202 KAR 7:555 - Ground agencies
RELATES TO: KRS 311A.030, 311A.190, 29 C.F.R. 1910.1030
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
311A.020 requires the Board of
Section 1. Utilization of Ground Vehicles by
Class I, II, III, and IV Licensed Agencies.
(1) At the time of initial inspection, each
agency shall inform the Kentucky Board of Emergency Medical Services (KBEMS )
office of the make, model, year, vehicle identification number or serial
number, and license tag number for each vehicle the agency plans to use for
medical care and transportation.
(2) A vehicle shall not be placed into
operation until the board has conducted a physical inspection of the vehicle
and determined it meets the requirements of 202 KAR Chapter 7.
(3) Each agency shall complete a Vehicle
Delete application in the Kentucky Emergency Medical Services Information
System (KEMSIS), no later than the next business day after the permanent
removal of any licensed vehicle from service by the license holder.
(4)
(a) A
licensed agency may use a replacement vehicle that meets all of the
requirements of 202 KAR Chapter 7 on a temporary basis while a permitted
vehicle is out of service. The agency shall complete an Add TEMPORARY
Vehicle/Aircraft Part 1 application in KEMSIS within twenty-four (24) hours of
the replacement.
(b) A temporary
replacement vehicle shall not be used for more than thirty (30) days annually
unless the KBEMS office has verified, through a physical inspection, that it
meets the requirements of 202 KAR Chapter 7.
(5) The KBEMS office shall be notified by a
completed Add TEMPORARY Vehicle/Aircraft Part 2 application in KEMSIS within
twenty-four (24) hours or on the next business day if a temporary vehicle is
removed from service and the original licensed vehicle is returned to
service.
(6)
(a) An agency that fails to report using a
temporary vehicle shall be required to immediately cease use of the replacement
vehicle until the reporting requirements are met.
(b) An agency that fails to remove a
temporary vehicle from service after thirty (30) days shall be fined $500 for
each day or partial day the vehicle is in service and not reported.
(7) This administrative regulation
shall not prevent a licensed agency from utilizing other means of transporting
patients in:
(a) Disasters;
(b) Mass casualty incidents; or
(c) Extraordinary scene conditions that would
impair access to the safety or care of the patient or personnel operating at
the scene.
Section
2. Provider Management Requirements.
(1) All licensed agencies shall maintain:
(a) An organizational chart that establishes
lines of authority, including the designation of:
1. An administrator responsible for assuring
compliance with KRS Chapter 311A and 202 KAR Chapter 7 during the daily
operation of the service; and
2. A
designee who shall serve in the absence of the administrator;
(b) Records and reports at the
ambulance agency base station including:
1. An
original, electronic equivalent, or copy of all patient care records consistent
with the U.S. Department of Transportation National Highway Traffic Safety
Administration (NHTSA) National Emergency Medical Services Information System
(NEMSIS) data dictionary found at
www.nemsis.org/technical-resources/version-3;
2. An electronic copy of all completed
patient care reports, which shall be maintained to ensure confidentiality and
safekeeping for at least seven (7) years from the date on which the service was
rendered, or in the case of a minor, at least three (3) years after the minor
reaches the age of majority; and
3.
Copies of Patient Care Reports for the preceding twelve (12) months, which
shall be accessible and be immediately available to the board, KBEMS office , or
representatives upon request;
(c) Personnel files for each employee or
volunteer who staffs a vehicle of a licensed agency. Personnel files shall be
maintained for at least one (1) year following separation from employment. As a
minimum, all personnel files shall contain:
1.
