proposed rulemaking...proposed rulemaking department of health [28 pa. code chs. 1001, 1003, 1005,...

PROPOSED RULEMAKINGDEPARTMENT OF HEALTH[28 PA. CODE CHS. 1001, 1003, 1005, 1007, 1009,

1011, 1013 AND 1015]Emergency Medical Services

The Department of Health (Department) gives noticethat it is proposing to amend 28 Pa. Code Part VII(relating to emergency medical services), to read as setforth in Annex A.

Purpose and Background

Interim regulations were published at 25 Pa.B. 3685(September 2, 1995), to facilitate implementation of theact of October 5, 1994 (P. L. 557, No. 82) (Act 82)amendments to the Emergency Medical Services Act (act)(35 P. S. §§ 6921—6938). Section 6 of Act 82 authorizedthe Department to bypass certain rulemaking proceduresto adopt the interim regulations, with the caveat thatthose regulations later be resubmitted through the cus-tomary rulemaking procedures.

Amendments to regulations dealing with subject matteraddressed by the act, but not addressed by the Act 82amendments, were not adopted through the interim rule-making process. The interim regulations were required tobe limited in scope to the parameters of Act 82.

Following the Department’s adoption of the interimregulations, under House Resolution 92 of 1995, theHouse Health and Human Services Committee issued aFinal Report on the Statewide emergency medical ser-vices (EMS) system, addressing the effectiveness of thesystem and problems in its administration. That reportwas distributed in November 1996. Thereafter, the De-partment commenced a review of its EMS regulations intheir entirety.

In developing the proposed amendments, the Depart-ment pursued early and meaningful input from theregulated community, as required by Executive Order1996-1 (relating to regulatory review and promulgation).On December 20, 1996, a first draft of proposed amend-ments was forwarded to the Pennsylvania EmergencyHealth Service Council (Council) for its comments andrecommendations. The Council circulated that draftthroughout the State’s EMS community, and solicitedinput from its membership. The Council submitted itscomments to the Department in June 1997.

On June 28, 1997, the Department published in thePennsylvania Bulletin notice that it was seeking earlypublic input with respect to its amendment of the EMSregulations, that members of the public could secure acopy of the Department’s preliminary draft, and that apublic meeting to discuss amendments would be held onAugust 4, 1997. Comments were received and the publicmeeting was convened as scheduled.

Under House Resolution 186 of 1997, the LegislativeBudget and Finance Committee (LBFC) conducted aperformance audit, beginning on or about July 29, 1997,of how moneys from the Emergency Medical ServicesOperating Fund were being allocated and spent by theDepartment and other participants in the Statewide EMSsystem to whom the funds were distributed by theDepartment. The LBFC issued its report on February 24,1998.

On April 1, 1998, the Department distributed, andconducted a public meeting to provide an overview of, arevised set of draft proposed regulations. Comments weresolicited through May 1, 1998.

In developing these proposed amendments the Depart-ment thoroughly considered the Final Report of theHouse Health and Human Services Committee basedupon House Resolution 92, the Final Report of the LBFCbased upon House Resolution 186, the written commentsreceived from the Council and the public, and the oralpresentations made by persons who participated in thepublic meetings. The Department was further assisted byextensive ongoing consultation with the Director of theCouncil following the August 4, 1997, public meeting.

By this proposed rulemaking the Department is meet-ing its statutory duty to subject the regulations it adoptedthrough the interim rulemaking process to the standardregulatory oversight procedures. The Department is alsotaking this opportunity to propose amendments to thoseregulations, as well as to other regulations it was notauthorized to amend through the interim rulemakingprocess.

It has been 9 years since the Department published itsinitial regulations under the act. A changed EMS environ-ment in that 9-year time span, statutory amendments,problems brought to the Department’s attention in ad-ministering the existing regulations, judicial decisionsthat have clarified the Department’s authority and re-sponsibilities under the act, and a statutory duty toprocess through the customary rulemaking proceduresstandards the Department has imposed through interimregulations, present compelling reasons for the Depart-ment to pursue comprehensive revisions to its EMSregulations at this time.

Summary

The regulations that have been adopted to facilitateadministration of the act are presented in the followingseven chapters: Chapter 1001 (relating to administrationof the EMS system), Chapter 1003 (relating to personnel),Chapter 1005 (relating to licensing of BLS and ALSambulance services), Chapter 1007 (relating to licensingof air ambulance services—rotorcraft), Chapter 1009 (re-lating to EMS medical command medical facilities), Chap-ter 1011 (relating to accreditation of training institutes)and Chapter 1013 (relating to special event EMS). Theproposed amendments would retain each of these chap-ters. Some of the titles would be revised. The proposalwould also add Chapter 1015 (relating to quick responseservices).

Chapter 1001. Administration of the EMS system

This chapter explains the purpose of the Department’sEMS regulations, defines terms used in the regulations,identifies standards for the Statewide and regional EMSdevelopment plans, prescribes criteria for the Depart-ment’s distribution of funds, establishes EMS data collec-tion and reporting responsibilities, sets standards forquality assurance programs to monitor the delivery ofEMS, creates standards for the integration of traumafacilities into the Statewide EMS system, explains andimposes duties on the regional EMS councils, addressesthe relationship between the Department and the Coun-cil, and imposes restrictions on EMS research by personsregulated under the act.

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Subchapter A. General Provisions

Section 1001.1 (relating to purpose) would be amendedto clarify that the Department does not use regulations toaddress or carry out all of its responsibilities under theact. For example, some of its responsibilities are ad-dressed by contract.

Section 1001.2 (relating to definitions) would beamended to revise several definitions to read more clearly.Definitions would be added for ‘‘APLS—advanced pediat-ric life support course,’’ ‘‘ambulance call report,’’ ‘‘ambu-lance identification number,’’ ‘‘board certification,’’ ‘‘con-tinuing education,’’ ‘‘direct support services,’’ ‘‘EMSOF—Emergency Medical Services Operating Fund,’’ ‘‘EMStraining institute,’’ ‘‘Medical Command Base StationCourse,’’ ‘‘medical treatment protocols,’’ ‘‘PALS—pediatricadvanced life support course,’’ ‘‘physician,’’ ‘‘PSAP—publicsafety answering point,’’ ‘‘registered nurse,’’ ‘‘service area’’and ‘‘Statewide BLS treatment protocols.’’

The definitions would explain what an APLS course, aPALS course and the Medical Command Base StationCourse are. It is proposed that successful completion ofan APLS or a PALS course, combined with other criteria,be required for a physician to become a medical commandphysician or an advanced life support (ALS) servicemedical director if the physician is not board certified inemergency medicine. Completion of the Medical Com-mand Base Station Course has been and would continueto be a requirement for both physician positions.

‘‘Ambulance call report’’ would be the label the Depart-ment assigns to the form or other reporting mechanism,perhaps through electronic data entry, by which it collectsstandardized patient data and other information fromambulance services under section 5(b)(3) of the act (35P. S. § 6925(b)(3)).

‘‘Ambulance identification number’’ would replace thepresent term ‘‘vehicle identification licensure number.’’The change would be made because the Department doesnot technically license ambulances, and to distinguish theterm from the term ‘‘vehicle identification number’’ usedby the Department of Transportation to identify vehicles.

‘‘Board certification’’ would identify private certifyingbodies recognized by the Department wherever the regu-lations specify that a criterion for qualifying for a certainposition, such as a medical command physician, requiresa board certification in a medical specialty. Reference tothese certifying bodies would not, however, preclude theDepartment from considering persons with certificationsissued by other private certifying bodies. The criteria forissuing certifications used by the specified entities wouldcomprise the baseline standards. The Department wouldgrant an exception to the regulation, under § 1001.4(relating to exceptions), if a candidate could establish thatthe certification that person received from another certify-ing agency was issued under standards equal to orgreater than those employed by the private certifyingbodies referenced in the definition.

A definition of ‘‘continuing education’’ would be added toidentify the objectives that learning activities would needto be designed to be recognized by the Department forcontinuing education purposes.

‘‘Direct support of EMS systems’’ would be definedbecause section 17 of the act (35 P. S. § 6937), whichrequires that at least 75% of all funds available to theDepartment for the initiation, expansion, maintenance,evaluation and improvement of EMS systems be allocatedfor the direct support of EMS systems, does not define

what is encompassed in the direct support of EMSsystems. The lack of a definition was identified as aproblem in the LBFC report.

‘‘EMSOF’’ would be defined to clarify that in the contextof the regulations the term refers to only that portion ofthe Emergency Medical Services Operating Fund appro-priated to the Department for EMS purposes, and doesnot include that portion of the appropriation assigned tothe Catastrophic Medical and Rehabilitation Fund (HeadInjury Program).

‘‘EMS training institute’’ would be defined to clarifythat when that term is used in the regulations it appliesonly to institutes accredited to offer training leading tomandatory certifications and recognitions issued by theDepartment under the act. For example, the term doesnot apply to an institution that offers continuing educa-tion exclusively.

Sections 5(c) and 11(h) and (i) of the act (35 P. S.§§ 6925(c) and 6931(h) and (i)) address the establishmentof and compliance with medical treatment protocols. Thedefinition of ‘‘medical treatment protocols’’ would clarifywhat is encompassed by this term and replace thedefinition of ‘‘medical protocols.’’ The definition of ‘‘State-wide BLS medical treatment protocols’’ would refer tobasic life support (BLS) treatment protocols the Depart-ment has developed for the Statewide use of prehospitalpersonnel when they are providing BLS services.

The terms ‘‘physician’’ and ‘‘registered nurse’’ wouldboth be defined to mean a person licensed in thisCommonwealth to practice the applicable profession, witha current renewal or registration of that license. Conse-quently, wherever those terms would appear in theregulations additional language pertaining to the licensebeing a current Pennsylvania license would not be re-quired.

‘‘PSAP—Public safety answering point’’ would be usedto label entities that dispatch ambulance services andother emergency response resources.

A proposed definition of ‘‘service area’’ is included toclarify to which political subdivisions an ambulance ser-vice must provide notice when it is going out of business.An ambulance service has a duty under section 12(q) ofthe act (35 P. S. § 6932(q)) to notify the chief executiveofficer of each political subdivision in its service area atleast 90 days prior to discontinuing service in that area.

The definitions of ‘‘air ambulance medical crew mem-ber,’’ ‘‘ambulance trip report number,’’ ‘‘BLS traininginstitute,’’ ‘‘closest available ambulance,’’ ‘‘EMS council,’’‘‘field internship,’’ ‘‘field preceptor,’’ ‘‘incident location,’’‘‘licensing agency,’’ ‘‘medical protocols,’’ ‘‘medical servicearea,’’ ‘‘on-line communication,’’ ‘‘Pennsylvania Field Pro-tocols for BLS,’’ ‘‘prescribing physician,’’ ‘‘primary re-sponse area,’’ ‘‘quick responder,’’ ‘‘transfer agreements’’and ‘‘vehicle licensure identification number’’ would beremoved. These terms would either no longer appear inthe regulations, be replaced by other terms, or not requiredefinition as their meanings would be either clear orotherwise explained in the regulations.

Section 1001.3 (relating to applicability) identifies, ingeneral terms, who is affected by Part VII (relating toemergency medical services) of the Department’s regula-tions. No substantive amendments are proposed.

Section 1001.4 (relating to exceptions) provides a pro-cess for persons to seek an exception to a regulatoryrequirement that is not also directly imposed by the act.It would be amended to clarify that an exception to a

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regulation in this part may be granted by the Depart-ment, on its own initiative, when it determines that thesubstantive requirements of § 1001.4 have been satisfied.Currently, the regulation provides that an exception maybe granted only upon application to the Department.

Section 1001.5 (relating to investigations) provides thatthe Department may investigate accidents involving am-bulances and complaints involving prehospital personneland EMS providers. These references do not adequatelyconvey the scope of the Department’s investigatory activ-ity under the act. The section would be revised to morefully describe the scope of the Department’s investigatoryactivities.

Section 1001.7 (relating to comprehensive regional EMSdevelopment plan) would be new. It would require eachregional EMS council to develop a regional plan forcoordinating and improving the delivery of EMS in theregion for which it has been assigned responsibility bythe Department. It would require that the regional EMScouncil give notice to the public and an opportunity forcomment before submitting the plan to the Departmentfor approval.

Section 1001.6 (relating to comprehensive EMS devel-opment plan) would be amended to provide that theregional EMS development plans would be incorporatedinto the Statewide EMS development plan. The sectionwould also be amended to require public notice and anopportunity for comment before the Department’s adop-tion of a Statewide plan.

The Statewide EMS development plan serves as ablueprint for how EMS problems are to be addressed andhow EMS systems are to be maintained in this Common-wealth. Section 10(a) of the act (35 P. S. § 6930(a))requires the Department to enter into contracts for theinitiation, expansion, maintenance and improvement ofEMS systems which are in accordance with the StatewideEMS development plan. This document is a planningdocument which impacts on the Department’s distributionof funds for EMS systems. It is not a vehicle by which theDepartment is permitted to bypass the rulemaking pro-cess to regulate providers of EMS. Consequently, theDepartment would not be regulating providers of EMSthrough this document.

Subchapter B. Award and Administration of Funding

The title of this subchapter would be revised to replacethe term ‘‘Contracts’’ with ‘‘Funding.’’ This change isproposed because the scope of this chapter is not andwould not be confined to addressing the distribution offunds through contracts exclusively.

Section 1001.21 (relating to purpose) describes thepurpose of the subchapter on funding. It would beamended to recognize that section 10(j) of the act permitsthe Department to contract with entities to assist theDepartment to comply with the act.

Section 1001.22 (relating to criteria for funding) identi-fies criteria for the distribution of EMSOF funds tocontractors and other recipients of those funds. It wouldbe amended to acknowledge that not all funding providedby the Department is through contracts—such as thedistribution of some of the EMSOF moneys to providers ofEMS. These are more in the nature of grants. Some of thefunding priorities would also be revised.

Section 1001.23 (relating to allocation of funds) identi-fies some of the factors that are considered in determin-ing the amount of funds to be distributed to eligiblerecipients. No substantive amendments are proposed.

Section 1001.24 (relating to application for contract)pertains to applications for contracts to plan, initiate,maintain, expand or improve an EMS system. It would beamended to clarify that the application process set forthin the section applies only to contracts for this purpose.

No substantive amendments are proposed to§§ 1001.25—1001.27 (relating to technical assistance; re-strictions on contracting; and subcontracting).

Section 1001.28 (relating to contracts with the Council)would be new. It would be added to clarify that some ofthe provisions in the subchapter do not apply to Depart-ment contracts with the Council. It would also providethat the Department will contract with the Council toprovide it with the funds the Council needs to performthe duties imposed upon it by the act, and may contractwith the Council for it to assist the Department incomplying with the act. Act 82 amended section 14(d) ofthe act (35 P. S. § 6934(d)) to permit the Department todistribute EMSOF moneys to the Council.

Subchapter C. Collection of Data and Information

Section 1001.41 (relating to data and information re-quirements for ambulance services) addresses an ambu-lance service’s responsibility to complete an ambulancecall report and to keep the report confidential. Thissection would be revised to delete the data elementscurrently specified. The required data elements are iden-tified in the ambulance call report form and wouldcontinue to be so identified. The data elements arerevised from time to time by the Department, in consulta-tion with the Council. The data elements currently speci-fied in the regulation are outdated.

Some of the data identifies patient condition andtreatment, while other data provides information on howwell the EMS system is functioning. The ambulanceservice would be required to provide the data solicited bythe form, and the form would specify which data is to behandled in a confidential manner. The present regulationtreats all data as confidential. ‘‘Ambulance call report’’would be defined in § 1001.2 (relating to definitions) in amanner that would permit the report to be completed bythe electronic input of data if permitted by the Depart-ment.

This section would also be amended to require certainpatient information solicited by the ambulance call reportto be reported immediately to a receiving facility, pre-scribe the time in which an ambulance call report is to becompleted after termination of services to the patient, andimpose a duty upon an ambulance service to establish apolicy prescribing who is to complete the report on behalfof the ambulance service. The ambulance call reportwould designate the data that is to be reported immedi-ately to the receiving facility.

Section 1001.42 (relating to dissemination of informa-tion) identifies the circumstances under which an ambu-lance call report may be released. This section would berevised to provide that persons who prepare or securedata from an ambulance call report by virtue of theirparticipation in the Statewide EMS system are requiredto prohibit access to only those data elements designatedas confidential by the Department in the body of theambulance call report. There is no need to keep confiden-tial information that does not address the history, assess-ment or treatment of the patient.

Subchapter D. Quality Improvement Program

The title of this subchapter would be amended tosubstitute ‘‘Improvement’’ for ‘‘Assurance.’’ The term

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‘‘quality improvement’’ has generally replaced ‘‘qualityassurance’’ in the health care industry.

This subchapter would be amended to clarify that thequality improvement program operated by the Depart-ment and regional EMS councils is to be limited tomonitoring and data collection activities. Section 5(b)(10)of the act empowers the Department to establish aquality improvement program only for the purpose of‘‘monitoring the delivery of [EMS].’’ The Department isnot empowered to impose patient service duties uponproviders of EMS or prehospital personnel under thisprovision. These clarifications would be made in§§ 1001.61 and 1001.62 (relating to components; andregional programs).

Sections 1001.63 and 1001.64 (relating to medical com-mand facilities; and ambulance services), which nowrequire medical command facilities and ambulance ser-vices to participate in the quality improvement program,would be deleted and replaced with § 1001.65 (relating tocooperation). This section would require all persons andentities authorized by the Department to participate inthe Statewide EMS system to provide the Departmentand the regional EMS councils with data and reportsrequested by them to monitor the delivery of EMS as partof quality improvement oversight.Subchapter E. Trauma Centers

This subchapter, comprised of §§ 1001.81—1001.84,was adopted by the Department under its duty undersection 5(b)(12) of the act to integrate trauma centers intothe Statewide EMS system. No substantive amendmentwould be made to these sections.Subchapter F. Requirements for Regional EMS Councilsand the Council

Section 1001.101 (relating to governing body) specifiesstandards for the governing bodies of the Council andregional EMS councils. It would not be amended.

Sections 1001.102 and 1001.103 (relating to councildirector; and personnel) would be deleted. These sectionsspecify duties of directors of regional EMS councils andthe Council, and written policies and procedures that areto be in place for both. Consistent with Executive Order1996-1, the Department would delete these regulationsbecause they are burdensome and do not serve a compel-ling interest, and because there are viable nonregulatoryalternatives that may be pursued to implement thesestandards if they become necessary. The Departmentbelieves that it is counterproductive to micro-manage theCouncil and the regional EMS councils. If the Depart-ment concludes that specific personnel and work policiesare required for the Council or a regional EMS council tocomplete a project, the Department may include thoseterms in the body of the contract covering the project.Subchapter G. Additional Requirements for RegionalEMS Councils

No substantive change would be made to §§ 1001.121,1001.122 and 1001.124 (relating to designation of regionalEMS councils; purpose of regional EMS councils; andcomposition). Language would be added to § 1001.121which would require a regional EMS council to berepresentative of the professions and organizations asprescribed in the statutory definition of ‘‘emergency med-ical services council’’ in section 3 of the act (35 P. S.§ 6923). Health care consumer representation would alsobe required.

Section 1001.123 (relating to responsibilities) identifiesthe major responsibilities of regional EMS councils. The

Department concluded that some of the responsibilitiesare set forth more than once, in slightly different lan-guage. The section would be amended to eliminate therepetition. It would also be amended to require regionalEMS councils to: notify emergency communications cen-ters and municipal and county governments of availableEMS resources and any dispatch recommendations that itor the Department may develop; assist prehospital per-sonnel and providers of EMS operating in the regionalEMS system to meet licensure, certification, recertifica-tion, recognition, biennial registration and continuingeducation requirements, as well as assisting the Depart-ment in ensuring that those requirements are met;apprise medical command facilities and ALS ambulanceservices in the region when an EMT-paramedic or prehos-pital registered nurse loses medical command authoriza-tion for an ambulance service in the region; and develop aconflict of interest policy applicable to its employes andofficials.

Section 1001.125 (relating to requirements) deals withmatters such as the composition of the regional EMScouncil when it is a nongovernmental body, and thecomposition of its advisory council when it is a govern-mental body. This section would be amended to requirethat if a regional EMS council is a unit of local govern-ment it shall have an advisory council representative ofthe professions and organizations designated in the act’sdefinition of ‘‘emergency medical services council,’’ as wellas health consumer representation, and that if the re-gional EMS council is a public or nonprofit organization,its governing body shall satisfy the same representationrequirements. The current regulatory designation of rep-resentatives is somewhat confining and not fully consis-tent with the statutory language prescribing composition.The Department would replace that language with thecomposition language contained in the act and considerwhether the statutory representation requirements aremet on a case by case basis.

This section also requires a regional EMS council tohave a medical advisory committee. As ‘‘medical advisorycommittee’’ is defined in § 1001.2, a majority of itsmembers must be physicians.

Subchapter H. Additional Requirements for the Council

No substantive revisions would be made to thissubchapter, comprised of §§ 1001.141—1001.143.

Subchapter I. Research in Prehospital Care

Section 5(b)(3) and (4) of the act contemplates that theDepartment will permit data collected through the State-wide EMS system to be used for research to identifypossible options for improving the system. The Depart-ment’s planning responsibilities imply that the Depart-ment may authorize research to aid it in making planningdecisions. This subchapter addresses the procedures forproviders of EMS to engage in clinical investigations orstudies that relate to direct patient care in the StatewideEMS system.

Section 1001.161 (relating to research) would beamended to revise the research proposal review process toprovide for the proposal to be submitted directly to theDepartment. The regulation would provide for the De-partment to then forward the proposal to the Council andthe appropriate regional EMS council, for review andrecommendation back to the Department, if the Depart-ment concludes that the proposal may have merit. Uponreceiving those recommendations the regulation wouldprescribe a 30-day time period for the Department to act.The Department intends the time period for action to be



directory; that is, its failure to act within that time periodwould not result in automatic approval of the proposal.Under current procedures, the Department does not seethe proposal until after it is reviewed by the Council anda regional EMS council. The regulation would also re-quire the proposal to include a plan for providing theDepartment with progress reports and a final report, andprovide that the Department may terminate the researchprematurely if conditions of approval are not satisfied.

Chapter 1003. Personnel

This chapter addresses qualifications and responsibili-ties of persons involved in the Statewide EMS system. Italso addresses the disciplinary process for prehospitalpersonnel certified or recognized by the Department, themedical command authorization process, continuing edu-cation requirements applicable to certain types of prehos-pital personnel and continuing education options appli-cable to others, and the accreditation standards forsponsors of continuing education.

Subchapter A. Administrative and Supervisory EMS Per-sonnel

Section 1003.1 (relating to Commonwealth EmergencyMedical Director) specifies the duties of the Common-wealth Emergency Medical Director. It would not berevised in a substantive manner.

Section 1003.2 (relating to regional EMS medical direc-tor) specifies the duties of regional EMS medical direc-tors. It would be revised to clarify that the regional EMSmedical director does not function independent of theregional EMS council except when acting upon appealsfrom adverse medical command authorization decisions.As the regulation currently reads, it purports to imposeupon regional EMS medical directors responsibilities theact imposes upon regional EMS councils. This sectionwould also be amended to exclude a paragraph regardingmedical advisory committees. The existing paragraphmerely repeats provisions in § 1001.125 (c) and (d)(relating to requirements).

Section 1003.3 (relating to medical command facilitymedical director) specifies the qualifications and responsi-bilities of a medical command facility medical director. Itwould be amended to require that a physician completeeither an APLS (advanced pediatric life support) or aPALS (pediatric advanced life support) course, amongother criteria, to qualify as a medical command facilitymedical director if the physician is not board certified inemergency medicine. Completion of an ACLS (advancedcardiac life support) course would be required every 2years to continue to qualify. Completion of an ATLS(advanced trauma life support) course would be requiredonly once. A similar change would be made to § 1003.4(relating to medical command physician). The regulationwould also be amended to provide that the physiciancould satisfy some course requirements specifically men-tioned in the regulation by completing other programsdetermined by the Department to meet or exceed thestandards of the specified programs.

Section 1003.4 (relating to medical command physician)specifies the qualifications and responsibilities of a med-ical command physician. It would be amended to includethe same options as mentioned in the prior paragraph.Another amendment would be to require a medicalcommand physician to provide medical command when-ever it is sought from prehospital personnel. The Depart-ment has received complaints from ambulance servicesthat transport initially stable patients over long dis-tances, that when emergencies arise during transport,

and communication with a customary medical commandphysician cannot be established, medical command physi-cians unfamiliar with the ambulance service and itsprehospital personnel will sometimes decline to providenecessary medical command. The amendment would rem-edy this problem.

To ease the difficulty of working with prehospitalpersonnel with whom a medical command physician isunfamiliar, the regulation would be amended to providethe medical command physician with discretion regardingthe treatment protocols to follow. The section would statethat in providing medical command to ground ambu-lances, the medical command physician may follow thetransfer and medical treatment protocols that applyeither in the EMS region in which treatment originates,or in the EMS region in which the prehospital personnelfirst receive medical command from the medical commandphysician.

Procedures for physicians to secure approval as medicalcommand physicians, which are not now addressed in theregulations, would be explained in this section. There hasbeen a widespread perception that it is the Department’sresponsibility to approve medical command physicians.This is not technically correct. A provision of the act maynot authorize the Department to approve medical com-mand physicians. Section 11(f) of the act (35 P. S.§ 6931(f)) provides that physicians shall be approved asmedical command physicians by regional EMS councils,which shall then notify the Department of the approvals.The Department is, however, responsible for prescribingthe criteria physicians must satisfy to qualify as medicalcommand physicians. See definition of ‘‘medical command’’in section 3 of the act. Regional EMS councils areobligated to approve a physician as a medical commandphysician if the physician meets the prescribed criteria.

The regulation would explain that a physician mayseek a determination of medical command physicianqualifications directly by a regional EMS council, or mayparticipate in a voluntary medical command physiciancertification program administered by the Department. Ifthe physician chooses the latter option and receivescertification, and demonstrates that he or she will func-tion under the auspices of a medical command facility, theregulation would provide that a regional EMS council towhich the physician applies for medical command physi-cian approval shall grant the approval.

Functioning under the auspices of a medical commandfacility is and would continue to be a requirement forapproval of a medical command physician by a regionalEMS council. The Department prescribes the equipmentand personnel requirements for a medical commandfacility. See definition of ‘‘medical command facility’’ insection 3 of the act. While no provision of the act compelsa facility to seek Department approval before operating asa medical command facility, section 11(j)(4) of the actaffords civil immunity for good faith medical commandsgiven to prehospital personnel only if the medical com-mand facility has been ‘‘recognized’’ by the Department.

The Department administers a program for the recogni-tion of medical command facilities. If a physician appliesto a regional EMS council for approval as a medicalcommand physician, and the medical command facility forwhich the physician intends to function has not receiveda certificate of recognition from the Department, thephysician would need to establish to the regional EMScouncil that the facility meets the criteria for a medicalcommand facility prescribed by the Department. However,if the facility has a current certificate of recognition from



the Department, the regulation would provide that theregional EMS council shall accept the certificate insteadof requiring the physician to prove that the facility meetsDepartment-prescribed standards.

Because medical command physicians may providemedical command to ambulance services operating out ofmore than one region, and may be providing medicalcommand for patients who cross regional borders, theregulation would also require a medical command facilityto give notice to the regional EMS council in each regionin which it expects medical command physicians function-ing under its auspices will be providing medical com-mand, and to explain the circumstances under whichmedical command would be given in that region.

No substantive change would be made to § 1003.5(relating to ALS service medical director).

Subchapter B. Prehospital and Other Personnel

Section 1003.21 (relating to ambulance attendant)would be amended to explain the ambulance attendant’srole when staffing an ambulance service and to identifythe services an ambulance attendant may perform whenserving on an ambulance crew. It would also clarify thatnotwithstanding the structured role that an ambulanceattendant performs when serving as a member of anambulance’s crew, an ambulance attendant may provideBLS services separate from an ambulance service in anemergency, with nonmedical good Samaritan civil liabilityprotection.

The 16 years of age criterion now in the regulationwould be removed since the act sets no age requirementfor an ambulance attendant. The age requirement for anambulance attendant is regulated by the child labor lawsin this Commonwealth, not the act. The child labor lawsprohibit a minor under 16 years of age from serving as anambulance attendant. See sections 2 and 7.3(g) of theChild Labor Law (35 P. S. §§ 42 and 48.3(g)).

The Department of Labor and Industry advises that thefollowing requirements apply to persons under 18 years ofage who work for a volunteer ambulance service as anambulance attendant and who have not graduated fromhigh school or been declared by the chief school adminis-trator to have achieved their academic potential. They arepermitted to receive on-the-job training as ambulanceattendants only if they have secured employment certifi-cates and are at all times under the constant supervisionof an adult ambulance company member. They may notserve as ambulance attendants for more than 8 hours in 1day, and must be given a half-hour off duty lunch break ifthey are on duty for more than 5 continuous hours. Theymay not serve on duty later than 12 a.m. on schoolnights, nor later than 1 a.m. on Friday or Saturdaynights during the school term; however, if they respond toa call prior to the deadline, they may continue to serveduring the duration of the response to that call. Theserequirements may change if the Child Labor Law orregulations adopted under that law are amended.

This section would also be amended to clarify that theservices that an ambulance attendant may provide aregoverned by the first aid skills taught in an advancedfirst aid course sponsored by the American Red Cross. Asnew first aid skills are added to the curriculum, anambulance attendant’s scope of practice would expand ifthe ambulance attendant has received the necessarytraining. The Department proposes to publish, at leastannually, a list of the advanced first aid skills taught inthe most recent advanced first aid course sponsored bythe American Red Cross.

Provisions would also be added to or incorporated byreference in each section relating to prehospital personnelwho perform BLS services exclusively (this section and§§ 1003.22 and 1003.23 (relating to first responder; andEMT)), to permit personnel to perform specified skillsonly if authorized to do so by the medical director of theambulance service. For example, this section would per-mit an ambulance attendant to use an automated exter-nal defibrillator when authorized by the ambulance ser-vice medical director. While the act requires an ALSambulance service to have a medical director, it does notrequire a BLS ambulance service to have a medicaldirector. Nevertheless, personnel on a BLS ambulanceservice would not be permitted to perform those few skillswhich the regulations would condition upon medicaldirector approval unless the BLS ambulance servicesecures the services of a medical director.

Section 1003.22 (relating to first responder) specifiesthe qualifications and functions of a first responder. Itwould include scope of practice and good Samaritanamendments similar, but not identical, to those proposedfor § 1003.21 (relating to ambulance attendant). The firstresponder’s scope of practice is governed by the BLStraining a first responder has received in a course theDepartment has approved for first responder training. Atpresent, that scope of practice is the scope of servicesembraced by the Emergency Responder course taught bythe American Red Cross—which is also the American RedCross’s basic course in advanced first aid—the courseestablishing the scope of practice for an ambulanceattendant. However, a first responder’s scope of practicemay exceed that of an ambulance attendant if theDepartment develops or approves courses for first re-sponder training which teach skills in addition to thosetaught in an advanced first aid course sponsored by theAmerican Red Cross. The Department proposes to pub-lish, at least annually, a list of first responder skillstaught in the most recent courses approved by theDepartment for first responder training.

Unlike an ambulance attendant, who requires no certi-fication from the Department, to function as a firstresponder an individual must be certified by the Depart-ment and then meet recertification requirements every 3years. This section would be amended to facilitate entryinto the Statewide EMS system of individuals who func-tion or have functioned as first responders in other states,by providing that the Department will accept in lieu ofsuccessful completion of the education and tests preap-proved by the Department, successful completion of edu-cation and tests that led to first responder or an equiva-lent status in another jurisdiction, provided theDepartment concludes that those education and testingrequirements are equal to or greater than those requiredfor certification in this state. Using this criteria, theDepartment has accepted and would continue to accept,among other examinations, the written and practicalskills examinations administered for the emergency re-sponder certification issued by the American Red Cross.

Section 1003.23 (relating to EMT) specifies the qualifi-cations and role of an EMT. It would be amended similarto the manner in which § 1003.21 (relating to firstresponder) would be amended. Provisions relating to EMTinstructor certification would be removed. That subjectmatter would be addressed in new §§ 1003.23a and1011.1 (relating to EMS instructor certification; and BLSand ALS training institutes).

Section 1003.23a (relating to EMS instructor certifica-tion) would be new. Current provisions for EMT instruc-



tor certification would be removed from § 1003.22 (relat-ing to EMT) and, with some amendments, would beinserted in this section. There is no statutory mandate forEMS instructor certification. However, the Departmentoffers this certification program to potential instructors toimprove the quality of training in EMS training insti-tutes.

Section 1003.24 (relating to EMT-paramedic) specifiesthe qualifications and role of an EMT-paramedic. It wouldbe amended to acknowledge that an EMT-paramedic mayprovide EMS as a Good Samaritan in addition to provid-ing EMS for an ambulance service.

Transition provisions for persons to convert certaincertifications to EMT-paramedic certification, which wereneeded when the regulations were adopted in 1989, wouldbe deleted as they no longer have any relevance.

As the sections relating to first responders and EMTswould be amended to facilitate entry into the StatewideEMS system of individuals who function or have func-tioned in those capacities in another state, this sectionwould be similarly amended, by providing that the De-partment will accept in lieu of successful completion ofthe education and tests preapproved by the Department,successful completion of education and tests that led toEMT-paramedic status in another jurisdiction, providedthe Department concludes that those education and test-ing requirements are equal to or greater than thoserequired for certification in this Commonwealth.

Scope of practice provisions would be revised to accom-modate changes in accepted ALS practice by EMT-paramedics without constantly revisiting and amendingthe regulation to permit the performance of additionalskills. To be able to perform those additional services theEMT-paramedic would be required to receive appropriatetraining either in a course approved by the Departmenttowards securing certification as an EMT-paramedic, in acourse determined by the Department to meet or exceedan EMT-paramedic training course preapproved by theDepartment, or in a Department-approved continuingeducation course. The Department proposes to publish, atleast annually in the Pennsylvania Bulletin, a list ofEMT-paramedic skills taught in the most recent coursesapproved by the Department for EMT-paramedic training.

Section 11(d)(2)(vi) of the act provides that if an EMT-paramedic loses medical command authorization, andchooses to function at the BLS level, the EMT-paramedicmust secure EMT certification in accordance with Depart-ment regulations. The practical effect of this provision isthat it requires that EMT-paramedic to secure continuingeducation or pass practical skill and written examinationsevery 3 years, to replace the annual continuing educationand skill proficiency requirements that the EMT-paramedic would have been required to satisfy if medicalcommand authorization had been maintained. The De-partment would amend the regulation to permit theEMT-paramedic to provide BLS services for 30 dayswithout EMT certification, for the ALS ambulance serviceunder the paramedic’s medical command authorizationwas removed or relinquished, provided that ambulanceservice’s ALS service medical director so authorizes.

Section 1003.25a (relating to health professional physi-cian) would be revised, as some of the preceding sections,to acknowledge that a health professional physician mayperform EMS as a medical good Samaritan. It would alsobe amended to eliminate conditions the section currentlyspecifies for a physician to function as a health profes-sional physician. The act’s definition of ‘‘health profes-

sional’’ states that a physician qualifies to function in thatcapacity if the physician has ‘‘education and continuingeducation in [ALS] and prehospital care.’’ 35 P. S. § 6923.It does not provide for the Department to certify healthprofessional physicians or to set standards physicianswould be required to meet to serve as health professionalphysicians. Therefore, it is incumbent upon a physicianand the ambulance service that uses the physician as ahealth professional to ensure that the physician is prop-erly educated and experienced to serve in that capacity. Ifthey need assistance in making this assessment they mayseek guidance from the Department, regional EMS coun-cils, and professional organizations with relevant exper-tise, such as the Pennsylvania Chapter of the AmericanCollege of Emergency Physicians.

Section 1003.25b (relating to prehospital registerednurse) specifies the qualifications and role of a prehospi-tal registered nurse. It would be revised to acknowledgethat a prehospital registered nurse may perform EMS asa medical good Samaritan, in addition to functioning as aprehospital registered nurse. It would also include en-dorsement provisions permitting persons who are licensedas registered nurses in this Commonwealth, who havefunctioned in the capacity of a prehospital registerednurse in another jurisdiction, to obtain recognition as aprehospital registered nurse from the Departmentthrough an abbreviated process. It would further berevised to clarify the scope of practice of a prehospitalregistered nurse by providing that the person couldperform those ALS services authorized by The Profes-sional Nursing Law (63 P. S. §§ 211—225), which exceedthe scope of practice of an EMT-paramedic, when autho-rized by a medical command physician through eitherdirect medical command orders or standing treatmentprotocols.

Section 1003.26 (relating to rescue personnel) pertainsto the Department’s certification of rescue personnel. Itwould be amended to clarify that the Department ap-proves courses for rescue personnel and issues certifica-tions to persons who complete those courses. Receipt of acertification is not, however, required by law as a precon-dition to freeing an entrapped person. The Department isgranted no regulatory oversight over rescue activitiesunder the act. The Department approves rescue programsand issues rescue technician certificates as a publicservice, in an effort to ensure that there are a sufficientnumber of personnel throughout this Commonwealth whohave appropriate training and skills to perform rescues.The certification would merely reflect the Department’sopinion that the person is qualified to perform the rescuestaught in the approved course. The section would berevised to clarify that receiving a rescue certificationissued by the Department is not a legal precondition toperforming rescues.

