Health, Family Health and Preparedness, Emergency Medical Services

Rule R426-15

Licensed and Designated Provider Operations

Notice of Proposed Rule

(Repeal)

DAR File No.: 36986
Filed: 10/23/2012 12:24:00 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this filing is to fulfill the Governor's mandate for rule review and simplification.

Summary of the rule or change:

The rule change eliminates redundancy, provides sequential numbering, and reflects best practice updates for all aspects of the Emergency Medical Services Act (Title 26, Chapter 8a).

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 8a

Anticipated cost or savings to:

the state budget:

No anticipated fiscal impact to the state budget because there are no changes in the rule requirements that are imposed by these amendments.

local governments:

No anticipated fiscal impact to local governments because there are no changes in the rule requirements that are imposed by these amendments.

small businesses:

No anticipated fiscal impact to small businesses because there are no changes in the rule requirements that are imposed by these amendments.

persons other than small businesses, businesses, or local governmental entities:

No anticipated fiscal impact to businesses because there are no changes in the rule requirements that are imposed by these amendments.

Compliance costs for affected persons:

No anticipated fiscal impact for affected persons because there are no changes in the rule requirements that are imposed by these amendments.

Comments by the department head on the fiscal impact the rule may have on businesses:

In response to the Governor's Executive Order to examine all administrative rules and reduce regulatory impact that may be inhibiting economic growth, the rules governing Emergency Medical Services providers are being repealed, simplified and reenacted. Fiscal impact is expected to be positive for business as the requirements are streamlined and updated.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Emergency Medical Services
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Guy Dansie at the above address, by phone at 801-273-6671, by FAX at 801-273-4165, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

12/17/2012

This rule may become effective on:

12/24/2012

Authorized by:

David Patton, Executive Director

R426. Health, Family Health and Preparedness, Emergency Medical Services.

[R426-15. Licensed and Designated Provider Operations.

R426-15-100. Authority and Purpose.

This rule is established under Title 26, Chapter 8a. It establishes standards for the operation of EMS providers licensed or designated under the provisions of the Emergency Medical Services System Act.

 

R426-15-200. Staffing.

(1) EMT ground ambulances, while providing ambulance services, shall have the following minimum complement of personnel:

(a) two attendants, each of whom is a certified EMT-Basic, EMT-Intermediate, EMT-Intermediate Advanced, or Paramedic.

(b) a driver, 18 years of age or older, who is the holder of a valid driver's license. If the driver is also an EMT-Basic, EMT-Intermediate, EMT-Intermediate Advanced, or Paramedic, the driver qualifies as one of the two required attendants.

(c) EMT ground ambulance services authorized by the Department to provide Intermediate or Intermediate Advanced services shall assure that at least one EMT-Intermediate or EMT-Intermediate Advanced responds on each call along with another certified EMT.

(d) if on-line medical control determines the condition of the patient to be "serious or potentially critical," at least one paramedic shall accompany the patient on board the ambulance to the hospital, if a Paramedic rescue is on scene.

(e) if on-line medical control determines the condition of the patient to be "critical," the ambulance driver and two Paramedics shall accompany the patient on board the ambulance to the hospital, if Paramedics are on scene.

(2) Quick response units, while providing services, shall have the following minimum complement of personnel:

(a) one attendant, who is an EMT-Basic, EMT-Intermediate, EMT-Intermediate Advanced, or Paramedic.

(b) quick response units authorized by the Department to provide Intermediate services shall assure that at least one EMT-Intermediate, EMT Intermediate Advanced or Paramedic responds on each call.

(3) Paramedic ground ambulance or rescue services shall have the following minimum complement of personnel:

(a) staffing at the scene of an accident or medical emergency shall be no less than two persons, each of whom is a Paramedic;

(b) a paramedic ground ambulance service, while providing paramedic ambulance services, shall have:

(i) a driver, 18 years of age or older, who is the holder of a valid driver's license;

(ii) if on-line medical control determines the condition of the patient as "serious or potentially critical," a minimum staffing of one Paramedic, and one EMT-Basic, EMT-Intermediate, or EMT Intermediate Advanced; and

(iii) if on-line medical control determines the condition of the patient as "critical," a minimum staffing of an ambulance driver and two Paramedics.

