[29 Pa.B. 903]
[Continued from previous Web Page] § 1005.6. Out-of-State providers.
Ambulance services located or headquartered outside of this Commonwealth that [have primary response areas or routinely transport] regularly engages in the business of providing emergency medical care and transportation of patients from within this Commonwealth, to facilities within or outside this Commonwealth, are required to be inspected and licensed by the Department.
§ 1005.7. Services owned and operated by hospitals.
[Ambulance services owned and operated by a] A hospital[,] licensed under Chapter 8 of the Health Care Facilities Act (35 P. S. §§ 448.801--448.820) [are] is not required to obtain a separate ambulance service license to [provide] own and operate an ambulance service. [These] An ambulance [services are] service owned and operated by a hospital is subject to the act and this part, and shall be inspected under this part, regardless of whether the hospital secures a license to operate as an ambulance service.
§ 1005.7a. Renewal of ambulance service license.
(a) The Department will notify the ambulance service to renew its license at least 120 days prior to the expiration date of the license.
(b) An ambulance service shall apply for renewal of its license between 120 days and 60 days prior to the expiration of its license. Failure to apply for renewal in a timely manner may result in the applicant not securing a renewal of its license before the prior license expires.
(c) The criteria for license renewal are the same as the requirements that would apply for original licensure at the time the renewal application is made.
§ 1005.8. Provisional [licenses] license.
(a) [The] If an ambulance service or an applicant for an ambulance service license fails to meet licensure requirements, the Department may issue it a provisional license, valid for a specific time period of not more than 6 months, when the Department [finds that an ambulance service:] deems it is in the public interest to do so.
(b) The Department may renew a provisional license once, for a period not to exceed 6 months except when a longer period of renewal is permitted under subsection (c), if:
(1) [Has] The ambulance service has substantially, but not completely, complied with applicable requirements for licensure.
(2) [Is complying] The ambulance service is making a good faith effort to comply with a course of correction approved by the Department.
(3) [Has existing deficiencies that will not adversely affect the health, welfare or safety of citizens of this Commonwealth.] The Department deems it is in the public interest to do so.
[(b) A provisional license may be renewed for 6 months if the Department determines that the ambulance service is making a good faith effort to correct existing deficiencies and it is in the public interest to do so.]
(c) The Department may renew a provisional BLS ambulance service license for [a period of] 12 months for a volunteer [fire department or a volunteer] ambulance service, or a volunteer fire department or rescue service that operates an ambulance service, which does not meet the minimum standards for staffing at the [basic life support] BLS level of care, but meets the other requirements of this chapter.
§ 1005.9. Temporary [licensure] license.
When [a new or existing ALS service] an ALS ambulance service or an applicant for an ALS ambulance service license cannot provide service 24 [hours a day] hours-a-day, 7 [days a week] days-a-week, the Department may issue a temporary license for operation of the ALS ambulance service when the Department deems it is in the public interest to do so. The temporary license is valid for 1 year and may be renewed once.
§ 1005.10. Licensure and general operating standards.
(a) Documentation requirements. An applicant for an ambulance service license shall have the following documents available for the inspection by the Department:
(1) [Roster] A roster of active personnel, including certification and recognition documentation with dates of expiration and identification numbers, and its process for scheduling staff to ensure that the minimum staffing requirements in subsection (d) are met.
(2) Copies of prehospital ambulance [trip] call reports or other formats on which those records are kept on patients treated or transported[, or both, during the 3-month period prior to the inspection date], if applicable.
(3) Call volume records from the previous year's operations, if applicable. These records shall include a record of each call received requesting the ambulance service to respond to an emergency, as well as a notation of whether it responded to the call and the reason if it did not respond.
(4) [Copies of mutual-aid agreements with other ambulance services which service the applicant's community or applicant's service area.] A record of the time periods for which the ambulance service notified the PSAP that it would not be available to respond to a call.
(5) Copies of all written policies required by this section.
