Current through Register Vol. 49, No. 9, September, 2024
The following Rules and Regulations Pertaining to Emergency
Medical Services are duly adopted and promulgated by the Arkansas State Board
of Health pursuant to the authority expressly conferred by Act 435 of
1975, Act 293 of 1981, Act 345 ofl987L_Act 1255 of 1997,
Act 38 of 1999, Act 60 of 1999, Act 666 of 1999, Arkansas Code
20-13-200, and the Laws of the State of Arkansas including without limitation,
Act 96 of 1913 {Arkansas Statutes, 1947, Section
82-110).
SECTION I.
DEFINITIONS
For the purpose of these regulations the following terms are
defined:
A. Advanced Life Support
(ALS) Medical Director: An Arkansas licensed physician who provides medical
oversight for any licensed ALS EMS entity, is either Board Certified in
Emergency Medicine or holds a current ACLS card, and is identified with the
Department as the medical director.
B. Advanced Response Service: A licensed
non-transporting service that is requested to respond to the scene of an
emergency and provides Advanced Life Support care to ill or injured patients
prior to the arrival of a licensed transporting ambulance service, subject to
compliance with the EMS Rules and Regulations relating to the level of care
available from the responding personnel.
C. Aeromedical Crew Members: Personnel
responsible for patient care on an air ambulance.
D. Aeromedical Training Requirements: Minimum
training requirements recommended by the Governor's Advisory Council on EMS and
approved by the Department.
E. Air
Ambulance: Any privately or publicly owned helicopter or fixed wing aircraft
specially designed, constructed or modified, maintained or equipped to be used
for the transportation of patients.
F. Air Ambulance Operation: One aircraft
making one flight in response to a patient transport request.
G. Air Ambulance Service: An entity operating
an aircraft used for air transportation that is specifically designed to
accommodate the aeromedical needs of persons who are ill, injured, wounded, or
otherwise mentally or physically incapacitated or helpless; who may require
emergency medical care in-flight, and who, in a physician's opinion, cannot be
safely transported on a standard commercial or charter flight. Such a service
includes suitable aircraft, flight crews, and aircraft maintenance in
accordance with Federal Aviation Administration (FAA) Regulation (FAR 135),
adequate aeromedical crewmembers, aircraft fittings and equipment, and
provision for medical control of aeromedical crewmembers.
H. Ambulance: Those vehicles used for
transporting any person by stretcher or gurney upon the streets or highways of
Arkansas, excluding vehicles intended solely for personal use by immediate
family members.
I. Ambulance
Service: Those services authorized and licensed by the Department to provide
care and transportation of patients upon the streets and highways of
Arkansas.
J. Ambulance Service
Encounter Form: A patient data form, which has been approved by the Department,
that describes the EMS encounter and is left with the care facility at time of
service or within a reasonable time after service. This form must include a
patient narrative.
K. Arkansas Code
20-13-200: Arkansas Code Title 20 (Public Health and Welfare). Subtitle 2
(Health and Safety). Chapter 13 (Emergency Medical Services).
L. Basic Life Support (BLS) Medical Director:
An Arkansas licensed physician who provides medical oversight for any licensed
BLS EMS entity, holds a current American Heart Association Healthcare Provider
card or the American Red Cross CPR for the Professional Rescuer, and is
identified with the Department as the medical director.
M. Certification: Official acknowledgment by
the Department that an individual has demonstrated competence to perform the
emergency medical services required for certification as provided by these
Rules and Regulations.
N. Charter
Flight: The utilization of an aircraft that is not registered to a scheduled
air carrier.
O. Controlled Drugs:
Those drugs identified as Schedule II-V as designated by federal law
P. Coordination Point: A fixed location(s)
where information about the air ambulance service may be obtained and where the
activities of dispatch, resource allocation, and flight operations are
conducted.
Q. Department: The
Arkansas Department of Health.
R.
Office of EMS and Trauma Systems (Office): The organization within the
Department responsible for the enforcement of EMS legislation within the State
of Arkansas.
S. Emergency Medical
Services: The transportation and medical care provided the ill or injured prior
to arrival at a medical facility by a certified emergency medical technician
(EMT) or other healthcare provider and continuation of the initial emergency
care within a medical facility subject to the approval of the medical staff and
governing board of that facility.
T. Emergency Medical Services Advisory
Council: Those persons appointed by the Governor to assist and advise the
Department concerning matters dealing with emergency medical
services.
U. Emergency Medical
Service Communication Network: A system of both telephone and radio that is
utilized in the delivery of pre-hospital care to the victims of illness or
injury.
V. Emergency Medical
Technician: A person who has been certified as an EMT, EMT-Ambulance,
EMT-Intermediate or EMT-Paramedic and who may perform those services equivalent
to level of certification.
W.
Emergency Medical Technician - Instructor: A person who has been certified to
teach EMT courses after completing an approved DOT EMT-Instructor course and
completion of all of the instructor requirements.
X. Emergency Medical Technician-Intermediate:
A person who has successfully completed an approved DOT training course that
includes formal course work, practical instruction, clinical and field
experience and who is certified to perform those skills and/or services set
forth in SECTION III.C.2 and SECTION III.D and functions in accordance with the
requirements set forth throughout these regulations.
Y. Emergency Medical Technician-Paramedic: A
person who has successfully completed an approved DOT training course that
includes formal course work, practical instruction, clinical and field
experience and who is certified to perform those skills and/or services set
forth in SECTION III.C.l and SECTION III.C.2 and functions in accordance with
the requirements set forth throughout these regulations.
Z. Emergency Request: A call for assistance
to an incident or condition which is perceived by the caller to have created an
actual threat to human life or physical well being of such magnitude and
character that immediate medical intervention by any Emergency Medical
Technician or other health professional is appropriate and necessary for
medical reasons.
AA. Enrolled
student: An enrolled student is one who attends at least three (3) out of the
first five (5) sessions of an EMT course at an approved EMT Training
Site.
BB. Extrication Services: The
services provided by the use of equipment for the purpose of gaining access and
entry to entrapped patients.
CC.
FAA FAR Part 135- Federal Aviation Administration Regulations governing air
taxi operations and commercial operation of small aircraft.
DD. Flight Nurse: A registered nurse licensed
in Arkansas who completes the required aeromedical crew member training
requirements recommended by the Governor's Advisory Council on EMS and approved
by the Department.
EE. Flight
Physician: A physician with a current valid license to practice medicine in
Arkansas or in the state of primary operation of the air ambulance service, and
who is certified in Advanced Cardiac Life Support.
FF. In-charge Member: The individual
designated by the licensed service who is responsible for patient
care.
GG. Intercept: Instances
where a transporting service requests assistance from a service better able to
provide the necessary patient care and/or transport.
HH. Intravenous Fluid: A solution used for
the purpose of a volume replacement fluid or to establish and maintain
intravenous cannulation.
II. Lapsed
EMT: An Emergency Medical Technician (any level) that does not complete
recertification requirements prior to their expiration date as issued by the
Office.
JJ. Lay Evaluator: An
individual approved by the Office to evaluate the practical portion of the
Arkansas EMT Certification exam.
KK. Legend Drug: Any drug which requires a
prescription by a licensed physician as required by federal law.
LL. Medical Facility: Any hospital, medical
clinic, physician's office, nursing home or other health care
facility.
MM. National Registry of
Emergency Medical Technicians (NREMT): A not-for-profit, independent,
non-governmental agency that functions as a registration agency which issues
certificates of competency verified by achievement of minimal competencies of
EMTs (Basic, Intermediate and Paramedic) through establishment and
implementation of uniform requirements of EMT training, examination, and
continuing education.(NREMT Brochure B-50/10-94/10M).
NN. Office: Office of Emergency Medical
Services & Trauma Systems.
OO.
Out of State Transfer (OST): Any person certified in another state or in the
military and are seeking Arkansas certification are referred to as out-of-state
transfers (OST's)
PP. Permit: An
authorization by the Department for the purpose of vehicle
registration.
QQ. Person: Any
individual, corporation, partnership, firm, association, trust, estate, public
or private institution, group, agency, political subOffice of this State or any
other state or political subOffice or agency thereof, and any legal successor,
representative, agent or agency of the foregoing. Federal government agencies
are excluded from this definition.
RR. Policy and Procedure: Any policy,
procedure, training requirement or equipment list related to these rules and
regulations as recommended by the Governor's Advisory Council on EMS and
approved by the Department. However, no policy or procedure shall supercede
these rules and regulations.
SS.
Probation: An administrative action imposed on an EMS service, EMT
certification, EMT-Instructor certification or authorized and accredited
training site for violations of EMS Rules and Regulations. The term of
Probation will be for no less than six (6) months and no more than two (2)
years unless otherwise covered in Section VII.A.4.
TT. Protocols: Standing orders authorized by
each licensee provided they are written or adopted by the Medical Director of
that licensed ambulance service, approved by the Department.
