Current through Register Vol. 48, No. 12, March 22, 2024
a) Vehicle
Design
1) Each new vehicle used as an
ambulance shall comply with the current criteria established by nationally
recognized standards such as National Fire Protection Association, Ground
Vehicle Standards for Ambulances, the Federal Specifications for the Star of
Life Ambulance, or the Commission on Accreditation of Ambulance Services (CAAS)
Ground Vehicle Standard for Ambulances.
2)
A licensed vehicle shall
be exempt from subsequent vehicle design standards or specifications
required by the Department in this Part, as long as
the vehicle is continuously in compliance with the vehicle design
standards and specifications originally applicable to that vehicle, or
until the vehicle's title of ownership is
transferred. (Section
3.85(b)(8) of
the Act)
b) Equipment
Requirements - Basic Life Support Vehicles Each ambulance used as a Basic Life
Support vehicle shall meet the following equipment requirements, as determined
by the Department by an inspection:
1)
Stretchers, Cots, and/or Litters
A) Primary
Patient Cot
B) Secondary Patient
Stretcher
2) Oxygen,
Portable
Shall be secured.
3) Suction, Portable
A manually operated suction device is acceptable if approved
by the Department.
4)
Medical Equipment
A) Squeeze bag-valve-mask
ventilation unit with adult size transparent mask, and child size
bag-valve-mask ventilation unit with child, infant and newborn size transparent
masks
B) Lower-extremity traction
splint, adult and pediatric sizes
C) Blood pressure cuff, one each, adult,
child and infant sizes and gauge
D)
Stethoscopes, two per vehicle
E)
Long spine board with three sets of torso straps, 72" x 16" minimum
F) Short spine board (32" x 16" minimum) with
two 9-foot torso straps, one chin and head strap or equivalent vest type (wrap
around) per vehicle; extrication device optional
G) Airway, oropharyngeal - adult, child, and
infant, sizes 0-5
H) Airway,
nasopharyngeal with lubrication, sizes 14-34F
I) Two adult and two pediatric sized
non-rebreather oxygen masks per vehicle
J) Two infant partial re-breather, or
equivalent oxygen masks per vehicle
K) Three nasal cannulas, adult and child
size, per vehicle
L) Bandage
shears, one per vehicle
M)
Extremity splints, adult, two long and short per vehicle
N) Extremity splints, pediatric, two long and
short per vehicle
O) Rigid cervical
collars - one pediatric, small, medium, and large sizes or adjustable size
collars, or equivalent per vehicle. Shall be made of rigid material to minimize
flexion, extension, and lateral rotation of the head and cervical spine when
spine injury is suspected
P)
Medical grade patient restraints, arm and leg, sets
Q) Pulse oximeter with pediatric and adult
sensors
R) AED or defibrillator
that includes pediatric capability
5) Medical Supplies
A) Trauma dressing - six per
vehicle
B) Sterile gauze pads - 20
per vehicle, 4 inches by 4 inches
C) Bandages, soft roller, self-adhering type,
10 per vehicle, 4 inches by 5 yards
D) Vaseline gauze - two per vehicle, 3 inches
by 8 inches
E) Adhesive tape rolls
- two per vehicle
F) Triangular
bandages or slings - five per vehicle
G) Burn sheets - two per vehicle, clean,
individually wrapped
H) Sterile
solution (normal saline) - four per vehicle, 500 cc or two per vehicle, 1,000
cc plastic bottles or bags
I)
Material or device intended to maintain body temperature
J) Obstetrical kit, sterile - minimum one,
pre-packaged with instruments and bulb syringe
K) Cold packs, three per vehicle
L) Hot packs, three per vehicle,
optional
M) Emesis basin - one per
vehicle
N) Drinking water - one
quart, in non-breakable container; sterile water may be substituted
O) Ambulance emergency run reports - 10 per
vehicle, on a form prescribed by the Department or one that contains the data
elements from the Department-prescribed form as described in Section
515.Appendix E or electronic documentation with paper backup
P) Sheets - two per vehicle, for ambulance
cot
Q) Blankets - two per vehicle,
for ambulance cot
R) Opioid
antagonist, including, but not limited to, Naloxone, with administration
equipment appropriate for the licensed level of care
S) Urinal
T) Bedpan
U) Remains bag, optional
V) Nonporous disposable gloves
W) Impermeable red biohazard-labeled
isolation bag
