[29 Pa.B. 903]
[Continued from previous Web Page] § 1003.27. Disciplinary and corrective action.
(a) The Department may, upon investigation, hearing and disposition, impose upon prehospital personnel who are certified or recognized by the Department one or more of the disciplinary or corrective measures in subsection (c) for one or more of the following reasons:
* * * * * (2) Deceptive or fraudulent procurement or misrepresentation of certification or recognition credentials.
* * * * * (12) Failure to comply with ambulance [trip] response reporting requirements as established by the Department.
* * * * * (15) Conviction of a misdemeanor which relates to the practice or the profession of the prehospital personnel practitioner. Conviction is a judgment of guilt.
* * * * * (d) The Department will conduct all aspects of the disciplinary process and any hearing that may be held in accordance with 1 Pa. Code Part II (relating to [general rules of administrative practice and procedure] General Rules of Administrative Practice and Procedure). A revocation or suspension of certification or recognition may be appealed to the Commonwealth Court under 2 Pa.C.S. §§ 501--508 and 701--704 (relating to [administrative agency law] Administrative Agency Law).
§ 1003.28. Medical command authorization.
(a) Authority to grant medical command. The ALS service medical director has the authority to grant, deny or restrict as provided in subsection (c)(3), medical command authorization to an EMT-paramedic or prehospital registered nurse who seeks to provide EMS on behalf of the ALS ambulance service. The ALS service medical director shall document the medical command authorization decision and how that decision was made. The decision of the ALS service medical director shall affect the medical command authorization status of the EMT-paramedic or prehospital registered nurse for that ALS ambulance service only.
(b) Prerequisites to initial determination regarding medical command authorization.
* * * * * (3) Before the ALS service medical director may grant medical command authorization to an individual, the ALS service medical director shall verify that the individual can competently perform each of the services set forth [in] within the [individual's applicable] scope of practice authorized by the individuals' certification or recognition, which is also permitted by the medical treatment protocols in the region or regions in which ambulances of the ALS ambulance service, out of which the individual will function, are stationed. If the individual had not previously been granted medical command authorization for any ALS ambulance service in this Commonwealth, the ALS service medical director shall [directly observe] determine the individual's [performance of each ALS service set forth in the individual's applicable scope of practice] competence to perform those services by direct observation or by consulting with a physician, EMT-paramedic or prehospital registered nurse who has directly observed the individual's performance of those services, and who the ALS service medical director has determined to be qualified to make the assessment. If the individual had previously been granted medical command authorization, the ALS service medical director shall verify that the individual can competently perform each [ALS service set forth in the individual's applicable scope of practice] of those services by either directly observing the individual's performance of those services; or by consulting with a physician, EMT-paramedic or prehospital registered nurse who has directly observed the individual's performance of those services, and who the ALS service medical director has determined to be qualified to make the assessment; or doing the following for services not directly observed or by:
* * * * * (iii) Performing a medical audit of records of services provided by the individual seeking medical command authorization, for patients attended to by that individual for the ALS ambulance for which the ALS service medical director is making the medical command authorization decision.
* * * * * (4) If the ALS service medical director determines that the individual applying for medical command authorization cannot competently perform [the ALS services within that individual's scope of practice] one or more of those services, the ALS service medical director shall either deny, or restrict as provided in subsection (c)(3), the individual's medical command authorization in a written document provided to the individual.
(c) Review of medical command authorization. At least annually, and more often as circumstances warrant, the ALS service medical director shall review the medical command authorization status of each EMT-paramedic and prehospital registered nurse providing services on behalf of the ALS ambulance service. In reviewing medical command authorization, the ALS service medical director shall ensure that the individual has completed or is completing the applicable continuing education requirements in § 1003.29 and has demonstrated competence, as verified by the ALS service medical director, in performing each of the [skills set forth in the individual's scope of practice] services that fall within the scope of the individual's medical command authorization. The ALS service medical director, upon review of medical command authorization, may:
* * * * * (2) Renew medical command authorization and require continuing education courses in any field the ALS service medical director deems appropriate. The ALS service medical director may require an individual to secure more continuing education credit than generally required for personnel operating under medical command authorization for the ALS ambulance service, only if the ALS service medical director determines that the individual does not demonstrate sufficient competence in performing a service, the continuing education is prescribed to address that deficiency and the number of continuing education hours generally required are not sufficient to provide the education the individual needs to remedy the problem.