A pre-employment and annual criminal background check administered by the
Kentucky Administrative Office of the Courts;
2. A copy of the employee's valid KBEMS
certification or licensure card; and
3. A copy of each employee's completion of
the National Incident Management System (NIMS) Incident Command System (ICS)
100, 200, 700, and 800 courses;
(d) A policy for the provision of a
pre-employment and annual health assessment of employees of the agency, which
shall include reporting mechanisms for work-related illness or
injury;
(e) A written plan for
providers to consult with online adult and pediatric medical direction. This
plan shall address as a minimum:
1. The
availability of medical direction twenty-four (24) hours a day, seven (7) days
a week;
2. The availability of
medical direction during an emergency event;
3. The provision of medical direction by a
medical professional with a higher level of training or expertise;
and
4. Recommended actions if:
a. There is an equipment failure, a
communication barrier, or other unusual circumstance; and
b. It is not possible to contact online
medical direction
(f) A plan and records for the provision of
continuing education for staff and volunteers, including:
1. A written plan for the method of
assessment of staff continuing education needs; and
2. A coordinated plan to meet those needs,
including a provision that all continuing education shall be provided either by
a licensed TEI or in accordance with
202 KAR
7:601;
(g) An infection control plan in accordance
with 29 C.F.R.
1910.1030;
(h) A written plan for training or educating
personnel for responding to hazardous materials, criminal, and potential
terrorist incidents, including plans for the protection and decontamination of
patients, ambulances, equipment, and staff;
(i) A written policy regarding the
appropriate destination of a patient who expires during transport if a valid
Kentucky EMS Do Not Resuscitate (DNR), or Medical Orders for Scope of Treatment
(MOST) form is present;
(j) A
written plan for the quality assessment of patient care and provider quality
improvement, including a monthly review of patient care reports and evaluation
of staff performance related to patient care. This plan shall address as a
minimum:
1. Employee health and
safety;
2. Compliance with
protocols and operating procedures;
3. Assessment of dispatch
protocols;
4. Vehicle operations
and vehicle safety;
5. Additional
training necessary for the patient care provider or providers;
6. Equipment preventive maintenance programs;
and
7. A process for the resolution
of customer complaints;
(k) A written plan for training personnel and
responding to mass casualty incidents and disasters;
(l) A written orientation program for all
personnel, including at a minimum:
1.
Validation of certification or license with KBEMS ;
2. Validation of the National Incident
Management System (NIMS) Incident Command System (ICS) 100, 200, 700, and 800
courses within sixty (60) days of employment for any employee who staffs a
licensed vehicle;
3. Validation of
Driver's License if applicable;
4.
A review of all agency policies, procedures, and protocols;
5. Communication equipment at the base
station and on each vehicle;
6.
Operational aspects of the agency fleet and equipment;
7. Inspection and routine maintenance of
agency fleet, facilities, and equipment;
8. Appropriate processes for disinfection of
agency fleet, facilities, and equipment;
9. Local navigation and geographic
orientation; and
10. Completion of
Patient Care Reports and other documentation as established by the
agency;
(m) Proof of
professional liability malpractice insurance of a minimum of $1,000,000;
and
(n) Proof of vehicular
liability insurance.
(2)
Each agency shall notify the board at least twenty-four (24) hours prior to the
transfer of coverage, cancellation, lapse, or other cessation or change in
professional liability malpractice insurance or vehicular liability
insurance.
(3) Each agency shall
verify valid staff certification or licensure as of the first day of the
calendar year.
(4) If ceasing to
operate, an agency shall provide the board with the physical storage location
of all Patient Care Reports within five (5) business days of closure. These
reports shall be maintained by the owner of the licensed agency, or a
contracted third party to meet the timeline established in subsection (1)(b) of
this section.
(5) Each agency that
allows an employed emergency responder to provide medical services while off
duty in accordance with
202 KAR 7:701, Section 6, shall
maintain and implement a policy regarding which employees are approved to
provide medical services off duty by the agency's medical director and the
manner in which worker's compensation and general liability insurance covers
employees off duty. The policy shall be signed by both the agency's
administrator and medical director , shall be reviewed annually, and shall
include:
(a) Direction on which employees may
remove medical equipment from the agency's premises for the purpose of
providing care off duty;
(b)
Direction on which equipment may be removed from the agency's premises for the
purpose of providing care off duty; and
(c) A provision that controlled substances
shall not be removed from the agency's premises for the purposes of providing
care off duty.
