used for air transportation that is specifically designed to
accommodate the air medical needs of persons who are ill, injured, wounded, or
otherwise mentally or physically incapacitated or helpless; who may require
emergency medical care in-flight.
G. Air Ambulance Service Area: The area of
operation within the state of Arkansas for a licensed air ambulance service as
defined by the service and on file with the Department.
H. Air Ambulance Service Medical Director: An
Arkansas licensed medical doctor (MD) or doctor of osteopathy (DO) who provides
medical oversight for any licensed air ambulance service, and who is either
board certified or board eligible in emergency medicine or general surgery and
is on file with the Department as the medical director.
I. Air Ambulance Service Medical Director
(Specialty): An Arkansas licensed medical doctor (MD) or doctor of osteopathy
(DO) who provides medical oversight for any licensed air ambulance service,
that solely provides specialty air transport services (e.g., pediatrics,
neonatal, high-risk obstetrics), rotary or fixed-winged aircraft. The
individual requires licensure or board eligibility in the specialty designation
of the air ambulance service for which they have medical oversight.
J. Air Medical Personnel: Personnel
responsible for patient care on an air ambulance.
K. Ambulance (Ground): 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. All
ambulances shall be issued a permit by the Department.
L. Ambulance Service: Entities authorized and
licensed by the Department to provide care and transportation of patients upon
the streets and highways of Arkansas.
M. Community Paramedic: A paramedic that is
licensed by the Department and provides care/services to patients not qualified
for home health services or who are qualified but have rejected home health
services; and meets all additional licensure requirements.
N. Controlled Drugs: Drugs identified as
Schedule II-V as designated by federal law.
O. Coordination Point: A fixed location(s)
where information about an air ambulance service may be obtained and where
activities such as dispatch, resource allocation, and flight operations are
conducted.
P. Department: The
Arkansas Department of Health.
Q.
Distributive Education: An educational activity in which the learner, the
instructor, and the educational materials are not all present at the same time,
and students and instructors are not able to interact in realtime. Continuing
Education (CE) activities that are offered online, via audio or video, or
through reading journal articles are considered distributive education. Virtual
Instructor-Led Training is not considered distributive education.
R. Emergency Medical Services: The
transportation and medical care provided to the ill or injured prior to arrival
at a medical facility by licensed Emergency Medical Services Personnel or other
healthcare providers 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; and comprehensive integrated medical care in emergency
and non-urgent settings with the oversight of a physician.
S. Emergency Medical Services Advisory
Council: Those persons appointed by the Governor to assist and advise the
Department concerning matters dealing with emergency medical
services.
T. Emergency Medical
Services Education Program (EEP): Those organizations authorized and accredited
by the Department or the Committee on Accreditation of Educational Programs
(CoAEMSP) to provide EMS education.
U. EMS Education Program Training Site
Authorization and Accreditation: Authorization and accreditation issued by the
Department or the Committee on Accreditation of Educational Programs (CoAEMSP)
to an organization for the purpose of engaging in EMS education in the state of
Arkansas.
V. Emergency Medical
Services Provider (EMSP): An individual licensed by the department at any level
established by the rules adopted by the State Board of Health and authorized to
perform those services set forth in the rules. These shall include without
limitation EMT, AEMT, paramedic, community paramedic, EMSP-
Instructor.
W. Emergency Medical
Services Provider Instructor: A person who has been licensed to teach Emergency
Medical Services Provider courses after completing a Department approved EMSP -
Instructor course and completion of all the instructor requirements.
X. Emergency Medical Technician: A person who
is licensed as an EMT, in Arkansas.
Y. Emergency Vehicle Operator: A person who
has successfully completed a nationally recognized first responder course with
a minimum of forty (40) hours of training and an Emergency Vehicle Operator
Course.
Z. Emergency Request: A
request for assistance to an incident that is perceived to have created an
actual threat to human life or wellbeing where immediate medical intervention
by any EMSP or other health professional is needed.
AA. Encounter Form: A patient care report
(PCR), that includes all State required data elements, and which has been
approved by the Department that describes the EMS encounter and is left with
the facility at time of service or within (24) twenty-four hours after transfer
of care. This form may be electronic or a hard copy and must include a patient
narrative.
BB. FAA FAR Part 135:
Federal Aviation Administration Regulations governing air taxi operations and
commercial operation of fixed-wing and rotor-wing aircraft.
CC. Fixed Wing Aircraft: A fixed-wing air
ambulance licensed by the Department that is specially constructed and equipped
and is intended to be used for transportation of patients.
DD. Flight Nurse: A registered nurse (RN)
licensed to practice in Arkansas who holds a current Arkansas EMSP license. An
RN that solely provides air ambulance specialty services (e.g., pediatrics,
neonatal, or high-risk obstetrics), or fixed-wing transports the flight nurse
shall not be required to be an Arkansas licensed EMSP and shall not participate
in air ambulance service prehospital transports.
EE. Flight Physician: A physician assigned to
flight duty. The physician must be a Post Graduate Year (PGY) 3 or above, with
a current and valid license to practice medicine as a medical doctor (MD) or
doctor of osteopathy (DO) in Arkansas or in the state of primary operation of
the air ambulance service. This physician must be board certified or board
eligible in emergency medicine or general surgery or is certified in the
specialty (e.g. Neonatal, Pediatrics, high-risk obstetrics, etc.) served by the
transport service. This physician must be certified in at least one of the
following: Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life
Support (PALS), Neonatal Resuscitation Program (NRP), or their equivalent for
the patient population served.