UU. Provisional Instructor: An EMT who has
completed initial instructor training but is in the process of finishing their
teaching requirements, with appropriate recommendation from the
Instructor-Trainer, before becoming a certified EMT Instructor.
VV. Reaction Time: The time between the
responding services' dispatch receives adequate information from the caller and
the time the vehicle and personnel initiate response.
WW. Revocation: An administrative action
imposed by the Department that terminates an EMS service license, EMT
certification, EMT-Instructor certification or authorized training site for
violating EMS Rules and Regulations.
XX. Service Area: The primary area of
operation within a county for a licensed ambulance service as defined by that
service and on file with the Office of EMS and Trauma Systems.
YY. Service License: Authorization issued by
the Department to a person, firm, corporation, association, county,
municipality or other legal entity for the purpose of engaging in care and/or
transport of patients in the State of Arkansas.
ZZ. Suspension: An administrative action
imposed by the Department that temporarily removes an EMS service license, EMT
certification, EMT-Instructor certification or training site authorization and
accreditation for violating EMS Rules and Regulations for a time to be
determined by the Department.
AAA.
Training Site: Those organizations authorized and accredited by the Department
to provide EMS education.
BBB.
Training Site Authorization and Accreditation: Authorization and accreditation
issued by the Department to an organization for the purpose of engaging in EMS
education in the state of Arkansas.
CCC. Training Site Representative: Individual
responsible for the organization, coordination, and day-to-day operations of
the EMS training programs.
DDD.
Unsound Mind: means and includes the inability to perceive all relevant facts
related to one's condition and proposed treatment so as to make an intelligent
decision based thereon, regardless of whether the inability is only temporary
or has existed for an extended period of time or occurs or has occurred only
intermittently and whether or not it is due to natural state, age, shock or
anxiety, illness, injury, drugs or sedation, intoxication, or other cause of
whatever nature.
EEE. Volunteer
Ambulance Service: An ambulance service operating a I-B registered ambulance
that is staffed by personnel who perform and give their services of there own
free will without expecting any compensation.
FFF. Words implying the masculine gender may
be applied to both males and females.
GGG. Written Warning: An administrative
action imposed on an EMS service, EMT certification, EMT-Instructor
certification or authorized training-site for first-time or minor offenses
unless otherwise stated.
SECTION
III. LICENSURE OF AMBULANCE SERVICES
Those services authorized and licensed by the Department to
provide care and transportation of patients.
A. Purpose
No person shall furnish, operate, maintain, conduct, advertise
or in any way engage in or profess to engage in the business of providing
transport of patients upon the streets and highways of Arkansas unless that
person holds a valid ambulance service license issued by the Department of
Health. This section shall not operate to alter the application of the Good
Samaritan Act under Arkansas Code
17-95-101.
B. General Standards
An application for the issuance or renewal of an ambulance
service license shall be made on forms provided by the Department of Health and
shall be accompanied by any fee as required by law or by regulations
promulgated by the Department of Health. Each license shall be renewed
annually.
All ambulances operating in this State must meet all standards
prescribed by and under Arkansas Code 20-13-200 and be licensed under this
subchapter and all personnel operating ambulances in this State must meet the
standards prescribed by and under Arkansas Code 20-13-200.
1. Patient's choice of nearest appropriate
medical facility
A licensee under this act shall transport any patient to the
care facility of the patient's choice within the service area of the ambulance.
If the patient is unable to make a choice, and the attending physician is
present and has expressed a choice of care facility within the service area,
the licensee shall comply with the attending physician's choice. If the
licensee is unable to make a choice, the attending physician is not present or
has not expressed a choice of facility, or there is no hospital in the service
area of the ambulance, the licensee shall transport the patient to the nearest
appropriate care facility.
2. Reports to the Health Care Facility
The licensee shall provide the care facility where the patient
was transported with a copy of an ambulance service encounter form prescribed
or approved by the Department of Health, which shall become part of the
patient's medical records.
3. Reports to the Department
Each licensee shall report, in a format approved by the
Department of Health, every request that results in the dispatch of a vehicle
with the exception of calls cancelled enroute or responses made where no
patient contact was made.
4. Each licensee shall have in force and
effect liability insurance coverage, issued by an insurance company licensed to
do business in the State of Arkansas, for each vehicle owned and operated by or
for the applicant or licensee. The Department of Health shall maintain evidence
of proof of current liability insurance coverage for each vehicle of each
licensee.
5. Each licensee shall be
issued a service license in at least one (1) of the classifications set forth
by the Department of Health.
6.
Each licensee, including air ambulance services, shall be required to obtain a
separate service license in each county the ambulance service has an
operational base.
7. Three (3)
formal citations (i.e. administrative actions administered by the
Office) during the license term for failure to comply with Arkansas
Code 20-13-200 and any regulations promulgated by the Department of Health in
regard to ambulance services shall result in administrative action including
revocation of the service license.
8. All documentation and fees must be
submitted to the Office prior to EMS License being issued. NO license shall be
issued until ALL licensure requirements have been met.
9 An ambulance service shall not, in any way,
advertise to the general public the service areas, skills, procedures, or
personnel certification levels which they cannot provide on every emergency
request, twenty-four (24) hours a day, seven (7) days a week.
10. The service area shall be clearly
identified on a map and in writing annually, and shall be on file with the
Department of Health.
11. An
ambulance service shall only transport patients who are properly secured. No
other device (i.e. wheelchair, incubator, etc.) may be used to transport
patients, unless there is adequate equipment that will secure the device in the
back of the ambulance based upon the manufactures' recommendations.
12. In mass casualty incidents, please
reference the MCI Rules and Regulations.
13. In instances in which patients are being
transported, an Intercept can be requested by the in-charge member of the
transporting service if the patient's condition dictates. It shall be the
decision of the in-charge crewmember of the intercepting service to either
transfer the patient to the Intercept unit or to move the equipment and
continue care in the transporting unit.
14. Patient Consent
a. It is recognized and established that, in
addition to such other persons as may be so authorized and empowered, any one
(1) of the following persons is authorized and empowered to consent, either
orally or otherwise, to any surgical or medical treatment or procedures not
prohibited by law which may be suggested, recommended, prescribed, or directed
by a licensed physician:
1) Any adult, for
himself;
2) Any parent, whether an
adult or a minor, for his minor child or for his adult child of unsound mind
whether the child is of the parent's blood, is an adopted child, is a
stepchild, or is a foster child; provided, however, the father of an
illegitimate child cannot consent for the child solely on the basis of
parenthood;
3) Any married person,
whether an adult or a minor, for himself;
4) Any female, regardless of age or marital
status, for herself when given in connection with pregnancy or childbirth,
except the unnatural interruption of a pregnancy;
5) Any person standing in loco parentis,
whether formally serving or not, and any guardian, conservator, or custodian,
for his ward or other charge under disability;
6) Any emancipated minor, for
himself;
7) Any unemancipated minor
of sufficient intelligence to understand and appreciate the consequences of the
proposed surgical or medical treatment or procedures, for himself;
8) Any adult, for his minor sibling or his
adult sibling of unsound mind;
9)
During the absence of a parent so authorized and empowered, any maternal
grandparent and, if the father is so authorized and empowered, any paternal
grandparent, for his minor grandchild or for his adult grandchild of unsound
mind;
10) Any married person, for a
spouse of unsound mind;
11) Any
adult child, for his mother or father of unsound mind;
b. An individual shall not be considered to
be "of unsound mind" for the purposes of this subchapter based solely upon the
fact of his refusal of medical care or treatment.
c. In addition to any other instances in
which consent is excused or implied at law, consent to surgical or medical
treatment or procedures suggested, recommended, prescribed, or directed by a
licensed physician will be implied in the following circumstances:
1) Where an emergency exists and there is no
one immediately available who is authorized, empowered to, or capable of
consent. An emergency is defined as a situation wherein, in competent medical
judgment, the proposed surgical or medical treatment or procedures are
immediately or imminently necessary and any delay occasioned by an attempt to
obtain a consent would reasonably be expected to jeopardize the life, health,
or safety of the person affected or would reasonably be expected to result in
disfigurement or impaired faculties;
2) Where any emergency exists, there has been
a protest or refusal of consent by a person authorized and empowered to do so,
and there is no other person immediately available who is authorized,
empowered, or capable to consent but there has been a subsequent material and
morbid change in the condition of the affected person
15. Clinical
Investigations
Clinical Investigations may be recommended by the Governor's
EMS Advisory Council and approved by the Department and the Board of Health.
Test periods will be temporary in nature, and will be determined on an
individual basis for each procedure and technique tested. A written request to
enroll in a Clinical Investigation must be submitted to the Governor's Advisory
Council on EMS and approved by the Department. Clinical Investigations beyond
the scope of the EMS Rules and Regulations are to be evaluated in a carefully
controlled study under appropriate medical control. At the completion of the
evaluation period, the test results will be forwarded to the Board of Health
for review. Permission for Clinical Investigations will be granted only to
determine if the procedure or technique should be added to the existing EMS
Rules and Regulations and must follow the clinical investigations guidelines
recommended by the Governor's Advisory Council on EMS and approved by the
Department.