(6) Each
agency shall in the county in which the agency's base station or a satellite is
located:
(a) Document evidence of
participation in a local, county, regional, or state disaster or preparedness
exercise within the preceding twelve (12) months;
(b) Coordinate with the county emergency
management director plans for the possible use of agency personnel for use in
the emergency operations center in a disaster; and
(c) Maintain a hard copy or electronic
equivalent of the most current adopted city, county, or urban county government
emergency management agency's emergency operations plan at the ambulance base
station .
Section
3. Operating Requirements.
(1)
Each licensed agency, except Class IV and VIII, shall provide service
twenty-four (24) hours a day, seven (7) days a week. Class IV and VIII agencies
shall operate during the hours of operation for their geographical service area
or designated event.
(2) Each
licensed agency shall retain staffing schedules for at least the previous
twelve (12) months.
(3) Each agency
administrator or designee shall be familiar with emergency management reporting
and procurement processes and software platforms utilized to communicate the
needs of the local government to state agencies.
(4) A licensed agency shall have a written
plan to assure all requests for service shall be promptly answered.
(5) A licensed agency shall have a written
scope of care policy to include the types of services performed, limitations of
response, and the types of medical teams provided.
(6) Any agency licensed and located within
the geographical service area that determines it is unable to have a vehicle
responding within ten (10) minutes from the initial time an emergency call is
received shall request that the next closest appropriate licensed agency
respond.
(7) If an agency licensed
for a specific geographical service area is unable to respond to a
non-emergency call within two (2) hours from the initial time a non-emergency
call is received, the requesting healthcare facility may contact any licensed
agency and request that the agency conduct the transport.
(8) An agency shall enter into a mutual aid
agreement with another Kentucky licensed ambulance agency operating within the
same or contiguous counties that provide response to medical emergencies. These
agreements shall be in writing and address:
(a) The type of mutual aid assistance to be
provided, including advanced life support (ALS) or basic life support (BLS)
medical care and transport and ALS or BLS medical first response;
(b) Response personnel, including levels of
training or education and provisions for joint in-service training or education
if appropriate;
(c) Response
vehicles, including unit identifiers and the station or location from which the
vehicles shall be operated;
(d) A
plan of action for the mutual aid agreement , including dispatch and
notification procedures;
(e) Radio
and other communications procedures between the ambulance agency and other
response agencies with which the agency has mutual aid agreements;
(f) On-scene coordination and scene control
including medical direction if several agencies respond to the same
incident;
(g) Exchange of patient
information, records, and reports as allowed by law; and
(h) The effective dates and process for
amendment or termination.
(9) A ground agency shall send a written
request for a mutual aid agreement to at least two (2) contiguous counties and
retain a copy of each request and each county's response;
(10) Each agency shall maintain a policy or
affiliation agreement with the primary call-taking center that provides
dispatch services for all or part of the service area of the ground agency. The
agreement shall state at a minimum that:
(a)
Requests for emergency ambulance service shall be dispatched or notified within
two (2) minutes from determining that the caller is requesting ambulance
response;
(b) If the closest
licensed agency for that geographic service area is unable to have a vehicle
responding to an emergency call within ten (10) minutes from the time the call
is dispatched, the agency shall notify the next closest appropriate licensed
agency to respond; and
(c) The
agreement shall specify which patient information shall be collected by the
call-taking center during a call for service.
(11) If a ground agency is unable to secure a
written affiliation agreement with the dispatch center , the ground agency shall
retain all written correspondence to the dispatch center requesting an
affiliation agreement and the dispatch center 's denial of the agency's
request.
(12) An agency shall not
respond to requests for emergency service outside of its licensed geographic
service area without first receiving authorization from the licensed agency in
the geographic service area in which the request originates.
