Ariz. Admin. Code § R9-25-705 - Minimum Standards for Operations as an Air Ambulance Service (Authorized by A.R.S. Sections 36-2202(A)(3) and (4), 36-2209 (A)(2), and 36-2213)

A. A licensee shall ensure that the air ambulance service:

1. Maintains eligibility for licensure as required under R9-25-703(C);

2. Makes a good faith effort to communicate information about its hours of operation to the general public through print media, broadcast media, the Internet, or other means;

3. Makes the air ambulance service's schedule of rates available to any individual upon request and, if requested, in writing;

4. Provides an accurate estimated time of arrival to the person requesting transport at the time that transport is requested and provides an amended estimated time of arrival to the person requesting transport if the estimated time of arrival changes;

5. Except as provided in subsection (B), only transports patients for whom the air ambulance service has the resources to provide appropriate medical care;

6. Does not perform interfacility transport of a patient unless:

a. The transport is initiated by the sending health care institution, and

b. The destination health care institution confirms that a bed is available for the patient;

7. Ensures that the protocol for the transfer of information to be communicated to emergency receiving facility staff concurrent with the transfer of care, required in R9-25-201(E)(2)(d)(i), includes:

a. The date and time the call requesting service was received by the air ambulance service;

b. The unique number used by the air ambulance service to identify the mission;

c. The name of the air ambulance service;

d. The number or other identifier of the air ambulance used for the mission;

e. The following information about the patient:

i. The patient's name;

ii. The patient's date of birth or age, as available;

iii. The principal reason for requesting services for the patient;

iv. The patient's medical history, including any chronic medical illnesses, known allergies to medications, and medications currently being taken by the patient;

v. The patient's level of consciousness at initial contact and when reassessed;

vi. The patient's pulse rate, respiratory rate, oxygen saturation, and systolic blood pressure at initial contact and when reassessed;

vii. The results of an electrocardiograph, if available;

viii. The patient's glucose level at initial contact and when reassessed, if applicable;

ix. The patient's level of responsiveness score, as applicable, at initial contact and when reassessed;

x. The results of the patient's neurological assessment, if applicable; and

xi. The patient's pain level at initial contact and when reassessed; and

f. Any procedures or other treatment provided to the patient at the scene or during transport, including any agents administered to the patient;

8. Creates a prehospital incident history report, in a Department-provided format, for each patient that includes the following information:

a. The name and identification number of the air ambulance service;

b. Information about the software for the storage and submission of the prehospital incident history report;

c. The unique number assigned to the mission;

d. The unique number assigned to the patient;

e. Information about the response to the call requesting service, including:

i. The mission level requested;

ii. Information obtained by the person providing direction for response to the request;

iii. Information about the air ambulance assigned to the mission;

iv. Information about the medical team responding to the call requesting service;

v. The priority assigned to the response; and

vi. Response delays, as applicable;

f. Whether patient care was transferred from another EMS provider or ambulance service and, if so, identification of the EMS provider or ambulance service;

g. The date and time that:

i. The call requesting service was received;

ii. The request was received by the person coordinating transport;

iii. The air ambulance service received the transport request;

iv. The air ambulance left for the patient's location;

v. The air ambulance arrived at the patient's location;

vi. The medical team in the air ambulance arrived at the patient's side;

vii. Transfer of the patient's care occurred at a location other than the destination, if applicable;

viii. The air ambulance departed the patient's location;

ix. The air ambulance arrived at the destination;

x. Transfer of the patient's care occurred at the destination;

xi. The air ambulance was available to take another mission;

h. Information about the patient, including:

i. The patient's first and last name;

ii. The address of the patient's residence;

iii. The county of the patient's residence;

iv. The country of the patient's residence;

v. The patient's gender, race, ethnicity, and age;

vi. The patient's estimated weight;

vii. The patient's date of birth; and

viii. If the patient has an alternate residence, the address of the alternate residence;

i. The primary method of payment for services and anticipated level of payment;

