Current through Register Vol. 49, No. 9, September, 2024
RULES PERTAINING TO EMERGENCY MEDICAL SERVICES
AUTHORITY
The following Rules pertaining to Emergency Medical Services
are duly adopted and promulgated by the Arkansas State Board of Health pursuant
to the authority expressly conferred by the Laws of the state of Arkansas in
Ark. Code Ann. §
20-13-201 et.seq., and other laws
of the state of Arkansas.
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 which 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 specially 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 gumey 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 real
time. 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 which 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 provide 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 which
provides an equal or higher level of medical care and/or transport.
HH.
Licensure: Official
acknowledgement 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: Any
hospital, medical clinic, physician's office, nursing home or other health care
facility.
OO.
Medical
Facility Transport Service: A medical facility regulated by the
Department that owns and operates an 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
which issues certificates of competency verified by 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 one's condition and proposed treatment of whether the
inability is only temporary or has existed for an extended period of time or
occurs or has occurred only intermittently and whether or not it is due to
natural state, age, shock or anxiety, illness, injury, drugs or sedation,
intoxication, or other cause of whatever nature. (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
approving and supervising the service's patient care performance improvement
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 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 services" 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.
Sliort 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: Any apparatus
that is used to transport individuals in the supine or Fowler's 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 II.
PURPOSE
The purpose of these Rules is to provide a framework to enhance
care provided to the ill or injured by Emergency Medical Services
Personnel.
SECTION III.
LICENSURE OF AMBULANCE SERVICES
No person shall furnish, operate, maintain, conduct, advertise
or in any way engage in or profess to engage in the business of providing
transport of patients upon the streets and highways of Arkansas unless that
person holds a valid ambulance service license issued by the Department of
Health. This section shall not operate to alter the application of the Good
Samaritan Act under Arkansas Code
17-95-101.
A. General Standards
An application for the issuance or annual renewal of an
ambulance service license shall be made to the Department and shall be
accompanied by an applicable fee. All documentation and fees must be submitted
to the Department prior to an EMS service or vehicle permit being issued. No
license shall be issued until all licensure requirements have been met.
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 Medical Facilities
Each ground & air ambulance service shall notify the
receiving medical facility by radio or by a means agreed upon by the receiving
facility in the event the radio is unavailable. The notification shall include
at minimum impending arrival, patient condition and care rendered to the
patient.
The ambulance service shall at the time of transfer of care
leave a completed encounter form or a completed Department approved short form.
If a short form is left with the medical facility, the ambulance service shall
submit a completed encounter form to the medical facility within twenty-four
(24) hours from transfer of care. Ambulance services shall comply with all
official requests for patient care records from medical facilities for patients
that were transported to that medical facility. The Department may inspect the
patient encounter forms of any service covered by these Rules.
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 within fifteen (15) days of the dispatch of the call. All
services shall have a quality improvement process to ensure that each run has
been submitted and that the data being submitted are complete and
accurate.
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 (I) of
the classifications set forth by the Department.
Each licensee, including air ambulance services, shall be
required to obtain a separate service license in each county the ambulance
service has an operational base.
Each service shall display a copy of the ambulance service
license in a prominent location on the premises of the ambulance service's
operational base at all times
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 Department 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 manufacture's recommendations and/or
federal requirements.
12.
Patient Consent
a. It is recognized and
established that, in addition to such other persons as may be so authorized and
empowered, any one (1) of the following persons is authorized and empowered to
consent, either orally or otherwise, to any surgical or medical treatment or
procedures not prohibited by law which may be suggested, recommended,
prescribed, or directed by a licensed physician:
1) Any adult, for himself;
2) Any parent, whether an adult or an
unemancipated minor, for a minor child or for an adult child of unsound mind
whether the child is of the parent's blood, is an adopted child, is a
stepchild, or is a foster child; provided However, the father of an
illegitimate child cannot consent for the child solely on the basis of
parenthood;
3) Any married person,
whether an adult or a minor, for self;
4) Any female, regardless of age or marital
status, for herself when given in connection with pregnancy or childbirth,
except the unnatural interruption of a pregnancy;
5) Any person standing in loco parentis,
whether formally serving or not, and any guardian, conservator, or custodian,
for his ward or other charge under disability;
6) Any emancipated minor, for
himself;
7) Any unemancipated minor
of sufficient intelligence to understand and appreciate the consequences of the
proposed surgical or medical treatment or procedures, for himself;
8) Any adult, for his minor sibling or his
adult sibling of unsound mind;
9)
During the absence of a parent so authorized and empowered, any maternal
grandparent and, if the father is so authorized and empowered, any paternal
grandparent, for his minor grandchild or for his adult grandchild of unsound
mind;
10) Any married person, for a
spouse of unsound mind;
11) Any
adult child, for his mother or father of unsound mind;
12) Any minor incarcerated in the Department
of Correction or the Department of Community Punishment, for
himself
b. In addition to
any other instances in which consent is excused or implied at law, consent to
surgical or medical treatment or procedures suggested, recommended, prescribed,
or directed by a licensed physician will be implied in the following
circumstances:
1) Where an emergency exists
and there is no one immediately available who is authorized, empowered to, or
capable of consent.
An emergency is defined as a situation wherein, in competent
medical judgment, the proposed surgical or medical treatment or procedures are
immediately or imminently necessary and any delay occasioned by an attempt to
obtain a consent would reasonably be expected to jeopardize the life, health,
or safety of the person affected or would reasonably be expected to result in
disfigurement or impaired faculties;
2) Where any emergency exists, there has been
a protest or refusal of consent by a person authorized and empowered to do so,
and there is no other person immediately available who is authorized,
empowered, or capable to consent but there has been a subsequent material and
morbid change in the condition of the affected
person.
13.
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.
14. Out-of-State
Ambulance Contracts for Disaster Assistance
Ambulance services shall contact the Department prior to
deploying or sending any Arkansas permitted ambulances to another state(s) to
fulfill obligations of a state/federal/private contract or agreement for a
disaster. The ambulance service shall contact the Department during regular
business hours or the Department Emergency Communication Center after
hours.
15. 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.
16.
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. In the event of
a mass casualty incident or an extenuating circumstance, an air ambulance
service may be considered a primary responder if access to patients is delayed
or inaccessible by ground ambulances. If an air ambulance service is notified
by a patient, bystander, responder prior to arrival of ground ambulance
service, the air ambulance service shall immediately activate the ground
ambulance service within that service area.
17. 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.
SECTION IV.
GROUND AMBULANCE SERVICE LICENSURE CLASSIFICATION AND GENERAL STANDARDS
A. Ambulance Service Classifications
1. Licensed community paramedic services
shall have vehicles permitted at the community paramedic level. Only licensed
paramedic services may operate a community paramedic program or
vehicles.
2. Licensed paramedic
Services shall have fifty percent (50%) or more ambulances permitted at the
paramedic level. Only licensed paramedic services may operate paramedic
ambulances.
3. Licensed AEMT
services shall have fifty percent (50%) or more ambulances permitted at the
AEMT level. Only AEMT and paramedic services may operate AEMT
ambulances.
4. Licensed EMT
services shall have ambulances permitted only at the EMT level. Paramedic and
AEMT services may also operate EMT ambulances.
5. Licensed advanced response services shall
only have vehicles permitted at the advanced response level.
6. Licensed EMT specialty services shall only
have ambulances permitted at the EMT specialty level.
7. Licensed EMT volunteer Services shall only
have ambulances permitted at the EMT volunteer level.
8. Licensed medical facility transport
services shall have ambulances permitted as a stretcher ambulance
9. A licensed ambulance service with multiple
levels of permitted vehicles, if not meeting the requirement for tiered
response (see Section IV.C), 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.
*Paramedic. A EMT and EMT services may not
license EMT-specialty, EMT-volunteer or stretcher
Ambulances
B. Medical Direction
1. Each licensed EMS service shall have a
medical director. This medical director must provide the Drug Enforcement
Agency license for the service. Exceptions include volunteer services, unless
medications are part of the service protocols/guidelines. The medical director
shall:
a. delegate other physicians or
qualified healthcare professionals designated by the medical director to
monitor and supervise the medical field performance of each EMS agency's EMSPs.
However, the medical director shall retain ultimate authority and
responsibility for the monitoring and supervision, for establishing protocols
and standing orders and for the competency of the performance of authorized
medical acts.
b. annually review
all service protocols/guidelines and ensure that they are appropriate for the
licensure level of each EMSP to whom the performance of medical acts is
delegated and authorized, and compliant with accepted standards of medical
practice and in line with the Departments minimum patient care guidelines. The
medical director shall be familiar with the training, knowledge and competence
of each of the EMSP to whom the performance of such acts is
delegated.
c. notify the Department
within fourteen (14) business days prior to his or her cessation of duties as
medical director.
d. ensure the
licensed services, for which direction is provided is in compliance with these
Rules.
e. have the authorization to
limit the scope of practice or remove their affiliation of any EMSP under their
direction. Medical directors who limit or remove their affiliation from an EMSP
shall immediately notify the Department in writing outlining why these steps
were taken.
f. Have knowledge and
oversight of their EMS Service who is participating in EMSP field/clinical
times and 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.
Physicians acting as medical directors for EMS education
programs recognized by the Department that require clinical and field
internship performance by students shall be permitted to delegate authority to
a student-in-training during their performance of program-required medical acts
and only while under the control of the education program.