[(3) Require completion of specified continuing education courses as a prerequisite to renewal of medical command authorization.
(4)] (3) Restrict [the scope of practice under] medical command authorization, if the restriction does not preclude the individual from performing the services specified within the scope of the individual's certification or recognition as permitted by the medical treatment protocols for the region. This permits imposing a restriction such as requiring on scene supervision when the individual performs a specified service or services, or permitting a specified service or services to be performed only when the individual is receiving online medical command.
[(5)] (4) ***
(d) Appeals to the regional EMS medical director. An individual whose medical command authorization has been denied [or restricted] by the ALS service medical director may appeal the decision within 14 days to the regional EMS medical director. The individual's appeal shall be in writing and shall specify the reasons the individual disagrees with the decision of the ALS service medical director. The regional EMS medical director shall conduct a hearing. If the regional EMS medical director is unable to conduct a fair hearing due to receiving prejudicial information prior to the hearing, or for another reason, the regional EMS council shall arrange for the regional EMS medical director of another region to conduct the hearing. At the hearing, the ALS service medical director shall have the burden to proceed and offer testimony and other evidence in support of the ALS service medical director's decision. The individual shall also have an opportunity to present testimony and other evidence in support of the individual's position. Both parties shall have an opportunity to cross-examine opposing witnesses and to submit oral and written position statements. The regional EMS medical director may give the parties up to 5 additional days following the hearing to submit written position statements. The regional EMS medical director will issue a written decision affirming, reversing or modifying the ALS service medical director's decision within 14 days [of] after the hearing or within 14 days [of] after the submission of post hearing position statements, if they are filed. The regional EMS medical director's written decision shall contain the regional EMS medical director's findings and conclusions. If the ALS service medical director fails to appear at the hearing, the regional EMS medical director shall reverse the ALS service medical director's decision. If the individual fails to appear at the hearing, the regional EMS medical director shall make a determination upon the evidence presented and either affirm, reverse or modify the decision of the ALS service medical director. The burden of proof is a preponderance of the evidence.
(e) Appeals to the Department. If either party is dissatisfied with the decision of the regional EMS medical director with regard to medical command authorization, that party shall have the right of immediate appeal to the Department. The party appealing the regional EMS medical director's decision shall submit a written statement to the Department specifying the reasons for the party's objections to the regional EMS medical director's decision within 14 days [of] after that decision. The other party shall have 14 days to respond. The Department will review the record before the regional EMS medical director, and if deemed advisable by the Department [shall] will hear argument and additional evidence. As soon as practicable, the Department, will issue a final decision containing findings of fact and conclusions of law which affirms, reverses or modifies the regional EMS medical director's decision.
(f) Scope of appeals. Appeals under this section shall be confined to a review and determination of whether, at the time of the assessment conducted by the ALS service medical director, the individual possessed the competence to perform [skills for which the individual was denied medical command authorization] all services within the scope of the individual's medical command authorization for the ambulance service.
(g) Service; determination of time period. Each party shall serve the other with any document the party files with a regional EMS medical director or the Department. In determining the time in which a document is to be filed under this section, time begins to run for the parties when the document is mailed, and time begins to run for a regional EMS medical director when the document is received by the regional EMS medical director.
§ 1003.29. Continuing education requirements.
(a) First responders. A first responder who elects to qualify for recertification by fulfilling continuing education requirements shall, prior to the expiration of the 3-year certification period, [attend] successfully complete the following:
(1) Sixteen hours of instruction [provided by a continuing education sponsor] in subjects related to the scope of practice of a first responder as set forth in § 1003.22(a) and (e) (relating to first responder) and which have been approved by the Department for continuing education credit. During the first full certification period the first responder begins following ______ (Editor's Note: The blank refers to the effective date of adoption this proposal.), at least eight of those credits shall be in medical and trauma education.
(2) A CPR course [for adult, child and infant sponsored by the American Heart Association, the American Red Cross or another CPR program determined by the Department to meet or exceed the standards of the specified programs] completed or taught biennially.