j. Information about the scene, including:

i. Specific information about the location of the scene;

ii. Whether the air ambulance was first on the scene;

iii. The number of patients at the scene;

iv. Whether the scene was the location of a mass casualty incident; and

v. If the scene was the location of a mass casualty incident, triage information;

k. Information about the reason for requesting service for the patient, including:

i. The date and time of onset of symptoms and when the patient was last well;

ii. Information about the complaint;

iii. The patient's symptoms;

iv. The results of the medical team's initial assessment of the patient;

v. If the patient was injured, information about the injury and the cause of the injury;

vi. If the patient experienced a cardiac arrest, information about the etiology of the cardiac arrest and subsequent treatment provided; and

vii. For an interfacility transport, the reason for the transport;

l. Information about any specific barriers to providing care to the patient;

m. Information about the patient's medical history, including;

i. Known allergies to medications,

ii. Surgical history,

iii. Current medications, and

iv. Alcohol or drug use;

n. Information about the patient's current medical condition, including the information in subsections (A)(7)(e)(v) through (xi) and the time and method of assessment;

o. Information about agents administered to the patient, including the dose and route of administration, time of administration, and the patient's response to the agent;

p. If not specifically included under subsection (A)(8)(k), (m)(iv), (n), or (o), the information required in A.A.C. R9-4-602(A);

q. Information about any procedures performed on the patient and the patient's response to the procedure;

r. Whether the patient was transported and, if so, information about the transport;

s. Information about the destination of the transport, including the reason for choosing the destination;

t. Whether patient care was transferred to another EMS provider or ambulance service and, if so, identification of the EMS provider or ambulance service;

u. Unless patient care was transferred to another EMS provider or ambulance service, information about:

i. Whether the destination facility was notified that the patient being transported has a time-sensitive condition and the time of notification;

ii. The disposition of the patient at the destination; and

iii. The disposition of the mission;

v. Any other narrative information about the patient, care receive by the patient, or transport; and

w. The name and certification level of the medical team member providing the information;

9. Creates a record for each mission that includes:

a. Mission date;

b. Mission level;

c. Mission type;

d. Staffing of the mission;

e. Aircraft type'fixed-wing aircraft or rotor-wing aircraft;

f. Name of the person requesting the transport;

g. Time of receipt of the transport request;

h. The estimated time of arrival, as provided according to subsection (A)(4);

i. Departure time to the patient's location;

j. Address of the patient's location;

k. Arrival time at the patient's location;

l. Departure time to the destination health care institution;

m. Name and address of the destination health care institution;

n. Arrival time at the destination health care institution;

o. Either the:

i. Unique reference number used by the air ambulance service to identify the patient, or

ii. Unique call number used by the air ambulance service to identify the specific mission; and

p. Aircraft tail number for the air ambulance used on the mission;

10. Establishes, documents, and, if necessary, implements a plan to address and minimize potential issues of patient health and safety due to the air ambulance service terminating operations at a physical address used for the air ambulance service that:

a. Is developed in conjunction with hospitals near the physical address used for the air ambulance service and other persons who may be adversely affected by the air ambulance service terminating operations;

b. Includes notification by the air ambulance service of the persons in subsection (A)(10)(a) of the intent to terminate operations, at least 30 calendar days before the termination of operations; and

c. Includes temporary measures that will be used until alternate methods may be arranged for patient transport that address patient health and safety;