No substantive change is being proposed to § 1003.27(relating to disciplinary and corrective action).

Section 1003.28 (relating to medical command authori-zation) specifies the criteria for an ALS service medicaldirector to grant medical command authorization, and theprocedures for EMT-paramedics and prehospital regis-tered nurses to appeal ALS service medical directordecisions to deny, restrict or remove medical commandauthorization. It would be amended in several respects.The options available to the ALS service medical directorto assess the competence of the ALS practitioner seekingmedical command authorization would be expanded.

Also, there would be limitations on how an ALS servicemedical director could restrict medical command authori-



zation. The Department believes that patient welfarewould be compromised if a patient was treated by an ALSpractitioner who was not permitted to perform an ALSskill required by the patient and generally permittedunder medical command authorization. Consequently, theregulation would be revised to provide that if the ALSpractitioner demonstrated certain deficiencies, the ALSservice medical director could continue to extend medicalcommand authorization to the individual with restrictionssuch as requiring the individual to perform certainfunctions under on-scene supervision. However, short ofwithdrawing the practitioner’s medical command authori-zation, an ALS service medical director could not precludethe individual from performing functions within thatpractitioner’s scope of practice as permitted by the med-ical treatment protocols in the region out of which theindividual practices. Another type of restriction thatwould be authorized would be to prescribe continuingeducation requirements greater than that required forother ALS personnel serving the ambulance service. Thiswould require that the ALS service medical director hasdetermined that the individual does not demonstratesufficient competence in performing a skill and that thenumber of continuing education hours generally requiredare not sufficient to provide the education the practitionerneeds to remedy the problem.

Other amendments would include a provision statingthat in hearings in which medical command authorizationdecisions are appealed the burden of proof is a preponder-ance of the evidence, and provisions addressing whenservice of documents is consummated and how timeperiods for filing hearing documents are to be calculatedin the appeal process.

Section 1003.29 (relating to continuing education re-quirements) specifies the continuing education require-ments and options for prehospital personnel. It would alsoinclude several amendments. The total number of con-tinuing education credit hours applicable to each categoryof certified or recognized prehospital practitioner wouldnot change. However, for each type of practitioner aspecified number of continuing education hours in med-ical and trauma education would be designated. Transi-tion periods would be provided before the medical andtrauma continuing education requirements would takeeffect. Also, the Department’s existing practice of prorat-ing annual continuing education requirements during thefirst calendar year an EMT-paramedic is certified or aprehospital registered nurse is recognized, based upon themonth the certification or recognition is secured, would beset forth in the regulation.

The options for satisfying continuing education CPRrequirements would be expanded. CPR requirementscould be met by not only attending a CPR course, but,alternatively, by teaching a CPR course. To secure creditfor teaching, the individual would not need to be theprimary instructor.

Language would also be added to clarify that anambulance service is not precluded from imposing con-tinuing education requirements in excess of those re-quired by the regulation, as a condition of employment,except that the ambulance service could not establishindividual requirements for ALS practitioners other thanas authorized in § 1003.28(c)(2) (relating to medicalcommand authorization).

Current provisions relating to continuing educationthrough endorsement would be relocated in proposed new§ 1003.31 (relating to credit for continuing education).

Section 1003.30 (relating to accreditation of sponsors ofcontinuing education) would be amended to permit acontinuing education sponsor to secure prior approval ofcontinuing education courses, and permit the continuingeducation sponsor to assign credit hours to a continuingeducation course it presents in a classroom setting, if theDepartment gives it approval to do so after determiningthat it has demonstrated a history of understanding andcompliance with the regulatory standards for providingcontinuing education to prehospital personnel.

Section 1003.31 (relating to credit for continuing educa-tion) would be new. It would define what constitutes acredit hour, and time units of instruction for which creditwould be awarded. It would also make provision forcontinuing education credit to be awarded for teaching,self study courses and other courses not presented in aclassroom setting, and for courses offered by organiza-tions with National or state accreditation to provideeducation. Additional matters that would be addressedare how continuing education credits would be reported toprehospital personnel, and the procedure for resolvingdisputes when a prehospital practitioner believes that heor she has not received credit that has been earned.

Section 1003.32 (relating to continuing education spon-sors) would also be new. This section would specifyresponsibilities of a continuing education sponsor withrespect to keeping records of attendance, reporting atten-dance, having a mechanism for course evaluation, retain-ing records, monitoring compliance and making availablevarious reports and records to the Department.

Section 1003.33 (relating to advertising) would be an-other new section. It would address how a continuingeducation sponsor may advertise a course approved bythe Department, as well as a course for which Depart-ment approval is being sought, but has not yet beenobtained.

Section 1003.34 (relating to withdrawal of accreditationor course approval) would also be new. It would providefor the Department to withdraw accreditation, downgradeaccreditation to provisional status or withdraw approvalof a continuing education course applicable to any futurepresentation of the course.

The Department would delete Subchapter C (relating toair ambulance personnel), and address much of thesubject matter of this subchapter in Chapter 1007 (relat-ing to the licensing of air ambulance services—rotorcraft).The Department believes that some of the provisions inthis subchapter, such as those in §§ 1003.43 and 1003.44(relating to air ambulance pilot; and air ambulancecommunications specialist), exceed the Department’s rule-making authority, since it has been given no authorityunder the act to regulate either communications special-ists or pilots. The more appropriate focus of the Depart-ment’s regulatory oversight is on the air ambulanceservice itself.

Also, the provision in § 1003.42 (relating to air ambu-lance crew members), that requires minimum staff in anair ambulance to consist of two ALS prehospital practitio-ners, is inconsistent with the staffing requirements ofsection 12(g) of the act (35 P. S. § 6932(g), which requiresan ALS ambulance (no statutory distinction is madebetween air and ground ALS ambulances) to be staffed bytwo prehospital personnel but only one ALS practitionerwhen providing treatment and transport to patients.While the Department continues to encourage air ambu-lance services to staff air ambulances with a minimum of



two ALS practitioners, it has no statutory authority tomandate that minimum staffing complement throughregulations.

The Department does have statutory authority to regu-late air ambulance services to ensure that they operate ina safe and efficient manner. Consequently, many of theresponsibilities that have been in Subchapter C as re-sponsibilities of individuals such as pilots, medical crewmembers and communications specialists, would be incor-porated in amendments to Chapter 1007 and imposedupon the air ambulance service itself.Chapter 1005. Licensing of BLS and ALS Ground Ambu-lance Services

This chapter specifies the licensure and operating crite-ria for ground ambulance services. The term ‘‘ground’’would be included in the title to clarify that the scope ofthis chapter relates to ground ambulance services exclu-sively. Chapter 1007 pertains to air ambulance services.

Section 1005.1 (relating to general provisions) would beamended to state that Chapter 1005 applies to groundambulance services. Subsection (c) would be revised toidentify types of ambulance vehicles an ALS ambulanceservice may employ rather than modes of ALS ambulanceservice operations.

Section 1005.2 (relating to applications) would be re-vised to reflect that there would be a change in some ofthe information solicited by an application for licensure.The most significant changes are that the applicationwould require that the applicant provide a roster andstaffing plan, and identify the physical structures whereambulances will be located or a plan for locating andoperating ambulances if not responding out of fixedbuildings. Also, the application would require the signa-ture of the principal official of the applicant.

Another change would be that instead of requesting theapplicant to identify primary and mutual aid serviceareas, the application would require the applicant toidentify an emergency service it commits to serve whencalled upon. An ambulance service that generally confinesits operations to interfacility transports would not need tocommit to providing emergency response to an area, but,if it had an available ambulance and crew, would berequired to respond to an emergency if dispatched.

Mutual aid agreements would continue to be encour-aged, but they would not be required for licensure. Thereare three reasons for this. First, some ambulance servicesengage almost exclusively in interfacility transports. Theyhave little need for mutual aid arrangements. Second,some ambulance services have attempted to keep com-petitors from locating in their service areas by refusing toenter into mutual aid agreements with them, and havethen argued to the Department that those competitors donot meet required standards for licensure because theyhave no mutual aid agreement. Third, the Department isproposing to revise § 1005.10 (e) (relating to licensureand general operating standards) to require ambulanceservices to contact PSAPs when unable to respond to anemergency, instead of the ambulance service making itsown arrangement for a substitute ambulance service.This should ensure that the most appropriate backupambulance service is contacted to respond to an emer-gency, rather than a less appropriate ambulance servicethat would have been contacted solely to honor a mutualaid agreement.

Subsection (d) would be added to require an ambulanceservice to file a change of vehicle form within 10 daysafter placing a new ambulance in operation. If the form

would be timely filed, the ambulance service would haveauthority to continue to use the ambulance unless itsauthority to do so would be disapproved following Depart-ment inspection.

Subsection (e) would require an ambulance service toapply for an amendment of its license prior to substan-tively altering its plan for locating and operating ambu-lances. For example, relocating ambulances within thesame service area would not be a substantive alterationand would not require an application for amendment.Moving ambulances to establish a new service area wouldbe a substantive alteration and would require an applica-tion for an amendment of the license. The Departmentwould need to ensure that all licensure criteria aresatisfied at the new or additional location before opera-tions could commence.

Amendments that would change the application proce-dure are that regional EMS councils would no longer berequired to forward a complete and accurate applicationto the Department, and then await Department directionbefore scheduling an onsite inspection of the applicant.Regional EMS councils, without Department direction,would simply schedule the inspection when the applica-tion is complete and appears to be accurate. Also, regionalEMS councils would not be required to review theapplication for conformance with regional plans beforethey conduct a survey. Actually, they do not do thatcurrently even though the regulation states that they aresupposed to. Instead, the inspector would review thepolicies and procedures of the applicant during the sur-vey, and ensure that necessary policies are in place.

Section 1005.3 (relating to right to enter, inspect andobtain records) pertains to an ambulance service’s duty topermit employes of the Department or regional EMScouncils to conduct inspections, review the applicant’s orambulance service’s policies, and secure copies of recordsfrom it. It would be revised to clarify that the ambulanceservice has a duty to permit the review and that itsfailure to do so constitutes misconduct and a basis fordiscipline.

Section 1005.4 (relating to notification of deficiencies toapplicants) pertains to how the Department and theregional EMS council interact with an applicant if thereare deficiencies following an onsite inspection. It would berevised to relate that the inspector will provide theapplicant with an inspection report specifying deficienciesimmediately upon completing the inspection. It wouldfurther revise procedures for the regional EMS councilsecuring a plan of correction and conducting a reinspec-tion. Finally, it would provide for Department involve-ment to address disputes upon the request of the appli-cant.

Section 1005.5 (relating to licensure) identifies theindicia of licensure issued to ambulance service anddirects ambulance services where to place those items.This section would be amended to specify changes insome of the information included in the license certificate.Clarification would be provided that the ambulance decalis considered part of the license and is to be placed in aconspicuous place on the outside of the ambulance. Therequirement that a license be posted in a conspicuousplace on the ambulance is set forth in section 12(j) of theact.

Section 1005.6 (relating to out-of-State providers) recog-nizes the statutory permission for ambulance services notlicensed in this Commonwealth to transport patients fromoutside the borders of this Commonwealth to facilities



situated inside this Commonwealth’s borders. The lan-guage would be revised, but no material amendmentwould be made to this section.

Section 1005.7 (relating to services owned and operatedby hospitals) parallels provisions in section 12(r) of theact which permits institutions licensed as hospitals by theDepartment to operate their own ambulance servicewithout securing a separate license from the Departmentto operate an ambulance service. In all other matters, theambulance service operations of hospitals are subject tothe requirements of the act and this part. No substantiveamendment is proposed to this section.

Section 1005.7a (relating to renewal of ambulanceservice license) would be new. It would explain that thecriteria for the renewal of a license is the same as thecriteria would be for securing an initial license if aninitial license had been sought at the time the renewalwas required. A time period for filing a renewal applica-tion prior to the expiration of a current license would bespecified.

Section 1005.8 (relating to provisional license) pertainsto the license the Department is permitted to issue to anambulance service when it fails to meet multiple minorlicensure requirements, or even a significant requirement,if the Department considers the operation of the ambu-lance service to be in the public interest. Section 12(m) ofthe act permits the Department to issue a provisionallicense for 6 months and to renew it for an additional 6months under regulations established by the Department,except a renewal may be for 12 months if the ambulanceservice is a volunteer BLS ambulance service, or avolunteer fire department or rescue service that operatesa BLS ambulance service. The only significant changeproposed by the Department is that to secure a renewalof a provisional license the applicant would need to showthat it had made a good faith effort to comply with acourse of correction approved by the Department.

Section 1005.9 (relating to temporary license) pertainsto the license that the Department is permitted to issueto an ALS ambulance service that cannot provide service24 hours a day, 7 days a week. Once again, the mostsignificant factor affecting the Department’s decision re-garding whether to issue a temporary license under thesecircumstances is whether the issuance of the licensewould be in the public’s interest. No significant amend-ment is proposed.

Section 1005.10 (relating to licensure and general oper-ating standards) is the section that enumerates most ofthe standards an ambulance service needs to meet tobecome licensed and to continue operations. Compliancewith many of the current standards, as well as several ofthe proposed additional standards, cannot be fully judgeduntil the ambulance service has become licensed andcommences operations. The Department proposes toamend the title of the section by including a reference to‘‘general operating standards’’ to emphasize that theenumerated standards continue to apply after ambulanceservice licensure.

Additional changes proposed are that the ambulanceservice would need to maintain documentation of its planfor ensuring that minimum staffing requirements aremet, a record of calls to which it did not respond and thereasons for not responding, a record of time periods thatthe ambulance service was not in operation and documen-tation that appropriate notification was given to relevantPSAPs, and a copy of all policies required by the section.

A BLS ambulance service would be permitted to carryALS equipment and drugs if it has a medical director who

has education and continuing education in ALS prehospi-tal care, provided that the arrangement would be specifi-cally authorized by the Department upon its determina-tion that the arrangement is in the public interest. Thishas occurred in one remote rural area and may benecessary in others.

A provision of the regulation dealing with who mayaccompany a patient in the patient compartment, whichwas inconsistent with language in the act, would berevised to eliminate that inconsistency.

The manner in which ambulance services may meetminimum staffing requirements would be addressed andclarified.

The Department is not empowered by the act toregulate persons who drive ambulances. However, section12(h)(1) and (4) of the act state that conditions forlicensure include that an ambulance service be staffed byresponsible people, and that it operate in a safe andefficient manner. Subsection (d)(3) would identify mini-mum standards a person must meet for the Departmentto consider a driver to be a ‘‘responsible’’ person. Theambulance service would be required to ensure that eachperson it permits to drive its ambulances meets theserequirements.

Subsection (e) would address an ambulance service’sduty to communicate with PSAPs. Community Life Sup-port Systems, Inc., et al. v. Department of Health, 689A.2d 1014 (Pa. Cmwlth. 1997) and Mars EmergencyMedical Services, Inc. v. Township of Adams and Boroughof Callery, 704 A.2d 1143 (Pa. Cmwlth. 1998), clarify thatthe Department is not empowered by the act to regulatethe dispatching of ambulance services. Nevertheless, asthe lead agency for EMS in this Commonwealth, theDepartment needs to ensure that ambulance servicesprovide information to PSAPs that may influence dis-patch decisions. Consequently, the Department is propos-ing to require an ambulance service to give a PSAP in itsarea advance notice when it will not be in operation, andto communicate with and provide information to PSAPsas they request to aid them in implementing dispatchprotocols.

The responsibility to communicate would continue afteran ambulance service receives a call and then determinesthat it is unable to mobilize its resources to respond to anemergency. These communications from ambulance ser-vices will enable the PSAPs to timely contact and dis-patch other available EMS providers when the publicinterest so warrants.

Finally, this portion of the regulation would requireambulance services to respond to calls for emergencyassistance as communicated by the PSAPs. Unfortunately,the Department has received reports of ambulance ser-vices arguing with each other as to which of them has theright to treat and transport a patient. Financial consider-ations cannot be permitted to undermine or delay patientcare. While there may be some dispute between munici-palities, counties and PSAPs as to who has the authorityto resolve which ambulance service among two or moresimilarly licensed ambulance services is best suited toprovide care to a patient on a case by case basis, thePSAP is the entity through which ambulance servicereceives the dispatch communication. The Departmentbelieves that an orderly Statewide EMS system is bestachieved when ambulance services follow the dispatchdirections communicated by PSAPs, regardless of theentity empowered to determine the dispatch protocol.

The Department would also revise the subsection (g)requirements pertaining to the use of lights and other



warning devices by providing that an ambulance servicemay use these devices only when transporting or respond-ing to a call involving a patient who presents or is in goodfaith perceived to present a combination of circumstancesresulting in a need for immediate medical intervention.Driving an ambulance at rapid speeds, even when alert-ing pedestrians and drivers of other vehicles through theuse of warning devices, creates a dangerous situation.That danger should be avoided unless compelling circum-stances dictate otherwise.

The subsection (f) provisions relating to scene controlwould be replaced by provisions addressing who maymanage patient care at the scene of the emergency and inthe ambulance.

The Department also proposes to impose upon anambulance service a duty to report to a regional EMScouncil an accident, injury or fatality involving an ambu-lance vehicle or a member of an ambulance crew whileperforming functions on duty. This information will beexamined and evaluated in considering how to betterprotect ambulance personnel and the public during ambu-lance service operations.

Additional responsibilities that would be imposed wouldbe for an ALS ambulance service to apprise an appropri-ate regional EMS council as to who has medical commandauthorization for that ambulance service, and any changein that status, and for an ambulance service to monitorcompliance with all requirements the act and the regula-tions impose upon the ambulance service and its staff.

Section 1005.11 (relating to drug use, control andsecurity) would be amended to better clarify the circum-stances under which ambulance services may stock andcarry drugs, and would address which drugs may be used,requirements for securing and maintaining those drugs,and who may administer such drugs. Some of the mostsignificant proposals deal with drugs being brought upona BLS ambulance by ALS personnel when those personnelrendezvous with a BLS ambulance to treat an ALSpatient, circumstances under which health professionalsmay bring drugs upon an ambulance and use those drugsupon patients other than as authorized by the applicableregional transfer and medical treatment protocols, andcontinuation of hospital ordered medication on an ambu-lance by a nurse, physician or physician assistant whenthe ambulance is involved in an interfacility transport.

Section 1005.12 (relating to disciplinary and correctiveactions) pertains to the disciplinary process applicable toambulance services. The title of the section would bechanged from ‘‘Grounds for suspension, revocation orrefusal of an ambulance service license’’ because the scopeof this section exceeds the enumeration of grounds fordiscipline. The most significant amendments proposedwould be to add as a basis for discipline not communicat-ing with PSAPs as would be prescribed in § 1005.10(e)(relating to licensure and general operating standards),and revising how the Department would communicatewith ambulance services and complainants during andupon completion of complaint investigations.

Section 1005.13 (relating to removal of ambulancesfrom operation) pertains to the removal of an ambulancefrom operation when there is a mechanical or equipmentdeficiency that poses a significant threat to the safety ofpatients or crew. No substantive amendment is beingproposed.

Section 1005.14 (relating to invalid coaches) pertains toa statutory exemption from ambulance requirements forvehicles that are used to transport individuals who

require assistance, but who are not anticipated to requireemergency medical care during transport. No amendmentis being proposed.

Section 1005.15 (relating to discontinuance of service)would be new. This section would address and clarify theduty imposed upon an ambulance service, by section 12(q)of the act, to not discontinue its operations prior to givingthe public, the Department and political subdivisions inits service area at least 90 days advance notice. Theregulation would also require the ambulance service toprovide similar notice to emergency communications cen-ters in the EMS region in which it would be ceasingoperations.Chapter 1007. Licensing of Air Ambulance Services—Rotorcraft

This chapter specifies the licensure and operating crite-ria for air ambulance services. Several sections in Chap-ter 1005 (relating to licensing of BLS and ALS groundambulance services), that would be applicable to groundambulance services, would be equally applicable to airambulance services. Express provision would be made inthis chapter to incorporate applicable provisions in Chap-ter 1005. Consequently, some of the current sections inthis chapter would not be needed. The unnecessaryprovisions would be deleted.

As a preliminary matter, the Department receivedcomments during the process of developing proposedamendments that the regulations should be extended toentities that operate fixed-wing aircraft that providemedical treatment and transport of patients. The Depart-ment is considering the recommendation, but is notprepared to propose regulations regulating such entitiesat this time.

Section 1007.1 (relating to general provisions) specifiesgeneral standards applicable to air ambulance services.The most significant amendment of this regulation wouldbe the addition of a subsection (e). That subsection wouldspecify the sections in Chapter 1005 (relating to licensingof BLS and ALS ground ambulance services) that wouldapply to air ambulance services as well as ground ambu-lance services. These would include §§ 1005.3—1005.5,1005.7a, 1005.8, 1005.9, 1005.11, 1005.13 and 1005.15.

All air ambulance services are licensed to provide ALScare. Some of the sections that would be referenced insubsection (e) would impose different requirements upona ground ambulance service depending upon whether theservice was licensed to provide ALS care or only BLScare. This subsection would clarify that the provisions ofthose sections which would apply to air ambulance ser-vices are those which would apply to ground ALS ambu-lance services.

Section 1007.2 (relating to applications) specifies theinformation solicited by applications for air ambulanceservice licenses. It would be amended to identify changesin some of the information that would be solicited. Thesection would also be amended to direct the applicant tofile the license application with the regional EMS councilhaving responsibility for the region in which the applicantintends to station its air ambulances, and it wouldprescribe how the application is to be processed by theregional EMS council. The section would further beamended to include a subsection identifying changes inthe operations of the air ambulance service which wouldrequire a license amendment.

Section 1007.3 (relating to licenses) would be deleted.This section addresses matters such as the Departmentprocedures for reviewing air ambulance license applica-



tions and display of the license. Some of the procedureswould be revised in § 1007.2 (relating to applications).Other matters would be addressed in § 1005.5 (relatingto licensure). Section 1007.1(e) (relating to general provi-sions) would make § 1005.5 applicable to air ambulanceservices.

Section 1007.4 (relating to renewal of air ambulancelicense) would be deleted. This section addresses variousprocedures to be followed for the renewal of an airambulance service license. This subject matter would beaddressed in § 1005.7a (relating to renewal of ambulanceservice license). Section 1007.1(e) (relating to generalprovisions) would make § 1005.7a applicable to air ambu-lance services.

Section 1007.5 (relating to inspections) would be de-leted. This section deals with the authority of Departmentemployes and agents to conduct inspections and investi-gations of air ambulance services. This subject matterwould be addressed in § 1005.3 (relating to right to enter,inspect and obtain records). Section 1007.1(e) (relating togeneral provisions) would make § 1005.3 applicable to airambulance services.

Section 1007.6 (relating to notification of deficiencies)would be deleted. This section deals with the process foraddressing deficiencies following an inspection of an airambulance service. This subject matter would be ad-dressed in § 1005.4 (relating to notification of deficienciesto applicants). Section 1007.1(e) (relating to general provi-sions) would make § 1005.4 applicable to air ambulanceservices.

Section 1007.7 (relating to licensure and general oper-ating standards) enumerates most of the standards anambulance service needs to meet to become licensed andto continue operations. The fact that these are ongoingrequirements was not conveyed by the title ‘‘Licensurerequirements.’’ Consequently, the Department proposes toamend the title by adding the language ‘‘general operat-ing’’ to also modify ‘‘requirements.’’ Moreover, compliancewith many of the current standards, as well as several ofthe proposed additional standards, cannot be fully judgeduntil the ambulance service has become licensed andcommences operations.

Many of the matters addressed in proposed amend-ments to the corresponding section pertaining to groundambulance services, § 1005.10 (relating to licensure andgeneral operating standards), are also addressed in pro-posed amendments to this section, such as requirementsof the air ambulance service to maintain documentationof its staffing plan, a record of calls to which it did notrespond and the reason for not responding, and a copy ofpolicies required by the section. Other similar subjectmatter addressed in the proposed amendments to thissection are what constitutes meeting minimum staffingrequirements; responsibilities with respect to communi-cating with PSAPs; medical command notification respon-sibilities; monitoring responsibilities; and the duty tomaintain written policies and procedures.

A significant change is proposed with respect to thepersonnel required to meet minimum staffing require-ments. The current regulations require that at least oneof the crew members be a physician or a nurse. Thisrequirement would be deleted. The staffing requirementswould be revised to be the same as that required for aground ALS ambulance service. This change is requiredas a matter of law. Section 12(g) of the act dictates theminimum staff that may be required, for licensure pur-poses, when responding to calls to provide EMS to

patients requiring ALS care. The statute makes no dis-tinction between air and ground ALS ambulance servicesin this regard. The Department has no authority tomandate an air ambulance service to exceed the staffingstandards enumerated in section 12(g) of the act. Ofcourse, an air ambulance service is free to exceed theminimum staffing standards prescribed by statute, andshould do so if providing proper care to patients requiresit to exceed those standards.

Section 1007.8 (relating to disciplinary and correctiveactions) deals with the disciplinary process applicable toair ambulance services. The amendments proposed to thissection are virtually the same as those proposed to thecounterpart section pertaining to ground ambulance ser-vices, § 1005.12 (relating to disciplinary and correctiveactions).

Section 1007.9 (relating to voluntary discontinuation ofservice) would be deleted. This section addresses the dutyimposed upon an air ambulance service, under section12(q) of the act, to not discontinue its operations prior togiving advance notice to the Department, political subdi-visions in its service area and the public. This subjectmatter would be addressed in § 1005.15 (relating todiscontinuance of service). Section 1007.1(e) (relating togeneral provisions) would make § 1005.15 applicable toair ambulance services.

Chapter 1009. Medical Command Facilities

This chapter deals with the distinct units in hospitalsout of which physicians who qualify as medical commandphysicians provide medical direction to prehospital per-sonnel when they are providing emergency medical carein prehospital settings and during the interfacility trans-port of patients.

Section 1009.1 (relating to operational criteria) setsforth the requirements that must be met for a distinctunit in a hospital to function as a medical commandfacility. The title would be changed from ‘‘Accreditationand operational criteria.’’ The reason for deleting thereference to ‘‘accreditation’’ is that the act neither re-quires nor makes provision for the Department to accreditmedical command facilities. However, the definition of‘‘medical command facility’’ in section 3 of the act, whichstates that a medical command facility is a distinct unitin a hospital ‘‘that contains the necessary equipment andpersonnel for providing medical command to and controlto an ambulance service,’’ when combined with otherprovisions of the act which declare that the Departmentshall serve as the lead agency for EMS in this Common-wealth (35 P. S. § 6925(b)) and shall have the authorityto promulgate regulations necessary to carry out theprovisions of the act (35 P. S. § 6937.1), implies that theDepartment shall prescribe the ‘‘necessary equipment andpersonnel’’ for a medical command facility. Some of themore significant amendments proposed to the section arethat the medical command facility apprise PSAPs when itis unable to provide medical command, that it have aplan to ensure the availability of medical command inmass casualty situations, and that it provide medicalcommand to prehospital personnel whenever they seekdirection.

Section 1009.2 (relating to recognition process) de-scribes the procedure to be followed if a facility chooses tobe recognized as a medical command facility by theDepartment. The title of the section would be changedfrom ‘‘Accreditation process.’’ The reason for the proposedchange is that the act does not provide for the accredita-tion of medical command facilities, but does offer them



some degree of protection from civil liability if they are‘‘recognized’’ by the Department. Section 11(j)(4) of the actprovides that a medical command facility that is recog-nized by the Department may not be liable for any civildamages resulting as a consequence of orders issuedthrough it, unless guilty of gross or willful negligence.Conditioning this civil liability protection upon being‘‘recognized’’ by the Department suggests that medicalcommand facilities may operate without the recognition,but would have greater exposure to civil liability if theychoose to do so.

This section would be completely rewritten to explainthat securing Department recognition reduces a medicalcommand facility’s exposure to civil liability. It would alsoexplain the role of the Department and regional EMScouncils in the recognition process and the appeal rightsof applicants which are denied medical command facilityrecognition, and it would provide for medical commandfacility recognition to have a 3-year term.

Section 1009.3 (relating to continuity of medical com-mand) would be deleted. This regulation grandfatheredmedical command facilities recognized by regional EMScouncils prior to July 1, 1989, the date the regulation waspromulgated. The regulation is no longer required.

Section 1009.4 (relating to withdrawal of medical com-mand facility recognition) identifies the procedures forconducting inspections and investigating complaintsagainst medical command facilities, the grounds for with-drawal of recognition and procedures for dealing withdeficiencies in lieu of withdrawing recognition. The titleof the section would be changed from ‘‘Suspension/revocation of accreditation.’’

Section 1009.5 (relating to review of medical commandfacilities) provides for regional EMS councils to conductbiennial reviews of medical command facilities. Thissection would be amended to permit the Departmentmore flexibility in determining the frequency of reviews.Comprehensive reviews conducted biennially could imposean excessive work burden on some regional EMS councils,while other regional EMS councils could conduct thereviews more frequently. This is because there are manymedical command facilities in some EMS regions, andvery few in others. The Department anticipates request-ing reviews more frequently than once every 2 years, butwould modify the scope of some reviews so that theywould not involve a comprehensive assessment of compli-ance with all recognition criteria. The title of the sectionwould be changed from ‘‘Biennial review of facilities.’’

Section 1009.6 (relating to discontinuance of service)would be new. This section would require a medicalcommand facility to provide the Department, the appro-priate regional EMS council, and providers of EMS forwhich they routinely medical command, with 60 daysnotice prior to discontinuing medical command opera-tions.Chapter 1011. Accreditation of Training Institutes

This chapter pertains to the Department’s accreditationof teaching institutes that provide persons with thetraining required by the Department’s regulations tobecome certified as a first responder, an EMT or an EMT-paramedic, or recognized as a prehospital registerednurse. Matters addressed are the criteria for accredita-tion, the process to secure accreditation, and the processfor denying, withdrawing, or conditioning accreditation.

Section 1011.1 (relating to BLS and ALS traininginstitutes) identifies the criteria to operate as a BLStraining institute to provide training leading to certifica-

tion as a first responder or an EMT, and as an ALStraining institute to provide training leading to certifica-tion as an EMT-paramedic or a prehospital registerednurse. This section is currently titled ‘‘BLS traininginstitutes’’ and deals only with facilities that providetraining leading to certification as a first responder or anEMT. Section 1011.2 (relating to ALS training institutes)addresses only the criteria for providing training leadingto certification as an EMT-paramedic or recognition as aprehospital registered nurse. The Department concludedthat there was a significant amount of duplication in thetwo sections. It is therefore proposing that the twosections be consolidated into one. Section 1011.2 would berepealed due to the proposed consolidation of the twosections.

Section 1011.3 (relating to accreditation process) identi-fies the process for an entity to become accredited as aBLS or ALS training institute. The Department proposesto remove provisions relating to hearings when accredita-tion is denied, and to consolidate them with other hearingprovisions in § 1011.4 (relating to denial, restriction orwithdrawal of accreditation). The Department also pro-poses to delete language providing for the automaticaccreditation of a training institute accredited by theAmerican Medical Association. Of course, an institutewould still be accredited if it would meet the minimumstandards imposed by this section. The provision proposedfor deletion would be replaced by language providing thatif the Department reviews the accreditation standards ofanother accrediting body, and concludes that they areequal to or greater than the accreditation standards ofthe Department, the Department could rely upon theaccreditation of that accrediting body to abbreviate theDepartment’s own accreditation review.

Section 1011.4 (relating to denial, restriction or with-drawal of accreditation) identifies the procedures forinvestigating complaints against EMS training institutes,for denying, withdrawing or conditioning accreditation,and for appealing those decisions. The title of the sectionwould be changed from ‘‘Suspension/revocation.’’

Chapter 1013. Special Event EMS

This chapter enables entities to have a Departmentdetermination as to whether EMS arrangements areadequate when those entities are responsible for themanagement and administration of a planned and organ-ized activity that places attendees or participants in adefined geographic area where access by emergency ve-hicles might be delayed due to people or traffic congestionat or near the event.

Section 1013.1 (relating to special event planning re-quirements) would be amended to clarify that submittinga special event EMS plan to the Department for itsapproval is not mandated under the act. Nevertheless, asthe Commonwealth’s lead agency for EMS, the Depart-ment believes that this is a public service it should makeavailable to entities desiring such a review. Municipalitiesmay also choose to mandate the review for special eventsheld within their borders. This section would also beamended to reflect that special event EMS plans are to beprocessed through the regional EMS council assignedresponsibility for the region in which the event is to takeplace. An additional substantive requirement for planapproval would be that it identify measures that haveand would be taken to coordinate EMS for the specialevent with local EMS and public safety agencies, such asambulance, police, fire, rescue and hospital agencies ororganizations.



Section 1013.2 (relating to administration, managementand medical direction requirements) would be amendedby requiring that a medical command physician providedirection and supervision for the EMS system for it tosecure Department approval for a special event involvingmore than 25,000 people.

Sections 1013.3—1013.7 would not be amended, exceptthat population figures triggering the application of cer-tain standards in §§ 1013.3 and 1013.5 would be adjusteddownward by 5,000, and equipment requirements in§ 1013.5 would not be confined to BLS equipment.

Section 1013.8 (relating to special event report) wouldbe new. It would require an entity that secured Depart-ment approval of a special event EMS plan to file withthe appropriate regional EMS council, after concluding aspecial event, a special event report containing informa-tion solicited by the Department in the report form.

Chapter 1015. Quick Response Service Recognition Pro-gram

This chapter addresses the mobilization of prehospitalpersonnel to arrive at the scene of emergency and provideEMS in advance of the arrival of an ambulance and itscrew. While most areas of this Commonwealth can bereached by an ambulance within a few minutes, there area few areas, generally rural or remote wilderness areas,where this is not the case. In those areas, the Depart-ment, the regional EMS councils and municipal organiza-tions have attempted to form units of prehospital person-nel to respond to emergencies prior to the arrival of anambulance. The label the Department has given to suchan early EMS response team is ‘‘quick response service(QRS).’’

A shortcoming of the act is that it does not directlyprovide for the creation or regulation of these quickresponse teams. While statutory criteria exists for grant-ing licenses and pursuing disciplinary and correctiveaction against ambulance services, no similar provisionsexist relative to the organization of prehospital personnelinto early response teams.

Nevertheless, the act contemplates that prehospitalpersonnel arriving at an emergency scene by ambulance,and transporting patients by ambulance, are not to be theexclusive components of prehospital EMS. For example,section 4(4)(i) and (ii) of the act (35 P. S. § 6924(4)(i) and(ii)) direct the Department to coordinate programs toensure that the Commonwealth’s EMS system has anadequate number of vehicles, in addition to ambulances,to transport patients, and that those vehicles be properlystaffed and equipped. Also, in 1994 the act was amendedby Act 82 to provide for the certification of first respond-ers, which the act describes as persons certified tostabilize and improve a patient’s condition in a prehospi-tal setting until more highly trained prehospital person-nel arrive at the scene. See section 11(a.1) of the act. Thischapter is designed to bring first responders and otherauthorized personnel who provide preambulance medicalassistance to patients into the Commonwealth’s EMSsystem in a more structured manner than has beenaccomplished by existing regulations.

Section 1015.1 (relating to quick response service)would be new. It would establish criteria for recognitionas a QRS, the process for securing the recognition, andprovide for renewal. To receive QRS recognition an appli-cant would have to maintain equipment that the Depart-ment will identify in the Pennsylvania Bulletin, have thecapability to be dispatched and to communicate with aresponding ambulance service, provide EMS only through

prehospital personnel and other persons authorized bylaw to provide the services, provide designated informa-tion on an ambulance call report for each call to which itresponds, and follow Statewide and regional medicaltreatment protocols.

Section 1015.2 (relating to discontinuation of service)would be new. It would require a QRS to provide advancenotice to the Department, the appropriate regional EMScouncil, and each political subdivision within its servicearea before discontinuing services.Fiscal Impact

The cost to the Department to administer and monitorthe continuing education program would increase becausean additional staff position would be required in theDepartment to coordinate the integration of revised con-tinuing education standards. Additionally, the Depart-ment would incur costs in developing review processes toincorporate alternative methods of course presentationwhich would be permitted by the amendments. Also, allcurrently approved continuing education courses (approxi-mately 700) would need to be re-evaluated and assignednew course numbers to reflect trauma and medical con-tinuing education credit hours for which the course wouldqualify. The Department would also need to revise thereporting and recordkeeping process for it to processcontinuing education information. Revision of forms andprinting would result in associated costs. One computerwork system for the additional staff person would beneeded.

The Department would also incur additional costs forthe continuing education program to update computersoftware to maintain a registry of continuing educationcourses. Also, costs would be incurred in updating con-tinuing education data processing capabilities. The totalestimated costs for these expenditures are $100,500 forFY 1998-99.

Currently, physicians who are not board certified inemergency medicine must complete additional courses tomaintain recognition as a medical command physician. Aphysician is required to renew ATLS and ACLS certifica-tion on a 4-year and 2-year basis. Of the 3,200 medicalcommand physicians, approximately 23% (736) of themare board certified in emergency medicine and, therefore,are not required to take additional courses. The regula-tions for other medical command physicians would berevised to require completion of an ATLS course on a onetime basis only. Costs for ATLS courses may range from$125—$325. Also, these courses are not readily availablein rural areas of the Commonwealth. Physicians fre-quently need to travel to distant parts of the State tocomplete ATLS courses. The regulations would result in acost reduction to that physician population ranging from$308,000—$800,800 every 4 years.Paperwork Requirements

Medical command facility medical director and medicalcommand physician applications would be revised. Themanual the Department distributes to facilities to aidthem in meeting medical command facility criteria wouldneed to be revised, reprinted and distributed. The Depart-ment would need to do likewise for the manual itdistributes to regional EMS councils to aid them insurveying license applicants.

