[41 Pa.B. 5865]
[Saturday, October 29, 2011]

[Continued from previous Web Page]

Subchapter B. EMS AGENCY SERVICES

Sec.

1027.31.	General standards for providing EMS.
1027.32.	Quick response service.
1027.33.	Basic life support ambulance service.
1027.34.	Advanced life support ambulance service.
1027.35.	Advanced life support squad service.
1027.36.	Critical care transport ambulance service.
1027.37.	Air ambulance service.
1027.38.	Special operations EMS services.

§ 1027.31. General standards for providing EMS.

 Regardless of the type of service through which an EMS agency is providing EMS, the following standards apply to the EMS agency and its EMS providers when functioning as an EMS provider on behalf of an EMS agency, except as otherwise provided in this subchapter:

 (1) An EMS provider who encounters a patient before the arrival of other EMS providers shall attend to the patient and begin providing EMS to the patient at that EMS provider's skill level.

 (2) An EMR may not be the EMS provider who primarily attends to a patient unless another higher level EMS provider is not present or all other EMS providers who are present are attending to other patients.

 (3) Except as set forth in paragraph (2), or unless there are multiple patients and the EMS needs of other patients require otherwise, among EMS providers who are present, an EMS provider who is certified at or above the EMS skill level required by the patient shall be the EMS provider who primarily attends to the patient.

 (4) If a patient requires EMS at a higher skill level than the skill level of the EMS providers who are present, unless there are multiple patients and the EMS needs of other patients require otherwise, an EMS provider who is certified at the highest EMS skill level among the EMS providers who are present shall be the EMS provider who primarily attends to the patient.

 (5) A member of the crew with the highest level of EMS provider certification shall be responsible for the overall management of the EMS provided to the patient or patients by the members of that crew. If more than one member of the crew is an EMS provider above the AEMT level, any of those EMS providers may assume responsibility for the overall management of the EMS provided to the patient or patients by the members of that crew.

 (6) If a crew of an EMS agency service needs additional assistance in attending to the needs of a patient or patients, it shall contact a PSAP to request that assistance.

 (7) Except as otherwise provided in this subchapter, an EMS agency shall operate 24 hours-a-day, 7 days-a-week, each type of service it is licensed to provide at each location it is licensed to operate that service.

 (8) A member of an EMS agency crew who responds to a call in a personal vehicle may not transport in that vehicle medications, equipment or supplies that an EMT is not authorized to use.

§ 1027.32. Quick response service.

 (a) Purpose. An EMS agency that operates a QRS uses EMS providers to respond to calls for EMS and provide EMS to patients before an ambulance arrives.

 (b) Vehicles. A QRS is not required to use a vehicle when responding to a call. If a QRS responds to a call using a vehicle, it may use a vehicle other than an EMS vehicle, such as a bicycle, motorized cart or all-terrain vehicle.

 (c) Staffing. The minimum staffing for a QRS is one EMS provider. If the QRS responds to a call with a BLS squad vehicle or ALS squad vehicle, the minimum staff shall also include an EMSVO, except that only one person is required if the EMSVO is also the EMS provider.

 (d) Providing EMS.

 (1) When a member of an ambulance crew arrives at the scene who is certified at the level for which the patient requires EMS or is a higher-level EMS provider than the EMS provider of the QRS crew exercising primary responsibility for the patient, the member of the QRS crew exercising primary responsibility for the patient shall relinquish that responsibility to that member of the ambulance crew.

 (2) Members of a QRS crew who are present shall follow the direction of the member of the ambulance crew who has assumed responsibility for the overall management of the EMS that is provided to the patient or patients at the scene and leave the scene or continue to provide assistance, as requested by that member of the ambulance crew.

§ 1027.33. Basic life support ambulance service.

 (a) Purpose. An EMS agency that operates a BLS ambulance service employs one or more BLS ambulances staffed by a crew capable of providing medical assessment, observation, triage, monitoring, treatment and transportation of patients who require EMS at or below the skill level of an AEMT.

 (b) Operating at the AEMT level. An EMS agency that chooses to operate a BLS ambulance service that provides EMS at the AEMT level shall apply for Department approval to operate in that manner through its application for a license as an EMS agency or an application to amend its EMS agency license. It shall satisfy equipment, staffing and supply requirements to be able to operate at least one BLS ambulance at the AEMT level. A BLS ambulance is operating at an intermediate ALS level when it is staffed, equipped and supplied to operate at the AEMT level and an AEMT or other provider above the EMT level is providing advanced EMS.

 (c) Staffing.

 (1) The minimum staffing for a BLS ambulance crew when responding to a call to provide EMS and transporting a patient is an EMS provider at or above the EMR level, a second EMS provider at or above the EMT level and an EMSVO, except that only a two-person crew is required if the EMSVO is also one of the EMS providers and an EMS provider above the EMR level is available to attend to the patient during patient transport. Until ______ , (Editor's Note: The blank refers to 2 years after the effective date of section 8133 of the act. Section 8133 of the act is effective 180 days after adoption of this proposed rulemaking.) an ambulance attendant who has not yet secured certification as an EMR may substitute for an EMR.

 (2) If the EMS agency responds to a call with a BLS ambulance operating at an intermediate ALS level, at least one of the EMS providers staffing the crew shall be an AEMT or higher level EMS provider and available to attend to the patient during patient transport.

 (3) Responding ambulance crew members may arrive at the scene separately, but the ambulance shall be fully staffed at or above the required minimum staffing level before transporting a patient.

 (d) Providing EMS when dispatched with higher level crews.

 (1) If a BLS ambulance operating at the BLS or intermediate ALS level and an ALS squad vehicle, ALS ambulance or air ambulance are dispatched to provide EMS for a patient, the following apply:

 (i) BLS ambulance crew members shall begin providing EMS to the patient at their skill levels, including transportation of the patient to a receiving facility if the crew determines transport is needed, until higher level EMS is afforded by the arrival of a higher level EMS provider.

 (ii) Upon the arrival of an EMS provider from the crew of an ALS squad vehicle, ALS ambulance or air ambulance, who is a higher level EMS provider than the highest level EMS provider of the BLS ambulance crew who is present, or who is above the AEMT level, the BLS ambulance crew shall relinquish primary responsibility for the patient to that EMS provider.

 (iii) Upon rendezvousing with an ALS ambulance or air ambulance, the BLS ambulance shall continue transporting the patient or release the patient to be transported by the other ambulance, consistent with the Statewide EMS protocols, as directed by the EMS provider exercising primary responsibility for the patient.

 (iv) The BLS ambulance crew shall reassume primary responsibility for the patient if that responsibility is relinquished back to that crew by the EMS provider of the ALS squad vehicle, ALS ambulance or air ambulance who had assumed primary responsibility for the patient.

 (2) A BLS ambulance and crew may transport from a receiving facility a patient who requires EMS above the skill level at which the ambulance is operating, if the sending or a receiving facility provides a registered nurse, physician assistant or physician to supplement the ambulance crew, that person brings on board the ambulance equipment and supplies to provide the patient with EMS above the EMS level at which the BLS ambulance is operating to attend to the EMS needs of the patient during the transport, and that person attends to the patient during the patient transport.

§ 1027.34. Advanced life support ambulance service.

 (a) Purpose. An EMS agency that operates an ALS ambulance service employs one or more ALS ambulances staffed by a crew capable of providing medical assessment, observation, triage, monitoring, treatment and transportation of patients who require EMS above the skill level of an AEMT.

 (b) Staffing. The minimum staffing for a ALS ambulance crew when responding to a call to provide EMS to a patient who requires EMS above the skill level of an EMT is an EMS provider at or above the EMT level, a second EMS provider above the AEMT level and an EMSVO, except that only a two-person crew is required if the EMSVO is also one of the EMS providers and an EMS provider above the AEMT level is available to attend to the patient during patient transport. Responding crew members may arrive at the scene separately, but the ambulance shall be fully staffed at or above the minimum staffing level before transporting a patient.

 (c) Providing EMS when dispatched with a BLS ambulance. If the crew of both an ALS ambulance and a BLS ambulance are dispatched to provide EMS for a patient, the following shall apply:

 (1) Upon arrival of an EMS provider from the ALS ambulance crew who is a higher level EMS provider than an AEMT or a higher level EMS provider than the highest level EMS provider of the BLS ambulance crew who is present, that EMS provider shall assume primary responsibility for the patient.