FF.
Ground Ambulance Service Area: The contiguous land area within a county defined
by city or identifiable geographical landmarks or county boundaries for which
area the ground ambulance service has an operational base and commits to
providing all emergency medical services requested. Service area maps shall be
kept on file and renewed annually with the services license renewal.
GG. Intercept: Instances where a transporting
service requests assistance from an ambulance service that provides an equal or
higher level of medical care and/or transport.
HH. Licensure: Official acknowledgment by the
Department that an individual has demonstrated competence to perform the
emergency medical services required for licensure under the rules and standards
adopted by the Arkansas Board of Health upon the recommendation by the
Emergency Medical Services Advisory Council.
II. Legend Drug: Any drug which requires a
prescription by a licensed physician as required by federal law.
JJ. Mass Casualty Incident: An event
involving a number of people who are suddenly injured or become ill that
overwhelms the local ambulance services, where the number of casualties vastly
exceeds the local resources and capabilities in a short period of time. If two
or more additional ambulance services are required to respond to the same
event; and/or assistance from the Department is needed to assist in the
coordination of medical resources, then the Department shall be
notified.
KK. Medical Director
(Advanced Life Support Services): An Arkansas licensed medical doctor (MD) or
doctor of osteopathy (DO) who shall be registered with the Department that is
familiar with the design and operation of EMS systems and experienced in
pre-hospital emergency care and emergency management of ill and injured
patients. The medical director shall be board certified or board eligible in
Emergency Medicine or have current experience in emergency medicine. For ALS
services that currently have a medical director that is not Board Certified in
Emergency Medicine and holds a current ACLS card, they shall be authorized to
utilize that medical director until such time they change or replace medical
directors.
LL. Medical Director
(Basic Life Support Services): An Arkansas licensed medical doctor (MD) or
doctor of osteopathy (DO) who is either an emergency department physician or a
physician who is either board certified or board eligible in their particular
specialty.
MM. Medical Director
(community paramedic service): An Arkansas licensed medical doctor (MD) or
doctor of osteopathy (DO) who is either board certified or board eligible in a
specialty that is involved in direct patient contact.
NN. Medical Facility: health care
facility.
OO. Medical Facility
Transport Service: A medical facility regulated by the Department that owns and
operates a licensed ambulance.
PP.
Mutual Aid: An agreement between emergency responders to lend assistance across
jurisdictional boundaries. This may occur due to an emergency response that
exceeds local resources.
QQ.
National Registry of Emergency Medical Technicians (NREMT): A not-for-profit,
independent, non-governmental agency that functions as a registration agency
that issues certificates of competency verified by the achievement of minimal
competencies of EMTs, AEMTs, and paramedics. NREMT provides a valid, uniform
process to assess the knowledge and skills required for competent practice
required by licensed EMSPs.
RR. Of
Unsound Mind: Means and includes the inability to perceive all relevant facts
related to existed for an extended period of time or occurs or has occurred
only intermittently and whether or not it is due to a natural state, age, shock
or anxiety, illness, injury, drugs or sedation, intoxication, or other cause of
whatever nature. (See Ark. Code §
20-9-601).
SS. Operational Base: Facility within the
service area of the ground or air ambulance service(s) designated to house the
ground or air ambulance(s), crew members, supplies, and communication
equipment.
TT. Paramedic: A person
who has successfully completed an accredited paramedic education program
approved by the Department and is licensed in Arkansas as a
paramedic.
UU. Patient Care
Performance Improvement Plan: A written plan that provides objective,
systematic and comprehensive monitoring of the quality, safety, and
appropriateness of patient care; identifying and prioritizing opportunities for
improvement. The ambulance service medical director will be responsible for
plan.
VV. Program Director: An
Individual responsible for oversight of a Department approved EMS education
program. Program directors are authorized to verify the successful completion
of EMS education.
WW. Probation: An
administrative action imposed on an EMS service, any EMSP license, or
authorized and accredited training site for violations of EMS Rules.
XX. Protocols (Guidelines): Offline written
standing orders authorized by ambulance services, approved and signed by the
ambulance service medical director of the licensed ambulance service.
YY. Provisional Instructor: An EMSP who has
completed initial instructor training but is in the process of finishing their
teaching requirements, with the appropriate recommendation from the training
program, before becoming a licensed EMS Instructor.
ZZ. Reaction Time: The time from when the
emergency call is received by the ambulance dispatch and adequate information
is made available which identifies the location and nature of the call, and
until the ambulance is enroute. This time shall be two (2) minutes or
less.
AAA. Receiving Facility: A
hospital emergency department, hospital, or medical facility capable of
receiving and treating patients.
BBB. Revocation: An administrative action
imposed by the Department that terminates any EMSP license, or authorized
training site for violating EMS Rules.
CCC. Rotor-Wing Aircraft: A rotor-winged air
ambulance permitted by the Department that is specially constructed and
equipped and is intended to be used for transportation of emergency medical
patients.
DDD. Service License:
License 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.
EEE. Short Form: Abbreviated, Department
approved Patient Care Report that is left at the medical facility at time of
transfer of care when a completed encounter form is not available.
FFF. Specialty Crew Members: Any person
substituted by the medical director or the air ambulance service medical
director (Specialty) for a specialty mission.
GGG. Specialty Mission: An assignment for an
air ambulance where the specified needs of a particular patient may require the
substitution of particular medical care providers, medical direction, and/or
equipment.
