Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment adds the Commission on
Accreditation of Ambulance Services Ground Vehicle Standard for Ambulances
v.1.0 edition and the National Fire Protection Association 1917 Standard for
Automotive Ambulances 2016 edition as acceptable standards/specifications for
vehicles specifically designed, manufactured, and equipped for use as an
ambulance.
PUBLISHER'S NOTE: The secretary of state has
determined that the publication of the entire text of the material which is
incorporated by reference as a portion of this rule would be unduly cumbersome
or expensive. This material as incorporated by reference in this rule shall be
maintained by the agency at its headquarters and shall be made available to the
public for inspection and copying at no more than the actual cost of
reproduction. This note applies only to the reference material. The entire text
of the rule is printed here.
(1) Application Requirements for Ground
Ambulance Service Licensure.
(A) Each
applicant for ownership of an ambulance service license or relicense shall
submit an application for licensure to the Bureau of Emergency Medical Services
(EMS) no less than thirty (30) days or no more than one hundred and twenty
(120) days prior to their desired date of licensure or relicensure.
(B) An application shall include the
following information: trade name of the ambulance service; location of
vehicles; number of vehicles to be operated by the ambulance service; name,
address, telephone numbers and e-mail address (if applicable) of operator of
the ambulance service; name of manager; name, address, whether a medical doctor
or doctor of osteopathy, telephone numbers, email address (if applicable), and
signature of medical director and date signed; certification by the medical
director that they are aware of the qualification requirements and the
responsibilities of an ambulance service medical director and agree to serve as
medical director; name, address, telephone numbers and e-mail address (if
applicable) of proposed licensee of the ambulance service; name of licensee's
chief executive officer; all ambulance service licensure and related
administrative licensure actions taken against the ambulance service or owner
by any state agency in any state; and certification by the applicant that the
application contains no misrepresentations or falsifications and that the
information given by them is true and complete to the best of their knowledge,
and that the ambulance service has both the intention and the ability to comply
with the regulations promulgated under the Comprehensive Emergency Medical
Service Systems Act, Chapter 190, RSMo Supp. 1998.
(C) Each ambulance service that meets the
requirements and standards of the statute and regulations shall be licensed and
relicensed for a period of five (5) years.
(D) Ambulance services which are currently
accredited by the Commission on Accreditation of Ambulance Services (CAAS) or
the Commission on Accreditation of Medical Transportation Services (CAMTS) and
have the required liability insurance coverage shall be considered to be
compliant with the rules for ambulance services. Accredited ambulance services
shall attach to their application evidence of accreditation and proof of their
liability insurance coverage. The Bureau of EMS may conduct periodic site
reviews as necessary to verify compliance.
(2) Each vehicle operated as an ambulance
shall meet the following vehicle design, specification, operation, and
maintenance standards:
(A) Vehicle Design and
Specification Standards. In providing the transportation of patients, ambulance
services shall utilize only vehicles specifically designed, manufactured, and
equipped for use as an ambulance and which meet current (at date of vehicle
manufacture) standards/specifications set forth by the U.S. Department of
Transportation KKK-A-1822, the Commission on Accreditation of Ambulance
Services
Ground Vehicle Standard for Ambulances v.1.0 edition
or the National Fire Protection Association
1917 Standard for
Automotive Ambulances 2016 Edition. The Commission on Accreditation of
Ambulance Services
Ground Vehicle Standard for Ambulances
v.1.0 edition is incorporated by reference in this rule as published in 2016
and is available at the Ground Vehicle Standard, 1926 Waukegan Road Suite 300,
Glenview Il 60025-1770. This rule does not incorporate any subsequent
amendments or additions. The National Fire Protection Association
1917
Standard for Automotive Ambulances 2016 Edition is incorporated by
reference in this rule as published in 2016 and is available at the National
Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169-7471. This
rule does not incorporate any subsequent amendments or additions. Exceptions to
these standards/specifications may include the following:
1. Image elements (such as paint) may be
altered to the agency's preference;
2. Variation of warning lights is allowed
for: type and color of lens, strobe lights in lieu of halogen lights,
additional warning lights beyond the U.S. Department of Transportation
KKK-A-1822, National Fire Protection Association 1917 Standard for
Automotive Ambulances 2016 edition or the Commission on Accreditation
of Ambulance Services Ground Vehicle Standard for Ambulances
v.1.0 edition specifications;
3.
Power supply and equipment in the patient compartment may be altered to the
agency's preference; and
4. Other
variations may be allowed by the Bureau of EMS;
(B) Operational Standards.
1. Ambulance services shall provide the
quantity of ambulance vehicles, medical supplies and personnel to meet the
emergency call volume which can be reasonably anticipated for their ambulance
service area.
2. Ambulance services
which are the 911 provider or the recognized emergency provider shall ensure
prompt response to all requests to that service for emergency care originating
from their ambulance service area twenty-four (24) hours per day, each and
every day of the year, and shall provide patients with medically necessary care
and transportation in accordance with that ambulance service's
protocols.