 (2) If the patient is assessed by the crew of the ALS ambulance to require EMS above the skill level at which the BLS ambulance is operating, and to require transport to a receiving facility, the EMS provider who is responsible for the overall management of the EMS provided to the patient shall decide, consistent with the Statewide EMS protocols, whether the patient shall be transported by the BLS ambulance or the ALS ambulance. In either event, an appropriately certified member of the ALS ambulance crew shall attend to the patient during the transport. If the BLS ambulance is used to transport the patient, that EMS provider shall use the equipment and supplies on the BLS ambulance, supplemented with the additional equipment and supplies, including medications, from the ALS ambulance after the ALS ambulance rendezvous with the BLS ambulance.

 (3) If at the scene or during patient transport by a BLS ambulance, the EMS provider of the ALS ambulance crew who has assumed primary responsibility for the patient determines that the BLS ambulance is operating at the skill level needed to attend to the patient's EMS needs, consistent with the Statewide EMS protocols, that EMS provider may relinquish responsibility for the patient to the BLS ambulance crew.

 (d) Responding to a call for a patient who requires EMS at or below the AEMT level. When an ALS ambulance is employed to respond to a call to provide EMS to a patient who requires EMS at or below the skill level of an AEMT, the staffing and the responsibilities of the ambulance crew are the same as set forth in § 1027.33 (relating to basic life support ambulance service).

§ 1027.35. Advanced life support squad service.

 (a) Purpose. An EMS agency that operates an ALS squad service employs one or more ALS squad vehicles that transports an EMS provider above an AEMT level, along with equipment and supplies, to rendezvous with an ambulance crew to provide medical assessment, observation, triage, monitoring and treatment of persons who require EMS above the skill level of an EMT.

 (b) Staffing. The minimum staffing for a ALS squad vehicle crew when responding to a call to provide EMS is an EMS provider above the AEMT level and an EMSVO, except that only one person is required if the EMSVO is also the EMS provider.

 (c) Providing EMS when dispatched with a BLS ambulance. If the crew of both an ALS squad vehicle and a BLS ambulance are dispatched to provide EMS for a patient, the following apply:

 (1) Upon arrival of an EMS provider from the ALS squad vehicle who is a higher level EMS provider than the highest level EMS provider of the BLS ambulance crew who is present, or is a higher level EMS provider than an AEMT, that EMS provider shall assume primary responsibility for the patient.

 (2) If the patient is assessed by the crew of the ALS squad vehicle to require EMS above the skill level at which the BLS ambulance is operating, and to require transport to a receiving facility, an appropriately certified member of the ALS squad vehicle shall attend to the patient during the transport by the BLS ambulance. That EMS provider shall use the equipment and supplies on the BLS ambulance, supplemented with the additional equipment and supplies, including medications, from the ALS squad vehicle after the ALS squad vehicle rendezvous with the BLS ambulance.

 (3) If at the scene or during patient transport by a BLS ambulance, the crew of the ALS squad vehicle determines that the BLS ambulance is operating at the skill level needed to attend to the patient's EMS needs, consistent with the Statewide EMS protocols, the EMS provider of the ALS squad vehicle who is responsible for the overall management of the EMS provided to the patient may relinquish responsibility for the patient to the BLS ambulance crew.

§ 1027.36. Critical care transport ambulance service.

 (a) Purpose. An EMS agency that operates a critical care transport ambulance service employs one or more ALS ambulances staffed by a crew capable of providing medical assessment, observation, triage, monitoring, treatment and transportation of patients who require EMS at the skill level needed to attend to and transport critically ill or injured patients between receiving facilities.

 (b) Staffing. The minimum staffing for a critical care transport crew when responding to a call to provide critical care transport is an EMSVO and two EMS providers above the AEMT level with at least one of the EMS providers being a paramedic, PHPE, PHRN or a PHP who has successfully completed a critical care transport educational program approved by the Department. Provided that one of the EMS providers is a paramedic, PHPE, PHRN or a PHP who has successfully completed a critical care transport educational program approved by the Department, another health care provider or providers may substitute for a second EMS provider above the AEMT level to attend to a patient with special medical needs if the EMS agency has submitted to the Department, and received the Department's approval, a plan that provides for substitution to attend to the needs of those patients in accordance with the Department-approved protocol the EMS agency has established for its critical care transport service. Responding crew members may arrive at the scene separately, but the ambulance shall be fully staffed at or above the minimum staffing level before transporting a patient.

 (c) Transport of critical care patient. During patient transport, two EMS providers who satisfy the minimum EMS provider staffing requirement in subsection (b) shall accompany the patient in the patient compartment of the ambulance and be available to attend to the patient during the transport.

 (d) Expanded scope of practice. When providing EMS through a critical care transport ambulance service, the scope of practice of an EMS provider above the AEMT level will be expanded. This expansion will include EMS skills, the use of equipment in addition to those included in the EMS provider's general scope of practice if the EMS provider has received education to perform those skills and use that equipment by having successfully completed a critical care transport educational program approved by the Department. The EMS provider is required to be able to document having received that education and to demonstrate competence in the performance of those skills to the EMS agency medical director. Use of that equipment by that level of EMS provider will be authorized by the Department as published in a notice in the Pennsylvania Bulletin. An EMS provider shall perform these skills as directed by the Statewide EMS protocols applicable to a critical care transport ambulance service or as otherwise directed by a medical command physician.

§ 1027.37. Air ambulance service.

 (a) Purpose. An EMS agency that operates an air ambulance service employs one or more air ambulances staffed by a crew capable of providing medical assessment, observation, triage, monitoring, treatment and transportation of patients who require EMS. An air ambulance should be employed when time to administer definitive care to a patient is of the essence and transportation by air ambulance to a receiving facility able to provide the care is faster than transportation by ground ambulance, or when a patient requires EMS provided by specialized equipment or providers not available on a ground ambulance and the air ambulance can provide this faster than the patient would receive such care at a receiving facility if transported by ground ambulance.

 (b) Staffing. The minimum staffing for an air ambulance crew when responding to a call to transport a patient by air ambulance is a pilot and two EMS providers above the AEMT level, with at least one of the EMS providers being a paramedic, PHPE, PHRN or a PHP who has successfully completed an air ambulance transport educational program approved by the Department. Provided that one of the EMS providers is a paramedic, PHPE, PHRN or a PHP who has successfully completed an air ambulance transport educational program approved by the Department, another health care provider or providers may substitute for a second EMS provider above the AEMT level to attend to a patient with special medical needs if the EMS agency has submitted to the Department, and received the Department's approval, a plan that provides for substitution to attend to the needs of those patients in accordance with the Department-approved protocol the EMS agency has established for its air ambulance service. Responding crew members may arrive at the scene separately, but the ambulance shall be fully staffed at or above the minimum staffing level before transporting a patient.

 (c) Transport of patient. During patient transport, two EMS providers who satisfy the minimum EMS provider staffing requirement in subsection (b) shall accompany the patient in the patient compartment of the ambulance and be available to attend to the patient during the transport.

 (d) Flight requirements.

 (1) An EMS agency's determination regarding whether to accept a flight shall be based solely on availability, weather conditions and safety considerations.

 (2) The crew of an air ambulance shall apprise the dispatching ground PSAP as soon as practical after receiving a dispatch call, its estimated time of arrival at the scene of the emergency. While the air ambulance is enroute to the scene of an emergency, if the crew of the air ambulance believes that the air ambulance and required staff will not be able to arrive at the emergency scene within the estimated time of arrival previously given, the air ambulance crew shall contact the ground PSAP and provide a new estimated time of arrival.

 (e) EMS protocols. In addition to following the Statewide EMS protocols, an EMS agency that operates an air ambulance service may establish and follow EMS protocols that address EMS not covered by the Department's EMS protocols, provided those protocols are approved by the Department. To secure that approval, the EMS agency shall submit the proposed protocols to the medical advisory committee of the regional EMS council through which it submitted its application to be licensed as an EMS agency. That medical advisory committee shall assess the appropriateness of the proposed protocols and then forward the proposed protocols to the Department with its recommendations.