(4) Paramedic inter-facility transfer services shall have the following minimum complement of personnel:

(a) if the physician describes the condition of the patient as "serious or potentially critical," minimum staffing shall be one Paramedic, and one EMT-Basic, EMT-Intermediate, or EMT-Intermediate Advanced;

(b) if the physician describes the condition of the patient as "critical," minimum staffing shall be two Paramedics and an ambulance driver.

(5) Each licensee shall maintain a personnel file for each certified individual. The personnel file must include records documenting the individual's qualifications, training, certification, immunizations, and continuing medical education.

(6) An EMT or Paramedic may only perform to the service level of the licensed or designated service, regardless of the certification level of the EMT or Paramedic.

 

R426-15-201. Vehicle Permit.

(1) EMS provider organizations that operate vehicles that Section 26-8a-304 requires to have a permit must annually obtain a permit and display a permit decal for each of its vehicles used in providing the service.

(2) The Department shall issue annual permits for vehicles used by licensees only if the new or replacement ambulance meets the:

(a) Federal General Services Administration Specification for ground ambulances as of the date of manufacture; and

(b) equipment and vehicle supply requirements.

(3) The Department may give consideration for a variance from the requirements of Subsection (2) to communities with limited populations or unique problems for purchase and use of ambulance vehicles.

(4) The permittee shall display the permit decal showing the expiration date and number issued by the Department on a publicly visible place on the vehicle.

(5) Permits and decals are not transferrable to other vehicles.

 

R426-15-202. Permitted Vehicle Operations.

(1) Ambulance licensees shall notify the Department of the permanent location or where the vehicles will be staged if using staging areas. The licensee shall notify the Department in writing whenever it changes the permanent location for each vehicle.

(2) Vehicles shall be maintained on a premises suitable to make it available for immediate use, in good mechanical repair, properly equipped, and in a sanitary condition.

(3) Each ambulance shall be maintained in a clean condition with the interior being thoroughly cleaned after each use in accordance with OSHA standards.

(4) Each ambulance shall be equipped with adult and child safety restraints and to the point practicable all occupants must be restrained.

 

R426-15-203. Vehicle Supply Requirements.

(1) In accordance with the licensure or designation type and level, the permittee shall carry on each permitted vehicle the minimum quantities of supplies, medications, and equipment as described in this subsection. Optional items are marked with an asterisk.

EQUIPMENT AND SUPPLIES FOR BASIC QUICK RESPONSE

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Heavy duty shears

2 Universal sterile dressings, 9"x5", 10"x8", 8"x9", or equivalent

12 Gauze pads, sterile, 4"x4"

8 Bandages, self-adhering, soft roller type, 4"x5 yards or equivalent

2 Rolls of tape

4 Cervical collars, one adult, one child, one infant, plus one other size

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

1 Portable jump kit stocked with appropriate medical supplies

AIRWAY EQUIPMENT AND SUPPLIES

1 Portable or fixed suction, with wide bore tubing and rigid pharyngeal suction tip

2 Bag mask ventilation units, one adult, one pediatric, with adult, child, and infant size masks

1 Baby syringe, bulb type, separate from the OB kit

3 Oropharyngeal airways, with one adult, one child, and one infant size

3 Nasopharyngeal airways, one adult, one child, and one infant

2 Non-rebreather or partial non-rebreather oxygen masks, one adult and one pediatric

1 Nasal cannula, adult

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

AUTOMATIC DEFIBRILLATOR EQUIPMENT AND SUPPLIES

1 Defibrillator, automatic portable battery operated, per vehicle or response unit

2 Sets of electrode pads for defibrillation

REQUIRED DRUGS

650mg Aspirin

2 Epinephrine auto-injectors, one standard and one junior (Preloaded syringes with age appropriate dosage of epinephrine 1:1000 is an acceptable substitute for auto-injectors)

