§ 1005.10. Licensure and general operating standards.

 (a)  Documentation requirements. An applicant for an ambulance service license shall have the following documents available for the inspection by the Department:

   (1)  A roster of active personnel, including certification and recognition documentation with dates of expiration and identification numbers; documentation of medical command authorization decisions and the medical command status of personnel, if applicable; its process for scheduling staff to ensure that the minimum staffing requirements set forth in subsection (d) are met; identification of persons who are responsible for making operating and policy decisions for the ambulance service, such as officers, directors and other ambulance service officials; and the criminal and disciplinary information for all persons who staff the ambulance service as required by subsections (d)(3) and (4)(vii) and (k).

   (2)  Copies of EMS patient care reports, or other formats on which those records are kept on patients treated or transported, if applicable.

   (3)  Call volume records from the previous year’s operations, if applicable. These records shall include a record of each call received requesting the ambulance service to respond to an emergency, as well as a notation of whether it responded to the call and the reason if it did not respond.

   (4)  A record of the time periods for which the ambulance service notified the PSAP, under subsection (e), that it would not be available to respond to a call.

   (5)  Copies of all written policies required by this section.

   (6)  Copies of any documents by which it agrees to manage another ambulance service or to be managed by another entity.

 (b)  Ambulance standards.

   (1)  For ambulance vehicles which transport patients the ambulance service will be required to show evidence that the vehicle has met 75 Pa.C.S. § §  4571 and 4572 (relating to visual and audible signals on emergency vehicles; and visual signals on authorized vehicles) and 67 Pa. Code Chapter 173 (relating to flashing or revolving lights on emergency and authorized vehicles), and the Federal KKK standards which were in effect at the time of the vehicle’s manufacture and which are not inconsistent with the Vehicle Code standards in 75 Pa.C.S. § §  4571 and 4572. These specifications will be for design types, floor plans, general configuration and exterior markings. An ALS squad unit vehicle is not subject to the Federal KKK standards; however, it is required to meet the standards in 75 Pa.C.S. § §  4571 and 4572. It is also required to have a minimum of six stars of life at least 3 inches in diameter prominently displayed on its exterior, at least two on both the front and rear and at least one on each side.

   (2)  The name of the ambulance service, or a fictitious name of the ambulance service duly registered with the Department of State, shall be displayed on both sides of an ambulance in lettering at least 3 inches in height, except these requirements do not apply to a temporary ambulance used for 30 days or less.

 (c)  Equipment and supplies. Required equipment and supplies shall be carried and readily available in working order for use on BLS and ALS vehicles.

   (1)  BLS and ALS vehicles shall carry medical equipment and supplies as published by the Department in the Pennsylvania Bulletin on an annual basis, or more frequently.

   (2)  An ALS squad unit vehicle is exempt from the requirement of carrying patient litters and equipment which is permanently installed.

   (3)  A BLS ambulance service may carry ALS equipment and drugs, in addition to those generally prescribed for use by a BLS ambulance service, only if it has a physician who is directly responsible for security, accountability, administration and maintenance of the equipment and drugs, and the arrangement is authorized by the Department upon its determination that the arrangement is in the public interest. The physician shall have education and continuing education in ALS and prehospital care and shall serve as the medical director of the BLS ambulance service.

 (d)  Personnel requirements.

   (1)  Minimum staffing requirements.

     (i)   BLS unit. A BLS ambulance, when transporting a patient, except for when engaging in the routine transfer of convalescent or other nonemergency cases, shall be staffed by at least two persons, one of whom shall be an EMT, EMT-paramedic, or health professional, and one of whom shall, at least, qualify as an ambulance attendant. A BLS ambulance need not meet the staffing requirement in this subparagraph when responding to a call, provided that the minimum staffing requirement is satisfied when transporting a patient. An EMT, EMT-paramedic or a health professional shall accompany the patient in the patient compartment of the ambulance during transport.

     (ii)   ALS units. Minimum staffing standards for an ambulance that is operating at the ALS level of care shall be as follows:

       (A)   Two persons shall respond to calls for assistance. This staff shall consist of one of the following:

         (I)   Two health professionals.

         (II)   One health professional and either one EMT or one EMT-paramedic.