 (f) Expanded scope of practice. When providing EMS through an air ambulance service, the scope of practice of an EMS provider above the AEMT level is expanded. This expansion will include EMS skills and the use of equipment in addition to those included in the EMS provider's general scope of practice if the EMS provider has received education to perform those skills and use that equipment by having successfully completed an air ambulance transport educational program approved by the Department. The EMS provider is required to be able to document having received that education and to demonstrate competency in the performance of those skills to the EMS agency medical director. Use of that equipment by that level of EMS provider will be authorized by the Department as published in a notice in the Pennsylvania Bulletin. An EMS provider shall perform these skills as directed by the Statewide EMS protocols applicable to an air ambulance service or as otherwise directed by a medical command physician.

§ 1027.38. Special operations EMS services.

 (a) Generally. A special operations EMS service provides EMS in austere environments that require specialized knowledge, equipment or vehicles to access a patient or it addresses patient care situations that differ from the routine situations that can be handled by a QRS, ambulance service or ALS squad service, or some combination thereof. Depending upon the type of special operations EMS service and the circumstances presented, a special operations EMS service may be able to meet the EMS needs of the patient by itself, or may need to work with other EMS services to meet the EMS needs of the patient.

 (b) Special provisions. The following apply to special operations EMS services:

 (1) When providing EMS through a special operations EMS service, an EMS provider's scope of practice is expanded to include EMS skills and the use of equipment in addition to those included in the EMS provider's general scope of practice if the EMS provider has received education to perform those skills and use that equipment by having successfully completed a course approved by the Department for that type of special operations EMS service, the EMS provider is able to document having received that education, and the performance of those skills and use of that equipment by that level of EMS provider is authorized by the Department as published in a notice in the Pennsylvania Bulletin. An EMS provider shall perform these skills as directed by the Statewide EMS protocols applicable to that type of special operations EMS service or as otherwise directed by a medical command physician.

 (2) Notwithstanding § 1021.41(a) (relating to EMS patient care reports), when an EMS agency is providing EMS exclusively through a special operations EMS service it shall document patient encounters as follows:

 (i) It shall document every patient encounter on a log that includes the minimum information required by the Department as published in a notice in the Pennsylvania Bulletin, including documentation required by the Statewide EMS protocols for any patient refusing treatment.

 (ii) For any patient transported by ambulance from a special operations EMS incident, it shall complete a written transfer of care form that contains the patient information that is essential for immediate transmission for patient care required under § 1021.41(c), and provide it to the EMS provider on the ambulance who accepts responsibility for the patient.

 (iii) For any patient transported by ambulance from a special operations EMS incident who receives EMS from the special operations EMS service exceeding the scope of practice of an EMT, it shall complete an EMS PCR and otherwise comply with § 1021.41.

 (iv) For any patient not transported by ambulance who refuses EMS or dies while under the care of a special operations EMS service, the special operations EMS service shall complete an EMS PCR and otherwise comply with § 1021.41.

 (3) Notwithstanding § 1027.31(8) (relating to general standards for providing EMS), when an EMS provider at or above the AEMT level is responding as part of a special operations EMS service in a vehicle other than an EMS vehicle, the EMS provider may transport in that vehicle EMS equipment and supplies that an EMT is not authorized to use, provided the EMS agency has adopted policies approved by its EMS agency medical director to ensure the proper storage and security of the equipment and medications, and the EMS provider abides by those policies.

 (4) To facilitate the ability of EMS providers to access and move patients, a special operations EMS service may use modes of transportation at the special operations EMS incident site, such as a bike, golf cart or other motorized vehicle, to transport EMS providers and patients.

 (c) Tactical EMS service.

 (1) Purpose. An EMS agency that provides a tactical EMS service provides EMS support to a law enforcement service to afford a rapid and safe EMS response if a person becomes ill or injured during a tactical law enforcement operation.

 (2) Affiliation. To secure and maintain an EMS agency license that authorizes the EMS agency to operate a tactical EMS service, an EMS agency shall demonstrate that it is affiliated with a law enforcement service operated by a government law enforcement agency or a consortium of government law enforcement agencies.

 (3) Staffing. An EMS agency that provides a tactical EMS service shall be staffed by at least six EMS providers who are above the AEMT level with a minimum of 2 years of experience as an EMS provider above the AEMT level, and who have completed an educational program approved by the Department on tactical EMS operations. The minimum staff when providing EMS support as a tactical EMS service is two EMS providers who meet these standards. All EMS providers who provide EMS for an EMS agency's tactical EMS service shall be 21 years of age or older.

 (4) Weapons. Notwithstanding § 1027.3(h) (relating to licensure and general operating standards), when an EMS provider is responding to a tactical law enforcement operation as part of a tactical EMS service, the EMS provider may carry weapons and other tactical items as otherwise permitted by law and approved by the affiliated law enforcement agency.

 (5) Reporting. The EMS agency shall provide a summary report of a tactical EMS operation response to the regional EMS council assigned to the region in which the tactical EMS service was provided, within 30 days of the tactical EMS operation, on a form or through an electronic process as prescribed by the Department.

 (d) Wilderness EMS service.

 (1) Purpose. An EMS agency that provides a wilderness EMS service provides EMS in the wilderness, backcountry or other wild and uncultivated area to afford an EMS response should a person become ill or injured in that setting.

 (2) Coordination. To secure and maintain an EMS agency license that authorizes the EMS agency to operate a wilderness EMS service, an EMS agency shall demonstrate that it has coordinated with a local, county or State emergency service or services and responds at their request.

 (3) Staffing. An EMS agency that provides a wilderness EMS service shall be staffed by at least six EMS providers who have completed an educational program approved by the Department on wilderness EMS operations. The minimum staff when providing EMS as a wilderness EMS service is two EMS providers at or above the EMT level who meet these standards. EMS providers who provide EMS for a wilderness EMS service shall be 18 years of age or older.

 (4) Reporting. The EMS agency shall provide a summary report of a wilderness EMS operation response to the regional EMS council assigned to the region in which the wilderness EMS service was provided, within 30 days of the wilderness EMS operation, on a form or through an electronic process, as prescribed by the Department.

 (e) Mass-gathering EMS service.

 (1) Purpose. An EMS agency that provides a mass-gathering EMS service provides EMS when there is a large gathering of persons under circumstances such as the following:

 (i) The number of anticipated participants or spectators would overwhelm normal EMS capabilities for the area or local hospital capabilities.

 (ii) The nature of the activity occurring at the mass-gathering site may result in increased risk of injury or illness to spectators or participants.

 (iii) Areas where access to normal EMS operations are limited due to factors such as physical/logistical restrictions in access routes, gathering areas and the number of spectators.

 (iv) Risk analysis has determined that the site of the mass-gathering could be considered a target of opportunity for terrorist activity.

 (2) Coordination. To secure and maintain an EMS agency license that authorizes the EMS agency to operate a mass-gathering EMS service, an EMS agency shall demonstrate that it has coordinated with an EMS agency that operates an ambulance service and other local, county or State emergency services.

 (3) Staffing. An EMS agency that provides mass-gathering EMS service shall be staffed by at least six EMS providers. The minimum staff when providing EMS support as a mass-gathering EMS service is two EMS providers with at least one EMS provider at or above the EMT level.

 (4) Reporting. The EMS agency shall provide a summary report of a mass-gathering event at which it provides EMS to the regional EMS council assigned to the region in which the mass-gathering EMS service was provided, within 30 days of the event, on a form or through an electronic process, as prescribed by the Department.

 (f) Urban search and rescue EMS service.

 (1) Purpose. An EMS agency that provides an urban search and rescue (USAR) EMS service provides EMS at an incident in which patients are entrapped by a structural collapse or other entrapment for an extended period of time.

 (2) Coordination. To secure and maintain an EMS agency license that authorizes the EMS agency to operate a USAR EMS service, an EMS agency shall demonstrate that it has coordinated with a local, county or State emergency service or services and responds at their request.

 (3) Staffing. An EMS agency that provides a USAR EMS service shall be staffed by at least six EMS providers above the level of AEMT who have completed an educational program approved by the Department on USAR EMS operations. The minimum staff when providing EMS as a USAR EMS service is two EMS providers above the AEMT level who meet these standards. EMS providers who provide EMS for a USAR EMS service shall be 18 years of age or older.

 (4) Reporting. The EMS agency shall provide a summary report of a USAR EMS operation response to the regional EMS council assigned to the region in which the USAR EMS service was provided, within 30 days of the USAR EMS operation, on a form or through an electronic process, as prescribed by the Department.

