KENTUCKY COMMUNITY AND TECHNICAL COLLEGE SYSTEM

Kentucky Board of Emergency Medical Services

(New Administrative Regulation)

 

      202 KAR 7:560. Ground vehicle staff.

 

      RELATES TO: KRS 189.910-189.950, 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 emergency medical services 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 the minimum staffing requirements for ground vehicles.

 

      Section 1. Staffing Requirements. (1) Each Class I agency BLS ambulance shall at minimum, be staffed by:

      (a) A driver certified as an emergency medical technician (EMT); and

      (b) An attendant certified as an emergency medical technician (EMT).

      (2) Each Class I agency ALS ambulance shall at minimum be staffed by:

      (a) A driver certified as an emergency medical technician (EMT); and

      (b) An attendant certified as an Advanced EMT or licensed as a paramedic.

      1. Each Class I ALS agency providing primary 911 emergency ambulance service shall ensure that an on-duty paramedic shall staff at least twenty-five (25) percent of the agency’s ambulances at any time during a twenty-four (24) hour period.

      2. To ensure compliance, each agency shall maintain its work schedules from the previous twelve (12) months until reviewed during its annual inspection.

      (3) Each Class I agency operating an ALS ambulance providing a BLS level of care shall at minimum be staffed by:

      (a) A driver certified as an emergency medical technician (EMT); and

      (b) An attendant certified as an emergency medical technician (EMT).

      (4) Each Class II agency shall at minimum be staffed by:

      (a) A driver certified as an emergency medical technician (EMT); and

      (b) An attendant certified as an emergency medical technician (EMT).

      (5) A Class III Adult Critical Care ambulance agency shall at minimum be staffed by:

      (a) A driver certified as an emergency medical technician (EMT);

      (b) An attendant licensed as a paramedic; and

      (c) One (1) licensed:

      1. Registered nurse with a current certification as a CCRN for adults that shall be obtained within one (1) year of hire;

      2. Advanced practice registered nurse certified in adult acute care;

      3. Respiratory therapist;

      4. Physician assistant specializing in critical care;

      5. Physician; or

      6. Additional paramedic.

      (6) Each Class III Pediatric Specialty Care Ambulance Agency shall at minimum be staffed by:

      (a) A driver certified as an emergency medical technician (EMT); and

      (b) Two (2) attendants licensed as a:

      1. Registered nurse with a current certification as a CCRN for Pediatrics that is obtained within one (1) year of hire;

      2. Advanced practice registered nurse certified in pediatric acute care;

      3. Respiratory therapist;

      4. Physician assistant;

      5. Physician; or

      6. Paramedic.

      (c) A paramedic and respiratory therapist shall not simultaneously serve as attendants.

      (7) Each Class III Neonatal Specialty Care Ambulance Agency shall at minimum be staffed by:

      (a) A driver certified as an emergency medical technician (EMT); and

      (b) An attendant licensed as a registered nurse with a current certification as a CCRN in Neonatology or RNC-NIC that is obtained within one (1) year of hire; and

      (c) One (1) licensed:

      1. Advanced practice registered nurse certified in neonatology;

      2. Respiratory therapist;

      3. Physician assistant specializing in neonatology;

      4. Physician; or

      5. Registered nurse with a current certification as a CCRN in Neonatology or RNC-NIC that is obtained within one (1) year of hire.

      (8) Each Class IV agency operating a BLS ambulance shall at minimum be staffed by:

      (a) A driver certified as an emergency medical technician (EMT); and

      (b) An attendant certified as an emergency medical technician (EMT).

      (9) Each Class IV service operating an ALS ambulance shall at minimum be staffed by:

      (a) A driver certified as an emergency medical technician (EMT); and

      (b) An attendant certified as an Advanced EMT or licensed as a paramedic.

      1. Each Class IV ALS agency that provides emergency and nonemergency transportation for restricted locations, such as industrial sites or other sites, shall ensure an on-duty paramedic staffs at least twenty-five (25) percent of the agency’s ambulances at any time during a twenty-four (24) hour period.