(b) [Vehicle] Ambulance standards. [Ambulance] For ambulance vehicles which transport patients [and were purchased after June 1, 1985, shall at the time of purchase or acquisition meet or exceed the Federal Specification KKK-A-1822, and amendments and revisions thereto, Section 1.2.1 Ambulance Types, Classes and Floor Plans and Section 3.1 General Vehicular Design Types and Floor Plans or other National standards as recognized and approved by the Department. Ambulance vehicles purchased before June 1, 1985], the ambulance service will be required to show evidence that the vehicle has met [the requirements of the Federal Specification KKK-A-1822] 75 Pa.C.S. §§ 4571 and 4572 (relating to visual and audible signals on emergency vehicles; and visual signals on authorized vehicles) and 67 Pa. Code Chapter 173 (relating to flashing or revolving lights on emergency and authorized vehicles) and the Federal KKK standards which were in effect at the time of [vehicle] vehicle's manufacture [or that the vehicle met the requirements of the Department's Voluntary Ambulance Certification Program VASC) at the time of VASC Certification] and which are not inconsistent with the standards in 75 Pa.C.S. §§ 4571 and 4572. These specifications will be for ambulance design types, floor plans and general configuration. An ALS squad unit vehicle is not subject to the Federal KKK standards; however, it is required to meet the standards in 75 Pa.C.S. §§ 4571 and 4572.
(c) Equipment and supplies. [Approved] Required equipment and supplies shall be carried and readily available in working order for use on BLS and ALS vehicles.
(1) BLS and ALS vehicles shall carry [BLS] medical equipment and supplies as [specified by the Department.
(2) The minimum list of equipment and supplies for BLS and ALS vehicles will be] published by the Department in the Pennsylvania Bulletin on an annual basis, or more frequently.
[(3)] (2) An ALS squad unit vehicle is exempt from the requirement of carrying patient litters and equipment which is permanently installed.
[(4) ALS vehicles and ALS squad units shall carry ALS medical equipment, supplies and drugs as prescribed by the Department.
(5)] (3) A BLS [services] ambulance service may carry ALS equipment and drugs [for use by the], in addition to those generally prescribed for use by a BLS ambulance service, only if it has a physician [affiliated with the service as long as the physician] medical director who has education and continuing education in ALS and prehospital care, and who is directly responsible for security, accountability, administration and maintenance of the equipment and drugs, [and when the service is approved to operate in this manner by the regional EMS council and the Department] if the arrangement is authorized by the Department upon its determination that the arrangement is in the public interest.
(d) Personnel requirements.
(1) Minimum staffing requirements.
(i) BLS unit. [Minimum staffing standards for ambulance services that operate at the BLS level of care shall be as follows:
(A) Ambulances,] A BLS ambulance, when transporting a patient, except for when engaging in the routine transfer of convalescent or other nonemergency cases, shall be staffed by at least two persons, [who] one of whom shall be an EMT, EMT-paramedic or health professional, and one of whom shall, at least, qualify as an ambulance [attendants] attendant. [At least one attendant] An EMT, EMT-paramedic or a health professional shall accompany the patient in the patient compartment of the ambulance during transport. [Ambulance personnel between 16--18 years of age shall be directly supervised by an adult crew member with equal or greater training during patient treatment and transport.
(B) Effective July 1, 1990, ambulances, when transporting patients, except for routine transfer of convalescent or other nonemergency cases, shall be staffed by at least two persons, one of whom shall be an EMT, EMT-paramedic or health professional, and one of who shall, at least, qualify as an ambulance attendant. The patient shall be accompanied in the patient compartment by the crew member with the highest level of certification.]
(ii) ALS units. Minimum staffing standards for an ambulance [services] that [operate] is operating at the ALS level of care shall be as follows:
* * * * * (C) An ALS squad unit meets minimum staffing requirements by transporting an EMT-paramedic or health professional to rendezvous with a BLS ambulance, and having the EMT-paramedic or health professional provide emergency medical treatment to, and accompany on the BLS ambulance during transport, a patient requiring ALS care.
(D) Minimum ALS staffing standards apply to the ALS ambulance service 24 hours-a-day, 7 days-a-week. An ALS mobile intensive care unit, itself, need only satisfy BLS ambulance staffing requirements under subparagraph (i) when responding to a call for BLS assistance exclusively. If the nature of the assistance requested is unknown, the mobile intensive care unit shall respond as if the patient requires ALS care.