 (g) Extraordinary applications. An EMS agency or an applicant for an EMS agency license may apply to operate under its license a type of special operations EMS service that is not addressed in this chapter. The Department will address each request on an individual basis. It will grant, conditionally grant or deny the request as it deems appropriate to protect the public interest. An EMS agency granted authorization to conduct a special operations EMS service under this subsection shall be subject to any later adopted regulations that apply to that type of special operations EMS service.

 (h) Construction. This section enables an EMS agency that has been licensed to provide a special operations EMS service to hold itself out as being licensed to provide that service and to provide that service in accordance with the requirements in this section. It does not require an EMS agency to be licensed to conduct a special operations EMS service to respond to a call requesting EMS under circumstances in which a special operations EMS service would be appropriate.

Subchapter C. MISCELLANEOUS

Sec.

1027.51.	Stretcher and wheelchair vehicles.
1027.52.	Out-of-State providers.

§ 1027.51. Stretcher and wheelchair vehicles.

 (a) Stretcher vehicle. A stretcher vehicle is a ground vehicle, other than an ambulance, that is commercially used to transport by stretcher a person who does not receive and cannot reasonably be anticipated to require medical assessment, monitoring, treatment or observation by EMS providers during transport, but who, due to the person's condition, requires vehicle transportation on a stretcher or in a wheelchair.

 (b) Wheelchair vehicle. A wheelchair vehicle is a ground vehicle, other than an ambulance, that is commercially used to transport by wheelchair a person who does not receive and cannot reasonably be anticipated to require medical assessment, monitoring, treatment or observation by EMS providers during transport, but who, due to the person's condition, requires vehicle transportation on a stretcher or in a wheelchair.

 (c) Prohibition. An entity may not operate a stretcher or wheelchair vehicle to transport a person who the entity knows or should reasonably know requires medical assessment, monitoring, treatment or observation during transport.

§ 1027.52. Out-of-State providers.

 (a) An entity located or headquartered outside of this Commonwealth, that is not licensed as an EMS agency by the Department, may not engage in the business of providing EMS to patients within this Commonwealth except when dispatched by a PSAP to provide EMS. This is to occur only when a PSAP determines that an EMS agency is unable to respond within a reasonable time or its response is not sufficient to deal with the emergency.

 (b) An entity located or headquartered outside of this Commonwealth, that is not licensed as an EMS agency by the Department, may provide EMS to patients when transporting them from locations outside this Commonwealth to locations within this Commonwealth.

 (c) An entity located or headquartered outside this Commonwealth, which is not an agency of the Federal government, needs to be licensed as an EMS agency by the Department to provide EMS to patients within this Commonwealth other than as described in subsections (a) and (b).

CHAPTER 1029. MEDICAL COMMAND FACILITIES AND RECEIVING FACILITIES

Subchap.

A.	MEDICAL COMMAND FACILITIES
B.	RECEIVING FACILITIES

Subchapter A. MEDICAL COMMAND FACILITIES

Sec.

1029.1.	General provisions.
1029.2.	Operational requirements.
1029.3.	Processing certification and registration applications.
1029.4.	Inspections and investigations.
1029.5.	Plan of correction.
1029.6.	Discontinuation of service.

§ 1029.1. General provisions.

 (a) Certification and registration required. To operate as a medical command facility, a medical unit shall be certified and currently registered as a medical command facility.

 (b) Certification requirements.

 (1) The Department will certify as a medical command facility a facility that was recognized by the Department as a medical command facility immediately prior to ______ (Editor's Note: The blank refers to the effective date of adoption of this proposed rulemaking.).

 (2) The Department will certify other applicants for certification as a medical command facility if the Department is satisfied that the applicant has met the following requirements:

 (i) It is a distinct medical unit operated by a hospital or consortium of hospitals.

 (ii) It has the equipment and personnel needed to provide medical command to and control over EMS providers.

 (iii) It employs a medical command facility medical director.

 (iv) It has adopted policies and procedures to ensure that a medical command physician is available to provide medical command at all times.

 (v) It satisfies the communications, recordkeeping and other requirements imposed under this chapter.

 (c) Certification application. An application for certification as a medical command facility shall be submitted on a form or through an electronic process, as prescribed by the Department, to the regional EMS council exercising responsibility for the EMS region in which the applicant is located. The application form shall solicit information to enable the Department to determine whether the applicant has satisfied the certification requirements under subsection (b).

 (d) Triennial registration. A medical command facility's certification is deemed registered when the certification is issued. Except for a medical command facility certified under subsection (b)(1), a medical command facility's registration of its certification is valid for 3 years. The initial registration of the certification of a medical command facility certified under subsection (b)(1) based upon its prior recognition as a medical command facility will expire when its recognition as a medical command facility would have expired under the Emergency Medical Services Act (35 P. S. §§ 6921—6938) (repealed by the act of August 18, 2009 (P. L. 308, No. 37)).

 (e) Registration application. A medical command facility shall submit an application for registration of its certification on a form or through an electronic process, as prescribed by the Department, between 60 and 90 days before its current registration expires to the regional EMS council exercising responsibility for the EMS region in which the applicant is located. The application form shall solicit information to enable the Department to determine whether the applicant continues to satisfy the certification requirements under subsection (b)(2).

§ 1029.2. Operational requirements.

 The operational requirements of a medical command facility are as follows:

 (1) It shall continue to satisfy all requirements under § 1029.1 (relating to general provisions).

 (2) It shall satisfy the following communication and recordkeeping requirements:

 (i) Compatibility with regional telecommunication systems plans, if in place.

 (ii) Communication by way of telecommunications equipment/radios with EMS providers providing EMS for an EMS agency within the area in which medical command is exercised.

 (iii) Audio recording of medical command communications or, when medical command is provided at the scene, otherwise documenting medical command sessions.

 (iv) Maintenance of the recording of a medical command session, or documentation of a medical command session when medical command is provided at the scene, for 7 years.

 (v) An appropriate program for training emergency department staff in the effective use of telecommunication equipment.

 (vi) Protocols to provide for prompt response to requests from EMS providers for both radio and telephone medical guidance, assistance or advice.

 (vii) Documentation that each medical command physician has been educated on all updates to Statewide EMS protocols.

 (3) It shall accurately and promptly relay information regarding patients to the appropriate receiving facility.

 (4) It shall adhere to EMS protocols approved by the Department except when a departure is required for good cause.

 (5) It shall establish a process whereby the medical command facility medical director or the director's designee identifies problems to EMS providers and instructs how to correct those problems.

 (6) It shall obtain a contingency agreement with at least one other medical command facility to assure availability of medical command at all times, including during mass casualty situations, natural disasters and declared states of emergency.

 (7) It shall establish internal procedures that comply with the Statewide EMS protocols.

 (8) It shall notify PSAPs, through which it routinely receives requests for medical command, when it will not have a medical command physician available to provide medical command.

 (9) It shall participate in the regional EMS council's quality improvement program.

 (10) It shall employ sufficient administrative support staff to enable the institution to carry out its essential duties, including audits, equipment maintenance, and processing and responding to complaints.

 (11) It shall establish a program of training for medical command physicians, EMS providers and emergency department staff and establish a method to assure that each medical command physician receives education about all updates and changes to the Statewide EMS protocols.

 (12) It shall provide medical command to EMS providers whenever they seek direction.

§ 1029.3. Processing certification and registration applications.

 (a) A regional EMS council that receives an application for medical command facility certification or an application to register that certification shall review the application for completeness. The regional EMS council shall apprise the applicant if the application is incomplete and obtain a completed application from the applicant.

 (b) The regional EMS council shall conduct an onsite inspection of the applying facility to verify information contained within the application and to complete a physical inspection of the medical command area.

 (c) After completing its review, the regional EMS council shall forward a copy of its recommendation to the Department and to the applying facility. If the applying facility disagrees with the recommendation of the regional EMS council, it may submit a written rebuttal to the Department within 10 days of its receipt of the recommendation.

 (d) The Department will review the application, information and recommendation submitted by the regional EMS council and the rebuttal statement, if any, submitted by the applying facility and make a decision within 30 days from the time of its receipt of the regional EMS council's recommendation to grant or deny the application.

 (e) The Department may inspect the facility and gather additional information to aid it in making a decision on the application.

§ 1029.4. Inspections and investigations.

 (a) The Department will conduct inspections of a medical command facility from time to time, as deemed appropriate and necessary, but at least once every 3 years, including when necessary to investigate a complaint or a reasonable belief that a violation of this subchapter may exist. The Department may have a regional EMS council conduct or assist the Department in conducting an inspection or investigation.