16. Basic
medical and extrication equipment
Each vehicle shall meet the basic medical and extrication
equipment requirements recommended by the Governor's Advisory Council on EMS
and approved by the Department.
17. Prohibitions
Licensees shall not carry nor dispense any drugs or medications
or perform any procedure not specifically recommended by the Governor's EMS
Advisory Council and approved by the Department.
18. Out-of-State Ambulance Contracts for
Disaster Assistance
Licensee shall contact the Department prior to
deploying/sending any Arkansas permitted ambulance to another state(s) to
fulfill obligations of a state/federal/private contract or agreement for a
disaster. Licensee shall contact the Department at 501-661-2262 during regular
scheduled office hours or 501-661-2136 after office hours.
C. Ambulance Service Licensure
1. The Office of EMS & Trauma Systems
shall issue a Paramedic Service License to those EMS services that have fifty
percent (50%) or more of their ambulances registered at the Paramedic
level.
2. The Office of EMS &
Trauma Systems shall issue an Intermediate Service License to those EMS
services that have fifty percent (50%) or more of their ambulances registered
at the Intermediate level.
3. The
Office of EMS & Trauma Systems shall issue a Basic Life Support (BLS)
Service License to those EMS services that have their
ambulances registered at one of the following levels:
a. I-A
b. I-B*
*Volunteer Ambulance Services will be
issued a BLS License and must meet the I-B vehicle
requirements.
D. Licensed ambulance services at the
Paramedic or Intermediate level
{Advanced Life Support (ALS) level)
shall be required to meet the following:
1. Twenty-four hour coverage
Each licensee shall provide 24-hour continuous service.
3. Two minute reaction time
Each licensee shall comply with a two-minute reaction time for
each emergency request.
4.
Multiple License
The issuance of multiple levels of license to the same
ambulance service is acceptable. All qualifications for the particular service
license must be met. The service will be required to provide the highest level
of response to all emergency requests, until those resources are depleted or
are not available. The caller will determine the emergency.
5. Multiple Vehicle Registration
The issuance of multiple levels of registered vehicles to the
same ambulance service is acceptable. However, the service will be required to
respond to all emergency requests with the highest registered vehicle until
those resources are depleted or are not available. The caller will determine
the emergency.
6. Legend
Drugs Register
Each licensee shall maintain a register of legend drugs to
include type, quantity, date received, and physician authorizing purchase and
usage.
7. Drug Enforcement
Agency (DEA) License
Each licensee shall submit to the Office of EMS and Trauma
Systems a copy of the DEA license to be utilized in acquiring controlled
drugs.
8. Hospital
notification
Each licensee shall notify the receiving hospital of impending
arrival, patient condition and care rendered to the patient.
9. Medical Director
Each licensee shall have an Arkansas licensed physician to
serve as the Advanced Life Support Medical Director who will provide medical
oversight pursuant to Arkansas statutes and meets the requirements of Section
LA. Lhis shall be the same physician providing the DEA number if required (6
above).
10. Protocols
Standing orders are authorized for use by each licensee
provided they are written or adopted by the Medical Director of that licensed
ambulance service, reviewed by the Department and Office of Pharmacy and on
file with the Office.
E. Licensed ambulance services at the Basic
Life Support (BLS) level shall be required to meet the following:
1. Twenty-four hour coverage
Each licensee shall provide 24-hour continuous service except
Volunteer organizations that use volunteer staff to provide service to the
general public.
2. Two
minute reaction time
Each licensee shall comply with a 2-minute reaction time for
each emergency request except Volunteer Ambulance Services.
3. Hospital notification
Each licensee shall notify the receiving hospital of impending
arrival, patient condition and care rendered to the patient.
F. Special Purpose Services:
1. Definition of license
A Special Purpose License shall be issued to an applicant who
provides a specific medical service to a limited population group and emergency
evacuation services only, and does not participate in the business of providing
continuous general population response for emergency medical services.
2. Appropriate vehicle and
equipment required
Each licensee shall ensure that the appropriate vehicle and
equipment be available to perform the services set forth in SECTION VII.
SECTION IV.
LICENSURE OF RESPONSE SERVICES
Those services authorized and licensed by the Department to
provide emergency care to critically ill or injured patients prior to the
arrival of a licensed transporting ambulance service.
An application for the issuance or renewal of an advanced
response service license shall be made on forms provided by the Department of
Health and shall be accompanied by any fee as required by law or by regulations
promulgated by the Department of Health. Each license shall be renewed
annually.
Advanced Response Service
A non-transporting service that is dispatched to respond to the
scene of an emergency and provides ALS care to ill or injured patients prior to
the arrival of a licensed transporting ambulance service is subject to
compliance with the EMS Rules and Regulations.
1. Purpose
No person shall furnish, operate, maintain, conduct, advertise
or in any way engage in or profess to engage in the business of providing
Advanced Life Support Response Services upon the streets and highways of
Arkansas unless that person holds a valid service license issued by the
Department. This provision shall not in any way operate to alter the
application of the Arkansas Good Samaritan Act {Arkansas Statutes
72-624).
2.
General Standards
a. Each licensee shall
report, in a format approved by the Department, every request, which results in
the dispatch of a vehicle.
b. Each
licensee shall have in force and effect liability insurance coverage, issued by
an insurance company licensed to do business in the State of Arkansas, for each
vehicle owned and operated by or for the applicant or licensee. The Department
of Health shall maintain evidence of proof of current liability insurance
coverage for each vehicle of each licensee.
c. Three citations during the license term
for failure to comply with these standards shall result in revocation of the
service license.
d. Each licensee
shall be an entity that chooses to provide Advanced Life Support to the General
Public, but does not transport patients except in mass casualty
incidents.
3. Specific
Standards
Each Advanced Response licensee shall, when appropriate,
provide the following skills with Medical Director oversight:
a. Advanced life support (ALS) skills
Each Advanced Response licensee shall, when appropriate,
perform those services set forth in SECTION VII.
b. Basic life support (BLS) skills
Each Advanced Response licensee shall, when appropriate,
perform those services set forth in SECTION VII.
c. Each licensee shall provide 24-hour
continuous service within its designated service area.
d. Each Advanced Response vehicle, when
responding to an emergency request, shall be attended by at least a licensed
physician, or an Emergency Medical Technician-Paramedic.
e. Each licensee shall comply with a
two-minute reaction time for each emergency request.
f. Each licensee shall have its vehicles
registered as Advanced Response.
g.
Each licensee shall submit to the Department a copy of the DEA license to be
utilized in acquiring drugs and medications.
h. Each licensee shall obtain, from the local
ambulance service, a written agreement that the care begun by the Advanced
Response personnel will be maintained during transport. This agreement will
include the allowance of ALS skills, by appropriate personnel to be continued
when a Basic Life Support licensee makes transport.
i. Each licensee shall have an Arkansas
licensed physician to serve as
Medical Director who will provide medical oversight pursuant to
Arkansas statutes and meets the requirements of Section LA. This shall be the
same physician providing the DEA number if required (above).
j. Each licensee shall provide the responding
transport service patient condition, care rendered to the patient and any
information requested by the service.
SECTION VII. CERTIFICATION OF PERSONNEL
A. Purpose
1. Types of certificates
The Department shall issue the following types of
certificates:
a. Advanced Life Support
1). Emergency Medical Technician-Paramedic
2). Emergency Medical
Technician-Intermediate
b. Basic Life Support
Emergency Medical Technician-Ambulance c. Instructor
1). Emergency Medical
Technician-Instructor
2). Emergency
Medical Technician-Instructor Trainer
2. Initial and renewal fees
An application for the initial issuance of a certification
shall be made on forms provided by the Department, and shall be accompanied by
a fee set forth by current EMS statute. Each certificate shall be renewed
biennially and shall be accompanied by a fee set forth by current Arkansas Code
20-13-200.
3. Certification
Card
Each Arkansas Certified EMT shall carry at all times the
Arkansas Certification Card issued by the Office or have the ability to contact
their EMS service or the Office for EMT certification verification when
providing patient care if level of certification is questioned.
4. Criminal History Form
Any applicant applying for certification shall complete one
time only a criminal history check form and shall request the Identification
Bureau of the Department of the Arkansas State Police to conduct a state and/or
national criminal history check on the applicant as required by Arkansas Code
20-13-200.
5. Approved
Skills for Emergency Medical Technicians
a.
Emergency Medical Technician-Paramedic when appropriate, may perform the
following skills with Medical Director oversight:
1) . Advanced life support (ALS) skills:
a) . Administration of approved intravenous
fluids
b). Airway maintenance and
ventilatory support including endotracheal intubation, nasotracheal intubation,
cricothyroidotomy, and needle thoracostomy
c). Administration of approved
drugs
d). Electrocardiogram
monitoring and interpretation
e).