The Department’s records for the existing 700 continu-ing education courses would need to be revised to reflectnew course numbers given to them to reflect trauma andmedical continuing education credit hours assigned tothem. Course forms would need to be revised by institu-



tions offering the courses. They would also incur revisedreporting and recordkeeping responsibilities.

In making the transition to the new regulatory stan-dards, the Department intends to employ all opportunityafforded by technology to reduce paperwork and costs.

Effective Date/Sunset Date

The proposed amendments will go into effect whenpublished in the Pennsylvania Bulletin as final regula-tions. No sunset date will be imposed. The Departmentwill monitor the regulations to ensure that they meetEMS needs within the scope of the Department’s author-ity to address through regulations.

Statutory Authority

Section 17.1 of the act (35 P. S. § 6937.1) provides thatthe Department, in consultation with the Council, maypromulgate regulations as may be necessary to carry outthe provisions of the act. Other sections of the act containmore narrow grants of authority to the Department topromulgate regulations.

In section 3 of the act, the definitions of ‘‘advanced lifesupport service medical director’’ and ‘‘CommonwealthEmergency Medical Director’’ provide that to qualify aseither, one must be a medical command physician or meetequivalent qualifications as established by the Depart-ment through regulation. In the same section, the defini-tions of ‘‘emergency medical technician’’ and ‘‘emergencymedical technician-paramedic’’ provide that both are to becertified in accordance with the current National stan-dard curriculum as set forth in the regulations of theDepartment. See, also, section 11(b)(1)(i) and (d)(1)(i) ofthe act. The definition of ‘‘medical command’’ in section 3of the act provides that medical command physicians areto meet qualifications prescribed by the Department.

Section 5(2) of the act authorizes the Department toemploy regulations to establish standards and criteriagoverning the award and administration of contractsunder the act. Section 5(11) of the act authorizes theDepartment to adopt regulations to establish standardsand criteria for EMS systems.

Section 11(a)(1) of the act provides that the Departmentshall employ regulations to develop standards for theaccreditation of educational institutes for EMS personnel.Section 11(a)(4), (d)(3) and (e) of the act provide that EMTand EMT-paramedics may, in the case of an emergency,perform duties deemed appropriate by the Department inaccordance with the Department’s regulations. Section11(d)(2)(ii)(A) and (B), and (e.1)(3)(i) and (ii) of the actprovides that ALS service medical directors shall base adecision on whether to grant medical command authoriza-tion to an EMT-paramedic or prehospital registered nurseupon the individual’s demonstrated competency in knowl-edge and skills as defined by Department regulation andthe individual’s completion of continuing education re-quirements adopted by regulation. Section 11(d)(2)(vi) and(e.1)(5) of the act provide that when an EMT-paramedicor prehospital registered nurse chooses to not seek ormaintain medical command authorization, and to functionexclusively as an EMT, that person is to apply to theDepartment for recognition as an EMT under Departmentregulations. Section 11(f) of the act provides that physi-cians approved by regional EMS councils as medicalcommand physicians may give medical commands subjectto Department regulatory requirements. Section 11(h) and(i) of the act provides that regional EMS council transferand medical treatment protocols are to be establishedunder Department regulation. Section 11(j)(2) of the act

grants immunity, for specified conduct, to EMS studentsenrolled in approved courses and supervised under De-partment regulations.

Section 12(b) of the act provides that applications forthe renewal of ambulance service licenses shall be madeon forms prescribed by the Department in accordancewith its regulations. Section 12(d) of the act provides thatthe Department shall promulgate regulations settingforth minimum essential equipment for BLS and ALSambulances, as well as design criteria for ambulances.

Section 14(d) of the act (35 P. S. § 6934(d)) providesthat the standards the Department employs to disbursemoneys from EMSOF to providers of EMS shall be underregulation.

Regulatory Review

Under section 5(a) of the Regulatory Review Act (71P. S. § 745.5(a)), on January 29, 1999, the Departmentsubmitted a copy of these proposed amendments to theIndependent Regulatory Review Commission (IRRC) andthe Chairpersons of the House Health and Human Ser-vices Committee and the Senate Public Health andWelfare Committee. In addition to submitting the pro-posed amendments, the Department has provided IRRCand the Committees with a copy of a detailed RegulatoryAnalysis Form prepared by the Department in compliancewith Executive Order 1996-1, ‘‘Regulatory Review andPromulgation.’’ A copy of this material is available to thepublic upon request.

If IRRC has objections to any portion of the proposedamendments, it will notify the Department within 10days of the close of the Committees’ review period. Thenotification shall specify the regulatory review criteriawhich have not been met by that portion. The RegulatoryReview Act specifies detailed procedures for review priorto final publication of the regulations, by the Department,the General Assembly and the Governor of objectionsraised.

Contact Person

Interested persons are invited to submit comments,suggestions or objections regarding the proposal to Mar-garet E. Trimble, Director, Emergency Medical ServicesOffice, Department of Health, 1027 Health and WelfareBuilding, P. O. Box 90, Harrisburg, PA 17108, (717)787-8740, within 30 days after publication of this noticein the Pennsylvania Bulletin. Persons with a disabilitymay also submit comments, suggestions or objections toMargaret Trimble in alternative formats, such as by audiotape, braille, or by using TDD: (717) 783-6514. Personswith a disability who require an alternate format of thisdocument (such as, large print, audio tape, braille) shouldcontact Margaret Trimble so that she may make thenecessary arrangements.

GARY L. GURIAN,Acting Secretary

Fiscal Note: 10-143. (1) General Fund; (2) Implement-ing Year 1998-99 is $34,000; (3) 1st Succeeding Year1999-00 is $Minimal; 2nd Succeeding Year 2000-01 is$Minimal; 3rd Succeeding Year 2001-02 is $Minimal; 4thSucceeding Year 2002-03 is $Minimal; 5th SucceedingYear 2003-04 is $Minimal; (4) Fiscal Year 1997-98 $6million; Fiscal Year 1996-97 $8 million; Fiscal Year1995-96 $6 million; (7) Emergency Medical Services;(8) recommends adoption. The Department can absorbany increased cost associated with these proposed amend-ments.



Annex A

TITLE 28. HEALTH AND SAFETY

PART VII. EMERGENCY MEDICAL SERVICES

CHAPTER 1001. ADMINISTRATION OF THE EMSSYSTEM

Subchapter A. GENERAL PROVISIONS

GENERAL INFORMATION

§ 1001.1. Purpose.

The [ Department has the duty under the act ]purpose of this part is to plan, guide, assist andcoordinate the development of regional EMS systems intoa unified Statewide system and to coordinate the systemwith similar systems in neighboring states, and tootherwise implement the Department’s responsibili-ties under the act consistent with the Department’srulemaking authority. [ The Department will ac-complish this purpose through this part. ]§ 1001.2. Definitions.

The following words and terms, when used in this part,have the following meanings, unless the context clearlyindicates otherwise:

ACLS course—Advanced cardiac life support course—Acourse in advanced cardiac life support sanctioned bythe American Heart Association.

ALS ambulance service—Advanced life support ambu-lance service—An entity licensed by the Department toprovide ALS services [ and transportation ] by ambu-lance to seriously ill or injured patients. The termincludes mobile ALS ambulance services that may ormay not transport patients.

ALS service medical director—Advanced life supportservice medical director—A medical command physicianor a physician meeting the equivalent qualifications [ setforth ] in § 1003.5 (relating to ALS service medicaldirector) who is employed by, contracts with or volunteerswith, either directly, or through an intermediary, an ALSambulance service to make medical command authori-zation decisions, provide medical guidance and adviceto the ALS ambulance service and [ to ] evaluate thequality of patient care provided by the prehospital person-nel utilized by the ALS ambulance service.

ALS services—Advanced life support services—The ad-vanced prehospital and interhospital emergency medicalcare of serious illness or injury by appropriately trainedhealth professionals and [ certified ] EMT-paramedics.

APLS course—Advanced pediatric life supportcourse—A course in advanced pediatric life supportsanctioned by the American Academy of Pediatricsand the American College of Emergency Physicians.

ATLS course—Advanced trauma life support course—Acourse in advanced trauma life support sanctioned bythe American College of Surgeons Committee on Trauma.

* * * * *

Air ambulance—A rotorcraft [ licensed by the De-partment for use as an EMS vehicle ] specificallydesigned, constructed or modified and equipped,used or intended to be used, and maintained oroperated for the purpose of providing emergencymedical care to, and air transportation of, patients.

[ Air ambulance medical crew member—A licens-ed physician, registered nurse or certifiedEMTparamedic, who meets the qualifications re-quired by Chapter 1007 (relating to licensing of airambulance services—rotor craft) and who is em-ployed to provide prehospital medical care andservices to patients transported by air ambulance. ]

Air ambulance medical director—A medical commandphysician or a physician meeting the minimum qualifica-tions [ set forth ] in [ § 1003.41 (relating to air ambu-lance medical director) ] § 1003.5 who is employed by,or contracts with, or volunteers with, either directly, orthrough an intermediary, an air ambulance service tomake medical command authorization decisions,provide medical guidance and advice to the [ ALS ] airambulance service, and [ to ] evaluate the quality ofpatient care provided by the prehospital personnel uti-lized by the air ambulance service.

Air ambulance service—An agency or entity licensed bythe Department to provide transportation and ALS careof patients by air ambulance.

* * * * *

Ambulance—A vehicle specifically designed, constructedor modified and equipped, used or intended to be used,and maintained or operated for the purpose of providingemergency medical care to patients, and the transporta-tion of [ , ] patients if used for that purpose. The termincludes ALS or BLS vehicles that may or may nottransport patients.

Ambulance attendant—An individual who [ holds avalid certificate evidencing the successful comple-tion of a course in advanced first aid sponsored bythe American Red Cross and a valid certificateevidencing the successful completion of a course inCPR sponsored by the American Heart Associationor the American Red Cross, or an individual whocan evidence the successful completion of anequivalent training program approved by the De-partment ] possesses the qualifications in§ 1003.21(b) (relating to ambulance attendant).

Ambulance call report—A summary of an emer-gency ambulance response, nonemergency ALS re-sponse, interfacility transport or nonemergencyBLS transport that becomes an emergency. Thereport shall contain information specified in a for-mat provided by the Department.

Ambulance identification number—A number is-sued by the Department to each ambulance oper-ated by an ambulance service.

Ambulance service—An entity which regularly engagesin the business or service of providing emergency medicalcare and transportation of patients in this Common-wealth. The term includes [ mobile ] ALS ambulanceservices that may or may not transport patients.

Ambulance service affiliate number—[ The ] A uniquenumber assigned by the Department to an ambulanceservice, the first two digits of which designate thecounty in which the ambulances of the ambulanceservice are based.



[ Ambulance trip report number—A unique num-ber assigned to an ambulance response and re-corded on the ambulance trip report form. ]

BLS ambulance service—Basic life support ambulanceservice—An entity licensed by the Department to provideBLS services and transportation by ambulance to [ seri-ously ill or injured ] patients.

BLS services—Basic life support services—The basicprehospital or interhospital emergency medical care andmanagement of illness or injury performed by speciallytrained [ and ], certified or licensed personnel.

[ BLS training institute—Basic life support train-ing institute—An entity accredited by the Depart-ment to conduct BLS training courses designed toprepare individuals to render prehospital andinterhospital BLS within an organized EMS sys-tem. ]

Basic rescue practices technician—An individual who[ holds a valid certificate of successful completionof a rescue training program conducted in accord-ance with the training curriculum approved by theDepartment ] is certified by the Department topossess the training and skills to perform a rescueoperation as taught in a basic rescue practicestechnician program approved by the Department.

Basic vehicle rescue technician—An individual who[ holds a valid certificate of successful completionof a vehicle rescue training program conducted inaccordance with the training curriculum approvedby the Department ] is certified by the Departmentto possess the training and skills to perform arescue from a vehicle as taught in a basic vehiclerescue technician program approved by the Depart-ment.

Board certification—Current certification in amedical specialty or subspecialty recognized byeither the American Board of Medical Specialties orthe American Osteopathic Association.

CPR—Cardiopulmonary resuscitation—The combina-tion of artificial respiration and circulation which isstarted immediately as an emergency procedure whencardiac arrest or respiratory arrest occurs[ , by thoseproperly trained and certified to do so ].

CPR [ Certification ] course—Cardiopulmonary re-suscitation [ certification ] course—A [ certificate evi-dencing successful completion of a ] course of in-struction in CPR, meeting the [ most current AmericanHeart Association ] Emergency Cardiac Care Com-mittee National Conference on CPR and EmergencyCardiac Care standards. The [ certification ] courseshall [ have a current valid date and ] encompass oneand two-rescuer adult, infant and child CPR, andobstructed airway methods.

[ Closest available ambulance—An ambulance,which as a result of a combination of location andother factors, such as traffic conditions, weather,and the like, can reach a patient most promptly. ]

* * * * *

Continuing education—Learning activities in-tended to build upon the education and experien-tial basis of prehospital personnel for the enhance-

ment of practice, education, administration,research or theory development, to strengthen thequality of care provided.

Continuing education sponsor—An entity or institutionthat [ applies to the Department and satisfies theDepartment’s requirements to become an ] is accred-ited by the Department as a sponsor of continuingeducation courses.

Council—The [ State Advisory Council, which shallbe known as the ] Board of Directors of the Pennsylva-nia Emergency Health Services Council.

Critical care specialty receiving facility—[ Facilities ]A facility identified by [ their ] its capability of provid-ing specialized emergency and continuing care to pa-tients [ within ], including, in one of the followingmedical areas: poisoning, neonatal, spinal cord injury,behavioral, burns, cardiac and trauma.

* * * * *

Department [ of Health certification ] identificationnumber—A number issued [ through the Department’scomputer system ] by the Department that identifiesan individual who participates in the Statewide EMSsystem and, who has been certified [ as an EMT,EMT-paramedic, EMT instructor, first responder,and the like. The certification includes the expira-tion date and the status level. ], recognized orotherwise assigned an identification number by theDepartment.

Direct support of EMS systems—Activities, equip-ment and supplies that are involved in the plan-ning, initiation, maintenance, expansion or im-provement of EMS systems.

EMSOF—Emergency Medical Services OperatingFund—Moneys appropriated to the Department un-der section 14(c) of the act (35 P. S. § 6934(c)) andwhich are not assigned to the Catastrophic Medicaland Rehabilitation Fund.

* * * * *

[ EMS council—A nonprofit incorporated entity orappropriate equivalent whose function is to plan,develop, maintain, expand and improve EMS sys-tems within a specific geographical area of thisCommonwealth and which is deemed by the De-partment as being representative of health profes-sions and major public and voluntary agencies,organizations and institutions concerned with pro-viding EMS. See the definition of ‘‘regional EMScouncil.’’ ]

* * * * *

EMS training institute—Emergency medical ser-vices training institute—An institute accredited bythe Department to provide a course required forthe certification or recognition of a prehospitalpractitioner.

* * * * *

EMT—Emergency medical technician—An individualtrained to provide prehospital emergency medical treat-ment and certified as such by the Department in accord-ance with the current [ NSC for basic EMTs ] EMT-NSC, as set forth in this part.



EMT-NSC—Emergency medical technician-Nationalstandard curriculum—[ The current National trainingprogram for emergency medical technicians ] Anoutline of knowledge and skills recommended forthe education and training of EMTs, as adopted bythe United States Department of Transportation.

EMT-paramedic—Emergency medical technician para-medic—An individual who is trained to provide prehospi-tal emergency medical treatment at an advanced leveland certified as such by the Department [ under ] inaccordance with the current [ NSC for EMT-paramedics ] EMT-NSC, as set forth in this part.

EMT-paramedic NSC—Emergency medical technician-paramedic National standard curriculum—[ The Na-tional training program for EMT-paramedics ] Anoutline of knowledge and skills recommended forthe education and training of EMT-paramedics, asadopted by the United States Department of Transporta-tion.

* * * * *

Emergency department—An area of the hospital dedi-cated to offering emergency medical evaluation and initialtreatment to individuals in need of emergency care. [ Anemergency department may be a section/division ofthe medicine or surgery department, or may beorganized as a separate department. ]

* * * * *

Federal KKK standards—The minimum standards andspecifications for ambulance vehicles [ set up ] adoptedby the United States Department of Transportation[ Federal KKK-A-1822-B 1985, and amendments orrevisions thereto ].

* * * * *

[ Field internship—A portion of a required EMT-paramedic training program during which the stu-dent obtains supervised experience on a licensedALS unit.

Field preceptor—A person who evaluates a stu-dent’s performance in a prehospital setting and isapproved by the ALS training institute medicaldirector. ]

* * * * *

Health professional—A [ licensed ] physician who haseducation and continuing education in ALS services andprehospital care or a prehospital registered nurse.

* * * * *

[ Incident location—The geographic site of anemergency usually indicated by a minor civil divi-sion code number. ]

Invalid coach—A vehicle primarily maintained, oper-ated and intended to be used for routine transport ofpersons who are convalescent or otherwise nonambulatoryand do not ordinarily require emergency medical treat-ment while in transit. The term does not include anambulance or [ an ] another EMS vehicle.

[ Licensing agency—The Department. ]Medical advisory committee—An advisory body, com-

posed of a majority of physicians, to advise [ the ] a

regional[ /State ] EMS council or the Council on issuesthat have potential impact on the delivery of emergencymedical care.

* * * * *

Medical command—An order given [ to a provider ofEMS by an authorized medical command physicianwho meets qualifications prescribed by the Depart-ment ] by a medical command physician to a pre-hospital practitioner in a prehospital, interfacilityor emergency care setting in a hospital, to provideimmediate medical care to prevent loss of life oraggravation of physiological or psychological ill-ness or injury.

Medical command authorization—Permission given bythe ALS service medical director, including an airambulance medical director, to an EMT- paramedic ora prehospital registered nurse under § 1003.28 (relatingto medical command authorization) to perform, on behalfof an ALS ambulance service, ALS services pursuant tomedical command or in accordance with Departmentapproved regional EMS council transfer and medicaltreatment protocols when medical command cannot besecured, is disrupted or is not required pursuant to theapproved regional EMS council transfer and medicaltreatment protocols.

Medical Command Base Station Course—Thecourse adopted by the Department for medicalcommand physicians and ALS service medical di-rectors which provides an overview of the medicalcommand system and base station direction.

Medical command facility—The distinct unit within afacility that contains the necessary equipment and per-sonnel, as prescribed in § 1009.1 (relating to opera-tional criteria) for providing medical command to andcontrol [ to an ambulance service ] over prehospitalpersonnel when providing medical command.

Medical command facility medical director—A medicalcommand physician [ responsible ] who meets thecriteria established by the Department to assumeresponsibility for the [ medical ] direction and controlof the [ medical command physicians at an accred-ited ] equipment and personnel at a medical com-mand facility.

Medical command physician—A physician [ licensedin this Commonwealth who meets the criteria setforth by the Department for a medical commandphysician and ] who is approved by [ the ] a regionalEMS council [ medical director ] to provide medicalcommand [ to prehospital and interhospital provid-ers ].

Medical [ control ] coordination—A system whichinvolves the medical community in all phases of theregional EMS system and consists of the following ele-ments:

* * * * *

(ii) Responsibility for [ overall supervision ] over-sight to assure implementation of all medical require-ments, with special emphasis on patient triage andmedical treatment protocol.

(iii) Effective emergency medical planning and [ desig-nation ] recommendation for Department recogni-



tion of [ on-line ] online command facilities with med-ical command physicians who give orders to prehospitalpatient care providers.

(iv) [ Medical ] Transfer and treatment protocols.

* * * * *

[ Medical protocols—Written prescribed medicalprocedures, adopted by the regional EMS councilsafter consultation with the regional EMS medicaladvisory committee and approval by the Depart-ment. Review of medical protocols by the regionalcouncils shall be made on an annual basis withnotification to the Department of changes. ]

* * * * *

[ Medical service area—A specified geographicarea within which responsibility for medical super-vision and control is designated by a regional EMScouncil based upon factors such as patient flowpatterns, area population and EMS call volumes. ]

Medical treatment protocols—Written prescribedmedical procedures.

Mutual aid response—Response by an ambulance unitto an emergency based on a written agreement between[ EMS providers ] ambulance services whereby thesigning parties agree to lend aid to one another underconditions specified in the agreement.

* * * * *

[ On-line communication—Direct radio or tele-phonic communication. ]

PALS course—Pediatric advanced life supportcourse—A course in advanced pediatric life supportsanctioned by the American Heart Association andthe American Academy of Pediatrics.

PSAP—Public safety answering point—A commu-nications center established to serve as the firstpoint at which calls by or on behalf of patients arereceived requesting emergency medical assistance.

Patient—An individual who is believed to be sick,injured, wounded or otherwise incapacitated and helplessand who needs immediate medical attention.

[ Pennsylvania Field Protocols for BLS—The mostcurrent BLS treatment guidelines recommended bythe Council’s Medical Advisory Committee and ap-proved by the Department as defined in the act. ]

* * * * *

Physician—An individual who has a currentlyregistered license to practice medicine or osteo-pathic medicine in this Commonwealth.

[ Prehospital ambulance trip report—A summaryof each ambulance call to which an ambulanceresponds. The report shall contain informationspecified on forms provided by the Department. ]

Prehospital personnel—[ Personnel certified or rec-ognized by the Department to render EMS to pa-tients outside of the hospital setting. ] The termincludes any of the following individuals:

(i) Ambulance attendants.

(ii) First responders.

(iii) EMTs.

(iv) EMT-paramedics.(v) Prehospital registered nurses.(vi) Health professional physicians.

Prehospital Personnel [ Training ] Manual—***

* * * * *

[ Prescribing physician—A physician licensed inthis Commonwealth who is either the medical com-mand physician who has ordered the controlledsubstance or the receiving emergency departmentphysician who has received the patient from theALS unit and will be replacing the controlled sub-stance. A prescribing physician shall possess a validDEA number.

Primary response area—The specified geographicarea assigned to a licensed ambulance service thatthen has responsibility for the provision of prehos-pital emergency medical care and transportation inthe area. Primary response areas are determinedby regional EMS council plans, according to factorssuch as the location of ambulance resources, ambu-lance response times and area population. A pri-mary response area designation is not intended tobe an exclusive designation. ]

Providers of EMS—A facility, BLS ambulance serviceor ALS ambulance service, or a QRS.

QRS—Quick [ Response Service ] response service—[ A service which meets Department requirementsand is strategically located to fill a response timegap if EMS cannot be provided within 10 minutes ofthe time a call for assistance is received. ] An entityrecognized by the Department to respond to anemergency and to provide EMS to patients pendingthe arrival of the prehospital personnel of an ambu-lance service.

[ Quick responder—A person responding as partof a designated quick response service which isstrategically located within a specified EMS servicearea and is coordinated through the local andregional EMS response system. The personnel shallbe trained and certified to the first responder levelor higher. ]

Receiving facility—A fixed facility that provides anorganized emergency department [ of emergencymedicine ], with a [ licensed and ACLS certified ]physician who is trained to manage cardiac, traumaand pediatric emergencies, and is present in thefacility [ who is ] and available to the emergency depart-ment 24 [ hours a day ] hours-a-day, 7 [ hours aweek ] days-a-week, and a registered nurse who ispresent in the emergency department 24 [ hours a day ]hours-a-day, 7 [ hours a week ] days-a-week. The[ facilities ] facility shall also comply with Chapter 117(relating to emergency services).

Regional EMS council—A nonprofit incorporated entityor appropriate equivalent whose function is to plan,develop, maintain, expand and improve EMS systemswithin a specific geographical area of this Commonwealthand which is deemed by the Department as being repre-sentative of health professions and major public andvoluntary agencies, organizations and institutions con-cerned with providing EMS in the region. [ See thedefinition of ‘‘EMS council.’’ ]



Registered nurse—An individual who has a cur-rent original or renewed license to practice nursingin this Commonwealth as a registered nurse.

* * * * *

Service area—The area in which an ambulanceservice routinely provides services.

* * * * *

Special event—A planned and organized activity orcontest, which will place [ a group of 10,000 or moreknown or estimated ] participants or attendees, orboth, in a defined geographic area where access byemergency vehicles might be delayed due to crowd ortraffic congestion at or near the event.

[ Specialized ] Special vehicle rescue [ training ]technician—An individual who [ holds a valid certifi-cate of successful completion of a training programin specialized rescue training conducted in accord-ance with the curriculum approved by the Depart-ment ] is certified by the Department to possess thetraining and skills to perform special rescue opera-tions as taught in the special vehicle rescue train-ing program approved by the Department.

* * * * *

Statewide BLS medical treatment protocols—Written medical treatment protocols adopted by theDepartment that have Statewide application to thedelivery of BLS services by prehospital personnel.

[ Transfer agreements—A formal written agree-ment between facilities providing for transfer ofpatients to specialized facilities which offerfollow-up care and rehabilitation as necessary toeffect the maximum recovery of the patient. ]

Trauma center—A facility accredited as a traumacenter by the Pennsylvania Trauma Systems Founda-tion.

[ Vehicle licensure identification number—A num-ber issued by the Department to each ambulance ofa ambulance service. ]§ 1001.3. Applicability.

[ (a) This part implements the act.

(b) ] This part affects regional EMS councils, theCouncil, other entities desiring to [ contract with ]receive funding from the Department or the regionalEMS councils for the provision of EMS, ALS and BLSambulance services, QRSs, instructors and institutesinvolved in the training of prehospital personnel includ-ing EMTs, EMT-paramedics, first responders, ambulanceattendants and health professionals, and trauma centersand local governments involved in the administration andsupport of EMS.

§ 1001.4. Exceptions.

(a) The Department may, for justifiable reason, grantexceptions to, and departures from, this part when thepolicy objectives and intentions of this part are otherwisemet or when compliance would create an unreasonablehardship, but would not impair the health, safety orwelfare of the public. No exceptions or departures fromthis part will be granted if compliance with the [ re-quirement is provided for ] standard is required bystatute.

* * * * *

(f) The Department may, on its own initiative,grant an exception to this part if the substantiverequirements of subsection (a) are satisfied.

§ 1001.5. Investigation.

[ (a) The Department may investigate accidentsinvolving an ambulance or other EMS vehicle.

(b) The Department may investigate complaintsinvolving EMS providers or personnel. ] The De-partment may investigate any person, entity oractivity for compliance with the provisions of theact and this part.

§ 1001.6. Comprehensive EMS development plan.

(a) The Department, with the advice of the Council,will develop and annually update a Statewide EMSdevelopment plan for the coordinated delivery of EMSin this Commonwealth.

* * * * *

(c) The Department will incorporate regionalEMS development plans into the Statewide EMSdevelopment plan.

(d) The Department will adopt a Statewide EMSdevelopment plan, and updates to the plan, afterpublic notice, an opportunity for comment and itsconsideration of comments received, and will makethe plan available to the General Assembly and allconcerned agencies, entities and individuals whorequest a copy.

§ 1001.7. Comprehensive regional EMS develop-ment plan.

(a) A regional EMS council shall develop andannually update a regional EMS development planfor coordinating and improving the delivery of EMSin the region for which it has been assigned respon-sibility.

(b) The plan shall contain:

(1) An inventory of emergency services resourcesavailable in the region.

(2) An assessment of the effectiveness of the ex-isting services and a determination of the need foradditional services.

(3) A statement of goals and specific measurableobjectives for delivery of EMS to persons in need ofEMS in the region.

(4) Identification of interregional problems andrecommended measures to resolve those problems.

(5) Methods to be used in achieving stated objec-tives.

(6) A schedule for achievement of the stated ob-jectives.

(7) A method for evaluating whether the statedobjectives have been achieved.

(8) Estimated costs for achieving the stated objec-tives.

(9) Other information as requested by the Depart-ment.

(c) A regional EMS council shall, in the course ofpreparing a regional EMS development plan, andupdates to the plan, provide public notice and an



opportunity for comment. It shall consider all com-ments before submitting a proposed plan to theDepartment.

(d) A regional EMS development plan shall be-come final after it is approved by the Department.The regional EMS council shall make the planavailable to all concerned agencies, entities andindividuals who request a copy.

Subchapter B. AWARD AND ADMINISTRATION OF[ CONTRACTS ] FUNDING

§ 1001.21. Purpose.This subchapter implements section 5(b)(2) of the act

(35 P. S. § 6925(b)(2)), which authorizes the Depart-ment to establish, by regulation, standards andcriteria governing the award and administration ofcontracts under the act, and section 10 of the act (35P. S. § 6930), which authorizes the Secretary to enter intocontracts with regional EMS councils and other appropri-ate entities for the initiation, expansion, maintenance andimprovement of EMS systems which are in accordancewith the Statewide EMS development plan, andwhich further authorizes the Secretary to enterinto contracts with organizations other than re-gional EMS councils to assist the Department incomplying with the provisions of the act.§ 1001.22. Criteria for funding.

(a) A potential contractor or other recipient of fundsfrom the Department, either directly or through theDepartment’s agent, may receive funding for the follow-ing:

(1) Public education, information and prevention re-garding EMS, including:

* * * * *

(2) Purchasing ambulances, medical equipment andrescue equipment which enables or enhances thedelivery of EMS. Equipment will be funded only ifapproved by the Department.

(i) Ambulances will be considered for funding if thefunds will be used for [ expansion for the service ] theaddition or replacement of existing vehicles or parts, bya licensed ambulance service or an [ ambulance ser-vice ] entity submitting an application for licensure asan ambulance service. [ Ambulances which arefunded shall meet or exceed standards defined,published and distributed by the Department. ]

(ii) Medical equipment will be considered for funding ifthe funds will be used to purchase medical equipment forambulances, [ QRS ] QRSs, [ first responder agen-cies ], rescue services and other emergency servicesapproved by the Department, including police and firedepartments and recognized medical commandfacilities.

(iii) Rescue equipment will be considered for funding ifthe funds will be used to purchase rescue equipment forambulance services, rescue services, fire departments,[ QRS ] QRSs, police agencies and other emergencyservices approved by the Department.

(3) Costs associated with training programs for prehos-pital personnel.

(i) [ These funds will be provided only to EMStraining facilities accredited by the Department forclasses that include first responders, EMTs, EMT-

paramedics, emergency services dispatchers, healthprofessionals and rescue technicians.

(ii) Costs associated with the training programsin subparagraph (i) that will be eligible for fundinginclude expenses associated with providing:

(A) Instructors.

(B) Course coordinators.

(C) Program medical directors.

(D) Clinical and field preceptors.

(E) Medical and nonmedical equipment and sup-plies.

(F) Field internships.

(G) Related travel expenses.

(H) Program directors. ]Educational costs associated with the conduct of

training programs for prehospital personnel, andfor other personnel who are involved in managinginterfacility patient transports.

[ (iii) ] (ii) ***

* * * * *

(5) Purchasing communications equipment, includingmedical command communications equipment, andalerting equipment for EMS purposes, if the purchasesare in accordance with regional EMS council and State-wide telecommunications plans.

(6) Purchasing equipment for [ hospital ] emergencydepartments, if the equipment is used or intended to beused in equipment exchange programs with ambulanceservices. The equipment purchased shall be of a type usedby prehospital and interhospital EMS personnel in thecare, treatment, stabilization and transportation of pa-tients in a prehospital or interhospital setting. It shall bethe type of equipment that can be easily or safelyremoved from the patient upon arrival or during treat-ment at the receiving [ medical ] facility.

* * * * *

(9) Emergency allocations.

(i) Costs associated with a State or Federally declaredemergency which the [ Secretary ] Department findsnecessary to carry out the purpose of the act. Eligibleapplicants are those recognized by the regional EMScouncil as participants in the delivery of emergencymedical or rescue services to or in the affected area.

(ii) Other emergency allocations found necessary by the[ Secretary ] Department to provide immediate re-sources or equipment to an area where the health andsafety of the residents of this Commonwealth are injeopardy.

(10) Costs associated with the implementation of volun-tary certification or recognition programs, [ includ-ing ] such as a voluntary rescue service certificationprogram.

* * * * *

(b) [ To be considered for funding, a potentialcontractor may not propose to provide ] Funds willnot be made available for any of the following:

* * * * *



(c) The Department will set forth additional pri-orities for funding on a yearly basis in noticespublished in the Pennsylvania Bulletin.

(d) The Department, by contract or notice pub-lished in the Pennsylvania Bulletin, may require acontractor or other applicant for funding to pro-vide matching funds in specified percentages as acondition for receiving funds distributed by theDepartment or a regional EMS council.§ 1001.23. Allocation of funds.

[ (a) ] The Department and regional EMS councilswill consider the following factors in determining whoshall receive funding and in what amount:

* * * * *(2) Conformity of the proposed application to the

[ State ] Statewide EMS development plan.

* * * * *

(4) [ Source of other funds ] Funds available to theapplicant for the purpose set forth in the application,including non-State contributions, Federal grants[ , ] orFederal contracts pertaining to EMS. Non-State contribu-tions include cash and in-kind services provided to thecontractor or toward the operation of an EMS system byprivate, public or government entities, including theFederal government.

* * * * *

[ (b) The Department will set forth priorities forfunding on a yearly basis in policies published bynotice in the Pennsylvania Bulletin. ]§ 1001.24. Application for contract.

To be considered for funding by the Department toplan, initiate, maintain, expand or improve an EMSsystem, a regional EMS council or other appropriateentity shall submit an application on a form [ pre-sented ] prepared by the Department[ , including, butnot limited to, ] and shall provide the followinginformation:

* * * * *§ 1001.26. Restrictions on contracting.

(a) The Department will not contract, during the sameterm of contract, [ for the organization of ] with morethan one regional EMS council [ which covers thesame geographic area or a substantial ] to exerciseresponsibility for all or a portion of the same geo-graphic area.

* * * * *§ 1001.27. Subcontracting.

(a) A regional EMS council, which has received acontract from the Department, may receive the Depart-ment’s written approval to subcontract certain of itscontractual duties to other [ EMS ] entities as deemednecessary and appropriate for the proper execution of thecontract with the Department.

* * * * *

§ 1001.28. Contracts with the Council

Sections 1001.22—1001.27 do not apply to con-tracts between the Department and the Council.The Department will contract with the Council toprovide it funds to perform the services the Council

is required to perform under the act, and maycontract with the Council for it to assist the De-partment in complying with other provisions of theact.

Subchapter C. COLLECTION OF DATA ANDINFORMATION

§ 1001.41. Data and information requirements forambulance services.(a) Ambulance services licensed to operate in this

Commonwealth shall collect, maintain and report accu-rate and reliable patient data and information for callsfor assistance [ in the format prescribed and onforms provided by the Department within a speci-fied time period ]. The report shall be made bycompleting an ambulance call report.

(b) [ The information collected shall include, butnot be limited to:

(1) Ambulance service affiliate number and ve-hicle identification number.

(2) Ambulance trip report number.(3) Patient sex and age.(4) Patient vital signs.(5) Incident location.(6) Type of incident.(7) Classification of the call at time of dispatch as

either emergency or nonemergency.(8) Date of call.(9) Times as follows:(i) Time call received for dispatch of ambulance

service.(ii) Time of dispatch of responding ambulance.(iii) Time of ambulance responding to incident

scene.(iv) Time of ambulance arrival at the scene.(v) Time extrication was completed.(vi) Time of ambulance departure from the scene.(vii) Time of ambulance arrival at facility.(viii) Time ambulance available for further ser-

vice.(10) Patient condition at the time emergency per-

sonnel arrived at the scene and arrived at thereceiving facility.

(11) History of present illness or injury.(12) Type of injury or illness.(13) Anatomic site of injury or illness.(14) Seriousness of patient illness or injury.(15) Highest level of care rendered to the patient.(16) Treatments, aids and medications given.(17) Indication of mutual aid response.(18) If mutual aid response, time of initial dis-

patch for the incident.(19) Times medications or treatment, or both

were rendered.(20) Medical command: time, type and quality of

transmission.(21) Type of telecommunication utilized to notify

receiving facility.



(22) Department identification number of medicalcommand physician, when medical command isobtained.

(23) Each ambulance crew member’s name, levelof EMS training and Department ID number ifassigned.

(24) Indication that CPR was in progress beforearrival; for example, citizen, QRS, first responder, ifapplicable.

(25) Support services utilized; for example, res-cue, fire, helicopter or coroner.

(26) Indication that QRS was utilized, if appli-cable.

(27) If utilized, the QRS’s arrival time at thescene of the incident.

(28) Receiving facility and location.(29) Documentation regarding refusal of care by

patient.(30) Documentation regarding a decision that

emergency care and transportation were notneeded.

(31) Information regarding patient seat belt us-age, if pertinent and available. ] The Departmentwill identify data items for the ambulance callreport as either confidential or not confidential.