 (b) A medical command facility and an applicant for medical command facility certification shall fully respond to an inquiry of the Department or a regional EMS council regarding its compliance with this subchapter and provide them full and free access to examine the facility and its records relating to its operation as a medical command facility.

§ 1029.5. Plan of correction.

 (a) Notification of violation. Upon determining that a medical command facility has violated the act or this subchapter, the Department may issue a written notice to the medical command facility specifying the violation or violations. The notice will require the medical command facility to take immediate action to discontinue the violation or violations or to submit a plan of correction, or both, to bring the medical command facility into compliance. If the medical command facility cannot remedy the problem immediately and a plan of correction is therefore required, the Department may direct that the violation be remedied within a specified period of time.

 (b) Response by medical command facility. After receiving the notice of violation or violations, the medical command facility shall do one of the following:

 (1) Comply with the requirements specified in the notice.

 (2) Refuse to comply with one or more of the requirements specified in the notice and apprise the Department of its decision, with an explanation, within the time and manner specified in the notice.

 (3) Comply with the requirements specified in the notice and apprise the Department of its decision, within the time and manner specified in the notice of any violation identified in the notice with which it disagrees, supported by an explanation for its disagreement.

 (c) Medical command facility disagreement or refusal to comply. If the medical command facility fails to comply with any of the directives in the notice and responds as required under subsection (b)(2), or disagrees with any of the violations identified and responds as required under subsection (b)(3), the Department will evaluate the explanation provided by the medical command facility to determine whether the response was justified. If the Department determines that the response was justified in whole or part, it will inform the medical command facility and rescind any violation identified or directive given in the notice that the Department determines should not have applied.

 (d) Consequence of failure to comply. A medical command facility's response to a notice under subsection (b)(2) does not act to stay any of the directives in the notice. A medical command facility's failure to comply with a directive in the notice constitutes a ground for discipline if the violation to which the directive relates is found to be true following a hearing.

§ 1029.6. Discontinuation of service.

 A medical command facility may not discontinue medical command operations without providing 90 days advance written notice to the Department, regional EMS councils responsible for regions in which the medical command facility routinely provides medical command and EMS agencies for which it routinely provides medical command. A medical command facility shall advertise notice of its intent to discontinue service as a medical command facility in a newspaper of general circulation in its service area at least 90 days in advance of discontinuing service as a medical command facility.

Subchapter B. RECEIVING FACILITIES

Sec.

1029.21.

Receiving facilities.

§ 1029.21. Receiving facilities.

 (a) General requirements. A receiving facility shall be a fixed location, with an organized emergency department, including a physician educated to manage cardiac, trauma, pediatric, obstetrics, medical behavioral and all-hazards emergencies. A physician who satisfies these requirements shall be present in the facility 24 hours-a-day, 7 days-a-week.

 (b) Patients with special needs. Patients with special needs, particularly those with time-sensitive illnesses, who need to be transported to a receiving facility shall be transported to a specialty receiving facility consistent with the Statewide EMS protocols. The Department will maintain, publish in the Pennsylvania Bulletin and update as appropriate a list of the following specialty receiving facilities:

 (1) Trauma centers, as well as trauma facilities in adjacent states accredited by an accrediting body similar to the Trauma Foundation, appropriate for adult and pediatric patients with serious trauma.

 (2) Receiving facilities appropriate for patients suspected to require percutaneous coronary intervention.

 (3) Receiving facilities appropriate for patients with symptoms of suspected acute stroke.

 (4) Receiving facilities appropriate for patients with suspected serious burns.

 (5) Receiving facilities appropriate for other patients with special needs as described in the Statewide EMS protocols.

 (c) Transports to receiving facilities. Unless directed otherwise by a medical command physician, if patient transport by ambulance is required for additional care that has not been prearranged, an ambulance must transport the patient to a receiving facility or other facility as the Department has designated in the Statewide EMS protocols.

 (d) Confirmation of receiving patient. When a patient has been transported to a receiving facility, the receiving facility shall acknowledge in writing that it has received the patient if the transporting ambulance crew requests that acknowledgement.

CHAPTER 1031. COMPLAINTS, DISCIPLINARY ACTIONS, ADJUDICATIONS AND APPEALS

Sec.

1031.1.	Administrative and appellate procedure.
1031.2.	Complaints and investigations.
1031.3.	Discipline of EMS providers.
1031.4.	Reinstatement of revoked EMS provider certification.
1031.5.	Discipline of EMS vehicle operators.
1031.6.	Emergency suspension of EMS provider and EMS vehicle operator certifications.
1031.7.	Discipline of EMS instructors.
1031.8.	Discipline of medical command physicians and medical command facility medical directors.
1031.9.	Automatic suspension for incapacity.
1031.10.	Discipline of EMS agencies.
1031.11.	Discipline of medical command facilities.
1031.12.	Discipline of EMS educational institutes.
1031.13.	Discipline of providers of EMS continuing education.
1031.14.	Civil money penalty for practicing without a license or certification.
1031.15.	Discipline of vendors of EMS PCR software.
1031.16.	Discipline of management companies.

§ 1031.1. Administrative and appellate procedure.

 (a) Administrative proceedings. Except as otherwise provided in this chapter, the Department will hold hearings and issue adjudications for proceedings conducted under the act and this subpart in accordance with 2 Pa.C.S. (relating to administrative law and procedure) and will conduct those proceedings under 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure).

 (b) Rules supplementing the General Rules of Administrative Practice and Procedure.

 (1) Formal administrative proceedings on an application for a license, certification, registration or accreditation, or to pursue disciplinary sanctions other than an emergency suspension, will be initiated by an order to show cause issued by the Bureau.

 (2) When responding to an order to show cause, a respondent shall aver, in new matter, matters in defense or mitigation of the charges which are not averred in the answer to the averments in the order to show cause, provided the respondent is given written notice of the respondent's responsibility to do so.

 (3) Except for good cause shown, such as for the purpose of impeachment, neither the Bureau nor the respondent may present evidence at a hearing in support of matters not pled, nor may a respondent raise a defense at a hearing that has not been pled in the respondent's answer or new matter to the order to show cause.

 (4) A request for a continuance shall be filed in writing at least 10 days prior to the date of the hearing. This requirement will be waived only upon a showing of good cause. If a respondent has not retained counsel, a request for a continuance on the day of the hearing to retain counsel will not be considered as good cause for the granting of a continuance.

 (5) If an interpreter is required, a request for an interpreter shall be filed in writing at least 30 days prior to the date of the hearing.

 (c) Judicial appeals. Department adjudications issued under the act and this chapter may be appealed to the Commonwealth Court under 42 Pa.C.S. § 763 (relating to direct appeals from government agencies).

§ 1031.2. Complaints and investigations.

 (a) Filing a complaint. A person may file with the Department a complaint about a violation of the act or this part by an individual or entity regulated by the Department under the act or an individual or entity believed to have provided EMS or have engaged in any other activity for which some type of authorization under the act or this subpart is required, without that individual or entity having secured a certification, license or other authorization from the Department to engage in that activity as required by the act and this subpart.

 (b) Filing office. The complaint shall be filed with the regional EMS council that serves the EMS region where the conduct occurred. The regional EMS council shall provide the Bureau with a copy of the complaint. A complaint concerning the conduct of a regional EMS council shall be filed directly with the Bureau.

 (c) Status of complainant. If a person files a complaint seeking to have the Department impose a disciplinary or corrective measure under this chapter, the Department's action in the handling of the complaint will be on behalf of the Commonwealth to determine whether there has been a violation of a statutory or regulatory requirement over which the Department has jurisdiction under the act.

 (d) Processing a complaint. Upon receipt of a complaint filed under this section, the Bureau will assess whether the Department has jurisdiction over the matter about which the complaint is filed. If the matter is within the Department's jurisdiction and an investigation is needed, the Bureau will investigate the complaint or assign the complaint to a regional EMS council or other appropriate entity to investigate. Unless the Bureau determines that disclosure to the individual or entity about whom the complaint has been filed will compromise the investigation or would be inappropriate for some other reason, the investigation will be initiated by providing that individual or entity with a copy of the complaint and requesting a response. If the matter is not within the Department's jurisdiction to address, the Bureau will advise the person who filed the complaint and refer the complainant to another agency if the Bureau believes that the matter about which the complaint has been filed may be within the other agency's jurisdiction.

