Current through September 17, 2024
All applicants and licensees who own or lease an ambulance
must meet the standards as set forth below:
006.01
AMBULANCE
STANDARDS. Ambulance standards are available on the Department's
website or may be requested from the Department at 301 Centennial Mall South,
Lincoln, NE 68509. Licensees must have documentation of the date an ambulance
was acquired. Ambulances and aircraft must:
(A) After the effective date of the
regulations, meet the National Fire Protection Association (NFPA) 1917 Standard
for Automotive Ambulances that is current on the effective date of these
regulations or the Commission on Accreditation of Ambulance Services (CAAS)
Ground Vehicle Standard for Ambulances that is current on the effective date of
these regulations;
(B) After the
effective date of the regulations, remounted ambulances must meet the
requirements of 172 NAC
12-005.01(A);
(C) Aircraft used for the transportation of
patients must comply with Federal Aviation Administration Regulations
14 CFR
135 that is current on the effective date of
these regulations and related bulletins and supplements; or
(D) Ambulances, including remounted
ambulances, that are owned by a licensed emergency medical service on the
effective date of these regulations may continue to be used as ambulances.
(i) If the ownership of an ambulance meets
the requirements of 172 NAC
12-005.01(D) is
transferred to another emergency medical service after the effective date of
these regulations, then the ambulance cannot be used as an ambulance. unless
the ambulance:
(1) Meets the requirements of
172 NAC
12-005.01(A) or
(B); or
(2) The ambulance is fifteen years of age or
less; and,
(3) Meets or exceeds the
Federal Specifications for Ambulances, KKK-A-1822C.
(ii) Section
005.01(D)(i) (2) and
(3) terminate ten years after effective date
of these regulations.
006.02
STANDARDS FOR EMERGENCY
MEDICAL SERVICES EQUIPMENT. Ambulances and non-transporting
emergency medical services must carry supplies and equipment, approved by the
physician medical director for providing care to pediatric and adult patients.
The equipment and supplies must include:
(A)
Equipment that can be used to provide the following procedures as authorized by
the service's license:
(i) Patient assessment
and diagnostic measurements;
(ii)
Airway management;
(iii) Bleeding
control and wound management;
(iv)
Extremity fracture immobilization;
(v) Cervical and spinal motion
restriction;
(vi) Burn
care;
(vii) Cardiac care;
(viii) Obstetrics and gynecology
care;
(ix) Intravenous
administration sets and fluids; and
(x) Administration of medications and
controlled substances;
(B) Patient transport and comfort
supplies;
(C) Supplies and
equipment for the protection of personnel and patients from infectious diseases
and for personal safety; and
(D)
Equipment and supplies appropriate for a critical care transport.
006.03
DRUG
ENFORCEMENT AGENCY CONTROLLED SUBSTANCE REGISTRATION. An advanced
life support emergency medical service must have a Drug Enforcement Agency
Controlled Substance Registration to deliver, store, or otherwise handle
controlled substances.
006.04
CLINICAL LABORATORY IMPROVEMENT AMENDMENTS. An
emergency medical service must have a current Clinical Laboratory Improvement
Amendments (CLIA) certificate for all levels of point-of-care testing utilized
by the service.
006.05
COMMUNICATION SYSTEMS. Each licensee must have a
communications system that is capable of two-way communications with receiving
hospitals, dispatchers, and medical control authorities.
006.06
AMBULANCE MAINTENANCE
STANDARDS. Each licensee must meet the maintenance standards set
out below:
(A) Ambulances must be maintained
as specified in the chassis manufacturer owner's manual and the recommendations
of the ambulance manufacturer;
(B)
Aircraft must be maintained in accordance with Federal Aviation Regulation 14
CFR Part 135 and 14 CFR Part 91 and related bulletins, and supplements as
required by this chapter;
(C)
Equipment used for patient care or support must be maintained in accordance
with the manufacturer's recommended procedures; and
(D) The licensee must keep and maintain all
ambulance and operational equipment owner manuals and maintenance procedure
manuals for the life of the ambulance or operational equipment or as long as
the equipment is owned or used by the emergency medical service.
006.07
INFECTION
CONTROL STANDARDS. The licensee must follow written policies,
approved by its physician medical director, concerning sanitation and infection
control and the following:
(A) Pre-exposure
precautions;
(B) Post-exposure
procedures for personnel. Such procedures must be in accordance with Neb. Rev.
Stat. §§
71-506 to
71-514.05;
(C) Procedures for decontamination and
cleaning of the ambulance;
(D)
Procedures for the decontamination and cleaning of equipment; and
(E) Procedures for the disposal of
contaminated or single use equipment and supplies.