X) Face protection
through any combination of masks and eye protection and face shields
Y) Suction catheters - sterile, single use,
two each, 6, 8, 10, 12, 14 and 18F, plus three tonsil tip semi-rigid pharyngeal
suction tip catheters per vehicle; all shall have a thumb suction control
port
Z) Pediatric specific
restraint systems or age/size appropriate car safety seats
AA) Current equipment/drug dosage sizing tape
or pediatric equipment/drug age/weight chart
BB) Flashlight, two per vehicle, for patient
assessment
CC) Current Illinois
Department of Transportation Safety Inspection sticker in accordance with
Section 13-101 of the Illinois Vehicle Code
DD) Illinois Poison Center telephone
number
EE) Department of Public
Health Central Complaint Registry telephone number posted where visible to the
patient
FF) Medical Grade
Oxygen
GG) Ten disaster triage
tags
HH) State-approved Mass
Casualty Incident (MCI) triage algorithms (START/JumpSTART)
c) Equipment
Requirements - Intermediate and Advanced Life Support Vehicles
Each ambulance used as an Intermediate Life Support vehicle
or as an Advanced Life Support vehicle shall meet the requirements in
subsections (b) and (d) and shall also comply with the equipment and supply
requirements as determined by the EMS MD in the System in which the ambulance
and its crew participate. Drugs shall include both adult and pediatric dosages.
These vehicles shall have a current pediatric equipment/drug dosage sizing tape
or pediatric equipment/drug dosage age/weight chart.
d) Equipment Requirements - Rescue and/or
Extrication
The following equipment shall be carried on the ambulance,
unless the ambulance is routinely accompanied by a rescue vehicle:
1) Wrecking bar, 24"
2) Goggles for eye safety
3) Flashlight - one per vehicle, portable,
battery operated
4) Fire
Extinguisher - two per vehicle, ABC dry chemical, minimum 5-pound unit with
quick release brackets. One mounted in driver compartment and one in patient
compartment
e) Equipment
Requirements - Communications Capability
Each ambulance shall have reliable ambulance-to-hospital
radio communications capability and meet the requirements provided in Section
515.400.
f) Equipment Requirements - Epinephrine
An EMT, EMT-I, A-EMT or Paramedic who has
successfully completed a Department-approved course in the administration of
epinephrine shall be required to carry epinephrine (both adult and
pediatric doses) with him or her in the ambulance or drug box
as part of the EMS Personnel medical supplies whenever he or she is
performing official duties, as determined by the EMS System within the
context of the EMS System plan. (Section 3.55(a-7) of the Act)
g) Personnel Requirements
1) Each Basic Life Support ambulance shall be
staffed by a minimum of one System authorized EMT, A-EMT, EMT-I, Paramedic or
PHRN, PHPA, PHAPN and one other System authorized EMT, A-EMT, EMT-I, Paramedic,
PHRN, PHPA, PHAPN or physician on all responses.
2) Each ambulance used as an Intermediate
Life Support vehicle shall be staffed by a minimum of one System authorized
A-EMT, EMT-I, Paramedic or PHRN, PHPA, PHAPN and one other System authorized
EMT, A-EMT, EMT-I, Paramedic, PHRN, PHPA, PHAPN or physician on all
responses.
3) Each ambulance used
as an Advanced Life Support vehicle shall be staffed by a minimum of one System
authorized Paramedic or PHRN, PHPA, PHAPN and one other System authorized EMT,
A-EMT, EMT-I, Paramedic, PHRN, PHPA, PHAPN or physician on all
responses.
h) Alternate
Rural Staffing Authorization-
1) A Vehicle
Service Provider that serves a rural or semi-rural population of 10,000
or fewer inhabitants and exclusively uses volunteers, paid-on-call
personnel or a combination to provide patient care may apply
for alternate rural staffing authorization to authorize the ambulance,
Non-Transport Vehicle, Special-Use Vehicle, or Limited Operation Vehicle to be
staffed by one EMS Personnel licensed at or above the level at which the
vehicle is licensed, plus one EMR when two licensed EMTs, A-EMTs, EMT-Is,
Paramedics, PHRNs, PHPAs, PHAPNs or physicians are not available to respond.
(Section 3.85(b)(3) of
the Act)
2) The EMS Personnel
licensed at or above the level at which the ambulance is licensed shall be the
primary patient care provider in route to the health care facility.