 (e) Notification of results of investigation. When an investigation is completed, the Bureau will notify the complainant of the general results of the investigation of the matter about which the complaint was filed. This notification does not include providing the complainant with a copy of any document collected or prepared during the course of the investigation. The Bureau will also provide the same information to the individual or entity about whom the complaint was filed if the individual or entity was officially apprised of the complaint or investigation. If the Department is considering taking disciplinary action against the individual or entity, notification may occur when a disciplinary decision is reached or when disciplinary charges are filed.

§ 1031.3. Discipline of EMS providers.

 (a) Grounds for discipline. The Department may discipline or impose corrective measures on an EMS provider or an applicant for EMS provider certification for one or more of the following reasons:

 (1) Having a lack of physical or mental ability to provide adequate EMS, with reasonable accommodations if the person has a disability.

 (2) Deceptively or fraudulently procuring or representing certification or registration credentials, or making misleading, deceptive or untrue representations to secure or aid or abet another person to secure a certification, license, registration or other authorization issued under this subpart.

 (3) Engaging in willful or negligent misconduct in providing EMS or engaging in practice beyond the scope of certification authorization without legal authority to do so.

 (4) Abusing or abandoning a patient.

 (5) Rendering EMS while under the influence of alcohol, illegal drugs or the knowing abuse of legal drugs.

 (6) Operating an emergency vehicle in a reckless manner or while under the influence of alcohol, illegal drugs or the knowing abuse of legal drugs.

 (7) Disclosing medical or other information about a patient when prohibited by Federal or State law.

 (8) Willfully preparing or filing a false medical report or record or inducing another person to do so.

 (9) Destroying a medical report or record required to be maintained.

 (10) Refusing to render EMS because of a patient's race, sex, creed, national origin, sexual preference, age, handicap or medical problem or refusing to render emergency medical care because of a patient's financial inability to pay.

 (11) Failing to comply with Department-approved EMS protocols.

 (12) Failing to comply with reporting requirements imposed by the act or this subpart.

 (13) Practicing without the current registration of a certification.

 (14) Being convicted of a felony, a crime related to the practice of the EMS provider or a crime involving moral turpitude.

 (15) Willfully falsifying or failing to prepare an EMS PCR or complete details on an EMS PCR.

 (16) Misappropriating drugs or EMS agency property.

 (17) Having a certification or other authorization to practice a profession or occupation revoked, suspended or subjected to other disciplinary sanction.

 (18) Violating, aiding or abetting another person to violate a duty imposed by the act, this subpart or an order of the Department previously entered in a disciplinary proceeding.

 (19) Based upon a finding of misconduct by the relevant Federal or State agency, having been excluded from a Federal or State health care program or having had equity or capital stock or profits of an entity equal to 5% or more of the value of the property or assets of the entity when it was excluded from a Federal or State health care program.

 (20) Any other reason as determined by the Department that poses a threat to the health and safety of the public.

 (b) Types of discipline authorized. If disciplinary action or corrective action is appropriate under subsection (a), the Department may:

 (1) Deny an application for certification or registration of the certification.

 (2) Issue a public reprimand.

 (3) Revoke, suspend, limit or otherwise restrict the certification.

 (4) Require the person to take refresher or other educational courses.

 (5) Impose a civil money penalty not exceeding $1,000 for each incident in which the EMS provider engages in conduct that constitutes a basis for discipline.

 (6) Stay enforcement of a suspension, revocation or other discipline and place the individual on probation with the right to vacate the probationary order for noncompliance.

 (c) Denial of registration. The Bureau will not deny a registration of an EMS provider certification without giving the EMS provider prior notice of the reason for the denial and providing an opportunity for a hearing. If the reason for the denial is the failure of the EMS provider to present prima facie evidence that the continuing education or examination requirement for registration has been satisfied, the opportunity for a hearing may occur after the prior registration has expired.

§ 1031.4. Reinstatement of revoked EMS provider certification.

 (a) Petition for reinstatement. A person whose EMS provider certification has been revoked may petition the Department for allowance to apply for reinstatement of the revoked certification no earlier than 5 years after the effective date of the revocation. The petition must aver facts to establish that the petitioner has been rehabilitated to the extent that issuing that person a reinstatement of the revoked certification would not be detrimental to the public interest. In assessing the public interest, the Department will weigh the facts that tend to show that the petitioner has been rehabilitated against the Department's duty to maintain public confidence in its ability to regulate EMS providers, deter other EMS providers from engaging in conduct similar to that which resulted in the revocation and protect persons who may require EMS.

 (b) Department action on the petition.

 (1) The Department will deny a petition for allowance to apply for reinstatement, without conducting a hearing, if it accepts as true all facts averred and it concludes that those facts fail to establish that the petitioner has been rehabilitated to the extent that reinstatement of the revoked certification would not be detrimental to the public interest.

 (2) The Department may grant or hold a hearing on a petition for allowance to apply for reinstatement if it concludes that the facts averred in the petition, if true, establish a prima facie case that the petitioner has been rehabilitated to the extent that reinstatement of the revoked certification would not be detrimental to the public interest.

 (c) Grant of petition for reinstatement. If the Department grants the petition, the petitioner shall repeat the educational program and the certification examinations that are required for the EMS provider certification the petitioner is seeking to reinstate and shall satisfy all other requirements for that certification that exist at the time the petitioner files an application for reinstatement after having successfully completed that education and the examinations.

 (d) Denial of petition for reinstatement. If the Department denies the petition, the petitioner may not again petition the Department for allowance to apply for reinstatement of the revoked certification until 1 year has expired from the date of the denial.

§ 1031.5. Discipline of EMS vehicle operators.

 (a) Grounds for discipline. The Department may discipline or impose corrective measures on an EMSVO or an applicant for EMSVO certification for one or more of the following reasons:

 (1) Having a lack of physical or mental ability to operate an EMS vehicle, with reasonable accommodations if the person has a disability.

 (2) Deceptively or fraudulently procuring or representing certification or registration credentials, or making misleading, deceptive or untrue representations to secure a certification or registration.

 (3) Operating an emergency vehicle in a reckless manner or while under the influence of alcohol, illegal drugs or the knowing abuse of legal drugs.

 (4) Having a driver's license suspended in any jurisdiction due to the use of alcohol or drugs or a moving traffic violation.

 (5) Operating a ground EMS vehicle without a driver's license or while a driver's license is suspended.

 (6) Being convicted of a felony or a crime involving moral turpitude.

 (7) Failing to report a criminal conviction that the applicant or EMSVO is required to report or failing to report the suspension of a driver's license due to the use of alcohol or drugs or a moving traffic violation.

 (8) Any other reason as determined by the Department that poses a threat to the health and safety of the public.

 (b) Types of discipline authorized. If disciplinary or corrective action is appropriate under subsection (a), the Department may:

 (1) Deny an application for certification or registration of the certification.

 (2) Issue a public reprimand.

 (3) Revoke or suspend the certification.

 (4) Impose conditions for lifting a suspension.

 (c) Automatic suspension. An EMSVO certification shall be automatically suspended for 4 years if an EMSVO is convicted of a criminal offense that involves driving under the influence of alcohol or drugs, and for 2 years if the EMSVO is convicted of a criminal offense that involves reckless driving or had a driver's license suspended due to the use of drugs or alcohol or a moving traffic violation.

§ 1031.6. Emergency suspension of EMS provider and EMS vehicle operator certifications.

 (a) Issuance of emergency suspension. The Department will issue an order suspending an EMS provider or EMS vehicle operator certification, without a hearing, if based upon evidence received that appears to be credible the Department determines that the person is a clear and immediate danger to the public health and safety.

 (b) Notice and preliminary hearing. Notice of the emergency suspension will include a written statement of the factual allegations upon which the determination is based. Unless an extension of time is requested by the EMS provider or EMS vehicle operator, within 30 days after an order under subsection (a) is issued, the Department shall conduct a preliminary hearing to determine whether there is a prima facie case supporting the emergency suspension. The EMS provider or EMS vehicle operator may be present at the preliminary hearing and may be represented by counsel, cross-examine witnesses, inspect physical evidence, call witnesses and offer testimony and other evidence to rebut the prima facie case. If and when the Department determines that the evidence does not establish a prima facie case that the EMS provider or EMS vehicle operator is a clear and immediate danger to the public health and safety, the Department will immediately issue an order lifting the suspension.

