§ 1007.7. Licensure and general operating requirements.
(a) Documentation requirements. An applicant for an air 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; identification of persons who are responsible for making operating and policy decisions for the air 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)(4) and (m); and the plan for staffing the air ambulance service.
(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 air ambulance service to respond to an emergency, as well as a notation of whether it responded to the call and the reason if it did not respond.
(4) Copies of the written policies required by this section.
(b) Air ambulance requirements. An air ambulance shall meet the following minimum requirements:
(1) The air ambulance shall be configured to carry at least one supine patient with sufficient access to the patient in order to begin and maintain ALS and other treatment modalities.
(2) The air ambulance design may not compromise patient safety in loading, unloading or during flight, and the air ambulance shall be equipped with either a cargo door or an entry that will allow loading and unloading the patient without excessive maneuvering.
(3) The air ambulance shall be climate controlled for the comfort of the patient.
(4) The air ambulance shall have adequate interior lighting so that medical care can be provided and patient status monitored without interfering with the pilot’s vision.
(5) The air ambulance shall be configured so that the patient is isolated from the cockpit to minimize in-flight distractions to the pilot and to prevent interference with the pilot’s manipulation of the flight controls.
(6) An air ambulance operating from sunset to sunrise shall be equipped with at least one tail rotor illuminating light and a controllable search light.
(7) The air ambulance shall carry, on a flight, survival gear appropriate to the expected terrain and environment.
(8) The air ambulance shall be equipped with appropriate patient restraints.
(9) The air ambulance shall be equipped with 110 V electrical output with appropriate cabin outlets for medical equipment use.
(10) The air ambulance shall be equipped with two-way radios capable of communicating with hospital communications centers, PSAPs and ambulances.
(c) Equipment and supply requirements. Required equipment and supplies shall be carried and readily available in working order for use on an air ambulance. The list of required equipment and supplies for an air ambulance will be published by the Department in the Pennsylvania Bulletin on an annual basis.
(d) Personnel requirements. An air ambulance service shall meet the following requirements related to personnel and staffing:
(1) Air ambulance medical director. It shall have an air ambulance medical director who possesses the qualifications specified in § 1003.5(b) (relating to ALS service medical director) and performs the duties specified in § 1003.5(a).
(2) Pilot and prehospital personnel. It shall assure that each air ambulance responding to a call for EMS is staffed with at least one pilot and prehospital personnel as set forth in § 1005.10(d)(1)(ii) (relating to licensure and general operating standards). At least one of the responding prehospital personnel shall be specially trained in air-medical transport.
(3) Other personnel requirements.
(i) It shall keep a pilot and two prehospital personnel staff as set forth in § 1005.10(d)(ii) available for the air ambulance at all times to assure immediate response to emergency calls.
(ii) It shall require prehospital personnel who staff an air ambulance to undergo annual physical examinations to assure that they are physically able to perform their jobs.
(iii) Minimum staffing standards are satisfied when an air ambulance service has a duty roster that identifies staff who meet minimum staff criteria 24 hours-a-day, 7 days-a-week and who have committed themselves as being available or been assigned by the air ambulance service to be available at the specified times, and when minimum required staff are present during the emergency medical treatment and transport of a patient.
(4) Responsible staff. It shall ensure that all persons who staff the air ambulance service, including its officers, directors and other members of its management team, prehospital personnel, and pilots, are responsible persons. In making that determination it shall require each person who staffs the air 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 the person, and to update that information if additional convictions and disciplinary sanctions occur. It shall consider this information in determining whether the person is a responsible person. It 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.
(e) Communicating with ground PSAPs.
(1) If requested by a ground PSAP, an air ambulance service shall apprise the PSAP as to when it will not be in operation, when weather conditions prevent or impede flight, and when its resources are already committed.
(2) An air ambulance service shall apprise the dispatching ground PSAP as soon as practical after receiving a dispatch call, its estimated time of arrival at the scene of the emergency. While its air ambulance is enroute to the scene of an emergency, if an air ambulance service believes that it will not be able to have an air ambulance and required staff arrive at the emergency scene within the estimated time of arrival previously given, the air ambulance service shall contact the ground PSAP and provide its new estimated time of arrival.
(f) Access to air ambulance service.
(1) The air ambulance service shall have a policy which addresses the following:
(i) Who, in addition to a PSAP, may request air ambulance service.
(ii) How its air ambulance services should be accessed.
(iii) General and medical guidelines for personnel to consider prior to requesting its air ambulance services.
(iv) To whom the air ambulance service provides its services, including general service area.
(v) What level of EMS is provided by the air ambulance service.
(vi) Patient preparation guidelines.
(vii) Aircraft enplanement and safety requirements.
(2) The air ambulance service shall disseminate this policy to relevant health care providers in the air ambulance service’s service area.