3) The Vehicle Service Provider shall obtain
the prior written approval for alternate rural staffing from the EMS MD. The
EMS MD shall submit to the Department a request for an amendment to the
existing EMS System plan that clearly demonstrates the need for alternate rural
staffing in accordance with subsection (h)(4) and that the alternate rural
staffing will not reduce the quality of medical care established by the Act and
this Part.
4) A Vehicle Service
Provider requesting alternate rural staffing authorization shall clearly
demonstrate all of the following:
A) That it
has undertaken extensive efforts to recruit and educatelicensed EMTs, A-EMTs,
EMT-Is, Paramedics, or PHRNs, PHPAs, PHAPNs;
B) That, despite its exhaustive efforts,
licensed EMTs, A-EMTs, EMT-Is, Paramedics or PHRNs, PHPAs, PHAPNs are not
available; and
C) That, without
alternate rural staffing authorization, the rural or semi-rural population of
10,000 or fewer inhabitants served will be unable to meet staffing requirements
as specified in subsection (g).
5) The alternate rural staffing authorization
and subsequent authorizations shall include beginning and termination dates not
to exceed 48 months. The EMS MD shall re-evaluate subsequent requests for
authorization for compliance with subsections (h)(4)(A) through (C). Subsequent
requests for authorization shall be submitted to the Department for approval in
accordance with this Section.
6)
Alternate rural staffing authorization may be suspended or revoked, after an
opportunity for hearing, if the Department determines that a violation of this
Part has occurred. Alternate rural staffing authorization may be summarily
suspended by written order of the Director, served on the Vehicle Service
Provider, if the Director determines that continued operation under the
alternate rural staffing authorization presents an immediate threat to the
health or safety of the public. After summary suspension, the Vehicle Service
Provider shall have the opportunity for an expedited hearing.
7) Vehicle Service Providers that cannot meet
the alternate rural staffing authorization requirements of this Section may
apply through the EMS MD to the Department for a staffing waiver pursuant to
Section 515.150.
i) Alternate Response Authorization
1) A Vehicle Service Provider that
exclusively uses volunteers or paid-on-call personnel or a combination to
provide patient care who are not required to be stationed with the vehicle may
apply to the Department for alternate response authorization to authorize the
ambulance, Non-Transport Vehicle, Special-Use Vehicle, or Limited Operation
Vehicle licensed by the Department to travel to the scene of an emergency
staffed by at least one licensed EMT, A-EMT, EMT-I, Paramedic, PHRN, PHPA,
PHAPN or physician.
2) A Vehicle
Service Provider operating under alternate response authorization shall ensure
that a second licensed EMS Personnel is on scene or in route to the emergency
response location.
3) Unless the
Vehicle Service Provider is approved for alternate rural staffing authorization
under subsection (h), the Vehicle Service Provider shall demonstrate to the
Department that it has written safeguards to ensure that no patient will be
transported with:
A) fewer than two EMTs,
Paramedics or PHRNs, PHPAs, PHAPNs;
B) a physician; or
C) a combination, at least one of whom shall
be licensed at or above the level of the license for the vehicle.
4) Alternate response
authorization may be suspended or revoked, after an opportunity for hearing, if
the Department determines that a violation of this Part has occurred. Alternate
response authorization may be summarily suspended by written order of the
Director, served on the Vehicle Service Provider, if the Director determines
that continued operation under the alternate response authorization presents an
immediate threat to the health or safety of the public. After summary
suspension, the licensee shall have the opportunity for an expedited hearing
(see Section 515.180).
j) Alternate Response Authorization -
Secondary Response Vehicles
1) A Vehicle
Service Provider that uses volunteers or paid-on-call personnel or a
combination to provide patient care, and staffs its primary response vehicle
with personnel stationed with the vehicle, may apply for alternate response
authorization for its secondary response vehicles. The secondary or subsequent
ambulance, Non-Transport Vehicle, Special-Use Vehicle, or Limited Operation
Vehicle licensed by the Department at the BLS, ILS or ALS level, when personnel
are not stationed with the vehicle, may respond to the scene of an emergency
when the primary vehicle is on another response. The vehicle shall be staffed
by at least one System authorized licensed EMT, A-EMT, EMT-I, PHRN, PHPA, PHAPN
or physician.
