Current through Vol. 42, No. 1, September 16, 2024
(a) No
person, company, governmental entity or trust authority shall operate,
advertise, or hold themselves out as providing any type of emergency medical
service agency without first obtaining a certification or license to operate
from the Department. The Department shall have sole discretion to approve or
deny an application based on the ability of the applicant to meet the
requirements of the Act or this chapter of rules.
(b) Persons, companies and governmental
entities that respond to requests for service off private or governmental
property or premises are required to be certified or licensed by the
Department. Entities that limit the interventions and activities of their staff
members to first aid, CPR, and the use of an AED are not required to be a
certified Emergency Medical Response Agency.
(1) Governmental entities not certified or
licensed by the Department may be part of mutual aid and disaster
plans.
(2) Governmental entities
may transport patients of governmental entities off governmental property to
appropriate facilities.
(3)
Contractors for governmental entities that provide transport services shall be
licensed by the Department.
(c) Persons, companies, and governmental
entities which operate on their own premises, are exempt from certification and
licensing requirement.
(d) An
application for a certification or license shall be submitted on forms
prescribed and provided by the Department. Ground ambulance, air ambulance, an
emergency medical response agency, stretcher van and specialty care services
shall each be considered a separate license.
(1) Specialty care licenses are statutorily
limited to patient care and interventions above the Paramedic scope of
practice.
(2) Specialty Care
applicants will declare in the application the type or types of specialty care
and patients that will be transported by the agency. The types of specialty
care and patients may include, but not be limited to:
(A) adult, pediatric, infant, neonatal, or a
combination of age types,
(B)
cardiac care, respiratory, neurological, septicemia, or other single or
multi-system complications or illnesses requiring specialized treatment during
the transport of the patient.
(3) Ground ambulance services are required to
meet the duty to act requirements as described in 63 O.S. §
1-2504.1.
(e) The
application shall be signed under oath by the party or parties seeking to
secure the license.
(f) The party
or parties who sign the application shall be considered the owner or agent
(licensee), and responsible for compliance to the Act and this
chapter.
(g) All applications shall
contain, but not be limited to the following:
(1) a statement of ownership which shall
include the name, address, telephone number, occupation and/or other business
activities of all owners or agents who shall be responsible for the service;
(A) If the owner is a partnership or
corporation, a copy of incorporation documents and the name of all partner(s)
or stockholder(s) with an ownership interest of five (5%) percent or more
(principal), and the name and addresses of any other ambulance service in which
any partner or stockholder holds an interest shall also be included.
(B) If the owner is an entity of government,
governmental trust, trust authority, or non-profit corporation, the name of
each board member, or the chief administrative officer and/or chief operation
officer shall be included.
(C) A
business plan which includes a financial disclosure statement showing evidence
of the ability to sustain the operation for at least one (1) year.
(D) For purposes of unannounced inspections,
the days and times the business office is open.
(2) Agencies that use emergency vehicles as
defined in Title 47 O.S. Section 103 shall show proof of vehicle liability
insurance, at least in the amount of one million dollars ($1,000,000.00) or to
the amount provided for in "The Governmental Tort Claims Act", Title 51 O.S.
Section
151 et
seq. This insurance requirement shall remain in effect at all times while the
service is licensed. Air ambulances are to maintain aircraft liability
insurance as required within Federal regulation.
(3) Proof of professional liability
insurance, at least in the amount of one million dollars ($1,000,000) or to the
amount provided for in "The Governmental Tort Claims Act," Title 51 O.S.
Section
151 et
seq. This insurance requirement shall remain in effect at all times while the
service is licensed;
(4) Proof of
participation in a workers' compensation insurance program for employees who
are subject to pertinent labor laws. This insurance requirement shall remain in
effect at all times while the service is licensed;
(h) Ground Ambulance Services, Air
Ambulances, Emergency Medical Response Agencies, and Specialty Care agencies
shall have medical control as prescribed by the Act and these rules and submit
with the application:
(1) a letter of
agreement from the physician to provide medical direction and establish the
protocols and the scope of practice provided at the service;
(2) the physicians primary practice address
or home address if the physician does not have a practice and email
address;
(3) For agencies providing
care within the Intermediate, Advanced EMT, and Paramedic scope of practice,
submit an Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD) registrant
certification or number;
(4) a
current Oklahoma medical license; and
(5) a curriculum vitae,
(i) a copy of any contract(s) for vehicles,
medical equipment, and/or personnel, if such exist;
(j) Ground Ambulance Services, Air
Ambulances, Emergency Medical Response Agencies, and Specialty Care agencies
shall submit a copy of patient care protocols and quality assurance plan or
policy as required by the medical director and as prescribed by the Act and
this chapter;
(1) The Department may require
quality assurance documentation for review and shall protect the
confidentiality of that information.
(2) The quality assurance documentation shall
be maintained by the agency for three (3) years.