Defibrillation and synchronized cardioversion
f). Oralgastric and nasogastric insertion,
lavage and suction
g). Additional
procedures and skills as recommended by the Governor's EMS Advisory Council and
approved by the Department.
2). Basic Life Support (BLS) skills:
a). Airway maintenance and ventilatory
support
b). Obtaining and
monitoring vital signs
c).
Cardiopulmonary resuscitation (CPR)
d). Defibrillation with an Automated External
Defibrillator (AED)
e). Performing
scene assessment, patient assessment and triage
f). Bleeding control, wound care, and
treatment for shock
g). Fracture
immobilization
h). Management of
medical, traumatic, and behavioral emergencies
i). Gaining access to patients and extricate
for treatment and transport
j).
Use of emergency medical services communication equipment
k). Provide verbal patient reports and
written run documentation to the care facility as required
l). Additional procedures and skills as
recommended by the Governor's EMS Advisory Council and approved by the
Department.
b. Emergency Medical Technician-Intermediate
when appropriate, may perform the following skills with Medical Director
oversight:
1) . Advanced Life Support (ALS)
skills:
a) . Administration of approved
intravenous fluids
b). Airway
maintenance and ventilatory support as recommended by the Governor's EMS
Advisory Council and approved by the Department.
c). Administration of approved
drugs
d). Additional procedures and
skills as recommended by the Governor's EMS Advisory Council and approved by
the Department.
2).
Basic Life Support (BLS) skills
a). Airway
maintenance and ventilatory support
b). Obtaining and monitoring vital
signs
c). Cardiopulmonary
resuscitation (CPR)
d).
Defibrillation with an Automated External Defibrillator (AED)
e). Performing scene assessment, patient
assessment and triage
f). Bleeding
control, wound care, and treatment for shock
g). Fracture immobilization
h). Management of medical, traumatic, and
behavioral emergencies
i). Gaining
access to patients and extricate for treatment and transport
j). Use of emergency medical services
communication equipment
k).
Provide verbal patient reports and written run documentation to the care
facility as required
c. Emergency Medical Technician-Ambulance
when appropriate, may perform the following skills Basic Life Support (BLS)
skills:
1.) Airway maintenance and
ventilatory support
2.) Obtaining
and monitoring vital signs
3.)
Cardiopulmonary resuscitation (CPR)
4.)
Defibrillation with an Automated External Defibrillator
(AED)
5.) Performing scene
assessment, patient assessment and triage
6.) Bleeding control, wound care, and
treatment for shock
7.) Fracture
immobilization
8.) Management of
medical, traumatic, and behavioral emergencies
9.) Gaining access to patients and extricate
for treatment and transport
10.)
Use of emergency medical services communication equipment
11.) Provide verbal patient reports and
written run documentation to the care facility as required
B.
Certification Standards
1. No person is
eligible to provide care, as defined in these Rules and Regulations, without a
Current Arkansas EMT Certification. Requirements for certification includes:
a. Emergency Medical Technician-Paramedic
1). Pre-requisites for training
a) Successful completion of an Arkansas EMT
Basic Course, or hold a current State EMT or Intermediate certification, or
Military and Federal Employees who have a current National Registry
card.
b) Current CPR card (AHA or
ARC) documenting completion of a CPR course designed specifically for
healthcare providers, or a copy of an official American Heart Association (AHA)
or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster.
2). Pre-requisites for
testing
a)Currently certified as an Arkansas
EMT.
(Note: Any person not holding Arkansas Certification must
comply with the requirements for a State and/or National Criminal History check
as required by Act 666 of 1999.)
b) Successful completion of a Department
approved Department of Transportation (DOT)- National Standard Curriculum
EMT-Paramedic program including all didactic, clinical and field internship
requirements or be accepted for reciprocity from another state.
c) Current AHA ACLS card or official AHA
roster, and current CPR Card (AHA or ARC) documenting completion of a CPR
course designed specifically for healthcare providers, or a copy of an official
American Heart Association (AHA) or American Red Cross CPR for the Professional
Rescuer (ARC) CPR course roster.
3). Certification requirements
Successfully complete the Arkansas EMT-Paramedic Examination
b. Emergency
Medical Technician-Intermediate
1).
Pre-requisites for training
a) Successful
completion of an Arkansas EMT Basic Course, or hold a current State EMT
certification, or Military and Federal Employees who have a current National
Registry card.
b) Current CPR card
(AHA or ARC) documenting completion of a CPR course designed specifically for
healthcare providers, or a copy of an official American Heart Association (AHA)
or American Red Cross CPR for the Professional Rescuer (ARC) CPR course roster.
2). Pre-requisites for
testing
a). Currently certified as an
Arkansas EMT.
(Note: Any person not holding Arkansas Certification must
comply with the requirements for a State and/or National Criminal History check
as required by Act 666 of 1999.)
b). Successful completion of a
Department-approved DOT National Standard Curriculum EMT-I training course
including all didactic, clinical and field internship requirements or be
accepted for reciprocity from another state.
3). Certification Requirements
Successfully complete the Arkansas EMT-Intermediate
Examination.
c.
Emergency Medical Technician-Ambulance
1). The
Department shall base certification on successful completion of the DOT-
National Standard Curriculum EMT training course including all didactic,
clinical and field internship requirements or successful completion of other
courses approved. Also, as part of the course completion requirements, ALL
students taking a basic EMT Course must complete a minimum eight (8) hour
Extrication Course. Students with training and certification in other states
without documented extrication must complete the eight (8) hours of required
extrication in order to be eligible for testing. The Extrication Course can be
conducted in one (1) of the following manners, or a combination of the
following methods:
a) Videos
b) Classroom lectures
c) Skills practice
d) Any combination of the above
2). Certification shall be based
on a successful completion of both the Arkansas practical skills examination
and the National Registry of EMTs written examination.
d. Emergency Medical Technician-Instructor
1) Instructor certification will run
concurrent with the current EMT expiration date.
2) Upon completion of the Instructor
requirements listed below, the Instructor Candidates will be placed on
PROVISIONAL status. PROVISIONAL Instructors must complete the following within
twelve (12) months of completion of the Instructor course:
a) Instruct a 120-hour EMT-Basic course or an
approved EMT Refresher Program at any level that follows current Department of
Transportation-National Standard Curriculum Guidelines and sponsored by an
Arkansas approved Training Site as long as ALL of the following requirements
have been met:
1. If the Provisional
Instructor chooses to teach a refresher program to meet this requirement, they
MUST be certified for a minimum of two (2) consecutive years at the level they
will teach.
2. All courses must be
sponsored by an Arkansas approved Training Site.
3. Applications for all courses must be
approved by the Office of EMS prior to starting (Instructor/Site Representative
must receive approval letter from the Office prior to starting)
4. All courses must follow the current
Department of Transportation National Standard Curriculum guidelines.
b) First course must be monitored,
using a Office of EMS & Trauma Systems approved evaluation tool, by one (1)
of the following (minimum of three (3) hours):
1. The Candidate's Instructor
Trainer
2. Another Instructor
approved by the EMS Specialist or Certification Administrator and the
candidates Instructor Trainer
3. An
EMS Specialist or Certification Administrator.
c) Complete Lay Evaluator Training d) The
Office will notify the candidate when they have successfully completed all
requirements to be placed on full Instructor status (removed from PROVISIONAL
status).
3) Instructor
Candidate Training Requirements
a) Certified
Arkansas EMT (Ambulance, Intermediate or Paramedic level)
b) Certified continuously for a minimum of
two (2) years as an EMT
c) Current
Basic Life Support Instructor course completion (American Heart Association OR
American Red Cross-ONLY)
d) Successfully complete a Office of EMS
approved forty (40) hour Department of Transportation-National Standard
Curriculum EMT-Instructor Course. For successful completion, students must
complete the end of course written with a minimum score 80%, and meet all other
course requirements.
e. EMT Instructor Teaching Advanced Courses
1). EMT- Intermediate who applies to teach an
EMT-Intermediate course must complete the following:
a) Have received full EMT-Instructor
status.
b) Have been certified as
an EMT-Intermediate for a minimum of two (2) years.
2). EMT-Paramedic who applies to teach an
EMT-Intermediate or EMT-Paramedic course must complete the following:
a) Have received full EMT-Instructor status
b) Copy of current ACLS Instructor
card
c) Have been certified as a
Paramedic for a minimum of two (2) years
f. Emergency Medical Technician-Instructor
Trainer
1). All of the following eligibility
requirements must be met for Instructors to become an EMT-Instructor Trainer:
a) Arkansas certification at the
EMT-Intermediate or EMT-Paramedic level
b) Certified continuously for two (2) years
in EMS as an EMT-Instructor
c)
Current Basic Life Support Instructor Trainer course completion (American Heart
Association OR American Red Cross - ONLY)
d) Successfully complete a Office of EMS
approved forty (40) hour Department of Transportation-National Standard
Curriculum EMT-Instructor Course. For successful completion, students must
complete the end of course written with a minimum score of 80% and meet all
other course requirements.
e)
Sponsored by an Arkansas approved Training Site.
f) Completed Lay Evaluator
Training.
g) Document minimum
of an Associate Degree or a Senior of Vocational Instruction
rating.
