The purpose of this rule is to ensure the consistent
quality of medical care delivered by air ambulance services in the state of
Washington.
(1) An air
ambulance
service operating in the
state of Washington must:
(a) Be licensed by the department in
compliance with this section unless an exception in
RCW
18.73.130 applies;
(b) Comply with all regulations and standards
in this chapter pertaining to licensed and verified
ambulance services and
vehicles, except that WAC
246-976-290 and
246-976-300 are replaced for air
ambulance services by subsections (7) and (8) of this section; and
(c) Comply with the standards in this section
for all types of transports, including interfacility and prehospital
transports.
(2) An air
ambulance service applying for initial or renewal licensure must:
(a) Provide a completed application for
licensure on forms provided by the department;
(b) Provide copies of the following current
and valid documentation issued by the Federal Aviation Administration (FAA):
(i) Air Taxi Registration (OST Form 4507)
showing the effective date of FAA registration and exemption under 14 C.F.R.
298;
(ii) Air
carrier certificate
authorizing common carriage under 14 C.F.R.
135, including Operations
Specifications (FAA form 8430-18) authorizing aeromedical helicopter or
fixed-wing air
ambulance operations as applicable;
(iii) Certificate of Registration (AC form
8050-3) for each air ambulance operated; and
(iv) Standard Airworthiness Certificate (FAA
form 8100-2) for each air ambulance operated;
(c) Provide a certificate of insurance
establishing current and valid public and passenger liability insurance
coverage for the air ambulance service;
(d) Provide a certificate of insurance
establishing current and valid professional and general liability insurance
coverage for the air ambulance service; and
(e) Provide proof of the air ambulance
service's current accreditation status and a copy of the current accreditation
report by a nationally recognized and department approved air ambulance
accreditation entity that demonstrates that the air ambulance service meets the
standards in this section. Failure to produce the accreditation report and
supporting documentation to the department may be grounds for denial,
suspension, or revocation of an ambulance license.
(3) An air
ambulance service requesting
initial licensure or renewal of licensure:
(a) That is ineligible to attain
accreditation because it lacks a history of operation, must meet the standards
in this section and provide proof that the air ambulance service is pursuing
accreditation review with an accreditation entity approved by the department. A
provisional license may be granted for no longer than two years at which time
the service must provide documentation from a department approved accreditation
entity that it meets the standards in this section.
(b) That has been unable to obtain
accreditation may apply for a waiver of the full accreditation requirement if
the air ambulance service meets all components of accreditation that are
consistent with the standards in this section other than criteria related to
the Federal Aviation Agency or Airline Deregulation Act regulated activities.
The applicant must supply a copy of the accreditation report and supporting
documentation to the department to show that it meets the standards in this
section.
(4) To meet the
minimum standards for medical oversight and patient care protocols an air
ambulance service must:
(a) Have a
physician
director. The
physician director must be:
(i)
The
department-certified
medical program director (MPD) of the county where the
air
ambulance service declares its primary base of operation or a
physician
delegate of that county's MPD, as provided in WAC
246-976-920(4);
(ii) Licensed to practice in the state of
Washington and in current good standing; and
(iii) Able to provide proof of educational
experience consistent with the mission statement and scope of care provided by
the air ambulance service;
(b) Ensure that all medical team members hold
current and valid Washington state health care profession licenses;
(c) Ensure that all prehospital personnel
used by the air
ambulance service per subsection (5) of this section hold
current and valid Washington
state certifications as defined in WAC
246-976-010 and in accordance
with
RCW
18.71.200 and
18.71.205. Certified prehospital
personnel must comply with
department approved, MPD patient care protocols;
(d) Have a quality management
program; and
(e) Ensure data
related to patient care and transport services is collected and reviewed
regularly and protected health care information is handled according to state
and federal law and regulations.
(5) An air
ambulance service must meet the
following minimum standards for staffing of air ambulances:
(a) All medical personnel on each transport
must have education, experience, qualifications, and credentials consistent
with the mission statement and scope of care provided by the air ambulance
service;
(b) Each critical care
transport (CCT) is staffed by a medical team of at least two individuals with
at least the following qualifications and licensure:
(i) One paramedic or registered nurse trained
in prehospital emergency care; and
(ii) One other person who must be a
registered nurse, respiratory therapist, paramedic, advanced EMT, EMT, or other
appropriate specialist as appointed by the physician director;
(c) Each
advanced life support
(ALS) transport is staffed by a medical team of at least two individuals with
at least the following qualifications and licensure:
(i) One paramedic; and
(ii) One other person, who must be a
paramedic, advanced EMT, EMT, or other appropriate specialist as appointed by
the physician director; and
(d) Each basic life support (BLS) transport
is staffed by a medical team of at least two individuals in accordance with
ambulance personnel requirements listed in
RCW
18.73.150.