C. Tiered
Response
1. A licensed ambulance service
which has either its own dispatch center or utilizes an outsourced or
commercial dispatch service. The dispatch service must use a dispatch process
with certified emergency medical dispatchers that is recognized by the
Department and is reliably able to differentiate and categorize the severity of
the emergency call and assign the appropriate level of ambulance to that call.
Services utilizing a tiered response dispatch process shall met
the following provisions:
a. Each
emergency call must be answered and screened by a certified Emergency Medical
Dispatcher (EMD). EMD Certification must be obtained and maintained by a
National Recognized Certifying body that is recognized by the Department. EMD
Certification or License shall be made available for review during EMS service
inspections.
b. The EMD Center must
have medical director oversight.
c.
The service shall be required to have a quality improvement program in place to
ensure compliance with their service tiered response protocols and shall be
reviewed by the medical director within thirty (30) days of the call
date.
d. All tiered responses that
require a higher level intercept shall be tracked separately and reported to
the Department on a quarterly basis.
e. The service shall have a process in place
that would specifically and reliably identity which calls are appropriate for
less than the highest level of permitted ambulance and track all calls in which
this dispatch process is implemented.
f. All requirements are met for the ambulance
that is responding to include equipment, personnel and licensure standards set
forth in regulation.
D. Quality Improvement and Service Records
1. Each licensed emergency medical services
agency shall conduct a quality improvement program. The quality improvement
program shall evaluate patient care and personnel performance for compliance
with the current standards of practice as set forth in the services medical
protocols/guidelines, 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 improvement program and review shall include the following:
a. The criteria used to select audited
runs;
b. Ambulance encounter form
review;
c. Problem identification
and resolution d. Investigation of complaints or incident reports;
e. Date of review;
f. Attendance at the review;
g. A summary of the review discussion.
2. 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:
a. Patient Care
Records;
b. Equipment
checks;
c. Personnel
certifications, continuing education and credentialing;
d. Policies and procedures; and
e. Any documents related to service
licensure.
E.
General Standards for Community Paramedic Services
1. Each licensed community paramedic service
shall have a medical director. This medical director must provide the Drug
Enforcement Agency license for the service. The medical director shall:
a. have an active Arkansas state license and
must maintain their license at all times.
b. be either Board Certified or Board
eligible in a specialty that is involved in direct patient contact. Each
medical director shall be approved by the Department.
c. provide monitoring and supervision of the
medical field performance of each community paramedic and be actively involved
in all aspects of the program, including but not limited to training, provider
selection, quality improvement, and evaluation of the programs goals and
objectives.
d. retain ultimate
authority and responsibility for the monitoring and supervision, for
establishing protocols/guidelines and standing orders and for the competency of
the performance of authorized medical acts.
e. ensure that all protocols/guidelines are
appropriate for community paramedic to whom the performance of medical acts is
delegated and authorized, and compliant with accepted standards of medical
practice.
f. be familiar with the
training, knowledge and competence of each of the EMS Personnel to whom the
performance of such acts is delegated.
g. notify the Department immediately upon his
or her cessation of duties as medical director.
h. ensure the licensed service for which
direction is provided is in compliance with these Rules.
2. Each licensed emergency medical services
agency shall conduct a quality improvement program. The quality improvement
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 improvement program and review shall include but is not limited to the
following:
a. The criteria used to select
audited runs;
b. Patient encounter
form review;
c. Problem
identification and resolution;
d.
Investigation of complaints or incident reports;
e. Date of review;
f. Attendance at the review;
g. A summary of the review discussion.
3. 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:
a. Patient Care
Records;
b. Equipment
checks;
c. Personnel
certifications, continuing education and credentialing;
d. Policies and procedures; and
e. Any documents related to service
licensure.
F.
Specific Standards
1. Licensed Paramedic
Services shall:
a. provide twenty-four (24)
hour emergency ambulance service coverage. All services shall have a documented
plan ensuring coverage within the services service area at all times.
b. meet the two-minute reaction
time.
c. maintain a register of
legend drugs to include type, quantity, date received, date of expiration and
physician authorizing purchase and usage.
d. 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.
e. have an Arkansas licensed medical director
as defined in Section I, medical director (Advanced Life Support
Services).
f. maintain a copy of
the physician Drug Enforcement Agency (DEA) registration to be utilized in
acquiring controlled drugs.
2. Licensed Community Paramedic Services may
provide care/services to:
a. Discharged
patients who have been screened for home health or hospice and;
1) Do not qualify for home health or hospice
services; or
2) Are documented as
having declined home health or hospice services.
b. A community paramedic may only participate
in care of a patient under the care of home health agency with the following
conditions:
1) Have a formal request of the
home health agency
2) Have clear
communications between the community paramedic service and home health
agency
3) Only act within the
request of the home health agency and under the scope of practice of the
community paramedic
c.
Discharged emergency department patients; and Pre-hospital patients.
d. Community paramedic care/services are
limited to:
1. Coordination of community
services (community paramedic services shall have a resource management
manual);
2. Chronic disease care,
monitoring and education;
3. Health
assessment;
4. Hospital discharge
follow-up care;
5. Laboratory
specimen collection; and
6.
Medication compliance.
3. Licensed AEMT Services shall:
a. provide twenty-four (24) hour emergency
ambulance service coverage. All services shall have a documented plan ensuring
AEMT coverage within the services service area at all times.
b. meet the two-minute reaction
time
c. have a medical director as
defined in Section I, Medical Director (Advanced Life Support Services).
4. Licensed EMT Services
shall:
a. provide twenty-four (24) hour
ambulance service coverage. All services shall have a documented plan ensuring
EMT coverage within the services service area at all times.
b. meet a two-minute reaction time
c. have a medical director as defined in
Section I of these rules. (If medications or expanded skills are in the EMT
services protocols)
d. maintain on
file with the Department a copy of the Medication Policy and Procedure which
meets the requirements of the Arkansas Department of Health Pharmacy Services
and Drug Control. (If medications or the expanded skills are in the EMT
services protocols)
5.
Licensed Advanced Response Agency shall:
a.
provide emergency care to critically ill or injured patients prior to the
arrival of a licensed transporting ambulance service.
b. be a government entity or a licensed
ambulance service for a service area in which they are currently
licensed.
c. meet a two-minute
reaction time
d. only be permitted
at the Pparamedic level.
e. shall
maintain a register of legend drugs to include type, quantity, date received,
date of expiration and physician authorizing purchase and usage if narcotics
are carried.
f. have a Mmedical
Ddirector as defined in Section I, Medical Director (Advanced Life Support
Services). Advanced Response Agencies shall have coordinated and agreed upon
guidelines/protocols by all transporting agency medical directors within the
advanced response agency's service area.
g. maintain a copy of the Department approved
Medication Policy and Procedures that meet the requirements of the Arkansas
Department of Health Pharmacy Services and Drug Control if narcotics are
carried.
h. staff each vehicle with
at least one (1) licensed Pparamedic at all times.
i. only transfer care to a licensed
Pparamedic transporting service or maintain advanced level of care throughout
transport if care is rendered to a basic life support transporting ambulance
service.
j. Agencies not operating
on a twenty-four (24) hour, seven (7) days a week basis, shall provide all of
the licensed transporting ambulance services within their service area a
schedule of operation that clearly indicates the levels of coverage and times
of availability. Agencies are required to immediately notify the licensed
transporting ambulance services of any changes to the schedule in real-time. It
is the responsibility of the advanced response agency to notify the local
licensed transporting ambulance services of dispatched advanced response
vehicles.
6. Licensed
Specialty Service:
a. A specialty service
license shall be issued to an applicant who provides a specific medical service
to a limited population group and emergency evacuation services only, and does
not participate in the business of providing continuous general population
response for emergency medical services and is limited to pediatrics, neonatal,
high risk obstetrics, or the industrial settings).
b. A specialty service shall have a medical
director as defined in Section I, medical director (Basic Life Support Services
see Section L KK and for Advanced Life Support Services see Section L JJ). This
applies to basic life support services if medications or expanded skills are in
the EMT services protocols/guidelines.
c. A specialty service shall maintain on file
with the Department a copy of the Medication Policy and Procedure which meets
the requirements of the Arkansas Department of Health Pharmacy Services and
Drug Control. (If medications or the expanded skills are in the EMT services
protocols/guidelines)
7.
Licensed EMT Volunteer Service:
a. An EMT
volunteer service license shall be issued to an applicant whose ambulances are
staffed by personnel who perform and give services without expectation of
compensation.
b. An EMT volunteer
service shall have a medical director as defined in Section I. KK of these
rules. (If medications or expanded skills are in the EMT services
protocols/guidelines)
c. An EMT
volunteer service shall maintain on file with the Department a copy of the
Medication Policy and Procedure which meets the requirements of the Arkansas
Department of Health Pharmacy Services and Drug Control. (If medications or the
expanded skills are in the EMT services protocols/guidelines)
8. Licensed Medical
Facility Transport Service
a. A medical
facility transport service shall be issued to a medical facility that is
regulated by the Arkansas Department of Health that owns and operates a
stretcher ambulance vehicle.
b. The
following criteria shall be met to obtain a medical facility transport service
license:
1) Use license solely for the
purpose of transporting a patient from one location to another for medical
tests or treatments and the patient is returned within twenty-four (24)
hours.
2) Receive authorization
from the patient's treating physician for the transport.
3) Keep the transport within a thirty (30)
mile radius of the health facility.
4) The health facility owns and operates the
transporting service.
5) Only
medically stable and non-emergent individuals may be transported.