(c) [ No person or ambulance service may dis-seminate the information collected under this sec-tion except as provided in § 1001.42 (relating todissemination of information). Licensed ] An ambu-lance [ services ] service shall [ provide to the De-partment evidence that ] store the information desig-nated as confidential in secured areas to assurethat access to unauthorized persons is prevented,and shall take other necessary measures to ensurethat the information is maintained in a confidentialmanner and is not available for public inspection ordissemination, except as authorized by § 1001.42 (re-lating to dissemination of information). [ Ambu-lance services that fail to maintain confidentialityof information are subject to suspension, revoca-tion or denial for license as provided for in Chapter1005 (relating to licensing of BLS and ALS ambu-lance services). ]

(d) When an ambulance service transports a pa-tient to a hospital, before its ambulance departsfrom the hospital, it shall provide to the individualat the hospital assuming responsibility for the pa-tient, either verbally, or in writing or other meansby which information is recorded, the patient infor-mation designated in the ambulance call report asessential for immediate transmission for patientcare. Within 24 hours following the conclusion of itsprovision of services to the patient, the ambulanceservice shall complete the full ambulance call re-port and provide a copy or otherwise transmit thedata to the receiving facility.

(e) The ambulance service shall have a policy fordesignating which member of the ambulance crewis responsible for completing the ambulance callreport.§ 1001.42. Dissemination of information.

(a) [ No ] A person who collects, has access to, orknowledge of, confidential information collected under

§ 1001.41 (relating to data and information requirementsfor ambulance services), by virtue of that person’sparticipation in the Statewide EMS system, may notprovide the ambulance call report, or disclose the[ knowledge ] confidential information contained inthe report or a report or record thereof, except:

* * * * *

(2) To another person or agency under contract with orlicensed by the Department and subject to strict supervi-sion by the Department to insure that the use of the datais limited to specific research, planning [ and ], quality[ assurance ] improvement and complaint investiga-tion purposes and that appropriate measures are takento protect patient confidentiality.

* * * * *

(5) For the purpose of quality [ assurance ] improve-ment activities, with strict attention to patient confiden-tiality.

* * * * *

(b) [ A person or organization in the possession ofpatient identifying data or records, shall store theinformation in secured areas to assure that accessto unauthorized persons is prohibited. ] The De-partment will regularly disseminate nonconfiden-tial, statistical data collected from ambulance callreports to providers of EMS for improvement ofservices.

Subchapter D. QUALITY [ ASSURANCE ]IMPROVEMENT PROGRAM

§ 1001.61. Components.

(a) The Department, in conjunction with the Council,will identify the necessary components for a StatewideEMS quality [ assurance ] improvement program forthe Commonwealth’s EMS system. The Statewide EMSquality improvement program shall be operated tomonitor the delivery of EMS through the collectionof data pertaining to emergency medical care pro-vided by prehospital personnel and providers ofEMS.

(b) The Department will develop, approve andupdate a Statewide EMS Quality Improvement Planin which it will establish goals and reportingthresholds.

§ 1001.62. Regional programs.

A regional EMS council, after considering inputfrom participants in and persons served by theregional EMS system, shall develop and implement aregional EMS quality [ assurance ] improvement pro-gram to monitor the delivery of EMS, which ad-dresses, at a minimum, the quality [ assurance ] im-provement components identified by the Department. Aregional EMS council quality improvement pro-gram shall:

(1) Conduct quality improvement audits on theregional EMS system including reviewing the qual-ity improvement activities conducted by the ALSservice medical directors and medical commandfacilities within the region.

(2) Have a regional quality improvement commit-tee that shall recommend to the regional EMScouncil ways to improve the delivery of prehospital



EMS care within the region based upon State andregional goals and reporting requirements.

(3) Develop and implement a regional EMS qual-ity improvement plan to assess the EMS system inthe region.

(4) Investigate complaints concerning the qualityof care rendered and forward recommendationsand findings to the Department.

(5) Submit to the Department reports as pre-scribed by the Department.

§ 1001.63. [ Medical command facilities ] (Re-served).

[ A medical command facility accredited by theDepartment shall actively participate in qualityassurance programs approved by the Department. ]§ 1001.64. [ Ambulance services ] (Reserved).

[ An ambulance service licensed to operate in thisCommonwealth shall actively participate in qualityassurance programs approved by the Department.The quality assurance programs shall incorporateprehospital data summary information required bythe Department. ]§ 1001.65. Cooperation.

Each individual and entity licensed, certified,recognized, accredited or otherwise authorized bythe Department to participate in the StatewideEMS system shall cooperate in the Statewide andregional EMS quality improvement programs, byproviding data, reports and access to records asrequested by the Department and regional EMScouncils to monitor the delivery of EMS.

Subchapter E. TRAUMA CENTERS§ 1001.81. Purpose.

The [ Department has the duty ] purpose of thissubchapter is to integrate trauma centers into theStatewide EMS system, by providing access to traumacenters and by providing for the effective and appropriateutilization of resources.

§ 1001.82. Requirements.

To ensure that trauma centers are integrated into theStatewide EMS system, [ accredited ] trauma centersin this Commonwealth shall:

* * * * *

(4) Maintain communications capabilities to allow fordirect access by a transferring ground ambulance or[ helicopter ] air ambulance to insure that patientinformation and condition updates are available andmedical consultation is available to the transferring ser-vice. The capabilities shall be in accordance with regionaland Statewide EMS telecommunications plans.

Subchapter F. REQUIREMENTS FOR REGIONALEMS COUNCILS AND THE COUNCIL

§ 1001.101. Governing body.

A regional EMS council and the Council shall have agoverning body[ , whether a unit of local governmentor a public or private nonprofit entity. Responsibil-ity for the contract will rest in the governingbody ].

* * * * *

§ 1001.102. [ Council director ] (Reserved).

[ The director shall:

(1) Prepare and annually update written policiesand procedures.

(2) Assist the governing body in formulatingpolicy and present the following to the governingbody at least annually:

(i) Project goals and objectives which includetime frames and available resources.

(ii) Written reports of project operations.

(iii) A performance report summarizing theprogress towards meeting goals and objectives. ]§ 1001.103. [ Personnel ] (Reserved).

[ The governing body shall:

(1) Adopt and implement written project person-nel policies and procedures which include, but arenot limited to:

(i) Recruitment, selection, promotion and termi-nation of staff.

(ii) Utilization of volunteers.

(iii) Wage and salary administration.

(iv) Employe benefits.

(v) Working hours.

(vi) Vacation and sick leave.

(vii) Rules of conduct.

(viii) Disciplinary actions.

(ix) Supervision of staff.

(x) Work performance evaluations.

(xi) Employe accidents and safety.

(xii) Employe grievances.

(2) Adopt a written policy to implement and coor-dinate personnel management, which includes, butis not limited to, confidential maintenance of per-sonnel records.

(3) Develop written policies and procedures toprovide for ongoing staff development. Documenta-tion includes, but is not limited to, an assessment ofstaff training needs and plans for addressing theseneeds.

(4) Maintain records on an employe which in-clude, but are not limited to:

(i) An application for employment.

(ii) The results of reference investigations.

(iii) Verification of training experience and pro-fessional licensure or registration, if applicable.

(iv) Salary information.

(v) A work performance evaluation.

(vi) Disciplinary actions.

(5) Develop written policies on employe rights,and document efforts by the project to inform staffof the following:

(i) The employee’s right to inspect his ownrecords.



(ii) The employe’s right to request the correctionor removal of inaccurate, irrelevant, outdated orincomplete information from the records.

(iii) The employe’s right to submit rebuttal dataor memoranda to his own records.

(6) Develop written job descriptions or projectpositions which include but are not limited to:

(i) A job title.(ii) Tasks and responsibilities of the job.(iii) Prerequisite skills, knowledge and experi-

ence. ]Subchapter G. ADDITIONAL REQUIREMENTS

FOR REGIONAL EMS COUNCILS§ 1001.121. Designation of regional EMS councils.

(a) The Department will designate [ an ] a regionalEMS council that satisfies the representation re-quirements in § 1001.125 (relating to requirements)for each geographic area of this Commonwealth.

* * * * *(c) The Department will evaluate the performance and

effectiveness of each regional EMS council on a periodicbasis to assure that each council is appropriately meetingthe needs of its region in planning, developing, maintain-ing, expanding, improving and upgrading the [ emer-gency medical services ] EMS system in its region.

§ 1001.123. Responsibilities.

[ The ] In addition to other responsibilities im-posed upon regional EMS councils by this part,regional EMS councils have responsibility for the follow-ing:

(1) Organizing, maintaining, implementing, expandingand improving the EMS system within the [ identified ]geographic area [ of ] for which the regional EMScouncil has assigned responsibilities.

(2) Developing and implementing comprehensive EMSplans, as approved by the Department. [ The plansare subject to approval by the Department andshall include the designation of primary responseareas. ]

(3) Advising PSAPs, and municipal and countygovernments, as to EMS resources available fordispatching and recommended dispatching criteriathat may be developed by the Department, or bythe regional EMS council as approved by the De-partment.

[ (3) ] (4) Developing, maintaining, implementing, ex-panding and improving programs of medical [ controland accountability ] coordination. The programs aresubject to approval by the Department.

[ (4) ] (5) ***

[ (5) ] (6) ***

[ (6) ] (7) ***

[ (7) ] (8) Providing [ licensed ] ambulance serviceswith data summary reports.

[ (8) Preparing plans for implementing, expand-ing, improving and maintaining EMS systems in thearea. The plan shall contain information as pre-scribed by the Secretary.

(9) Carrying out, to the extent feasible, the EMSsystem plans.

(10) ] (9) Assuring the reasonable availability of train-ing programs, including continuing education pro-grams, for EMS personnel. The programs shall includethose that lead to certification or recognition by theDepartment. Regional EMS councils may also developand implement additional educational programs.

[ (11) ] (10) Monitoring medical command facilitiesand [ medical control and accountability of ] prehos-pital [ emergency ] personnel [ for ] compliance withminimum standards established by the Department, andambulance service medical director and medicalcommand physician medical control of prehospitalpersonnel.

[ (12) Developing processes and procedures for ](11) Facilitating the integration of medical commandfacilities into the regional EMS system in accordancewith policies and guidelines established by the Depart-ment.

[ (13) Determining system needs and recommend-ing the allocation of resources based upon thisneed assessment. Guidelines for needs assessmentwill be provided by the Department and shall beconsistent with the State EMS plan.

(14) Establishing and implementing criteria forthe evaluation or referral of acutely ill and injuredpersons for transport to the most appropriate facil-ities in accordance with policies, guidelines andcriteria established by the Department. The criteriashall address the treatment and transfer of trauma,cardiac, spinal cord, poison, burns, neonatal andbehavioral patients. Facilities in the region mayparticipate on a voluntary basis in the categoriza-tion process established by the Department.

(15) ] (12) Developing and implementing regional pro-tocols for the triage, treatment, transport and transfer ofpatients to the most appropriate facility. Protocols shallbe developed [ by the ] in consultation with theregional EMS council’s medical advisory [ and facil-ities committees ] committee and approved by the[ Secretary or a designee ] Department. Protocolsshall, at a minimum:

(i) Include a method of identifying patients requiringspecialized medical care, utilizing measurable criteria toidentify patient referral[ , including, but not limitedto, the seven critical care groups identified inparagraph (14). The Department will provide guide-lines for recommended protocols ].

(ii) Be based upon the specialty care capabilities of thereceiving facilities and available [ prehospital ] provid-ers of EMS [ providers, ] prehospital personnel, localgeodemographic considerations and transport time consid-erations.

* * * * *

(iv) Be reviewed annually, and revised as necessary inconsultation with the regional EMS council’s [ re-gional ] medical advisory committee.

(v) Be consistent with Chapter 1003 (relating topersonnel) which governs the scope of practice of [ emer-



gency medical technicians, paramedics, ] EMTs,EMT-paramedics and other prehospital [ EMS ] person-nel.

* * * * *

(vii) [ Prohibit patient transfer unless it is formedical necessity or upon request of the patient. ]Address patient choice regarding receiving facility.

[ (viii) Require written transfer agreements be-tween appropriate facilities.

(ix) ] (viii) Set forth a procedure for the efficienttransfer of patients. When appropriate, these regionalprotocols shall be developed in consultation with specialtycare facilities in the region. [ The transfer protocolsshall contain the following requirements:

(A) The process of transferring patients from onefacility to another shall be carried out as expedi-tiously as possible.

(B) The receiving facility shall have at least onestaff person available 24 hours a day, 7 days a week,who, without consultation from other personnel,has the authority to approve or disapprove trans-fers.

(C) If the facility is designated as a critical carespecialty receiving hospital and that hospital disap-proves a transfer from another facility, that hos-pital shall participate in a backup network whichwill identify another available receiving facility.

(D) Providers involved in a transfer shall insurethat necessary patient information and recordswill accompany the patient. Prehospital andinterhospital personnel shall be advised of patientcare needs during the transfer. Hospital personnelaccompanying the patient shall be familiar with theambulance and hospital equipment accompanyingthe patient, and capable of operating the equip-ment for appropriate administration of care to thepatient.

(16) Developing a program to assess the qualityof EMS system in its region and investigating com-plaints concerning the quality of care rendered andforwarding recommendations and findings to theDepartment in regard to each complaint investi-gated. Complaint investigations shall be conductedin accordance with administrative rules and proce-dures and written documentation of facts and find-ings shall be provided the Department. Qualityassurance programs implemented by regional EMScouncils shall be consistent with guidelines pre-scribed by the Department.

(17) Developing a review process for investigat-ing complaints received by either the council or theDepartment concerning care rendered by prehospi-tal personnel or providers.

(18) ] (13) Assisting Federal, State or local agencies,upon request, in the provision of onsite mitigation, techni-cal assistance, situation assessment, coordination of func-tions or postincident evaluations, in the event of apotential or actual disaster, mass casualty situation orother substantial threat to public health.

[ (19) ] (14) Maintaining an [ EMS resource ] inven-tory of EMS resources and personnel available on avolunteer basis as conditions and circumstances require.

Recruitment of volunteer expertise available shallbe requested when needed.

[ (20) ] (15) Designating a regional medical director[ subject to approval by the Department.

(21) ] (16) ***

(17) Assisting prehospital personnel and ambu-lance services operating in the regional EMS sys-tem to meet the licensure, certification, recertifica-tion, recognition, biennial registration andcontinuing education requirements established un-der the act and this part, and assisting the Depart-ment in ensuring that those requirements are met.

(18) Apprising medical command facilities andALS ambulance services in the region when anEMT-paramedic or prehospital registered nurse hashad medical command authorization removed by anALS ambulance service in the region.

(19) Developing a conflict of interest policy andrequiring all employes and officials to agree to thepolicy in writing.

[ (22) ] (20) ***

§ 1001.124. Composition.Regional EMS councils shall be organized by one of

the following:* * * * *

§ 1001.125. Requirements.(a) If the regional EMS council is a unit of local

government, it shall have an advisory council which is[ broadly representative of EMS providers, publicsafety agencies, health care facilities, consumersand elected public officials ] deemed by the Depart-ment to be representative of health care consumers,the health professions, and major private and pub-lic and voluntary agencies, organizations and insti-tutions concerned with providing EMS.

(b) If the regional EMS council is a public or privatenonprofit organization, its governing body shall [ berepresentative of the following:

(1) EMS providers.(2) Public safety agencies.

(3) Health care facilities.

(4) Consumers.

(5) Elected public officials ] satisfy the represen-tation requirements in subsection (a).

* * * * *

(d) The regional[ /State ] medical advisory committeeshall assist the regional EMS council’s medical director inmatters of medical [ control and a majority of itsmembers shall be physicians ] coordination.

* * * * *

Subchapter H. ADDITIONAL REQUIREMENTSFOR THE COUNCIL

§ 1001.141. Duties and purpose.

The Council shall advise the Department on emergencyhealth services issues that relate to manpower andtraining, communications, ambulance services, specialcare units, the content of ambulance call reports, thecontent of rules and regulations, standards and policies



promulgated by the Department and other subjects asrequired by the act or deemed appropriate by theDepartment or the Council. The Council shall alsoadvise the Department on the content of the StatewideEMS development plan, and proposed revisions to it.Subchapter I. RESEARCH IN PREHOSPITAL CARE§ 1001.161. Research.

(a) [ Proposals for clinical ] Clinical investigationsor studies that relate to direct patient care [ shall be ]may not be conducted by providers of EMS unlessthe investigation or study is proposed to and ap-proved by the Department. [ An investigation or studymay not be undertaken unless approved. ]

(b) A proposal for clinical investigation or study shallbe presented to the [ regional medical director, themedical advisory committee of the regional EMScouncil, the medical advisory committee of theCouncil and the Commonwealth Emergency Med-ical Director for review and comment. Recommen-dations shall be forwarded to the Departmentwithin 60 days from the date the proposal is sub-mitted ] Department. If the Department concludesthat the proposal may have merit, it will refer theproposal to the Council, and to the regional EMScouncil having responsibilities in the region wherethe investigation or study would be undertaken.The Council and the regional EMS council shallhave the proposal reviewed by their medical advi-sory committees and consider the comments ofthose committees, and shall forward their recom-mendations to the Department within 60 days afterreceiving the proposal from the Department.

(c) The Department will approve or disapprovethe proposal within 30 days after receiving therecommendations of the Council and the regionalEMS council. If the proposal is approved, the [ EMS ]prehospital personnel identified in the proposal mayfunction in accordance with the proposal and underconditions specified by the Department during the term ofthe clinical investigation or study.

(d) A proposal shall include and address the followingconsiderations and items in a format specified by theDepartment:

* * * * *

(7) [ A letter approving the investigation from theappropriate regional EMS council. ] Institutionalreview board approval when required by law.

* * * * *(10) A plan for providing the Department with

progress reports and a final report on the investi-gation or study.

(e) The Department may direct that the investiga-tion or study be terminated prematurely for itsfailure to satisfy conditions of approval.

CHAPTER 1003. PERSONNEL

Subchapter A. ADMINISTRATIVE ANDSUPERVISORY EMS PERSONNEL

§ 1003.1. Commonwealth Emergency Medical Direc-tor.

(a) Roles and responsibilities. The CommonwealthEmergency Medical Director is responsible for the follow-ing:

* * * * *(2) Assisting in the development and implementation of

a Statewide EMS quality [ assurance ] improvementprogram.

* * * * *

(5) Reviewing and evaluating regional transfer andmedical treatment protocols and making recommenda-tions for the Statewide [ medical protocals ] BLSmedical treatment protocols and Statewide criteriafor the evaluation, triage, treatment, transport,transfer and referral, including bypass protocols ofacutely ill and injured persons to the most appro-priate facility.

(6) Evaluating regional EMS quality [ assurance ]improvement programs.

(7) Providing direction and guidance to the regionalEMS medical directors for training and quality [ assur-ance activities ] improvement monitoring and as-sistance.

(8) Meeting with [ directors ] representatives andcommittees of regional EMS councils and the Council asnecessary and as directed by the Department to provideguidance and direction.

* * * * *

(b) Equivalent qualifications. If the CommonwealthEmergency Medical Director is not a medical commandphysician, the Commonwealth Emergency Medical Direc-tor shall possess the following qualifications:

* * * * *

(3) Knowledge regarding the base station [ radio ]direction of prehospital personnel and the operation ofemergency dispatch.

* * * * *

(c) Disclosure. The Commonwealth Emergency Med-ical Director shall disclose to the Department all financialor other interest in providers of EMS and in othermatters which present a potential conflict of interest.§ 1003.2. Regional EMS medical director.

(a) Roles and responsibilities. Each regional EMS coun-cil shall have a regional EMS medical director who shallcarry out the following duties:

(1) [ Approve ] Assist the regional EMS council toapprove or reject applications for medical commandphysicians received from medical command facility med-ical directors.

* * * * *

(3) [ Establish and review system-wide medicalprotocols in ] Assist the regional EMS council, afterconsultation with the regional medical advisory commit-tee [ and regional EMS council ], to establish andrevise transfer and medical treatment protocols forthe regional EMS system.

[ (4) Assist the Department in ensuring that per-sonnel in the EMS system meet the certification,recertification, recognition, biennial registrationand continuing education requirements establishedunder the act.

(5) Establish standards for EMS dispatch to as-sure that the an appropriate response unit is dis-



patched to the medical emergency scene and thatproper patient evaluation is conducted.

(6) ] (4) [ Establish ] Assist the regional EMScouncil to establish field treatment protocols for deter-mining when a patient will not be transported to atreatment facility and establish procedures for document-ing the reasons for a nontransport decision.

[ (7) ] (5) [ Establish ] Assist the regional EMScouncil to establish field protocols to govern situationsin which a patient may be transported without consent,in accordance with Pennsylvania law. The protocols shallcover appropriate documentation and review procedures.

[ (8) ] (6) [ Establish ] Assist the regional EMScouncil to establish criteria for level of care and type oftransportation to be provided in various medical emergen-cies, such as ALS versus BLS, and ground versus air[ specialty unit transportation ] ambulance, anddistribute approved criteria to PSAPs.

[ (9) Establish operation standards for medicalcommand facilities.

(10) ] (7) Conduct quality [ assurance ] improve-ment audits of the regional EMS system includingreviewing the quality [ assurance ] improvement ac-tivities conducted by the ALS service medical directorswithin the region.

[ (11) ] (8) Serve on the State EMS Quality [ Assur-ance ] Improvement Committee.

[ (12) ] (9) ***

[ (13) ] (10) Facilitate [ and assure ] continuity ofpatient care during inter-regional transport.

[ (14) ] (11) Recommend to the Department suspen-sion [ or ], revocation or restriction of prehospitalpersonnel certifications and recognitions.

[ (15) ] (12) ***

[ (16) ] (13) ***

[ (17) Delegate portions of his authority to otherqualified physicians.

(18) Meet with the ALS service medical directorswithin the region as necessary to disseminate infor-mation regarding State statutes, regulations, poli-cies and direction. ]

(b) Minimum qualifications.(1) A regional EMS council medical director shall have

the following qualifications:

(i) [ A valid license to practice medicine in thisCommonwealth as a doctor of medicine or doctor ofosteopathy ] Licensure as a physician.

* * * * *

(iii) Experience in base station [ radio ] direction ofprehospital emergency units.

* * * * *

(2) The [ Secretary ] Department may waive theboard certification requirement upon written request bythe regional EMS council.

(c) [ Medical advisory committee. Each regionalEMS council shall have a medical advisory commit-tee to provide the council medical director with

advice on issues relevant to the areawide EMSsystem. ] Disclosure. A regional EMS medical direc-tor shall disclose to a regional EMS council allfinancial or other interest in providers of EMS andin other matters which present a potential conflictof interest.

§ 1003.3. Medical command facility medical direc-tor.

(a) Roles and responsibilities. A medical commandfacility shall have a medical command facility med-ical director. A medical command facility medical direc-tor is responsible for the following:

* * * * *

(2) Quality [ assurance ] improvement.

* * * * *

(5) Clinical and continuing education training of pre-hospital [ emergency care ] personnel.

(6) Recommendations to the regional EMS medicaldirector regarding medical command physician applica-tions from [ his institution ] the medical commandfacility.

(b) Minimum qualifications.

(1) A medical command facility medical director shallhave the following qualifications:

* * * * *

(ii) Board certification in emergency medicine or, [ inlieu of this, current ACLS and ATLS certification ]have successfully completed the ACLS coursewithin the preceding 2 years and the ATLS course,and either an APLS or PALS course, or otherprograms determined by the Department to meet orexceed the standards of those programs, along withboard certification in surgery, internal medicine, familymedicine, pediatrics or anesthesiology.

* * * * *

(iv) Experience in base station [ radio ] direction ofprehospital emergency units.

(v) Experience in the training of [ basic ] BLS and[ advanced prehospital emergency health ] ALS pre-hospital personnel.

* * * * *

(2) The [ Secretary ] Department may waive theboard certification requirement upon written request bythe regional EMS council.

§ 1003.4. Medical command physician.

(a) Roles and responsibilities. A medical command phy-sician shall [ carry out the following duties:

(1) Provide ] provide medical command to prehospi-tal [ emergency health ] personnel.

[ (2) Assist with the duties of medical control ]This includes providing online medical command toprehospital personnel whenever they seek direc-tion.

(b) Minimum qualifications. A medical command physi-cian shall:



(1) [ Hold a valid license to practice in this Com-monwealth as a Doctor of Medicine or Doctor ofOsteopathy ] Be a physician.

(2) Be board certified in emergency medicine or[ , inlieu of this, be certified in ATLS and ] have success-fully completed the ACLS course within the preced-ing 2 years and the ATLS course, and either anAPLS or PALS course, or other programs deter-mined by the Department to meet or exceed thestandards of those programs.

(3) [ Complete ] Have completed the [ AmericanMedical Association’s (AMA’s) Continuing MedicalEducation Credits ] continuing medical educationcredits required for membership in the AmericanMedical Association, or its equivalent, or be serving a[ postgraduate ] post year III in an approved residencyprogram in emergency medicine or a [ postgraduate ]post graduate year II in an approved residency programin emergency medicine with concurrent [ on-line ]online supervision by an approved medical commandphysician.

* * * * *

(6) [ Complete base station in medical, commandcourse within 2 years of the adoption of a course bythe Department ] Have completed the Medical Com-mand Base Station Course.

[ (7) Be approved by the regional EMS medicaldirector. ]

(c) Approval of medical command physician.

(1) A physician may function as a medical com-mand physician if approved to do so by a regionalEMS council.

(2) A regional EMS council shall approve a physi-cian as a medical command physician if the physi-cian demonstrates that the physician will functionunder the auspices of a medical command facilityand establishes one of the following:

(i) That the physician satisfies the qualificationsfor a medical command physician in subsection (b).

(ii) That the physician has received certificationas a medical command physician from the Depart-ment upon successfully completing the voluntarymedical command physician certification programadministered by the Department.

(3) A regional EMS council shall conclude thatthe physician will be operating under the auspicesof a medical command facility if the physicianestablishes one of the following:

(i) That the facility meets the requirements for amedical command facility prescribed in § 1009.1(relating to operational criteria).

(ii) That the facility has received recognition as amedical command facility from the Departmentunder § 1009.2 (relating to recognition process).

(d) Notice requirements.

(1) A medical command facility shall give noticeto each regional EMS council having responsibilityfor an EMS region in which the medical commandfacility anticipates medical command physiciansfunctioning under its auspices will be providingmedical command, and shall explain the circum-stances under which medical command will begiven in that region.

(2) A regional EMS council that has approved aphysician as a medical command physician shallgive notice of the approval to the Department.

(e) Transfer and medical treatment protocols. Amedical command physician shall provide medicalcommand to prehospital personnel in ground ambu-lances and QRSs consistent with the transfer andmedical treatment protocols which are in effect ineither the region in which treatment originates orthe region in which the prehospital personnel be-gin receiving online medical command from themedical command physician.

§ 1003.5. ALS service medical director.

(a) Roles and responsibilities. An ALS service medicaldirector is responsible for the following:

(1) Providing medical guidance and advice to the ALSambulance service[ . ], including:

(i) Reviewing the Statewide BLS medical treat-ment protocols and the regional transfer and med-ical treatment protocols, and ensuring that the ALSambulance service’s prehospital personnel are fa-miliar with them, and amendments and revisionsthereto.

(ii) Providing guidance to the ALS ambulancewith respect to the ordering, stocking and replace-ment of drugs, and compliance with laws and regu-lations impacting upon the ALS ambulance ser-vice’s acquisition, storage and use of those drugs.

(iii) Participating in the regional and Statewidequality improvement plans, including continuousquality improvement reviews of patient care and itsinteraction with the regional EMS system.

(iv) Recommending to the relevant regional EMScouncil, when appropriate, specific transfer andmedical treatment protocols for inclusion in theregional transfer and medical treatment protocols.

(2) Granting [ or ], denying or restricting medicalcommand authorization to members of the ALS ambu-lance service’s prehospital personnel who require thisauthorization, and participating in appeals from decisionsto deny or restrict medical command authorization inaccordance with [ § 1003.29 ] § 1003.28 (relating to med-ical command authorization).

* * * * *

(b) Equivalent qualifications. If the ALS service med-ical director is not a medical command physician, the ALSservice medical director shall:

* * * * *

(2) Have experience in the base station [ radio ] direc-tion of prehospital personnel [ and the operation ofemergency dispatch ].

* * * * *



(5) Successfully complete [ Parts A and B of ] theMedical Command Base Station Course [ adopted bythe Department ].

Subchapter B. PREHOSPITAL [ EMS ] ANDOTHER PERSONNEL

§ 1003.21. Ambulance attendant.

(a) Roles and responsibilities. [ Attendants providefirst aid in accordance with the American RedCross First Aid standards and provide CPR inaccordance with American Heart Association stan-dards. ] An ambulance attendant, as part of thecrew of an ambulance or a QRS, may perform BLSactivities within the ambulance attendant’s scopeof practice, as set forth in subsection (c), at thescene of an emergency or enroute to a facility. Thissection does not prohibit an ambulance attendantfrom providing BLS services as a good Samaritan.

(b) [ Minimum qualifications. ] Qualifications.[ Ambulance attendants ] To qualify as an ambu-lance attendant an individual shall satisfy one ofthe following:

(1) Possess a [ valid ] current certificate evidencingsuccessful completion of an advanced first aid coursesponsored by the American Red Cross [ or anotheradvanced first aid course approved by the Depart-ment ] and a certificate issued within the last 2years evidencing successful completion of a CPRcourse.

(2) Possess a [ valid CPR certification ] currentcertificate evidencing successful completion of acourse determined by the Department to be equiva-lent to the requirements in paragraph (1).

[ (3) Be at least 16 years of age. ](c) Scope of practice. An ambulance attendant

shall have the authority to provide the followingBLS services if trained to do so:

(1) Patient assessment—including vital signs—and ongoing evaluation.

(2) Pulmonary or cardiopulmonary resuscitationand foreign body airway obstruction management.

(3) Administration of oxygen by means of a resus-citation mask, nasal cannula, nonrebreather maskand bag valve mask.

(4) Insertion of oropharyngeal or nasopharyngealairways.

(5) Oropharyngeal suctioning

(6) Assessment and management of cardiac, respi-ratory, diabetic shock, behavioral and heat/coldemergencies, as prescribed within an advancedfirst aid course meeting the requirements in sub-section (b)(1) or (2).

(7) Emergency treatment for bleeding, burns, poi-soning, seizures, soft tissue injuries, chest-abdomi-nal-pelvic injuries, muscle and bone injuries, eyeinjuries and childbirth (including care of the new-born), as prescribed within an advanced first aidcourse meeting the requirements in subsection(b)(1) or (2).

(8) Application of spinal immobilization devicesand splinting materials, including traction splints.

(9) Basic triage and basic maneuvers to gainaccess to the patient.

(10) Patient lifting and moving techniques.

(11) Use of an automated external defibrillatorwhen approved by the medical director of theambulance service.

(12) Assist a prehospital practitioner who isabove the level of first responder in the use ofDepartment-approved automatic ventilators andpulse oximetry when approved by the medical di-rector of the ambulance service.

(13) Other BLS services taught in a course inadvanced first aid sponsored by the American RedCross, if the ambulance attendant has receivedtraining to perform those services in the course orin an equivalent training program approved by theDepartment, and is able to document having re-ceived the training. The Department will publish inthe Pennsylvania Bulletin, at least annually, a listof the skills and services taught in the most recentcourse in advanced first aid sponsored by theAmerican Red Cross. If the course sponsored by theAmerican Red Cross teaches services in addition toadvanced first aid, the Department will excludethose services from the published list.

§ 1003.22. First responder.

(a) Roles and responsibilities. A first responder mayperform, at the scene of an emergency, enroute to afacility [ or trauma center ], or in an emergency settingin a facility, the BLS services [ set forth ] in subsection(e) to stabilize and improve a patient’s condition untilmore highly trained [ prehospital ] personnel arrive [ atthe scene ]. Following the arrival of more highly trained[ prehospital ] personnel, a first responder may con-tinue to perform the BLS services within a first respond-er’s scope of practice as set forth in subsection (e) underthe direction of more highly trained [ prehospital ]personnel. This section does not prohibit a firstresponder from providing BLS services as a GoodSamaritan.

(b) Certification.

(1) The Department will certify as a first responder anindividual who meets the following qualifications:

* * * * *

(iii) Has successfully completed a first responder train-ing course approved by the Department. The Depart-ment will publish annually in the PennsylvaniaBulletin a list of courses leading to first respondercertification.

(iv) Has passed a written examination for first re-sponder certification prescribed by the Department, orhas passed an examination which the Departmenthas determined to be equivalent in both contentand manner of administration.

(v) Has passed a practical test of first responder skillsprescribed by the Department, or has passed an exami-nation which the Department has determined to beequivalent in both content and manner of adminis-tration.

(2) A first responder’s certification is valid for 3 years,subject to disciplinary action under section 11(j.1) of the



act (35 P. S. § 6931(j.1)) and § 1003.27 (relating todisciplinary and corrective action). [ An individual whoreceived certification as a first responder under thevoluntary first responder certification program inexistence prior to September 2, 1995, will bedeemed certified. The certification is valid for 3years from the date the certification was issued.Following expiration of the deemed certification,the recertification requirements set forth in subsec-tion (c) apply. ]

(c) Recertification. A first responder shall apply forrecertification between 1 year and 60 days prior toexpiration of the first responder’s certification from theDepartment. Failure to apply for recertification in atimely manner may result in the individual not beingrecertified before the prior certification expires. The De-partment will recertify as a first responder an individualwho meets the following qualifications:

* * * * *

(3) [ Successfully completes ] Has successfullycompleted one of the following:

* * * * *

(d) [ Reciprocal certification ] Certification by en-dorsement.

(1) [ The Department will grant first respondercertification to an individual who is currently certi-fied as a first responder in another state who meetsthe following qualifications: ] For an individualwho is 16 years of age or older and who is currentlycertified in another state as a first responder or asa person with similar responsibilities, the Depart-ment will endorse the following qualifications asequivalent to those in subsection (b):

(i) [ Completes an application on a form pre-scribed by the Department ] Successful completionof training curriculum which meets or exceeds thestandards for the training course prescribed by theDepartment in subsection (b)(1)(iii).

(ii) [ Is 16 years of age or older. ] Successfulcompletion of a written examination for first re-sponder certification, or an equivalent certification,which is determined by the Department to meet orexceed the standards of the written examinationprescribed by the Department under subsection(b)(1)(iv).

(iii) [ Can demonstrate successful completion of afirst responder training curriculum which is recog-nized by the Department as meeting or exceedingstandards for the curriculum in the first respondertraining course approved by the Department,within the 2 years preceding submission of theapplication, or, in the alternative, successfully com-pletes the Pennsylvania first responder trainingcourse approved by the Department. ] Successfulcompletion of a practical skills examination forfirst responder certification, or an equivalent certi-fication, which is determined by the Department tomeet or exceed the standards of the practical skillsexamination prescribed by the Department undersubsection (b)(1)(v).

[ (iv) Has successfully completed written andpractical certification examinations recognized by

the Department as meeting or exceeding the stan-dards of the examinations prescribed by the De-partment. ]

(2) An individual whose first responder certification orequivalent certification in another state is expired atthe time of application may seek to have the satisfac-tion of paragraph (1)(i) endorsed as equivalent tothe satisfaction of subsection (b)(1)(iii), but will[ meet the requirements in paragraph (1)(i)—(iii) ]not be considered by the Department for endorse-ment of qualifications under paragraph (1)(ii) or(iii), and shall successfully complete the first responderpractical skills and written knowledge [ examination ]examinations prescribed by the Department after ap-plying for certification through examination.

(3) [ Reciprocal certification ] Certification underthis subsection is valid for 3 years. Upon expiration of[ reciprocal ] that certification, the individual [ towhom the Department granted reciprocal certifica-tion ] shall meet the requirements for recertification insubsection (c).

(e) Scope of practice. (1) A first [ responder shallhave authority to provide the following BLS ser-vices: ] responder’s scope of practice includes theBLS services which may be performed by an ambu-lance attendant as set forth in § 1003.21(c) (relatingto ambulance attendant), if the first responder hasbeen trained to perform those services.

[ (1) Patient assessment and evaluation.

(2) Pulmonary or cardiopulmonary resuscitation.

(3) Administration of oxygen via an oxygen mask,nasal cannula, a bag valve mask or a manuallyoperated positive valve unit.

(4) Application of oropharyngeal or nasopharyn-geal airways and pocket masks.

(5) Oropharyngeal or nasopharyngeal suctioning.

(6) Emergency medical treatment prescribedwithin the first responder training program forbleeding, shock, burns, heat and cold emergencies,poisoning, fractures and childbirth.

(7) Use of an automatic external defibrillator,when the use is approved by the regional EMScouncil in accordance with criteria established bythe Department.

(8) Use of spinal immobilization devices.

(9) Use of Department approved automatic venti-lators and pulse oximetry when approved by themedical director for the ambulance service afterappropriate training.

(10) Other BLS services authorized by Depart-ment-approved regional EMS council transfer andmedical treatment protocols or under medical com-mand. ]

(2) A first responder’ s scope of practice alsoincludes other BLS services taught in a first re-sponder training course approved by the Depart-ment, if the first responder has received training toperform those services in the course, in a coursewhich is determined by the Department to meet orexceed the standards of a first responder trainingcourse preapproved by the Department, or in acourse for which a first responder may receive



continuing education credit towards recertifica-tion, and is able to document having received thetraining.

(3) The Department will publish in the Pennsylva-nia Bulletin, at least annually, a list of the servicestaught in first responder training courses mostrecently approved by the Department.

(4) If the approved course is not offered by theDepartment, the Department may exclude from thepublished list, services taught which the Depart-ment determines are not appropriate services to beperformed by a first responder.