HHH. Specialty Purpose
Service: A licensed service that 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.
III. Stretcher: An position. This includes
all devices that can be transformed from wheelchair to stretcher.
JJJ. Suspension: An administrative action
imposed by the Department that temporarily removes an EMS service license, any
EMSP License, or training site authorization and accreditation for violating
EMS Rules.
KKK. Training Site
Representative: Individual responsible for the organization, coordination, and
day-to-day operations of the EMSP training programs.
LLL. Volunteer Ambulance Service: An
ambulance service operating an EMT-volunteer permitted ambulance that is
staffed by personnel who perform and give services without expectation of
compensation.
MMM. Written Warning:
An administrative action imposed on an EMS service, EMSP license, or authorized
training site for violating EMS Rules.
SECTION V. PERMITTING OF
GROUND EMERGENCY VEHICLES
A. Application
An application for the issuance or renewal of an emergency
vehicle permit shall be made on forms provided by the Department.
B. Ground Vehicle General
Standards
1. Each vehicle of a licensed ground
ambulance service shall be issued a permit in one of the classifications set
forth below.
a. Paramedic
b. Community Paramedic
c. AEMT
d. EMT
e. Advanced Response
f. EMT-Volunteer (EMT-V)
g. EMT-Specialty (EMT-S)
h. Stretcher
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
that would permit an EMSP to render care beyond the scope of practice and/or
violate these Rules. *Excludes community paramedic
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 AEMT
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 and staffing purposes 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. 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)*:
a.
displayed on the top of the ambulance.
b. The permit sticker issued by the
Department will be displayed on the rear lower-left corner of the
ambulance.
The following identifiers may also be displayed in contrasting
color(s):
a. The permit level of the
ambulance may be displayed on the front two fenders of the ambulance.
b. The word "Ambulance" labeled in mirror
image located on the front of the ambulance hood.
c. The word "Ambulance" on the rear of the
ambulance.
12. Each
ambulance shall be equipped with a siren capable of emitting sound audible
under normal conditions from a distance of less then 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) *Community paramedic
and 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 or equivalent, 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 sunlight.
*Community paramedic and 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 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, EMSP, 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 vehicle's 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, airconditioned, 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 permitted ambulance subject to the requirements of
these Rules. 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 Rules.
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 service's initial and annual
renewal application.
33. Each
permitted vehicle shall keep a current copy, either in print or electronic, of
the services approved medical director approved protocols/guidelines in the
ambulance at all times.
34. EMSP
shall perform only those skills at the level of the permitted vehicle.
*Does not apply to Stretcher Ambulances
C. Ambulance Staffing
Requirements
1. Paramedic Permitted Ambulances
a. Each paramedic permitted ambulance shall
be staffed at all times by a minimum of two (2) licensed individuals, one (1)
of whom shall be a paramedic. The remaining individual may be a paramedic,
AEMT, or EMT. The paramedic shall staff the patient compartment at all times
during patient transport.
b.
Permitted ambulances that are providing general patient transfers and not
primary 911 emergency responses may staff their ambulances in the following
manner.
* Each permitted ambulance shall be staffed at all times by a
minimum of two (2) individuals, one (1) of whom shall be a paramedic in the
patient compartment at all times during patient transport. The second
individual must be at a minimum trained as an emergency vehicle operator
(EVO).
2. AEMT
Permitted Ambulances
a. Each AEMT permitted
ambulance shall be staffed at all times by a minimum of two (2) licensed
individuals, one (1) of whom shall be a paramedic or AEMT. The remaining
individual may be a paramedic, AEMT, or EMT. The AEMT, EMT, or paramedic shall
staff the patient compartment at all times during patient transport.
3. EMT Permitted Ambulances
a. Each permitted ambulance shall be attended
by two (2) licensed individuals. Each EMT permitted ambulance shall be staffed
at all times by a paramedic, AEMT, or EMT. The EMT, AEMT, or paramedic shall
staff the patient compartment at all times during patient transport.
b. Permitted ambulances that are providing
general patient transfers and not primary 911 emergency responses, or that have
depleted all available 911 resources may staff their ambulances in the
following manner.
1) Each permitted ambulance
shall be staffed at all times by a minimum of two (2) individuals, one (1) of
whom shall be a paramedic, AEMT, or EMT with any of the above in the patient
compartment at all times during patient transport. The second individual must
be at a minimum trained as an emergency vehicle operator (EVO).
4. Advanced Response
Permitted Vehicles
a. Vehicles shall be
permitted at the paramedic level only and shall be staffed at all times by a
minimum of one (1) licensed paramedic.
b. Transfer patient care to a licensed
paramedic transporting service or maintain advanced level of care throughout
transport if care is rendered to a basic life support transporting ambulance
service.
5. EMT-Volunteer
Permitted Ambulances
a. Each EMT Volunteer
permitted ambulances shall be staffed at all times by a minimum of two (2)
individuals, one (1) of whom shall be a licensed physician, paramedic, AEMT,
RN, or EMT, with any of the above in the patient compartment at all times
during patient transport. The second individual must be at minimum trained in
CPR (Basic Life Support).
6. Specialty Permitted Ambulances
a. Each Specialty permitted ambulances shall
be staffed at all times by a minimum of two (2) individuals, one (1) of whom
shall be a licensed physician, paramedic, AEMT, RN, or EMT, with any of the
above in the patient compartment at all times during patient transport. The
second individual must be at minimum trained in CPR Basic Life
Support).