6) If the medical condition of a patient
suddenly changes which requires care to be rendered, the operator of the
Stretcher Ambulance will immediately divert to the closest hospital and/or
contact the local EMS service to request assistance appropriate emergency care
shall be initiated and continued until the EMS service has intercepted the
transport or arrival at the hospital.
c. Stretcher ambulances shall not transport
patients requiring the following:
1) Invasive
procedures (I.V. therapy, drug administration, I.V. pumps, etc.).
2) Mechanical monitoring
procedures.
3) Mechanical
respiratory procedures.
4) Oxygen
therapy, excluding patient-owned
equipment.
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 which 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 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)*:
a.
'star of Life" emblem must be displayed on the top of the ambulance.
b. The permit sticker issued by the
Department will be displayed on the rear lower left comer 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 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) * 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 sufficient intensity to be visible at five hundred feet (500") in normal
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 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 AWFN 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 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 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 services 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.
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 the patient during the
transport.
SECTION
VI AIR AMBULANCE SERVICE LICENSURE CLASSIFICATION STANDARDS
A. Air Ambulance Service Classifications
1. Each vehicle of a licensed air ambulance
service shall be issued a permit in one of the classifications set forth below.
a. Air Medical Rotor-Wing
b. Air Medical Rotor-Wing Specialty
c. Air Medical Fixed-Wing
B. General
Standards
1. A vehicle may not be operated as
an air 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 of an aircraft shall follow the
FAA standards outlined in the certificate holder's operation manual.
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 Rules, in conjunction with other
state's applicable rules when appropriate.
6. Each air ambulance service shall have and
maintain a coordination point, twenty-four (24) hours a day, seven (7) days a
week.
7. Each air rotor-wing
aircraft must have radio capability to communicate air-to-ground and the
ability to communicate 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:
a. time the call was received
b. time the aircraft was dispatched
c. time the aircraft departed
d. name of party requesting the flight with
verification telephone number
e.
pertinent medical and logistical support information.
10. Each air ambulance operator must
maintain, for seven (7) years, a patient encounter record for each patient
flight. This record may be electronic or hard copy.
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 ensure:
a. that all
EMSP, for which direction is provided, are properly educated and licensed
pursuant to these Rules. This includes skills verification.
b. that each EMSP, for which direction is
provided, is following service protocols/guidelines.
c. the licensed services, for which direction
is provided is in compliance with these Rules.
d. the services written protocols/guidelines
are reviewed annually and prior to implementation of any changes and review the
duty readiness policy.
13. Each service shall maintain a register of
legend drugs as outlined in Section XIV.
14. Each service shall maintain a copy of the
Department approved Medication Policy and Procedures 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/guidelines in the aircraft at all times. These can be in
print or electronic.
16. Quality
Assurance Program for Licensed Ambulance Services
Documentation for the quality assurance program and review
shall include the following:
a. The
criteria used to select audited runs; Ambulance encounter form
review;
b. Problem identification
and resolution;
c. Investigation of
complaints or incident reports;
d.
Date of review;
e. Attendance at
the review;
f. A summary of the
review discussion.
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
Rules prescribed herein. Each service shall maintain and make available to the
Department for inspection all patient encounter forms.
C. Specific Air Medical Service Standards
1. Each Air Medical Rotor-Wing and Air
Medical Rotor-Wing Specialty ambulances shall:
a. provide twenty-four (24) hour emergency
ambulance service coverage.
b. meet
the two- minute reaction time with the exception of hazardous weather
conditions that would preclude response.
c. have a minimum of one (1) incoming
telephone line dedicated to emergency requests for the air ambulance
service.
d. an Air Ambulance
Communication Specialist that is an EMT (licensed / Certified by the State
where the communications center is located, that is present in the
communication center and actively involved in the communications
process.
e. a communication center
with the following:
1) A system to record all
communications pertaining to flight requests. The system must have
time-encoding and playback capabilities. Recordings shall be kept for a minimum
of sixty (60) days.
2) Maps of all
areas where the service responds to scene flights. Maps shall be an Arkansas
State Highway and Transportation Department General Highway Map for Counties or
the equivalent and can be electronic or printed copy.
f. have personnel capable of plotting scene
coordinates and directing the helicopter to a scene location, twenty-four (24)
hours a day.
g. have a policy
addressing Post Accident/Incident Plan.
h. arrange for flight following at least
every fifteen (15) minutes.
Documentation of such flight following must be maintained
during all phases of flight.
2. Each Air Medical Fixed-Wing ambulance
shall have:
a. a minimum of one (1) incoming
telephone line dedicated to requests for the air ambulance service.
b. an air ambulance communication specialist
assigned to receive all dispatch and flight request information on behalf of
the air ambulance service.
SECTION VII. PERMITTING OF AIR AMBULANCE
VECHICLES
A. Application
An application for the issuance or renewal of an air ambulance
vehicle permit shall be made to the Department.
B. Air Ambulance Vehicle General Standards
1. Air Ambulance Vehicles Shall:
a. be configured to allow the air medical
personnel to treat the patient including advanced life support
procedures.
b. ensure that all
outdated, misbranded, adulterated or deteriorated fluids, supplies and
medications are removed from an aircraft immediately.
c. carry the minimum approved supplies and
equipment for the level of licensure of the air ambulance. All equipment and
supplies shall be clean, sanitary and in good working order. * See Appendix
1
d. be properly climate controlled
at a temperature range of 50°-85°. All pharmaceuticals shall be kept
within the recommended temperature range as established by the
manufacturer.
e. Each air ambulance
service shall have in force and effect malpractice insurance coverage in the
amount of no less than $1,000,000 per occurrence and no less than $3,000,000
aggregate for all air medical personnel. The service shall maintain proof of
current insurance policy.
C. Air Ambulance Vehicle Specific Standards
1. Rotor-Wing and Rotor-Wing Specialty
Vehicles Shall:
a. have communication
capabilities for 123.05 mHz, 155.340 mHz, 155.235 mHz, and 155.280 mHz radio
frequencies.
b. have a two-way
radio with the ability to communicate:
1)
between the pilot and air medical personnel;
2) with physicians who are responsible for
directing patient care in transit, and with ground personnel who coordinate the
transfer of the patient.
3)
air-to-air and air to ground; and
4) in the trauma system utilizing a trauma
AWIN radio or another suitable medium capable of real-time, direct
communication with the ATCC.
2. Fixed-Wing Vehicles Shall:
a. have communication capabilities for 123.05
mHz and other nationwide frequencies.
b. have ability to communicate:
1) between the pilot and air medical
personnel;
2) with physicians who
are responsible for directing patient care in transit, and with ground
personnel who coordinate the transfer of the patient and.
3) air-to-air and air to ground;
and
4) capable of real-time, direct
communication with the ATCC when transporting trauma
patients.
D. Air Ambulance Staffing Requirements
1. Air Medical Rotor-Wing
a. All flights shall be staffed by a minimum
of two (2) air medical personnel one of who must be a flight nurse or
physician. The physician may be the medical director or their designee who
meets the appropriate air medical training requirement. The air ambulance
service medical director may select other crew members at their discretion from
the following: paramedic, respiratory therapist, RN or physician as long as the
personnel meets the minimum training requirements.
2. Air Medical Rotor-Wing Specialty
a. All flights shall be staffed by a minimum
of two (2) air medical personnel one of who must he a flight nurse or
physician. The air ambulance service medical director may select other crew
members at their discretion from the following: paramedic, respiratory
therapist, RN or physician as long as the personnel meets the minimum training
requirements.
3. Air
Medical Fixed-Wing
a. All flights shall be
staffed by a minimum of one (1) medical crew member that shall be a licensed
EMSP, critical care nurse, flight physician, or other appropriate medical
personnel selected by the air ambulance service medical director. If a
physician is on the flight, the minimum crew members shall be a flight nurse or
paramedic.
E.
Air Medical Personnel Training Requirements - Prehospital Air Medical
Rotor-Wing (Non Physician Crew)
1) Minimum
Orientation and Recurrent Training in the Following Areas:
a. Prehospital Environment
1) Will be covered by EMT licensure
Requirement
b. Air
Medical Environment
1) Aircraft: Safety
Issues to include as required by the FAA -Annual Recurrent Training, to include
Crew Resource Management.
2) Air
Medical Patient Transport Considerations (Preparation, Handling and
Equipment)
3) Altitude Physiology
and Stressors of Flight - one (1) hour initially and annually.
4) Day and Night Flying Protocols - To be
included in FAA Annual Safety Inspection.
5) EMS Communications (radios) and
familiarization with EMS System - one (1) hour initially.
6) Invasive Procedures (or Manikin
Equivalent) for competency maintenance, four (4) intubations/year - recommended
one (1) successful intubation/quarter.
7) Quality Management - one (1) hour
yearly.
c. Preparatory
(mandatory for both the RN/EMT and paramedic) Minimum
Experience for Flight Nurses:
1) Minimum of
three (3) years current registered nursing experience in critical care and/or
emergency nursing (e.g. ICU, CVICU, ER, or ecu). If a RN has two (2) years of
critical care and/or emergency nursing experience and three (3) years of EMS
experience at the paramedic level they may be considered eligible for flight
nurse status. A Paramedic with three (3) years of flight experience may be
allowed to transition into the flight nurse role provided that they
successfully complete a program specific flight nurse orientation.
Minimum Experience for paramedics Conducting Air Ambulance
Transport:
2) Minimum of
three (3) years current paramedic experience with a paramedic ambulance
service.
d. Trauma
1) Disaster and Triage: two (2) hours
initially and annually.