(iii) All units. Minimum staffing standards are satisfied when an ambulance service has a duty roster that identifies staff who meet minimum staff criteria and who have committed themselves to be available at the specified times, and when minimum required staff are present during the emergency medical treatment and transport of a patient.
(2) ALS service medical director. A [licensed] An ALS ambulance service shall have an ALS medical director whose duties include the following:
* * * * * (ii) Making medical command authorization determinations for EMT-paramedics and prehospital registered nurses as set forth in § 1003.28 (relating to medical command authorization).
(iii) Reviewing the medical command authorization status of EMT-paramedics and prehospital registered nurses utilized by the ALS ambulance service as set forth in § 1003.28 at least once annually.
* * * * * (3) Ambulance drivers. [A] An ambulance service shall ensure that a person who drives an ambulance for that service is a responsible person. Notwithstanding other considerations that may bear upon whether a driver of an ambulance is a responsible person, a person who drives an ambulance [vehicle] for [a licensed] an ambulance service [shall] will not be considered to be a responsible person unless that individual:
(i) [Be] Is at least 18 years of age.
(ii) [Hold] Has a valid driver's license.
(iii) [Observe relevant] Observes all traffic laws.
(iv) [Not be] Is not addicted to, or under the influence of, alcohol or drugs.
(v) [Be] Is free from physical or mental defect or disease that may impair the person's ability to drive an ambulance.
[(vi) Not have been convicted within the last 4 years of driving under the influence of alcohol or drugs, and, within the last 2 years, not have been convicted of reckless driving or have had a driver's license suspended under the point system. Persons who have been convicted of one or more of these violations shall repeat an emergency vehicle operator's course of instruction approved by the Department.
(vii) Take and] (vi) Has successfully [complete] completed an emergency vehicle operator's course of instruction[,] approved by the Department[, within 3 years of course approval. Personnel who have completed an emergency vehicle operator's course of instruction acceptable to the Department by July 1, 1992, shall be deemed to be in compliance with this requirement.]
(vii) Has not been convicted within the last 4 years of driving under the influence of alcohol or drugs, or, within the last 2 years, has not been convicted of reckless driving or had a driver's license suspended. The person will not be considered to be a responsible person until the designated time has elapsed and the individual, after the conviction or suspension of license, repeats an emergency vehicle operator's course of instruction approved by the Department.
(e) [Coverage agreement.
(1) A licensed ambulance service shall have a written agreement with one or more neighboring ambulance services for coverage during times when its own ambulance is not available for service in its primary response area. The agreement shall specify the respective duties, responsibilities and coverage times of the parties involved and shall be filed with the Department.
(2) An ambulance service which is unable to provide 24-hours-a-day, 7-day-a-week services shall provide for alternate ambulance service either through a mutual aid agreement or other type of contract as approved by the regional EMS council.
(3) When a licensed ambulance service does not have an ambulance enroute to a reported emergency call within 10 minutes of the time of dispatch, the call shall be referred to the closest available ambulance service. Once a request for service has been referred to another service, if the referring service is subsequently able to initiate a response which will access the patient more quickly than the service to which the request was referred, the service which can access the patient most quickly shall respond.]
Communicating with PSAPs.
(1) Responsibility to communicate unavailability. An ambulance service shall apprise the PSAP in its area as to when it will not be in operation and when its resources are committed so that it will not be able to have an ambulance and required staff respond to a call requesting it to provide emergency assistance.
(2) Responsibility to communicate delayed response. An ambulance service shall apprise the PSAP, as soon as practical after receiving a dispatch call, if it is not able to have an ambulance and required staff immediately en route to an emergency.
(3) Responsibility to communicate with PSAP generally. In addition to the communications required by paragraphs (1) and (2), an ambulance service shall provide a PSAP with information, and otherwise communicate with a PSAP, as the PSAP requests to enhance the ability of the PSAP to make dispatch decisions.