7. Permitted
Stretcher Ambulances
a. Each ambulance used
for the non-emergent transport of patients will be staffed by a minimum of two
(2) individuals. One (1) shall be trained at a minimum in CPR (Basic Life
Support), and one (1) shall be an Arkansas licensed EMSP, LPN, RN, MD or DO.
The certified/licensed individual shall be attending to the patient during the
transport.
SECTION XI. GENERAL TRAINING SITE AND
EDUCATION REQUIREMENTS
The following section pertains to all EMSP training
sites
A. All Arkansas EMSP Training
Sites must be accredited by the Department following the Department
Accreditation Manual. Paramedic training sites shall be accredited by the
Commission on Accreditation of Allied Health Education Programs (CAAHEP) and
the Committee on Accreditation of Educational Programs for the Emergency
Medical Services Professions (CoAEMSP) using current Accreditation
Standards.
B. The Department shall
review all EMSP courses and EMS Education Programs (EEP) prior to the beginning
of any period of instruction.
C.
Classes shall be conducted in an environment conducive to learning
D. Trainees must be in uniform with a
standard means of identification when engaged in patient care.
E. Education courses must follow the
nationally accepted EMS Education Standards.
F. EMT instructors must be either an Arkansas
licensed physician or an Arkansas licensed EMSP-instructor at any level.
Paramedic courses must follow the accreditation requirements set forth by the
Commission on Accreditation of Allied Health Education Programs (CAAHEP) and
the Committee on Accreditation of Educational Programs for the Emergency
Medical Services Professions (CoAEMSP).
G. Physicians acting as medical directors for
EMS education programs recognized by the Department, that require clinical and
field internship performance by students, may delegate authority to a student
in training during their performance of program required medical acts and only
while under the control of the education program.
H. Off-Site Courses must meet the following:
1. All EMT and AEMT 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 the written approval of both the sponsoring
institution and the Department.
3.
Written documentation shall verify one of the following concerning equipment.
a. All equipment needed for the course as
required by the Department is available at the course location and is not
removed from any permitted ambulance. Department staff may inspect the course
location at any time during the course.
Or
b. The
EMS education program sponsor provides all equipment. For offsite courses, due
to loading/transport/use time, that set of equipment cannot be considered
available for any other course during that specific time period unless a policy
exists requiring return within a certain time frame.
Or
c.
Equipment used for the course may be provided as a combined effort by the EMS
Education Program 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.
I. Sponsorship of Multiple Courses
1. Any EMS Education Program (EEP) may offer
concurrent courses providing the following criterion has been met:
a. There must be adequate equipment available
for each course offered to ensure that each student has appropriate access to
each needed item.
J. EMS education programs must submit all
applicable paperwork in the time frame specified by the Department.
K. EMS education programs must ensure
students meet minimum educational requirements for the national certifying
examination.
L. Any potential site
wishing to apply to be a paramedic training site must:
1. Meet Arkansas requirements as listed in
the Section of EMS Accreditation Manual for EMT, AEMT, and EMT bridge
courses.
2. Submit their
application and site review to the Committee on Accreditation of Educational
Programs for the Emergency Medical Services Professions (CoAEMSP), and in
pending status for a site visit.
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.
M. Psychomotor Testing
1. AEMT and paramedic psychomotor testing
will follow the guidelines outlined in the NREMT 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 Psychomotor
Skills Exam Coordinator User Guide. Any deviation from these requirements must
be approved by the Department in writing prior to the exam.
SECTION XII. EMS
EDUCATION PROGRAM REQUIREMENTS
A. Paramedic
EMS Education Programs
1. All current Arkansas
paramedic and community paramedic education Programs must complete one of the
following prior to starting paramedic or community paramedic education program:
a. Achieved accreditation by a National
Accrediting Organization or body as recognized by the Office such as the
Committee on Accreditation of Educational Programs for the Emergency Medical
Services Professions (CoAEMSP).
b.
Have submitted all required paperwork, including the self-study, and be
awaiting the Committee on Accreditation of Educational Programs for the
Emergency Medical Services Professions (CoAEMSP) site visit or holds a CoAEMSP
official Letter of Review.
B. Paramedic Training
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. Medical
Facility training
a. Clinical phases of
training will be conducted within a medical facility.
b. Paramedic students will be educated,
within the hospital or medical facility by qualified personnel under guidelines
and requirements stated in the curriculum and approved by the medical
facilities governing body during clinical phases of training.
c. There must be a medical director
designated, having emergency department experience, who meets the requirements
in Section I. holding current Advanced Cardiac Life Support (ACLS) 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.
5.
Field Internship
Internship must be completed with an Arkansas licensed
paramedic ambulance service or a service that meets the requirements of the
Committee on Accreditation of Educational Programs for the Emergency Medical
Services Professions (CoAEMSP) and approved by the Department. There shall be a
written agreement allowing students to actively participate in patient care.
The student must be in the patient compartment during transport and have direct
supervision by a licensed paramedic at all times.
6. 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.
7. There must
be a medical director designated, having emergency department experience, who
meets the requirements in Section I., holding current Advanced Cardiac Life
Support (ACLS) 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.
C. Community Paramedic
1. Community paramedic curriculum,
evaluations, clinical and field internship will follow the state-approved
community paramedic curriculum and consist of a minimum of (300) hours of
classroom and clinical education.
2. The Department shall approve all community
paramedic courses and EMS education program locations prior to the beginning of
any period of instruction.