(b) EMTs. An EMT who elects to qualify for recertification by fulfilling continuing education requirements shall, prior to the expiration of the 3-year certification period, [attend] successfully complete the following:
(1) Twenty-four hours of instruction [provided by a continuing education sponsor] in subjects related to the scope of practice of an EMT as set forth in § 1003.23(a) and (e) (relating to EMT) and which have been approved by the Department for continuing education credit. During the first full certi- fication period the EMT begins following ______ (Editor's Note: The blank refers to the effective date of adoption of this proposal.) at least 12 of those credits shall be in medical and trauma education.
(2) A CPR course [for adult, child and infant sponsored by the American Heart Association, the American Red Cross or another CPR program determined by the Department to meet or exceed the standards of the specified programs] completed or taught biennially.
(c) EMT-paramedics. To be eligible to receive and retain medical command authorization, an EMT-paramedic shall [attend] successfully complete in each calendar year, 18 hours of instruction [provided by a continuing education sponsor] in subjects related to the scope of practice of an EMT-paramedic as set forth in § 1003.24(a) and (d) (relating to EMT-paramedic) and which have been approved by the Department for continuing education credit, and shall biennially attend or teach a CPR course [for adult, child and infant sponsored by the American Heart Association, the American Red Cross or another CPR program determined by the Department to meet or exceed the standards of the specified programs]. Beginning in 1999, at least 9 of the 18 hours of instruction shall be in medical and trauma education. In the initial year of certification, the EMT-paramedic's continuing education requirements, to secure renewal of medical command authorization for the following year, shall be prorated based upon the month the certification was secured.
(d) Prehospital registered nurses. To be eligible to receive and retain medical command authorization, a prehospital registered nurse shall [attend] successfully complete in each calendar year, 18 hours of instruction [provided by a continuing education sponsor] in subjects related to the scope of practice of a prehospital registered nurse as set forth in § 1003.25b(a) and (c) (relating to prehospital registered nurse) and which have been approved by the Department for continuing education credit, and shall attend or teach biennially a CPR course [for adult, child and infant sponsored by the American Heart Association, the American Red Cross or another CPR program determined by the Department to meet or exceed the standards of the specified programs]. Beginning in 1999, at least 9 of the 18 hours of instruction shall be in medical and trauma education. In the initial year of recognition, the prehospital registered nurse's continuing education requirements, to secure renewal of medical command authorization for the following year, shall be prorated based upon the month the recognition was secured.
(e) [Continuing education credit for instruction. Prehospital personnel may also accrue hours to be credited to the individual's continuing education requirements equivalent to the number of hours the individual is an instructor in a continuing education course offered by a continuing education sponsor, or a course that satisfies requirements for initial certification or recognition of prehospital personnel conducted by an accredited training institute for prehospital personnel. EMT-paramedics and prehospital registered nurses may secure no more than 6 hours of continuing education credit in a calendar year for serving as an instructor in courses for EMTs or first responders.] This section does not prohibit an ambulance service from requiring prehospital personnel to satisfy continuing education requirements it may choose to impose as a condition of employment, provided that the ambulance service may not do the following:
(1) Excuse a prehospital practitioner from meeting continuing education requirements imposed by this section.
(2) Establish individual continuing education requirements for the EMT-paramedics or prehospital registered nurses staffing the ambulance service, except as authorized by § 1003.28(c)(2) (relating to medical command authorization).
[(f) Continuing education credit through endorsement. Prehospital personnel who attend courses offered by any organization or agency with National or state accreditation to provide continuing education may apply to the Department to receive credit for these courses. The individual shall have the burden of demonstrating to the Department that these courses meet standards equivalent to those standards imposed by this part.]
§ 1003.30. Accreditation of sponsors of continuing education.
(a) Entities and institutions may apply for accreditation as a continuing education sponsor by submitting to the Department an application [on] in a [form supplied] format prescribed by the Department. The applicant shall supply all information requested [on] in the application. The Department will grant accreditation to an applicant for accreditation as a continuing education sponsor [who] if the applicant satisfies the Department that the courses the applicant will offer will meet the following minimum standards:
* * * * * (5) The courses shall be presented by a qualified responsible instructor in a suitable setting devoted to the educational purpose of the course.