§ 1003.23. EMT.

(a) Roles and responsibilities.

[ (1) The scope of practice of an EMT includes theBLS services which may be performed by a firstresponder under § 1003.22(e) (relating to firstresponder) and other BLS services involved in therescue, triage and transfer and transport of emer-gency and nonemergency patients, under section11(e) of the act (35 P. S. § 6931(e)) and in accord-ance with the Department of Transportation EMTNational Standard Curriculum, and amendmentsand revisions thereto.

(2) An EMT’s scope of practice shall be limited tothe activities listed in paragraph (1), except if theSecretary authorizes an EMT to perform additionalactivities. ]

An EMT may perform, in a prehospital,interhospital or emergency care setting in a hos-pital, or during the transfer of convalescent orother nonemergency cases, the BLS services setforth in subsection (e), to prevent loss of life oraggravation of physiological or psychological ill-ness or injury. This section does not prohibit anEMT from providing BLS services as a good Sa-maritan.

(b) Certification.

(1) [ To qualify for EMT certification, an indi-vidual shall: ] The Department will certify as anEMT an individual who meets the following qualifi-cations:

(i) [ Successfully complete a basic EMT trainingcourse approved by the Department ] Completes anapplication on a form prescribed by the Depart-ment.

(ii) [ Successfully complete an EMT practicalskills examination developed by the Departmentand administered by the Department ] Is 16 yearsof age or older.

(iii) [ Successfully complete a written EMT exami-nation developed by the Department and adminis-tered by the Department ] Has successfully com-pleted an EMT training course approved by theDepartment.

(iv) [ Possess current CPR certification ] Has suc-cessfully completed a written EMT examinationprescribed by the Department.

(v) [ Be at least 16 years of age or older ] Hassuccessfully completed an EMT practical skills ex-amination prescribed by the Department.

(2) The Department will also certify as an EMT anindividual who completes an application on a form pre-scribed by the Department and who has one of thefollowing:

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(c) [ Reciprocal certification ] Certification by en-dorsement.

(1) [ An individual who possesses EMT certifica-tion from another state may qualify for reciprocalcertification as an EMT in this Commonwealth.Applications shall be submitted to the regionalEMS councils. The Department has the authority tomake the final decision on the applications.

(2) Reciprocal certification may be granted toEMTs from states that the Department has formalreciprocity agreements with if:

(i) The applicant is currently certified or licensedin a state with reciprocity agreements with theCommonwealth.

(ii) The applicant successfully completed writtenand practical exams within 2 1/2 years of applica-tion.

(iii) The current certification has an expirationdate of more than 6 months from date of applica-tion.

(iv) If the current certification remaining is lessthan 6 months, the applicant shall successfullycomplete written and practical Pennsylvania EMScertification exams.

(v) The applicant completes the student registra-tion form and a request for reciprocity form pro-vided by the Department. The applicant shall at-tach a copy of incoming State certification orlicense to the request for reciprocity form.

(3) Certification may be granted to applicantswith certification or National registry from stateswithout formal reciprocity agreements if:

(i) The applicant is currently certified or licensedas an EMT.

(ii) The applicant provides written verification ofcompletion of an EMT-NSC National Standard Cur-riculum Course.

(iii) The applicant successfully completes Penn-sylvania written and practical certification exams.

(iv) The current certification has an expirationdate of more than 6 months from date of applica-tion.

(4) EMT certification may be granted to appli-cants currently certified by the military, if:

(i) The applicant provides written verification ofsuccessful completion of an EMT-NSC course.

(ii) The applicant successfully completes Pennsyl-vania written and practical certification exams.

(iii) Current certification has an expiration dateof more than 6 months from date of application.

(5) Reciprocal certification may be granted withan expiration date of 3 years from the date thecertification was issued by the incoming state.

(6) Pennsylvania residents who have beengranted reciprocity in this Commonwealth and cur-



rently need recertification shall take the Depart-ment’s practical and written certification examina-tions. ]

For an individual who is 16 years of age or olderand currently certified as an EMT in another state,the Department will endorse the following qualifi-cations as equivalent to those in subsection (b):

(i) Successful completion of EMT training cur-riculum that meets or exceeds the standards of thetraining course prescribed by the Department un-der subsection (b)(1)(iii).

(ii) Successful completion of a written examina-tion for EMT certification which is determined bythe Department to meet or exceed the standards ofthe written examination prescribed by the Depart-ment under subsection (b)(1)(iv).

(iii) Successful completion of a practical skillsexamination for EMT certification which is deter-mined by the Department to meet or exceed thestandards of the practical skills examination pre-scribed by the Department under subsection(b)(1)(v).

(2) An individual whose EMT certification in an-other state is expired at the time of applicationmay seek to have the satisfaction of paragraph(1)(i) endorsed as equivalent to the satisfaction ofsubsection (b)(1)(iii), but will not be considered bythe Department for endorsement of qualificationsunder paragraph (1)(ii) or (iii), and shall success-fully complete the EMT practical skills and writtenexaminations prescribed by the Department afterapplying for certification through examination.

(3) Certification under this subsection is valid for3 years. Upon expiration of that certification theindividual shall meet the requirements for recertifi-cation in subsection (d).

(d) Recertification. An EMT shall apply for recertifica-tion between 1 year and 60 days prior to expiration of theEMT’s certification from the Department. Failure to applyfor recertification in a timely manner may result in theindividual not being recertified before the prior certifica-tion expires. The Department will recertify as an EMT anindividual who meets the following qualifications:

* * * * *

(3) [ Files with the Department proof of success-ful completion of ] has successfully completed one ofthe following:

* * * * *

(e) [ EMT instructor certification ] Scope of prac-tice.

[ (1) To qualify for EMT instructor certificationan individual shall:

(i) Be 18 years of age or older.

(ii) Successfully complete an EMT instructorcourse as provided by the Department or possess atleast a bachelor’s degree or teacher’s certificationin secondary education.

(iii) Possess current certification as an EMT orEMT-paramedic.

(iv) Possess current certification in CPR.

(v) Possess a minimum of 1 year’s experiencefunctioning at the EMT or EMT-paramedic levelproviding prehospital care.

(vi) Possess demonstrated competence in teach-ing the didactic and practical skills portions of thecurriculum. The Department is responsible for as-sessing an instructor’s competence.

(vii) Possess recommendations from the regionalEMS council and an approved training institutethat the individual be certified as an instructor.

(2) EMT instructor certification shall expire con-currently with the individual’s EMT or EMT-para-medic certification. ]

An EMT’s scope of practice, under medical com-mand direction or utilization of the Statewide BLSmedical treatment protocols, includes the BLS ser-vices which may be performed by a first responderas set forth in § 1003.22(e) (relating to first re-sponder) and the following:

(1) Administration to a patient or assisting apatient to administer drugs previously prescribedfor that patient, as specified in the Statewide BLSmedical treatment protocols.

(2) Transportation of a patient with an indwell-ing intravenous catheter without medication run-ning.

(3) Other BLS services taught in a basic trainingprogram for EMTs approved by the Department, ifthe EMT has received training to perform thoseservices in such a course, in a course which isdetermined by the Department to meet or exceedthe standards of a training program for EMTspreapproved by the Department, or in a course forwhich an EMT may receive continuing educationcredit towards recertification, and is able to docu-ment this training. The Department will publish inthe Pennsylvania Bulletin, at least annually, a listof the services in the most recent basic trainingprogram for EMTs approved by the Department. Ifthe approved course is not offered by the Depart-ment, the Department may exclude from the pub-lished list, services taught which the Departmentdetermines are not appropriate services to be per-formed by an EMT.

[ (f) Instructor recertification

(1) To qualify for recertification as an EMT in-structor, an individual shall:

(i) Receive favorable ratings from the Depart-ment during annual reviews of the instructor underactual classroom conditions.

(ii) Provide documentation to the Departmentthat the instructor did a minimum of 20 hours ofteaching per year.

(iii) Possess current certification as an EMT oran EMT-paramedic.

(iv) Possess current certification in CPR.

(v) Possess recommendations for recertificationfrom the regional EMS council and an approvedtraining institute.

(vi) Complete additional continuing education re-quirements established and approved by the De-partment.



(2) EMT instructor recertification shall expireconcurrently with the individual’s EMT or EMT-paramedic recertification. ]§ 1003.23a. EMS instructor certification.

(a) Qualifications for certification. The Depart-ment will issue an EMS instructor certification toan individual who meets the following require-ments:

(1) Has completed an application for EMS in-structor certification on a form prescribed by theDepartment.

(2) Is 18 years of age or older.(3) Has successfully completed an EMS instructor

course approved by the Department, or possesses abachelor’s degree in education or a teacher’s certi-fication in education.

(4) Has successfully completed an EMT-Basictransition program or update, or has completed anEMT-Basic course.

(5) Possesses current certification as an EMT orEMT-paramedic, or recognition as a health profes-sional.

(6) Possesses current certification in CPR.

(7) Possesses at least 1 year experience function-ing at the EMT, EMT-paramedic or health profes-sional level providing prehospital care.

(b) Renewal of instructor certification. An EMSinstructor certification is valid for 3 years. TheDepartment will renew an EMS instructor certifica-tion for an individual who meets the followingrequirements:

(1) Has completed an application for renewal ofan EMS instructor certification on a form pre-scribed by the Department.

(2) Has demonstrated competence in teaching thedidactic and practical skills portions of the curricu-lum.

(3) Has provided documentation to the Depart-ment to establish that the individual conducted atleast 20 hours of teaching per year.

(4) Possesses current certification as an EMT orEMT-paramedic, or recognition as a health profes-sional.

(5) Possesses current certification in CPR.

(6) Has completed an EMS instructor update pro-gram within 3 years prior to applying for renewalof certification.§ 1003.24. EMT-paramedic.


(1) An [ individual who is certified by the Depart-ment as an ] EMT-paramedic [ and ] who has beengranted medical command authorization under § 1003.28(relating to medical command authorization), or an indi-vidual who is a student in an approved EMT-paramedictraining program under the supervision of an approvedpreceptor, may provide in a prehospital, interhospital orin an emergency care setting in a facility, or during thetransfer of convalescent or other nonemergencycases, BLS services which may be performed by anEMT as set forth in § 1003.23(a) and (e) (relating toEMT), as well as the ALS services [ listed ] in subsec-

tion (d) to prevent loss of life or aggravation of physiologi-cal or psychological illness or injury. This section doesnot prohibit an EMT-paramedic from providingEMS as a Good Samaritan.

(2) An EMT-paramedic who does not have or choosesnot to maintain medical command authorization [ inaccordance with ] under § 1003.28 may apply to theDepartment for certification as an EMT. The rules appli-cable to certification of an EMT-paramedic as an EMT arein § 1003.23(b)(2) [ (relating to EMT) ]. An EMT-para-medic without medical command authorization who iscertified as an EMT may provide only the BLS serviceswithin an EMT’s scope of practice as set forth in§ 1003.23(a) and (e) until the EMT-paramedic has re-gained medical command authorization in accordancewith § 1003.28. Following loss of medical commandauthorization, an EMT-paramedic may function asan EMT for the ALS ambulance service underwhich the EMT-paramedic has lost medical com-mand authorization, for 30 days without securingEMT certification, if approval to do so is granted bythe ALS service medical director for that ALSambulance service.

(b) Certification.

(1) [ To be certified as an EMT-paramedic, anindividual shall ] The Department will certify as anEMT-paramedic an individual who meets the fol-lowing qualifications:

(i) Completes an application on a form prescribedby the Department.

[ (i) ] (ii) Possesses current certification as an EMT.

(iii) Is 18 years of age or older.

[ (ii) Successfully complete ] (iv) Has successfullycompleted a training course for EMT-paramedics ap-proved by the Department.

[ (iii) Successfully complete ] (v) Has successfullycompleted a practical examination of EMT-paramedicskills[ , as verified by the medical director of thetraining program on a form provided by the De-partment.

(iv) Possess current CPR certification.

(v) Successfully complete ] (vi) Has successfullycompleted a written examination for EMT-paramedicsadministered by the Department.

[ (vi) Be 18 years of age or older.

(2) An individual who possesses EMT-paramediccertification from another state or National regis-try may qualify for EMT-paramedic certification inthis Commonwealth by meeting the Department’srequirements for reciprocity in § 1003.23(c).

(3) ] (2) [ The Department will consider an ] Anindividual certified as an EMT-paramedic [ to be ] ispermanently certified as an EMT-paramedic, subject todisciplinary action under section 11(j.1) of the act (35 P. S.§ 6931(j.1)) and § 1003.27 (relating to disciplinary andcorrective action).

[ (4) ] (3) ***

(c) Transition of EMT-paramedic I and EMT-paramedic II certification to EMT-paramedic.



(1) Current certification by the Department as anEMT-paramedic II is equivalent to certification asan EMT-paramedic. After June 30, 1989, EMT-paramedic II certifications will not be issued by theDepartment. Only certification as an EMT-para-medic will be issued after June 30, 1989.

(2) Certification as an EMT-paramedic I will notbe issued after June 30, 1989. Individuals currentlycertified as an EMT-paramedic I shall successfullycomplete additional certification requirements asdetermined by the Department to bring them up tothe level of EMT-paramedic by June 30, 1989, ortheir certification will revert to the status of anEMT for the remainder of their certification pe-riod. ]

Certification by endorsement.(1) For an individual who is 18 years of age or

older and who is currently certified in anotherstate as an EMT-paramedic, the Department willendorse the following qualifications as equivalentto those in subsection (b):

(i) Certification as an EMT-paramedic in theother state instead of current certification as anEMT in this Commonwealth.

(ii) Successful completion of EMT-paramedictraining curriculum that meets or exceeds the stan-dards of the training course prescribed by theDepartment under subsection (b)(1)(iv).

(iii) Successful completion of a written examina-tion for EMT-paramedic certification which is de-termined by the Department to meet or exceed thestandards of the written examination prescribed bythe Department under subsection (b)(1)(vi).

(iv) Successful completion of a practical skillsexamination for EMT-paramedic certification whichis determined by the Department to meet or exceedthe standards of the practical skills examinationprescribed by the Department under subsection(b)(1)(v).

(2) An individual whose EMT-paramedic certifica-tion in another state is expired at the time ofapplication may seek to have the satisfaction ofparagraph (1)(ii) endorsed as equivalent to the sat-isfaction of subsection (b)(1)(iv), but will not beconsidered by the Department for endorsement ofqualifications under paragraph (1)(i), (iii) or (iv),and shall successfully complete the EMT-paramedicpractical skills and written examinations pre-scribed by the Department after making applica-tion for certification through examination.

(d) Scope of practice. An EMT-paramedic’s scope ofpractice includes the BLS services which may be per-formed by an EMT as [ set forth ] in § 1003.23(a) and(e) and the ALS services set forth in this subsection. AnEMT-paramedic, with medical command authorization,following the order of a medical command physician, oruse of Department approved transfer and medical treat-ment protocols as authorized by the ALS service medicaldirector, may:

* * * * *

(10) Perform [ vagal ] Valsalva maneuvers.

* * * * *

(19) Perform other ALS services [ authorized by theDepartment-approved regional EMS council trans-

fer and medical treatment protocols ] taught in atraining course for EMT-paramedics approved bythe Department, if the EMT-paramedic has receivedtraining to perform those services in such a course,in a course which is determined by the Departmentto meet or exceed the standards of a trainingcourse for EMT-paramedics preapproved by theDepartment, or in a course for which an EMT-paramedic may receive continuing education credittowards qualifying for medical command authoriza-tion, and is able to document this training. TheDepartment will publish, at least annually, a list ofthe ALS services taught in the most recent trainingcourse for EMT-paramedics approved by the De-partment. If the approved course is not offered bythe Department, the Department may exclude fromthe published list, services taught which the De-partment determines are not appropriate servicesto be performed by an EMT-paramedic.

§ 1003.25a. Health professional physician.

[ (a) Basic qualifications. ] Physicians who haveeducation and continuing education in ALS ser-vices and prehospital care may [ participate in EMSteams ] function as a member of the crew on anambulance as a health [ professionals ] professional.This section does not prohibit a health professionalphysician from providing EMS as permitted under42 Pa.C.S. § 8331 (relating to medical good Samari-tan civil immunity).

[ (b) Minimum qualifications At a minimum, ahealth professional physician shall:

(1) Be a practicing physician.

(2) Possess valid CPR certification.

(3) Possess valid ACLS certification.

(4) Possess current certification as an EMT-paramedic, or successfully complete a prehospitalhealth professional training program approved bythe Department and a practical skills evaluationand written examination administered by the De-partment.

(c) Recognition of current practitioners who arephysicians. A 1-year grace period after the approvalof a prehospital physician course will permit anindividual currently working in the prehospitalsetting to challenge the practical or written por-tion, or both, of the physician prehospital examformat under the following conditions:

(1) The physician shall take written and practicalprehospital physician exams and possess:

(i) A valid license to practice in this Common-wealth as a Doctor of Medicine or Doctor of Oste-opathy.

(ii) Evidence of participation in an educationalprogram sponsored by a hospital or regional train-ing institute intended to provide the physician withthe knowledge and skills needed to provide anadvanced level of prehospital care, including physi-cal assessment, immobilization and stabilization,patient extrication, airway management, EKG andrhythm interpretation and pharmacology.

(iii) A letter of support from a director of amedical command facility specific to challengingthe exams.



(2) The physician need take only the practicalprehospital physician exam and possess:

(i) A valid license to practice in this Common-wealth as a Doctor of Medicine or Doctor of Oste-opathy.

(ii) Evidence of participation in an educationalprogram sponsored by a hospital or regional train-ing institute intended to provide the physician withthe knowledge and skills needed to provide anadvanced level of prehospital care, including physi-cal assessment, immobilization and stabilization,patient extrication, airway management, EKG andrhythm interpretation and pharmacology.

(iii) Board certification in an appropriate spe-cialty or a residency in an emergency medicineresidency program or currently advanced cardiaclife support and advanced trauma life supportcourse certified.

(iv) A letter of support from a director of amedical command facility specific to challengingthe exams.

(d) Health professionals with specialty transportteams. For the purposes of § 1005.10(d) (relating tolicensure standards), a physician may function as ahealth professional for specialty transport situa-tions when operating under institutional policiesand procedures approved by the Department. ]§ 1003.25b. Prehospital registered nurse.


(1) A prehospital registered nurse who has medicalcommand authorization under § 1003.28 (relating to med-ical command authorization) may provide the ALS ser-vices in § 1003.24(d) (relating to EMT-paramedic) andthose listed in subsection (c) in addition to the BLSservices in § 1003.23(a) and (e) (relating to EMT) torespond to the perceived needs of an individual forimmediate medical care in an emergency. This sectiondoes not prohibit a prehospital registered nursefrom providing EMS as permitted under 42 Pa.C.S.§ 8331 (relating to medical good Samaritan civilimmunity).

(2) A prehospital registered nurse who does not have orchooses not to maintain medical command authorizationmay apply to the Department for recognition as an EMT.The rules applicable to certification of a prehospitalregistered nurse as an EMT are set forth in§ 1003.23(b)(2). Following loss of medical commandauthorization, a prehospital registered nurse mayfunction as an EMT for the ALS ambulance serviceunder which the prehospital registered nurse haslost medical command authorization, for 30 dayswithout securing EMT certification, if approval todo so is granted by the ALS service medical direc-tor for that ALS ambulance service.

(b) Recognition of a prehospital registered nurse.

(1) The Department will recognize as a prehospitalregistered nurse a [ licensed ] registered nurse whomeets the following qualifications:

* * * * *

(iii) Has successfully completed the American HeartAssociation or American Red Cross basic cardiac lifesupport training program and the [ American HeartAssociation advanced cardiac life support training

program ] ACLS course, or other programs determinedby the Department to meet or exceed the standards of thespecified programs.

* * * * *

(2) A [ licensed ] registered nurse who received recog-nition as a health professional registered nurse under thevoluntary health professional registered nurse recognitionprogram conducted by the Department prior to September2, 1995, will be deemed to have Department recognitionas a prehospital registered nurse.

(3) Department recognition of a prehospital registerednurse under [ paragraphs (1) and (2) will be ] thissection is permanent subject to disciplinary action undersection 11(j.1) of the act (35 P. S. § 6931(j.1)) and§ 1003.27 (relating to disciplinary and corrective action).

* * * * *

(c) Scope of practice. A prehospital registered nursewith medical command authorization may perform, inaddition to those services within an EMT-paramedic’sscope of practice, [ the following services:

(1) Those ] other ALS services authorized by TheProfessional Nursing Law (63 P. S. §§ 221—225.5)[ . ]

[ (2) Other ALS services authorized by theDepartment-approved regional EMS council trans-fer and medical treatment protocols.

(3) Other ALS services authorized by medicalcommand in the case of a prehospital registerednurse who functions on an air ambulance service ],when authorized by a medical command physicianthrough either on line medical command or stand-ing treatment protocols.

(d) Recognition by endorsement.

(1) The Department will grant recognition as aprehospital registered nurse to an individual whohas served in a similar capacity in another stateand who meets the following qualifications:

(i) Completes an application on a form prescribedby the Department.

(ii) Is 18 years of age or older.

(iii) Has successfully completed the AmericanHeart Association or the American Red Cross basiclife support training program and the ACLS course,or other programs determined by the Departmentto meet or exceed the standards of the specifiedprograms.

(iv) Is licensed as a registered nurse in both thisCommonwealth and another state.

(v) Has successfully completed either of the fol-lowing:

(A) The written ALS examination for prehospitalregistered nurses approved by the Department andthe EMT practical skills examination.

(B) Written and practical skills examinations de-termined by the Department to meet or exceed theexaminations approved by the Department.

(vi) Has successfully completed one of the follow-ing:

(A) The Pennsylvania prehospital registerednurse curriculum adopted by the Department.



(B) A knowledge and skills assessment processadopted by the Department.

(C) Curriculum or a knowledge and skills assess-ment process, which is determined by the Depart-ment to meet or exceed the standards adopted bythe Department.

§ 1003.26. Rescue personnel.

(a) Basic rescue practices technician.

(1) Roles and responsibilities. A [ certified ] basic res-cue practices technician is [ authorized ] an individualcertified by the Department as possessing the train-ing and skills to perform rescue skills in accordancewith the basic rescue practices course approved by theDepartment. A [ certified ] basic rescue practices techni-cian utilizes basic tools and equipment of the rescueservice [ and is responsible for employing thesetools, equipment and techniques ] to perform a safeand efficient rescue operation.

* * * * *

(b) Basic vehicle rescue technician.

(1) Roles and responsibilities. A [ certified ] basic ve-hicle rescue technician is [ authorized ] an individualcertified by the Department as possessing the train-ing and skills to perform rescue skills in accordancewith the basic vehicle rescue course approved by theDepartment [ which ]. That program provides the stu-dent with the knowledge and skills necessary to achievethe rescue of persons involved in automobile accidents[ on highways ].

* * * * *

(c) [ Specialized ] Special vehicle rescue technician.

(1) Roles and responsibilities. A [ person certified inspecialized ] special vehicle rescue [ training is au-thorized ] technician is an individual certified bythe Department as possessing the training andskills to perform [ rescue skills ] rescues in accordancewith the specialized rescue training course approved bythe Department.

* * * * *

(3) Minimum qualifications. An individual shall com-plete a training program approved by the Department fora specific level of specialized vehicle rescue performance,and also shall successfully complete a written examina-tion developed by the Department and administered bythe Department.

(d) Rescue instructor [ roles and responsibilities.

(1) Rescue instructors shall:

(i) Follow the prescribed course of instruction inleading the student to mastery of unit’s objectivesand finally to mastery and accomplishment of suc-cessfully reaching the course objective.

(ii) Assure that teaching aids are present and inoperating condition.

(iii) Assure that tools, equipment and supportmaterials are present and in operating condition.

(iv) Set-up the classroom facility to permit acomfortable, yet successful, learning environment.

(v) Assure that field training facilities are suffi-cient to meet the needs of the practice phase of thetraining program.

(vi) Obtain and prepare classroom materials andexercises which reflect local resources, policies andpractices.

(vii) Keep discussion oriented toward basic res-cue practices.

(viii) Prepare practice and remedial activities, asrequired, to permit students to meet stated objec-tives.

(ix) Assign responsibilities to assistant instruc-tors.

(x) Supervise assistant instructors.

(xi) Monitor and evaluate student and assistantinstructor attendance, and performance.

(xii) Maintain records of student and instructorattendance, performance evaluation and knowledgelevels.

(xiii) Provide recommendations for course im-provement.

(2) At a minimum, rescue instructors shall:

(i) Be certified as an EMT by the Department,and be certified in the fundamentals of firefighting.

(ii) Successfully complete a course of instructionin the techniques and philosophy of teaching. Oneof the following shall be submitted as proof ofcompletion of this requirement:

(A) A baccalaureate degree with an educationmajor.

(B) State certification as an EMT-instructor.

(C) State certification as a fire service instructor.

(iii) Successfully complete the Basic Rescue Prac-tices Training Program which they intend to teach.

(iv) Be certified as a rescue instructor by theDepartment.

(v) Be able to demonstrate their ability to operateevery tool and piece of equipment identified on theminimum equipment list in a manner above theaverage person’s ability to perform.

(vi) Agree to actively participate in the presenta-tion of at least one certified basic rescue course peryear in order to maintain their instructor certifica-tion.

(3) The Department will give special consider-ation to competent instructors who do not meet therequirements in paragraph (2)(ii)(A)—(C). The can-didate shall submit a letter to the Department ofHealth, Division of Emergency Medical Services,Post Office Box 90, Harrisburg, Pennsylvania17108. ] The Department will develop a programproviding for the certification of rescue instructors.Courses that seek Department approval as a rescuetraining course shall be taught by certified rescueinstructors.

(e) Certificates. The rescue technician certifica-tions issued by the Department under this sectiondo not constitute a legal prerequisite to performingrescues. The rescue instructor certifications issuedby the Department under this section do not consti-tute a legal prerequisite to serving as a rescue



instructor in programs other than rescue trainingcourses approved by the Department. The Depart-ment approves the rescue programs and issues thecertifications referenced within this section to pro-mote the Statewide EMS system having an ad-equate number of personnel with sufficient train-ing and skills to perform rescues.§ 1003.27. Disciplinary and corrective action.

(a) The Department may, upon investigation, hearingand disposition, impose upon prehospital personnel whoare certified or recognized by the Department oneor more of the disciplinary or corrective measures insubsection (c) for one or more of the following reasons:

* * * * *(2) Deceptive or fraudulent procurement or misrepre-

sentation of certification or recognition credentials.* * * * *

(12) Failure to comply with ambulance [ trip ] re-sponse reporting requirements as established by theDepartment.

* * * * *(15) Conviction of a misdemeanor which relates to the

practice or the profession of the prehospital personnelpractitioner. Conviction is a judgment of guilt.

* * * * *(d) The Department will conduct all aspects of the

disciplinary process and any hearing that may be held inaccordance with 1 Pa. Code Part II (relating to [ generalrules of administrative practice and procedure ]General Rules of Administrative Practice and Pro-cedure). A revocation or suspension of certification orrecognition may be appealed to the CommonwealthCourt under 2 Pa.C.S. §§ 501—508 and 701—704 (relat-ing to [ administrative agency law ] AdministrativeAgency Law).§ 1003.28. Medical command authorization.

(a) Authority to grant medical command. The ALSservice medical director has the authority to grant, denyor restrict as provided in subsection (c)(3), medicalcommand authorization to an EMT-paramedic or prehos-pital registered nurse who seeks to provide EMS onbehalf of the ALS ambulance service. The ALS servicemedical director shall document the medical commandauthorization decision and how that decision was made.The decision of the ALS service medical director shallaffect the medical command authorization status of theEMT-paramedic or prehospital registered nurse for thatALS ambulance service only.

(b) Prerequisites to initial determination regardingmedical command authorization.

* * * * *

(3) Before the ALS service medical director may grantmedical command authorization to an individual, the ALSservice medical director shall verify that the individualcan competently perform each of the services set forth[ in ] within the [ individual’s applicable ] scope ofpractice authorized by the individuals’ certificationor recognition, which is also permitted by themedical treatment protocols in the region or re-gions in which ambulances of the ALS ambulanceservice, out of which the individual will function,are stationed. If the individual had not previously beengranted medical command authorization for any ALS

ambulance service in this Commonwealth, the ALS ser-vice medical director shall [ directly observe ] deter-mine the individual’s [ performance of each ALSservice set forth in the individual’s applicablescope of practice ] competence to perform thoseservices by direct observation or by consulting witha physician, EMT-paramedic or prehospital regis-tered nurse who has directly observed the individu-al’s performance of those services, and who the ALSservice medical director has determined to bequalified to make the assessment. If the individualhad previously been granted medical command authoriza-tion, the ALS service medical director shall verify that theindividual can competently perform each [ ALS serviceset forth in the individual’s applicable scope ofpractice ] of those services by either directly ob-serving the individual’s performance of those ser-vices; or by consulting with a physician, EMT-paramedic or prehospital registered nurse who hasdirectly observed the individual’s performance ofthose services, and who the ALS service medicaldirector has determined to be qualified to make theassessment; or doing the following for services notdirectly observed or by:

* * * * *

(iii) Performing a medical audit of records of servicesprovided by the individual seeking medical commandauthorization, for patients attended to by that indi-vidual for the ALS ambulance for which the ALSservice medical director is making the medicalcommand authorization decision.

* * * * *

(4) If the ALS service medical director determines thatthe individual applying for medical command authoriza-tion cannot competently perform [ the ALS serviceswithin that individual’s scope of practice ] one ormore of those services, the ALS service medical direc-tor shall either deny, or restrict as provided in subsec-tion (c)(3), the individual’s medical command authoriza-tion in a written document provided to theindividual.

(c) Review of medical command authorization. At leastannually, and more often as circumstances warrant, theALS service medical director shall review the medicalcommand authorization status of each EMT-paramedicand prehospital registered nurse providing services onbehalf of the ALS ambulance service. In reviewing med-ical command authorization, the ALS service medicaldirector shall ensure that the individual has completedor is completing the applicable continuing educationrequirements in § 1003.29 and has demonstrated compe-tence, as verified by the ALS service medical director, inperforming each of the [ skills set forth in the indi-vidual’s scope of practice ] services that fall withinthe scope of the individual’s medical commandauthorization. The ALS service medical director, uponreview of medical command authorization, may:

* * * * *

(2) Renew medical command authorization and requirecontinuing education courses in any field the ALS servicemedical director deems appropriate. The ALS servicemedical director may require an individual to se-cure more continuing education credit than gener-ally required for personnel operating under med-ical command authorization for the ALS ambulance



service, only if the ALS service medical directordetermines that the individual does not demon-strate sufficient competence in performing a ser-vice, the continuing education is prescribed toaddress that deficiency and the number of continu-ing education hours generally required are notsufficient to provide the education the individualneeds to remedy the problem.

[ (3) Require completion of specified continuingeducation courses as a prerequisite to renewal ofmedical command authorization.

(4) ] (3) Restrict [ the scope of practice under ]medical command authorization, if the restriction doesnot preclude the individual from performing theservices specified within the scope of the individu-al’s certification or recognition as permitted by themedical treatment protocols for the region. Thispermits imposing a restriction such as requiring onscene supervision when the individual performs aspecified service or services, or permitting a speci-fied service or services to be performed only whenthe individual is receiving online medical com-mand.

[ (5) ] (4) ***

(d) Appeals to the regional EMS medical director. Anindividual whose medical command authorization hasbeen denied [ or restricted ] by the ALS service medicaldirector may appeal the decision within 14 days to theregional EMS medical director. The individual’s appealshall be in writing and shall specify the reasons theindividual disagrees with the decision of the ALS servicemedical director. The regional EMS medical director shallconduct a hearing. If the regional EMS medical direc-tor is unable to conduct a fair hearing due toreceiving prejudicial information prior to the hear-ing, or for another reason, the regional EMS coun-cil shall arrange for the regional EMS medicaldirector of another region to conduct the hearing.At the hearing, the ALS service medical director shallhave the burden to proceed and offer testimony and otherevidence in support of the ALS service medical director’sdecision. The individual shall also have an opportunity topresent testimony and other evidence in support of theindividual’s position. Both parties shall have an opportu-nity to cross-examine opposing witnesses and to submitoral and written position statements. The regional EMSmedical director may give the parties up to 5 additionaldays following the hearing to submit written positionstatements. The regional EMS medical director will issuea written decision affirming, reversing or modifying theALS service medical director’s decision within 14 days[ of ] after the hearing or within 14 days [ of ] after thesubmission of post hearing position statements, if theyare filed. The regional EMS medical director’s writtendecision shall contain the regional EMS medical director’sfindings and conclusions. If the ALS service medicaldirector fails to appear at the hearing, the regional EMSmedical director shall reverse the ALS service medicaldirector’s decision. If the individual fails to appear at thehearing, the regional EMS medical director shall make adetermination upon the evidence presented and eitheraffirm, reverse or modify the decision of the ALS servicemedical director. The burden of proof is a preponder-ance of the evidence.

(e) Appeals to the Department. If either party is dissat-isfied with the decision of the regional EMS medicaldirector with regard to medical command authorization,

that party shall have the right of immediate appeal to theDepartment. The party appealing the regional EMS med-ical director’s decision shall submit a written statement tothe Department specifying the reasons for the party’sobjections to the regional EMS medical director’s decisionwithin 14 days [ of ] after that decision. The otherparty shall have 14 days to respond. The Departmentwill review the record before the regional EMS medicaldirector, and if deemed advisable by the Department[ shall ] will hear argument and additional evidence. Assoon as practicable, the Department, will issue a finaldecision containing findings of fact and conclusions of lawwhich affirms, reverses or modifies the regional EMSmedical director’s decision.

(f) Scope of appeals. Appeals under this section shall beconfined to a review and determination of whether, at thetime of the assessment conducted by the ALS servicemedical director, the individual possessed the competenceto perform [ skills for which the individual wasdenied medical command authorization ] all ser-vices within the scope of the individual’s medicalcommand authorization for the ambulance service.

(g) Service; determination of time period. Eachparty shall serve the other with any document theparty files with a regional EMS medical director orthe Department. In determining the time in whicha document is to be filed under this section, timebegins to run for the parties when the document ismailed, and time begins to run for a regional EMSmedical director when the document is received bythe regional EMS medical director.

§ 1003.29. Continuing education requirements.

(a) First responders. A first responder who elects toqualify for recertification by fulfilling continuing educa-tion requirements shall, prior to the expiration of the3-year certification period, [ attend ] successfully com-plete the following:

(1) Sixteen hours of instruction [ provided by a con-tinuing education sponsor ] in subjects related to thescope of practice of a first responder as set forth in§ 1003.22(a) and (e) (relating to first responder) andwhich have been approved by the Department forcontinuing education credit. During the first fullcertification period the first responder begins fol-lowing (Editor’s Note: The blank refers tothe effective date of adoption this proposal.), atleast eight of those credits shall be in medical andtrauma education.

(2) A CPR course [ for adult, child and infantsponsored by the American Heart Association, theAmerican Red Cross or another CPR program de-termined by the Department to meet or exceed thestandards of the specified programs ] completed ortaught biennially.

(b) EMTs. An EMT who elects to qualify for recertifica-tion 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 acontinuing education sponsor ] in subjects related tothe scope of practice of an EMT as set forth in§ 1003.23(a) and (e) (relating to EMT) and whichhave been approved by the Department for continu-ing education credit. During the first full certi-



fication period the EMT begins following (Editor’sNote: The blank refers to the effective date ofadoption of this proposal.) at least 12 of thosecredits shall be in medical and trauma education.

(2) A CPR course [ for adult, child and infantsponsored by the American Heart Association, theAmerican Red Cross or another CPR program de-termined by the Department to meet or exceed thestandards of the specified programs ] completed ortaught biennially.

(c) EMT-paramedics. To be eligible to receive and retainmedical command authorization, an EMT-paramedic shall[ attend ] successfully complete in each calendar year,18 hours of instruction [ provided by a continuingeducation sponsor ] in subjects related to the scope ofpractice of an EMT-paramedic as set forth in§ 1003.24(a) and (d) (relating to EMT-paramedic)and which have been approved by the Departmentfor continuing education credit, and shall bienniallyattend or teach a CPR course [ for adult, child andinfant sponsored by the American Heart Associa-tion, the American Red Cross or another CPRprogram determined by the Department to meet orexceed the standards of the specified programs ].Beginning in 1999, at least 9 of the 18 hours ofinstruction shall be in medical and trauma educa-tion. In the initial year of certification, the EMT-paramedic’s continuing education requirements, tosecure renewal of medical command authorizationfor the following year, shall be prorated based uponthe month the certification was secured.

(d) Prehospital registered nurses. To be eligible to re-ceive and retain medical command authorization, a pre-hospital registered nurse shall [ attend ] successfullycomplete in each calendar year, 18 hours of instruction[ provided by a continuing education sponsor ] insubjects related to the scope of practice of a prehospitalregistered nurse as set forth in § 1003.25b(a) and (c)(relating to prehospital registered nurse) andwhich have been approved by the Department forcontinuing education credit, and shall attend orteach biennially a CPR course [ for adult, child andinfant sponsored by the American Heart Associa-tion, the American Red Cross or another CPRprogram determined by the Department to meet orexceed the standards of the specified programs ].Beginning in 1999, at least 9 of the 18 hours ofinstruction shall be in medical and trauma educa-tion. In the initial year of recognition, the prehospi-tal registered nurse’s continuing education require-ments, to secure renewal of medical commandauthorization for the following year, shall be pro-rated based upon the month the recognition wassecured.