2) Thermal,
Chemical and Electrical: two (2) hours initially and
annually.
e.
Certifications Required
1) Neonatal
Resuscitation Program (NRP) or equivalent course
2) Pediatric Advanced Life Support (PALS)
course or Pediatric Education for Prehospital Providers (PEPP) course or
equivalent course
3) Advanced
Cardiac Life Support (ACLS) or equivalent course
4) Prehospital Trauma Life Support (PHTLS),
International Trauma Life Support (ITLS), Trauma Nurse Core Course (TNCC), or
equivalent course.
5) FEMAICS 100,
200, 700
F. Air Medical Personnel Training
Requirements - Prehospital Air Medical Rotor-Wing conducting specialty flights
(High Risk Obstetrics and Neonatal Transports)
1. High Risk Obstetrical
a. Basic Fetal Monitoring Class - four (4)
hours initially, one (1) hour annually
b. The following didactic topics shall be
covered annually:
1) Fetal
Assessment
2) Triage and Assessment
of the Pregnant Patient
3)
Conditions Warranting Transport and Stabilization
4) Emergency Childbirth and Complications of
Delivery
5) Placenta Previa and
Placental A bruption
6) Prolapsed
Cord
7) Pre-Eclampsia
8) Post-Partum Hemorrhage
9) OB Trauma
10) Medications
c. Certifications Required
1) Advanced Cardiac Life Support (ACLS) or
equivalent
2) Neonatal
Resuscitation Program (NRP) or equivalent
2. Neonatal Transport
a. The following didactic topics shall be
covered annually:
1) Maternal Physiologic and
Pharmacologic Factors Affecting the Neonate
2) Physical Examination
3) Gestational Age Assessment
4) Interpretation of Clinical, Laboratory,
Radiographic and Other Diagnostic Data
5) Thermoregulation
6) Oxygen Monitoring
7) Fluid and Electrolyte Therapy
8) Pharmacology, including drug dose
calculations
b. Anatomy,
Pathophysiology, Assessment and Treatment of:
1) Acute and Chronic Respiratory
Diseases
2) Cardiovascular (CV)
Abnormalities
3) Surgical
Emergencies
4) Infectious
Diseases
5) Musculoskeletal
Abnormalities
6) Neurological and
Spinal Cord Injuries
7) Prematurity
and Post Maturity
8) Hematologic
Disorders
9) Metabolic and
Endocrine Disorders
10) Disorders
of the Head, Eyes, Nose and Throat
11) Genetic Disorders, Congenital Heart
Disease
12) Psychosocial and
Bereavement Support
13) Mechanical
Ventilation Techniques during Transport
c. The following clinical areas shall be
covered
1) Oxygen Administration
2) Anesthesia Bag and Mask
Ventilation
3) Application of Nasal
Continuous Positive Airway Pressure (CPAP)
4) Endotracheal Intubation
5) Ventilation and Inhaled
6) Nitric Oxide if indicated
7) IV and Intra-Arterial Access, which might
include:
8) Intraosseous
Access
9) Venipuncture for Lab
Specimen Collection
10)
Cardiopulmonary Resuscitation (CPR)
11) Hemorrhage Control
12) Radiographic
Interpretation
d.
Certifications Required
1) Neonatal
Resuscitation Program (NRP) or equivalent
G. Air Medical
Personnel Training Requirements - Air Medical Rotor-Wing Specialty
1. Minimum Orientation and Recurrent Training
in the Following Areas:
a. Air Medical
Environment
1) Aircraft Safety Issues to
include as required by the FAA Annual Recurrent Training, to include Crew
Resource Management.
2) Air Medical
Patient Transport Considerations (Preparation, Handling and
Equipment)
3) Altitude Physiology
and Stressors of Flight - one (1) hour initially and annually.
4) Day and Night Flying Protocols - To be
included in FAA Annual Safety Inspection.
5) EMS Communications (radios) and
familiarization with EMS System - one (1) hour initially.
6) Invasive Procedures (or Manikin
Equivalent) for competency maintenance, 4 intubations/year - recommended one
(1) successful intubation/quarter.
7) Quality Management - one (1) hour
yearly.
8) Stress Recognition and
Management
b. Preparatory
(Mandatory for both the RN/EMT, Paramedic) Minimum Experience
for Flight Nurses
1) Minimum of three (3)
years current registered nursing experience in specialty care (e.g. Neonatal
Intensive Care Unit, Intensive Care Unit Pediatric Intensive Care Unit, Labor
& Delivery, etc.), emergency nursing or other as appropriate to the mission
of the air ambulance service.
Minimum Experience for Paramedics
2) Minimum of three (3) years current
paramedic experience with a paramedic ambulance service.
Minimum Training Requirements for Specialty Care Air Medical
Personnel
3) Specialty Care
air medical personnel must have appropriate state licensure or certification
requirements by appropriate agencies or governing bodies and have relevant
specialty experience as described by program policy. At minimum these personnel
must have the following training as noted in Division I - Air Medical
Environment.
H. Air Medical Personnel Training
Requirements - Air Medical Fixed-Wing
1.
Minimum Orientation and Recurrent Training in the following areas:
a. Air Medical Environment
1) Aircraft Safety Issues to include and as
required by the FAA -Annual Recurrent Training, to include Crew Resource
Management.
2) Air Medical Patient
Transport Considerations (preparation, handling and equipment)
3) Altitude Physiology and Stressors of
Flight - one (1) hour initially and annually.
b. Preparatory (mandatory for all fixed-wing
medical personnel) Minimum Experience for RN on a Fixed-Wing
1) Minimum of two (2) years current RN
experience in critical care and/or emergency nursing (e.g. ICU, CVICU, ER, or
CCU). For specialty transports, a RN must have a minimum of two (2) years
current registered nursing experience in the specialty of the patient being
transported.
Minimum Experience for Paramedics Conducting Fixed-Wing
Transport
1) Minimum of two (2) years
current paramedic experience with a paramedic ambulance service.
Minimum Experience for Specialty Care Fixed-Wing
Personnel
1) Specialty care fixed-wing
personnel must have appropriate state license or certification requirements by
appropriate agencies or governing bodies and have relevant specialty experience
as described by program policy. At minimum these personnel must have the
following training as noted in Air Medical Environment.
c. Certifications Required
1) Advanced Cardiac Life Support (ACLS) or
equivalent course
2) Pediatric
Advanced Life Support (PALS) course or Pediatric Education for Prehospital
Providers (PEPP) course or equivalent course if transporting pediatric
patients
3) Neonatal Resuscitation
Program (NRP) or equivalent course if transporting neonatal
patients.
I. Air Medical Personnel Training
Requirements for Air Medical Rotor-Wing Air Ambulance Communication Specialists
1. Minimum Initial and Recurrent Training in
the Following Areas:
a. Medical Terminology
b. Knowledge of EMS
c.
Familiarization with equipment used in the field setting
d. FAR's pertinent to the medical transport
service
e. FCC regulations
pertinent to the medical transport service
f. General safety rules and emergency
procedures pertinent to air medical transport service
g. Map Skills including - ability to locate
an aircraft utilizing coordinates
h. Ability to articulate weather radar
information to pilots
i. Types of
radio frequency bands used in air medical EMS
j. Assistance with hazardous materials
response and recognition procedure using appropriate reference
materials
k. Stress recognition and
management
l. Customer
service/public relations/phone etiquette
m. Quality Management
n. Crew Resource Management (CRM) pertinent
to communications
o. Computer
literacy and software training
p.
Post-Accident Incident Plan (PAIP)
J. Documentation for Recurrent Training
2. Documentation showing
completion of all recurrent training as outlined in Section VII.E.1. and shall
be submitted to the Department annually with the air ambulance service license
renewal for all licensed EMT and communication specialists.
SECTION VIII. APPROVED EMERGENCY
MEDICAL SERVICES PERSONNEL SKILLS
A.
Paramedics and AEMT's may function within their scope of practice while off
duty or while not staffing a permitted ambulance within the service area of the
ambulance service with whom the EMSP is employed full time.
1. The following must be submitted to the
Department for review and approval prior to implementation of this practice:
a. Written approval from the ambulance
service medical director.
b.
Written approval from ambulance service manager/director.
c. Verification that the individual(s) are
licensed by the Department to perform the skills requested.
d. Submit medical director approved treatment
protocols addressing this specific practice and any equipment carried by the
EMSP.
e. In all cases, where
advanced care is initiated and transport is required, advanced care must be
maintained enroute to the hospital in a paramedic or AEMT permitted ambulance.
* Advanced life support equipment cannot be stored on a
licensed EMT ambulance.
2. An AEMT 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/guidelines as long as they meet ALL of the following requirements:
a. Written approval from the team's medical
director and submitted to the Department for review.
b. Written approval is received from the
team's manager/director and submitted to the Department for review and
approval.
c. Submit medical
director approved protocols/guidelines specific to this practice to the
Department prior to implementation of program.
d. Verification that the Individual(s) are
licensed by the Department to perform the skills
e. Individual's performance is not tied to a
licensed ambulance service at the time they are performing skills for the
response team
f. In all cases,
where advanced care is initiated, advanced care must be maintained on scene and
enroute to the hospital in a paramedic or AEMT permitted ambulance.