2) A Vehicle Service
Provider operating under the alternate response authorization shall ensure that
a second System authorized licensed EMT, A-EMT, EMT-I, Paramedic, PHRN, PHPA,
PHAPN or physician is on the scene or in route to the emergency response
location, unless the Vehicle Service Provider is approved for alternate rural
staffing authorization, in which case the second individual may be an EMR or
First Responder.
3) Unless the
Vehicle Service Provider is approved for alternate rural staffing authorization
under subsection (h), the Vehicle Service Provider shall demonstrate to the
Department that it has written safeguards to ensure that no patient will be
transported without at least one EMT who is licensed at or above the level of
ambulance, plus at least one of the following: EMT, Paramedic, PHRN, PHPA,
PHAPN or physician.
4) Alternate
response authorization for secondary response vehicles may be suspended or
revoked, after an opportunity for hearing, if the Department determines that a
violation of this Part has occurred. Alternate response authorization for
secondary response vehicles may be summarily suspended by written order of the
Director, served on the Vehicle Service Provider, if the Director determines
that continued operation under the alternate response authorization for
secondary vehicles presents an immediate threat to the health or safety of the
public. After summary suspension, the Vehicle Service Provider shall have the
opportunity for an expedited hearing (see Section 515.180).
k) Alternative Staffing for
Private Ambulance Providers, Excluding Local Government Employers
An ambulance provider may request approval from IDPH to use
an alternative staffing model for interfacility transfers for a maximum of one
year in accordance with the requirements for Vehicle Service Providers in
210 ILCS
50/3.85 of the Act and may be renewed annually.
1) An ambulance provider requesting
alternative staffing for BLS ambulances for interfacility transfers will
provide the following to IDPH:
A) Assurance
that an EMT will remain with the patient at all times and an EMR will act as
driver.
B) Certificate of
completion of a defensive driver course for the EMR and validation that the EMT
has one year of pre-hospital experience.
C) A system plan modification form stating
this type of transport will only be for identified interfacility transports or
medical appointments excluding dialysis.
D) Dispatch protocols for properly screening
and assessing patients appropriate for transports utilizing the alternative
staffing models.
E) A quality
assurance plan which must include monthly review of dispatch screening and
outcome.
2) The System
modification form and program plan shall be submitted to the EMSMD for approval
and forwarded to the REMSC for review and approval. The provider shall not
implement the alternative staffing plan until approval by the EMSMD and the
Department.
3) Each EMS System must
develop an EMS Workforce Development and Retention Committee.
A) The Committee shall be representative of
the following:
i) At least one individual
representing each private ambulance provider;
ii) At least one individual representing each
municipal provider;
iii) Two
individuals representing the Associate Hospitals;
iv) Two individuals representing the
Participating Hospitals;
v) One
individual representing the Resource Hospital; and
vi) The EMS System Medical
Director.
B) The
Committee shall:
i) Assess whether there are
EMS staffing shortages within the System and the impact of any staffing
shortage on response times and other relevant metrics.
ii) Develop recommendations to address such
staffing shortages, including, but not limited to, alternative staffing models
including the use of EMRs.
C) No later than 1/31/22, the EMSMD shall
submit a final report of the Committee to the Department along with any
proposed system modifications to address the staffing shortages of the
System.
D) Under the approval of
the EMSMD, private ambulance providers may submit a plan for alternative
staffing models.
i) The alternative staffing
model would include expanded scopes of practice as determined by the EMSMD and
approved by the Department.
ii)
This may include the use of an EMR at the BLS, AEMT/ILS, or ALS levels of
care.
iii) If an EMSMD proposes an
expansion of the scope of practice for EMRs, such expansion shall not exceed
the education standards prescribed by IDPH.
E) The alternative staffing plan shall be
renewed annually if the following criteria are met:
i) All system modification forms and
supportive planning documentation are submitted, validated, and approved by the
EMSMD who shall submit to the Department for final approval.
ii) All plans must demonstrate that personnel
will meet the training and education requirements as determined by IDPH for
expanding the scope of practice for EMRs, testing to assure knowledge and skill
validation, and a quality assurance plan for monitoring transports utilizing
alternative staffing models that include EMRs.
iii) This plan shall be submitted to the
REMSC for review and approval.
iv)
This plan shall not be implemented without Department approval, which shall not
be unreasonably withheld. Deference shall be given to the EMSMD's approval of
the plan.
l) Rural population staffing credentialing
exemption (5000 or fewer inhabitants) for volunteer EMS
agencies:
1)
An EMSMD may
create an exception to the credentialing process to allow registered nurses,
physician assistants and advanced practice nurses to apply to serve as
volunteers who perform the same work as EMTs after completion of the
following:
A) Assurance by the EMSMD that the
registered nurse, physician assistant or advance practice nurse has a valid
license.