(6) An air
ambulance service must meet the
following minimum standards for training of air
ambulance medical personnel:
(a) Establish and maintain a structured
training program. If prehospital personnel are used by the air
ambulance
service, the
training program must also meet requirements as defined in chapter
246-976 WAC;
(b) Create and
maintain a file for each medical team member containing documentation of the
personnel member's qualifications including, as applicable, licenses,
certifications, and training records; and
(c) Ensure that each medical team member
completes training in the following subjects before serving on a transport:
(i) Aviation terminology;
(ii) Altitude physiology and stressors of
flight;
(iii) Patient loading and
unloading;
(iv) Safety in and
around the aircraft;
(v) In-flight
communications;
(vi) Use, removal,
replacement, and storage of the medical equipment installed on the
aircraft;
(vii) In-flight emergency
procedures;
(viii) Emergency
landing and evacuation procedures; and
(ix) Policies and procedures for the air
ambulance service, including policies to address altitude
limitations.
(7) An air
ambulance service must meet the
following minimum standards for aircraft configuration and equipment to safely
and effectively treat ill and injured patients on air
ambulance transports and
that include:
(a) A climate control system to
prevent temperature extremes that would adversely affect patient
care;
(b) Interior lighting that
allows for patient care and monitoring without interfering with the pilot's
vision;
(c) At least one outlet per
patient and electric current which is capable of operating all electrically
powered medical equipment unless battery power is available that exceeds the
flight time for the transport;
(d)
A back-up source of electric current or batteries capable of operating all
electrically powered life support equipment for at least a minimum of one
hour;
(e) An entry that allows for
patient loading and unloading without rotating a patient and stretcher more
than thirty degrees about the longitudinal (roll) axis or forty-five degrees
about the lateral (pitch) axis and without compromising the operation of
monitoring systems, intravenous lines, or manual or mechanical
ventilation;
(f) Adequate space
that allows each medical team member sufficient access to each patient to begin
and maintain treatment modalities, including complete access to the patient's
head and upper body for effective airway management;
(g) Adequate placement of stretcher and
medical equipment that does not impede rapid egress by personnel or patient
from the aircraft; and
(h) A
communications system that is capable of air to ground communication with,
ground fire and EMS services, public safety vehicles, hospitals, medical
control, and communication centers and that allows the flight crew and medical
team members to communicate with each other during the transport.
(8) An air
ambulance service must
meet the following minimum standards for medical equipment aboard air
ambulances:
(a) Maintain and provide a
minimum of the following equipment, supplies, and medications consistent with
the mission statement and scope of care provided on transports. All equipment,
supplies, and medications must be
approved for use by the MPD and
physician
director.
(i) Minimum equipment available for
each
basic life support (BLS) transport must include:
(A) Oral/nasal pharyngeal airway;
(B) Nonrebreather oxygen mask;
(C) Bag valve mask;
(D) Pulse oximeter;
(E) Oxygen source;
(F) Automated external
defibrillator;
(G) Noninvasive
vital sign measurement;
(H)
Glucometer;
(I) Equipment for
control of bleeding to include tourniquets;
(J) Infection control;
(K) Medications consistent with scope of
practice and care required for the transport type;
(L) Spinal motion restriction; and
(M) Neonatal and pediatric equipment
sufficient for all aspects of prehospital and interfacility specialized care,
if the air ambulance service provides transport to this population.
(ii) Minimum equipment available
for each
advanced life support (ALS) transport must include:
(A) All BLS equipment required in (a)(i) of
this subsection; and
(B) Equipment
for endotracheal intubation to include alternative airways such as supraglottic
airways;
(C) Equipment for needle
thoracostomy;
(D) Noninvasive
carbon dioxide (CO2) monitoring with numerical and
waveform capability;
(E) Equipment
to establish and maintain a peripheral IV;
(F) Equipment to establish and maintain an
intraosseous infusion;
(G)
Ventilator;
(H) Equipment to
provide continuous positive airway pressure (CPAP);
(I) Cardiac monitor capable of performing
twelve lead ECG, defibrillation, cardioversion, and external pacing;
(J) Medications consistent with scope of
practice and care required for the transport type; and
(K) Neonatal and pediatric equipment
sufficient for all aspects of prehospital and interfacility specialized care,
if the air ambulance service provides transport to this population.
(iii) Minimum equipment available
for each critical care transport (CCT) must include:
(A) All BLS equipment required in (a)(i) of
this subsection; and
(B) All ALS
equipment required in (a)(ii) of this subsection; and
(C) Multimodality ventilators capable of
invasive ventilation appropriate to all age groups transported;
(D) Invasive hemodynamic monitoring,
transvenous pacemakers, central venous pressure and arterial
pressure;
(E) Medications
consistent with scope of practice and care required for the transport type;
and
(F) Neonatal and pediatric
equipment sufficient for all aspects of prehospital and interfacility
specialized care, if the air ambulance service provides transport to this
population.
(iv) Ensure
that during a transport, the air ambulance has the equipment and supplies
necessary to provide an appropriate level of medical care for the patient and
to protect the health and safety of the personnel on the transport;
(v) Maintain and provide upon request
equipment, supply and medication inventories that document what is included for
each type of transport; and
(vi)
Ensure the equipment and supplies on an air ambulance are secured, stored, and
maintained in a manner that prevents hazards to personnel and
patients.