Current through Register Vol. 46, No. 19, March 20, 2024
(1) An air ambulance service program seeking
authorization shall:
a. Apply for
authorization at the following levels:
(1)
EMT-Basic.
(2) Paramedic
specialist.
(3) Critical care
transport.
b. Conduct
all air ambulance service flights under a minimum of FAR rules, Part
135.
c. Maintain an adequate number
of aircraft and personnel to provide 24-hour-per-day, 7-day-per-week coverage.
The number of aircraft and personnel to be maintained shall be determined by
the service and shall be based upon, but not limited to, the following:
(1) Number of calls;
(2) Service area and population;
and
(3) Availability of other
services in the area.
d.
Staff fixed-wing ambulances, at a minimum on each flight request, with the
following staff while a patient is being transported:
(1) One health care provider who is certified
or licensed in the state from which the aircraft launches and is certified as
an EMT-Basic or higher level; and
(2) One FAA-certified commercial pilot who is
appropriately rated in the aircraft being used for the transport.
e. Staff rotorcraft ambulances, at
a minimum on each flight request, with the following staff while a patient is
being transported:
(1) Two health care
providers who are certified or licensed in the state from which the aircraft
launches, one of whom must at a minimum be certified as a paramedic specialist;
and
(2) One FAA-certified
commercial pilot who is appropriately rated in the aircraft being used for the
transport.
f. Train
medical crew members in the following areas:
(1) Patient care limitations in
flight.
(2) Altitude
physiology.
(3) Appropriate
utilization of air medical services.
(4) Communication system.
(5) Aircraft operations and safety.
(6) Emergency safety and survival.
(7) Prehospital scene response and
safety.
(8) Crew resource
management.
(9) Program flight risk
assessment procedures.
g.
Apply to the department to receive approval to provide critical care
transportation based upon appropriately trained staff and approved
equipment.
h. Ensure that the
health care provider with the highest level of certification (on the
transporting service) attends the patient, unless otherwise established by
protocol approved by the medical director.
(2) Air ambulance service program operational
requirements. Air ambulance service programs shall:
a. Complete and maintain a patient care
report concerning the care provided to each patient. Services shall provide, at
a minimum, a verbal report upon delivery of a patient to a receiving facility
and shall provide a complete PCR within 24 hours to the receiving
facility.
b. Ensure that personnel
duties are consistent with the level of certification and the service program's
level of authorization.
c. Maintain
current personnel rosters and personnel files. The files shall include the
names and addresses of all personnel and documentation that verifies EMS
provider credentials including, but not limited to:
(1) Current provider level
certification.
(2) Current course
completions/certifications/endorsements as may be required by the medical
director.
d. If requested
by the department, notify the department in writing of any changes in personnel
rosters.
e. Have a medical director
and 24-hour-per-day, 7-day-per-week on-line medical direction
available.
f. Ensure that the
appropriate service program personnel respond as required in this rule and that
personnel respond in a reasonable amount of time.
g. Notify the department in writing within
seven days of any change in service director or ownership or control or of any
reduction or discontinuance of operations.
h. Select a new or temporary medical director
if for any reason the current medical director cannot or no longer wishes to
serve in that capacity. Selection shall be made before the current medical
director relinquishes the duties and responsibilities of that
position.
i. Within seven days of
any change of medical director, notify the department in writing of the
selection of the new or temporary medical director who must have indicated in
writing a willingness to serve in that capacity.
j. Implement a continuous quality improvement
program for patient transport missions to include as a minimum:
(1) Medical audits.
(2) Skills competency.
(3) Flight safety procedures.
(4) Appropriateness of air medical
response.
(5) Review of flight risk
assessment.
(6) Loop closure
requiring physician review of patient transport missions.
k. Document an equipment maintenance program
to ensure proper working condition and appropriate quantities.
(3) Air ambulance equipment and
vehicle standards.
a. All air ambulance
service programs shall carry equipment and supplies in quantities as determined
by the medical director and appropriate to the service program's level of care
and available medical crew member personnel, and as established in the service
program's approved protocols.
b.
Pharmaceutical drugs may be carried and administered by appropriate staff upon
completion of training and pursuant to the service program's established
protocols approved by the medical director.
c. All pharmaceuticals shall be maintained in
accordance with the rules of the state board of pharmacy.
d. Accountability for drug exchange,
distribution, storage, ownership, and security shall be subject to applicable
state and federal requirements. The method of accountability shall be described
in the written pharmacy agreement. A copy of the written pharmacy agreement
shall be submitted to the department.
e. Each aircraft shall be equipped and
maintained in accordance with FAA operating requirements.
f. Each aircraft shall be equipped with a
survival kit.
(4)
Communications and flight dispatch program.
a.
Each service program shall maintain a telecommunications system between the
medical crew member and the source of the service program's medical direction
and other appropriate entities.
b.
All telecommunications shall be conducted in an appropriate manner and on a
frequency approved by the Federal Communications Commission and the
department.
c. A flight-following
policy shall be adopted. This policy shall at a minimum contain the following:
(1) Minimum time between communications with
aircraft and its monitoring center;
(2) Documentation of communications with
flight;
(3) Lost communications
procedures; and
(4) Overdue
aircraft procedures.
d.