3.
Community paramedic programs must obtain and maintain paramedic training site
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 nurses,
paramedic/EMSP-instructors, or subject matter experts in the fields they are
representing.
5. There shall be an
academic as well as a clinical atmosphere. Community paramedic students must
have a standard means of identification when engaged in the patient care and
clinical portions of the community paramedic program.
6. Clinical Internship
a. Clinical experience shall be provided
under the supervision of a community paramedic service medical director,
advanced practice registered nurse, physician assistant, home health registered
nurse or other licensed healthcare provider that is a subject matter expert in
the clinical field they represent.
b. Required clinical contacts can be found in
Appendix 3
c. Areas of clinical
experience shall include at a minimum:
* Emergency department services;
* Home health services;
* Hospital case management;
* Public health agencies services
D. AEMT Training
1. AEMT curriculum, evaluations, clinical and
field internships will be developed and approved by the Department accredited
EMS Accreditation Manual.
2. The
Department shall approve all AEMT courses and training sites prior to the
beginning of any periods of instruction.
3. AEMT training may be sponsored only by a
higher education institution that has affiliation with an Arkansas licensed
hospital or a Department approved EMS program. Any Arkansas licensed ambulance
service applying for accreditation and approval by the Department must be a
licensed advanced life support (ALS) service and hold an Arkansas Department of
Higher Education Private Career Education License.
4. Primary Instructors must be either
Arkansas licensed physicians or EMSP Instructor at the AEMT level or
higher.
5. AEMT training sites must
follow AEMT policies as set forth in the Section of EMS Accreditation Manual
for EMT, AEMT, and EMT bridge courses.
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 1., holding current Advanced Cardiac Life
Support (ACLS) 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.
a.
Medical facility clinical phases of training will be conducted within a medical
facility with hospital concurrence.
b. AEMT students will be trained, within the
hospital or medical facility, by qualified personnel under guidelines and
requirements stated in the curriculum and approved by the medical staff and the
facilities governing body during clinical phases of training.
10. Field Internship
a. Internship must be completed with an
Arkansas licensed paramedic or AEMT licensed ambulance service or a service
that meets the requirements of the Committee on Accreditation of Educational
Programs for the Emergency Medical Services Professions (CoAEMSP) and approved
by the Department 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 Training
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. Any Arkansas licensed
ambulance service applying for accreditation and approval by the Department,
must be a licensed advanced life support (ALS) service and hold an Arkansas
Department of Higher Education private career education license.
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., holding a current Advanced Cardiac
Life Support (ACLS) 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.
8. Medical Facility Training
a. Clinical phases of training will be
conducted within a medical facility with hospital concurrence.
b. EMT students will be trained, within the
hospital or medical facility, by qualified personnel under guidelines and
requirements stated in the phases of training.
9. Field Internship
a. Internship must be completed with an
Arkansas licensed ambulance service or a service that meets the requirements of
the Committee on Accreditation of Educational Programs for the Emergency
Medical Services Professions (CoAEMSP) and approved by the Department with
which there is an agreement allowing students to actively participate in
patient care. The student must be in the patient compartment during
transport.
F.
EMS Education Program for EMSP -Instructor Courses
1. Requirements to conduct an EMS-Instructor
Course are as follows:
a. The course must be
sponsored by an Arkansas approved EMS Education Program in affiliation with an
educational institution (Vo-Tech School, Technical College, Community College,
four-year college or university).
b. All courses must be reviewed by the
Department prior to starting.
c.
All courses must follow the current EMS Education Standards instructor
guidelines.
d. An individual who
holds a Bachelor's Degree, or higher must assist with the course.
2. The EMS-Instructor Trainer must
submit the following information to the Department:
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 Department prior to starting course).
e. List of applicants for
verification/approval of EMSP status by 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 Section XIII.
SECTION XIV.
DRUGS AND PHARMACEUTICALS
A. NOTICE OF
INSPECTION
Investigators and inspectors for Pharmacy Services and Drug
Control, and Arkansas Department of Health, are directed to make
investigations, inspections and, make copies of the records and orders,
wherever located, of all services licensed by the Department in order to
determine whether or not said licensed ambulance services have violated the
laws of the state of Arkansas respecting prescribing and using of narcotics and
other drugs and whether or not said services have violated the provisions of
the law.
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. 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
D. PROCEDURE IN
CASE OF LOSS OF CONTROLLED SUBSTANCES
1. Each
licensed ambulance service or medical director shall notify the Office of
Pharmacy Services and Drug Control, and 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 (1) 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 (7)
days.
E. RECORDS OF
CONTROLLED SUBSTANCES
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 patient's 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.
F. SURRENDER OF UNWANTED CONTROLLED
SUBSTANCES
Must be in accordance with the Office of Drug Enforcement
Agency's Regulations regarding all controlled substances no longer usable due
to deterioration, expired dating, or no longer used by the service.
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. This manual shall also be submitted to the Department.
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
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.
4. Services shall have a quality assurance
process for all controlled substances that includes a routine audit process.
Any discrepancies shall be immediately reported to the Department and the
DEA.