B) 20 hours of continuing
education for each individual to include at a minimum: airway
management, ambulance operation, ambulance equipment, extrication,
telecommunication, prehospital cardiac, and trauma care. (Section
3.89 of the Act)
C)
8 hours of observation riding
time for each individual. (Section
3.89 of the Act)
D) Policy outlining requirements for
credentialing, additional CME; requirements and rejecting of a
volunteer.
E) The plan for system
level recognition will be submitted to the Department for approval and once
approved, will be for a period of one year.
m) Operational Requirements
1) An ambulance that is transporting a
patient to a hospital shall be operated in accordance with the requirements of
the Act and this Part.
2) A
licensee shall operate its ambulance service in compliance with this Part, 24
hours a day, every day of the year. Except as required in this subsection (k),
each individual vehicle within the ambulance service shall not be required to
operate 24 hours a day, as long as at least one vehicle for each level of
service covered by the license is in operation at all times. An ALS vehicle can
be used to provide coverage at either an ALS, ILS or BLS level, and the
coverage shall meet the requirements of this Section.
A) At the time of application for initial or
renewal licensure, and upon annual inspection, the applicant or licensee shall
submit to the Department for approval a list containing the anticipated hours
of operation for each vehicle covered by the license.
i) A current roster shall also be submitted
that lists the System authorized EMTs, A-EMTs, EMT-Is, Paramedics, PHRNs,
PHPAs, PHAPNs or physicians who are employed or available to staff each vehicle
during its hours of operation. The roster shall include each staff person's
name, license number, license expiration date and telephone number, and shall
state whether the person is scheduled to be on site or on call.
ii) An actual or proposed four-week staffing
schedule shall also be submitted that covers all vehicles, includes staff names
from the submitted roster, and states whether each staff member is scheduled to
be on site or on call during each work shift.
B) Licensees shall obtain the EMS MD's
approval of their vehicles' hours of operation prior to submitting an
application to the Department. An EMS MD may require specific hours of
operation for individual vehicles to assure appropriate coverage within the
System.
C) A Vehicle Service
Provider that advertises its service as operating a specific number of vehicles
or more than one vehicle shall state in the advertisement the hours of
operation for those vehicles, if individual vehicles are not available 24 hours
a day. Any advertised vehicle for which hours of operation are not stated shall
be required to operate 24 hours a day. (See Section
515.800(j).)
3) For each patient transported to
a hospital, the ambulance staff shall, at a minimum, measure and record the
information required in Appendix E.
4) A Vehicle Service Provider shall provide
emergency service within the service area on a per-need basis without regard to
the patient's ability to pay for the service.
5) A Vehicle Service Provider shall provide
documentation of procedures to be followed when a call for service is received
and a vehicle is not available, including copies of mutual aid agreements with
other ambulance providers. (See Section
515.810(h).)
6) A Vehicle Service Provider shall not
operate its ambulance at a level exceeding the level for which it is licensed
(basic life support, intermediate life support, advanced life support), unless
the vehicle is operated pursuant to an EMS System-approved in-field service
level upgrade or ambulance service upgrades - rural population.
7) The Department will inspect ambulances
each year. If the Vehicle Service Provider has no violations of this Section
that threaten the health of safety of patients or the public for the previous
five years and has no substantiated complaints against it, the Department will
inspect the Vehicle Service Provider's ambulances in alternate years, and the
Vehicle Service Provider may, with the Department's prior approval,
self-inspect its ambulances in the other years. The Vehicle Service Provider
shall use the Department's inspection form for self-inspection. Nothing
contained in this subsection (k)(7) shall prevent the Department from
conducting unannounced inspections.
n) A licensee may use a replacement vehicle
for up to 10 days without a Department inspection, provided that the EMS System
and the Department are notified of the use of the vehicle by the second working
day.
o)
Patients,
individuals who accompany a patient, and EMS Personnel may not
smoke while inside an ambulance or SEMSV. The Department of Public
Health shall impose a civil penalty on an individual who
violates this subsection (m) in the amount of $100.
(Section 3.155(h) of the
Act)
p) Any provider may request a
waiver of any requirements in this Section under the provisions of Section
515.150.