2 Concentrated oral glucose tubes or equivalent

50 Grams Activated Charcoal

OPTIONAL DRUGS

Acetaminophen elixir 160mg/5ml

Nerve Antidote Kits (Mark I Kits or DuoDote)

EQUIPMENT AND SUPPLIES FOR AN INTERMEDIATE QUICK RESPONSE

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Heavy duty shears

2 Universal sterile dressings, 9"x5", 10"x8", 8"x9", or equivalent

12 Gauze pads, sterile, 4"x4"

8 Bandages, self-adhering, soft roller type, 4"x5 yards or equivalent

2 Rolls of tape

4 Cervical collars, one adult, one child, one infant, plus one other size

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

2 Concentrated oral glucose tubes or equivalent

1 Portable jump kit stocked with appropriate medical supplies

1 Glucose measuring device

AIRWAY EQUIPMENT AND SUPPLIES

1 Portable or fixed suction, with wide bore tubing and rigid pharyngeal suction tip

2 Bag mask ventilation units, one adult, one pediatric, with adult, child, and infant size masks

1 Baby syringe, bulb type, separate from the OB kit

3 Oropharyngeal airways, with one adult, one child, and one infant size

3 Nasopharyngeal airways, one adult, one child, and one infant

2 O2 masks, non-rebreather or partial non-rebreather, one adult and one pediatric

1 Nasal cannula, adult

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

2 Small volume nebulizer container for aerosol solutions

1 Laryngoscope with batteries curved and straight blades with bulbs and two extra batteries and two extra bulbs*

1 Water based lubricant, one tube or equivalent*

7 Endotracheal tubes, one each: cuffed 8, 7.5, 7, 6, uncuffed 5, 4, 3*

2 Stylets, one adult and one pediatric*

1 Device for securing the endotracheal tube*

2 Endotracheal tube confirmation device*

2 Flexible sterile endotracheal suction catheters from 5-12 french*

2 Oro-nasogastric tubes, one adult, and one pediatric *

AUTOMATIC DEFIBRILLATOR EQUIPMENT AND SUPPLIES

1 Defibrillator, automatic portable battery operated, per vehicle or response unit

2 Sets of electrode pads for defibrillation

IV SUPPLIES

10 Alcohol or Iodine preps

2 IV start kits or equivalent

12 Over-the-needle catheters, two each, sizes 14g, 16g, 18g, 20g, 22g and 24g

2 Arm boards, two different sizes

2 IV tubings with micro drip chambers

3 IV tubings with standard drip chambers

5 Extension tubings

4 Syringes, one 30 or 60cc, one 10cc, one 5cc, and one 3cc

1 Sharps container

1 Safety razor

1 Vacutainer holder

4 Vacutainer tubes

REQUIRED DRUGS

2 25gm Activated Charcoal

1 2.5mg premixed Albuterol Sulfate

2 Atropine Sulfate 1mg each

2 25gm preload Dextrose 50% or Glucagon (must have at least 1 D50)

1 1cc (1mg/1cc) Epinephrine 1:1,000

2 Epinephrine 1:10,000 1mg each

2 Naloxone HCL 2mg each

1 bottle 0.4mg Nitroglycerine (tablets or spray)

650mg Aspirin

4,000cc Ringers Lactate or Normal Saline

OPTIONAL DRUGS

Acetaminophen elixirer 160mg/5ml

Nerve Agent Antidote kits (Mark I Kits or DuoDote)

CyanoKit

EQUIPMENT AND SUPPLIES FOR A BASIC AMBULANCE

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Pillows, with vinyl cover or single use disposable pillows

2 Emesis basins, emesis bags, or large basins

1 Fire extinguisher, with current inspection sticker, of the dry chemical type with a rating of 2A10BC or halogen extinguisher of minimum weight 2.5 - 10 pounds