C. Recertification Standards
Arkansas EMT recertification is required every two (2) years in
order to ensure EMTs maintain the ability, skills and knowledge needed to
properly perform prehospital medical patient care. It is based on a combination
of training programs and testing of basic critical skills. Individuals will not
be authorized to provide care as EMTs from their expiration date until they
receive their new identification card. EMT-Instructor recertification
requirements must be completed to maintain Instructor status, but does not
affect Arkansas EMT certification. An individual can lose their Instructor
status, but still be recertified at their EMT level.
Any currently certified EMT applying for recertification shall
complete one time only a criminal history check form and shall request the
Identification Bureau of the Department of the Arkansas State Police to conduct
a state and/or national criminal history check on the applicant.
1. Emergency Medical Technician - Basic and
Ambulance
a. Completed Application Form
signed in ink (available from the Office).
b. A $10.00 certification fee payable to the
Arkansas Department of Health.
c.
Current CPR card (AHA or ARC) documenting completion of a CPR course designed
specifically for healthcare providers, or a copy of an official American Heart
Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC)
CPR course roster.
d. Complete and
document one (1) of the following:
1.) An
approved EMT Basic Refresher Program (a minimum of twenty-four (24) hours)
including an end-of-course written and practical skills exam, documented by a
letter from a certified Arkansas EMT Instructor on approved Training Site
letterhead
2.) Complete Forty-eight
(48) hours of Continuing Education pre-approved by the Office (with a minimum
of three (3) areas, maximum of sixteen (16) hours per area).
2. EMT - Intermediate
a. Completed Application Form signed in ink
(available from the Office of EMS).
b. A $10.00 certification fee payable to the
Arkansas Department of Health.
c.
Current CPR card (AHA or ARC) documenting completion of a CPR course designed
specifically for healthcare providers, or a copy of an official American Heart
Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC)
CPR course roster.
d. Documentation
signed and dated by the Medical Director verifying competency in the following
skills: Patient Assessment, Airway Management with appropriate device(s), IV
Therapy, MAST and D50W Administration.
e. Complete and document ALL of the
following:
1). An approved EMT Basic
Refresher Program (a minimum of twenty-four (24) hours) including an
end-of-course written and practical skills exam, documented by a letter from a
certified Arkansas EMT Instructor on approved Training Site
letterhead
2). Twelve (12) hours of
Intermediate level Refresher training pre-approved by the Office.
3). Thirty-six (36) Hours of Continuing
Education pre-approved by the Office (with a minimum of three (3) areas,
maximum of sixteen (16) hours per area.)
3. EMT - Paramedic
a. Completed Application Form signed in ink
(available from the Office).
b. A
$10.00 certification fee payable to the Arkansas Department of
Health.
c. Current CPR card (AHA or
ARC) documenting completion of a CPR course designed specifically for
healthcare providers, or a copy of an official American Heart Association (AHA)
or American Red Cross CPR for the Professional Rescuer (ARC) CPR course
roster.
d. A copy (front and back)
of your current American Heart Association ACLS Provider card or official AHA
course roster (valid past your current EMT-P expiration date).
e. Documentation signed and dated by the
Medical Director verifying competency in the following skills: Patient
Assessment, Endotracheal Intubation, IV Therapy, Drug Therapy and
MAST.
f. Twenty-four (24) hours of
Continuing Education pre-approved by the Office (with a minimum of three (3)
areas, maximum of sixteen (16) hours per area).
g. In addition to the above, complete and
document one of the following:
1) An approved
forty-eight (48) hour EMT-Paramedic Refresher course, including an
end-of-course written and practical skills exam, documented by a letter from
the certified EMT-Paramedic instructor on approved Training Site
letterhead.
2) Forty-eight (48)
hours Refresher Training/Continuing Education pre-approved by the Office
adhering to and including the content of the EMT-Paramedic Refresher National
Standard Curriculum.
4. EMT - Instructor
Instructor Certification is for a two (2) year period to run
concurrent with your current EMT level of certification.
The following must be completed and submitted for ALL
Instructors:
a. Completed Application
Form signed in ink (available from the Office of EMS).
b. A copy (front and back) of your current
CPR Instructor card or official course roster, either:
1) American Heart Association
2) American Red Cross
c. Complete eight (8) hours of Continuing
Education at the Instructor level pre-approved by the Office.
d. Meet the recertification requirements for
your level of certification (EMT-A, EMT-Intermediate, or
EMT-Paramedic)
e. Document the
following requirements for your level of certification:
1). EMT-Ambulance certified as an
EMT-Instructor, must complete one of the following:
a) One (1) full EMT course teaching more than
50% of the course materials
b) Two
(2) EMT courses as co-instructor teaching
c) Two (2) Refresher courses
d) Forty-eight (48) hours of classroom
instruction with prior approval by ADH, or with a letter from the lead
instructor or training site representative verifying hours and topics of
instruction taught at an approved EMT course.
2). EMT-Intermediate certified as an
EMT-Instructor, must complete one of the following:
a) One (1) EMT course teaching more than 50%
of the course material
b) Two (2)
EMT courses as co-instructor
c) Two
(2) Refresher courses
d) One (1)
EMT-Intermediate course teaching more than 50%> of the course
material
e) Forty-eight (48) hours
of classroom instruction with prior approval by ADH, or with a letter from the
lead instructor or training site representative verifying hours and topics of
instruction taught at an approved EMT course.
3). EMT-Paramedic certified as an
EMT-Instructor, must complete one of the following:
a) One (1) EMT course teaching more than 50%
of the course material
b) Two (2)
EMT courses as co-instructor
c) Two
(2) Refresher Courses
d) One (1)
EMT-Intermediate course
e) One (1)
EMT-Paramedic course teaching more than 50% of the course material
f) One (1) forty-eight (48) hour Paramedic
refresher course with a letter from the lead instructor or training site
representative verifying hours and topics of instruction taught at an approved
EMT course.
4).
EMT-Instructor Trainer must complete all of the following:
a) Maintain current Arkansas EMT-Intermediate
or EMT-Paramedic certification
b)
Maintain current EMT-Instructor certification
5. Late EMT Recertification
Applications
a. Recertification will be
allowed for those who submit their documentation after their expiration date
IF:
1) All required educational hours were
completed PRIOR to the expiration date;
2) All specific training (i.e, Refresher,
ACLS, CPR, etc.) was completed PRIOR to the expiration date; AND
3) All documentation was submitted
PRIOR to the next recertification period.
b. Persons who have NOT submitted
the documentation PRIOR to their expiration date will be considered lapsed
BEGINNING with the expiration date and will remain lapsed until the paperwork
is submitted, reviewed by the Office, meets the above criteria, and
documentation of recertification is issued (current wallet ID
card).
D.
Lapsed Emergency Medical Technicians
Individuals who do not complete their educational and training
requirements for recertification prior to their expiration date will be
considered lapsed and will have to complete the following requirements for
their certification level prior to receiving their new State Certification
card:
1. EMT-Ambulance
a.
LAPSED TWO (2)
YEARS OR LESS:
1)
Document successful completion of an approved Basic EMT Refresher Course
(minimum 24 hours);
2) Document current CPR card (AHA or ARC)
documenting completion of a CPR course designed specifically for healthcare
providers, or a copy of an official American Heart Association (AHA) or
American Red Cross CPR for the Professional Rescuer (ARC) CPR course
roster;
3) Submit Arkansas
application form, completely filled out with signature, and a $10.00
certification fee payable to the Arkansas Department of Health.
4) Challenge and pass the Arkansas Basic EMT
written and practical examination.
b.
LAPSED MORE THAN TWO
(2) YEARS:
1)
Document successful completion of an approved Basic EMT Course following the
Department of Transportation National Standard Curriculum (NSC) for EMT
Training, minimum 120 hours;
2)
Submit Arkansas application form, completely filled out with signature, and a
$10.00 certification fee payable to the Arkansas Department of
Health;
3) Mail copy of National
Registry application and testing fee (money order payable to National
Registry) directly to National Registry office, and mail original
National Registry application to the Office of EMS & TS;
4) Challenge and pass the Arkansas Basic EMT
Certification examination (written and practical for
EMT-A).
2. EMT- Intermediate
a.