(4) Response to dispatch by PSAP. An ambulance service shall respond to a call for emergency assistance as communicated by the PSAP.
(f) [Policy and procedures. An ambulance service shall establish written policies and procedures governing the function of personnel, the operation of ambulances and the provision of EMS. The policies shall be available for inspection by the Department and shall address the following topics:
(1) Recordkeeping. An ambulance service shall have a written policy requiring responding ambulance personnel to complete a prehospital ambulance trip report on forms provided by the Department for each ambulance call to which the service responds.
(2) Scene control. An ambulance service shall establish a written policy on scene control directing prehospital personnel as follows:
(i) Control of all aspects of patient management at an emergency scene shall be the responsibility of the individual in attendance who has the highest level of EMS certification/recognition. For the purposes of this section, level of certification/recognition, shall be as follows:
(A) 1--Health professional.
(B) 2--EMT-paramedic.
(C) 3--EMT.
(D) 4--First responder.
(E) 5--Ambulance attendant.
(ii) If a prehospital care provider is not available, the authority is vested in the most appropriately trained representative of a public safety agency at the scene of the emergency.]
(f) Patient management. All aspects of patient management are to be handled by a prehospital practitioner with the level of EMS certification or recognition necessary to care for the patient based upon the condition of the patient.
[(3)] (g) Use of lights and other warning devices. [Ambulance services shall establish a policy covering the use of warning devices which includes the following requirements:
(i)] Ambulances [responding to an incident scene or to an emergency care facility] may use emergency lights or audible warning devices, or both, [for cases] only when transporting or responding to a call involving [patients with life-threatening or potentially life-threatening illnesses or injuries] a patient who presents or is in good faith perceived to present a combination of circumstances resulting in a need for immediate medical intervention. When transporting the patient, the need for immediate medical intervention must be beyond the capabilities of the ambulance crew using available supplies and equipment.
[(ii) Ambulances responding to the incident scene or to an emergency care facility may not use emergency lights and audible warning devices for cases involving patients that do not have life-threatening or potentially life-threatening illnesses or injuries.
(4)] (h) Weapons and explosives. [Ambulance services shall establish a written policy directing that weapons] Weapons and explosives may not be worn by ambulance personnel or carried aboard an ambulance. This [section] subsection does not apply to law enforcement officers who are serving in an authorized law enforcement capacity.
(i) Accident, injury and fatality reporting. An ambulance service shall report to the appropriate regional EMS council, in a form or manner prescribed by the Department, an ambulance vehicle accident that is reportable under 75 Pa.C.S. (relating to Vehicle Code), and an accident or injury to an individual that occurs in the line of duty of the ambulance service that results in a fatality, or medical treatment at a facility. The report shall be made within 24 hours after the accident or injury. The report of a fatality shall be made within 8 hours after the fatality.
(j) Medical command notification. An ALS ambulance service shall identify, to the regional EMS council having responsibility in the region out of which it operates, the prehospital personnel used by it that have medical command authorization in the region for that ALS ambulance service. It shall also notify the regional EMS council when a prehospital practitioner loses medical command authorization for that ALS ambulance service.
(k) Monitoring compliance. An ambulance service shall monitor compliance with the requirements that the act and this part impose upon the ambulance service and its staff.
(l) Policies and procedures. An ambulance service shall maintain written policies and procedures addressing each of the requirements imposed by this section, as well as the requirements imposed by §§ 1001.41, 1001.42, 1001.65 and 1005.11 and shall also maintain written policies and procedures addressing infection control, management of personnel safety, and the placement and operation of its ambulances.
§ 1005.11. [Medication] Drug use, control and security.
(a) [A licensed ALS] An ambulance service may stock [certain approved] drugs [and medications for emergency medical purposes, under written authorization by the medical director of a regional EMS council,] as approved by the Department, and shall carry drugs in an ambulance in conformance with the [ALS plan for the service's area] transfer and medical treatment protocols applicable in the region in which its ambulance is stationed. Additional drugs may be stocked by an ALS ambulance service as authorized by the ALS service medical director if the ALS ambulance service uses health professionals, and additional drugs may be carried or brought on an ambulance as follows:
(1) Drugs which the applicable regional transfer and medical treatment protocols prescribe for the treatment of an ALS patient may be brought on a BLS ambulance by an EMT-paramedic or health professional when rendezvousing with a BLS ambulance to treat an ALS patient on behalf of an ALS ambulance service.
