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. Intermediate advanced life support ambulance service.
1027.35. Advanced life support ambulance service.
1027.36. Basic life support squad service.
1027.37. Intermediate advanced life support squad service.
1027.38. Advanced life support squad service.
1027.39. Critical care transport ambulance service.
1027.40. Air ambulance service.
1027.41. Special operations EMS services.
1027.42. Water ambulance service.§ 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 EMS vehicle 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 EMS vehicle crew. If more than one member of the EMS vehicle 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 EMS vehicle crew.
(6) If an EMS vehicle crew needs additional assistance in attending to the needs of a patient or patients, it shall contact a PSAP or its EMS agency dispatch center to request that assistance.
(7) Except as otherwise provided in this subpart, 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 vehicle 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.
Source The provisions of this § 1027.31 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
Cross References This section cited in 28 Pa. Code § 1027.41 (relating to special operations EMS services).
§ 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, intermediate ALS 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.
Source The provisions of this § 1027.32 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
§ 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 an ambulance 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 EMT.
(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 the requirements under § 1027.34 (relating to intermediate advanced life support ambulance service).
(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 ambulance 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 April 11, 2016, an ambulance attendant who has not yet secured certification as an EMR may substitute for an EMR.
(2) 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 a higher level EMS vehicle crew. If a BLS ambulance and a higher level EMS vehicle crew are dispatched to provide EMS for a patient, the following shall apply:
(1) 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 ambulance crew determines transport is needed, until higher level EMS is afforded by the arrival of a higher level EMS provider.
(2) Upon the arrival of a higher level EMS vehicle crew, the BLS ambulance shall continue transporting the patient or release the patient to be transported by the higher level EMS vehicle crew, consistent with the Statewide EMS protocols, as directed by the EMS provider exercising primary responsibility for the patient.
(3) The BLS ambulance crew shall reassume primary responsibility for the patient if that responsibility is relinquished back to that ambulance crew by the EMS provider of the higher level EMS vehicle crew who had assumed primary responsibility for the patient.
(4) A BLS ambulance and its ambulance 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.
(e) Application. For purposes of this section, the term ‘‘higher level EMS vehicle crew’’ means the EMS vehicle crew of an intermediate ALS ambulance, intermediate ALS squad vehicle, ALS ambulance, ALS squad vehicle or air ambulance.
Source The provisions of this § 1027.33 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
Cross References This section cited in 28 Pa. Code § 1027.34 (relating to intermediate advanced life support ambulance service); 28 Pa. Code § 1027.35 (relating to advanced life support ambulance service); and 28 Pa. Code § 1027.42 (relating to water ambulance service).
§ 1027.34. Intermediate advanced life support ambulance service.
(a) Purpose. An EMS agency that operates an intermediate ALS ambulance service employs one or more intermediate ALS ambulances staffed by an ambulance crew capable of providing medical assessment, observation, triage, monitoring, treatment and transportation of patients who require EMS at the AEMT level.
(b) Staffing. The minimum staffing for an intermediate ALS ambulance crew when responding to a call to provide EMS to a patient who requires EMS at the skill level of an AEMT is an EMS provider at or above the AEMT level, a second EMS provider at or above the EMR level and an EMSVO, except that only a two-person ambulance crew is required if the EMSVO is also one of the EMS providers and an EMS provider at or above the AEMT level is available to attend to the patient during patient transport. Responding ambulance crew members may arrive at the scene separately, but the ambulance shall be fully staffed at or above the minimum staffing level before transporting the patient.
(c) Providing EMS when dispatched with a lower level EMS vehicle crew. If an intermediate ALS ambulance and a lower level EMS vehicle crew are dispatched to provide EMS for a patient, the following shall apply:
(1) If the patient is assessed by the intermediate ALS ambulance crew to require EMS above the skill level at which the lower level EMS vehicle crew is operating, and requires 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, who will transport the patient. An appropriately certified member of the intermediate ALS ambulance crew shall attend to the patient during the transport. If the lower level EMS vehicle is used to transport the patient, the EMS provider in charge shall use the equipment and supplies on the lower level EMS vehicle, supplemented with the additional equipment and supplies, including medications, from the intermediate ALS ambulance.
(2) If at the scene or during transport by the lower level EMS vehicle crew, the EMS provider of the intermediate ALS ambulance crew who has assumed primary responsibility for the patient determines that the lower level EMS vehicle crew 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 lower level EMS vehicle crew.
(d) Providing EMS when dispatched with a higher level EMS vehicle crew. If an intermediate ALS ambulance and a higher level EMS vehicle crew are dispatched to provide EMS for a patient, the following shall apply:
(1) Intermediate ALS 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.
(2) Upon the arrival of a higher level EMS vehicle crew, the intermediate ALS ambulance shall continue transporting the patient or release the patient to be transported by the higher level EMS vehicle crew, consistent with the Statewide EMS protocols, as directed by the EMS provider exercising primary responsibility for the patient.