2 Head immobilization devices or equivalent

2 Lower extremity traction splints or equivalent, one adult and one pediatric

2 Non-traction extremity splints, one upper, one lower, or PASG pants

2 Spine boards, one short and one long (Wood must be coated or sealed)

2 Heavy duty shears

2 Urinals, one male, one female, or two universal

1 Printed Pediatric Reference Material

2 Blankets

2 Sheets

6 Towels

2 Universal sterile dressings, 9"x5", 10"x8", 8"x9", or equivalent

12 Gauze pads, sterile, 4"x4"

8 Bandages, self-adhering, soft roller type, 4"x5 yards or equivalent

2 Rolls of tape

4 Cervical collars, one adult, one child, one infant, plus one other size

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

1 Obstetrical kit, sterile

2 Occlusive sterile dressings or equivalent

1 Car seat, approved by Federal Safety standard

1 Portable jump kit stocked with appropriate medical supplies

2 Preventive T.B. transmission masks

2 Protective eye wear (goggles or face shields)

2 Full body substance isolation protection, or one for each crew member

1 Thermometer or equivalent

1 Water based lubricant, one tube or equivalent

2 Biohazard bags

1 Disinfecting agent for cleaning vehicle and equipment of body fluids

1 Glucose measuring device

AIRWAY EQUIPMENT AND SUPPLIES

1 Portable or fixed suction, with wide bore tubing and rigid pharyngeal suction tip

2 Bag mask ventilation units, one adult, one pediatric, with adult, child, and infant size masks

1 Baby syringe, bulb type, separate from the OB kit

3 Oropharyngeal airways, with one adult, one child, and one infant size

3 Nasopharyngeal airways, one adult, one child, and one infant

4 Non-rebreather or partial non-rebreather oxygen masks, two adult and two pediatric

2 Nasal cannulas, adult

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

1 Permanent large capacity oxygen delivery system

AUTOMATIC DEFIBRILLATOR EQUIPMENT AND SUPPLIES

1 Defibrillator, automatic portable battery operated, per vehicle or response unit

2 Sets of electrode pads for defibrillation

REQUIRED DRUGS

1 500cc Irrigation solution

650mg Aspirin

2 Epinephrine auto-injectors, one standard and one junior (Preloaded syringes with age appropriate dosage of epinephrine 1:1000 is an acceptable substite for auto-injectors)

2 Concentrated oral glucose tubes or equivalent

50 Grams Activated Charcoal

OPTIONAL DRUGS

Acetaminophen elixir 160mg/5ml

Nerve Antidote Kits (Mark I Kits or DuoDote)

EQUIPMENT AND SUPPLIES FOR AN INTERMEDIATE AMBULANCE

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Pillows, with vinyl cover or single use disposable pillows

2 Emesis basins, emesis bags, or large basins

1 Fire extinguisher, with current inspection sticker, of the dry chemical type with a rating of 2A10BC or halogen extinguisher of minimum weight 2.5 - 10 pounds

