N.M. Admin. Code § 7.27.5.19 - APPLICATION FOR AIR AMBULANCE CERTIFICATION

All applications for certification as an air ambulance shall contain the following:

A. service name;

B. ownership structure: sole proprietor, partnership, corporation, etc.;

C. service mailing address;

D. physical location of facilities: use additional sheets as necessary;

E. communications;

(1) business telephone;

(2) facsimile number;

(3) dispatch center telephone;

(4) emergency point of contact;

(5) operations telephone;

(6) cellular telephone;

(7) pager number;

F. communications center: physical location of the communications center;

G. medical service management personnel:

(1) program administrator: name, telephone, facsimile, and other contact information as applicable;

(2) medical director: name, license number, telephone, facsimile, and other contact information as applicable;

(3) clinical care supervisor: name, telephone, facsimile, and other contact information as applicable;

H. hours of operations: 24 hour, 7 days a week, other (please explain);

I. type of air ambulance certificate requested:

(1) fixed wing only;

(2) rotor wing only;

(3) combination service;

J. level of service requested:

(1) advanced life support;

(2) critical care;

(3) specialty care;

K. service affiliation:

(1) private or government service;

(2) hospital, police, independent, or municipal;

L. aircraft certificate holder:

(1) service name;

(2) contact person;

(3) address;

(4) business telephone;

(5) facsimile;

(6) certificate number;

M. type of aircraft: for fixed and rotor wing, the following information is required:

(1) make of aircraft(s);

(2) model of aircraft(s);

(3) tail number(s);

N. level of staffing: For both fixed and rotor wing, please attach a copy of your staffing plan to include the following:

(1) EMS personnel: EMT-P and the number of each;

(2) nursing personnel: number and type;

(3) physician(s): number and type;

(4) other personnel: number and type;

O. emergency information: emergency contact information shall be provided for the service director, clinical care supervisor, medical director, and dispatch agency;

P. all applicants shall meet the CAMTS accreditation standards for the level of service of the air ambulance service; some CAMTS accreditation standards may be waived by the bureau for initial certification since new start-up air ambulance services cannot achieve CAMTS accreditation without being in service for a period of time; some CAMTS accreditation standards have exceptions that are listed in 7.27.5.16 NMAC; in general the initial application for air ambulance certification shall include the following:

Standards	Reference Number
Medical Section
Capabilities and Resources of the Medical Transport Service and receiving hospitals	01.00.00
Medical Personnel	02.00.00
Medical Director	02.01.00
Medical Control Physician	02.02.00
Clinical Care Supervisor	02.03.00
Staffing	02.04.00
Mission Types	02.05.00
Training and Continuing Education	02.06.00
Aircraft/Ambulance Section
Medical Configuration	03.00.00
Operational Issues	04.00.00
Aircraft/Ambulance Equipment	05.00.00
Communications	06.00.00
Management and Administrative Responsibilities
Management Policies	07.00.00
Utilization Review	07.01.08
Quality Management	08.00.00
Infection Control	09.00.00
Rotor Wing Standards
Certificate of the Aircraft Operator	10.00.00
Weather and Weather Minimums	11.00.00
Pilot Personnel	12.00.00
Maintenance	13.00.00
Helipad	14.00.00
Refueling	15.00.00
Community Outreach	16.00.00
Fixed Wing Standards
Certificate of the Aircraft Operator	17.00.00
Aircraft	18.00.00
Weather	19.00.00
Pilot Personnel	20.00.00
Policies	21.00.00
Maintenance	22.00.00
Refueling	26.00.00
Community Outreach	27.00.00
Ground Inter-facility Standards: Not Applicable.	N/A
Addendums
Addendum A - Rationale for Change - Critical Care Alternative
Addendum B - Education Matrix
ALS-BLS Ground Standards: Not Applicable	N/A
Medical Escort Standards: Not Applicable	N/A

Notes

N.M. Admin. Code § 7.27.5.19

7.27.5.19 NMAC - Rp, 7.27.5.19 NMAC, 01/01/06