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, and approved by the Department, 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 XVI. VIOLATIONS
A. Regulatory Administration
1. 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 prescribed herein. Each service shall
maintain and make available (during normal business hours) to the Department
for inspection records including, but not limited to:
a. Patient records
b. Equipment checks
c. EMSP certifications, continuing education,
and credentialing
d. Policies and
procedures
e. Any document related
to service licensure
B. Penalty
1. The Department may impose one or more
penalties for any offense committed hereunder, including revocation,
suspension, or probation of a license, or any other discipline which is
appropriate under the circumstances, including but not limited to requiring
completion of education requirements.
a. As to
ambulance service licenses, pursuant to Arkansas Code §
20-13-1005, three formal citations
during the license term for failure to comply with Subchapter 10 of Chapter 13
of Subtitle 2 of Title 20 of the Arkansas Code, and any Rules promulgated by
the Department of Health in regard to ambulance services shall result in
revocation of the ambulance service license. However, the Arkansas State Board
of Health and Department of Health are not limited in disciplinary action up to
and including revocation of licensure in the event of fewer than three (3)
formal citations.
b. Any
non-licensed person found violating these rules may be prohibited from
obtaining Arkansas State Licensure for one (1) year. If 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 Offenses:
* Conviction, pleading guilty, or nolo contendere to any
criminal offense listed in Arkansas Code Ann §
20-13-1106
* Demonstration of incompetence, knowingly or willfully
violating these Rules, or other inability to provide adequate service.
* Violating any, as well as federal, state, or local laws,
rules affecting, but not limited to, the practice of EMS.
* Any conduct which is in violation of any criminal, civil,
and/or administrative code or statute.
* Falsifying, destroying, or failing to make accurate,
complete, and/or clearly written or oral patient care reports documenting a
patient's condition upon arrival at the scene, the prehospital care provided,
and the patient's status during transport, including signs, symptoms, and
responses during duration of transport per EMS provider's approved
policy.
* Disclosing confidential information or knowledge concerning a
patient except where required or allowed by law.
* Causing or permitting physical or emotional abuse or injury
to a patient or the public, and/or failing to report such abuse or injury to
the Department, appropriate legal authority, and/or the Department within
twenty-four (24) hours after the event occurs.
* Failing to report to the employer, appropriate legal
authority, or the Department, an event of abuse or injury to a patient or the
public within twenty-four (24) hours (or the next business day within
twenty-four (24) hours) after the event.
* Failure to follow the medical director's protocol, performing
advanced level or invasive treatment without medical direction or supervision,
or practicing beyond the scope of certification or licensure.
* Failing to respond to a call while on duty and/or leaving
duty assignment without proper authority.
* Abandoning a patient.
* Failing to comply with the terms of a Department ordered
probation or suspension.
* Misrepresenting the level of any certification or
licensure.
* Misappropriating or failure to take precautions to prevent
misappropriation of medications, supplies, equipment, personal items, or money
belonging to the patient, employer, or any other person or entity.
* Falsifying or altering, or assisting another in falsifying or
altering, any Department application, EMS license; or using or possessing any
such altered certificate or license.
* Cheating and/or assisting another to cheat on any
examination, written or psychomotor, by any provider licensed by the Department
or any institution or entity conducting EMS education and/or training or
providing an EMS examination leading to obtaining licensure or renewing
licensure.
* Obtaining or attempting to obtain and/or assisting another in
obtaining or attempting to obtain, any advantage, benefit, favor or gain by
fraud, forgery, deception, misrepresentation, untruth or subterfuge.
* Illegally possessing, dispensing, administering or
distributing, or attempting to illegally dispense, administer, or distribute
controlled substances as defined by the federal or state laws.
* Receiving disciplinary action relating to an EMS certificate
or license or another health provider certificate or license issued in another
state or in a U.S. Territory or in another nation, or receiving disciplinary
action relating to another health provider certificate or license issued in
Arkansas.
* Failing or refusing to timely give the Department full and
complete information requested by the Department.
* Failing to notify the Department of being convicted or
pleading guilty or nolo contendere of a criminal offense within ten (10)
business days of the conviction or plea, other than any class C misdemeanor not
related to EMS.
* Failing to notify the Department within five (5) business
days of his or her being arrested, charged, or indicted for any criminal
offense, other than any class C misdemeanor not directly related to EMS.
* Engaging in any conduct that jeopardizes or has the potential
to jeopardize the health or safety of any person.
* Failure of any drug screening test administered during an EMS
work or volunteer shift, or within twelve (12) hours of the beginning or end of
any such shift.
* Resigning employment or refusing by the employee, of an
employer drug screening test right before, after, or during an assigned EMS
work or volunteer shift.
* Failing to maintain the requisite of skill, knowledge, and/or
academic acuity to timely and/or accurately perform the duties or meet the
responsibilities required of a licensed EMSP at appropriate licensure level
that endangers the safety or welfare of patients and/or EMSP's.
* Delegating medical functions to other personnel without
approval from the medical director per approved protocols.
* Behaving in a disruptive manner or exhibiting unprofessional
conduct toward other EMS personnel, law enforcement officers, firefighters,
hospital personnel, other medical personnel, patients, family members, or
others on the scene.
* Falsifying or altering clinical and/or internship documents
for EMS students.
* Falsifying or failing to complete daily readiness checks on
EMS vehicles, medical supplies, and/or equipment as required by EMS
employers.
* Engaging in acts of dishonesty that relate to the EMS
profession.
* Behavior that exploits the EMS personnel-patient relationship
in a sexual way. This behavior is non-diagnostic and/or non-therapeutic, may be
verbal or physical, and may include expressions or gestures that have sexual
connotations or that a reasonable person would construe as such.