(13) A licensed Class I ground agency that is
located in a geographical service area containing multiple destination
hospitals, with regard to the furnishing of 911 response and transportation,
shall not engage in:
(a) Exclusive or coercive
practices regarding transportation decisions with regard to any affiliated
hospital or hospital emergency department;
(b) Preferential transportation to any
affiliated hospital emergency department if the transports are not justified by
time, place, patient convenience, or other objective factors affecting a
patient;
(c) Noncompetitive
transportation to any affiliated hospital emergency department; or
(d) Transports to any affiliated hospital
emergency department if that hospital is not the closest to the patient
location or most appropriate based on the availability of particular services
or patient preference.
(14) Each licensed Class I ground agency
shall schedule a minimum of one (1) staffed ambulance to be staged in the
agency's geographic service area.
(15) An agency that cannot meet the timelines
established in subsection (10) of this section shall contact another licensed
agency and receive an estimated time of arrival to the request for service. If
the mutual aid agency can arrive at the location where the request originated
more quickly than the agency licensed for the geographic service area, the
agency licensed for the geographic service area shall request mutual aid from
its neighboring agency to respond to the call.
(16) An agency shall not refuse a request for
emergency pre-hospital response if a unit is available in its geographic
service area.
(17) An agency shall
not exhaust its resources by answering a nonemergency call or for response to
mutual aid requests.
(18) This
administrative regulation shall not be construed to prevent a licensed agency
from providing medical first response emergency or nonemergency pre-hospital
care at or below the level for which the agency is licensed through the use of
designated agency-owned response vehicles.
(19) A communications system shall be
developed, coordinated, and maintained by each licensed agency. The
communication system shall comply with paragraphs (a) through (f) of this
subsection.
(a) Radio equipment used in
emergency medical services vehicles shall be appropriately licensed through the
Federal Communications Commission (FCC). Copies of the current FCC licenses
shall be on file in the agency office.
(b) Each ambulance shall have an operational
push-to-talk two-way radio programmed with all very high frequency (VHF)
Kentucky State Mutual Aid Frequencies in accordance with the Commonwealth of
Kentucky Field Operations Guide (KY-FOG).
(c) Each ambulance shall be equipped with a
minimum of one (1) mobile two-way radio located in the driver's
compartment.
(d) Each ambulance
shall have a minimum of two (2) portable push-to-talk two-way radios capable,
under normal conditions, of operating on the agency, dispatch center , mutual
aid, and hospital frequencies.
(e)
Each ambulance shall be equipped with two-way radio communication equipment
with the ability to communicate from the driver's compartment and patient care
compartment.
(f) One (1)
alternative method of two-way communication may be substituted for one (1)
portable two-way radio.
Section 4. Ceasing Continuous Service.
(1) A licensed Class I, II, III, VI, or VII
agency that ceases to provide continuous service on a twenty-four (24) hour
basis shall surrender its license to the board office within twenty-four (24)
hours of the agency ceasing to provide continuous service.
(2) The agency's chief operations or service
director shall immediately contact the executive director of the board upon
determining that his or her Class I, II, III, VI, or VII agency will cease
providing continuous service, and shall provide the approximate date and time
that the agency will cease continuous service.
(3) The agency's chief operations or service
director shall immediately contact the executive director of the board upon
determining that his or her Class I, II, III, VI, or VII agency has ceased
providing continuous service, and shall provide the date and time that the
agency ceased continuous service.
(4) Notwithstanding subsection (1) of this
section and Section 3(1) of this administrative regulation, a Class I, II, III,
VI, or VII agency shall resume continuous service no later than seventy-two
(72) hours after ceasing continuous service if the executive director of the
board determines, in writing, that:
(a)
Circumstances beyond the agency's control exist which justify the agency's
temporary lapse in continuous service; and
(b) Public health, safety, and welfare will
be better served by allowing the agency to resume continuous service within
seventy-two (72) hours after ceasing continuous service.