(2) Drugs other than those authorized by the applicable regional transfer and medical treatment protocols may also be carried on an ALS ambulance, or brought on board a BLS ambulance by a health professional, when the requirements of subsection (d)(2) are satisfied.
(3) Drugs other than those authorized by the applicable regional transfer and medical treatment protocols may also be carried on an ALS ambulance, or brought on board a BLS ambulance by a registered nurse, physician assistant or physician when the following standards are met:
(i) The ambulance is engaged in an interfacility transport.
(ii) The physician, registered nurse or physician assistant has special training required for the continuation of treatment provided to the patient at the facility, and the use of drugs not maintained on the ambulance is or may be required to continue that treatment.
(iii) The physician, registered nurse or physician assistant does not substitute for required staff.
(4) A BLS [services] ambulance service, if not also licensed as both an ALS and BLS ambulance service, may not [possess] stock drugs [or medications] which are not prescribed by the Department for use by a BLS ambulance, and a BLS ambulance service may not carry the drugs, except as authorized under this section and § 1005.10(c)[(5)](3) (relating to licensure and general operating standards).
(b) The Department will publish at least annually by notice in the Pennsylvania Bulletin a list of drugs [and medications] approved for use by [licensed ALS] ambulance services when also permitted by the applicable regional transfer and medical treatment protocols.
(c) [For purposes of emergency administration, a licensed ALS unit] An ambulance service may [have possession of certain designated controlled substances and other] procure and replace drugs, [as approved and published by the Department on an annual basis through an appropriate service contract or written affiliation with] from a hospital, pharmacy or from a participating and supervising physician, if not otherwise prohibited by law. [ Responsibility for drugs and controlled substances remains with the original dispensing physician, hospital or pharmacy of record. Replacement of designated controlled substances and other drugs may be obtained from a dispensing physician, hospital, or pharmacy of record if subsections (j) and (k) are followed.]
(d) Administration of drugs [and medications] by prehospital personnel, other than those approved for use by a BLS ambulance service, shall be restricted to [ALS personnel] EMT-paramedics and health professionals who have been authorized to administer [medication] the drugs by the [regional] ALS service medical director, when under orders of a medical command physician[, regional] or pursuant to standing orders in the EMS region's transfer and medical treatment [protocol or standing orders protocols]; except all prehospital personnel other than a first responder and an ambulance attendant may administer to a patient, or assist the patient to administer, drugs previously prescribed for that patient, as specified in the Statewide BLS medical treatment protocols.
(1) An EMT-paramedic is restricted to administering drugs permitted by the applicable regional transfer and medical treatment protocols and the Statewide BLS medical treatment protocols.
(2) A health professional may administer drugs in addition to those permitted by the applicable regional transfer and medical treatment protocols and the Statewide BLS medical treatment protocols, provided the health professional has received approval to do so by the ALS service medical director of the ambulance service, and has been ordered to administer the drug by the medical command physician.
(e) [Areas of control including labeling, adulteration, misbranding, checking expiration dates and storage shall be adhered to by the practitioner who has responsibility for the drugs as is required under The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. §§ 780-101--780-144). The original dispensing practitioner to ALS units as identified on the ambulance service license application will examine drug stock to insure product quality and will reconcile the inventory of drugs a minimum of once a month for supply and administration records.] The ambulance service shall adequately monitor and direct the use, control and security of drugs provided to the ambulance service. This includes:
(1) Ensuring proper labeling and preventing adulteration or misbranding of drugs, and ensuring drugs are not used beyond their expiration dates.
(2) Storing drugs as required by The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. §§ 780-101--780-144), and as otherwise required to maintain the efficacy of drugs and prevent their misappropriation.