B. EMSPs are
permitted to perform only those skills and administer only those medications
outlined in the EMSPs National Scope of Practice once they are trained in the
skill or pharmacology of that medication, and credentialed by the EMS service's
medical director. In order to provide patient care in Arkansas, all EMSP's must
hold a current Arkansas EMSP license.
ALS Services approved to provide Rapid Sequence Induction (RSI)
must first meet all RSI requirements and be approved by the Department.
Paramedics are allowed to use paralytics to maintain the paralysis of an
already intubated patient, if approved by medical
direction.
SECTION
IX. EDUCATION, TESTING AND LICENSURE OF MEDICAL PERSONNEL
A. The Department shall license or certify
individuals for the provision of Emergency Medical Services
1. The Department shall issue the following
types of licenses or certifications:
a.
Advanced Life Support
1) Paramedic
2) Community Paramedic
3) Advanced Emergency Medical Technician
(AEMT)
b. Basic Life
Support
1) Emergency Medical
Technician
c. Instructor
1) Emergency Medical
Services-Instructor
2) Emergency
Medical Services-Instructor Trainer
d. Emergency Vehicle Operator
2. Fees
An application for the initial issuance of a license shall be
submitted to the Department, and shall be accompanied by the fee set forth by
Arkansas Code Ann. §
20-13-211. An application for the
emergency vehicle operator (EVO) certification and community paramedic
licensure shall be submitted to the Department with the application fee
waived.
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.
a. All licensure levels, except EVOs, shall
maintain the following during their license period:
1) Current CPR certification
2) maintain a National Registry of Emergency
Medical Technician (NREMT) certification for the level in which they are
licensed.
b. All
paramedics and community paramedics shall maintain the following throughout
their licensure period:
1) Current ACLS
certification
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 or emergency
vehicle operator certification shall complete a state and/or federal criminal
history check.
5. Paramedic
a. Successful completion of an Arkansas and
Committee on Accreditation of Educational Programs for the Emergency Medical
Services Professions (CoAEMSP) and Committee on Allied Health Education and
Accreditation (CAHEA) accredited paramedic program including all didactic,
clinical and field internship requirements.
b. Successful completion of the NREMT
paramedic certification process.
6. Community Paramedic
a. Successful completion of a Department
approved community paramedic curriculum.
b. Hold NREMT certification as a paramedic
and be in good standing with the NREMT.
c. Hold an Arkansas license as a paramedic
and be in good standing with the Department.
d. Have two (2) years of full time service as
a paramedic and be actively employed by a licensed paramedic service. Potential
licensees shall submit a letter from a licensed paramedic service indicating a
minimum of 1000 hours worked per year for two (2) years and confirming that
they are actively employed by that service.
7. Advanced Emergency Medical Technician
a. Successful completion of an Arkansas
accredited Advanced Emergency Medical Technician program including all
didactic, clinical and field internship requirements, and
b. Successful completion of the NREMT AEMT
certification process.
8.
Emergency Medical Technician
a. Successful
completion of an Arkansas accredited EMT program including all didactic,
clinical and field internship requirements
b. Successful completion of both the Arkansas
practical skills examination and the NREMT certification
process.
9. Emergency
Medical Services Provider Instructor
a. Hold
an Arkansas EMSP license and be in good standing with the Department.
b. Licensed as an EMSP continuously from any
state, national or military for a minimum of two (2) years
c. Successful completion of an approved forty
(40) hour EMSP instructor course with a current affiliation with an educational
institution (Vo-Tech School, Technical College, Community College, College or
University) or licensed ambulance service training department.
d. Copy of a current Basic Life Support CPR
instructor card.
e. Copy of a
current American Heart Association ACLS instructor card for EMSP paramedic
instructors only.
10.
Emergency Vehicle Operator
a. Successful
completion of a National recognized First Responder Course of a minimum of
forty (40) hours of training.
b.
Copy of a current signed Basic Life Support CPR card (Must follow current
American Heart Association Guidelines and require a hands on skills component)
documenting completion of a CPR course designed specifically for healthcare
providers.
c. Emergency Vehicle
Operator Course
d. Ten (10) hours
of refresher training every two years to include emergency vehicle operations.
B. General
Licensure Renewal Standards
One (1) Continuing Education (CE) Hour is defined as every
fifty (50) minutes of approved classroom or skills laboratory activities, or
each hour of media based/serial production. Continuing Education courses or
activities shall not be approved or accepted for less than one half hour of
credit. CE hours shall not be awarded until all requirements have been met and
the EMSP attended the complete training. Credit can be applied for college
courses that relate to your role as an EMS professional. Hour-for-hour credit
can be applied for nationally standardized courses (including, but not limited
to, ABLS, ACLS, AMLS, EMPACT, EPC, ITLS, PHTLS, PALS, PEPP, etc.) The following
cannot be applied towards the National
Continued Competency Program Topic Hours (NCCR, LCCR and ICCR):
a. Performance of duty or volunteer time with
agencies
b. Clinical
rotations
c. Instructor methodology
courses
d. Management/leadership
courses
e. Preceptor hours
C. Application and
Recertification Audits
Initial and renewal applications are randomly selected for
audit. If a licensee's EMSP's application is randomly selected, the licensee
EMSP must provide documentation for all hours used for their renewal, or
information included on their initial application within fifteen (15) business
days from notification. Documentation may consist of course completion
certificates, training rosters, written verification from the training officer,
or other proof as approved by the Department.
D. Renewal Standards
1. All individuals applying for renewal of a
license or emergency vehicle operator certification shall submit the following
to the Department:
a. Completed renewal
application.
b. Application fee set
forth by current EMS statute payable to the Arkansas Department of Health. Not
applicable for emergency vehicle operators or community paramedic
licensure.
c. Copy of a current
Basic Life Support CPR card (Must follow current American Heart Association
Guidelines and require a hands on skills component) documenting completion of a
CPR course designed specifically for healthcare providers.
d. Document completion of all education
requirements for your level of licensure or certification. It is the
responsibility of the EMSP to maintain copies of all rosters, certificates,
and/or proof of attendance to all continuing education used for renewal. These
documents will be required should the EMSP be audited.
2. Specific Renewal Requirements by EMS Level
a. Emergency Medical Technician
1) Continuing education hours need to meet
the NREMT requirements are outlined below. Licensee must complete all
requirements in a-c.
a. Twenty (20) hours
following the topic required for National Certification. Up to seven (7) hours
in this category can be distributive education.
b. Ten (10) hours in the following topic
areas Up to seven (7) hours in this category can be Distributive Education.
i. Arkansas Trauma System - Two (2)
hours
ii. Pediatric - Two (2)
hours
iii. Stroke/CVA - Two (2)
hours
iv. Cardiology - Two (2)
hours
v. Documentation - One (1)
hour
vi. Ethics and Professionalism
- One (1) hour
c. Ten
(10) hours in any EMS related topic areas. Up to ten (10) hours in this
category can be Distributive Education.
2) NREMT certification and verification is
required.
EMTs who have never held national certification shall document
completion of all education requirements outlined in 1) a.-c. above prior to
their state license expiration date to obtain state EMT license.
b. AEMT
1) Continuing education hours need to meet
the NREMT requirements are outlined below. Licensee must complete all
requirements in a-c.
a. Twenty-five (25) hours
following the topics required for National Certification. Up to eight (8) hours
in this category can be distributive education.
b. Twelve and one-half (12.5) hours in the
following topic areas. Up to eight (8) hours in this category can be
Distributive Education.
i. Arkansas Trauma
System - Two (2) hours
ii.
Pediatric - Two and one-half hours (2.5)
iii. Stroke/CVA - Two (2) hours
iv. Cardiology - Two (2) hours
v. Documentation - Two (2) hours
vi. Ethics and Professionalism - Two (2)
hours
c. Twelve and
one-half (12.5) CE hours in any EMS related topic area. Up to Twelve and
one-half (12.5) hours in this category can be Distributive Education.
2) NREMT certification
and verification is required.
AEMTs who have never held national certification shall document
completion of all education requirements outlined in 1) a.-c. above prior to
their state license expiration date to obtain state AEMT license.
3) Medical director's electronic
signature on the renewal application verifying competency in AEMT
skills
c. Paramedic
1) Continuing education hours need to meet
the NREMT requirements are outlined below. Licensee must complete all
requirements in a-c.
a. Thirty (30) hours
following the topics required for National Certification Up to ten (10) hours
in this category can be Distributive Education.
b. Fifteen (15) hours in the following topic
areas. Up to ten (10) hours in this category can be Distributive Education.
i. Arkansas Trauma System -Two (2)
hours
ii. Pediatric - Three (3)
hours
iii. Stroke/CVA - Four (4)
hours
iv. Cardiology - (2)
hours
v. Documentation - Two (2)
hours
vi. Ethics and
Professionalism - Two (2) hours
c. Fifteen (15) hours in any EMS related
topic area. Up to fifteen (15) hours in this category can be Distributive
Education.
2) NREMT
certification and verification is required. Paramedics who have never held
national certification shall document completion of all education requirements
outlined in 1) a.-c. above prior to their state license expiration date to
obtain state paramedic license.
3)
Medical director's electronic signature on the renewal application verifying
competency in advanced paramedic skills.
4) Copy of current American Heart Association
ACLS card.
d. Community
Paramedic
1) Submit a copy of your current
NREMT certification card prior to your license expiration date. No license
shall be issued until current National Registry certification can be
verified.
2) Complete an additional
fifteen (15) hours of practice focused training beyond the renewal requirements
as a paramedic.