[(6) The course shall be open to all prehospital personnel interested in the subject matter.]
* * * * * (c) At least [30] 90 days prior to expiration of the 3-year accreditation period, a continuing education sponsor shall apply to the Department for renewal of the sponsor's accreditation. The Department will renew the sponsor's accreditation if the sponsor meets all of the following requirements:
* * * * * (3) The sponsor has satisfied its responsibilities under § 1003.32 (relating to responsibilities of continuing education sponsors).
(d) If the Department deems that the continuing education sponsor has demonstrated a history of understanding and compliance with the regulatory standards for providing continuing education to prehospital personnel, the Department may apprise the continuing education sponsor that its accreditation constitutes prior approval of continuing education courses offered under this chapter which are presented in a classroom setting, and permit the continuing education sponsor to assign the number of credit hours for the course, based upon the criteria in § 1003.31(a) (relating to credit for continuing education).
§ 1003.31. Credit for continuing education.
(a) Credit hour. A prehospital practitioner shall receive 1 hour credit for each 60 minutes of instruction presented in a classroom setting by a continuing education sponsor. Credit may not be received if attendance or other participation in the course is not adequate to meet the educational objectives of the course as determined by the course sponsor. Credit may not be received for other than 30 or 60-minute units of instruction, however the course shall be at least 60 minutes. For completing a continuing education course that is not presented in a classroom setting, or that is not presented by a continuing education sponsor, the prehospital practitioner shall receive the number of credit hours assigned by the Department to the course.
(b) Course completion. A prehospital practitioner may not receive credit for a continuing education course not completed, as evidenced by satisfaction of the check-in/check-out process for a course presented in a classroom setting by a continuing education sponsor, which reflects that the prehospital practitioner met the continuing education attendance requirement for receiving credit, and the continuing education sponsor's report to the Department verifying that the prehospital practitioner has completed the course. The course will also not be considered completed if the prehospital practitioner does not satisfy other course completion requirements imposed by this chapter and the continuing education sponsor.
(c) Continuing education credit for instruction. A prehospital practitioner shall receive credit equal to the number of hours served as an instructor in a continuing education course offered by a continuing education sponsor, or in a course that satisfies requirements for initial certification or recognition of a prehospital practitioner conducted by a training institute for prehospital personnel accredited by the Department.
(d) Continuing education credit through endorsement. A prehospital practitioner who attends or teaches a course offered by an organization with National or state accreditation to provide education may apply to the Department to receive credit for the course. The prehospital practitioner shall have the burden of demonstrating to the Department that the course meets standards substantially equivalent to the standards imposed in this chapter.
(e) Continuing education credit assigned to courses not conducted by a continuing education sponsor. If a course is offered by an organization with National or state accreditation to provide education, which is not a continuing education sponsor, the Department will assign credit to the course, including the possibility of no credit or partial credit, based upon considerations of whether the course bears entirely upon appropriate subject matter and whether the method of presenting the course meets standards substantially equivalent to those prescribed in this chapter.
(f) Continuing education credit assigned to self-study courses. Credit may be sought from the Department for a self-study continuing education course. The prehospital practitioner shall submit an application to the Department to approve the self-study course for credit prior to commencing the course and shall supply the Department with the materials the Department requests to conduct the evaluation. The Department will assign credit to the course based upon considerations of whether the course addresses appropriate subject matter and whether the method of completing the course meets standards substantially equivalent to those prescribed in this chapter. The Department may require modifications to the proposed self-study as a precondition to approving it for credit.
(g) Continuing education credit assigned to courses not presented in a classroom setting. A prehospital practitioner shall be awarded credit for completing a course without the prehospital practitioner physically attending the course in a classroom setting, provided the course has been approved by the Department for credit when presented in that manner.
(h) Reporting continuing education credits to prehospital personnel. A record of the continuing education credits received by prehospital personnel shall be maintained in a Statewide registry. A report of the continuing education accumulated shall be provided annually to first responders and EMTs, and semiannually to EMT-paramedics and prehospital registered nurses at the mailing address on record with the Department.