LAPSED TWO (2)
YEARS OR LESS:
1)
Document successful completion of an approved Basic EMT Refresher Course
(minimum 24 hours) and twelve (12) hours of Intermediate level
continuing education (prior approval by the Office of EMS & TS is
needed for credit to be given);
2) Document current CPR card (AHA or ARC)
documenting completion of a CPR course designed specifically for healthcare
providers, or a copy of an official American Heart Association (AHA) or
American Red Cross CPR for the Professional Rescuer (ARC) CPR course
roster;
3) Submit Arkansas
application form, completely filled out with signature, and a $10.00
certification fee payable to the Arkansas Department of Health;
4) Submit a letter from an Arkansas licensed
ambulance service or training site medical director verifying skills;
5) Challenge and pass the Arkansas/National
Registry EMT-Intermediate written and practical examination.
b.
LAPSED MORE THAN
TWO (2) YEARS:
1) Document successful completion of an
approved Basic EMT Course following the Department of Transportation National
Standard Curriculum (NSC) for EMT Training, minimum 120 hours;
2) Submit Arkansas application form,
completely filled out with signature, and a $10.00 certification fee payable to
the Arkansas Department of Health;
3) Mail copy of National Registry application
and testing fee (money order payable to National Registry)
directly to National Registry office, and mail original National
Registry application to the Office of EMS & Trauma Systems;
4) Challenge and pass the Arkansas Basic EMT
Certification examination (written and practical for
EMT-A);
5) Document
successful completion of an approved Arkansas EMT-Intermediate Course following
the Department of Transportation National Standard Curriculum (NSC) for EMT
Training;
6) Submit Arkansas
application form, completely filled out with signature, and a $10.00
certification fee payable to the Arkansas Department of Health;
7) Mail National Registry application and
testing fee (money order payable to National Registry) for the
Intermediate exam directly to National Registry office;
8) Challenge and pass the Arkansas/National
Registry EMT-Intermediate Certification examination (written and
practical).
3. EMT-Paramedic
a.
LAPSED TWO (2)
YEARS OR LESS:
1)
Document successful completion of an approved forty-eight (48) hour Paramedic
Refresher Course;
2) Current CPR
card (AHA or ARC) documenting completion of a CPR course designed specifically
for healthcare providers, or a copy of an official American Heart Association
(AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course
roster;
3) Submit copy of current
American Heart Association ACLS card or official course roster;
4) Submit Arkansas application form,
completely filled out with signature, and a $10.00 certification fee payable to
the Arkansas Department of Health;
5) Submit a letter from an Arkansas licensed
ambulance service or training site medical director verifying skills;
6) Challenge and pass the Arkansas/National
Registry EMT-Paramedic written and practical examination.
b.
LAPSED MORE THAN TWO
(2) YEARS:
1)
Document successful completion an approved Basic EMT Course following the
Department of Transportation National Standard Curriculum (NSC) for EMT
Training, minimum 120 hours;
2)
Submit Arkansas application form, completely filled out with signature, and a
$10.00 certification fee payable to the Arkansas Department of
Health;
3) Mail copy of National
Registry application and testing fee (money order payable to National
Registry) directly to National Registry office, and mail original
National Registry application to the Office of EMS & Trauma
Systems;
4) Challenge and pass the
Arkansas Basic EMT Certification examination (written and practical for
EMT-A).
5) Document
successful completion of an approved Arkansas EMT-Paramedic Course following
the Department of Transportation National Standard Curriculum (NSC) for EMT
Training;
6) Submit Arkansas
application form, completely filled out with signature, and a $10.00
certification fee payable to the Arkansas Department of Health;
7) Mail National Registry application and
testing fee (money order payable to National Registry) for the
Paramedic exam directly to National Registry office;
8) Challenge and pass the Arkansas/National
Registry EMT-Paramedic Certification examination (written and
practical).
E. Request for Extension to complete EMT
Recertification Requirements
1. Submit a
letter to the Office of EMS & Trauma Systems no later than
thirty (30) days prior to the expiration date requesting an
extension. The letter must include the reason(s) the extension is being
requested (what circumstances have occurred during the past
two (2) years that requires an extension).
Include information to substantiate the need for an extension
(i.e. Military Orders, medical documentation from a physician,
etc)
2. Office of EMS
& Trauma Systems will review each letter of request
AND all supporting documents separately and make a
decision on a case by case basis by the expiration date.
3. If the Office of EMS & Trauma Systems
receives the request or documentation after their
expiration date, the EMT will be considered LAPSED and the request
will not be accepted or reviewed. However, requests from EMTs on active duty
with the military and stationed overseas will be reviewed as long as a copy of
their orders are attached to the request.
4. After all of the information is reviewed,
a letter will be sent to the applicant explaining the Office of EMS &
Trauma Systems decision.
5.
If an individual is found to be providing care while certification is
lapsed, they will be subject to Disciplinary Action. In addition, the licensed
ambulance service, if applicable, will be notified of Disciplinary Actions (See
Section XIII) taken against them for allowing a non-certified EMT to operate on
an ambulance.
6.
If your request is granted and you receive an extension, you are
NOT eligible to provide patient care, as an Arkansas certified EMT, past your
expiration date UNTIL you complete all of your recertification
requirements!
F. Reciprocity
The Department is authorized to approve Arkansas certification
testing for individuals who hold certifications or licenses issued by other
states. In addition, military, ex-military and federal employees who hold a
current National Registry of EMTs card will be eligible for Arkansas
certification testing. Certification will be equal to their preexisting
certification, not to exceed two (2) years. The Department shall require any
person seeking reciprocity to comply with the following requirements:
1. Certification in another state and/or
National Registration does not authorize you to function as an EMT in Arkansas.
Presenting yourself as an EMT in this state prior to certification could
jeopardize your chance to become an Arkansas EMT. Also, any service employing
an EMT not Arkansas certified is risking disciplinary action.
2. Applicants must be within their original
certification period or have recertified in the state the EMT is transferring
from prior to applying to Arkansas. Applicants must also challenge and
successfully complete the Arkansas certification requirements prior to their
out-of-state expiration date.
3.
All state certified and Nationally Registered Basic EMTs seeking Arkansas
certification must complete and submit the following documentation to the
Office:
a. A completed Verification of EMT
Status Form (obtained from the Office).
b. A completed Arkansas application
signed and dated in INK, for EMT certification form (obtained
from the Office).
c. A $10.00
certification fee payable to the Arkansas Department of Health. Note:
certification fees are not refundable.
d. Arkansas Criminal Background Check form,
which includes a State and FBI check, (form(s) obtained from the
Office).
e. Document Current CPR
course (AHA or ARC) documenting completion of a CPR class designed specifically
for healthcare providers, or a copy of an official American Heart Association
(AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course
roster.
f. Copies of your current
State certification and National Registry cards.
Note: If you are not currently a National Registry
cardholder, you must acquire one before being Arkansas certified. Contact the
Office of EMS & Trauma Systems to obtain the procedures you must follow to
acquire National Registry
status.
g. Successfully complete the Arkansas
Practical Skills Exam if you have a current National Registry card. If not,
successfully complete National Registry Written Exam and the Arkansas Practical
Skills Exam.
4. All
state certified and Nationally Registered EMT-Intermediates seeking Arkansas
certification must complete and submit the following documentation to the
Office:
a. A completed Verification of EMT
Status Form (obtained from the Office).
b. A completed Arkansas application
signed and dated in INK, for EMT certification form (obtained
from the Office).
c. A $10.00
certification fee payable to the Arkansas Department of Health. Note:
certification fees are not refundable.
d. Arkansas Criminal Background Check form,
which includes a State and FBI check. (Form(s) obtained from the
Office).
e. Document Current CPR
card (AHA or ARC) documenting completion of a CPR course designed specifically
for healthcare providers, or a copy of an official American Heart Association
(AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course
roster.
f. Copies of your current
State certification and National Registry cards.
Note: If you are not currently a National Registry
cardholder, you must acquire one before being Arkansas certified. Contact the
Office of EMS & Trauma Systems to obtain the procedures you must follow to
acquire National Registry
status.
g. Verification of the following skills
within the past two (2) years:
1) Three (3)
Esophageal Obturator Airway (EOA) / Esophageal Gastric Tube Airway (EGTA)
intubations which were conducted under the supervision of the Medical Director
of an approved training site, Medical Director of a Licensed Advanced Life
Support ambulance service or any person qualified/approved as an instructor for
Intermediate and Paramedic training courses (Verification can be accomplished
by using an Intubation Manikin).
2)
Three (3) each intravenous cannulation starts verified by a physician,
registered nurse or any person qualified/approved as an instructor for
Intermediate and Paramedic training courses (Verification can be accomplished
using an IV Manikin).
5. All state certified and Nationally
Registered EMT-Paramedics seeking Arkansas certification must complete and
submit the following documentation to the Office:
a. A completed Verification of EMT Status
Form (obtained from the Office).
b.
A completed Arkansas application signed and dated in INK, for
EMT certification form (obtained from the Office).
c. A $10.00 certification fee payable to the
Arkansas Department of Health. Note: certification fees are not
refundable.
d. Arkansas
Criminal Background Check form, which includes a State and FBI check. (Form(s)
obtained from the Office).
e.