3) Submit
documentation from the community paramedic programs medical director affirming
that the licensee is active in performing the skills of a community
paramedic.
e. Emergency
Vehicle Operator
1) Submit a copy of current
Basic Life Support CPR card
2) Ten
(10) hours of refresher training every two years to include emergency vehicle
operations
3.
EMSP - Instructor Renewal Requirements:
EMSP instructor licensure is for a two (2) year period to run
concurrently with the current EMSP level of licensure.
The following must be completed and submitted for ALL
Instructors:
a. A copy of a current
Basic Life Support CPR instructor card (Must follow current American Heart
Association Guidelines and require a hands on skills component)
b. Paramedics instructors shall maintain and
submit current American Heart Association ACLS instructor
certification.
c. Complete twelve
(12) hours of continuing education at the EMSP Instructor level, to include
Professional Development or instructor specific education.
d. Meet the renewal requirements for your
level of licensure (EMT, AEMT, or paramedic)
e. Complete and provide documentation fi"om
the EMS Education Program for (1) one of the following:
1) One (1) full EMT course teaching more than
50% of the course (Must be affiliated with an educational
institution)
2) Two (2) EMT courses
as co-instructor (Must be affiliated with an educational institution)
3) Forty-eight (48) hours of classroom
instruction with a letter from the lead instructor or EMS education program
verifying hours and topics of instruction taught.
f. Submit a signed letter of good standing
from the training site in which your EMSP instructor certification is aligned
with.
4. EMSP renewal
applications submitted after expiration date
a. Renewal will be allowed for those who
submit their documentation after the expiration date, IF:
1) All required educational hours, as
outlined in Section IX. C. for the appropriate license level, were completed
PRIOR to their current expiration date;
2) All specific training (e.g.. Refresher,
ACLS, CPR, etc.) was completed PRIOR to their current expiration date;
AND
3) All documentation was
submitted no later than two (2) years after their current expiration
date
b. EMSP's submitting
their renewal material after the expiration date, but having completed all
requirements prior to their current expiration date will be relicensed to their
previous expected expiration date.
No EMSP may provide patient care until a
license has been
issued.
E. Lapsed Arkansas Licensed Emergency Medical
Service Providers
Individuals who do not complete their educational and training
requirements for renewal prior to their expiration date will be considered
lapsed and will have to complete the following requirements for their licensure
level prior to receiving their new licensure card.
No EMSP that is lapsed shall provide patient care until a
license has been issued:
1. EMT
a.
LAPSED TWO (2)
YEARS OR LESS:
1)
Document successful completion of required educational hours, as outlined in
Section IX. C. for the appropriate license level within the previous twelve
(12) months;
2) Documentation of an
additional twelve (12) hours of continuing education within the past twelve
(12) months.
3) Copy of a current
Basic Life Support CPR card (Must follow current American Heart Association
Guidelines and require a hands-on skills component) documenting completion of a
CPR course designed specifically for healthcare providers
4) Submit completed Arkansas application
form.
5) $20 Application fee set
forth by Arkansas Code Ann. §
20-13-211 payable to the Arkansas
Department of Health.
6) Validation
of competency on all EMT psychomotor skills by an accredited EMS training
program or EMS medical director.
2. AEMT
a.
LAPSED TWO (2) YEARS OR LESS:
1) Document successful completion of all
required educational hours, as outlined in Section IX. C. for the appropriate
license level within the previous twelve (12) months.
2) Documentation of an additional twenty-four
(24) hours advanced continuing education within the past twelve (12)
months.
3) Copy of current Basic
Life Support CPR card (Must follow current American Heart Association
Guidelines and require a hands-on skills component) documenting completion of a
CPR course designed specifically for healthcare providers
4) Submit completed Arkansas application
form
5) $20 Application fee set
forth by Arkansas Code Ann. §
20-13-211 payable to the Arkansas
Department of Health.
6) Validation
of competency on all AEMT psychomotor skills by an accredited EMS training
program, EMS medical director or successfully challenge the NREMT psychomotor
exam.
3.
Paramedic
a.
LAPSED TWO
(2) YEARS OR LESS:
1) Document successful completion of all
required educational hours, as outlined in Section DC. C. for the appropriate
license level within the past twelve (12) months.;
2) Documentation of an additional twenty-four
(24) hours advanced continuing education within the past twelve (12)
months
3) Copy of a current CPR
card (Must follow current American Heart Association Guidelines and require a
hands-on skills component) documenting completion of a CPR course designed
specifically for healthcare providers.
4) Submit a signed copy of current American
Heart Association ACLS card.
5)
Submit completed Arkansas application form;
6) $20 Application fee set forth by Arkansas
Code Ann. § 20-13-20 -13-211 payable to the Arkansas Department
Health.
7) Validation of competency
on all paramedic psychomotor skills by an accredited EMS training program, EMS
medical director or challenge the NREMT psychomotor
exam.
4.
Community Paramedic
a. LAPSED TWO (2) YEARS
OR LESS
1) Meet all renewal requirements set
forth under Section IX.
2)
Documentation of the additional fifteen (15) hours of practice focused training
beyond the renewal requirements as a paramedic; and
3) Submit documentation from the community
paramedic programs medical director affirming that the licensee is active in
performing the skills of a community paramedic.
5. All licensed EMSP levels
a.
LAPSED MORE THAN TWO (2)
YEARS1) All EMSP's shall
complete all initial licensure requirements as outlined in Section
IX.
F. Request for Extension to Complete EMT
License Renewal Requirements
1. Extensions
will only be considered if the EMSP 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:
a. personal illness or
hospitalization;
b. extensive
travel or relocation within the affected time period;
c. military service
d. immediate family illness or death;
or
e. extraordinary circumstances
beyond the control of the EMSP.
2. Extension Decisions:
a. If the Department receives the request
and/or documentation after the EMSP's expiration date or the extension request
is denied, the EMSP will be considered LAPSED. See Section VII. D.
G.
Reciprocity
1. Required Qualifications. An
applicant applying for reciprocal licensure shall meet the following
requirements:
a. The applicant shall hold a
substantially similar license in another United States jurisdiction.
i. A license from another state is
substantially similar to an Arkansas EMSP license if the other state's
licensure qualifications require: NREMT certification, Basic Life Support CPR
certification and Advanced Cardiac Life Support if applicable.
ii. The applicant shall hold his or her
occupational licensure in good standing;
iii. The applicant shall not have had a
license revoked for:
i. An act of bad faith;
or
ii. A violation of law, rule, or
ethics;
iv. The
applicant shall not hold a suspended or probationary license in a United States
jurisdiction;
b. The
applicant shall be sufficiently competent in the EMS field; and
c. hold current NREMT certification.
2. Required
documentation. An applicant shall submit a fully-executed application, the
required fee, and the documentation described below. Submission of an Arkansas
criminal history background check and payment of the applicable fee to include
both state and federal checks. This requirement may be waived if the individual
holds a registered nurse license that is current and in good standing, or holds
a current and in good standing registered nurse license from a nursing compact
state.
a. As evidence that the applicant's
license from another jurisdiction is substantially similar to Arkansas's, the
applicant shall submit the following information:
i. Evidence of current and active licensure
in that state. The Department may verify this information online if the
jurisdiction at issue provides primary source verification on its website or by
telephone to the other state's licensing board; and
ii. Evidence that the other state's licensure
requirements match those listed in Section IX. H.l.a.i. The Department may
verify this information online or by telephone to the other state's licensing
board.
b. To
demonstrate that the applicant meets the requirement in Section IX.H.1.a. ii.
through iv., the applicant shall provide the Department with:
i. The names of all states in which the
applicant is currently licensed or has been previously licensed;
ii. Letters of good standing or other
information from each state in which the applicant is currently or has ever
been licensed showing that the applicant has not had his license revoked for
the reasons listed in Section H.1.a.iii. and does not hold a license on
suspended or probationary status as described in Section IX. H.l. a. iv. The
Department may verify this information online if the jurisdiction at issue
provides primary source verification on its website or by telephone to the
other state's licensing board.
c. As evidence that the applicant is
sufficiently competent in the field of EMS, an applicant shall:
i. Hold a current NREMT
certification
ii. Basic Life
Support CPR certification and Advanced Cardiac Life Support if
applicable.
iii. Community
paramedics must submit verification of education including scope of practice
from transferring state with a letter from an Arkansas community paramedic
medical director showing the candidate would be accepted to the community
paramedic program.
3. Temporary and Provisional License
a. The Department shall issue a temporary and
provisional license immediately upon receipt of the application, the required
fee, and the documentation required under Section IX. H. 2.a. i. and ii.
b. The temporary and provisional
license shall be effective for at least ninety (90) days or until the
Department makes a decision on the application, unless the Department
determines that the applicant does not meet the requirements in Section IX.H.1.
a. and b. in which case the temporary and provisional license shall be
immediately revoked.
c. An
applicant may provide the rest of the documentation required above in order to
receive a license, or the applicant may only provide the information necessary
for the issuance of a temporary and provisional license.
d. The Department shall require an applicant
to hold a current NREMT certification if the applicant is licensed in another
state that does not offer reciprocity to Arkansas residents that is similar to
reciprocity to out-of-state applicants in A.C.A. §
17-1-108.
e. Reciprocity in another state will be
considered similar to reciprocity under A.C.A. §
17-1-108 if the reciprocity
provisions in the other state:
i. Provide the
least restrictive path to licensure for Arkansas applicants;
ii. Does not require Arkansas applicants to
participate in the apprenticeship, education, or training required as a
prerequisite to licensure of a new professional in that state, except that the
state may require Arkansas applicants to participate in continuing education or
training that is required for all professionals in that state to maintain
licensure.
iii. Does not require
Arkansas applicants to take a state-specified education unless required under
the same conditions described in A.C.A. §
17-1-108.