2 Head immobilization devices or equivalent

2 Lower extremity traction splints or equivalent, one adult and one pediatric

2 Non-traction extremity splints, one upper, one lower, or PASG pants

2 Spine boards, one short and one long (Wood must be coated or sealed)

2 Heavy duty shears

2 Urinals, one male, one female, or two universal

1 Printed Pediatric Reference Material

2 Blankets

2 Sheets

6 Towels

2 Universal sterile dressings, 9"x5", 10"x8", 8"x9", or equivalent

12 Gauze pads, sterile, 4"x4"

8 Bandages, self-adhering, soft roller type, 4"x5 yards or equivalent

2 Rolls of tape

4 Cervical collars, three adult and one pediatric or equivalent

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

1 Obstetrical kit, sterile

2 Concentrated oral glucose tubes or equivalent

2 Occlusive sterile dressings or equivalent

1 Car seat, approved by Federal Safety standard

1 Portable jump kit stocked with appropriate medical supplies

2 Preventive T.B. transmission masks

2 Protective eye wear (goggles or face shields)

2 Full body substance isolation protection or one for each crew member

1 Thermometer or equivalent

2 Biohazard bags

1 Disinfecting agent for cleaning vehicle and equipment of body fluids

1 Glucose measuring device

AIRWAY EQUIPMENT AND SUPPLIES

1 Portable or fixed suction, with wide bore tubing and rigid pharyngeal suction tip

2 Bag mask ventilation units, one adult, one pediatric, with adult, child, and infant size masks

1 Baby syringe, bulb type, separate from the OB kit

3 Oropharyngeal airways, with one adult, one child, and one infant size

3 Nasopharyngeal airways, one adult, one child, and one infant

4 Non-rebreather or partial non-rebreather oxygen masks, two adult and two pediatric

2 Nasal cannulas, adult

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

1 Permanent large capacity oxygen delivery system

2 Small volume nebulizer container for aerosol solutions

1 Laryngoscope with batteries curved and straight blades with bulbs and two extra batteries and two extra bulbs *

1 Water based lubricant, one tube or equivalent*

7 Endotracheal tubes, one each: cuffed 8, 7.5, 7, 6, uncuffed 5, 4, 3*

2 Stylets, one adult and one pediatric*

1 Device for securing the endotracheal tube*

2 Endotracheal tube confirmation device*

2 Flexible sterile endotracheal suction catheters from 5-12 french*

2 Oro-nasogastric tubes, one adult, and one pediatric *

AUTOMATIC DEFIBRILLATOR EQUIPMENT AND SUPPLIES

1 Defibrillator, automatic portable battery operated, per vehicle or response unit

2 Sets of electrode pads for defibrillation

IV SUPPLIES

10 Alcohol or Iodine preps

2 IV start kits or equivalent

12 Over-the-needle catheters, two each, sizes 14g, 16g, 18g, 20g, 22g and 24g

2 Arm boards, two different sizes

2 IV tubings with micro drip chambers

3 IV tubings with standard drip chambers

5 Extension tubings

4 Syringes, one 30 or 60cc, one 10cc, one 5cc, and one 3cc

1 Three-way stopcock

1 Sharps container

1 Safety razor

1 Vacutainer holder

4 Vacutainer tubes

2 Intraosseous needles, two each, 15 or 16, and 18 guage*

REQUIRED DRUGS

2 25gm Activated Charcoal

2 2.5mg premixed Albuterol Sulfate

2 Atropine Sulfate 1mg each

2 Dextrose 50% or Glucagon (must have at least 1 D50)

4 1cc (1mg/1cc) Epinephrine 1:1,000

2 Epinephrine 1:10,000 1mg each

2 100 mg preload Lidocaine

2 10mg Morphine Sulfate

2 Naloxone HCL 2mg each

1 bottle or 0.4mg Nitroglycerine (tablets or spray)

1 2gm Lidocaine IV Drip

1 500cc Irrigation solution

650mg Aspirin

4,000cc Ringers Lactate or Normal Saline

OPTIONAL DRUGS

Acetaminophen elixir 160mg/5ml

Fentanyl

Midazolam

Nubain

Promethazine

Zofran

Nerve Agent Antidote kits (Mark I Kits or DuoDote)

CyanoKit

EQUIPMENT AND SUPPLIES FOR AN INTERMEDIATE ADVANCED AMBULANCE

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Pillows, with vinyl cover or single use disposable pillows

2 Emesis basins, emesis bags, or large basins

1 Fire extinguisher, with current inspection sticker, of the dry chemical type with a rating of 2A10BC or halogen extinguisher of minimum weight 2.5 - 10 pounds