      2. To ensure compliance, each agency shall maintain its work schedules from the previous twelve (12) months until reviewed by board staff during its annual inspection.

      (10) Each Class VI BLS medical first response agency shall at minimum be staffed by a certified:

      (a) Emergency medical responder (EMR); or

      (b) Emergency medical technician (EMT).

      (11) Each Class VI ALS medical first response agency shall at minimum be minimally staffed by:

      (a) A certified Advanced EMT; or

      (b) A licensed paramedic.

      (12) Each Class VIII BLS agency shall be minimally staffed by a certified:

      (a) Emergency medical responder (EMR); or

      (b) Emergency medical technician (EMT).

      (13) Each Class VIII ALS agency shall be minimally staffed by:

      (a) A certified Advanced EMT; or

      (b) A licensed paramedic.

      (14) Each Class I ALS, Class III ACC, Class IV ALS, and Class VI ALS agency shall have a licensed paramedic on duty at all times.

      (15) At all times, the attendant shall monitor the patient and remain with the patient in the patient compartment.

      (16) This administrative regulation shall not prevent an agency from utilizing staff other than those required by this administrative regulation in:

      (a) Disasters;

      (b) Mass casualty incidents; or

      (c) Extraordinary scene conditions that would impair the safety of the patient or personnel operating at the scene.

      (17) A certified emergency medical responder who were employed by a Class I, II, or III agency as a driver prior to January 1, 2018 may continue in that role if the emergency medical responder’s employment relationship with the Class I, II, or III agency does not lapse.

      (18) Alternative staff shall not operate a licensed vehicle unless at the direction of the agency administrator and the vehicle is out of service and not subject to an emergency response.

 

      Section 2. Motor Vehicle Operator Requirements. (1) Each person operating a vehicle shall:

      (a) Be at least eighteen (18) years of age;

      (b) Hold a valid driver's license in any state or territory of the United States; and

      (c) Complete at least four (4) hours of driver training and education every two (2) years.

      (2) The driver training and education shall consist of a:

      (a) Review of driving a vehicle under emergency conditions;

      (b) Review of KRS 189.910 through 189.950 regarding operation of emergency vehicles;

      (c) Demonstration by the student of forward and back-up driving maneuvers in a controlled situation, such as in an obstacle course designed specifically for this purpose; and

      (d) Review of defensive driving techniques and procedures with hands-on experience or exposure by visual aids or planned demonstrations.

 

      Section 3. Public Notice of Negative Action. The board office shall cause to be published, on the KBEMS Web site or similar publication of the board, or otherwise disseminate, the name of any licensed agency that is fined, placed on probationary status, placed on restricted status, suspended, or had a license revoked.

 

JIM DUKE, Chairperson

      APPROVED BY AGENCY: December7, 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) 281-6480, email aevans@mmlk.com.

 

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 staffing requirements for ground vehicles.

      (b) The necessity of this administrative regulation: This administrative regulation is necessary to establish a minimum staffing standard for all ground emergency medical services agencies.

      (c) How this administrative regulation conforms to the content of the authorizing statutes: This administrative regulation conforms with the board’s statute as it establishes minimum standards for staff of ground emergency medical service agencies.

      (d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: This administrative regulation lists the minimum staffing requirements for each class of ground emergency medical service agencies.

      (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: The authorizing statute allows the board to establish minimum standards for the operation of emergency medical service agencies.

      (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 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: The entities will need to review their staffing of vehicles to ensure they are in compliance.

      (b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3): The cost will vary depending on the amount of staff, if any, needed to be in compliance.

      (c) As a result of compliance, what benefits will accrue to the entities identified in question (3): The agencies will know the level of certification required to serve in each role on an ambulance based on its classification.

      (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, if needed.

      (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 amendment.

      (8) State whether or not this administrative regulation established any fees or directly or indirectly increased any fees: This administrative regulation does not directly or indirectly 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 agencies 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