(3) The intermediate ALS ambulance crew shall reassume primary responsibility for the patient if that responsibility is relinquished back to that ambulance crew by the EMS provider of the higher level EMS vehicle crew who had assumed primary responsibility for the patient.
(e) Responding to a call for a patient who requires EMS below the AEMT level. When an intermediate ALS ambulance is employed to respond to a call to provide EMS to a patient who requires EMS 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).
(f) Application. For purposes of this section, the term ‘‘lower level EMS vehicle crew’’ means the EMS vehicle crew of a BLS ambulance or BLS squad vehicle. The term ‘‘higher level EMS vehicle crew’’ means the EMS vehicle crew of an ALS ambulance, ALS squad vehicle or air ambulance.
Source The provisions of this § 1027.34 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
Cross References This section cited in 28 Pa. Code § 1027.33 (relating to basic life support ambulance service); 28 Pa. Code § 1027.35 (relating to advanced life support ambulance service); and 28 Pa. Code § 1027.42 (relating to water ambulance service).
§ 1027.35. Advanced life support ambulance service.
(a) Purpose. An EMS agency that operates an ALS ambulance service employs one or more ALS ambulances staffed by an ambulance 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 an ALS ambulance crew when responding to a call to provide EMS to a patient who requires EMS above the skill level of an AEMT 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 ambulance 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 ambulance 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 lower level EMS vehicle crew. If an ALS ambulance and a lower level EMS vehicle crew 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 the highest level EMS provider of the lower level EMS vehicle crew who is present, that EMS provider shall assume primary responsibility for the patient.
(2) If the patient is assessed by the ALS ambulance crew to require EMS above the skill level at which the lower level EMS vehicle crew is operating, and requires 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, who will transport the patient. An appropriately certified member of the ALS ambulance crew shall attend to the patient during the transport. If the lower level EMS vehicle is used to transport the patient, that EMS provider shall use the equipment and supplies on the lower level EMS vehicle, supplemented with the additional equipment and supplies, including medications, from the ALS ambulance.
(3) If at the scene or during patient transport by the lower level EMS vehicle crew, the EMS provider of the ALS ambulance crew who has assumed primary responsibility for the patient determines that the lower level EMS vehicle crew 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 lower level EMS vehicle crew.
(d) Responding to a call for a patient who requires EMS at the AEMT level. When an ALS ambulance is employed to respond to a call to provide EMS to a patient who requires EMS at the skill level of an AEMT, the staffing and responsibilities of the ambulance crew are the same as set forth in § 1027.34 (relating to intermediate advanced life support ambulance service).
(e) Responding to a call for a patient who requires EMS below the AEMT level. When an ALS ambulance is employed to respond to a call to provide EMS to a patient who requires EMS 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).
(f) Application. For purposes of this section, the term ‘‘lower level EMS vehicle crew’’ means the EMS vehicle crew of a BLS ambulance, BLS squad vehicle, intermediate ALS ambulance or intermediate ALS squad vehicle.
Source The provisions of this § 1027.35 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
Cross References This section cited in 28 Pa. Code § 1027.42 (relating to water ambulance service).
§ 1027.36. Basic life support squad service.
(a) Purpose. A BLS squad vehicle transports EMS providers, along with basic EMS equipment and supplies, to rendezvous with an ambulance crew or to respond prior to the arrival of an ambulance, to provide EMS at or below the AEMT level of care. A BLS squad vehicle may not transport patients.
(b) Staffing. The minimum staffing for a BLS squad vehicle crew when responding to a call to provide EMS is an EMS provider at or above the EMT 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 higher level ambulance crew. If a BLS squad vehicle and a higher level ambulance crew are dispatched to provide EMS for a patient, the following shall apply:
(1) BLS squad vehicle crew members shall begin providing EMS to the patient at their skill levels until higher level EMS is afforded by the arrival of a higher level EMS provider.
(2) Upon the arrival of a higher level ambulance crew, the BLS squad vehicle shall release the patient to be transported by the higher level ambulance crew, consistent with the Statewide EMS protocols, as directed by the EMS provider exercising primary responsibility for the patient.
(d) Application. For purposes of this section, the term ‘‘higher level ambulance crew’’ means the ambulance crew of an intermediate ALS ambulance, ALS ambulance or air ambulance.
Source The provisions of this § 1027.36 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
§ 1027.37. Intermediate advanced life support squad service.
(a) Purpose. An intermediate ALS squad vehicle transports EMS providers at the AEMT level, along with equipment and supplies, to rendezvous with an ambulance crew or to respond prior to the arrival of an ambulance, to provide medical assessment, monitoring, treatment and observation of a patient who requires advanced EMS. An intermediate ALS squad vehicle may not transport patients.
