KENTUCKY COMMUNITY AND TECHNICAL COLLEGE SYSTEM
Kentucky Board of Emergency Medical Services
(New Administrative Regulation)
202 KAR 7:555. Ground agencies.
RELATES TO: KRS 311A.030, 311A.190
STATUTORY AUTHORITY: KRS 311A.020, 311A.025, 311A.030, 311A.190
NECESSITY, FUNCTION, AND CONFORMITY: KRS 311A.020 requires the board to exercise all administrative functions in the regulation of the EMS system and the licensing of ambulance services and medical first response agencies. KRS 311A.030 requires the board to promulgate administrative regulations for the licensing, inspection, and regulation of ambulance providers and medical first response agencies. This administrative regulation establishes minimum licensing requirements.
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 Change Form, no later than the next business day after the permanent removal of any licensed vehicle from service by the license holder.
(4) 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 a Vehicle Change Form 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 Vehicle Change Form 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:
(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.
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 NIMS ICS 100, 200, 700, and 800;
(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 in the event of equipment failure, communication barriers, or other unusual circumstance if 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, DNR, or 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 NIMS ICS 100, 200, 700, and 800 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;
(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, and 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 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’s office within twenty-four (24) hours of the agency ceasing to provide continuous service.
(5) A licensed agency shall have a written plan to assure all requests for service shall be promptly answered.
(6) 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.
(7) 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 from the dispatch center shall notify the next closest appropriate licensed agency to respond.
(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 ALS or 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) In the event that 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 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) 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.
(15) An agency shall not refuse a request for emergency pre-hospital response if a unit is available in its geographic service area.
(16) An agency shall not exhaust its resources by answering a nonemergency call or for response to mutual aid requests.
(17) 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.
(18) A communications system shall be developed, coordinated, and maintained by each licensed agency. The communication system shall comply with paragraphs (a) through (e) of this subsection.
(a) Radio equipment used in emergency medical services vehicles shall be appropriately licensed through the FCC. Copies of the current FCC licenses shall be on file in the agency office.
(b) A licensed agency shall have the capability to communicate on all 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 mobile two (2) way radio communication equipment with a control point located in both the driver’s compartment and patient care compartment of the vehicle capable, under normal conditions, of operating on agency, dispatch center, mutual aid, and hospital frequencies.
(d) Each ambulance shall have a minimum of two (2) portable push-to-talk two (2) way radio communication devices capable of operating on the agency dispatch center, mutual aid, and hospital frequencies.
(e) One (1) alternative method of two (2) way communication may be substituted for one (1) portable two (2) way radio.
Section 4. 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 5. 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 6. Incorporation by Reference. (1) The following material is incorporated by reference:
(a) "Commonwealth of Kentucky Field Operations Guide (KY-FOG)", (6/2012);
(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_v3/188.8.131.52302/DataDictionary/PDFHTML/DEMEMS/NEMSISDataDictionary.pdf; and
(c) "Vehicle Change Form", (12/2017).
(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, 118 James Court, Suite 50, Lexington, Kentucky 40505, Monday through Friday, 8 a.m. to 4:30 p.m.
JIM DUKE, Chairperson
APPROVED BY AGENCY: December 7, 2017
FILED WITH LRC: December 13, 2017 at 2 p.m.
PUBLIC HEARING AND PUBLIC COMMENT PERIOD: A public hearing on this administrative regulation shall be held on January 24, 2018 at 10:00 a.m. Eastern Standard Time at 118 James Court, Suite 50, Lexington, Kentucky 40505. Individuals interested in being heard at this hearing shall notify this agency in writing by 5 workdays prior to the hearing of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who wishes to be heard will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on the proposed administrative regulation. Written comments shall be accepted through January 31, 2018. Send written notification of intent to be heard at the public hearing or written comments on the proposed administrative regulation to the contact person.
CONTACT PERSON: Angela Evans; Legal Counsel, Kentucky Fire Commission; McBrayer, McGinnis, Leslie & Kirkland, PLLC, 201 East Main Street Suite 900, Lexington, Kentucky 40507, phone (859) 231-8780, fax (859) 231-1175, email firstname.lastname@example.org.
REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT
Contact Person: Angela Evans
(1) Provide a brief summary of:
(a) What this administrative regulation does: This administrative regulation establishes the operating procedures for ground ambulance agencies.
(b) The necessity of this administrative regulation: This administrative regulation is necessary to provide a uniform process for ground ambulance operations for which all agencies are required to abide by.
(c) How this administrative regulation conforms to the content of the authorizing statutes: This administrative regulation conforms with the board’s authority to create standards for ground ambulance services.
(d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: This administrative regulation sets forth the requirements for ground ambulances to operate.
(2) If this is an amendment to an existing administrative regulation, provide a brief summary of:
(a) How the amendment will change this existing administrative regulation: This is a new regulation.
(b) The necessity of the amendment to this administrative regulation: This is a new regulation.
(c) How the amendment conforms to the content of the authorizing statutes: This is a new regulation.
(d) How the amendment will assist in the effective administration of the statutes: This is a new regulation.
(3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation: There are approximately 1,264 licensed ground ambulance agencies.
(4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:
(a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment: This administrative regulation establishes a twenty-four (24) hour time frame for an agency to surrender its license when it ceases to provide continuous twenty-four (24) hour service and a twenty-four (24) hour time frame to notify the board of a transfer or lapse in insurance.
(b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3): There is no cost to agencies.
(c) As a result of compliance, what benefits will accrue to the entities identified in question (3): The agencies will have set standards for the ground ambulance agencies and clearly defined time frames to notify the board of various circumstances.
(5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation: None
(a) Initially: None
(b) On a continuing basis: None
(6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation: Board funds.
(7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment: No fee increase is necessary to implement this regulation.
(8) State whether or not this administrative regulation established any fees or directly or indirectly increased any fees: This administrative regulation does not establish any fees.
(9) TIERING: Is tiering applied? Tiering was not applied as the regulation is applicable to all credential holders. This regulation does not distinguish between similarly situated individuals on the basis of any factor.
FISCAL NOTE ON STATE OR LOCAL GOVERNMENT
1. What units, parts or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation? Ambulance providers and first response agencies.
2. Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation: KRS 311A.020, 311A.025, 311A.030, 311A.190
3. Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.
(a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year? This administrative regulation will not generate revenue.
(b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years? This administrative regulation will not generate revenue.
(c) How much will it cost to administer this program for the first year? No cost
(d) How much will it cost to administer this program for subsequent years? No cost
Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
Revenues (+/-): None
Expenditures (+/-): None
Other Explanation: None