(i) Resolution of discrepancies. It is the responsibility of the prehospital practitioner to review the report of continuing education credits and to notify the appropriate regional EMS council of any discrepancy within 30 days after the report is mailed. The Department will resolve all discrepancies between the number of continuing education credits reported and the number of continuing education credits a prehospital practitioner alleges to have earned, which are not resolved by the regional EMS council.
§ 1003.32. Responsibilities of continuing education sponsors.
(a) Record of attendance. A continuing education sponsor shall maintain a record of attendance for a course presented in a classroom setting by maintaining a check-in/check-out process approved by the Department, and shall assign at least one person to ensure that all individuals attending the course check in when entering and check out when leaving. If an individual enters a course after the starting time, or leaves a course before the finishing time, the assigned person shall ensure that the time of arrival or departure is recorded for the individual.
(b) Reporting attendance. A continuing education sponsor shall report to the Department, in the manner and format prescribed by the Department, attendance at each continuing education course presented in a classroom setting within 10 days after the course has been presented.
(c) Course evaluation. A continuing education sponsor shall develop and implement methods to evaluate its course offerings to determine their effectiveness. The methods of evaluation shall include providing a course evaluation form to each person who attends a course.
(d) Record retention. The continuing education sponsor shall retain for each course it presents, the completed course evaluation forms and the check-in/check-out record for a course presented in a classroom setting. If the continuing education sponsor has received Department approval to assign credit to a course under § 1003.30(d) (relating to accreditation of sponsors of continuing education), the retained records shall also include course materials used, a record of the course instructor's qualifications, the course instructor's lesson plans and examinations if applicable. These records shall be retained for at least 4 years from the presentation of the course.
(e) Providing records. A continuing education sponsor shall promptly provide the Department with complete and accurate records relating to the course as requested by the Department.
(f) Course not presented in a classroom setting. A continuing education sponsor shall be exempt from the requirements of subsections (a) and (b) for a course which is not presented in a classroom setting, if the course is approved by the Department for credit when presented in that manner. When presenting the course to the Department for approval for credit, the continuing education sponsor shall present a procedure for monitoring, confirming and reporting prehospital practitioner participation in a manner that achieves the purposes of subsections (a) and (b).
(g) Monitoring responsibilities. A continuing education sponsor shall ensure that a course was presented in a manner that met all of the educational objectives for the course, and shall determine whether each prehospital practitioner who enrolled in the course met the requirements of this chapter and the continuing education sponsor to receive credit for completing the course.
(h) Course completion. A continuing education sponsor shall report to the Department, in a manner and format prescribed by the Department, completion of a course by a prehospital practitioner who completes the course, and shall identify to the Department a prehospital practitioner who seeks credit for a course but who did not meet the requirements of the continuing education sponsor or this chapter to receive continuing education credit. The continuing education sponsor shall also provide a prehospital practitioner who completes a course with a document certifying completion of the course.
§ 1003.33. Advertising.
(a) A continuing education sponsor may advertise a course as a continuing education course in a manner that states or suggests that the course meets the requirements of this chapter only if the course has been approved by the Department or is deemed approved under § 1003.30(d) (relating to accreditation of sponsors of continuing education).
(b) When a course has been approved for continuing education credit, the continuing education sponsor shall announce, in its brochures or registration materials: this course has been approved by the Department for ______ (the approved number of hours) of continuing education credit for ______(the type of prehospital practitioner to which the course applies).
(c) If a continuing education sponsor advertises that it has applied to the Department to secure continuing education credit for a course, prior to presenting the course it shall disclose to all enrollees whether the course has been approved or disapproved for credit.
§ 1003.34. Withdrawal of accreditation or course approval.
If the continuing education sponsor fails to satisfy the requirements of this chapter, the Department may:
(1) 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.
Subchapter C. [AIR AMBULANCE PERSONNEL] (Reserved) § 1003.41. [Air ambulance medical director] (Reserved).
[(a) Roles and responsibilities. An air ambulance medical director is responsible for the following:
(1) Providing medical guidance and advice to the air ambulance service personnel.
(2) Participating in training of medical flight crew members.
(3) Granting or denying medical command authorization in accordance with § 1003.28 (relating to medical command authorization) to medical flight crew members who require the authorization.