(3) Including in the ambulance call report information as to the administration of drugs by patient name, drug identification, the date and time of administration, the manner of administration, dosage, the name of the medical command physician who gave the order to administer the drug and the name of person administering the drug.
(4) Maintaining records of drugs administered, lost or otherwise disposed of, and records of drugs received and replaced.
(5) Providing the pharmacy, physician or hospital that Is requested to replace a drug, with a written record of the use and administration, or loss or other disposition of the drug, which identifies the patient and includes any other information required by law.
(6) Ensuring, in the event of an unexplained loss or theft of a controlled substance, that the dispensing pharmacy, physician or hospital has contacted local or State police and the Department's Drugs, Devices and Cosmetics Office, and has filed a DEA Form 106 with the Federal drug enforcement administration.
(7) Arranging for the original dispensing pharmacy, physician or hospital, or its ALS service medical director, to provide it consultation and other assistance necessary to ensure that it meets the requirements of this section.
[(f) When drugs are administered, records shall verify the administration of the drug by patient name, drug identification, date and time of administration; dosage, name of physician who provided medical command and name of person administering the drug.
(g) When drugs are administered, an adequate record of use shall be maintained for a minimum of 2 years by the involved parties. Variations in maintaining records are acceptable; however, a process shall be in effect which provides for the written verification of medication orders. Records shall be kept by each licensed service of drugs distributed, supplied and resupplied to them, and be made available to the Department for inspection upon demand.
(h) Drugs and medications administered by a licensed or certified EMT-paramedic or health professional shall be maintained and controlled in conformity with The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. §§ 780-101--780-144) and the Pharmacy Act (63 P. S. §§ 390-1--390-13).
(i) A physician giving a medical command to an EMT-paramedic or health professional to administer a drug shall first identify the drug and then specify the dosage and the manner of administration.
(j) When a Schedule II controlled substance has been ordered and administered, the prescribing physician shall, within 72 hours, forward a signed prescription to the dispensing/replacing pharmacy, hospital or physician. The prescription for the controlled substance shall include the information required by law and the physician's DEA number.
(k) A hospital, physician or pharmacy may replace a drug, controlled substance or legend device to a licensed ambulance service upon presentation of a written record of use and administration. This written record shall include information required by law and patient identification.
(l) No licensed ambulance service may purchase or acquire legend drugs and controlled substances except as provided for in subsection (c).
(m) In the event of an unexplained loss or theft of controlled drugs, a dispensing hospital/pharmacy or physician shall contact local or State police or the State Bureau of Drug Control. In addition, a DEA Form 106 shall be filed with the Federal Drug Enforcement Administration.]
§ 1005.12. [Grounds for suspension, revocation or refusal of an ambulance service license] Disciplinary and corrective actions.
(a) The Department may, in compliance with proper administrative procedure, reprimand, or suspend, revoke or refuse to issue a license, or issue a provisional or temporary license as permitted by §§ 1005.8 and 1005.9 (relating to provisional license; and temporary license) for the following reasons:
(1) A serious violation of the act or this part. A serious violation is one which poses a continued significant threat to the health and safety of the public.
* * * * * (4) Fraud or deceit in obtaining or attempting to obtain a license [or permit].
* * * * * (8) Failure to have appropriate medical equipment and supplies required for licensure as identified in § 1005.10(c) (relating to licensure and general operating standards).
(9) Failure [to staff a sufficient number of certified or licensed personnel to provide service 24 hours a day, 7 days a week, or failure to provide agreements as per § 1005.10(e)(2)] of an ALS ambulance service to staff a sufficient number of qualified EMS personnel to provide service 24 hours-a-day, 7 days-a-week in accordance with required staffing standards.
* * * * * (15) Refusal to render EMS because of a patient's race, sex, creed, [National] national origin, sexual preference, age, handicap, medical problem or financial inability to pay.
(16) Failure to comply with the regional EMS council transfer and medical treatment protocols[, plans, policies and procedures] which have been approved by the Department.
* * * * * (18) [A consistent pattern of a failure to respond to emergency calls within a 10 minute time period.] Repeated failure by an ambulance service to communicate with the PSAP or comply with the dispatch communication as required by § 1005.10(e).