Current CPR card (AHA or ARC) documenting completion of a CPR course designed
specifically for healthcare providers, or a copy of an official American Heart
Association (AHA) or American Red Cross CPR for the Professional Rescuer (ARC)
CPR course roster.
f. Submit copy
of current AHA ACLS card or course roster documenting successful completion
within the previous 24 months.
g.
Copies of your Current State certification and National Registry cards.
Note: If you are not currently a National Registry
cardholder, you must acquire one before being Arkansas certified. Contact the
Office of EMS & Trauma Systems to obtain the procedures you must follow to
acquire National Registry
status.
h. Verification of the following skills
within the past two (2) years:
1) Three (3)
each endotracheal intubations verified by a physician, anesthesiologist, CRNA,
or any person qualified/approved as an instructor for Paramedic training
courses (Verification can be accomplished by using an Intubation
Manikin).
2) Three (3) each
intravenous cannulation starts verified by a physician, registered nurse or any
person qualified/approved as an instructor for Paramedic training courses
(Verification can be accomplished using an IV Manikin).
6. Military trained personnel will
be eligible for EMT-Basic/Ambulance Certification ONLY, unless documentation of
completion of a State Approved Department of Transportation National Standard
Curriculum EMT-I or EMT-P course can be provided. A DD Form 214 listing a
medical MOS, AFSC, or NEC must be submitted. The applicant must not have been
separated from the Military
(Personnel stationed in the Continental
United States or overseas) for more than twelve (12) months, and must
have been active in the job description within the previous twelve (12) months.
a. Military Personnel seeking Basic
certification must complete the following requirements:
1) . Submit a copy of DD Form 214 (reserve
personnel must submit a copy of training information from their 201
file).
2) . A completed
Verification of EMT Status Form (obtained from the Office).
3) . A completed Arkansas application signed
and dated in INK, for EMT certification form (obtained from the
Office).
4) . A $10.00
certification fee payable to the Arkansas Department of Health. Note:
certification fees are not refundable.
5) . Arkansas Criminal Background Check form,
which includes a State and FBI check, (form(s) obtained from the
Office).
6) . Document Current CPR
card (AHA or ARC) documenting completion of a CPR course designed specifically
for healthcare providers, or a copy of an official American Heart Association
(AHA) or American Red Cross CPR for the Professional Rescuer (ARC) CPR course
roster.
7) . A copy of your current
National Registry card.
8) .
Verification of an eight (8) hour extrication course.
9) . Successfully complete the Arkansas
Practical Skills Exam.
b. Military Personnel seeking Emergency
Medical Technician-Intermediate certification must complete the requirements
listed in Section VII.F.4 above.
c.
Military Personnel seeking Emergency Medical Technician-Paramedic certification
must complete the requirements listed in Section VII.F.5 above.
7. Federal Employees
a. Federal Employees seeking Basic Emergency
Medical Technician certification must complete the following requirements:
1) A completed Verification of EMT Status
Form (obtained from the Office).
2)
A completed Arkansas application signed and dated in INK, for
EMT certification form (obtained from the Office).
3) A $10.00 certification fee payable to the
Arkansas Department of Health. Note: certification fees are not
refundable.
4) Arkansas
Criminal Background Check form, which includes a State and FBI check, (form(s)
obtained from the Office).
5)
Document Current CPR card (AHA or ARC) documenting completion of a CPR course
designed specifically for healthcare providers, or a copy of an official
American Heart Association (AHA) or American Red Cross CPR for the Professional
Rescuer (ARC) CPR course roster.
6)
A copy of your current National Registry card.
7) Verification of an eight (8) hour
extrication course.
8) Successfully
complete the Arkansas Practical Skills Exam
b. Federal Employees seeking Emergency
Medical Technician-Intermediate certification must complete the requirements
listed in Section VII.F.4 above.
c. Federal Employees Emergency Medical
Technician-Paramedic certification must complete the requirements listed in
Section VII.F.5 above.
SECTION X. BASIC AND ADVANCED TRAINING SITE
REQUIREMENTS
A. Paramedic Training Sites
1. By July 1, 2003 all current Arkansas
Paramedic Training Sites must complete one of the following:
a. Have achieved accreditation by a National
Accrediting Organization as recognized by the Office.
b. Have submitted all required paperwork,
including the self-study and be awaiting a site visit.
2. Any potential site wishing to apply to be
a Paramedic Training Site after July 1, 2003 must have been awarded national
accreditation as a Paramedic Training Site, as recognized by the Office, and
met Arkansas requirements as listed in the Arkansas Site Accreditation
Manual.
B. Emergency
Medical Technician-Paramedic Training
1. The
Department shall approve all EMT-P courses and training sites prior to the
beginning of any period of instruction.
2. Training sites must meet and maintain the
standards set forth in the Training Site Accreditation Standards as recommended
by the Governor's EMS Advisory Council and approved by the
Department.
3. Primary Instructors
must be either Arkansas licensed physicians, registered nurse/EMT Instructor,
or EMT-Paramedic/EMT-Instructor. A paramedic who is an EMT-Instructor will
teach at least fifty (50) percent of each course.
4. In-Hospital training
a. Clinical phases of training will be
conducted within a medical facility with hospital concurrence.
b. EMT-Paramedic students will be trained,
within the hospital, by qualified personnel under guidelines and requirements
stated in the curriculum and approved by the medical staff and the hospital's
governing body during clinical phases of training.
c. All requirements for hours, hospital,
ambulance, patient contact and training set forth in the 1999 ALS
Implementation Plan must be met by all classes beginning after July 1,
2001.
5. Field Internship
a. Internship must be completed with a
paramedic licensed ambulance service with which there is an agreement allowing
students to actively participate in patient care. The student must be in the
patient compartment during transport
b. All requirements for both field
internships set forth in the current ALS Implementation Plan must be met for
all classes after July 1, 2001.
6. Only those students from approved courses
and recommended by their instructor and medical director will be allowed to
challenge the State of Arkansas certification examination.
7. There must be a Medical Director
designated, having emergency department experience, who meets the requirements
in Section 1 .A. and documents current Advanced Cardiac Life Support
credentials or is Board Certified in Emergency Medicine.
C. Emergency Medical Technician-Intermediate
Training
1. The Department shall approve all
EMT-Intermediate courses and training sites prior to the beginning of any
periods of instruction.
2.
EMT-Intermediate training may be sponsored only by a higher education
institution that has affiliation with an Arkansas licensed hospital or
EMT-Paramedic training site.
3.
Primary Instructors must be either Arkansas licensed physicians, registered
nurses/EMT Instructor, EMT-Paramedic/EMT Instructor, or
EMT-Intermediate/EMT-Instructor (applies only to EMT-Intermediates completing
the 1999 EMT-Intermediate DOT-NSC).
4. The Department will set the course of
instruction and minimum number of hours of total instruction.
5. There shall be an academic as well as a
clinical atmosphere. Trainees must be in uniform with a standard means of
identification when engaged in the patient care and clinical portions of the
program.
6. Only those students
from approved courses and recommended by their instructor and medical director
will be allowed to challenge the State of Arkansas certification
examination.
7. There must be a
Medical Director designated, having emergency department experience, who meets
the requirements in Section 1 .F. and documents Advanced Cardiac Life Support
certification current within one year of becoming a Medical Director or is
Board Certified in Emergency Medicine.
8. In-Hospital Training
a. Clinical phases of training will be
conducted within a medical facility with hospital concurrence.
b. EMT-Intermediate students will be trained,
within the hospital, by qualified personnel under guidelines and requirements
stated in the curriculum and approved by the medical staff and the hospital's
governing body during clinical phases of training.
c. All requirements for hours, hospital,
ambulance, patient contact and training set forth in the 1999 ALS
Implementation Plan must be met by all classes beginning after July 1,
2001.
9. Field
Internship
a. Internship must be completed
with a Paramedic or Intermediate licensed ambulance service with which there is
an agreement allowing students to actively participate in patient care. The
student must be in the patient compartment during transport.
b. All requirements for both field
internships set forth in the 1999 ALS Implementation Plan must be met for all
classes after July 1, 2001.
D. Emergency Medical Technician-Ambulance
Training
1. The Department shall approve all
EMT-Basic courses and training sites prior to the beginning of any periods of
instruction.
2. Basic EMT training
may be sponsored only by a higher education institution that is affiliated with
an Arkansas licensed hospital or an approved training site.
3. Primary Instructors must be either
Arkansas licensed physicians, registered nurses/EMT Instructor,
EMT-Paramedic/EMT Instructor, EMT-Intermediate/EMT-Instructor or
EMT-Ambulance/EMT Instructor.
4.
The Department will set the course of instruction and minimum number of hours
of total instruction.
5. There
shall be an academic as well as a clinical atmosphere. Trainees must be in
uniform with a standard means of identification when engaged in the patient
care and clinical portions of the program.
