Missouri Code of State Regulations
Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES
Division 30 - Division of Regulation and Licensure
Chapter 40 - Comprehensive Emergency Medical Services Systems Regulations
Section 19 CSR 30-40.810 - Ground Ambulance Transport of Patients to Locations That Are Not Hospitals

(A) Advanced emergency medical technician (also known as Emergency Medical Technician-Intermediate) shall mean the mid-level of licensure of licensed emergency medical services personnel who meet the requirements of 19 CSR 30-40.342(5);

(B) Advanced life support shall mean an advanced level of care as provided to the adult and pediatric patient when a patient is in a more critical condition and a paramedic is required to assist in the treatment of the patient during transport by an ambulance;

(C) Basic life support shall mean a basic level of care, as provided to the adult and pediatric patient where only emergency medical technicians are on ambulances during transport;

(D) BHCC shall mean Behavioral Health Crisis Centers designated by the Missouri Department of Mental Health;

(E) Department shall mean the Missouri Department of Health and Senior Services;

(F) Emergency Medical Technician means the lowest level of licensure of licensed emergency medical services personnel who meet the requirements in 19 CSR 30-40.342(2);

(G) Ground ambulance services shall mean ambulance services licensed under 19 CSR 30-40.309;

(H) Hospital shall mean the definition of hospital in section 197.020, RSMo, or a hospital operated by the state of Missouri;

(I) Medical director shall mean the medical director of an ambulance service as required by 19 CSR 30-40.303; and

(J) Paramedic shall mean the highest level of licensure of licensed emergency medical services' personnel who meet the requirements in 19 CSR 30-40.342(4).

(A) Hospital-owned or operated ground ambulance services should communicate with their hospitals and legal counsel about their ability to transport to locations that are not hospitals based on the federal Emergency Medical Treatment and Labor Act (EMTALA) law. Hospital-owned or operated ground ambulance services are required to transport patients according to EMTALA laws. Ground ambulance services may transport patients to locations that are not hospitals, such as BHCCs in Missouri, following a request for emergency care:

(B) When providing services to patients transported to locations that are not hospitals following a request for emergency care, licensed emergency medical services personnel for ground ambulance services shall follow written medical protocols, physician orders to provide medical care, or orders from qualified health care professionals who have collaborative practice arrangements with physicians and are allowed under Missouri law and their collaborative practice arrangement to dispense or prescribe drugs and provide treatment. Paramedics for the ground ambulance services evaluating patients do not have to be on the ambulance crew that transports patients. Paramedics for the ground ambulance services can arrive on the scene to evaluate the patient and the patient may be transported to the location, which is not a hospital, with a basic life support ambulance staffed by emergency medical technicians and/or advanced emergency medical technicians if the patient does not require advanced life support care. Patients shall be transported by advanced life support ambulances or basic life support ambulances based on the patients' care needs.

(C) Licensed ground ambulance service personnel who evaluate and transport patients to facilities providing mental health services that are not hospitals, such as BHCCs in Missouri, shall be trained by the ground ambulance service or other providers on evaluating and caring for patients with mental health concerns. This training may include ground ambulance service personnel attending and completing the Missouri Crisis Intervention Team forty- (40-) hour course discussed in section 190.147, RSMo.

(D) Written transportation and medical protocols set forth in subsections (2)(A) and (2)(B) shall be approved by the medical director of the service. Community or regional EMS transportation protocols for transport to a trauma, stroke, or STEMI center shall also be approved by the EMS medical director's advisory committee, and the director of the department pursuant to 19 CSR 30-40.770.

(E) Ground ambulance services shall conduct training and activities with the services' personnel to ensure written transportation protocols and medical protocols set forth in subsections (2)(A) and (2)(B) are properly implemented and followed.

(F) Ground ambulance services shall evaluate the written transportation and medical protocols set forth in subsections (2)(A) and (2)(B) to ensure the protocols are being properly implemented and followed by the services' personnel during a review of these transports through the services' quality improvement program.