11. Establishes, documents, and implements a quality improvement program, as specified in policies and procedures, through which:

a. Data related to initial patient assessment, patient care, transport services provided, and patient status upon arrival at the destination are:

i. Collected continuously;

ii. For the information required in subsection (A)(8), submitted to the Department, in a Department-provided format and within 48 hours after the date of a mission, for quality improvement purposes; and

iii. If the air ambulance service is notified that the submission of information to the Department according to subsection (A)(11)(a)(ii) was unsuccessful, corrected and resubmitted within seven days after notification;

b. Continuous quality improvement processes are developed to identify, document, and evaluate issues related to the provision of services, including:

i. Care provided to patients with time-sensitive conditions;

ii. Transport or documentation, and

iii. Patient status upon arrival at the destination;

c. A committee consisting of the administrative medical director, the individual managing the air ambulance service or desig-nee, and other employees as appropriate:

i. Review the data in subsection (A)(11)(a) and any issues identified in subsection (A)(11)(b) on at least a quarterly basis; and

ii. Implement activities to improve performance when deviations in patient care, transport, or documentation are identified; and

d. The activities in subsection (A)(11)(c) are documented, consistent with A.R.S. §§ 36-2401, 36-2402, and 36-2403; and 12. Beginning within 12 months after the effective date of this Section, establish and maintain a method to electronically document patient information and treatment that is capable of being transferred.

B. An air ambulance service may transport a patient for whom the air ambulance does not have the resources to provide appropriate medical care:

1. In a rescue situation in which:

a. An individual's life, limb, or health is imminently threatened;

b. The threat may be reduced or eliminated by removing the individual from the situation to a location in which medical services may be provided; and

c. There is no other practical means of transport, including another air ambulance service, available; or

2. For an interfacility transport of a patient if:

a. The sending health care institution provides medically appropriate life support measures, staff, and equipment to sustain the patient during the interfacility transport; and

b. Each staff member provided by the sending health care institution has completed training in the subject areas listed in R9-25-707(A) before participating in the interfacility transport.

C. If an air ambulance service completes a mission under subsection (B) for which the air ambulance service does not have the resources to provide appropriate medical care, the licensee shall ensure that the air ambulance service creates a record within five working days after the mission, including:

1. The information required under subsection (A)(8),

2. The manner in which the air ambulance service deviated from subsection (A)(5), and

3. The justification for operating under subsection (B).

D. If an air ambulance service uses a single-member medical team as authorized under R9-25-706(B) and (C), the licensee shall ensure that the air ambulance service creates a record within five working days after the mission, including:

1. The information required under subsection (A)(9),

2. The name and qualifications of the individual comprising the single-member medical team, and

3. The justification for using a single-member medical team.

E. If an air ambulance service completes a critical care interfacility transport mission under conditions permitted in R9-25-802(F), the licensee shall ensure that the air ambulance service creates a record within five working days after the mission, including:

1. The information required under subsection (A)(9),

2. A description of the life-support equipment used on the mission,

3. A list of the equipment and supplies required in R9-25-802(C) that were removed from the air ambulance for the mission, and

4. The justification for conducting the mission as permitted under R9-25-802(F).

F. A licensee shall ensure that an individual does not serve on the medical team for an interfacility maternal transport unless the air ambulance service's medical director has verified and attested in writing to the individual's having the proficiencies described in R9-25-706(A)(2).

G. A licensee shall ensure that an individual does not serve on the medical team for an interfacility neonatal transport unless the air ambulance service's medical director has verified and attested in writing to the individual's having the proficiencies described in R9-25-706(A)(3).

H. A licensee shall ensure that the air ambulance service:

1. Retains each document required to be created or maintained under this Article or Article 2 or 8 of this Chapter for at least three years after the last event recorded in the document, and

2. Produces each document for Department review upon request.

I. A licensee shall ensure that, while on a mission, two-way voice communication is available:

1. Between and among personnel on the air ambulance, including the pilot; and

2. Between personnel on the air ambulance and the following persons on the ground:

a. Personnel;

b. Physicians providing on-line medical direction or on-line medical guidance to medical team members; and

c. For a rotor-wing air ambulance mission:

i. Emergency medical services providers, and

ii. Law enforcement agencies.

Notes

Ariz. Admin. Code § R9-25-705

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1). Renumbered from R9-25-710 and amended by final rulemaking at 28 A.A.R. 842, effective 6/5/2022. Amended by final expedited rulemaking at 29 A.A.R. 1461, effective 6/6/2023.