4. Military Personnel
and Returning Military Veterans
a. As used in
this subsection, "returning military veteran" means a former member of the
United States Armed Forces who was discharged from active duty under
circumstances other than dishonorable. 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.
As used in this subsection "automatic licensure" means granting
the occupational licensure without an individual having met occupational
licensure requirements provided under this title or by the rules of the
occupational licensing entity.
b. The Department shall grant automatic
licensure to an individual who holds a substantially equivalent license in
another U.S. jurisdiction or holds NREMT certification and is:
i. An active duty military service member
stationed in the state of Arkansas;
ii. A returning military veteran applying for
licensure within one (1) year of his or her discharge from active duty;
or
iii. The spouse of a person
under b (i) or (ii) above.
c. The Department shall grant such automatic
licensure upon receipt of all the below:
i.
Payment of the initial licensure fees and submission of a DD214 (or other
formal discharge documentation) showing separation from the military (personnel
stationed in the Continental United States or overseas, reserve personnel must
submit a copy of training information from their 201 file).
ii. Evidence that the individual holds a
substantially equivalent license in another state or holds NREMT certification;
and
iii. Evidence that the
applicant is a qualified applicant under Section a. above.
d.
SECTION X. HOSPITAL STAFFING
In order for an Arkansas Licensed EMSP to perform skills for
which they are licensed within a hospital, the EMSP shall ensure that the
following actions have been taken by the hospital:
A. The medical staff must approve the
privileges granted to the individual EMSP with the concurrence of the
hospital's governing body. Specific policies governing the supervision and the
procedures to be performed by the EMSP must be developed by the hospital
medical staff and also approved by the hospital's governing body. EMSP's may
not perform a procedure on a patient in a hospital that he or she is not
licensed to perform.
B. Approved
EMSP's in a hospital setting must function in accordance with physician's
orders and under the direct supervision of either the physician or the
registered nurse responsible for emergency services within a
hospital.
C. In addition, with
hospital concurrence, students in EMSP training programs must be trained by
qualified personnel within the hospital under guidelines established by the
medical staff and approved by the hospital governing body.
D. A roster with the delineation of
privileges shall be maintained and readily available.
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 a 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 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 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,
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 curriculum and approved by the facility's governing
body during clinical 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 XIII. EMSP EDUCATION STANDARDS AND
LICENSURE REQUIREMENTS
No person is eligible to provide care, as defined in these
Rules, without a current Arkansas EMSP License. Requirements for licensure
include:
A. Paramedic
1. Pre-requisites for an education program
a. Holds any current state EMT license or
AEMT licensure. Military must hold a current NREMT EMT or AEMT license. Those
that do not hold an Arkansas license must obtain Arkansas licensure prior to
beginning any field or clinical internship.
b. Copy of a current Basic Life Support CPR
card (must follow current American Heart Association Guidelines and require a
hands on skills component) prior to beginning any field or clinical
internship.
2.
Pre-requisites for field/clinical participation
a. Candidate must be Arkansas licensed EMT or
an Arkansas AEMT prior to starting any field or clinical participation and
maintain licensure throughout the field/clinical training.
3. Pre-requisites for testing
a. Currently licensed as an Arkansas
EMSP.
b. Successful completion of a
Department approved paramedic course.
c. Copy of a current Basic Life Support CPR
card (Must follow current American Heart Association Guidelines and require a
hands on skills component).
d.
Submit a copy of a current American Heart Association Advanced Cardiac Life
Support (ACLS) card.
4.
Licensure requirements
a. Successful
completion of the NREMT certification examination including both didactic and
psychomotor exams.
B. Community Paramedic
1. Pre-requisites for an education program
a. Holds a current Arkansas paramedic
license.
b. Holds a current Basic
Life Support CPR card (Must follow current American Heart Association
Guidelines and require a hands on skills component) prior to beginning any
field or clinical internship.
c.
Holds a current American Heart Association Advanced Cardiac Life Support (ACLS)
card.
2. Pre-requisites
for testing
a. Meets all requirements
outlined in Section XIII. B.1. a-c.
b. Successful completion of a Department
approved community paramedic course.
3. Licensure requirements
a. Have two (2) years of Full time service as
a paramedic and actively employed by a licensed paramedic service. Prospective
EMSPs shall submit a letter from a licensed paramedic service indicating a
minimum of 1000 hours worked per year for two (2) years and confirming that
they are actively employed by that service.
b. Community paramedic licensure will run
concurrent with the current EMSP expiration date.
C. Advanced
Emergency Medical Technician
1.
Pre-requisites for education program
a.
Successful completion of a Department approved EMT course, or holds a current
state EMT license/certification from another state with a current NREMT
certification card, or military personnel who hold current NREMT
certification.
b. Copy of a current
Basic Life Support CPR card (Must follow current American Heart Association
Guidelines and require a hands on skills component) prior to beginning any
field or clinical internship.
2. Pre-requisites for field/clinical
participation
a. Candidate must be a current
Arkansas licensed EMT prior to starting any field or clinical participation and
maintain licensure throughout the field/clinical training.
3. Pre-requisites for testing
a. Currently licensed as an Arkansas
EMT.
b. Successful completion of a
Department approved AEMT program.
c. Copy of a current signed Basic Life
Support CPR card (Must follow current American Heart Association Guidelines and
require a hands on skills component) documenting completion of a CPR course
designed specifically for healthcare providers.
4. Licensure requirements
a. Successfully complete the NREMT AEMT
certification examination including both didactic and psychomotor exams.
D. Emergency
Medical Technician
1. Licensure requirements
a. Licensure shall be based on successful
completion of a Department approved EMT course including all didactic, clinical
and field internship requirements.
b. Successfully complete the Arkansas
psychomotor skills examination and the National Registry of EMTs didactic
examination.
c. Copy of a current
signed Basic Life Support CPR card (Must follow current American Heart
Association Guidelines and require a hands on skills component) documenting
completion of a CPR course designed specifically for healthcare providers.
E. Emergency
Medical Service Personnel - Instructor
1.
Instructor licensure will run concurrent with the current EMSP expiration
date.
2. Instructor Candidate
Education Requirements
a. Currently licensed
Arkansas EMSP for a minimum of two (2) years.
b. Licensed as an EMSP continuously from any
state, national or military for a minimum of two (2) years and currently
licensed as an Arkansas EMSP.
c.
Current Basic Life Support CPR instructor card (Must follow current American
Heart Association Guidelines and require a hands on skills
component).
d. Successfully
complete a Section approved forty (40) hour EMSP instructor course or holds a
minimum of a bachelor's degree in education. For successful completion of the
forty (40) hour EMSP instructor course, students must complete the end of
course didactic examination with a minimum score 80%, and meet all other course
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 require the candidate to repeat the instructor course:
a. Instruct an initial EMT course or an
approved forty (40) hour EMT Refresher that is sponsored by a Department
approved EMS education program as long as all of the following requirements
have been met:
1) Provisional instructors
choosing to teach a forty (40) hour refresher program to meet this requirement
shall be licensed for a minimum of two (2) consecutive years at the level they
will teach.
2) All courses taught
must be sponsored by a Department approved EMS education program.
3) All courses must be approved by the
Department prior to starting (Instructor/Program Director must receive approval
notification from the Department prior to starting the course)
4) Submit a letter of recommendation from the
training site representative of an accredited EMS education program with the
application.
5) Current Basic Life
Support CPR instructor card (must follow current American Heart Association
Guidelines and require a hands on skills component)
6) The Provisional instructor shall teach a
minimum of twelve (12) hours of the first course and must be monitored for a
minimum of five (5) hours by one (1) of the following:
a. The Candidate's instructor
trainer
b. EMS instructor approved
by the Department
c. Training site
representative
F. EMSP Instructor Teaching Advanced Courses
1. AEMTs who apply to teach an AEMT course
must meet the following:
a. Hold an EMSP
instructor license.
b. Been licensed
as an AEMT for a minimum of two (2) years.
2. Paramedics who apply to teach an AEMT or
paramedic course must meet the following:
a.
Hold an EMSP instructor license.
b.
Hold a current ACLS Instructor card
c. Have been licensed as an Arkansas
paramedic for a minimum of two (2) years
G. EMSP Educator Trainer
1. All of the following eligibility
requirements must be met for EMSP instructors to become an EMSP Educator
Trainer:
a. Arkansas licensed EMSP
b. Licensed continuously for two (2) years in
EMS as an EMSP instructor.
c.
Sponsored by an Arkansas approved EMS educational program.
d. A minimum of an Associate Degree in an
Allied Health Field, Education, or Emergency Management.
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. 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
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 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.
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 XV. GUIDELINES FOR TRAUMATICALLY
INJURED PATIENTS
A. TRIAGE OF TRAUMATICALLY
INJURED PATIENTS
Licensed ambulance services shall appropriately triage all
traumatically injured patients using the Field Triage Decision Scheme: The
Arkansas Trauma Triage Protocol identified as Appendix 2. The Lead EMSP will
make the destination decision considering the ATCC recommendation, patient's
condition, distance of travel, patient preference, and system status.