(4) Performing medical audits of patient care provided by the air ambulance service's medical flight crew members.
(b) Minimum qualifications. If the air ambulance medical director is not a medical command physician, the air ambulance medical director shall:
(1) Possess the minimum qualifications for a medical command physician in § 1003.4(b)(1)--(5) (relating to medical command physician).
(2) Have experience in the base station radio direction of prehospital personnel.
(3) Have knowledge of altitude physiology and of potential medical complications which may arise during transport of a patient by air ambulance.
(4) Have knowledge of air craft safety and the capabilities and limitations of the aircraft used.
(5) Have knowledge regarding the application, use, maintenance and hazards of routine or special medical equipment used during transport of patients by the air ambulance service.
(6) Successfully complete Parts A and B of the Medical Command Base Station Course adopted by the Department.]
§ 1003.42. [Air ambulance medical crew members] (Reserved).
[(a) Roles and responsibilities. The air ambulance medical air crew members shall have the following responsibilities:
(1) To assure that equipment/supplies that are required for an air ambulance flight are on the aircraft and in working order prior to takeoff for patient transport.
(2) To provide medical care and intervention according to direct medical command or written protocols/standing orders.
(3) To maintain a patient treatment record, documenting medical care rendered by the medical flight crew and the disposition of the patient at the receiving medical facility. The patient treatment record shall be maintained at the base hospital.
(4) To evaluate each patient for potential adverse effects from flight operations.
(5) To assure that the patient and equipment are secured during flight.
(b) Minimum qualifications. Air ambulance medical air crew members shall have the following minimum qualifications:
(1) Recognition as a Pennsylvania licensed health professional or certification as an EMT-paramedic.
(2) Knowledge and skill in the application, operation, care and removal of on-board medical equipment used in the care of the patient, as well as knowledge of potential in-flight complications which may arise from the use of the equipment, and the treatment of these complications, as well as knowledge of flight physiology.
(3) Training in the use of extrication devices, rescue and survival techniques appropriate to the terrain and the conditions under which the service is operated.
(4) Knowledge of policies and procedures of the air ambulance service.
(5) Knowledge of safety operations in and around aircraft, and in-flight and post-flight aircraft accident and incident procedures.
(6) Knowledge of the use of the installed aircraft and portable communications equipment.]
§ 1003.43. [Air ambulance pilot] (Reserved).
[(a) Roles and responsibilities. A pilot employed and dispatched for air ambulance service flight shall have the following responsibilities:
(1) To assure that the aircraft is ready for flight at all times.
(2) To proceed expeditiously and as directly as possible to the flight destination considering weather, appropriate safety rules, noise abatement procedures, flight path and altitude clearances.
(3) To flight follow with the communications center at intervals not to exceed 15 minutes. If the aircraft is outside the radio range of the base communications center, adequate flight following shall be planned and executed.
(b) Minimum qualifications. Pilots employed and dispatched for air ambulance service flight shall:
(1) Meet FAA requirements for medical certification, licensing and aircraft type ratings pertaining to the flight, as specified at 14 CFR Part 135 (relating to air taxi operators and commercial operators).
(2) Be trained in, and familiar with, the Pennsylvania Emergency Medical Services Communications Systems within their service area.
(3) Be trained by the manufacturer in the operation of the specific type of aircraft, and have at least 5 hours of flying time in the aircraft before serving as pilot in command.
(4) Be specifically trained, and preferably experienced, in flying the terrain and conditions unique to the air ambulance service area.
(5) Possess recurrent training in accordance with FAA requirements found at 14 CFR 135.351 (relating to recurrent training).
(6) Hold a current rotorcraft certification with a minimum of 2,000 rotorcraft flight hours as pilot in command.]
§ 1003.44. [Air ambulance communications specialist] (Reserved).
[(a) Roles and responsibilities. Communications specialists who dispatch air ambulance service aircraft have the following responsibilities:
(1) To take emergency calls and dispatch appropriate air ambulance services to respond to the emergency.
(2) To document the following information:
(i) Time of initial and subsequent air ambulance request calls.
(ii) Name of party or agency requesting the air ambulance service and a verification phone number.
(iii) Pertinent patient medical information.