(3) The quality assurance policy shall
include, but not be limited to:
(A)
refusals,
(B) air ambulance
utilization,
(C) airway
management,
(D) cardiac arrest
interventions,
(E) time sensitive
medical and trauma cases,
(F) other
selected patient care reports not specifically included, and
(G) how to provide internal and external
feedback of findings determined through reviews. Documentation of the feedback
will be maintained as part of the quality assurance documentation
(H) treatment protocols that expand beyond
the published state protocols;
(k) Ground ambulance service and Pre-hospital
emergency medical response agency applications are required to submit
documentation that supports agency licensure from the governmental authority
(ies) having jurisdiction over the proposed emergency response area. If the
emergency response area encompasses multiple jurisdictions, a written
endorsement shall be presented from each. The ground ambulance and prehospital
emergency medical response agency application shall contain from each
endorsement the following;
(1) a map and
written description of the endorsed or approved response area,
(2) name(s) and title(s) of the person(s)
providing approval,
(3) any
expiration date,
(4) name of the
service receiving the endorsement.
(5) Ground ambulance service supporting
documentation will be consistent with the County EMS plan as required in 19
O.S. Section 1-1203.
(l)
Pre-hospital emergency medical response agency applications shall include a
letter of support or agreement from a licensed ambulance service within the
proposed emergency medical response service area that includes:
(1) support of the application,
(2) support of the medical control physician
choice, and
(3) plans or policies
for supporting or participating in quality assurance activities.
(4) If an applicant is unable to provide a
letter of support from a licensed ambulance service within their proposed
response area, the applicant can request an exemption. The Department has the
discretion to approve or deny the exemption request.
(m) Event standby emergency response agency
applications will include the following restrictions and requirements:
(1) if the applicant is providing care to the
public on public property, then letters of governmental support and documents
verifying coordination with local ambulance services are required for that
agency to have the authority to provide care at that setting.
(2) if the agency is providing care to the
public in a business or establishment open to the public on private property,
then letters of governmental support are not required.
(3) At all times, the standby event emergency
medical response agency shall coordinate with other licensed and certified EMS
agencies responsible for the event location when the event is within a licensed
ambulance service area or approved area for prehospital emergency medical
response agencies.
(n)
All emergency medical response agencies are prohibited from transporting
patients
(o) Stretcher Van service
applications will include the following restrictions and requirements:
(1) Stretcher Vans are prohibited from
carrying medications other than oxygen and those other medications which are
passenger supplied and administered. The passenger must have a current
physician prescription and/or order for the administration of oxygen. A copy of
the order shall be maintained in agency files.
(2) Stretcher van applications will include a
quality assurance process or policy that includes:
(A) The Department may require quality
assurance documentation for review and shall protect the confidentiality of
that information.
(B) The quality
assurance documentation shall be maintained by the agency for three (3)
years.
(C) Any passenger condition
where the passenger entered the 911 system,
(D) If oxygen is continued, the physician
order must be maintained with the trip report or passenger report;
(E) a review other selected passenger reports
not specifically included, and
(F)
process to provide internal and external feedback of findings determined
through reviews. Documentation of the feedback will be maintained as part of
the quality assurance documentation.
(p) Stretcher Van Services are to submit the
following with their application:
(1) A map
or narrative description which identifies the proposed service area;
(2) evidence that the proposed service area
is an emergency medical service region, ambulance district, or county with a
population in excess of five hundred thousand (500,000)
people;
(q) Ground
ambulance services will include a description of the proposed level of service
in the proposed licensed service area, including:
(1) a map defining the whole licensed service
area including location(s) of base station, substations, and posts;
(2) a description of the level of care to be
provided;
(r) Ground
Services, Air Ambulances, and prehospital emergency medical response agencies
shall submit a communication policy addressing:
(1) receiving and dispatching emergency and
non-emergency calls;
(2) ensuring
compliance with State and local EMS communication plans.
(s) Specialty Care Services and Stretcher Van
services shall submit communication policy addressing the screening process
that ensures a request for service will meet the agency's capability, capacity,
and licensure requirements. Documentation of the screening will be retained as
part of the patient care report or call log.
(t) a response plan that includes:
(1) providing and receiving mutual aid with
all surrounding, contiguous, or overlapping, licensed service areas,
(2) providing for and receiving disaster
assistance in accordance with local and regional plans and command structures
such as an incident command structure using national incident management
support models.
(u)
confidentiality policy ensuring confidentiality of all documents and
communications regarding protected patient health information.
(v) For an initial or new ground ambulance
service, air ambulance service, specialty care, and stretcher van service
license application, shall be accompanied by a non-refundable fee of six
hundred ($600.00) dollars plus twenty ($20.00) dollars for each vehicle, in
excess of two (2) vehicles utilized for patient transport. An additional fee of
one hundred fifty ($150.00) dollars shall be included for each ambulance
substation in addition to the base station. An Emergency Medical Response
Agency Application shall be accompanied by a non-refundable fee of fifty
($50.00) dollars.
(w) All
applicants except air ambulance services are required to show documentation of
compliance with any "Sole Source" Ordinance or Resolution. If an area of
Oklahoma is being served by a licensed ambulance service, or services, and the
area has adopted "sole source" resolutions or ordinances or an Emergency
Services District as established pursuant to Article 10, Section 9 (c) of the
Oklahoma Constitution, the Department shall require the approval of the
community (ies) and/or the emergency medical services authority of that service
area, before an additional ambulance service shall be licensed for that same
service area.
(x) For all license
applications, a business plan which includes a financial disclosure statement
showing evidence of the ability to sustain the operation for at least one (1)
year is required to be submitted with the application.