(e) [ Continuing education credit for instruction.Prehospital personnel may also accrue hours to becredited to the individual’s continuing educationrequirements equivalent to the number of hoursthe individual is an instructor in a continuingeducation course offered by a continuing educationsponsor, or a course that satisfies requirements forinitial certification or recognition of prehospitalpersonnel conducted by an accredited training in-stitute for prehospital personnel. EMT-paramedicsand prehospital registered nurses may secure nomore than 6 hours of continuing education credit

in a calendar year for serving as an instructor incourses for EMTs or first responders. ] This sectiondoes not prohibit an ambulance service from re-quiring prehospital personnel to satisfy continuingeducation requirements it may choose to impose asa condition of employment, provided that the am-bulance service may not do the following:

(1) Excuse a prehospital practitioner from meet-ing continuing education requirements imposed bythis section.

(2) Establish individual continuing education re-quirements for the EMT-paramedics or prehospitalregistered nurses staffing the ambulance service,except as authorized by § 1003.28(c)(2) (relating tomedical command authorization).

[ (f) Continuing education credit through endorse-ment. Prehospital personnel who attend coursesoffered by any organization or agency with Na-tional or state accreditation to provide continuingeducation may apply to the Department to receivecredit for these courses. The individual shall havethe burden of demonstrating to the Departmentthat these courses meet standards equivalent tothose standards imposed by this part. ]§ 1003.30. Accreditation of sponsors of continuing

education.

(a) Entities and institutions may apply for accredita-tion as a continuing education sponsor by submitting tothe Department an application [ on ] in a [ form sup-plied ] format prescribed by the Department. Theapplicant shall supply all information requested [ on ] inthe application. The Department will grant accreditationto an applicant for accreditation as a continuing educa-tion sponsor [ who ] if the applicant satisfies theDepartment that the courses the applicant will offer willmeet the following minimum standards:

* * * * *

(5) The courses shall be presented by a qualifiedresponsible instructor in a suitable setting devoted tothe educational purpose of the course.

[ (6) The course shall be open to all prehospitalpersonnel interested in the subject matter. ]

* * * * *

(c) At least [ 30 ] 90 days prior to expiration of the3-year accreditation period, a continuing education spon-sor shall apply to the Department for renewal of thesponsor’s accreditation. The Department will renew thesponsor’s accreditation if the sponsor meets all of thefollowing requirements:

* * * * *

(3) The sponsor has satisfied its responsibilitiesunder § 1003.32 (relating to responsibilities of con-tinuing education sponsors).

(d) If the Department deems that the continuingeducation sponsor has demonstrated a history ofunderstanding and compliance with the regulatorystandards for providing continuing education toprehospital personnel, the Department may apprisethe continuing education sponsor that its accredita-tion constitutes prior approval of continuing educa-tion courses offered under this chapter which arepresented in a classroom setting, and permit the



continuing education sponsor to assign the numberof credit hours for the course, based upon thecriteria in § 1003.31(a) (relating to credit for con-tinuing education).§ 1003.31. Credit for continuing education.

(a) Credit hour. A prehospital practitioner shallreceive 1 hour credit for each 60 minutes of instruc-tion presented in a classroom setting by a continu-ing education sponsor. Credit may not be receivedif attendance or other participation in the course isnot adequate to meet the educational objectives ofthe course as determined by the course sponsor.Credit may not be received for other than 30 or60-minute units of instruction, however the courseshall be at least 60 minutes. For completing acontinuing education course that is not presentedin a classroom setting, or that is not presented by acontinuing education sponsor, the prehospital prac-titioner shall receive the number of credit hoursassigned by the Department to the course.

(b) Course completion. A prehospital practitionermay not receive credit for a continuing educationcourse not completed, as evidenced by satisfactionof the check-in/check-out process for a course pre-sented in a classroom setting by a continuing edu-cation sponsor, which reflects that the prehospitalpractitioner met the continuing education atten-dance requirement for receiving credit, and thecontinuing education sponsor’s report to the De-partment verifying that the prehospital practi-tioner has completed the course. The course willalso not be considered completed if the prehospitalpractitioner does not satisfy other course comple-tion requirements imposed by this chapter and thecontinuing education sponsor.

(c) Continuing education credit for instruction. Aprehospital practitioner shall receive credit equalto the number of hours served as an instructor in acontinuing education course offered by a continu-ing education sponsor, or in a course that satisfiesrequirements for initial certification or recognitionof a prehospital practitioner conducted by a train-ing institute for prehospital personnel accreditedby the Department.

(d) Continuing education credit through endorse-ment. A prehospital practitioner who attends orteaches a course offered by an organization withNational or state accreditation to provide educa-tion may apply to the Department to receive creditfor the course. The prehospital practitioner shallhave the burden of demonstrating to the Depart-ment that the course meets standards substantiallyequivalent to the standards imposed in this chap-ter.

(e) Continuing education credit assigned tocourses not conducted by a continuing educationsponsor. If a course is offered by an organizationwith National or state accreditation to provideeducation, which is not a continuing educationsponsor, the Department will assign credit to thecourse, including the possibility of no credit orpartial credit, based upon considerations ofwhether the course bears entirely upon appropriatesubject matter and whether the method of present-ing the course meets standards substantiallyequivalent to those prescribed in this chapter.

(f) Continuing education credit assigned to self-study courses. Credit may be sought from the De-

partment for a self-study continuing educationcourse. The prehospital practitioner shall submitan application to the Department to approve theself-study course for credit prior to commencingthe course and shall supply the Department withthe materials the Department requests to conductthe evaluation. The Department will assign creditto the course based upon considerations of whetherthe course addresses appropriate subject matterand whether the method of completing the coursemeets standards substantially equivalent to thoseprescribed in this chapter. The Department mayrequire modifications to the proposed self-study asa precondition to approving it for credit.

(g) Continuing education credit assigned tocourses not presented in a classroom setting. Aprehospital practitioner shall be awarded credit forcompleting a course without the prehospital practi-tioner physically attending the course in a class-room setting, provided the course has been ap-proved by the Department for credit whenpresented in that manner.

(h) Reporting continuing education credits to pre-hospital personnel. A record of the continuing edu-cation credits received by prehospital personnelshall be maintained in a Statewide registry. A re-port of the continuing education accumulated shallbe provided annually to first responders and EMTs,and semiannually to EMT-paramedics and prehospi-tal registered nurses at the mailing address onrecord with the Department.

(i) Resolution of discrepancies. It is the responsi-bility of the prehospital practitioner to review thereport of continuing education credits and to notifythe appropriate regional EMS council of any dis-crepancy within 30 days after the report is mailed.The Department will resolve all discrepancies be-tween the number of continuing education creditsreported and the number of continuing educationcredits a prehospital practitioner alleges to haveearned, which are not resolved by the regional EMScouncil.§ 1003.32. Responsibilities of continuing education

sponsors.(a) Record of attendance. A continuing education

sponsor shall maintain a record of attendance for acourse presented in a classroom setting by main-taining a check-in/check-out process approved bythe Department, and shall assign at least one per-son to ensure that all individuals attending thecourse check in when entering and check out whenleaving. If an individual enters a course after thestarting time, or leaves a course before the finish-ing time, the assigned person shall ensure that thetime of arrival or departure is recorded for theindividual.

(b) Reporting attendance. A continuing educationsponsor shall report to the Department, in themanner and format prescribed by the Department,attendance at each continuing education coursepresented in a classroom setting within 10 daysafter the course has been presented.

(c) Course evaluation. A continuing educationsponsor shall develop and implement methods toevaluate its course offerings to determine theireffectiveness. The methods of evaluation shall in-clude providing a course evaluation form to eachperson who attends a course.



(d) Record retention. The continuing educationsponsor shall retain for each course it presents, thecompleted course evaluation forms and the check-in/check-out record for a course presented in aclassroom setting. If the continuing education spon-sor has received Department approval to assigncredit to a course under § 1003.30(d) (relating toaccreditation of sponsors of continuing education),the retained records shall also include course mate-rials used, a record of the course instructor’s quali-fications, the course instructor’s lesson plans andexaminations if applicable. These records shall beretained for at least 4 years from the presentationof the course.

(e) Providing records. A continuing educationsponsor shall promptly provide the Departmentwith complete and accurate records relating to thecourse as requested by the Department.

(f) Course not presented in a classroom setting. Acontinuing education sponsor shall be exempt fromthe requirements of subsections (a) and (b) for acourse which is not presented in a classroom set-ting, if the course is approved by the Departmentfor credit when presented in that manner. Whenpresenting the course to the Department for ap-proval for credit, the continuing education sponsorshall present a procedure for monitoring, confirm-ing and reporting prehospital practitioner partici-pation in a manner that achieves the purposes ofsubsections (a) and (b).

(g) Monitoring responsibilities. A continuing edu-cation sponsor shall ensure that a course waspresented in a manner that met all of the educa-tional objectives for the course, and shall deter-mine whether each prehospital practitioner whoenrolled in the course met the requirements of thischapter and the continuing education sponsor toreceive credit for completing the course.

(h) Course completion. A continuing educationsponsor shall report to the Department, in a man-ner and format prescribed by the Department,completion of a course by a prehospital practi-tioner who completes the course, and shall identifyto the Department a prehospital practitioner whoseeks credit for a course but who did not meet therequirements of the continuing education sponsoror this chapter to receive continuing educationcredit. The continuing education sponsor shall alsoprovide a prehospital practitioner who completes acourse with a document certifying completion ofthe course.

§ 1003.33. Advertising.

(a) A continuing education sponsor may advertisea course as a continuing education course in amanner that states or suggests that the coursemeets the requirements of this chapter only if thecourse has been approved by the Department or isdeemed approved under § 1003.30(d) (relating toaccreditation of sponsors of continuing education).

(b) When a course has been approved for continu-ing education credit, the continuing educationsponsor shall announce, in its brochures or regis-tration materials: this course has been approved bythe Department for (the approved num-ber of hours) of continuing education credit for

(the type of prehospital practitioner towhich the course applies).

(c) If a continuing education sponsor advertisesthat it has applied to the Department to securecontinuing education credit for a course, prior topresenting the course it shall disclose to all enroll-ees whether the course has been approved or disap-proved for credit.§ 1003.34. Withdrawal of accreditation or course

approval.If the continuing education sponsor fails to sat-

isfy the requirements of this chapter, the Depart-ment may:

(1) Withdraw its accreditation.(2) Downgrade its accreditation status to provi-

sional accreditation, subject to withdrawal if defi-ciencies are not resolved within a time periodprescribed by the Department.

(3) Withdraw approval of a continuing educationcourse applicable to any future presentation of thecourse.

Subchapter C. [ AIR AMBULANCE PERSONNEL ](Reserved)

§ 1003.41. [ Air ambulance medical director ] (Re-served).

[ (a) Roles and responsibilities. An air ambulancemedical director is responsible for the following:

(1) Providing medical guidance and advice to theair ambulance service personnel.

(2) Participating in training of medical flightcrew members.

(3) Granting or denying medical command autho-rization in accordance with § 1003.28 (relating tomedical command authorization) to medical flightcrew members who require the authorization.

(4) Performing medical audits of patient careprovided by the air ambulance service’s medicalflight crew members.

(b) Minimum qualifications. If the air ambulancemedical director is not a medical command physi-cian, the air ambulance medical director shall:

(1) Possess the minimum qualifications for a med-ical command physician in § 1003.4(b)(1)—(5) (relat-ing to medical command physician).

(2) Have experience in the base station radiodirection of prehospital personnel.

(3) Have knowledge of altitude physiology and ofpotential medical complications which may ariseduring transport of a patient by air ambulance.

(4) Have knowledge of air craft safety and thecapabilities and limitations of the aircraft used.

(5) Have knowledge regarding the application,use, maintenance and hazards of routine or specialmedical equipment used during transport of pa-tients by the air ambulance service.

(6) Successfully complete Parts A and B of theMedical Command Base Station Course adopted bythe Department. ]§ 1003.42. [ Air ambulance medical crew members ]

(Reserved).

[ (a) Roles and responsibilities. The air ambu-lance medical air crew members shall have thefollowing responsibilities:



(1) To assure that equipment/supplies that arerequired for an air ambulance flight are on theaircraft and in working order prior to takeoff forpatient transport.

(2) To provide medical care and intervention ac-cording to direct medical command or writtenprotocols/standing orders.

(3) To maintain a patient treatment record, docu-menting medical care rendered by the medicalflight crew and the disposition of the patient at thereceiving medical facility. The patient treatmentrecord shall be maintained at the base hospital.

(4) To evaluate each patient for potential adverseeffects from flight operations.

(5) To assure that the patient and equipment aresecured during flight.

(b) Minimum qualifications. Air ambulance med-ical air crew members shall have the followingminimum qualifications:

(1) Recognition as a Pennsylvania licensed healthprofessional or certification as an EMT-paramedic.

(2) Knowledge and skill in the application, opera-tion, care and removal of on-board medical equip-ment used in the care of the patient, as well asknowledge of potential in-flight complicationswhich may arise from the use of the equipment,and the treatment of these complications, as well asknowledge of flight physiology.

(3) Training in the use of extrication devices,rescue and survival techniques appropriate to theterrain and the conditions under which the serviceis operated.

(4) Knowledge of policies and procedures of theair ambulance service.

(5) Knowledge of safety operations in and aroundaircraft, and in-flight and post-flight aircraft acci-dent and incident procedures.

(6) Knowledge of the use of the installed aircraftand portable communications equipment. ]§ 1003.43. [ Air ambulance pilot ] (Reserved).

[ (a) Roles and responsibilities. A pilot employedand dispatched for air ambulance service flightshall have the following responsibilities:

(1) To assure that the aircraft is ready for flightat all times.

(2) To proceed expeditiously and as directly aspossible to the flight destination consideringweather, appropriate safety rules, noise abatementprocedures, flight path and altitude clearances.

(3) To flight follow with the communications cen-ter at intervals not to exceed 15 minutes. If theaircraft is outside the radio range of the basecommunications center, adequate flight followingshall be planned and executed.

(b) Minimum qualifications. Pilots employed anddispatched for air ambulance service flight shall:

(1) Meet FAA requirements for medical certifica-tion, licensing and aircraft type ratings pertainingto the flight, as specified at 14 CFR Part 135(relating to air taxi operators and commercial op-erators).

(2) Be trained in, and familiar with, the Pennsyl-vania Emergency Medical Services Communica-tions Systems within their service area.

(3) Be trained by the manufacturer in the opera-tion of the specific type of aircraft, and have atleast 5 hours of flying time in the aircraft beforeserving as pilot in command.

(4) Be specifically trained, and preferably experi-enced, in flying the terrain and conditions uniqueto the air ambulance service area.

(5) Possess recurrent training in accordance withFAA requirements found at 14 CFR 135.351 (relatingto recurrent training).

(6) Hold a current rotorcraft certification with aminimum of 2,000 rotorcraft flight hours as pilot incommand. ]§ 1003.44. [ Air ambulance communications special-

ist ] (Reserved).

[ (a) Roles and responsibilities. Communicationsspecialists who dispatch air ambulance service air-craft have the following responsibilities:

(1) To take emergency calls and dispatch appro-priate air ambulance services to respond to theemergency.

(2) To document the following information:

(i) Time of initial and subsequent air ambulancerequest calls.

(ii) Name of party or agency requesting the airambulance service and a verification phone num-ber.

(iii) Pertinent patient medical information.

(iv) Names of referring and receiving physiciansat hospitals.

(v) Landing and destination sites.

(vi) The details of needed ground transportationarrangements at pick-up and landing sites.

(vii) Times and reasons for aborted or missedflights.

(viii) Details of coordination with ground person-nel for landing and receipt of the aircraft.

(ix) Other data pertinent to the service’s specificneeds for completing activity review reports.

(b) Minimum qualifications. Air ambulance com-munications specialists shall have training com-mensurate with the scope of responsibility giventhem by the particular dispatch center. ]

CHAPTER 1005. LICENSING OF BLS AND ALSGROUND AMBULANCE SERVICES

§ 1005.1. General provisions.

(a) This chapter applies to ground ambulanceservices. [ 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 engagedin providing a BLS or ALS ambulance service upon thehighways or in other public places in this Commonwealth,unless that person holds a current valid license as a BLSor ALS ambulance service issued by the Department[ unless exempted by ] or is from these prohibitionsunder the act.



(b) The Department will license an [ ambulance ser-vice ] applicant as a BLS or ALS ambulance service, orboth, when it meets the requirements of the act and thispart.

(c) An ALS ambulance service may [ be licensed toprovide ALS under medical command and direc-tion, in one or more ] employ either or both of thefollowing [ modes ] types of ambulances:

(1) A mobile intensive care unit vehicle, which is a[ unit ] vehicle that [ responds and transports seri-ously ill or injured ] is designed, constructed,equipped and maintained or operated to provideemergency medical care to and transportation ofpatients.

(2) An ALS squad unit vehicle, which is a vehicle thatis specifically modified and equipped, and is maintainedor operated for the purpose of transporting ALS prehos-pital personnel and equipment to the scene of an emer-gency.

[ (3) An ALS transport service, which is a unitthat transports patients between health carefacilities/institutions. ]

(d) In addition to the general requirements for excep-tions in § 1001.4 (relating to exceptions), the Departmentmay grant exceptions to regulatory licensure stan-dards for ALS and BLS ambulance services that arelicensed in a contiguous state if:

* * * * *

§ 1005.2. Applications.

(a) An application for [ licensure ] an original orrenewal ambulance service licensure shall be submit-ted [ by ambulance service providers ] on formsprescribed by the Department. The application shallcontain[ , but not be limited to, ] the following informa-tion as well as any additional information that maybe 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 appli-cant commits to serve, or, alternatively, a statementthat the applicant intends to engage primarily ininterfacility transports.

(6) Personnel [ work status—partially paid, fullypaid or volunteer ] roster and staffing plan.

(7) [ Design types and the ] The number and types(BLS, mobile intensive care unit, ALS squad unit) ofambulance vehicles to be operated by the [ service ]applicant, and identifying information relating tothose ambulances.

* * * * *

(9) Primary physical building location, and otherbuilding locations out of which it will operateambulances or a full description of how its ambu-lances will be placed and respond to emergencycalls if they will not be operated out of otherbuilding locations.

[ (9) ] (10) Statement attesting to the veracity of theapplication, which shall be signed by [ a responsibleperson affiliated with ] the principal official of theapplicant.

(b) The [ ambulance service ] applicant shall[ complete and ] submit the application to the regionalEMS council [ in whose jurisdiction ] exercising re-sponsibility for the EMS region in which the [ ser-vice is located ] applicant will station its ambu-lances if licensed.

(1) The regional EMS council shall review the applica-tion for completeness[ , ] and accuracy [ and conform-ance with regional EMS plans and protocols.

(2) Complete applications shall be forwarded tothe Department by the regional EMS council within14 days of receipt. ]

(3) ] (2) Incomplete applications shall be returned bythe regional EMS council to the applicant within 14 daysof receipt.

(c) Upon receipt of a complete application, the [ De-partment ] regional EMS council will schedule andconduct an onsite inspection of the applicant’s [ service ]vehicles, equipment and personnel qualifications,as well as other matters that bear upon whetherthe applicant satisfies the statutory and regulatorycriteria for licensure. The inspection shall be per-formed within 45 days after receipt by the [ Depart-ment ] regional EMS council of the completed applica-tion.

(d) An ambulance service shall submit a changeof vehicle form to the regional EMS council within10 days after placing a new ambulance in service,and may continue to operate the ambulance unlessits authority to do so is disapproved by the Depart-ment following inspection.

(e) An ambulance service shall apply for andsecure an amendment of its license prior to sub-stantively altering the location or operation of itsambulances in an EMS region, such as a change inlocation or operations which would not enable it totimely respond to emergencies in the emergencyservice area it committed to serve when it appliedfor a license. The application for an amendment ofan ambulance service license shall be submitted tothe regional EMS council on a form prescribed bythe Department.

§ 1005.3. Right to enter [ and ], inspect and obtainrecords.(a) Upon the request of an employe or agent of the

Department during regular and usual business hours, orat other times when that person possesses a reasonablebelief that violations of this part may exist, a licenseeshall:

* * * * *

(2) Produce for inspection [ personnel and otheremployment ], permit copying and provide within areasonable 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 un-der § 1005.10 (relating to licensure and generaloperating standards).



(3) Permit the [ agent ] person to examine vehicles,required equipment and [ recordkeeping ] suppliesand security facilities [ for information collectedunder § 1001.41 ].

(b) The Department’s [ agent ] representative shalladvise the licensee that the inspection is being conductedunder section 12(k) of the act (35 P. S. § [ 6938 ] 6932k)and this chapter.

(c) [ The Department reserves the right to enterand make inspections at least quarterly, and atother times upon complaint or a reasonable beliefthat violations of this part may exist.

(d) ] Failure of a licensee to produce records [ forinspection ] or to permit an examination [ of equip-ment and facilities ] as required by this sectionconstitutes misconduct in operating the ambulanceservice and shall be grounds for [ suspension, revoca-tion ] disciplinary sanctions or denial of license.

§ 1005.4. Notification of deficiencies to applicants.

(a) [ Within 30 days of an inspection, ] Uponcompletion of the license inspection the inspectorshall provide the applicant for an ambulance servicelicense [ and the regional EMS council shall benotified as to ] an inspection report specifying theresults of the inspection.

(b) If the [ Department has determined ] inspectordetermines that deficiencies warrant a reinspection, the[ Department will give written notice to the appli-cant and the regional EMS council of the deficien-cies ] inspector shall give the ambulance servicewritten notice of the matters to be reinspected.

(c) [ The ] If the type of deficiency requires a planof correction, the applicant shall have 30 days in whichto [ respond to the Department ] provide the inspec-tor with a plan to correct the [ deficiencies ] defi-ciency. [ The Department will review the plan ofcorrection, and, if ] If the plan is found to be accept-able, the [ Department ] inspector will [ make anonsite ] conduct a reinspection in accordance with thetime frame given in the plan of correction.

(d) [ Within 30 days of the reinspection, the De-partment will give written notice to the applicantand the regional EMS council of the results of thereinspection. ] If the applicant disagrees with anydeficiency cited by the inspector following theinspection or reinspection, or the regional EMScouncil’s rejection of a plan of correction, theapplicant shall apprise the Department of the mat-ter in dispute, and the Department will resolve thedispute.

(e) [ When the applicant meets the requirementsof this part, the Department will proceed with thelicensure process. ] The Department will act uponthe license application within 30 days after theinspection process has been completed.§ 1005.5. Licensure.

(a) A license to operate as an ambulance service willbe issued by the Department when it has [ been ]determined that requirements for licensure have beenmet.

(b) A license certificate will [ indicate ] specify thename of the ambulance service, its license number,the address of its primary headquarters, the [ date ]dates of issuance and expiration, the levels of servicethe ambulance service [ provider ] is authorized toprovide and the name of the regional EMS councilthrough which the license application was pro-cessed. If the ambulance service is an ALS ambu-lance service, the license certificate will alsospecify the types of ALS ambulance the ambulanceservice has been authorized to use.

(c) [ A license shall be issued for each level ofservice being provided by the licensee. The issu-ance of a license for both BLS and ALS shall bedetermined by the contents of the application, andwith the concurrence of the regional EMS council,within whose jurisdiction the applicant is locatedor headquartered.

(d) ] The current license certificate shall be displayedin a public and conspicuous place in the ambulanceservice’s [ quarters ] primary headquarters.

[ (e) ] (d) An ambulance [ vehicle of an ambulanceservice ] shall be identified by a decal issued by theDepartment which shall be considered part of itslicense 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 De-partment may not be displayed on a vehicle by [ aservice ] an entity not [ currently ] licensed as anambulance service by the Department.

[ (g) ] (f) ***

§ 1005.6. Out-of-State providers.Ambulance services located or headquartered outside of

this Commonwealth that [ have primary response ar-eas or routinely transport ] regularly engages inthe business of providing emergency medical careand transportation of patients from within this Com-monwealth, to facilities within or outside this Com-monwealth, are required to be inspected and licensed bythe Department.§ 1005.7. Services owned and operated by hospitals.

[ Ambulance services owned and operated by a ]A hospital[ , ] licensed under Chapter 8 of the HealthCare Facilities Act (35 P. S. §§ 448.801—448.820) [ are ]is not required to obtain a separate ambulance servicelicense to [ provide ] own and operate an ambulanceservice. [ These ] An ambulance [ services are ] ser-vice owned and operated by a hospital is subject tothe act and this part, and shall be inspected under thispart, regardless of whether the hospital secures alicense to operate as an ambulance service.§ 1005.7a. Renewal of ambulance service license.

(a) The Department will notify the ambulanceservice to renew its license at least 120 days priorto the expiration date of the license.

(b) An ambulance service shall apply for renewalof its license between 120 days and 60 days prior tothe expiration of its license. Failure to apply forrenewal in a timely manner may result in theapplicant not securing a renewal of its licensebefore the prior license expires.



(c) The criteria for license renewal are the sameas the requirements that would apply for originallicensure at the time the renewal application ismade.

§ 1005.8. Provisional [ licenses ] license.

(a) [ The ] If an ambulance service or an appli-cant for an ambulance service license fails to meetlicensure requirements, the Department may issue ita provisional license, valid for a specific time period of notmore than 6 months, when the Department [ finds thatan ambulance service: ] deems it is in the publicinterest to do so.

(b) The Department may renew a provisional li-cense once, for a period not to exceed 6 monthsexcept when a longer period of renewal is permit-ted under subsection (c), if:

(1) [ Has ] The ambulance service has substantially,but not completely, complied with applicable requirementsfor licensure.

(2) [ Is complying ] The ambulance service ismaking a good faith effort to comply with a course ofcorrection approved by the Department.

(3) [ Has existing deficiencies that will not ad-versely affect the health, welfare or safety of citi-zens of this Commonwealth. ] The Departmentdeems it is in the public interest to do so.

[ (b) A provisional license may be renewed for 6months if the Department determines that the am-bulance service is making a good faith effort tocorrect existing deficiencies and it is in the publicinterest to do so. ]

(c) The Department may renew a provisional BLSambulance service license for [ a period of ] 12months for a volunteer [ fire department or a volun-teer ] ambulance service, or a volunteer fire depart-ment or rescue service that operates an ambulanceservice, which does not meet the minimum standards forstaffing 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 ALSambulance service or an applicant for an ALSambulance 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 licensefor operation of the ALS ambulance service when theDepartment deems it is in the public interest to do so.The temporary license is valid for 1 year and may berenewed once.

§ 1005.10. Licensure and general operating standards.

(a) Documentation requirements. An applicant for anambulance service license shall have the following docu-ments available for the inspection by the Department:

(1) [ Roster ] A roster of active personnel, includingcertification and recognition documentation with datesof expiration and identification numbers, and its pro-cess for scheduling staff to ensure that the mini-mum staffing requirements in subsection (d) aremet.

(2) Copies of prehospital ambulance [ trip ] call re-ports or other formats on which those records arekept on patients treated or transported[ , or both,during the 3-month period prior to the inspectiondate ], if applicable.

(3) Call volume records from the previous year’s opera-tions, if applicable. These records shall include arecord of each call received requesting the ambu-lance service to respond to an emergency, as well asa notation of whether it responded to the call andthe reason if it did not respond.

(4) [ Copies of mutual-aid agreements with otherambulance services which service the applicant’scommunity or applicant’s service area. ] A record ofthe time periods for which the ambulance servicenotified the PSAP that it would not be available torespond to a call.

(5) Copies of all written policies required by thissection.

(b) [ Vehicle ] Ambulance standards. [ Ambulance ]For ambulance vehicles which transport patients [ andwere purchased after June 1, 1985, shall at the timeof purchase or acquisition meet or exceed theFederal Specification KKK-A-1822, and amendmentsand revisions thereto, Section 1.2.1 AmbulanceTypes, Classes and Floor Plans and Section 3.1General Vehicular Design Types and Floor Plans orother National standards as recognized and ap-proved by the Department. Ambulance vehicles pur-chased before June 1, 1985 ], the ambulance servicewill be required to show evidence that the vehicle hasmet [ the requirements of the Federal SpecificationKKK-A-1822 ] 75 Pa.C.S. §§ 4571 and 4572 (relatingto visual and audible signals on emergency ve-hicles; and visual signals on authorized vehicles)and 67 Pa. Code Chapter 173 (relating to flashing orrevolving lights on emergency and authorized ve-hicles) and the Federal KKK standards which werein effect at the time of [ vehicle ] vehicle’s manufacture[ or that the vehicle met the requirements of theDepartment’s Voluntary Ambulance CertificationProgram VASC) at the time of VASC Certification ]and which are not inconsistent with the standardsin 75 Pa.C.S. §§ 4571 and 4572. These specificationswill be for ambulance design types, floor plans andgeneral configuration. An ALS squad unit vehicle isnot 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 ] Requiredequipment and supplies shall be carried and readilyavailable in working order for use on BLS and ALSvehicles.

(1) BLS and ALS vehicles shall carry [ BLS ] medicalequipment and supplies as [ specified by the Depart-ment.

(2) The minimum list of equipment and suppliesfor BLS and ALS vehicles will be ] published by theDepartment in the Pennsylvania Bulletin on an an-nual basis, or more frequently.

[ (3) ] (2) An ALS squad unit vehicle is exempt fromthe requirement of carrying patient litters and equipmentwhich is permanently installed.



[ (4) ALS vehicles and ALS squad units shallcarry ALS medical equipment, supplies and drugsas prescribed by the Department.

(5) ] (3) A BLS [ services ] ambulance service maycarry ALS equipment and drugs [ for use by the ], inaddition to those generally prescribed for use by aBLS ambulance service, only if it has a physician[ affiliated with the service as long as the physi-cian ] medical director who has education andcontinuing education in ALS and prehospital care,and who is directly responsible for security, accountabil-ity, administration and maintenance of the equipmentand drugs, [ and when the service is approved tooperate in this manner by the regional EMS counciland the Department ] if the arrangement is autho-rized by the Department upon its determinationthat the arrangement is in the public interest.

(d) Personnel requirements.

(1) Minimum staffing requirements.

(i) BLS unit. [ Minimum staffing standards forambulance services that operate at the BLS level ofcare shall be as follows:

(A) Ambulances, ] A BLS ambulance, when trans-porting a patient, except for when engaging in theroutine transfer of convalescent or other nonemergencycases, shall be staffed by at least two persons, [ who ]one of whom shall be an EMT, EMT-paramedic orhealth professional, and one of whom shall, at least,qualify as an ambulance [ attendants ] attendant. [ Atleast one attendant ] An EMT, EMT-paramedic or ahealth professional shall accompany the patient in thepatient compartment of the ambulance during transport.[ Ambulance personnel between 16—18 years of ageshall be directly supervised by an adult crew mem-ber with equal or greater training during patienttreatment and transport.

(B) Effective July 1, 1990, ambulances, whentransporting patients, except for routine transfer ofconvalescent or other nonemergency cases, shall bestaffed by at least two persons, one of whom shallbe an EMT, EMT-paramedic or health professional,and one of who shall, at least, qualify as an ambu-lance attendant. The patient shall be accompaniedin the patient compartment by the crew memberwith the highest level of certification. ]

(ii) ALS units. Minimum staffing standards for anambulance [ services ] that [ operate ] is operating atthe ALS level of care shall be as follows:

* * * * *

(C) An ALS squad unit meets minimum staffingrequirements by transporting an EMT-paramedic orhealth professional to rendezvous with a BLS am-bulance, and having the EMT-paramedic or healthprofessional provide emergency medical treatmentto, and accompany on the BLS ambulance duringtransport, a patient requiring ALS care.

(D) Minimum ALS staffing standards apply to theALS ambulance service 24 hours-a-day, 7 days-a-week. An ALS mobile intensive care unit, itself,need only satisfy BLS ambulance staffing require-ments under subparagraph (i) when responding toa call for BLS assistance exclusively. If the nature

of the assistance requested is unknown, the mobileintensive care unit shall respond as if the patientrequires ALS care.

(iii) All units. Minimum staffing standards aresatisfied when an ambulance service has a dutyroster that identifies staff who meet minimum staffcriteria and who have committed themselves to beavailable at the specified times, and when mini-mum required staff are present during the emer-gency medical treatment and transport of a patient.

(2) ALS service medical director. A [ licensed ] AnALS ambulance service shall have an ALS medical direc-tor whose duties include the following:

* * * * *(ii) Making medical command authorization determina-

tions for EMT-paramedics and prehospital registerednurses as set forth in § 1003.28 (relating to medicalcommand authorization).

(iii) Reviewing the medical command authorization sta-tus of EMT-paramedics and prehospital registered nursesutilized by the ALS ambulance service as set forth in§ 1003.28 at least once annually.

* * * * *

(3) Ambulance drivers. [ A ] An ambulance serviceshall ensure that a person who drives an ambu-lance for that service is a responsible person. Not-withstanding other considerations that may bearupon whether a driver of an ambulance is a respon-sible person, a person who drives an ambulance [ ve-hicle ] for [ a licensed ] an ambulance service [ shall ]will not be considered to be a responsible personunless 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 influ-ence of, alcohol or drugs.

(v) [ Be ] Is free from physical or mental defect ordisease that may impair the person’s ability to drive anambulance.

[ (vi) Not have been convicted within the last 4years of driving under the influence of alcohol ordrugs, and, within the last 2 years, not have beenconvicted of reckless driving or have had a driver’slicense suspended under the point system. Personswho have been convicted of one or more of theseviolations shall repeat an emergency vehicle opera-tor’s course of instruction approved by the Depart-ment.

(vii) Take and ] (vi) Has successfully [ complete ]completed an emergency vehicle operator’s course ofinstruction[ , ] approved by the Department[ , within 3years of course approval. Personnel who have com-pleted an emergency vehicle operator’s course ofinstruction acceptable to the Department by July 1,1992, shall be deemed to be in compliance with thisrequirement. ]

(vii) Has not been convicted within the last 4years of driving under the influence of alcohol ordrugs, or, within the last 2 years, has not beenconvicted of reckless driving or had a driver’slicense suspended. The person will not be consid-



ered to be a responsible person until the designatedtime has elapsed and the individual, after theconviction or suspension of license, repeats anemergency vehicle operator’s course of instructionapproved by the Department.

(e) [ Coverage agreement.

(1) A licensed ambulance service shall have awritten agreement with one or more neighboringambulance services for coverage during times whenits own ambulance is not available for service in itsprimary response area. The agreement shall specifythe respective duties, responsibilities and coveragetimes of the parties involved and shall be filed withthe Department.

(2) An ambulance service which is unable to pro-vide 24-hours-a-day, 7-day-a-week services shall pro-vide for alternate ambulance service either througha mutual aid agreement or other type of contract asapproved by the regional EMS council.

(3) When a licensed ambulance service does nothave an ambulance enroute to a reported emer-gency call within 10 minutes of the time of dis-patch, the call shall be referred to the closestavailable ambulance service. Once a request forservice has been referred to another service, if thereferring service is subsequently able to initiate aresponse which will access the patient morequickly than the service to which the request wasreferred, the service which can access the patientmost quickly shall respond. ]

Communicating with PSAPs.

(1) Responsibility to communicate unavailability.An ambulance service shall apprise the PSAP in itsarea as to when it will not be in operation andwhen its resources are committed so that it will notbe able to have an ambulance and required staffrespond to a call requesting it to provide emer-gency assistance.

(2) Responsibility to communicate delayed re-sponse. An ambulance service shall apprise thePSAP, as soon as practical after receiving a dis-patch call, if it is not able to have an ambulanceand required staff immediately en route to anemergency.

(3) Responsibility to communicate with PSAP gen-erally. In addition to the communications requiredby paragraphs (1) and (2), an ambulance serviceshall provide a PSAP with information, and other-wise communicate with a PSAP, as the PSAP re-quests to enhance the ability of the PSAP to makedispatch decisions.

(4) Response to dispatch by PSAP. An ambulanceservice shall respond to a call for emergency assist-ance as communicated by the PSAP.

(f) [ Policy and procedures. An ambulance serviceshall establish written policies and procedures gov-erning the function of personnel, the operation ofambulances and the provision of EMS. The policiesshall be available for inspection by the Departmentand shall address the following topics:

(1) Recordkeeping. An ambulance service shallhave a written policy requiring responding ambu-lance personnel to complete a prehospital ambu-

lance trip report on forms provided by the Depart-ment for each ambulance call to which the serviceresponds.

(2) Scene control. An ambulance service shall es-tablish a written policy on scene control directingprehospital personnel as follows:

(i) Control of all aspects of patient managementat an emergency scene shall be the responsibility ofthe individual in attendance who has the highestlevel of EMS certification/recognition. For the pur-poses 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 appropriatelytrained representative of a public safety agency atthe scene of the emergency. ]

(f) Patient management. All aspects of patientmanagement are to be handled by a prehospitalpractitioner with the level of EMS certification orrecognition necessary to care for the patient basedupon the condition of the patient.