(iv) Names of referring and receiving physicians at hospitals.
(v) Landing and destination sites.
(vi) The details of needed ground transportation arrangements at pick-up and landing sites.
(vii) Times and reasons for aborted or missed flights.
(viii) Details of coordination with ground personnel for landing and receipt of the aircraft.
(ix) Other data pertinent to the service's specific needs for completing activity review reports.
(b) Minimum qualifications. Air ambulance communications specialists shall have training commensurate with the scope of responsibility given them by the particular dispatch center.]
CHAPTER 1005. LICENSING OF BLS AND ALS GROUND AMBULANCE SERVICES § 1005.1. General provisions.
(a) This chapter applies to ground ambulance services. [No] person, or other entity, as an owner, agent or otherwise, may not operate, conduct, maintain, advertise or otherwise engage in or profess to be engaged in providing a BLS or ALS ambulance service upon the highways or in other public places in this Commonwealth, unless that person holds a current valid license as a BLS or ALS ambulance service issued by the Department [unless exempted by] or is from these prohibitions under the act.
(b) The Department will license an [ambulance service] applicant as a BLS or ALS ambulance service, or both, when it meets the requirements of the act and this part.
(c) An ALS ambulance service may [be licensed to provide ALS under medical command and direction, in one or more] employ either or both of the following [modes] types of ambulances:
(1) A mobile intensive care unit vehicle, which is a [unit] vehicle that [responds and transports seriously ill or injured] is designed, constructed, equipped and maintained or operated to provide emergency medical care to and transportation of patients.
(2) An ALS squad unit vehicle, which is a vehicle that is specifically modified and equipped, and is maintained or operated for the purpose of transporting ALS prehospital personnel and equipment to the scene of an emergency.
[(3) An ALS transport service, which is a unit that transports patients between health care facilities/institutions.]
(d) In addition to the general requirements for exceptions in § 1001.4 (relating to exceptions), the Department may grant exceptions to regulatory licensure standards for ALS and BLS ambulance services that are licensed in a contiguous state if:
* * * * * § 1005.2. Applications.
(a) An application for [licensure] an original or renewal ambulance service licensure shall be submitted [by ambulance service providers] on forms prescribed by the Department. The application shall contain[, but not be limited to,] the following information as well as any additional information that may be solicited by the application form:
* * * * * (4) [Type and level] Level of service--ALS or BLS.
(5) [Service] The emergency service area [served--both primary and mutual-aid] the applicant commits to serve, or, alternatively, a statement that the applicant intends to engage primarily in interfacility transports.
(6) Personnel [work status--partially paid, fully paid or volunteer] roster and staffing plan.
(7) [Design types and the] The number and types (BLS, mobile intensive care unit, ALS squad unit) of ambulance vehicles to be operated by the [service] applicant, and identifying information relating to those ambulances.
* * * * * (9) Primary physical building location, and other building locations out of which it will operate ambulances or a full description of how its ambulances will be placed and respond to emergency calls if they will not be operated out of other building locations.
[(9)] (10) Statement attesting to the veracity of the application, which shall be signed by [a responsible person affiliated with] the principal official of the applicant.
(b) The [ambulance service] applicant shall [complete and] submit the application to the regional EMS council [in whose jurisdiction] exercising responsibility for the EMS region in which the [service is located] applicant will station its ambulances if licensed.
(1) The regional EMS council shall review the application for completeness[,] and accuracy [and conformance with regional EMS plans and protocols.
(2) Complete applications shall be forwarded to the Department by the regional EMS council within 14 days of receipt.]
(3)] (2) Incomplete applications shall be returned by the regional EMS council to the applicant within 14 days of receipt.
(c) Upon receipt of a complete application, the [Department] regional EMS council will schedule and conduct an onsite inspection of the applicant's [service] vehicles, equipment and personnel qualifications, as well as other matters that bear upon whether the applicant satisfies the statutory and regulatory criteria for licensure. The inspection shall be performed within 45 days after receipt by the [Department] regional EMS council of the completed application.
(d) An ambulance service shall submit a change of vehicle form to the regional EMS council within 10 days after placing a new ambulance in service, and may continue to operate the ambulance unless its authority to do so is disapproved by the Department following inspection.