Flight programs shall provide staff or contract with a flight dispatch system
for receiving flight requests. Communication specialists shall be trained in
the following:
(1) Flight
operations;
(2) Aviation
weather;
(3) Aviation
maintenance;
(4) Flight
following;
(5) Flight risk
assessment;
(6) Flight service
minimum safety standards; and
(7)
Overdue aircraft procedures.
(5) Flight risk assessment policy.
a. Each service shall have a flight risk
assessment policy in accordance with current FAA guidelines.
b. Flight risk assessment policies shall
mandate adherence to policy for all flights.
c. Flight risk assessment policies shall
address other flight services being requested, en route, or having been denied
request to same incident.
(6) Air ambulance service program-incident
and accident response and reports.
a. Air
medical services shall have a policy in place outlining
missing/overdue/accident issues. This policy will contain at a minimum the
following:
(1) Overdue aircraft procedures;
and
(2) Postincident action
plans.
b. Incidents of
fire or other destructive or damaging occurrences or theft of a service program
aircraft, vehicle, equipment, or drugs shall be reported to the department
within 48 hours following the occurrence of the incident.
c. A report relating to an accident resulting
in personal injury, death or property damage shall be submitted to the
department within seven days following an accident involving a service program
aircraft or vehicle. A complete FAA/NTSB accident report shall be submitted to
the bureau of EMS upon completion of the report.
(7) Reportable patient data-adoption by
reference.
a. The department shall prepare
compilations for release or dissemination on all reportable patient data
entered into the EMS service program registry during the reporting period. The
compilations shall include, but not be limited to, trends and patient care
outcomes for local, regional, and statewide evaluations. The compilations shall
be made available to all service programs submitting reportable patient data to
the registry.
b. Access and release
of reportable patient data and information.
(1) The data collected by and furnished to
the department pursuant to this subrule are confidential records of the
condition, diagnosis, care, or treatment of patients or former patients,
including outpatients, pursuant to Iowa Code section
22.7. The
compilations prepared for release or dissemination from the data collected are
not confidential under Iowa Code subsection
22.7(2).
However, information which individually identifies patients shall not be
disclosed, and state and federal law regarding patient confidentiality shall
apply.
(2) The department may
approve requests for reportable patient data for special studies and analysis
provided that the request has been reviewed and approved by the deputy director
of the department with respect to the scientific merit and confidentiality
safeguards and the department has given administrative approval for the
proposal. The confidentiality of patients and the EMS service program shall be
protected.
(3) The department may
require entities requesting the data to pay any or all of the reasonable costs
associated with furnishing the reportable patient data.
c. To the extent possible, activities under
this subrule shall be coordinated with other health data collection
methods.
d. Quality assurance.
(1) For the purpose of ensuring the
completeness and quality of reportable patient data, the department or an
authorized representative may examine all or part of the patient care report as
necessary to verify or clarify all reportable patient data submitted by a
service program.
(2) Review of a
patient care report by the department shall be scheduled in advance with the
service program and completed in a timely manner.
e. "Iowa Trauma Patient Data Dictionary" is
available through the Iowa Department of Public Health, Bureau of Emergency
Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075, or
the bureau of EMS website
(idph.iowa.gov/BETS/Trauma/data-registry).
f. "Iowa EMS Patient Registry Data
Dictionary" identified in 641-paragraph 136.2(1)"c" is
incorporated by reference for inclusion criteria and reportable patient data to
be reported to the department. For any differences which may occur between the
adopted reference and this chapter, the administrative rules shall
prevail.
g. "Iowa EMS Patient
Registry Data Dictionary" identified in 641-paragraph
136.2(1)"c" is available through the Iowa Department of Public
Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des
Moines, Iowa 50319-0075, or the bureau of EMS website
(idph.iowa.gov/BETS/EMS/data-registry).
(8) An air ambulance service
program shall:
a. Submit reportable patient
data identified in subrule 144.4(7) via electronic transfer. Data shall be
submitted in a format approved by the department.
b. Submit reportable patient data identified
in subrule 144.4(7) to the department for each calendar quarter. Reportable
patient data shall be submitted no later than 90 days after the end of the
quarter.
(9) The patient
care report is a confidential document and shall be exempt from disclosure
pursuant to Iowa Code subsection
22.7(2)
and shall not be accessible to the general
public. Information contained in these reports, however, may be utilized by any
of the indicated distribution recipients and may appear in any document or
public health record in a manner which prevents the identification of any
patient or person named in these reports.
(10) Implementation. The director may grant
waivers from the requirements of this chapter for any air medical service.
Waivers shall be reasonably related to undue hardships which existing services
experience in complying with this chapter. Services requesting waivers shall be
subject to other applicable rules adopted pursuant to Iowa Code chapter 147A.
Nothing in this chapter shall be construed to require any service to provide a
level of care beyond minimum basic care standards.