(b) Staffing. The minimum staffing for an intermediate ALS squad vehicle crew when responding to a call to provide EMS is an EMS provider at or 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 lower level ambulance crew. If an intermediate ALS squad vehicle and a lower level ambulance crew are dispatched to provide EMS for a patient, the following shall apply:
(1) If the patient is assessed by the intermediate ALS squad vehicle crew to require EMS above the skill level at which the lower level ambulance crew is operating, and requires transport to a receiving facility, an appropriately certified member of the intermediate squad vehicle shall attend to the patient during the transport by the lower level ambulance crew. That EMS provider shall use the equipment and supplies on the lower level ambulance, supplemented with the additional equipment and supplies, including medications, from the intermediate ALS squad vehicle.
(2) If at the scene or during patient transport by the lower level ambulance crew, the intermediate ALS squad vehicle crew determines that the lower level ambulance crew is operating at the skill level needed to attend to the patient’s needs, consistent with Statewide EMS protocols, the EMS provider of the intermediate 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 lower level ambulance crew.
(d) Providing EMS when dispatched with a higher level ambulance crew. If an intermediate ALS squad vehicle and a higher level ambulance crew are dispatched to provide EMS for a patient, the following shall apply:
(1) Intermediate ALS squad vehicle crew members shall begin providing EMS to the patient at their skill levels until higher level EMS is afforded by the arrival of a higher level EMS provider.
(2) Upon the arrival of a higher level ambulance crew, the intermediate ALS squad vehicle shall release the patient to be transported by the higher level ambulance crew, consistent with Statewide EMS protocols, as directed by the EMS provider exercising primary responsibility for the patient.
(e) Application. For purposes of this section, the term ‘‘lower level ambulance crew’’ means the ambulance crew of a BLS ambulance. The term ‘‘higher level ambulance crew’’ means the ambulance crew of an ALS ambulance or air ambulance.
Source The provisions of this § 1027.37 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
§ 1027.38. Advanced life support squad service.
(a) Purpose. An ALS squad vehicle transports EMS providers above the AEMT level, along with equipment and supplies, to rendezvous with an ambulance crew or to respond prior to the arrival of an ambulance, to provide medical assessment, monitoring, treatment and observation of a patient who requires EMS at or above the skill level of an AEMT. An ALS squad vehicle may not transport patients.
(b) Staffing. The minimum staffing for an 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 lower level ambulance crew. If an ALS squad vehicle and a lower level ambulance crew are dispatched to provide EMS for a patient, the following shall 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 lower level ambulance crew who is present, that EMS provider shall assume primary responsibility for the patient.
(2) If the patient is assessed by the ALS squad vehicle crew to require EMS above the skill level at which the lower level ambulance crew is operating, and requires transport to a receiving facility, an appropriately certified member of the ALS squad vehicle shall attend to the patient during the transport by the lower level ambulance crew. That EMS provider shall use the equipment and supplies on the lower level ambulance, supplemented with the additional equipment and supplies, including medications, from the ALS squad vehicle.
(3) If at the scene or during patient transport by the lower level ambulance crew, the ALS squad vehicle crew determines that the lower level ambulance crew 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 lower level ambulance crew.
(d) Application. For purposes of this section, the term ‘‘lower level ambulance crew’’ means the ambulance crew of a BLS ambulance or intermediate ALS ambulance.
Source The provisions of this § 1027.38 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
§ 1027.39. 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 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 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 competency in the performance of those skills and use of that equipment to the EMS agency medical director. Performance of those skills and 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.
Source The provisions of this § 1027.39 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
§ 1027.40. 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 of, 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 en route 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 and use of that equipment to the EMS agency medical director. Performance of those skills and 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.
Source The provisions of this § 1027.40 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
§ 1027.41. 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 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 required to be able to document having received that education and to demonstrate competency in the performance of those skills and use of that equipment to the EMS agency medical director. Performance of those skills and 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 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 pertaining to EMS PCR form elements, 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(j) (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.
Source The provisions of this § 1027.41 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
§ 1027.42. Water ambulance service.
(a) Generally. An EMS agency that operates a water ambulance service employs one or more water ambulances staffed by an ambulance crew capable of providing medical assessment, observation, triage, monitoring, treatment and transportation of patients who require EMS.
(b) Application. The requirements for ambulances, EMS agencies and EMS vehicles under this subpart apply to water ambulance services except as otherwise provided in this subpart.
(c) Specific provisions.
(1) A BLS water ambulance service shall meet the requirements of § 1027.33 (relating to basic life support ambulance service).
(2) An intermediate ALS water ambulance service shall meet the requirements of § 1027.34 (relating to intermediate advanced life support ambulance service).
(3) An ALS water ambulance service shall meet the requirements of § 1027.35 (relating to advanced life support ambulance service).
(d) EMSVOs. Notwithstanding subsection (c), the minimum staffing standards for a water ambulance service do not include an EMSVO.
Source The provisions of this § 1027.42 adopted October 11, 2013, effective April 10, 2014, 43 Pa.B. 6093.
No part of the information on this site may be reproduced for profit or sold for profit.
This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