3. Public liability
insurance or proof of self-insurance, conditioned to pay losses and damage
caused by or resulting from the negligent operation, maintenance, or use of
ambulance services under the service's operating authority or for loss or
damage to property of others. Documents submitted as proof of insurance shall
specify the limits of coverage and include the ambulance service license
number. Public liability coverage for ambulance services which transport
patients in the patient compartment of a vehicle shall meet or exceed-
A. Two hundred fifty thousand dollars
($250,000) for bodily injury to, or death of, one (1) person;
B. Five hundred thousand dollars ($500,000)
for bodily injury to, or death of, all persons injured or killed in any one (1)
accident, subject to a minimum of two hundred fifty thousand dollars ($250,000)
per person; and
C. One hundred
thousand dollars ($100,000) for loss or damage to property of others in one (1)
accident, excluding cargo; and
(C) Maintenance Standards. The ambulance
service shall have a policy to provide for the effective maintenance of all its
ambulances and maintain records that demonstrate compliance with such
policy.
(3) Each vehicle
operated as an ambulance shall meet the following equipment requirements:
(A) Documentation that each vehicle is
equipped with pediatric and adult medical supplies and equipment as required by
the ambulance service medical director for the various patient care activities
in the out-of-hospital setting to which it will respond. Each service shall be
able to produce these records for inspection during normal business hours;
and
(B) The ambulance service shall
have a policy and provide for the effective maintenance, storage, usage and
replacement of its medical equipment, devices and medications.
(4) Each vehicle operated as an
ambulance shall meet the following staffing requirements:
(A) When transporting a patient, at least one
(1) licensed EMT, registered nurse, or physician shall be in attendance with
the patient in the patient compartment at all times; and
(B) When an ambulance service provides
advanced life support care under its protocols, the patient shall be attended
by an EMT-Paramedic, registered nurse or physician.
(5) Each ambulance service shall maintain
accurate records and forms on the following:
(A) An ambulance report to record information
on each emergency request for service and each ambulance run;
(B) Ground ambulance service
license;
(C) Medical director
protocol and policy authorization;
(D) Vehicle maintenance records;
(E) Vehicle driver education
records;
(F) Equipment maintenance
records; and
(G) Records required
by other regulatory agencies.
(6) Each ambulance service shall have a
medical control plan that has been approved by their medical director and
service manager. The medical control plan is that portion of the medical
protocols which specifically addresses the transfer of patient care between
agencies.
(7) Each ambulance
service that provides advanced life support services, basic life support
services utilizing medications (medications include activated charcoal, oral
glucose and/or oxygen) or providing assistance with patients' medications
(patient medications include a prescribed inhaler, nitroglycerin and/or
epinephrine), or basic life support services performing invasive procedures
including invasive airway procedures (invasive airway procedures include
esophageal or endo-tracheal intubation) shall have a designated medical
director, working under an agreement, who is trained and meets the requirements
for a medical director in accordance with
19
CSR 30-40.303.
(8) Each vehicle operated as an ambulance
shall have the capability to communicate by voice with local hospital(s),
trauma centers, and the service's own dispatching agency.
(9) There shall be an ongoing quality
improvement program designed to objectively and systematically monitor, review
and evaluate the quality and appropriateness of patient care, pursue
opportunities to improve patient care and resolve identified
problems.
(10) Each ambulance
service shall maintain policies and procedures that include the following:
(A) Safety program, including infection
control program;
(B) Vehicle
operations and driving procedures;
(C) Communications procedures;
(D) Ambulance operations
procedures;
(E) Standards for
clinical care (medical protocols);
(F) Vehicle and equipment
maintenance;
(G) Disaster/multiple
casualty protocols; and
(H) Quality
improvement program.
(11) Each ambulance service shall display a
copy of their ambulance service license in the patient care compartment of each
ambulance vehicle operated by the ambulance service.
(12) Each ambulance service that held a valid
ambulance vehicle license on August 28, 1998, and meets all the legislative and
regulatory requirements for licensure shall be issued an initial license for a
period of one to five (1-5) years. The Bureau of EMS will determine the initial
licensure period for each ambulance service by randomly selecting an equal
number of ambulance services for each of the five (5) periods of licensure
based on the date the application is received by the Bureau of EMS.
(13) An existing ambulance service licensee
may apply for and be granted by Bureau of EMS a reduction in their primary
service area if they meet the following requirements:
(A) Submit a completed application for
licensure, requesting a reduction of their ambulance service area and include a
detailed description of the affected area that will no longer be included in
their primary service area; and
(B)
Provide written documentation of an agreement with another licensed ambulance
service, stating the service has agreed to provide ambulance service to the
vacated service area through an expansion of their services, by either contract
or mutual aid agreement or provide public notice to residents of the affected
area.
1. Public notice to residents of the
affected area includes:
A. Publishing notice
in a newspaper of the largest general circulation, that is published in the
county in the area affected by the decision to withdraw ambulance coverage, a
minimum of one (1) year in advance of the proposed date of discontinuation of
ambulance services. A completed affidavit of publication and an original
clipping of published notice must accompany the application for licensure;
and
B. Providing written notice to
the county commission of any county that as a whole or in part, will be
affected by the discontinuation of services, a minimum of one (1) year in
advance of the proposed date of discontinuation of ambulance
services.
*Original authority: 190.103, RSMo 1998; 190.105, RSMo
1973, amended 1998, 2002; 190.107, RSMo 1998; 190.109, RSMo, 1998 amended 2002;
190.120, RSMo 1973, amended 1980, 1998, 2002; 190.160, RSMo, 1973, amended
1998, 2002; 190.165, RSMo 1973, amended 1978, 1998, 2002; 190.175, RSMo 1973,
amended 1998, 2002; 190.176, RSMo 1998; 190.185, RSMo 1973, amended 1989, 1993,
1995, 1998, 2002; and 190,190, RSMo 1973, amended
1998.