(g) Flight requirements. The air ambulance service shall ensure that:
(1) A determination to accept the flight is based solely on availability, safety procedures and weather conditions.
(2) The air ambulance proceeds expeditiously and as directly as possible to the flight destination, considering the weather, appropriate safety rules, noise abatement procedures and flight path and altitude clearances.
(3) The air ambulance engages in flight following with an air communications center at intervals not to exceed 15 minutes. If the air ambulance is outside of radio range of the base communications center, adequate flight following shall be planned and executed.
(4) The air ambulance is ready for flight at all times when the air ambulance service has not reported to ground PSAPs that the air ambulance is unavailable to respond to emergencies.
(h) Medical service requirements. The air ambulance service shall ensure that:
(1) Equipment and supplies required for an air ambulance flight are on the air ambulance and in working order prior to takeoff for patient transport.
(2) Medical care and intervention is provided according to direct medical command or written protocols/standing orders.
(3) A patient treatment record is maintained, documenting medical care rendered by the medical flight crew and the disposition of the patient at the receiving medical facility. The patient treatment record shall be maintained at the base hospital.
(4) Each patient is evaluated for potential adverse effects from flight operations.
(5) The patient and equipment are secured during flight.
(6) The patient is transported to the nearest appropriate receiving facility. That facility shall be a trauma center when required by Department-approved bypass protocols.
(i) Air ambulance medical director’s operational requirements. The air ambulance service shall have a policy setting forth the air ambulance medical director’s operational procedures which shall include procedures for at least the following:
(1) The performance of responsibilities set forth in § 1003.5(a).
(2) The development of medical treatment protocols for the air ambulance service, submitting them to the regional EMS council medical advisory committee for its review and recommendations, and securing approval of the medical treatment protocols from the Department.
(j) Communication center arrangements. The air ambulance service shall ensure that it has access to an air communications center that meets the following standards:
(1) Has a designated person—communications specialist—assigned to receive and dispatch requests for emergency air medical services and charged with the relay of information between the flight crew, requesting agency and receiving hospital.
(2) Is operational 24 hours-a-day, 7 days-a-week and has radio capabilities to transmit to and receive from the air ambulance. At a minimum, 123.05 MHz, radio frequency shall be available.
(3) Has at least one incoming telephone line that is dedicated to the air ambulance service.
(4) Has a system for recording incoming and outgoing telephone and radio transmissions. The system shall have an inherent time recording capability and recordings shall be kept for a minimum of 30 days.
(5) Has the capability of communicating with the flight crew so that the air ambulance may take off within the scheduled takeoff time.
(6) Has a backup emergency power source.
(7) Maintains a status board listing flight crew names and other pertinent operational information.
(8) Has copies of operational protocols and procedures, including emergency operation plans in the event of overdue, missing or downed aircraft.
(9) Has posted or displayed applicable licenses and permits.
(10) Maintains current maps and navigational aids.
(11) Collects and maintains records of the following data:
(i) The time of initial and subsequent air ambulance request calls.
(ii) The name of the party or agency requesting the air ambulance service and a verification phone number.
(iii) Pertinent patient medical information.
(iv) The names of referring and receiving physicians at hospitals.
(v) The landing and destination sites.
(vi) The details of needed ground transportation arrangements at pickup and landing sites.
(vii) The times and reasons for aborted or missed flights.
(viii) The details of coordination with ground personnel for landing and receipt of the aircraft.
(ix) Other data pertinent to the air ambulance service’s specific needs for completing activity review reports.
(k) Community education program requirements.
(1) An air ambulance service shall develop a professional and community education program that will promote proper air medical service utilization.
(2) The educational program shall include the following:
(i) Communication to the public that the air ambulance service accepts medically necessary calls from authorized personnel and does not discriminate against a person because of race, creed, sex, color, age, religion, national origin, ancestry, medical problem, handicap or ability to pay.
(ii) A safety program covering landing site designation and safe conduct around the air ambulance, which shall be offered to appropriate agencies and individuals.
(iii) Training regarding stabilization and preparation of the patient for airborne transport, which shall be provided to prehospital personnel.
(iv) An active community relations program.
(l) Medical command notification. An air 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 air ambulance service. The service shall also notify the regional EMS council when a prehospital practitioner loses medical command authorization for that air ambulance service.
(m) Monitoring compliance. An air ambulance service shall monitor compliance with all requirements that the act and this part impose upon the air ambulance service and its staff. An air ambulance service shall file a written report with the Department if it determines that a prehospital practitioner who is a member of the air ambulance service, or who has recently left the air 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 air ambulance service.
(n) Policies and procedures. An air 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 (relating to data and information requirements for ambulance services; dissemination of information; and cooperation) 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 air ambulances.
Authority