[ (3) ] (g) Use of lights and other warning devices.[ Ambulance services shall establish a policy cover-ing the use of warning devices which includes thefollowing requirements:

(i) ] Ambulances [ responding to an incident sceneor to an emergency care facility ] may use emergencylights or audible warning devices, or both, [ for cases ]only when transporting or responding to a callinvolving [ patients with life-threatening or poten-tially life-threatening illnesses or injuries ] a pa-tient who presents or is in good faith perceived topresent a combination of circumstances resultingin a need for immediate medical intervention.When transporting the patient, the need for imme-diate medical intervention must be beyond thecapabilities of the ambulance crew using availablesupplies and equipment.

[ (ii) Ambulances responding to the incidentscene or to an emergency care facility may not useemergency lights and audible warning devices forcases involving patients that do not have life-threatening or potentially life-threatening illnessesor injuries.

(4) ] (h) Weapons and explosives. [ Ambulance ser-vices shall establish a written policy directing thatweapons ] Weapons and explosives may not be worn byambulance personnel or carried aboard an ambulance.This [ section ] subsection does not apply to law en-forcement officers who are serving in an authorized lawenforcement capacity.

(i) Accident, injury and fatality reporting. An am-bulance service shall report to the appropriateregional EMS council, in a form or manner pre-scribed by the Department, an ambulance vehicleaccident that is reportable under 75 Pa.C.S. (relat-ing to Vehicle Code), and an accident or injury to



an individual that occurs in the line of duty of theambulance service that results in a fatality, ormedical treatment at a facility. The report shall bemade within 24 hours after the accident or injury.The report of a fatality shall be made within 8hours after the fatality.

(j) Medical command notification. An ALS ambu-lance service shall identify, to the regional EMScouncil having responsibility in the region out ofwhich it operates, the prehospital personnel usedby it that have medical command authorization inthe region for that ALS ambulance service. It shallalso notify the regional EMS council when a pre-hospital practitioner loses medical command autho-rization for that ALS ambulance service.

(k) Monitoring compliance. An ambulance serviceshall monitor compliance with the requirementsthat the act and this part impose upon the ambu-lance service and its staff.

(l) Policies and procedures. An ambulance serviceshall maintain written policies and procedures ad-dressing each of the requirements imposed by thissection, as well as the requirements imposed by§§ 1001.41, 1001.42, 1001.65 and 1005.11 and shallalso maintain written policies and procedures ad-dressing infection control, management of person-nel safety, and the placement and operation of itsambulances.

§ 1005.11. [ Medication ] Drug use, control and secu-rity.

(a) [ A licensed ALS ] An ambulance service maystock [ certain approved ] drugs [ and medicationsfor emergency medical purposes, under writtenauthorization by the medical director of a regionalEMS council, ] as approved by the Department, andshall carry drugs in an ambulance in conformancewith the [ ALS plan for the service’s area ] transferand medical treatment protocols applicable in theregion in which its ambulance is stationed. Addi-tional drugs may be stocked by an ALS ambulanceservice as authorized by the ALS service medicaldirector if the ALS ambulance service uses healthprofessionals, and additional drugs may be carriedor brought on an ambulance as follows:

(1) Drugs which the applicable regional transferand medical treatment protocols prescribe for thetreatment of an ALS patient may be brought on aBLS ambulance by an EMT-paramedic or healthprofessional when rendezvousing with a BLS ambu-lance to treat an ALS patient on behalf of an ALSambulance service.

(2) Drugs other than those authorized by theapplicable regional transfer and medical treatmentprotocols may also be carried on an ALS ambu-lance, or brought on board a BLS ambulance by ahealth professional, when the requirements of sub-section (d)(2) are satisfied.

(3) Drugs other than those authorized by theapplicable regional transfer and medical treatmentprotocols may also be carried on an ALS ambu-lance, or brought on board a BLS ambulance by aregistered nurse, physician assistant or physicianwhen the following standards are met:

(i) The ambulance is engaged in an interfacilitytransport.

(ii) The physician, registered nurse or physicianassistant has special training required for the con-tinuation of treatment provided to the patient atthe facility, and the use of drugs not maintained onthe ambulance is or may be required to continuethat treatment.

(iii) The physician, registered nurse or physicianassistant does not substitute for required staff.

(4) A BLS [ services ] ambulance service, if notalso licensed as both an ALS and BLS ambulanceservice, may not [ possess ] stock drugs [ or medica-tions ] which are not prescribed by the Departmentfor use by a BLS ambulance, and a BLS ambulanceservice may not carry the drugs, except as autho-rized under this section and § 1005.10(c)[ (5) ](3) (re-lating to licensure and general operating standards).

(b) The Department will publish at least annually bynotice in the Pennsylvania Bulletin a list of drugs [ andmedications ] approved for use by [ licensed ALS ]ambulance services when also permitted by theapplicable regional transfer and medical treatmentprotocols.

(c) [ For purposes of emergency administration, alicensed ALS unit ] An ambulance service may[ have possession of certain designated controlledsubstances and other ] procure and replace drugs,[ as approved and published by the Department onan annual basis through an appropriate servicecontract or written affiliation with ] from a hospital,pharmacy or from a participating and supervising physi-cian, if not otherwise prohibited by law. [ Responsi-bility for drugs and controlled substances remainswith the original dispensing physician, hospital orpharmacy of record. Replacement of designatedcontrolled substances and other drugs may be ob-tained from a dispensing physician, hospital, orpharmacy of record if subsections (j) and (k) arefollowed. ]

(d) Administration of drugs [ and medications ] byprehospital personnel, other than those approvedfor use by a BLS ambulance service, shall be re-stricted to [ ALS personnel ] EMT-paramedics andhealth professionals who have been authorized toadminister [ medication ] the drugs by the [ re-gional ] ALS service medical director, when underorders of a medical command physician[ , regional ] orpursuant to standing orders in the EMS region’stransfer and medical treatment [ protocol or stand-ing orders protocols ]; except all prehospital per-sonnel other than a first responder and an ambu-lance attendant may administer to a patient, orassist the patient to administer, drugs previouslyprescribed for that patient, as specified in theStatewide BLS medical treatment protocols.

(1) An EMT-paramedic is restricted to administer-ing drugs permitted by the applicable regionaltransfer and medical treatment protocols and theStatewide BLS medical treatment protocols.

(2) A health professional may administer drugs inaddition to those permitted by the applicable re-gional transfer and medical treatment protocolsand the Statewide BLS medical treatment proto-cols, provided the health professional has received



approval to do so by the ALS service medicaldirector of the ambulance service, and has beenordered to administer the drug by the medicalcommand physician.

(e) [ Areas of control including labeling, adultera-tion, misbranding, checking expiration dates andstorage shall be adhered to by the practitioner whohas responsibility for the drugs as is requiredunder The Controlled Substance, Drug, Device andCosmetic Act (35 P. S. §§ 780-101—780-144). Theoriginal dispensing practitioner to ALS units asidentified on the ambulance service license applica-tion will examine drug stock to insure productquality and will reconcile the inventory of drugs aminimum of once a month for supply and adminis-tration records. ] The ambulance service shall ad-equately monitor and direct the use, control andsecurity of drugs provided to the ambulance ser-vice. This includes:

(1) Ensuring proper labeling and preventingadulteration or misbranding of drugs, and ensuringdrugs are not used beyond their expiration dates.

(2) Storing drugs as required by The ControlledSubstance, Drug, Device and Cosmetic Act (35 P. S.§§ 780-101—780-144), and as otherwise required tomaintain the efficacy of drugs and prevent theirmisappropriation.

(3) Including in the ambulance call report infor-mation as to the administration of drugs by patientname, drug identification, the date and time ofadministration, the manner of administration, dos-age, the name of the medical command physicianwho gave the order to administer the drug and thename of person administering the drug.

(4) Maintaining records of drugs administered,lost or otherwise disposed of, and records of drugsreceived and replaced.

(5) Providing the pharmacy, physician or hospitalthat Is requested to replace a drug, with a writtenrecord of the use and administration, or loss orother disposition of the drug, which identifies thepatient and includes any other information re-quired by law.

(6) Ensuring, in the event of an unexplained lossor theft of a controlled substance, that the dispens-ing pharmacy, physician or hospital has contactedlocal or State police and the Department’s Drugs,Devices and Cosmetics Office, and has filed a DEAForm 106 with the Federal drug enforcement ad-ministration.

(7) Arranging for the original dispensing phar-macy, physician or hospital, or its ALS servicemedical director, to provide it consultation andother assistance necessary to ensure that it meetsthe requirements of this section.

[ (f) When drugs are administered, records shallverify the administration of the drug by patientname, drug identification, date and time of admin-istration; dosage, name of physician who providedmedical command and name of person administer-ing the drug.

(g) When drugs are administered, an adequaterecord of use shall be maintained for a minimum of2 years by the involved parties. Variations in main-taining records are acceptable; however, a process

shall be in effect which provides for the writtenverification of medication orders. Records shall bekept by each licensed service of drugs distributed,supplied and resupplied to them, and be madeavailable to the Department for inspection upondemand.

(h) Drugs and medications administered by alicensed or certified EMT-paramedic or health pro-fessional shall be maintained and controlled inconformity 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 anEMT-paramedic or health professional to adminis-ter a drug shall first identify the drug and thenspecify the dosage and the manner of administra-tion.

(j) When a Schedule II controlled substance hasbeen ordered and administered, the prescribingphysician shall, within 72 hours, forward a signedprescription to the dispensing/replacing pharmacy,hospital or physician. The prescription for the con-trolled substance shall include the information re-quired by law and the physician’s DEA number.

(k) A hospital, physician or pharmacy may re-place a drug, controlled substance or legend deviceto a licensed ambulance service upon presentationof a written record of use and administration. Thiswritten record shall include information requiredby law and patient identification.

(l) No licensed ambulance service may purchaseor acquire legend drugs and controlled substancesexcept as provided for in subsection (c).

(m) In the event of an unexplained loss or theft ofcontrolled drugs, a dispensing hospital/pharmacyor physician shall contact local or State police orthe State Bureau of Drug Control. In addition, aDEA Form 106 shall be filed with the Federal DrugEnforcement Administration. ]§ 1005.12. [ Grounds for suspension, revocation or

refusal of an ambulance service license ] Disci-plinary and corrective actions.

(a) The Department may, in compliance with properadministrative procedure, reprimand, or suspend, re-voke or refuse to issue a license, or issue a provisionalor temporary license as permitted by §§ 1005.8 and1005.9 (relating to provisional license; and tempo-rary license) for the following reasons:

(1) A serious violation of the act or this part. A seriousviolation is one which poses a continued significantthreat to the health and safety of the public.

* * * * *

(4) Fraud or deceit in obtaining or attempting to obtaina license [ or permit ].

* * * * *

(8) Failure to have appropriate medical equipment andsupplies required for licensure as identified in§ 1005.10(c) (relating to licensure and general operat-ing standards).

(9) Failure [ to staff a sufficient number of certi-fied or licensed personnel to provide service 24hours a day, 7 days a week, or failure to provide



agreements as per § 1005.10(e)(2) ] of an ALS ambu-lance service to staff a sufficient number of quali-fied EMS personnel to provide service 24 hours-a-day, 7 days-a-week in accordance with requiredstaffing standards.

* * * * *(15) Refusal to render EMS because of a patient’s race,

sex, creed, [ National ] national origin, sexual prefer-ence, age, handicap, medical problem or financial inabilityto pay.

(16) Failure to comply with the regional EMS counciltransfer and medical treatment protocols[ , plans,policies and procedures ] which have been approvedby the Department.

* * * * *

(18) [ A consistent pattern of a failure to respondto emergency calls within a 10 minute time pe-riod. ] Repeated failure by an ambulance service tocommunicate with the PSAP or comply with thedispatch communication as required by§ 1005.10(e).

[ (19) Other reasons as determined by the Depart-ment to pose a significant threat to the health andsafety of the public. ]

(b) Upon receipt of a written complaint describing[ specific violations of the ambulance regulations ]conduct for which the Department may take disci-plinary action against an ambulance service, theDepartment will:

* * * * *

(2) [ Notify ] Provide the ambulance service with acopy of the [ charges ] complaint and [ investigationprocedures ] request a response unless the Depart-ment determines that disclosure to the ambulanceservice of the complaint will compromise the inves-tigation or would be inappropriate for some otherreason.

(3) [ Conduct and develop ] Develop a written re-port of the investigation.

(4) Notify the [ ambulance service ] complainant ofthe results of the investigation of the complaint, aswell as the ambulance service if the ambulanceservice has been officially apprised of the com-plaint or investigation. This notification does notinclude providing a copy of the written reportdeveloped under paragraph (3).

(c) [ The Department will immediately suspend,after a hearing has been held, the license for theviolations specified in subsection (a)(1), (6), (11),(15) and (17). This suspension shall be for a periodof up to 90 days. A second offense of these enumer-ated violations during the same license period shallresult in the automatic revocation of the license.

(1) The Department will suspend the license forother violations for a period to be determined bythe Department. The Department may revoke alicense for repeated violations.

(2) Upon suspension or revocation of an ambu-lance license, the service shall cease operations andno person may permit or cause the service tocontinue.

(3) ] The Department will provide public notification of[ suspension or revocation of ] the sanction it im-poses upon an ambulance service license.

§ 1005.13. Removal of ambulances from operation.

(a) When a vehicle manifests evidence of a mechanicalor equipment deficiency which poses a significant threatto the health or safety of patients or crew, [ it ] theambulance service shall [ be ] immediately [ sus-pended ] suspend the vehicle from operation. Novehicle, which has been suspended from operation, maybe operated as an ambulance until the deficiency hasbeen corrected.

(b) When a vehicle, upon examination by the Depart-ment, manifests evidence of a mechanical or equipmentdeficiency which poses a significant threat to the healthor safety of patients or crew, it shall be immediatelysuspended from operation as directed by the Depart-ment. No vehicle, which has been suspended from opera-tion by the Department, may be operated as an ambu-lance until the Department has certified that thedeficiency has been corrected.

§ 1005.14. Invalid coaches.

* * * * *

(b) The terms ‘‘ambulance,’’ ‘‘emergency[ , ]’’ or othersimilar designations may not be used by invalid coaches.Invalid coaches may not be equipped with emergencywarning devices, audible or visible, such as flashinglights, sirens, air horns or other devices except thosewhich are required by 75 Pa.C.S. [ §§ 101—9910 ] (relat-ing to [ the ] Vehicle Code).

§ 1005.15. Discontinuation of service.

An ambulance service may not discontinue ser-vice, except upon order of the Department, withoutproviding each regional EMS council, PSAP and thechief executive officer of each political subdivisionwithin its service area 90 days advance notice. Theambulance service shall also advertise notice of itsintent to discontinue service in a newspaper ofgeneral circulation in its service area at least 90days in advance of discontinuing service, and shallprovide the Department with written notice that ithas met these responsibilities at least 90 days inadvance of discontinuing service.

CHAPTER 1007. LICENSING OF AIR AMBULANCESERVICES—ROTORCRAFT

§ 1007.1. General provisions.

(a) [ Except as provided in subsection (c), noagency or ] This chapter applies to air ambulanceservices. No person [ either ], or other entity, asowner, agent or otherwise, may furnish, operate, conduct,maintain, advertise, engage in or profess to engage inproviding an air ambulance service in this Common-wealth, unless the agency or person holds a [ currentvalid ] license as an air ambulance service issued bythe Department or is exempted from these prohibi-tions under the act.

(b) The Department will license an applicant as anair ambulance service when it meets the requirements ofthe act and this part.

(c) [ Air ambulance services operated by hospi-tals ] 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 servicelicense to own and operate an air ambulance ser-vice. [ The ] An air ambulance service owned andoperated by a hospital is subject to the act and thispart, and shall be inspected under this part, regardlessof whether the hospital applies for or secureslicensure as an air ambulance service.

(d) The Department will issue a [ permit ] certificateacknowledging a hospital’s authority to own andoperate an air ambulance [ services operated byhospitals ] service if the hospital chooses to operatean air ambulance service without securing a sepa-rate 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 groundALS ambulance services, also apply to air ambu-lance services.

§ 1007.2. Applications.

(a) [ An application for a license to operate an airambulance service may be obtained from the Penn-sylvania Department of Health, Division of Emer-gency Medical Services, Post Office Box 90, Harris-burg, Pennsylvania 17108.

(b) ] An application for an original or renewal licenseto operate as an air ambulance service shall [ besubmitted to the Department and shall ] contain thefollowing information, as well as any additionalinformation that may be solicited by the applica-tion form:

(1) The name and address of the [ vendor of the airambulance service or proposed ambulance service ]applicant and the name [ and address ], if different,under which the [ service will be operating ] appli-cant intends to operate.

(2) The [ name, address and ] FAA certification num-ber of the aircraft operator.

(3) [ The experience and qualifications of the ap-plicant to operate an air ambulance service ] Thetype of organization—profit or nonprofit.

(4) A description of each aircraft to be used as an airambulance, including the make, model, year of manufac-ture, FAA registration number, name, monogram or otherdistinguishing designation and FAA air worthiness certifi-cation.

(5) The [ geographical ] intended emergency med-ical service area and the location and description of theplaces from which the air ambulance service is to operate.

(6) The name, training and qualifications of the airambulance medical director[ , who has responsibilityfor auditing the medical care provided by the airambulance service ].

(7) A personnel roster [ of medical personnel ]which includes level of certification [ or ], licensure andrecognition, and a staffing plan.

* * * * *

(9) [ A statement in which the applicant agrees toprovide patient specific data, as identified by the

Department, to the Department ] The communica-tions access and capabilities of the applicant.

(10) [ Other information the Department deemsnecessary and prescribes as part of the applica-tion ] A statement attesting to the veracity of theapplication, which shall be signed by the chiefexecutive officer.

(b) The applicant shall submit the application tothe regional EMS council exercising responsibilityfor the EMS region in which the applicant willstation its air ambulances if licensed.

(1) The regional EMS council shall review theapplication for completeness and accuracy.

(2) Incomplete applications shall be returned bythe regional EMS council to the applicant within 14days of receipt.

(c) Upon receipt of a complete application, theregional EMS council will schedule and conduct anonsite inspection of the applicant’s air ambulances,equipment and personnel qualifications, as well asother matters that bear upon whether the applicantsatisfies the statutory and regulatory criteria forlicensure. The inspection shall be performed within45 days after receipt by the regional EMS council ofthe completed application.

(d) An air ambulance service shall apply for anamendment of its license and secure Departmentapproval of the amendment prior to commencingthe operation of an air ambulance not previouslyinspected and approved by the Department or sub-stantively altering its plan for locating and operat-ing air ambulances, except that if the air ambu-lance service is replacing an air ambulance, at thesame location, it may operate the air ambulanceimmediately, apply for an amendment within 10days, and continue to operate the air ambulanceunless its authority to do so is disapproved by theDepartment following inspection.

§ 1007.3. [ Licenses ] ( Reserved).

[ (a) Within 30 days of receipt of an appropriatelycompleted application from the air ambulance ser-vice applicant, the Department will initiate thelicensure process.

(b) The Department will issue a regular license tooperate an air ambulance service after an onsiteinspection and review conducted by the Depart-ment indicates that the applicant’s service is incompliance with the act, this part, other applicablelaws and the regional EMS plan for the areas to beserved.

(c) An air ambulance license will be issued for 3years from the date of issue and will remain validfor that period of time unless revoked or suspendedby the Department. Annual inspections shall beconducted to assure compliance.

(d) Change of ownership requires reapplicationfor a license. An air ambulance service licenseeshall file with the Department an application forrenewal of the ambulance service license within 10business days of acquisition of the service by thenew owner.

(e) Change of aircraft operator requires submis-sion of supplemental information to the Depart-ment within 10 business days of the effective date



of the operator change. The licensee shall providethe Department with new information requiredunder § 1007.2(b)(2), (4) and (7) (relating to applica-tions). The Department may inspect the aircraftoperator and each aircraft to assure compliancewith appropriate provisions of this part before thelicense is renewed.

(f) Upon change of aircraft during the licensingperiod, another application for an air ambulancelicense shall be submitted to the Department on theform prescribed. If the change of aircraft is for atemporary period, not to exceed 30 days, the airambulance service shall only notify the Departmentof the change and the reasons.

(g) The current license shall be posted in a con-spicuous place in the air ambulance service’s op-erations center and on or in the aircraft where it isclearly visible. ]§ 1007.4. [ Renewal of air ambulance license ] (Re-

served).

[ (a) The Department will notify the applicantservice at least 90 days prior to the expiration dateof the license. The notification will include a re-newal application.

(b) The applicant shall submit to the Departmentthe renewal application postmarked at least 60days prior to the expiration of the license.

(c) The criteria for license renewal are the sameas the current requirements for original licensure. ]§ 1007.5. [ Inspections ] (Reserved).

[ (a) Upon the request of an agent of the Depart-ment during regular and usual business hours, orat other times when a reasonable belief that viola-tions of this part may exist, a licensee shall:

(1) Produce for inspection records maintainedunder § 1001.41(c) (relating to data and informationrequirements for ambulance services).

(2) Produce for inspection personnel and otheremployment records that pertain to certification ofpersonnel, staffing, equipment and mutual aidagreements.

(3) Permit the agent to examine required equip-ment and recordkeeping facilities for informationcollected under § 1001.41(c).

(b) The Department’s agent shall advise the licen-see that the inspection is being conducted undersection 12(k) of the act (35 P. S. § 6932(k)) and thischapter.

(c) The Department reserves the right to enterand make the inspections at least quarterly, and atother times upon complaint or a reasonable beliefthat violations of this part may exist.

(d) Failure of a licensee to produce records forinspection or to permit examination of equipmentand facilities is grounds for suspension, revocationor denial of license. ]§ 1007.6. [ Notification of deficiencies ] (Reserved).

[ (a) Within 30 days of an inspection, the airambulance service and the regional EMS councilshall be notified as to deficiencies found and theresults of the inspection.

(b) The ambulance service has 30 days in whichto respond to the Department with a plan to cor-rect deficiencies and schedule a reinspection. Theplan of correction shall be approved by the Depart-ment. If the plan is approved, the Department willschedule a reinspection.

(c) Within 30 days of the reinspection, the Depart-ment will give written notice to the service of thefindings regarding the deficiencies and the resultsof the reinspection. ]§ 1007.7. Licensure and general operating require-

ments.(a) Documentation requirements. An applicant for

an air ambulance service license shall have thefollowing documents available for the inspection bythe Department:

(1) A roster of active personnel, including certifi-cation and recognition documentation with dates ofexpiration and identification numbers, and the planfor staffing the air ambulance service.

(2) Copies of prehospital ambulance call reports,or other formats on which those records are kepton patients treated or transported, if applicable.

(3) Call volume records from the previous year’soperations, if applicable. These records shall in-clude a record of each call received requesting theair ambulance service to respond to an emergency,as well as a notation of whether it responded to thecall and the reason if it did not respond.

(4) Copies of the written policies required by thissection.

(b) [ Aircraft ] Air ambulance requirements. [ Air-craft operated by a licensed ] An air ambulance[ service ] shall meet the following minimum require-ments:

(1) The [ aircraft ] air ambulance shall be config-ured to carry at least one supine patient with sufficientaccess to the patient in order to begin and maintain ALSand other treatment modalities.

(2) The [ aircraft ] air ambulance design may notcompromise patient safety in loading, unloading or duringflight, and shall be equipped with either a cargo door oran entry that will allow loading and unloading thepatient without excessive maneuvering.

(3) The [ aircraft ] air ambulance shall be climatecontrolled for the comfort of the patient.

(4) The [ aircraft ] air ambulance shall have ad-equate interior lighting so that medical care can beprovided and patient status monitored without interferingwith the pilot’s vision.

(5) The [ aircraft ] air ambulance shall be config-ured so that the patient is isolated from the cockpit tominimize in-flight distractions to the pilot and to preventinterference with the pilot’s manipulation of the flightcontrols.

* * * * *

(7) [ Survival ] The air ambulance shall carrysurvival gear appropriate to the terrain and environ-ment [ shall be carried on flights ].

(8) The [ aircraft ] air ambulance shall be equippedwith appropriate patient restraints.



(9) The [ aircraft ] air ambulance shall be equippedwith 110 [ A ] V electrical output with appropriate cabinoutlets for medical equipment use.

(10) The [ aircraft ] air ambulance shall be equippedwith two-way radios capable of communicating withhospital [ communication ] communications centers,[ public safety communication centers ] PSAPs andambulances.

[ (b) ] (c) Equipment and supply requirements. [ Ap-proved ] Required equipment and supplies shall becarried and readily available in working order for use on[ aircraft operated by a licensed ] an air ambulance[ service ]. The [ minimum ] list of required equip-ment and supplies for [ aircraft ] an air ambulancewill be published by the Department [ as a notice ] inthe Pennsylvania Bulletin on an annual basis.

[ (c) Medications. Approved medications anddrugs shall be carried and available for administra-tion to patients on aircraft operated by a licensedair ambulance service. The minimum list of medica-tions and drugs for aircraft will be published by theDepartment as a notice in the Pennsylvania Bulle-tin on an annual basis.

(d) Patient data. Air ambulance services licensedto operate in this Commonwealth shall collect,maintain and report accurate and reliable patientdata and information for calls for assistance in theformat prescribed or on forms provided by theDepartment within the specified time period.

(1) The information collected shall include infor-mation identified in § 1001.41 (relating to data andinformation requirements for ambulance services).

(2) Air ambulance services licensed to operate inthis Commonwealth shall meet the requirements of§ 1001.41 and § 1001.42 (relating to dissemination ofinformation). ]

[ (e) ] (d) Personnel requirements. [ Air ] An air am-bulance [ services ] service shall meet the followingrequirements related to personnel and staffing:

(1) Air ambulance medical director. [ The ser-vice ] It shall [ employ ] have an air ambulance med-ical director who possesses the qualifications specified in§ [ 1003.41(b) (relating to air ambulance medicaldirector) to serve as the medical director respon-sible for ] 1003.5(b) (relating to ALS service medicaldirector) and performs the duties specified in§ [ 1003.41 ] 1003.5(a). [ If the air ambulance med-ical director leaves or is removed from service, aqualified replacement shall be hired within 30 daysof the previous medical director’s departure. Theair ambulance service shall inform the Departmentof a change in air ambulance service medical direc-tors within 30 days of a medical director’s depar-ture ].

(2) Pilot and prehospital personnel. [ The ser-vice ] It shall assure that each air ambulance respondingto a call for EMS services is staffed with at least one pilotand [ two medical crew members who possess theminimum qualifications defined in §§ 1003.42(b)and 1003.43(b) (relating to air ambulance medicalcrew members; and air ambulance pilot) ] prehospi-

tal personnel as set forth in § 1005.10(d)(1)(ii) (re-lating to licensure and general operating stan-dards). At least one of the [ medical crew members ]responding prehospital personnel shall be [ either aphysician or nurse ] specially trained in [ aeromedi-cal ] air-medical transport.

(3) Other personnel requirements.

(i) [ The service ] It shall keep a pilot and two[ medical crew members ] prehospital personnelstaff as set forth in § 1005.10(d)(ii) available for the[ aircraft ] air ambulance at all times to assure imme-diate response to emergency calls.

[ (4) The service shall have a communicationscenter, operational 24 hours per day, 7 days perweek and staffed with a communications specialistwho has the minimum qualifications in § 1003.44(b)(relating to air ambulance communications special-ist). ]

[ (5) The service ] (ii) It shall require [ that flightcrew members ] prehospital personnel who staff anair ambulance to undergo annual physical examinationsto assure that they are physically able to perform theirjobs.

(iii) Minimum staffing standards are satisfiedwhen an air ambulance service has a duty rosterthat identifies staff who meet minimum staff crite-ria 24 hours-a-day, 7 days-a-week and who havecommitted themselves to be available at the speci-fied times, and when minimum required staff arepresent during the emergency medical treatmentand transport of a patient.

(e) Communicating with ground PSAPs.

(1) If requested by a ground PSAP, an air ambu-lance service shall apprise the PSAP as to when itwill not be in operation, when weather conditionsprevent or impede flight, and when its resourcesare already committed.

(2) An air ambulance service shall apprise thedispatching ground PSAP as soon as practical afterreceiving a dispatch call, its estimated time ofarrival at the scene of the emergency. While its airambulance is enroute to the scene of an emergency,if an air ambulance service believes that it will notbe able to have an air ambulance and required staffarrive at the emergency scene within the estimatedtime of arrival previously given, the air ambulanceservice shall contact the ground PSAP and provideits new estimated time of arrival.

(f) [ Policy requirements. The air ambulance ser-vice shall have in place written policies as follows:

(1) ] Access to air ambulance service.

[ (i) ] (1) The air ambulance service shall have [ inplace a written policy which describes its policyregarding access to its service. This policy shallinclude the following information ] a policy whichaddresses the following:

[ (A) ] (i) Who, in addition to a PSAP, may requestair ambulance service.

[ (B) ] (ii) How its air ambulance services should beaccessed.



[ (C) ] (iii) General and medical guidelines for person-nel to consider prior to requesting its air ambulanceservices.

[ (D) ] (iv) ***

[ (E) ] (v) What level of EMS [ are ] is provided bythe air ambulance service.

[ (F) ] (vi) ***

[ (G) ] (vii) ***

[ (ii) This ] (2) The air ambulance service shalldisseminate this policy [ shall be disseminated ] torelevant health care providers in the air [ ambu-lances’s ] ambulance service area.

[ (2) Air ambulance pilot operational ] (g) Flightrequirements. [ This ] The air ambulance service shall[ have in place a written policy governing pilotoperational procedures which includes the follow-ing requirements ] ensure that:

[ (i) The pilot shall make a ] (1) A determination toaccept the flight is based solely on safety procedures andweather conditions.

[ (ii) ] (2) The [ pilot shall proceed ] air ambu-lance proceeds expeditiously and as directly as possibleto the flight destination, considering the weather, appro-priate safety rules, noise abatement procedures and flightpath and altitude clearances.

[ (iii) ] (3) The [ pilot shall ] air ambulance en-gages in flight [ follow ] following with [ a ] an aircommunications center at intervals not to exceed 15minutes. If the [ aircraft ] air ambulance is outside ofradio range of the base communications center, adequateflight following shall be planned and executed.

[ (iv) ] (4) The [ pilot is responsible for assuringthat the aircraft air ] ambulance is ready for flight atall times when the air ambulance service has notreported to ground PSAPs that the air ambulanceis unavailable to respond to emergencies.

[ (3) ] (h) Medical [ crew members’ operational ]service requirements. The air ambulance service shall[ have in place a written policy governing medicalcrew members operational procedures which in-cludes the following requirements ] ensure that:

[ (i) ] (1) [ Medical crew members are responsiblefor assuring that equipment/ ] Equipment and sup-plies required for an air ambulance flight are on the[ aircraft ] air ambulance and in working order priorto takeoff for patient transport.

[ (ii) ] (2) Medical [ crew members shall provide ]care and intervention is provided according to directmedical command or written protocols/standing orders.

[ (iii) Medical crew members shall maintain a ] (3)A patient treatment record is maintained, documentingmedical care rendered by the medical flight crew and thedisposition of the patient at the receiving medical facility.The patient treatment record shall be maintained at thebase hospital.

[ (iv) Medical crew members shall evaluate each ](4) Each patient is evaluated for potential adverseeffects from flight operations.

[ (v) Medical crew members shall assure that the ](5) The patient and equipment are secured during flight.

[ (4) ] (i) Air ambulance medical director’s opera-tional requirements. The air ambulance service shallhave [ in place ] a [ written ] policy setting forth theair ambulance medical director’s operational procedureswhich shall include procedures for at least the following:

[ (i) ] (1) [ To assure that the medical condition orhistory of the patient is made known only to med-ical crew members, and other EMS providers whohave participated in the delivery of patient care ]The performance of responsibilities set forth in§ 1003.5(a) (relating to ALS service medical direc-tor).

[ (ii) To assure adequate training and experienceof medical flight crew members.

(iii) For developing ] (2) The development of med-ical treatment protocols for [ use by medical crewmembers ] the air ambulance service, [ and ] sub-mitting them [ for approval ] to the regional EMScouncil medical [ direction ] advisory committee for itsreview and recommendations, and securing ap-proval of the medical treatment protocols from theDepartment.

[ (iv) For establishing and operating a qualityassurance program whereby the quality and appro-priateness of patient care provided by the airambulance service can be continuously docu-mented, reviewed and evaluated.

(5) ] (j) Communication center [ operational require-ments ] arrangements. The air ambulance serviceshall [ have in place a written policy governingcommunication center operational procedureswhich includes the requirements that the communi-cations center shall ] ensure that it has access to anair communications center that meets the followingstandards:

[ (i) Have ] (1) Has a designated person—communica-tions specialist—assigned to receive and dispatch re-quests for emergency air medical services and chargedwith the relay of information between the flight crew,requesting agency and receiving hospital.

[ (ii) Be ] (2) Is operational 24 hours [ per ]-a-day, 7[ days a week ] days-a-week and [ have ] has radiocapabilities to transmit to and receive from the airambulance [ aircraft ]. At a minimum, 123.05 MHz,radio frequency shall be available.

[ (iii) Have ] (3) Has at least one incoming telephoneline that is dedicated to the air ambulance service.

[ (iv) Have ] (4) Has a system for recording incomingand outgoing telephone and radio transmissions. Thesystem shall have an inherent time recording capabilityand recordings shall be kept for a minimum of 30 days.

[ (v) Have ] (5) Has the capability of communicatingwith the flight crew so that the [ aircraft ] air ambu-lance may take off within the scheduled takeoff time.

[ (vi) Have ] (6) Has a backup emergency powersource.



[ (vii) Maintain ] (7) Maintains a status board list-ing flight crew names and other pertinent operationalinformation.

[ (viii) Have ] (8) Has copies of operational protocolsand procedures, including emergency operation plans inthe event of overdue, missing or downed aircraft.

[ (ix) Have ] (9) Has posted or displayed applicablelicenses and permits.

[ (x) Maintain ] (10) Maintains current maps andnavigational aids.

[ (6) Communications specialist operational re-quirements. The service shall have in place a writ-ten policy governing communication specialist op-erational procedures. The written policy shallinclude a requirement that the communication spe-cialist document contains, at a minimum, the fol-lowing information: ]

(11) Collects and maintains records of the follow-ing data:

* * * * *(ix) Other data pertinent to the air ambulance ser-

vice’s specific needs for completing activity review reports.

[ (g) ] (k) Community education program requirements.

* * * * *(2) The educational program shall include the follow-

ing:

(i) [ The service shall communicate ] Communica-tion to the public that the [ emergency ] air [ med-ical ] ambulance service accepts medically necessarycalls from authorized personnel and does not discriminateagainst a person because of race, creed, sex, color, age,religion, [ National ] national origin, ancestry, medicalproblem, handicap or ability to pay.

(ii) A safety program covering landing site designationand safe conduct around the [ aircraft ] air ambulance,which shall be offered to appropriate agencies andindividuals.

(iii) Training regarding stabilization and preparation ofthe patient for airborne transport, which shall be pro-vided to prehospital [ EMS ] personnel.

(iv) [ The service shall institute a ] An active com-munity relations program.

(l) Medical command notification. An air ambu-lance service shall identify, to the regional EMScouncil having responsibility in the region out ofwhich it operates, the prehospital personnel usedby it that have medical command authorization inthe region for that air ambulance service. Theservice shall also notify the regional EMS councilwhen a prehospital practitioner loses medical com-mand authorization for that air ambulance service.

(m) Monitoring compliance. An air ambulanceservice shall monitor compliance with the require-ments that the act and this part impose upon theair ambulance service and its staff.

(n) Policies and procedures. An air ambulanceservice shall maintain written policies and proce-dures addressing each of the requirements imposedby this section, as well as the requirements im-posed by §§ 1001.41, 1001.42 and 1001.65 (relating to

data and information requirements for ambulanceservices; dissemination of information; and coop-eration), and shall also maintain written policiesand procedures addressing infection control, man-agement of personnel safety, and the placement andoperation of its air ambulances.

§ 1007.8. [ Grounds for suspension, revocation orrefusal of an air ambulance license ] Disciplinaryand corrective actions.

(a) The Department may, in compliance with properadministrative procedure, reprimand, or suspend, re-voke or refuse to issue a license, or issue a provisionalor temporary license as permitted by §§ 1005.8 and1005.9 (relating to provisional license; and tempo-rary license) for the following reasons:

(1) A serious violation of the act or this part. A seriousviolation is one which poses a continued significantthreat to the health and safety of the public.

* * * * *

(4) Fraud or deceit in obtaining or attempting to obtaina license [ or permit ].

* * * * *

(7) Failure to secure an air ambulance medical directorand ensure that the air ambulance medical director[ meets the roles and ] exercises the responsibilitiesin § [ 1003.41(a) (relating to air ambulance medicaldirector) ] 1003.5(a) (relating to ALS service med-ical director).

(8) Failure to have appropriate medical equipment andsupplies required for licensure as identified in § 1007.7(b)(relating to licensure and general operating require-ments).

* * * * *

(11) Failure to employ a sufficient number of certified,recognized or licensed personnel to provide service 24hours [ per ]-a-day, 7 [ days a week ] days-a-week.

(12) Failure of the air [ medical ] ambulance serviceto be available 24 hours [ per ]-a-day, 7 [ days a week ]days-a-week to authorized callers within the servicearea. Exceptions to this requirement include unsafeweather conditions, commitment to another flight,grounding due to maintenance or other reasons thatwould prevent response. The air [ medical ] ambulanceservice shall maintain a record of each failure to respondto a request for service, and make the record availableupon request to the Department. Financial inability topay does not constitute sufficient grounds to deny re-sponse for emergency air service.