[(19) Other reasons as determined by the Department to pose a significant threat to the health and safety of the public.]
(b) Upon receipt of a written complaint describing [specific violations of the ambulance regulations] conduct for which the Department may take disciplinary action against an ambulance service, the Department will:
* * * * * (2) [Notify] Provide the ambulance service with a copy of the [charges] complaint and [ investigation procedures] request a response unless the Department determines that disclosure to the ambulance service of the complaint will compromise the investigation or would be inappropriate for some other reason.
(3) [Conduct and develop] Develop a written report of the investigation.
(4) Notify the [ambulance service] complainant of the results of the investigation of the complaint, as well as the ambulance service if the ambulance service has been officially apprised of the complaint or investigation. This notification does not include providing a copy of the written report developed under paragraph (3).
(c) [The Department will immediately suspend, after a hearing has been held, the license for the violations specified in subsection (a)(1), (6), (11), (15) and (17). This suspension shall be for a period of up to 90 days. A second offense of these enumerated violations during the same license period shall result in the automatic revocation of the license.
(1) The Department will suspend the license for other violations for a period to be determined by the Department. The Department may revoke a license for repeated violations.
(2) Upon suspension or revocation of an ambulance license, the service shall cease operations and no person may permit or cause the service to continue.
(3)] The Department will provide public notification of [suspension or revocation of] the sanction it imposes upon an ambulance service license.
§ 1005.13. Removal of ambulances from operation.
(a) When a vehicle manifests evidence of a mechanical or equipment deficiency which poses a significant threat to the health or safety of patients or crew, [it] the ambulance service shall [be] immediately [suspended] suspend the vehicle from operation. No vehicle, which has been suspended from operation, may be operated as an ambulance until the deficiency has been corrected.
(b) When a vehicle, upon examination by the Department, manifests evidence of a mechanical or equipment deficiency which poses a significant threat to the health or safety of patients or crew, it shall be immediately suspended from operation as directed by the Department. No vehicle, which has been suspended from operation by the Department, may be operated as an ambulance until the Department has certified that the deficiency has been corrected.
§ 1005.14. Invalid coaches.
* * * * * (b) The terms ''ambulance,'' ''emergency[,]'' or other similar designations may not be used by invalid coaches. Invalid coaches may not be equipped with emergency warning devices, audible or visible, such as flashing lights, sirens, air horns or other devices except those which are required by 75 Pa.C.S. [§§ 101--9910] (relating to [the] Vehicle Code).
§ 1005.15. Discontinuation of service.
An ambulance service may not discontinue service, except upon order of the Department, without providing each regional EMS council, PSAP and the chief executive officer of each political subdivision within its service area 90 days advance notice. The ambulance service shall also advertise notice of its intent to discontinue service in a newspaper of general circulation in its service area at least 90 days in advance of discontinuing service, and shall provide the Department with written notice that it has met these responsibilities at least 90 days in advance of discontinuing service.
CHAPTER 1007. LICENSING OF AIR AMBULANCE SERVICES--ROTORCRAFT § 1007.1. General provisions.
(a) [Except as provided in subsection (c), no agency or] This chapter applies to air ambulance services. No person [either], or other entity, as owner, agent or otherwise, may furnish, operate, conduct, maintain, advertise, engage in or profess to engage in providing an air ambulance service in this Commonwealth, unless the agency or person holds a [current valid] license as an air ambulance service issued by the Department or is exempted from these prohibitions under the act.
(b) The Department will license an applicant as an air ambulance service when it meets the requirements of the act and this part.
(c) [Air ambulance services operated by hospitals] A hospital licensed under Chapter 8 of the Health Care Facilities Act (35 P. S. §§ 448.801--448.820) [are] is not required to obtain a separate air ambulance service license to own and operate an air ambulance service. [The] An air ambulance service owned and operated by a hospital is subject to the act and this part, and shall be inspected under this part, regardless of whether the hospital applies for or secures licensure as an air ambulance service.