(e) An ambulance service shall apply for and secure an amendment of its license prior to substantively altering the location or operation of its ambulances in an EMS region, such as a change in location or operations which would not enable it to timely respond to emergencies in the emergency service area it committed to serve when it applied for a license. The application for an amendment of an ambulance service license shall be submitted to the regional EMS council on a form prescribed by the Department.
§ 1005.3. Right to enter [and], inspect and obtain records.
(a) Upon the request of an employe or agent of the Department during regular and usual business hours, or at other times when that person possesses a reasonable belief that violations of this part may exist, a licensee shall:
* * * * * (2) Produce for inspection [personnel and other employment], permit copying and provide within a reasonable period of time, records that pertain to [certification of] personnel and their qualifications, staffing, equipment [and mutual aid agreements], supplies and policies and procedures required under § 1005.10 (relating to licensure and general operating standards).
(3) Permit the [agent] person to examine vehicles, required equipment and [recordkeeping] supplies and security facilities [for information collected under § 1001.41].
(b) The Department's [agent] representative shall advise the licensee that the inspection is being conducted under section 12(k) of the act (35 P. S. § [6938] 6932k) and this chapter.
(c) [The Department reserves the right to enter and make inspections at least quarterly, and at other times upon complaint or a reasonable belief that violations of this part may exist.
(d)] Failure of a licensee to produce records [for inspection] or to permit an examination [of equipment and facilities] as required by this section constitutes misconduct in operating the ambulance service and shall be grounds for [suspension, revocation] disciplinary sanctions or denial of license.
§ 1005.4. Notification of deficiencies to applicants.
(a) [Within 30 days of an inspection,] Upon completion of the license inspection the inspector shall provide the applicant for an ambulance service license [and the regional EMS council shall be notified as to] an inspection report specifying the results of the inspection.
(b) If the [Department has determined] inspector determines that deficiencies warrant a reinspection, the [Department will give written notice to the applicant and the regional EMS council of the deficiencies] inspector shall give the ambulance service written notice of the matters to be reinspected.
(c) [The] If the type of deficiency requires a plan of correction, the applicant shall have 30 days in which to [respond to the Department] provide the inspector with a plan to correct the [deficiencies] deficiency. [The Department will review the plan of correction, and, if] If the plan is found to be acceptable, the [Department] inspector will [make an onsite] conduct a reinspection in accordance with the time frame given in the plan of correction.
(d) [Within 30 days of the reinspection, the Department will give written notice to the applicant and the regional EMS council of the results of the reinspection.] If the applicant disagrees with any deficiency cited by the inspector following the inspection or reinspection, or the regional EMS council's rejection of a plan of correction, the applicant shall apprise the Department of the matter in dispute, and the Department will resolve the dispute.
(e) [When the applicant meets the requirements of this part, the Department will proceed with the licensure process.] The Department will act upon the license application within 30 days after the inspection process has been completed.
§ 1005.5. Licensure.
(a) A license to operate as an ambulance service will be issued by the Department when it has [been] determined that requirements for licensure have been met.
(b) A license certificate will [indicate] specify the name of the ambulance service, its license number, the address of its primary headquarters, the [date] dates of issuance and expiration, the levels of service the ambulance service [provider] is authorized to provide and the name of the regional EMS council through which the license application was processed. If the ambulance service is an ALS ambulance service, the license certificate will also specify the types of ALS ambulance the ambulance service has been authorized to use.
(c) [A license shall be issued for each level of service being provided by the licensee. The issuance of a license for both BLS and ALS shall be determined by the contents of the application, and with the concurrence of the regional EMS council, within whose jurisdiction the applicant is located or headquartered.
(d)] The current license certificate shall be displayed in a public and conspicuous place in the ambulance service's [quarters] primary headquarters.
[(e)] (d) An ambulance [vehicle of an ambulance service] shall be identified by a decal issued by the Department which shall be considered part of its license and which shall be applied to the outside of the [vehicle] ambulance in a conspicuous place.
[(f) A] (e) An ambulance decal issued by the Department may not be displayed on a vehicle by [a service] an entity not [currently] licensed as an ambulance service by the Department.
[(g)] (f) ***
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