* Falsifying or making any false statements in any information
provided to or by the Department to include misrepresentation, fraud, or
concealment including but not limited to applications for licensure,
certification, or renewal of licensure or certification and continuing
education requirements.
* Acting negligently, neglectfully, or with intent to cause
harm toward a patient or other person.
* Reporting to duty or rendering patient care while under the
influence of alcohol (According to current Arkansas Legal Code) illegal drugs
or illegally obtained drugs concurrent with State Law.
* Use of alcohol or any intoxicating substance (other than as
directed by a physician) while on duty.
* Providing false information to regulatory officials or
willfully concealing known deficiencies during an inspection.
* Conviction of driving under the influence of alcohol or other
intoxicating substance while on duty, on emergency response or during patient
transport.
* Failure to report substance abuse of on-duty EMS personnel to
the Department.
* Failure to follow accepted standards of care in the
management of a patient or in response to a medical emergency.
* Using equipment and/or performing procedures beyond the
EMSP's level of licensure, scope of practice, or the level of licensure of the
ambulance service.
* Unauthorized release or divulgence of confidential
information to an unauthorized person or using confidential patient information
for personal or financial benefit.
* Providing care as an Arkansas EMSP independent or with a
licensed EMS service while having a lapsed or expired Arkansas EMSP
license.
* Failure to respond or accept official Departmental
correspondence sent by certified mail.
* Misappropriation, stealing, and/or embezzlement of EMS grants
or equipment purchased under such grants.
* Falsification of records related to ambulance service
operations.
* Failing to provide patient information to a hospital or other
health care facility in response to an authorized request.
* Failing to report to the Department actions regarding
incompetent, unethical, or illegal practice by any EMSP.
* Requiring EMS Personnel to violate EMS Rules or EMSP
standards.
* Engaging in the delivery of emergency medical services on a
revoked, suspended, expired, or inactive Arkansas license.
* Alteration of/or transferring a vehicle permit from one
vehicle to another. Operating an ambulance or EMS vehicle that is not licensed
or insured.
* Failure to follow all requirements concerning drugs and
pharmaceuticals.
* Carrying and/or using equipment not approved by the
Department for the licensure level.
* Using an EMT who is lapsed or not Arkansas licensed to meet
ambulance staffing requirements.
* Failure to have all necessary equipment and non-expired
supplies in licensed ambulances for the level of licensure.
* Failure to follow the manufacturer's recommendations for the
use of medical equipment in a manner which causes harm to the patient.
* Conviction of a violation of Federal Communications
Commission Concurrent with Federal Laws (FCC) Rules.
* Falsification by the instructor of facts on student
paperwork/applications.
* Teaching an EMS related course that requires pre-approval
from the Department without having that approval.
* Abandonment of an approved EMT course.
* Failure to complete and submit required documentation for
all students.
* Failure to teach courses by National Standard
Curriculum.
* Failure to observe recognized professional teaching
standards
* Falsification of continuing education documentation
* Falsification by the training site of records related to
courses or training
* Conduct or actions by the training site that results in harm
to the health and safety of the student
* Failure to meet and maintain the criteria for program
approval as set by the Department or accrediting body
* Failure to allow the Department to inspect, observe, or
evaluate programs, including program personnel, facilities, classes, and
clinical practice sessions
* Use of training personnel not competent for the type of
training offered
* Failure to observe recognized professional standards in the
course content and operation of the training program
* Failure to keep accurate and adequate records, of the names
and addresses and type of training completed of all graduates and attendees for
a minimum of two (2) years
* Allowing an AEMT or paramedic student to participate in
medical facility or field internship without being a licensed EMT.
* Failure to offer training consistent with the approved
application
C. Criteria for Denial of EMSP Licensure
An EMSP certification/license may be denied for the following
reasons:
1. Failing to meet any
requirements set forth in these rules or other applicable law.
2. Previous conduct of the applicant during
the performance of duties that are similar to those required of EMS personnel,
whether performed as a volunteer or for compensation, which is contrary to
acceptable standards of care or conduct for EMS personnel, or contrary to
accepted standards of conduct as described or required in these
Rules.
3. Submitting false
information, or failing to disclose material facts, on or in conjunction with
any Arkansas application for certification or licensure or renewal of
certification or licensure.
4.
Staffing an EMS vehicle deemed to be in service while the person's previously
issued certification or license is expired, suspended, or has been
revoked.
5. Any other fact,
condition, or circumstance which in the judgment of the Department renders the
applicant or renewal applicant unfit to practice as an EMSP.
D. 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
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. If the 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. 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
Department.
b. Formal - those held
for the purpose of adjudication of rights before the Department.
6. Where, in the opinion of the
Department, the 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.
8. Probation: The
department may place an EMSP license on probation, and as a probationary
condition may require the licensee to:
a.
report regularly to the Department on matters that are the basis of the
probation;
b. limit practice to the
areas prescribed by the Department;
c. Continue or review professional education
until the person attains a degree of skill satisfactory to the Department in
those areas that are the basis of the probation; and/or
d. Complete or continue to meet certain
requirements or conditions related to the circumstances surrounding the
certificant's or licensee's rule violations or background to assure that he or
she will continue to meet and maintain general EMS standards
9. Any person, whose EMSP license
has been revoked by the department and who later regains certification or
licensee under this section, shall be placed on probation for one year and be
required to meet certain conditions to assure that he or she will meet and
maintain general EMS standards
10.