         (III)   One EMT and one EMT-paramedic.

         (IV)   Two EMT-paramedics.

       (B)   An ALS ambulance service may be staffed by one EMT-paramedic or one health professional when responding to calls for assistance, if the minimum ALS staffing requirements in this subsection are met during emergency medical treatment and transport of the patient.

       (C)   An ALS squad unit meets minimum staffing requirements by transporting an EMT-paramedic or health professional to rendezvous with a BLS ambulance, and having the EMT-paramedic or health professional provide emergency medical treatment to, and accompany on the BLS ambulance during transport, a patient requiring ALS care.

       (D)   Minimum ALS staffing standards apply to the ALS ambulance service 24 hours-a-day, 7 days-a-week. A mobile ALS care unit, itself, need only satisfy BLS ambulance staffing requirements under subparagraph (i) when responding to a call for BLS assistance exclusively. If the nature of the assistance requested is unknown, the mobile intensive care unit shall respond as if the patient requires ALS care.

     (iii)   All units.

       (A)   Minimum staffing standards are satisfied when an ambulance service has a duty roster that identifies staff who meet minimum staff criteria and who have committed themselves or been assigned by the ambulance service to be available at the specified times, or a staff availability schedule that identifies staff who meet minimum staff criteria and have identified themselves to the ambulance service as being available at the specified times, and minimum staff are present at times required by this subsection, the staff being the staff of the ambulance service except as otherwise authorized in this subsection.

       (B)   The ambulance service shall comply with the Child Labor Law (43 P. S. § §  41—66.1) and regulations adopted under that law when it is using persons 18 years of age and younger to staff and ambulance.

   (2)  ALS service medical director. An ALS ambulance service shall have an ALS service medical director whose duties include the following:

     (i)   Providing medical guidance and advice to the ambulance service.

     (ii)   Making medical command authorization determinations for EMT-paramedics and prehospital registered nurses as set forth in §  1003.28 (relating to medical command authorization).

     (iii)   Reviewing the medical command authorization status of EMT-paramedics and prehospital registered nurses utilized by the ALS ambulance service as set forth in §  1003.28 at least once annually.

     (iv)   Evaluating the quality of patient care provided by the ALS and BLS prehospital personnel utilized by the ALS ambulance service.

   (3)  Responsible staff. An ambulance service shall ensure that all persons who staff the ambulance service, including its officers, directors and other members of its management team, prehospital personnel, and ambulance drivers, are responsible persons. In making that determination it shall require each person who staffs the ambulance service to provide it with information as to misdemeanor and felony convictions, and disciplinary sanctions against a license, certification or other authorization to practice a health care occupation or profession, that have been imposed against that person, and to update that information if and when additional convictions and disciplinary sanctions occur. The ambulance service shall consider this information in determining whether the person is a responsible person. An ambulance service shall also provide the Department with advance notice, 30 days if possible, of any change in its management personnel to include as a new member of its management team a person who has been convicted of a felony or misdemeanor or has had a disciplinary sanction imposed against a license, certification or other authorization to practice a health care occupation or profession.

   (4)  Ambulance drivers. Notwithstanding other considerations that may bear upon whether a driver of an ambulance is a responsible person, a person who drives an ambulance for an ambulance service will not be considered to be a responsible person unless that individual:

     (i)   Is at least 18 years of age.

     (ii)   Has a valid driver’s license.

     (iii)   Observes all traffic laws.

     (iv)   Is not addicted to, or under the influence of, alcohol or drugs.

     (v)   Is free from physical or mental defect or disease that may impair the person’s ability to drive an ambulance.

     (vi)   Has successfully completed an emergency vehicle operator’s course of instruction approved by the Department.

     (vii)   Has not been convicted within the last 4 years of driving under the influence of alcohol or drugs, or, within the last 2 years, has not been convicted of reckless driving or had a driver’s license suspended. The person will not be considered to be a responsible person until the designated time has elapsed and the individual, after the conviction or suspension of license, repeats an emergency vehicle operator’s course of instruction approved by the Department.

 (e)  Communicating with PSAPs.

   (1)  Responsibility to communicate unavailability. An ambulance service shall apprise the PSAP in its area as to when it will not be in operation due to inadequate staffing or for another reason and when its resources are committed in such a manner that it will not be able to have an ambulance and required staff respond to a call requesting it to provide emergency assistance.