 (c) Beginning of formal disciplinary proceedings. After issuing an order under subsection (a), the Department shall begin formal disciplinary action under § 1031.3 or § 1031.5 (relating to discipline of EMS providers; and discipline of EMS vehicle operators).

 (d) Duration of emergency suspension if prima facie case is established. If the Department determines that a prima facie case supporting the emergency suspension is established at the preliminary hearing, the emergency suspension shall remain in effect, but no longer than 180 days unless agreed upon by the parties.

§ 1031.7. Discipline of EMS instructors.

 (a) Grounds for discipline. The Department may discipline or impose corrective measures on a certified EMS instructor, or an applicant for certification as an EMS instructor, for one or more of the following reasons:

 (1) Any reason an EMS provider may be disciplined under § 1031.3 (relating to discipline of EMS providers).

 (2) Providing instruction while under the influence of alcohol or illegal drugs or the knowing abuse of legal drugs.

 (3) Failing to perform a duty imposed upon an EMS instructor under this subpart.

 (4) Any other reason as determined by the Department that poses a threat to the health and safety of students.

 (b) Types of discipline authorized. If disciplinary action or corrective action is appropriate under subsection (a), the Department may:

 (1) Deny an application for certification.

 (2) Issue a public reprimand.

 (3) Revoke, suspend, limit or otherwise restrict the certification.

 (4) Impose a civil money penalty not exceeding $1,000 for each incident in which the EMS instructor engages in conduct that constitutes a basis for discipline.

 (5) Stay enforcement of a suspension, revocation or other discipline and place the individual on probation with the right to vacate the probationary order for noncompliance.

§ 1031.8. Discipline of medical command physicians and medical command facility medical directors.

 (a) Grounds for discipline. The Department may discipline or impose corrective measures on a medical command physician or medical command facility medical director for the following reasons:

 (1) Violating a responsibility imposed on the physician by § 1023.2 or § 1023.3 (relating to medical command physician; and medical command facility medical director).

 (2) Without good cause, failing to comply with an EMS protocol established or approved by the Department.

 (b) Types of discipline authorized. If disciplinary action or corrective action is appropriate under subsection (a), the Department may:

 (1) Deny the application for a certification.

 (2) Issue a public reprimand.

 (3) Revoke, suspend, limit or otherwise restrict or condition the certification.

 (4) Impose a civil money penalty not exceeding $1,000 for each incident in which the physician engages in conduct that constitutes a basis for discipline.

 (5) Stay enforcement of any suspension, revocation or other discipline and place the individual on probation with the right to vacate the probationary order for noncompliance.

§ 1031.9. Automatic suspension for incapacity.

 The Department will automatically suspend a certification issued under this subpart upon receiving a certified copy of court records establishing that the person has been adjudicated as incapacitated under 20 Pa.C.S. § 5511 (relating to petition and hearing; independent evaluation) or an equivalent statutory provision, and will lift the suspension upon receiving a certified copy of court records establishing that the person has regained capacity under 20 Pa.C.S. § 5517 (relating to adjudication of capacity and modification of existing orders) or an equivalent statutory provision.

§ 1031.10. Discipline of EMS agencies.

 (a) Discipline of EMS agencies. The Department may discipline an EMS agency or an applicant for an EMS agency license for one or more of for the following reasons:

 (1) Violating a requirement of the act or a regulation adopted under the act.

 (2) Failing to submit a plan of correction acceptable to the Department to correct a violation cited by the Department or failing to comply with a plan of correction accepted by the Department.

 (3) Refusing to accept a conditional provisional license properly sought by the Department or to abide by its terms.

 (4) Engaging in fraud or deceit in obtaining or attempting to obtain a license.

 (5) Lending its license or, except as authorized by the Department in acting upon the license application or an application to amend the license, enabling another person to manage or operate the EMS agency or any service the EMS agency is licensed to provide.

 (6) Engaging in incompetence, negligence or misconduct in operating the EMS agency or in providing EMS to patients.

 (7) Using the license of another or in any way knowingly aiding or abetting the improper granting of a license, certification, accreditation or other authorization issued under the act.

 (8) Failing to meet or continue to meet applicable licensure standards.

 (9) The EMS agency is not a responsible person or is not staffed by responsible persons and refuses to remove from its staff the irresponsible person or persons when directed to do so by the Department.

 (10) Being convicted of a felony or a crime involving moral turpitude or related to the practice of the EMS agency.

 (11) Making misrepresentations in seeking funds made available through the Department.

 (12) Refusing to render EMS because of a patient's race, sex, creed, national origin, sexual preference, age, handicap, medical problem or refusing to respond to an emergency and render EMS because of a patient's financial inability to pay.

 (13) Violating an order previously issued by the Department in a disciplinary matter.

 (b) Types of discipline authorized. If disciplinary action is appropriate under subsection (a), the Department may:

 (1) Deny an application for a license.

 (2) Issue a public reprimand.

 (3) Revoke, suspend, limit or otherwise restrict the license.

 (4) Impose a civil money penalty not exceeding $5,000 for each incident in which the EMS provider engages in conduct that constitutes a basis for discipline.

 (5) Stay enforcement of a suspension, revocation or other discipline and place the EMS agency on probation with the right to vacate the probationary order for noncompliance.

§ 1031.11. Discipline of medical command facilities.

 (a) Discipline of medical command facilities. The Department may discipline a medical command facility or an applicant for a medical command facility certification for one or more of the following reasons:

 (1) Submitting a fraudulent or deceptive application for certification or registration of the certification.

 (2) Violating a requirement in § 1029.1 or § 1029.2 (relating to general provisions; and operational requirements).

 (3) Refusing to permit an inspection or to respond to an inquiry as required under § 1029.4 (relating to inspections and investigations).

 (4) Failing to comply, without just cause, with an EMS protocol approved by the Department.

 (5) Failing to submit a plan of correction acceptable to the Department to correct a violation cited by the Department or failing to comply with a plan of correction accepted by the Department.

 (b) Types of discipline authorized. If disciplinary action is appropriate under subsection (a), the Department may:

 (1) Deny an application for a certification.

 (2) Issue a public reprimand.

 (3) Revoke, suspend, limit or otherwise restrict or condition the certification.

 (4) Impose a civil money penalty not exceeding $5,000 for each act that constitutes a basis for discipline.

 (5) Stay enforcement of a suspension, revocation or other discipline and place the medical command facility on probation with the right to vacate the probationary order for noncompliance.

§ 1031.12. Discipline of EMS educational institutes.

 The Department may deny, withdraw or condition the accreditation of an EMS training institute for one or more of the following reasons:

 (1) Failure to satisfy the responsibilities imposed upon it under §§ 1025.1—1025.3 (relating to accreditation and operational requirements of EMS educational institutes; accreditation process; and advertising).

 (2) An absence of students in the program for 2 consecutive years.

 (3) Submission of a fraudulent or deceptive application for accreditation.

§ 1031.13. Discipline of providers of EMS continuing education.

 If a continuing education sponsor or an applicant for accreditation as a continuing education sponsor fails to satisfy the requirements in §§ 1025.21—1025.23 (relating to accreditation of sponsors of continuing education; responsibilities of continuing education sponsors; and advertising) or submits a fraudulent or deceptive application for accreditation, the Department may:

 (1) Deny or withdraw its accreditation.

 (2) Downgrade its accreditation status to provisional accreditation, subject to withdrawal if deficiencies are not resolved within a time period prescribed by the Department.

 (3) Withdraw approval of a continuing education course applicable to any future presentation of the course.

§ 1031.14. Civil money penalty for practicing without a license or certification.

 (a) Operating an EMS agency without a license. The Department may impose a civil money penalty of up to $5,000 per day upon a person who owns or operates an EMS agency in this Commonwealth without having a license to operate that EMS agency.

 (b) Practicing as an EMS provider without a certification. The Department may impose a civil money penalty of up to $1,000 per day upon a person who provides EMS without an EMS provider's certification or other legal authority to provide EMS.

§ 1031.15. Discipline of vendors of EMS PCR software.

 The Department may assess a vendor of EMS PCR software a civil money penalty of up to $5,000 for each day a vendor violates a duty imposed by § 1021.43(b) or (d) (relating to vendors of EMS patient care reports).

§ 1031.16. Discipline of management companies.

 (a) The Department may deny, withdraw or condition the approval of an entity to offer management services for one or more of the following reasons:

 (1) The entity is not a responsible person.