6. Only those students from approved courses
that have successfully completed all course requirements as documented by the
instructor and medical director will be allowed to challenge the State of
Arkansas certification examination.
7. There must be a Medical Director
designated, having provided care in an emergency room, meets the requirements
in Section I.F. and documents ACLS certification current within one year of
becoming a Medical Director or be Board Certified in Emergency
Medicine.
8. In-Hospital Training
a. Clinical phases of training will be
conducted within a medical facility with hospital concurrence.
b. Basic EMT students will be trained, within
the hospital, by qualified personnel under guidelines and requirements stated
in the curriculum and approved by the medical staff and the hospital's
governing body during clinical phases of training.
9. Field Internship
a. Internship must be completed with a
Paramedic, Intermediate or Basic licensed ambulance service with which there is
an agreement allowing students to actively participate in patient care. The
student must be in the patient compartment during transport.
E. Emergency Medical
Technician-Instructor Training
1.
Requirements to conduct an EMT-Instructor Course are as follows:
a. The course must be sponsored by an
Arkansas approved EMT Training site in affiliation with an educational
institution (Vo-Tech School, Technical College, Community College, four year
college or university).
b. All
courses must be approved prior to starting by the Office of EMS.
c. All courses must follow the current
Department of Transportation National Standard Curriculum guidelines.
d. All courses must conduct a practical
skills exam (those skills on which students test for certification) with a
performance of 80% or above.
e. An
individual who holds a Bachelor's Degree, or higher, in education, or adult
education must assist with the course.
2. The EMT-Instructor Trainer must submit the
following information to the Office of EMS:
a. A curriculum vitae of all instructional
staff
b. Copy of course
curriculum
c. Copy of current Basic
Life Support (BLS) Instructor card
d. Application/written request to conduct an
Instructor course (Instructor/Site Representative must receive approval letter
from the Office prior to starting course).
e. List of applicants for
verification/approval of EMT status by Office of EMS
3. Upon completion of EMT-Instructor course,
the Instructor Trainer must submit end of course documentation including a list
of students who successfully completed the course.
4. Each student successfully completing the
EMT-Instructor course will be responsible for completing the requirements
outlined in the Requirements for Arkansas EMT-Instructor Certification (Section
VII.B.l.d.) for their level of EMT certification.
SECTION XI DRUGS AND
PHARMACEUTICALS
A.
NOTICE OF
INSPECTION
Investigators and inspectors for the Office of Pharmacy
Services and Drug Control, Arkansas Department of Health, are directed to make
investigations and inspections and make copies of the records and orders,
wherever located, of all services licensed by the Office of EMS in order to
determine whether or not the said services have violated the laws and
regulations of the State of Arkansas respecting prescribing and using of
narcotics and potentially dangerous drugs and whether or not said services have
violated the provisions of the law.
B.
REGISTRATION
A separate registration in the name of the Medical Director
(Physician) is required for each service license place of business at one
general physical location where controlled substances are maintained or
distributed to ambulances specifically licensed to maintain drugs.*
C.
SECURITY
1. The
controlled substances storage area at the ambulance service's physical location
shall be accessible only to specifically authorized employees.
2. The Licensee shall provide adequate
security for all legend drugs on-board all registered vehicles. Schedule II
drugs have a separate requirement for security that also must be complied with
by the Licensee.
D.
PROCEDURE IN CASE OF LOSS OF CONTROLLED SUBSTANCES
Each Paramedic Licensee or Medical Director shall notify the
Office of Pharmacy Services and Drug Control, Arkansas Department of Health
(661-2325), immediately upon discovery of any suspected loss, theft and/or
other diversion of any controlled substance under their supervision.
E.
RECORDS OF
CONTROLLED SUBSTANCES
1. The
Medical Director (Physician) of the service is responsible for maintaining
accurate and complete records of such drugs received and a record of all such
drugs administered, or professionally used otherwise.*
2. The basic records are: receipt and
disposition of controlled drugs within the service, patient medical records
(Encounter Forms), and the controlled drug procurement and disposition
records.
3. The record shall in
every case show the date of receipt, the name and address of the person or
business from whom received and the kind and quantity of drugs
received.
4. The record shall show:
the drugs administered, date of administration, the name and address of the
person to whom or for whose use the drugs were administered, and the kind and
quantity of drugs.
* Exception: Hospital based Service (The hospital's DEA
Registration allows for the drugs to be supplied to the service through the
hospital pharmacy where records of administration and distribution are the
responsibility of the hospital).
5. Patient medication records shall consist
of at least, (1) physician's order authorizing the dispensing and
administration of medications (Standing Orders), (2) medication administration
record indicating the date, time and signature of the EMT-Paramedic
administering controlled drugs to the patient, and (3) the EMT-Paramedic notes
indicating the date, time, method of administration, and condition of the
patient before and after the controlled drugs were administered and signature
of the EMT-Paramedic administering the drug.
6. In addition to patient's medical records,
a record of the procurement and disposition of controlled drug must be
maintained.
7. The disposition
record must reflect the actual dosage administered to the patient, the patients
name, date, time and signature of the EMT-Paramedic administering the
controlled drug. Any error of entry on the disposition and procurement record
shall follow a policy of correction of errors and accurate accountability. If
the person who procures the controlled drug is not the person who administers
the drug, then both persons must sign the disposition record.
8. When breakage or wastage of a controlled
drug occurs, the amount administered and the amount wasted must be recorded by
the EMT-Paramedic who wasted the drug and verified by the signature of a
licensed person and/or certified EMT who witnessed the wastage and how it was
wasted.
9. Adequate accountability
does not require the use of a specific system or form. The system employed must
be designed so that all requirements listed are met.
10. Each service shall maintain inventory
records in one consolidated record system. Records of Schedule II substances
shall be maintained separately from all other records. Inventories of Schedule
III, IV and V shall be maintained either separately from all other records or
in such form that the information required is readily retrievable from the
ordinary business records.
11.
Every record shall be kept by the Registrant and be readily retrievable and
available for at least two (2) years from the date of the recording for
inspection and copying by authorized agents of the Office of Pharmacy Services
and Drug Control, Arkansas Department of Health, or the Office of EMS &
Trauma Systems, Arkansas Department of Health.
F.
SURRENDER OF UNWANTED
CONTROLLED SUBSTANCES
All controlled substances no longer usable due to
deterioration, expired dating, or no longer used by the service:
1. must be delivered in person or by
registered mail or other means of shipment with return receipt and all
completed copies of Report of Drugs Surrendered (Form PhA:DC-l) furnished by
the Department of Health to: Office of Pharmacy Services and Drug Control,
Arkansas Department of Health, 4815 West Markham Street, Little Rock, AR
72205-3867, OR
2. may be destroyed
only by authorized agents of the Arkansas Department of Health on
site.
G.
POLICIES AND PROCEDURES MANUAL
A policies and procedures manual pertaining to drug handling
shall be developed and submitted to the Office of Pharmacy Services and Drug
Control for approval. The manual shall include at a minimum the
following:
1. Detailed job
descriptions, duties and responsibilities of each employee handling
drugs.
2. Procedures for:
registration of the Medical Director, security of drugs and limiting access to
one person responsible for the accountability during shift, accurate and
complete record keeping of drugs, and availability of records for inspection.
3 Procedures in case of loss of
drugs, surrender of unwanted drugs, and wastage.
H.
STORAGE OF PHARMACEUTICALS BY
LICENSED AMBULANCE SERVICES1.
All pharmaceuticals will be stored in accordance with the instructions included
in the package inserts of each drug . Factors such as heat, freezing,
susceptibility to light, etc., are described in the insert, and all services
will provide suitable storage to comply with the instructions.
2. Freezing is defined as storage at
temperatures at or below 32 degrees Fahrenheit (32 F). Excessive heat is
defined as temperatures at or above 104 degrees Fahrenheit (104F). The licensee
will provide protection of fluids and pharmaceuticals on units.
I.
ADDITIONS TO THE
REQUIRED AND OPTIONAL DRUG LISTS
All additions to the Optional Drug List will be approved by the
Medical Director, recommended by the Governor's Advisory Council on EMS &
Trauma Systems and approved by the Office of EMS, prior to implementing the
drug.
J.
PURCHASING DRUGS FROM HOSPITALS
The policy of purchasing small quantities of legend drugs from
hospital pharmacies by the supervising physician of non-hospital based
ambulance services or EMS systems is acceptable. There is no requirement for
hospitals to participate in this sale.
This will certify that the foregoing Rules and Regulations
Pertaining to Emergency Medical Services were adopted by the Arkansas State
Board of Health at a regular board session held in Little Rock, Arkansas, on
the 24 th. day of April, 2008.
Paul K. Halverson, DrPH, FACHE Secretary, Arkansas State Board
of Health Director, Arkansas Department of Health
The foregoing Rules and Regulations having been filed in my
Office are hereby in compliance with the Administrative Procedures Act on this
28 th day of May, 2008.