(13) Failure [ of an air ambulance service licen-see ] to notify the Department of the change of ownershipor aircraft operation.

* * * * *

(18) Refusal to render EMS because of a patient’s race,sex, creed, [ National ] national origin, sexual prefer-ence, age, handicap, medical problem or financial inabilityto pay.

(19) Failure to comply with regional EMS counciltransfer and medical treatment protocols.

* * * * *



(21) [ Other reasons as determined by the Depart-ment which pose a significant threat to the healthand safety of the public ] Repeated failure to com-municate with a PSAP as required by § 1007.7(e).

(b) Upon receipt of a written complaint describing[ specific violations of this chapter ] conduct forwhich the Department may take disciplinary actionagainst an air ambulance service, the Departmentwill:

* * * * *

(2) [ Notify ] Provide the air ambulance service witha copy of the [ charges ] complaint and [ investiga-tion procedures ] request a response unless theDepartment determines that disclosure to the airambulance service of the complaint will compro-mise the investigation or would be inappropriatefor some other reason.

(3) [ Conduct and develop ] Develop a written re-port of the investigation.

(4) Notify the [ air ambulance service ] complain-ant of the results of the investigation of the complaint,as well as the air ambulance service if the airambulance service has been officially apprised ofthe complaint or investigation. This notificationdoes not include providing a copy of the writtenreport developed under paragraph (3).

[ (c) The Department will immediately suspendthe license for the violations specified in§ 1005.12(a)(1), (6), (11), (15) and (17) (relating togrounds for suspension, revocation or refusal of anambulance service license). This suspension shallbe for a period of up to 90 days. A second offenseduring the same license period shall result in theautomatic revocation of the license.

(d) The Department will suspend the license forother violations for a period to be determined bythe Department. The Department may revoke alicense for repeated violations.

(e) Upon suspension or revocation of an air am-bulance license, the service shall cease operationsand no person may permit or cause the service tocontinue.

(f) ] (c) The Department will provide public notifica-tion of [ suspension, including the length of suspen-sion period or revocation of ] sanctions it imposesupon an air ambulance service license.

[ (g) Upon suspension or revocation of an airambulance license, the service shall cease opera-tions and no person may permit or cause theservice to continue. ]§ 1007.9. [ Voluntary discontinuation of service ]

(Reserved).

[ (a) Air ambulance service licenses may not vol-untarily discontinue service until 90 days after thelicensee notifies the Department in writing that theservice is to be discontinued.

(b) Notice to the Department shall include astatement that the licensee has notified the chiefexecutive officer of each political subdivision in thelicensee’s ambulance service area and that the

intent to discontinue service has been advertised ina newspaper of general circulation in the servicearea.

(c) The air ambulance service licensee shall no-tify the Department in advance of anticipated tem-porary discontinuance of service expected to lastfor at least 7 consecutive days. ]

CHAPTER 1009. [ EMS ] MEDICAL COMMAND[ MEDICAL ] FACILITIES

§ 1009.1. [ Accreditation and operational ] Opera-tional criteria.

[ Medical command facilities shall be accreditedby the Department ]. To qualify [ for accreditation ]as [ an EMS ] a medical command facility, an institutionshall [ demonstrate that it complies ] comply withthe following criteria [ related to personnel, capabili-ties, procedures and programs by ]:

(1) [ Employing ] Employ a [ physician ] medicalcommand facility medical director who meets therequirements specified [ at ] in § 1003.3(b) (relating tomedical command facility medical director) [ for a med-ical command facility medical director ].

(2) [ Employing ] Employ sufficient staff to ensurethat at least one approved medical command physician,meeting the requirements [ of ] in § 1003.4(b) (relatingto medical command physician), is present in the facility24 hours [ per ]-a-day, 7 days [ per ]-a-week.

(3) [ Possessing communication capabilities andrecordkeeping protocols that provide for the fol-lowing ] Satisfy the following communication andrecordkeeping requirements:

* * * * *

(ii) Communication by way of telecommunicationsequipment/radios with BLS and ALS units within the[ respective medical service ] area in which medicalcommand is exercised.

* * * * *

(iv) Maintenance of a medical command record, con-taining [ specific ] appropriate information on patientsfor whom medical command is sought.

* * * * *

(4) [ Demonstrating the capacity to accurately ]Accurately and promptly relay information regardingpatients to the appropriate receiving [ hospital ] facil-ity.

(5) [ Adhering ] Adhere to [ transportation in-struction and hospital assignment ] transfer andmedical treatment protocols established by the regionalEMS council, or, when dealing with an air ambu-lance service, as approved by the Department.

(6) [ Establishing ] Establish a program of regularcase audit conferences involving the medical commandfacility medical director or [ his ] the director’s desig-nee and prehospital personnel for purposes of problemidentification, and a process to correct identified prob-lems.



(7) [ Obtaining ] Obtain a contingency agreementwith at least one other medical command facility toassure availability of medical command.

(8) [ Establishing ] Establish internal proceduresthat comply with regional EMS transfer and medicaltreatment protocols [ developed by the respectiveregional EMS council ].

(9) Notify PSAPs, through which it routinely re-ceives requests for medical command, when it willnot have a medical command physician available toprovide medical command.

(10) Establish a plan to ensure that medical com-mand is available at all times during mass casualtysituations, natural disasters and declared states ofemergency.

(11) [ Participating ] Participate in the [ respec-tive ] regional EMS council’s quality [ assurance pro-grams ] improvement program for monitoring thedelivery of EMS.

[ (10) Adopting ] (12) Adopt procedures for maintain-ing medical command communication records and tapesunder § 117.43 (relating to medical records).

[ (11) Employing ] (13) Employ sufficient administra-tive support staff to enable the institution to carry out itsessential duties which include, but are not limited to:audits, [ continuing education, ] equipment mainte-nance and processing and responding to complaints.

[ (12) Establishing ] (14) Establish a program oftraining [ and continuing education ] for medical com-mand physicians, prehospital personnel and emergencydepartment staff.

(15) Provide medical command to prehospitalpersonnel whenever they seek direction.

§ 1009.2. [ Accreditation ] Recognition process.

(a) [ Regional EMS councils shall recommend tothe Department those facilities which meet thecriteria for accreditation. If the applying facilitydisagrees with the recommendation of the regionalEMS council, it may submit a written request forreconsideration by the council.

(b) The Department has 60 days to accredit ordeny accreditation from the time of receipt of theregional EMS council’s recommendation.

(c) Denial of accreditation shall be based oncause.

(d) The Department may review and inspect facil-ities to aid in accreditation decisions.

(e) If the applying facility disagrees with thedecision by the Department, an appeal may be filedunder 2 Pa.C.S. §§ 501—508 and 701—704 (relatingto Administrative Agency Law). ]

To qualify for the civil immunity protection af-forded by section 11(j)(4) of the act (35 P. S.§ 6931(j)(4)), a facility shall secure recognition as amedical command facility from the Department. Tosecure recognition as a medical command facility, afacility shall submit an application to the Depart-ment through a regional EMS council exercisingresponsibility for an EMS region in which theapplicant intends to provide medical commandthrough medical medical command physicians who

function under its auspices. Application for medicalcommand facility recognition shall be made onforms prescribed by the Department.

(b) The regional EMS council shall review theapplication for completeness.

(c) If the application is complete, the regionalEMS council shall conduct an onsite inspection ofthe applying facility to verify information con-tained within the application and to complete aphysical inspection of the medical command area.

(d) After completing its review, the regional EMScouncil shall forward a copy of its recommendationto the Department and to the applying facility. Ifthe applying facility disagrees with the recommen-dation of the regional EMS council, it may submit awritten rebuttal to the Department.

(e) The Department will review the application,information and recommendation submitted by theregional EMS council, and the rebuttal statement, ifany, submitted by the applying facility, and willmake a decision within 60 days from the time of itsreceipt of the regional EMS council’s recommenda-tion to grant or deny recognition.

(f) The Department may review and inspect facil-ities to aid it in making medical command facilityrecognition decisions.

(g) If the applying facility disagrees with thedecision by the Department, it may appeal thedecision under 1 Pa. Code § 35.20 (relating to ap-peals from actions of the staff) if the decision wasnot issued by the agency head as defined in 1Pa. Code § 31.3 (relating to definitions) and, if itdisagrees with the decision of the agency head, itmay file an appeal under 2 Pa.C S. §§ 501—508 and701—704 (relating to Administrative Agency Law).

(h) Recognition as a medical command facilitywill be valid for 3 years. A facility shall file anapplication for renewal of its recognition as amedical command facility 60 days prior to expira-tion of the medical command facility’s recognitionfrom the Department. Failure to apply for renewalof recognition in a timely manner may result in thefacility having a lapse in the civil immunity protec-tion afforded by section 11(j)(4) of the act.

§ 1009.3. [ Continuity of medical command ] (Re-served).

[ A facility recognized by the regional EMS coun-cil as a medical command facility as of July 1, 1989shall continue to be accredited until July 1, 1991, oruntil surveyed by the Department, whichevercomes first. ]§ 1009.4. [ Suspension/revocation of accreditation ]

Withdrawal of medical command facility recogni-tion.

(a) The Department may [ suspend accreditationfor up to 90 days for the following reasons:

(1) Failure to comply with regional EMS councilprotocols or guidelines.

(2) Violation of accreditation criteria in § 1009.1(relating to accreditation and operational criteria).

(3) Failure to cooperate in the data collection andretrieval procedures required by the Department.



(4) Other reasons deemed appropriate by the De-partment.

(b) A medical command facility shall correct thedeficiencies that were cited by the Department asreasons for suspension by the end of the suspensionperiod set by the Department.

(c) The Department may revoke accreditation forfailure to correct deficiencies within the suspen-sion period ] withdraw medical command facilityrecognition if the facility fails to continue to meetthe standards for a medical command facility in§ 1009.1 (relating to operational criteria).

(b) The Department will conduct inspections of amedical command facility from time to time, asdeemed appropriate and necessary, including whennecessary to investigate a complaint or a reason-able belief that violations of this part may exist.

(c) If the facility fails to continue to meet thestandards for a medical command facility in§ 1009.1, as an alternative to rescinding medicalcommand facility recognition, the Department mayrequest the facility to submit a plan of correction tocorrect the deficiencies. The procedures are asfollows:

(1) The Department will give written notice tothe facility and the regional EMS council of thedeficiencies.

(2) The facility shall have 30 days in which torespond to the Department with a plan to correctthe deficiencies.

(3) The Department will review the plan of cor-rection and, if the plan is found to be acceptable,the Department may make an onsite reinspectionin accordance with the time frame given in theplan of correction.

(4) Within 30 days after the review of the plan ofcorrection, as well as 30 days after the reinspection,the Department will give written notice to thefacility and the regional EMS council of the resultsof the Department’s review of the plan of correctionand reinspection.

(d) Upon receipt of a written complaint describ-ing conduct for which the Department may with-draw medical command facility recognition, theDepartment will:

(1) Initiate an investigation of the specificcharges.

(2) Provide the medical command facility with acopy of the complaint and request a response un-less the Department determines that disclosure tothe medical command facility of the complaint willcompromise the investigation or would be inappro-priate for some other reason.

(3) Develop a written report of the investigation.

(4) Notify the complainant of the results of theinvestigation of the complaint, as well as the med-ical command facility if the medical command facil-ity has been officially apprised of the complaint orinvestigation. This notification does not includeproviding a copy of the written report developedunder paragraph (3).

§ 1009.5. [ Biennial review ] Review of [ accred-ited ] medical command facilities.

The regional EMS councils shall conduct a [ biennial ]review of medical command facilities as requestedby the Department, and at other times may inspect[ accredited ], medical command facilities. These re-views and inspections shall be conducted to audit forcontinued compliance with, at a minimum, the criteriain § 1009.1 (relating to [ accreditation and ] opera-tional criteria) as directed by the Department.


A medical command facility may not discontinuemedical command operations without providing 60days advance written notice to the Department,regional EMS councils responsible for regions inwhich the medical command facility routinely pro-vides medical command and providers of EMS forwhich it routinely provides medical command.

CHAPTER 1011. ACCREDITATION OF TRAININGINSTITUTES

§ 1011.1. BLS and ALS training institutes.

(a) Eligible entity. A BLS and an ALS training insti-tute shall be accredited by the Department. A [ BLS ]training institute shall be a secondary or postsecondaryinstitution, hospital, regional EMS council or anotherentity which meets the criteria in this part.

(b) [ Accreditation criteria. To qualify for accredi-tation as a BLS training institute, an entity shalldemonstrate compliance with the following:

(1) Criteria ] Training programs.

(1) [ The ] A BLS training institute shall evidencethe ability to conduct one or more of the followingtraining programs approved by the Department:

(i) Emergency Medical Technician[ -Ambulance ]Course[ , National Standard Curriculum.

(ii) Emergency Medical Technician RefresherCourse, National Standard Curriculum.

(iii) Emergency Medical Services ( ] (iii) EMS[ ) ]First Responder Course[ , First Edition or amend-ments and revisions thereto ].

[ (iv) EMS First Responder Refresher Course.

(v) EMT Instructor Training Program, NationalStandard Curriculum ].

(2) An ALS training institute shall evidence theability to conduct one or more of the followingtraining programs approved by the Department:

(i) Emergency Medical Technician-ParamedicCourse.

(ii) Prehospital Registered Nurse Course.

[ (2) ] (c) Personnel.

[ (i) ] (1) Medical director.

[ (A) An ] (i) A training institute shall have a medicaldirector who is a physician [ licensed in this Common-wealth ]. The medical director shall be experienced inemergency medical care, and shall have demonstratedability in education[ / ] and administration.



[ (B) ] (ii) The responsibilities of the medical directorshall include:

[ (I) Assuring that the ] (A) Reviewing course con-tent [ is in ] to ensure compliance with this part.

[ (II) Assisting with ] (B) Reviewing and approv-ing the training institute’s criteria for the recruit-ment, selection and orientation of training institute fac-ulty.

[ (III) ] (C) ***

(D) Reviewing the quality and medical content ofthe education, and compliance with protocols.

(E) Participating in the review of new technologyfor training and education.

(iii) Additional responsibilities for a medical di-rector of an ALS training institute include:

(A) Approving the content of course written andpractical skills examinations.

(B) Identifying and approving facilities wherestudents are to fulfill clinical and field internshiprequirements.

(C) Identifying and approving individuals toserve as field and clinical preceptors to superviseand evaluate student performance when fulfillingclinical and field internship requirements.

(D) Signing skill verification forms for studentswho demonstrate the knowledge and skills requiredfor successful completion of the training course andentry level competency for the prehospital practi-tioner for which the training course is offered.

[ (ii) ] (d) Administrative director.

[ (A) ] (1) A BLS training institute shall have anadministrative director who [ is a currently certifiedEMT and ] has at least 1 year experience in adminis-tration and 1 year experience in prehospital care.

(2) An ALS training institute shall have an ad-ministrative director who has at least 1 year expe-rience in administration and 1 year experience inALS prehospital care.

[ (B) ] (3) Responsibilities of the administrative direc-tor include ensuring:

[ (I) Application ] (i) The adequacy of the systemfor processing student applications and [ oversight ]of the student selection process.

[ (II) Class scheduling and assignment ] (ii) Theadequacy of the process for the screening andselection of instructors for the training institute.

[ (III) Preparation, maintenance and ] (iii) Theinstitute maintains an adequate inventory of neces-sary training equipment and that the training equip-ment is properly prepared and maintained.

[ (IV) Administration ] (iv) The adequate adminis-tration of the course and written and practical skillsexaminations involved in the course.

[ (V) Maintenance ] (v) There is an adequate sys-tem for the maintenance of student records and files.

[ (VI) ] (vi) [ Student/faculty liaison ] There is anappropriate mechanism to resolve disputes be-tween students and faculty.

[ (iii) ] (e) Course coordinator.

[ (A) ] (1) The [ BLS ] training institute shall desig-nate a course coordinator for each training course [ ofinstruction ] conducted by the training institute. [ Thecoordinator shall possess certification as an EMTinstructor, and shall have other qualifications asprescribed by the Department’s Prehospital Person-nel Training Manual. ]

(2) A course coordinator shall have:

(i) Reading and language skills commensuratewith the resource materials to be utilized in thecourse.

(ii) Knowledge of the Statewide BLS medicaltreatment protocols.

(3) A course coordinator for an ALS trainingcourse shall also satisfy the following requirements:

(i) One year experience in ALS prehospital care.

(ii) One year experience as an EMT-paramedic ora health professional, or as a supervisor of ALSprehospital care.

(iii) Have knowledge of the ALS transfer andmedical treatment protocols for the region.

[ (B) The ] (4) A course coordinator is responsible forthe management and supervision of each [ BLS ] trainingcourse offered by the training institute for which heserves as a course coordinator.

[ (C) ] (5) Specific duties of [ the ] a course coordina-tor [ also include:

(I) Scheduling and supervising course instruc-tors.

(II) Scheduling and supervising student clinicalobservation activities.

(III) Completing course records, including indi-vidual student performance summaries and scores.

(IV) Providing counseling services to students ]shall be assigned by the training institute.

(6) One person may serve both as the administra-tive director and a course coordinator.

[ (iv) ] (f) Instructors.

[ (A) ] (1) A [ BLS ] training institute shall ensure theavailability of qualified and responsible instructors foreach training course. [ Instructors shall meet thequalifications required by § 1003.23(e) (relating toEMT). ]

(2) An instructor shall be 18 years of age or older,and possess a high school diploma or GED equiva-lent.

(3) At least 75% of the instruction provided intraining courses shall be provided by instructorswho are health professional physicians or prehospi-tal personnel and who have at least 1 year ofexperience as a health professional physician or aprehospital practitioner above the level of a firstresponder and at or above the level they are teach-ing, and have completed an EMS instructor courseapproved by the Department or possess a bach-elor’s degree in education or a teacher’s certifica-



tion in education; or be determined by a reviewbody of the training institute to meet or exceedthese standards.

(4) An instructor who does not satisfy the re-quirements in paragraph (3) shall be qualified toprovide the instructional services offered as deter-mined by the training institute after consulting thePrehospital Practitioner Manual and with the ap-propriate regional EMS council.

[ (B) ] (5) ***

[ (v) Other faculty. A BLS training institute mayuse the instructional services of other personnel asmay be deemed appropriate, subject to approval bythe regional EMS council. ]

(g) Clinical preceptors.

(1) An ALS training institute shall ensure theavailability of clinical preceptors for each trainingcourse.

(2) A clinical preceptor is responsible for thesupervision and evaluation of students while fulfill-ing clinical requirements for a training program.

(h) Field preceptors.

(1) An ALS training institute shall ensure theavailability of field preceptors for each student.

(2) A field preceptor is responsible for the super-vision and evaluation of students while fulfilling afield internship for a training program.

[ (3) ] (i) Facilities and equipment. A training insti-tute shall:

[ (i) The institute shall maintain ] (1) Maintainfacilities necessary for the provision of [ BLS ] trainingcourses. The facilities shall include classrooms and spacefor equipment storage, and shall be of sufficient size toconduct didactic and practical skill performance sessions.[ The regional EMS council is responsible for deter-mining the appropriateness of the facilities pro-vided. ]

[ (ii) The institute shall provide ] (2) Provide andmaintain the essential equipment and supplies [ as ] toadminister the course. These shall be identified inthe [ Department’s ] Prehospital Personnel [ Training ]Manual.

[ (4) ] (j) Operating procedures. A training instituteshall:

[ (i) The institute shall adopt ] (1) Adopt andimplement [ the Department’s ] a nondiscriminationpolicy with respect to student selection and faculty re-cruitment.

[ (ii) A file shall be maintained ] (2) Maintain afile on each enrolled student [ to include ] whichincludes class performance, practical and written exami-nation results, and reports made concerning the progressof the student during the training program.

[ (iii) The institute shall provide ] (3) Provide amechanism by which students may grieve decisions madeby the institute regarding dismissal or other disciplinaryaction. [ The grievance procedure shall be subject toapproval by the regional EMS council. ]

[ (iv) Students shall be provided ] (4) Providestudents with a clear description of the program and itscontent, including learning goals, course objectives andcompetencies to be attained.

[ (v) The institute shall evidence compliance withpolicies contained in the Department’s PrehospitalPersonnel Training Manual. ]

(5) Have a policy regarding the transfer of astudent into or out of a training program from onetraining institute to another.

(6) Have a continuing quality improvement pro-cess in place for students, instructors, and clinicalevaluation.

§ 1011.2. [ ALS training institutes ] (Reserved).

[ (a) Eligible entity. An ALS training instituteshall be accredited by the Department. An ALStraining institute shall be a secondary or apostsecondary institution, hospital, EMS council oranother entity which meets the criteria in this part.

(b) Criteria. To qualify for accreditation as anALS training institute, an entity shall demonstratecompliance with the following:

(1) Training programs. The institute shall evi-dence the ability to conduct one or more of thefollowing training programs approved by the De-partment.

(i) Emergency Medical Technician-ParamedicCourse, National Standard Curriculum.

(ii) Emergency Medical Technician-ParamedicRefresher Course, National Standard Curriculum.

(iii) Health professional.(2) Administration.(i) Medical director.(A) An institute shall have a medical director

who is a physician licensed in this Commonwealth.The medical director shall be experienced in emer-gency medical care, and shall have demonstratedability in education/ administration.

(B) The responsibilities of the medical directorinclude:

(I) Assuring that the course content is in compli-ance with this part.

(II) Assisting with the recruitment, selection andorientation of training institute faculty.

(III) Providing technical advice and assistance totraining institute faculty and students.

(IV) Approving the content of written and practi-cal skills examinations.

(V) Identifying and approving facilities and ALSservices where students can fulfill clinical and fieldinternship requirements.

(VI) Identifying and approving individuals whowill serve as field and clinical preceptors for super-vising and evaluating student performance whenfulfilling clinical and field internship requirements.

(ii) Administrative director.

(A) The administrative director shall have atleast 1 year of experience in administration and 1year of experience in ALS prehospital care educa-tion.



(B) Responsibilities of the administrative direc-tor include:

(I) Application processing and oversight of thestudent selection process.

(II) Class scheduling and assignment of instruc-tors.

(III) Preparation, maintenance and inventory ofnecessary training equipment.

(IV) Administration of written and practical skillexaminations.

(V) Maintenance of student records and files.

(VI) Student/faculty liaison.

(iii) Course coordinator.

(A) The ALS training institute shall designate acourse coordinator for each course of instructionconducted by the training institute. The coordina-tor shall be a currently certified EMT-paramedic orhealth professional as defined in this part, andshall have other qualifications prescribed by theDepartment’s Prehospital Personnel TrainingManual.

(B) The course coordinator is responsible for themanagement and supervision of each ALS trainingcourse offered by the training institute.

(C) Specific duties of the course coordinator alsoinclude:

(I) Scheduling and supervising course instruc-tors.

(II) Scheduling and supervising student clinicalobservation activities and field internships.

(III) Completing course records, including indi-vidual student performance summaries and scores.

(IV) Providing counseling services for students.

(iv) Instructors.

(A) The ALS training institute shall ensure theavailability of instructors for each course.

(B) An instructor shall be experienced in theeducation of individuals at the ALS level, andapproved by the course medical director as quali-fied to teach those sections of the course to whichthe instructor is assigned.

(C) An instructor is responsible for presentingcourse materials in accordance with the curriculumestablished by this part.

(v) Clinical preceptors.

(A) The ALS training institute shall ensure theavailability of clinical preceptors for each course.

(B) The clinical preceptor is responsible for thesupervision and evaluation of paramedic studentswhile fulfilling clinical requirements in an ap-proved facility.

(vi) Field preceptors.

(A) The ALS training institute shall ensure theavailability of field preceptors for each student.

(B) The field preceptor is responsible for supervi-sion and evaluation of paramedic students whilefulfilling field internships with an approved ALSservice.

(vii) Other faculty. An ALS training institute mayuse the instructional services of other personnel asmay be deemed appropriate, subject to approval bythe regional EMS council.

(3) Facilities and equipment.(i) The institute shall maintain facilities appro-

priate to conduct ALS training courses. Facilitiesinclude classrooms and space for equipment stor-age, and shall be of sufficient size to conductdidactic and practical skill performance sessions.The regional EMS council is responsible for deter-mining the appropriateness of the facilities.

(ii) The institute shall provide and maintain theessential equipment and supplies as identified inthe Department’s Prehospital Personnel TrainingManual. The equipment includes items necessary toperform skills required by the course curriculum,as defined in this part.

(4) Operating procedures.(i) The institute shall adopt and implement the

Department’s nondiscrimination policy with re-spect to student selection and faculty recruitment.

(ii) A file shall be maintained on each enrolledstudent to include class performance, practical andwritten examination results and reports made con-cerning the progress of the student during thetraining program.

(iii) The institute shall provide a mechanism bywhich students may grieve decisions made by theinstitute regarding dismissal or other disciplinaryaction. The grievance procedure shall be subject toapproval by the regional EMS council.

(iv) Students shall be provided with a clear de-scription of the program and its content, includinglearning goals, course objectives and competenciesto be attained.

(v) The institute shall evidence compliance withpolicies contained in the Department’s PrehospitalPersonnel Training Manual. ]§ 1011.3. Accreditation process.

For an ALS or BLS institute to be accredited by theDepartment, the following are required:

* * * * *

(2) The regional EMS council shall review the applica-tion for completeness[ , ] and accuracy [ and conform-ance with the regional EMS plans and protocols ].

* * * * *

(5) Within 150 days of receipt, the Department willreview the application and make one of the followingdeterminations:

(i) Full accreditation. The training institute [ cur-rently ] meets the criteria in [ § ]§ 1011.1 [ or 1011.2 ](relating to BLS and ALS training institutes[ ; and ALStraining institutes) ] as applicable, and will be accred-ited to operate for 3 years.

(ii) Conditional accreditation. The training institutedoes not [ currently ] meet criteria in [ § ]§ 1011.1 [ or1011.2 ] as applicable, but the deficiencies identified aredeemed correctable by the Department. The program willbe allowed to proceed or continue with close observationby the Department. Deficiencies which prevent full ac-



creditation shall be enumerated and corrected within atime period specified by the Department. Conditionalaccreditation may not exceed 1 year, and may not berenewed.

(iii) Nonaccreditation. The institute does not [ cur-rently ] meet criteria in [ § ]§ 1011.1 [ or 1011.2 ] andthe deficiencies identified are deemed to be seriousenough to preclude any type of accreditation. [ Theapplicant may request a hearing from the Depart-ment under 2 Pa.C.S. §§ 501—508 and 701—704(relating to Administrative Agency Law). ]

* * * * *(7) Prior to and during accreditation, training insti-

tutes are subject to review, including inspection ofrecords, facilities and equipment by the Department. Anauthorized representative of the Department [ or itsdesignee has the right to ] may enter, visit and inspectan accredited training institute or a facility operated byor in connection with the training institute, with orwithout prior notification.

[ (8) A training institute accredited by the Ameri-can Medical Association shall be considered to havemet the requirements in this part, and shall beaccredited by the Department for a period to coin-cide with that of the American Medical Associa-tion’s certification. ] The Department may acceptthe survey results of another accrediting body ifthe Department determines that the accreditationstandards of the other accrediting body are equalto or exceed the standards in this chapter, and thatthe survey process employed by the other accredit-ing body is adequate to gather the informationnecessary for the Department to make an accredita-tion decision.

[ (9) ] (8) ***

§ 1011.4. [ Suspension/revocation ] Denial, restric-tion or withdrawal of accreditation.

(a) The Department may [ suspend or revoke ] deny,withdraw or condition the accreditation of a traininginstitute [ upon written complaint and investiga-tion ] for one or more of the following:

(1) Failure to maintain compliance with the appli-cable criteria in [ § ]§ 1011.1 [ or 1011.2 ] (relating toBLS and ALS training institutes[ ; and ALS traininginstitutes ]) [ and standards and policies in theDepartment’s Prehospital Personnel TrainingManual ].

* * * * *(b) Before denying or withdrawing accreditation, or

granting conditional accreditation, the Departmentwill give written notice to the institute’s administrativedirector and the regional EMS council that the action iscontemplated. The notice will identify reasons for [ with-drawal of accreditation ] the intended decision andwill provide sufficient time for response [ and a requestfor appeal and review of the Department’s determi-nation ].

(c) [ A revocation or suspension of accreditationmay be appealed under 2 Pa.C.S. §§ 501—508 and701—704 (relating to administrative agency law). ]If an institute that applies for accreditation, or has

its accreditation withdrawn or conditioned, dis-agrees with the decision of the Department, it mayappeal the decision under 1 Pa. Code § 35.20 (relat-ing to appeals from actions of the staff) if thedecision was not issued by the agency head asdefined in 1 Pa. Code § 31.3 (relating to definitions)and, if it disagrees with the decision of the agencyhead, it may file an appeal under 2 Pa.C.S. §§ 501—508 and 701—704 (relating to Administrative AgencyLaw).

(d) Upon receipt of a written complaint describ-ing conduct for which the Department may with-draw training facility accreditation, the Depart-ment will:

(1) Initiate an investigation of the specificcharges.

(2) Provide the training facility with a copy ofthe complaint and request a response unless theDepartment determines that disclosure to the train-ing facility of the complaint will compromise theinvestigation or would be inappropriate for someother reason.

(3) Develop a written report of the investigation.

(4) Notify the complainant of the results of theinvestigation of the complaint, as well as the train-ing facility if the training facility has been officiallyapprised of the complaint or investigation. Thisnotification does not include providing a copy ofthe written report developed under paragraph (3).

CHAPTER 1013. SPECIAL EVENT EMS§ 1013.1. Special event EMS planning requirements.

(a) Procedure for obtaining required plan approval. Aperson, agency or organization responsible for the man-agement and administration of special events, as definedin § 1001.2 (relating to definitions), [ shall ] may submita plan for EMS to the Department, through the re-gional EMS council assigned responsibility for theregion in which the special event is to occur, tosecure a determination from the Department as towhether the plan is adequate to address the EMSneeds presented by a special event or a series ofspecial events conducted at the same location. Theplan shall be [ approved ] submitted prior to the startof the special event.

(1) Persons, agencies or organizations, managing facil-ities or locations which are involved in special events asdefined in § 1001.2, who seek the Department’s ap-proval of an EMS plan for a special event or seriesof special events conducted at the same location,shall submit an annual plan to the [ Department ]appropriate regional EMS council at least [ 60 ] 90days prior to the date of the first scheduled event of eachcalendar year.

(2) The Department will approve or disapprove a spe-cial event EMS plan within [ 30 ] 60 days [ of itsreceipt ] after a complete plan is filed with theregional EMS council.

(b) Plan content. The special event EMS plan shallcontain information[ , ] including[ , but not limited to ]:

* * * * *

(11) Measures that have and will be taken tocoordinate EMS for the special event with localemergency care services and public safety agen-



cies—such as ambulance, police, fire, rescue andhospital agencies or organizations.

(c) Plan approval. To secure Department ap-proval of an EMS plan for a special event, theapplicant shall satisfy the requirements of thischapter.§ 1013.2. Administration, management and medical

direction requirements.

(a) Special event EMS director. [ Emergency medicalservices ] EMS provided at a special event shall besupervised by an individual identified as the special eventEMS director.

(1) Responsibilities. The responsibilities of the specialevent EMS director include[ , but are not limited to ]:

* * * * *

(iii) [ Coordination of special event EMS, withlocal emergency care services and public safetyentities—such as ambulance, police, fire rescue andhospital agencies or organizations ] Ensuringimplementation of the EMS coordination measurescontained in the special event EMS plan.

* * * * *(b) Special event emergency supervisory physician.(1) Requirement. A special event EMS system shall be

directed and supervised by a [ licensed ] medical com-mand physician for events involving more than[ 30,000 ] 25,000 actual or anticipated participants orattendees, or both.

(2) Qualifications. A special event emergency supervi-sory physician shall possess the following qualifications:

* * * * *

(ii) [ A valid license to practice medicine in thisCommonwealth as a Doctor of Medicine or Doctorof Osteopathy ] Be licensed as a physician.

§ 1013.3. Special event EMS personnel and capabil-ity requirements.

* * * * *

(b) One staffed and Pennsylvania licensed ambulancevehicle shall be stationed onsite of a special event with aknown or estimated population of between [ 10,000 ]5,000 and [ 30,000 ] 25,000 participants or attendees, orboth.

(c) Two staffed and Pennsylvania licensed ambulancevehicles shall be stationed onsite of a special event with aknown or estimated population greater than [ 30,000 ]25,000 but less than [ 60,000 ] 55,000 participants orattendees, or both.

(d) Three staffed and Pennsylvania licensed ambulancevehicles shall be stationed onsite of any special eventwith a known or estimated population greater than[ 60,000 ] 55,000 participants or attendees, or both.

* * * * *

§ 1013.5. Onsite facility requirements.

A special event for which greater than [ 30,000 ]25,000 participants or spectators, or both, will be involvedshall require the use of onsite treatment facilities. Theonsite treatment facilities shall provide:

* * * * *

(2) Sufficient beds, cots and [ BLS ] equipment toprovide for evaluation and treatment of at least foursimultaneous patients.

* * * * *§ 1013.6. Communications system requirements.

(a) A special event EMS system shall have onsitecommunications capabilities to insure:

* * * * *

(3) Communication with existing community [ emer-gency communications centers ] PSAPs.

* * * * *§ 1013.8. Special event report.

The person or organization that filed the specialevent EMS plan shall complete a special eventreport form prepared by the Department and pro-vided to it by the relevant regional EMS council,and shall file the completed report with that re-gional EMS council within 30 days following aspecial event.

CHAPTER 1015. QUICK RESPONSE SERVICERECOGNITION PROGRAM

Sec.1015.1. Quick response service.1015.2. Discontinuation of service.

§ 1015.1. Quick response service.

(a) Criteria. An applicant for recognition as aQRS shall file an application in which it shallcommit to the following conditions to receive De-partment recognition as a QRS:

(1) The applicant will maintain essential equip-ment and supplies for a QRS, as published by theDepartment at least annually in the PennsylvaniaBulletin, for immediate use when dispatched.

(2) The applicant has capabilities to be dis-patched and to communicate with a respondingambulance service.

(3) EMS it provides will be performed by prehos-pital personnel or other persons authorized by lawto perform the services.

(4) The applicant shall satisfy the requirementsapplicable to ambulance services in §§ 1001.41 and1001.42 (relating to data and information require-ments for ambulance services; and dissemination ofinformation), for data elements included in an am-bulance call report which the Department desig-nates for completion by a QRS.

(5) The applicant shall provide EMS in compli-ance with regional medical treatment protocols andthe Statewide BLS medical treatment protocols.

(b) Recognition process.

(1) An applicant for Department recognition as aQRS shall submit an application on forms pre-scribed by the Department to the regional EMScouncil having jurisdiction over the area in whichthe applicant intends to locate. The applicationshall contain the following information:

(i) The name and address of the applicant.

(ii) The physical location of the applicant.

(iii) Service affiliations (police department, firedepartment, ambulance service, or other).



(iv) The service area.(v) The types and number of vehicles it will

employ, if any.(vi) Communication access and capabilities of the

applicant.(vii) A roster of persons who have committed to

serve as QRS members, and their qualifications.(viii) A summary of how the QRS will interface

with ambulance services.(ix) Verification that the applicant will satisfy the

requirements of subsection (a).(x) A statement attesting to the veracity of the

application, which shall be signed by the principalofficial of the applicant.

(2) The regional EMS council shall review theapplication for completeness and accuracy. It shallreturn an incomplete application to the applicantwithin 14 days of receipt.

(3) Upon receipt of a complete application, theregional EMS council shall conduct, within 45 days,an onsite inspection of the applicant to determinewhether the applicant satisfies the regulatory crite-ria for QRS recognition. Deficiencies identified dur-ing the inspection shall be documented and madeknown to the applicant. A reinspection shall bescheduled when the applicant notifies the regionalEMS council that the deficiencies have been cor-rected. The results shall be forwarded to the De-partment.

(c) Recognition.(1) A certificate of recognition as a QRS will be

issued by the Department when it has been deter-mined that requirements for recognition have beenmet.

(2) The certificate of recognition will specify thename of the QRS, the date of issuance, the date of

expiration, the regional EMS council throughwhich the application was processed and the recog-nition number assigned by the Department.

(3) The QRS may identify a vehicle being utilizedfor response by applying to the outside of thevehicle a QRS decal issued by the Department

(4) The QRS decal issued by the Department maynot be displayed on a vehicle not utilized forresponse by the QRS.

(5) A certificate of recognition is nontransferableand remain valid for 3 years unless withdrawn bythe Department due to the QRS failing to continueto meet the standards for recognition as a QRS insubsection (a).

(d) Renewal of recognition. A QRS may continueto participate in the Quick Response Service Recog-nition Program by resubmitting an application in aformat prescribed by the Department to the appro-priate regional EMS council at least 60 days priorto the expiration date of its certificate of recogni-tion.


A QRS may not discontinue service, except uponorder of the Department, without providing eachregional EMS council and the chief executive of-ficer of each political subdivision within its servicearea 90 days advance notice. The QRS shall alsoadvertise notice of its intent to discontinue servicein a newspaper of general circulation in its servicearea at least 90 days in advance of discontinuingservice, and shall provide the Department withwritten notice that it has met these responsibilitiesat least 90 days in advance of discontinuing service.

[Pa.B. Doc. No. 99-260. Filed for public inspection February 12, 1999, 9:00 a.m.]



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