 (2) Persons having a substantial ownership interest in the entity are not responsible persons.

 (3) The entity will not be staffed by or conduct its activities through responsible persons.

 (4) The entity refuses to provide the Department with records or information reasonably requested by the Department to make a determination regarding paragraphs (1)—(3).

 (5) The entity conducts the operation or managerial control of an EMS agency, or conducts the day-to-day operations of the EMS agency, in a manner that subjects the EMS agency to possible disciplinary action under § 1031.10 (relating to discipline of EMS agencies).

 (6) The entity violates a requirement of the act or a regulation adopted under the act that is applicable to the entity.

 (7) Engaging in fraud or deceit in obtaining or attempting to obtain or maintain Department approval.

 (b) For purposes of subsection (a):

 (1) A responsible person is a person who has not engaged in an act contrary to justice, honesty or good morals which indicates that the person is likely to betray the public trust in managing the operation of the EMS agency, or is a person who has engaged in this conduct but has been rehabilitated and is not likely to again betray the public trust.

 (2) A person has a substantial ownership in the entity if the person has equity in the capital, stock or the profits of the applicant equal to 5% or more of the property or assets of the applicant.

 (3) A person staffs an entity that manages an EMS agency if the person manages activity integral to the operation of the EMS agency.

CHAPTER 1033. SPECIAL EVENT EMS

Sec.

1033.1.	Special event EMS planning requirements.
1033.2.	Administration, management and medical direction requirements.
1033.3.	Special event EMS personnel and capability requirements.
1033.4.	Onsite facility requirements.
1033.5.	Communications system requirements.
1033.6.	Requirements for educating event attendees regarding access to EMS.
1033.7.	Special event report.

§ 1033.1. Special event EMS planning requirements.

 (a) Procedure for obtaining required plan approval. The entity responsible for the management and administration of a special event may submit a special event EMS plan to the Department, through the regional EMS council assigned responsibility for the region in which the special event is to occur, to secure a determination from the Department as to whether the plan is adequate to address the EMS needs presented by a special event or a series of special events conducted at the same location.

 (1) The applicant shall submit its plan at least 90 days prior to the date of the first day of the event.

 (2) The Department will approve or disapprove a special event EMS plan within 60 days after a complete plan is filed with the regional EMS council.

 (3) The Department's approval of a special event EMS plan will be for the special event or series of special events in a calendar year, as identified in the plan. The entity shall submit a new special event EMS plan to secure Department approval of a plan for a special event or series of special events in a subsequent calendar year.

 (b) Plan content. The special event EMS plan must contain the following information:

 (1) The type and nature of event, location, length and anticipated attendance.

 (2) Identification of sponsoring organization.

 (3) The name and qualifications of the special event EMS medical director and the special event EMS director.

 (4) A listing of all EMS agencies that will be involved, the type of EMS service each EMS agency will provide and the number and level of certification of EMS providers each EMS agency will provide, as well as the number and type of health care practitioners who are not participating on behalf of an EMS agency, including EMS providers who are not participating on behalf of an EMS agency, who will be involved.

 (5) The type and quantity of EMS vehicles and other vehicles, equipment and supplies to be utilized by each EMS agency that will be involved.

 (6) A written agreement with each EMS agency that has agreed to participate, in which the EMS agency identifies the type of EMS service, the number of EMS providers by certification level, the vehicles, the equipment and supplies it will provide.

 (7) A description of the onsite treatment facilities including maps of the special event site.

 (8) A description of the special event emergency medical communications capabilities.

 (9) A risk assessment for the event, and a plan for responding to a possible disaster or mass casualty incident at the event site, including a plan for emergency evacuation of the event site.

 (10) A plan for educating event attendees regarding EMS system access and specific hazards, such as severe weather.

 (11) Measures that have and will be taken to coordinate EMS for the special event or events with local emergency care services and public safety agencies—such as EMS, police, fire, rescue and hospital agencies or organizations.

 (c) Plan approval. To secure Department approval of a special event EMS plan, the applicant shall satisfy the requirements in this chapter.

§ 1033.2. Administration, management and medical direction requirements.

 (a) Special event EMS director. EMS provided at a special event shall be supervised by a special event EMS director.

 (1) Responsibilities. The responsibilities of the special event EMS director include:

 (i) Preparing a plan under § 1033.1 (relating to special event EMS planning requirements).

 (ii) Managing the delivery of special event EMS.

 (iii) Ensuring implementation of the EMS coordination measures contained in the special event EMS plan.

 (iv) Ensuring that a record is kept that lists the individuals that requested or received EMS and the disposition of each case, including identification of the transporting EMS agency and ambulance, and the receiving facility, if the individual was transported to a receiving facility.

 (2) Qualifications. A special event EMS director shall be experienced in the administration and management of EMS at the level of EMS provided for in the special event EMS plan.

 (b) Special event EMS medical director.

 (1) Responsibilities. The responsibilities of a special event EMS medical director include:

 (i) Ensuring that each EMS provider provided by an EMS agency that is used under the special event EMS plan has been appropriately credentialed by the provider's EMS agency medical director to provide EMS at the level required in the plan.

 (ii) Ensuring that if onsite medical command is provided, that it be provided through a medical command facility and that medical command communications are documented.

 (iii) Ensuring that equipment and medications are appropriately stored and secured.

 (iv) Reviewing with the EMS agency medical directors for the EMS agencies involved, quality improvement issues related to the special event.

 (v) Ensuring that adequate EMS PCRs and records are maintained for patients who receive EMS during the special event.

 (2) Qualifications. A special event EMS medical director shall be an EMS agency medical director or satisfy the standards for being an EMS agency medical director in § 1023.1(b) (relating to EMS agency medical director) without serving as an EMS agency medical director.

§ 1033.3. Special event EMS personnel and capability requirements.

 (a) Special event EMS providers shall be certified at appropriate levels based on the level of EMS approved by the Department in the special event EMS plan.

 (b) One ambulance shall be stationed onsite at a special event if the event is expected to involve the presence of between 5,000 and 25,000 persons at any one time.

 (c) Two ambulances shall be stationed onsite at a special event if the event is expected to involve the presence of more than 25,000 but less than 55,000 persons at any one time.

 (d) Three ambulances shall be stationed onsite at a special event if the event is expected to involve the presence of more than 55,000 persons at any one time.

 (e) Sufficient EMS providers shall be available to assure the availability of EMS to persons present at the special event.

§ 1033.4. Onsite facility requirements.

 A special event expected to involve the presence of more than 25,000 persons at any one time shall require the use of onsite treatment facilities. The onsite treatment facilities shall provide:

 (1) Environmental control, providing protection from weather elements to ensure patient safety and comfort.

 (2) Sufficient beds, cots and equipment to provide for evaluation and treatment of at least four simultaneous patients.

 (3) Adequate lighting and ventilation to allow for patient evaluation and treatment.

§ 1033.5. Communications system requirements.

 A special event EMS system shall have onsite communications capabilities to ensure:

 (1) Uniform access to care for patients in need of EMS.

 (2) Onsite coordination of the activities of EMS providers, including capability for interoperable communication with all EMS agencies involved in the plan and with EMS agencies local to the event site that are not involved in the special event EMS plan.

 (3) Communication with existing community PSAPs.

 (4) Communication interface with other involved public safety agencies.

 (5) Communication with receiving facilities.

 (6) Communication with ambulances providing emergency transportation.

 (7) Communication with medical command physicians.

§ 1033.6. Requirements for educating event attendees regarding access to EMS.

 (a) The entity responsible for the management and administration of a special event shall develop and implement a plan to educate special event participants and spectators about the following:

 (1) The presence and location of EMS at the special event.

 (2) The methods of obtaining EMS at the special event.

 (b) The entity responsible for the management and administration of a special event shall establish a procedure and means for alerting the participants and spectators of specific hazards or serious changing conditions, such as severe weather, and for providing event evacuation instructions.

§ 1033.7. Special event report.

 An entity for which the Department has approved a special event EMS plan shall complete a special event report form prepared by the Department and provided to it by the relevant regional EMS council and file the completed report with that regional EMS council within 30 days following the last day of a special event. Among other matters, the report shall provide a summary of the patient information required to be kept under § 1033.2(a)(1)(iv) (relating to administration, management and medical direction requirements).

[Pa.B. Doc. No. 11-1865. Filed for public inspection October 28, 2011, 9:00 a.m.]

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