   (2)  Responsibility to communicate delayed response. An ambulance service shall apprise the PSAP, as soon as practical after receiving a dispatch call, if it is not able to have an ambulance and required staff en route to an emergency within the time as may be prescribed by a PSAP for that type of communication.

   (3)  Responsibility to communicate with PSAP generally. In addition to the communications required by paragraphs (1) and (2), an ambulance service shall provide a PSAP with information, and otherwise communicate with a PSAP, as the PSAP requests to enhance the ability of the PSAP to make dispatch decisions.

   (4)  Response to dispatch by PSAP. An ambulance service shall respond to a call for emergency assistance as communicated by the PSAP, provided it is able to respond as requested.

 (f)  Patient management. All aspects of patient management are to be handled by a prehospital practitioner with the level of EMS certification or recognition necessary to care for the patient based upon the condition of the patient.

 (g)  Use of lights and other warning devices. Ambulances may not use emergency lights or audible warning devices, unless they do so in accordance with standards imposed by 75 Pa.C.S. (relating to Vehicle Code) and are transporting or responding to a call involving a patient who presents or is in good faith perceived to present a combination of circumstances resulting in a need for immediate medical intervention. When transporting the patient, the need for immediate medical intervention must be beyond the capabilities of the ambulance crew using available supplies and equipment.

 (h)  Weapons and explosives. Weapons and explosives may not be worn by ambulance personnel or carried aboard an ambulance. This subsection does not apply to law enforcement officers who are serving in an authorized law enforcement capacity.

 (i)  Accident, injury and fatality reporting. An ambulance service shall report to the appropriate regional EMS council, in a form or manner prescribed by the Department, an ambulance vehicle accident that is reportable under 75 Pa.C.S., and an accident or injury to an individual that occurs in the line of duty of the ambulance service that results in a fatality, or medical treatment at a facility. The report shall be made within 24 hours after the accident or injury. The report of a fatality shall be made within 8 hours after the fatality.

 (j)  Medical command notification. An ALS ambulance service shall identify, to the regional EMS council having responsibility in the region out of which it operates, the prehospital personnel used by it that have medical command authorization in the region for that ALS ambulance service. It shall also notify the regional EMS council when a prehospital practitioner loses medical command authorization for that ALS ambulance service.

 (k)  Monitoring compliance. An ambulance service shall monitor compliance with the requirements that the act and this part impose upon the ambulance service and its staff. An ambulance service shall file a written report with the Department if it determines that a prehospital practitioner who is a member of the ambulance service, or who has recently left the ambulance service, has engaged in conduct not previously reported to the Department, for which the Department may impose disciplinary sanctions under §  1003.27 (relating to disciplinary and corrective action). The duty to report pertains to conduct that occurs during a period of time in which the prehospital practitioner is functioning for the ambulance service.

 (l)  Policies and procedures. An ambulance service shall maintain written policies and procedures addressing each of the requirements imposed by this section, as well as the requirements imposed by § §  1001.41, 1001.42, 1001.65, 1005.11 and Chapter 1051 (relating to out-of-hospital do-not-resuscitate orders), and shall also maintain written policies and procedures addressing infection control, management of personnel safety, substance abuse in the workplace, and the placement and operation of its ambulances.

   The provisions of this §  1005.10 amended under the Do-Not Resuscitate Act, 20 Pa.C.S. Chapter 54.

   The provisions of this §  1005.10 amended September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363; amended December 13, 2002, effective March 1, 2003, 32 Pa.B. 6117; amended February 6, 2004, effective February 7, 2004, 34 Pa.B. 677. Immediately preceding text appears at serial pages (269378) to (269380), (287207) to (287208) and (294005) to (294006).

   This section cited in 28 Pa. Code §  1005.3 (relating to right to enter, inspect and obtain records); 28 Pa. Code §  1005.8 (relating to provisional license); 28 Pa. Code §  1005.11 (relating to medication use, control and security); 28 Pa. Code §  1005.12 (relating to grounds for suspension, revocation or refusal of an ambulance service license); and 28 Pa. Code §  1007.7 (relating to licensure and general operating requirements).