(d) The Department will issue a [permit] certificate acknowledging a hospital's authority to own and operate an air ambulance [services operated by hospitals] service if the hospital chooses to operate an air ambulance service without securing a separate license to do so.
(e) Sections 1005.3--1005.5, 1005.7a, 1005.8, 1005.9, 1005.11, 1005.13 and 1005.15, which apply to ground ALS ambulance services, also apply to air ambulance services.
§ 1007.2. Applications.
(a) [An application for a license to operate an air ambulance service may be obtained from the Pennsylvania Department of Health, Division of Emergency Medical Services, Post Office Box 90, Harrisburg, Pennsylvania 17108.
(b)] An application for an original or renewal license to operate as an air ambulance service shall [be submitted to the Department and shall] contain the following information, as well as any additional information that may be solicited by the application form:
(1) The name and address of the [vendor of the air ambulance service or proposed ambulance service] applicant and the name [and address], if different, under which the [service will be operating] applicant intends to operate.
(2) The [name, address and] FAA certification number of the aircraft operator.
(3) [The experience and qualifications of the applicant to operate an air ambulance service] The type of organization--profit or nonprofit.
(4) A description of each aircraft to be used as an air ambulance, including the make, model, year of manufacture, FAA registration number, name, monogram or other distinguishing designation and FAA air worthiness certification.
(5) The [geographical] intended emergency medical service area and the location and description of the places from which the air ambulance service is to operate.
(6) The name, training and qualifications of the air ambulance medical director[, who has responsibility for auditing the medical care provided by the air ambulance service].
(7) A personnel roster [of medical personnel] which includes level of certification [or], licensure and recognition, and a staffing plan.
* * * * * (9) [A statement in which the applicant agrees to provide patient specific data, as identified by the Department, to the Department] The communications access and capabilities of the applicant.
(10) [Other information the Department deems necessary and prescribes as part of the application] A statement attesting to the veracity of the application, which shall be signed by the chief executive officer.
(b) The applicant shall submit the application to the regional EMS council exercising responsibility for the EMS region in which the applicant will station its air ambulances if licensed.
(1) The regional EMS council shall review the application for completeness and accuracy.
(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 regional EMS council will schedule and conduct an onsite inspection of the applicant's air ambulances, 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 regional EMS council of the completed application.
(d) An air ambulance service shall apply for an amendment of its license and secure Department approval of the amendment prior to commencing the operation of an air ambulance not previously inspected and approved by the Department or substantively altering its plan for locating and operating air ambulances, except that if the air ambulance service is replacing an air ambulance, at the same location, it may operate the air ambulance immediately, apply for an amendment within 10 days, and continue to operate the air ambulance unless its authority to do so is disapproved by the Department following inspection.
§ 1007.3. [Licenses] ( Reserved).
[(a) Within 30 days of receipt of an appropriately completed application from the air ambulance service applicant, the Department will initiate the licensure process.
(b) The Department will issue a regular license to operate an air ambulance service after an onsite inspection and review conducted by the Department indicates that the applicant's service is in compliance with the act, this part, other applicable laws and the regional EMS plan for the areas to be served.
(c) An air ambulance license will be issued for 3 years from the date of issue and will remain valid for that period of time unless revoked or suspended by the Department. Annual inspections shall be conducted to assure compliance.
(d) Change of ownership requires reapplication for a license. An air ambulance service licensee shall file with the Department an application for renewal of the ambulance service license within 10 business days of acquisition of the service by the new owner.
(e) Change of aircraft operator requires submission of supplemental information to the Department within 10 business days of the effective date of the operator change. The licensee shall provide the Department with new information required under § 1007.2(b)(2), (4) and (7) (relating to applications). The Department may inspect the aircraft operator and each aircraft to assure compliance with appropriate provisions of this part before the license is renewed.
(f) Upon change of aircraft during the licensing period, another application for an air ambulance license shall be submitted to the Department on the form prescribed. If the change of aircraft is for a temporary period, not to exceed 30 days, the air ambulance service shall only notify the Department of the change and the reasons.
(g) The current license shall be posted in a conspicuous place in the air ambulance service's operations center and on or in the aircraft where it is clearly visible.]
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