(5) A licensed Class I, II, III, VI, or VII
agency that ceases continuous service shall be deemed to pose a threat to the
public and the agency's license shall be temporarily suspended in accordance
with KRS
311A.075 if:
(a) The agency fails to surrender its license
in accordance with subsection (1) of this section; and
(b) The executive director of the board does
not make the determinations set forth in subsection (4)(a) and (b) of this
section; or
(c) The executive
director of the board makes the determinations set forth in subsection (4)(a)
and (b) of this section, but the agency fails to resume continuous service
within seventy-two (72) hours after ceasing continuous service and fails to
surrender its license to the board office within seventy-two (72) hours after
ceasing continuous service.
Section 5. Issuance of Temporary Class I
Hardship Licenses to Counties.
(1) The board
office shall issue a temporary Class I hardship license to the county or
counties listed as the geographic service area on a Class I license that:
(a) Is the only Class I license for the
geographic service area; and
(b) Is
surrendered in accordance with Section 4(1) of this administrative regulation;
or
(c) Is temporarily suspended in
accordance with Section 4 of this administrative regulation and
KRS
311A.075.
(2) A temporary hardship license shall not be
transferrable.
(3) A county issued
a temporary hardship license may contract with a licensed Class I agency to
provide service to the geographic service area listed on the temporary hardship
license.
(4) Notwithstanding
Sections 3(1) and 4(1) of this administrative regulation, a county issued a
temporary hardship license shall begin providing continuous service no later
than 120 days after the license is issued.
(5) Notwithstanding any other administrative
regulation promulgated by the board, for up to and not exceeding 120 days after
a temporary hardship license is issued to a county under this section, the
county may request that any licensed Class I agency respond to a call for
service in the geographic service area listed on the temporary hardship
license.
(6) A temporary hardship
license shall expire one (1) year after the license is issued, after a new
Class I license for the geographic service area is issued, or, if the Class I
license for the geographic service area was temporarily suspended in accordance
with Section 4 of this administrative regulation, after that license is
reinstated, whichever occurs first.
Section 6. Medical Directors.
(1) Each licensed agency shall have a medical
director who meets the requirements established in
202 KAR 7:801.
(2) A licensed agency shall notify KBEMS
within twenty-four (24) hours of a decision to discontinue a medical director
agreement by either the agency or the medical director .
(3)
(a) If
an agency is found to be operating without a medical director , the agency shall
be provided emergency medical direction by the KBEMS Medical Advisor for a fee
of $100 per day for the first thirty (30) calendar days the agency is without a
medical director .
(b) The fee shall
increase to $500 per day after thirty (30) calendar
days.
Section
7. Public Notice of Negative Action. The board office shall cause
to be published, on the KBEMS web site or similar publication of the board, the
name of any licensed agency that is fined, placed on probationary status,
placed on restricted status, suspended, or had a license revoked.
Section 8. Incorporation by Reference.
(1) The following material is incorporated by
reference:
(a) "Commonwealth of Kentucky Field
Operations Guide (KY-FOG)", (6/2012) found at
https://kwiec.ky.gov/SiteCollectionDocuments/KYFOG.pdf.;
(b) "NHTSA NEMSIS Data Dictionary", (v3.40)
U.S. Department of Transportation National Highway Traffic Safety
Administration (NHTSA) National Emergency Medical Services Information System
(NEMSIS) data dictionary found at
https://www.nemsis.org/media/nemsis_v3/3.4.0.150302/DataDictionary/PDFHTML/DEMEMS/NEMSISDataDictionary.pdf;
(c) "Vehicle Delete application in KEMSIS",
(12/2019);
(d) "Add TEMPORARY
Vehicle/Aircraft application Part 1 in KEMSIS", (12/2019); and
(e) "Add TEMPORARY Vehicle/Aircraft
application Part 2 in KEMSIS", (12/2019).
(2) This material may be inspected, copied,
or obtained, subject to applicable copyright law, at the Office of the Kentucky
Board of Emergency Medical Services, 500 Mero Street, 5th Floor 5SE32,
Frankfort, Kentucky 40601, Monday through Friday, 8 a.m. to 4:30 p.m.
(3) This material is also available on the
board's Web site at: kyems.com.
Notes
STATUTORY AUTHORITY: KRS 311A.020, 311A.025, 311A.030, 311A.190
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