Reapplication
a. Two (2) years after denial,
revocation of a license, or the voluntary surrender of a certificate or
license, an individual may petition the Department in writing for reapplication
for certification or licensure. Expiration of a certificate or license during
the suspension period shall not affect the two-year waiting period required
before a petition can be submitted.
b. The petitioner bears the burden of proving
fitness for certification or licensure
c. The Department may allow the petitioner to
file an application for certification or licensure if there is proof that the
health, safety, and confidence of the public will be protected.
d. The Department may deny any petitioner if,
in the judgment of the Department, the reason for the original action continues
to exist or if the petitioner has failed to offer sufficient proof that there
is no longer a threat to public health, safety, and/or confidence.
11. Notification of disposition. A
copy of the order of final disposition of proposed disciplinary action shall be
sent to any licensed EMSP, first responder organization, medical director,
institution, or facility with which the certificant or licensee is known to be
associated at the address shown in the current records of the
Department.
E. Clinical
Investigations
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
EMS Advisory Council and approved by the Department. Clinical investigations
beyond the scope of the EMS Rules 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 must
follow the clinical investigations guidelines recommended by the EMS Advisory
Council and approved by the Department.
SECTI ON
XX. REPEAL
All Rules and parts of Rules in conflict herewith are hereby
repealed.
SECTI ON OF EMERGENCY MEDI CAL SERVI CES MI NI MUM REQUIRED
PARAMEDIC EQUIPMENT LIST
**ALL EQUIPMENT MUST INCLUDE ALL AGE APPROPRIATE SIZES**
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SECTION OF EMERGENCY MEDICAL SERVICES
MINIMUM REQUIRED ADVANCED EMT EQUIPMENT LIST
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SECTION OF EMERGENCY MEDICAL SERVICES MINIMUM REQUIRED BASIC
EQUIPMENT LIST
Includes EMT, EMT-Volunteer, EMT-Specialty
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SECTION OF EMERGENCY MEDICAL SERVICES
MINIMUM REQUIRED ADVANCED RESPONSE EQUIPMENT LIST
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SECTION OF EMERGENCY MEDICAL SERVICES
REQUIRED STRETCHER AMBULANCE EQUIPMENT LIST
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SECTION OF EMERGENCY MEDICAL SERVICES
MINIMUM REQUIRED Air Ambulance Rotor-Wing EQUIPMENT LIST
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Field Triage Decision Scheme: The Arkansas Trauma Triage
Protocol
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Detailed Experience
(Clinical phases of the Community Paramedic program shall
consist of a minimum of 210 hours to include the following minimum patient
contacts listed below)
1. Public
Health and Collaboration - (Public Health Clinic)
A. Must Observe 6 (six) Immunizations in the
following age categories - Adult and Pediatrics
B. Must observe reporting of communicable
diseases
2. Public Health
and Collaboration - (Home Health)
All experiences within the home health setting must be
completed with a Home Health Registered Nurse or other designated provider as
outlined below.
A. 6 (six) home safety
evaluation and inspections must observe and participate in. May be completed
with a Physical Therapist.
B. 20
(Twenty) Patient contacts to include the following experiences
* Home Health Patient Assessments - Observe and
participate
* Patient Documentation/Charting at home visits
* Medication reconciliation with patient - Observe and
participate
C. 10 (Ten)
contacts with patients in each of the following categories:
* CHF Assess and management plan - Observe and Participate
in
* COPD Assess and management plan - Observe and Participate
in
* Diabetic related illness issues - Participate in Neurologic
conditions (CVA, TBI, MS, etc) observe and participate in
* Wound care
3. Emergency Room -
A. Must Observe 10 (ten) Physician/APN/PA
comprehensive or focused physical exam on the following age groups:
* Adult Patients
* Geriatric Patients
* Pediatric patients
B. Must review with the Physician/APN/PA, the
following:
* 20 (twenty) lab interpretations
* 5 (five) CT or MRI interpretations
* 5 (five) preparation instructions for CT/MRI
* 10 (ten) Hand Held point of care analyzer testing
* Stitch and Staple removal- Observe and participate in
* Cast Care and assessment - Observe and participate in
4. HOSPICE-
A. 10 (ten) home visits to include the
following:
* Nursing services
* Social services
* Chaplain services
B. 10 (ten) patient contacts addressing
palliative care and/or pain management
C. Review 3 (three) hospice criteria for the
patient referrals
D. 2 (two)
in-depth instructional trainings on In-home medication pump
operations
5. CLINIC (any
medical facility setting)
A. 5 (five) Urine
specimen collections
B. 5 (five)
Wound, throat, nasal, sputum or related cultures
C. 5 (five) Health Promotion studies
education- HA1C, Cholesterol, Colonoscopy, etc.
D. 10 (ten) otoscope - observe and
participate in use of.
6.
Hospital
24 (twenty-four) hours of hospital case management to include
but not limited to
* Discharge planning
* Utilization Review
* Case Management
7. Public Health Clinic
A. Individuals must observe a minimum of 8
(eight) hours in the public health setting
8. General Settings
The following can take place in any care setting to include but
not limited to Emergency Department, Physical Therapy, Home Health, Public
Health Clinic.
10 (ten) patient contacts involving instruction and use of
crutches, wheelchairs, walkers, canes, hospital beds, Hoyer lifts, slide
boards
10 (ten) uses in the access central lines, ports, ileostomies,
Foley catheters, PEG tubes, wound management
**20% of the patient contacts in each of sections 2, 3, 4,
& 5 may be made within an Arkansas licensed community paramedic
service**