B. URGENT TRAUMA TRANSFERS
The following rules regarding the process for inter-facility
trauma transfers applies to those services participating in the states trauma
system. Services not participating shall have written protocols addressing
procedures for the timely inter-facility transfer of urgent trauma patients as
defined below to appropriate adult or pediatric trauma centers based on a
patient's medical needs. Any deviation from the services protocol shall be
reviewed by the services medical director.
The need for an urgent trauma transfer exists when, in the
opinion of the treating physician, two conditions are met:
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 service. The patient and paperwork should
be ready for transfer at that time.
All urgent trauma transfer requests shall prompt a review at
the local TRAC PI Subcommittee to ensure that the system is being used
appropriately, the urgent trauma transfer is accomplished in a timely manner,
and that each segment of the system performed its responsibilities. Potential
abuses of the system shall be elevated to the State TRAC/PI Subcommittee of the
TAC for adjudication and recommendation of action steps to the ADH in order to
prevent future abuses.
C. NON-URGENT TRAUMA TRANSFERS
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 (1) hour to arrive at the transferring
facility. The transferring hospital shall have the patient ready for pick-up by
the agreed upon time.
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 contender to any
criminal offense listed in Arkansas Code Ann §
20-13-1106
* Demonstration of incompetence, knowingly or willfully
violating these Rules or other inability to provide adequate service.
* Violating any, as well as federal, state, or local laws,
rules affecting, but not limited to, the practice of EMS.
* Any conduct which is in violation of any criminal, civil
and/or administrative code or statute.
* Falsifying, destroying or failing to make accurate, complete
and/or clearly written or oral patient care reports documenting a patient's
condition upon arrival at the scene, the prehospital care provided, and
patient's status during transport, including signs, symptoms, and responses
during duration of transport as per EMS provider's approved policy.
* Disclosing confidential information or knowledge concerning
a patient except where required or allowed by law.
* Causing or permitting physical or emotional abuse or injury
to a patient or the public, and/or failing to report such abuse or injury to
the Department, appropriate legal authority and/or the Department within
twenty-four (24) hours after the event occurs.
* Failing to report to the employer, appropriate legal
authority or the Department, an event of abuse or injury to a patient or the
public within twenty-four (24) hours (or the next business day within
twenty-four (24) hours) after the event.
* Failure to follow the medical director's protocol,
performing advanced level or invasive treatment without medical direction or
supervision, or practicing beyond the scope of certification or
licensure.
* Failing to respond to a call while on duty and/or leaving
duty assignment without proper authority.
* Abandoning a patient.
* Failing to comply with the terms of a Department ordered
probation or suspension.
* Misrepresenting level of any certification or
licensure.
* Misappropriating or failure to take precautions to prevent
misappropriation of medications, supplies, equipment, personal items, or money
belonging to the patient, employer or any other person or entity.
* Falsifying or altering, or assisting another in falsifying
or altering, any Department application, EMS license; or using or possessing
any such altered certificate or license.
* Cheating and/or assisting another to cheat on any
examination, written or psychomotor, by any provider licensed by the Department
or any institution or entity conducting EMS education and/or training or
providing an EMS examination leading to obtaining licensure or renewing
licensure.
* Obtaining or attempting to obtain and/or assisting another
in obtaining or attempting to obtain, any advantage, benefit, favor or gain by
fraud, forgery, deception, misrepresentation, untruth or subterfuge.
* I llegally possessing, dispensing, administering or
distributing, or attempting to illegally dispense, administer, or distribute
controlled substances as defined by the federal or state laws.
* Receiving disciplinary action relating to an EMS certificate
or license or another health provider certificate or license issued in another
state or in a U.S. Territory or in another nation, or receiving disciplinary
action relating to another health provider certificate or license issued in
Arkansas.
* Failing or refusing to timely give the Department full and
complete information requested by the Department.
* Failing to notify the Department of being convicted or
pleading guilty or nolo contendere of a criminal offense within ten (10)
business days of the conviction or plea, other than any class C misdemeanor not
related to EMS.
* Failing to notify the Department within five (5) business
days of his or her being arrested, charged or indicted for any criminal
offense, other than any class C misdemeanor not directly related to EMS.
* Engaging in any conduct that jeopardizes or has the
potential to jeopardize the health or safety of any person.
* Failure of any drug screening test administered during an EMS
work or volunteer shift, or within twelve (12) hours of the beginning or end of
any such shift.
* Resigning employment or refusing by the employee, of an
employer drug screening test right before, after or during an assigned EMS work
or volunteer shift.
* Failing to maintain the requisite of skill, knowledge and/or
academic acuity to timely and/or accurately perform the duties or meet the
responsibilities required of a licensed EMSP at appropriate licensure level
that endangers the safety or welfare of patients and/or EMSP's.
* Delegating medical functions to other personnel without
approval from the medical director per approved protocols.
* Behaving in a disruptive manner or exhibiting unprofessional
conduct toward other EMS personnel, law enforcement officers, firefighters,
hospital personnel, other medical personnel, patients, family members or others
on scene.
* Falsifying or altering clinical and/or internship documents
for EMS students.
* Falsifying or failing to complete daily readiness checks on
EMS vehicles, medical supplies and/or equipment as required by EMS
employers.
* Engaging in acts of dishonesty which relate to the EMS
profession.
* Behavior that exploits the EMS personnel-patient relationship
in a sexual way. This behavior is non-diagnostic and/or non-therapeutic, may be
verbal or physical, and may include expressions or gestures that have sexual
connotation or that a reasonable person would construe as such.
* Falsifying or making any false statements in any information
provided to or by the Department to include misrepresentation, fraud, or
concealment including but not limited to applications for licensure,
certification, or renewal of a licensure or certification and continuing
education requirements.
* Acting negligently, neglectfully, or with intent to cause
harm toward a patient or other person
* Reporting to duty or rendering patient care while under the
influence of alcohol (According to current Arkansas Legal Code) illegal drugs
or illegally obtained drugs concurrent with State Law.
* Use of alcohol or any intoxicating substance (other than as
directed by a physician) while on duty.
* Providing false information to regulatory officials or
willfully concealing known deficiencies during an inspection.
* Conviction of driving under the influence of alcohol or
other intoxicating substance while on duty, on emergency response or during
patient transport.
* Failure to report substance abuse of on-duty EMS personnel to
the Department.
* Failure to follow accepted standards of care in the
management of a patient or in response to a medical emergency.
* Using equipment and/or performing procedures beyond the
EMSP's level of licensure, scope of practice, or the level of licensure of the
ambulance service.
* Unauthorized release or divulgence of confidential
information to an unauthorized person or using confidential patient information
for personal or financial benefit.
* Providing care as an Arkansas EMSP independent or with a
licensed EMS service while having a lapsed or expired Arkansas EMSP
license.
* Failure to respond or accept official Departmental
correspondence sent by certified mail.
* Misappropriation, stealing and/or embezzlement of EMS grants
or equipment purchased under such grants.
* Falsification of records related to ambulance service
operations.
* Failing to provide patient information to a hospital or other
health care facility in response to an authorized request.
* Failing to report to the Department actions regarding
incompetent, unethical, or illegal practice by any EMSP.
* Requiring EMS Personnel to violate EMS Rules or EMSP
standards.
* Engaging in the delivery of emergency medical services on a
revoked, suspended, expired, or inactive Arkansas license.
* Alteration of/or transferring a vehicle permit fi-om one
vehicle to another. Operating an ambulance or EMS vehicle that is not licensed
or insured.
* Failure to follow all requirements concerning drugs and
pharmaceuticals
* Carrying and/or using equipment not approved by the
Department for the licensure level.
* Using an EMT who is lapsed or not Arkansas licensed to meet
ambulance staffing requirements.
* Failure to have all necessary equipment and non-expired
supplies in licensed ambulances for the level of licensure.
* Failure to follow the manufacturer's recommendations for the
use of medical equipment in a manner which causes harm to the patient.
* Conviction of violation of Federal Communications Commission
Concurrent with Federal Laws (FCC) Rules.
* Falsification by the instructor of facts on student
paperwork/applications.
* Teaching an EMS related course that requires pre-approval
from the Department without having that approval.
* Abandonment of an approved EMT course.
* Failure to complete and submit required documentation for all
students.
* Failure to teach courses by National Standard
Curriculum.
* Failure to observe recognized professional teaching
standards
* Falsification of continuing education documentation
* Falsification by the training site of records related to
courses or training
* Conduct or actions by the training site that results in harm
to the health and safety of the student
* Failure to meet and maintain the criteria for program
approval as set by the Department or accrediting body
* Failure to allow the Department to inspect, observe, or
evaluate programs, including program personnel, facilities, classes, and
clinical practice sessions
* Use of training personnel not competent for the type of
training offered
* Failure to observe recognized professional standards in the
course content and operation of the training program
* Failure to keep accurate and adequate records, of the names
and addresses and type of training completed of all graduates and attendees for
a minimum of two (2) years
* Allowing an AEMT or paramedic student to participate in
medical facility or field internship without being a licensed EMT.
* Failure to offer training consistent with the approved
application
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 are 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.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
a.I nformal - 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 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.
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 certificate 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.
SECTION XVII. SEVERABI LI TY
I f any provision of these Rules, or the application thereof to
any person or circumstances is held invalid, such invalidity shall not affect
other provisions or applications of these Rules which can give effect without
the invalid provisions or applications, and to this end the provisions hereto
are declared to be severable.
SECTION
XVIII. REPEAL
All Rules and parts of Rules in conflict herewith are hereby
repealed.
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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- HAIC, 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**