006.08
AMBULANCE INSPECTION
STANDARDS. A licensee which transports patients must establish and
perform, at a minimum, monthly vehicle inspections to assure the vehicle's
emergency warning devices, electrical systems, engine, and fuel systems are in
proper working order. Operational equipment, used for patient care or support,
must be inspected, at a minimum, monthly and tested by the service for proper
operation or function. All drugs must be inventoried, at a minimum, monthly.
Checklists must be developed and used by the service to conduct these
inspections monthly. Completed checklists must be maintained for five
years.
006.09
PERSONNEL
STANDARDS. A licensee must meet the statutory requirements and the
following personnel standards:
(A) Maintain a
current roster of the names of its employees and members of the
service;
(B) Only use licensed
emergency care providers and individuals as identified in Neb. Rev. Stat.
§
38-1226 to provide patient
care:
(C) When acting as an
emergency care provider for a basic life support service, the provider may only
provide the level of care as defined in Neb. Rev. Stat. §
38-1206.01 and
38-1207.01. When acting as an
emergency care provider for an advanced life support service, the provider may
provide the level of care for a basic life support service and the level of
care as defined in Neb. Rev. Stat. §
38-1204.01,
38-1207.01, and
38-1208.01; and
(D) Staffing of at least one critical care
paramedic or a licensed physician, registered nurse, physician assistant, or
advanced practice nurse practitioner when providing critical care
transportation.
006.10
PERSONNEL TRAINING STANDARDS. A licensee must provide
training every two years for its members that includes, but is not limited to,
the following areas:
(A) Emergency vehicle
driving for operators of ambulances or aircraft safety for operators of
aircraft;
(B) Infection control
standards;
(C) Procedures for
dealing with hazardous materials;
(D) Health Insurance Portability and
Accountability Act (HIPAA) Training;
(E) Personal safety issues; and
(F) Equipment used in the care of
patients.
006.11
PERSONNEL TRAINING DOCUMENTATION. Training must be
documented for each individual that participated in training provided by the
licensee. The documentation must be maintained by the service for five
years.
006.12
PHYSICIAN
MEDICAL DIRECTION STANDARDS. Every licensee must have a physician
medical director who meets the requirements and responsibilities in the
Emergency Medical Services Practice Act and this chapter.
006.12(A)
PHYSICIAN MEDICAL
DIRECTOR QUALIFICATIONS. A physician medical director must have
the following:
(i) Experience in, and
knowledge of, emergency care of acutely ill or traumatized patients;
(ii) Be familiar with the design and
operation of local, regional, and state emergency medical service
systems;
(iii) Obtain at least
three hours of category one continuing medical education within the subject
area of emergency medical services every twenty-four months; and
(iv) An advanced life support service
providing critical care services shall maintain a physician medical director
with specialty board certification in emergency medicine or a critical care
subspecialty.
006.12(B)
PHYSICIAN MEDICAL DIRECTOR RESPONSIBILITIES. A
physician medical director is responsible for:
(i) Notifying the Department of the name(s)
of licensed emergency medical services for which the individual is the
physician medical director;
(ii)
Notifying the Department immediately when responsibility as the physician
medical director for an emergency medical service is terminated and the date of
the termination;
(iii) Development
and approval of protocols and standing orders for the emergency medical
service;
(iv) Ensuring and
documenting the competency of each licensed emergency care provider to perform
skills used by the emergency medical service and documentation of any
limitations on the practice of any emergency care provider;
(v) Implementation of a medical quality
assurance program. The medical quality assurance program must include:
(1) An annual review of protocols and
standing orders;
(2) Documentation
of medical care audits as required by physician medical director; and
(3) Continuing medical education for the
emergency medical services personnel;
(vi) Ultimate authority and responsibility
for monitoring and for the overall supervision of the medical aspects of the
emergency medical service;
(vii)
Ensuring each written standing order and protocol is appropriate for the
licensure and skill level of each of the individuals to whom the performance of
medical acts is delegated and authorized; and
(viii) The oversight of the distribution,
storage, ownership and security of medications and controlled substances
utilized by the emergency medical service.
006.13
RECORDS MAINTENANCE
STANDARDS. Each licensee must maintain records as set out below:
006.13(A)
PERSONNEL
RECORDS. Current personnel files on each emergency care provider
must be maintained. All records must be maintained until superseded. Each file
must include the following:
(i) Name, address,
and telephone number;
(ii) Current
level of licensure; and
(iii)
Current cardiopulmonary resuscitation certification.
006.13(B)
AMBULANCE AND EQUIPMENT
RECORDS. A licensee must maintain records of vehicle and equipment
maintenance and repair for no less than five years.