2 Head immobilization devices or equivalent

2 Lower extremity traction splints or equivalent, one adult and one pediatric

2 Non-traction extremity splints, one upper, one lower, or PASG pants

2 Spine boards, one short and one long (Wood must be coated or sealed)

2 Heavy duty shears

2 Urinals, one male, one female, or two universal

1 Printed Pediatric Reference Material

2 Blankets

2 Sheets

6 Towels

2 Universal sterile dressings, 9"x5", 10"x8", 8"x9", or equivalent

12 Gauze pads, sterile, 4"x4"

8 Bandages, self-adhering, soft roller type, 4"x5 yards or equivalent

2 Rolls of tape

4 Cervical collars, three adult and one pediatric or equivalent

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

1 Obstetrical kit, sterile

2 Concentrated oral glucose tubes or equivalent

4 Occlusive sterile dressings or equivalent

1 Car seat, approved by Federal Safety standard

1 Portable jump kit stocked with appropriate medical supplies

2 Preventive T.B. transmission masks

2 Protective eye wear (goggles or face shields)

2 Full body substance isolation protection or one for each crew member

1 Thermometer or equivalent

2 Biohazard bags

1 Disinfecting agent for cleaning vehicle and equipment of body fluids

1 Glucose measuring device

AIRWAY EQUIPMENT AND SUPPLIES

1 Portable or fixed suction, with wide bore tubing and rigid pharyngeal suction tip

2 Bag mask ventilation units, one adult, one pediatric, with adult, child, and infant size masks

1 Baby syringe, bulb type, separate from the OB kit

3 Oropharyngeal airways, with one adult, one child, and one infant size

3 Nasopharyngeal airways, one adult, one child, and one infant

2 Magill forceps, one adult and one child

4 Non-rebreather or partial non-rebreather oxygen masks, two adult and two pediatric

2 Nasal cannulas, adult

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

1 Oxygen saturation monitor

1 Permanent large capacity oxygen delivery system

2 Small volume nebulizer container for aerosol solutions

1 Laryngoscope with batteries curved and straight blades with bulbs and two extra batteries and two extra bulbs

1 Water based lubricant, one tube or equivalent

7 Endotracheal tubes, one each: cuffed 8, 7.5, 7, 6, uncuffed 5, 4, 3

2 Stylets, one adult and one pediatric.

1 Device for securing the endotracheal tube

2 Endotracheal tube confirmation device

2 Flexible sterile endotracheal suction catheters from 5-12 french

2 Oro-nasogastric tubes, one adult, and one pediatric

DEFIBRILLATOR EQUIPMENT AND SUPPLIES

1 Portable cardiac monitor/defibrillator/pacer with adult and pediatric capabilities

2 Sets Electrodes or equivalent

2 Sets Combination type defibrillator pads or equivalent

2 Combination type TCP Pads or equivalent

IV SUPPLIES

10 Alcohol or Iodine preps

2 IV start kits or equivalent

12 Over-the-needle catheters, two each, sizes 14g, 16g, 18g, 20g, 22g and 24g

2 Arm boards, two different sizes

2 IV tubings with micro drip chambers

3 IV tubings with standard drip chambers

5 Extension tubings

4 Syringes, one 30 or 60cc, one 10cc, one 5cc, and one 3cc

1 Three-way stopcock

1 Sharps container

1 Safety razor

1 Vacutainer holder

4 Vacutainer tubes

2 Intraosseous needles, two each, 15 or 16, and 18 guage

REQUIRED DRUGS

2 25gm Activated Charcoal

2 2.5mg premixed Albuterol Sulfate or equivalent

2 Atropine Sulfate 1mg

2 Dextrose 50% or Glucagon (must have 1 D50)

2 10mg either Diazepam or Midazolam, or both. However, Diazepam is not required after July 1, 2008

1 Epinephrine 1:1,000 15mg or equivalent

2 Epinephrine 1:10,000 1mg each

2 100 mg preload Lidocaine

2 10mg Morphine Sulfate

2 Naloxone HCL 2mg each

1 Bottle 0.4mg Nitroglycerine (tablets or spray)

1 2gm Lidocaine IV Drip

1 500cc Irrigation solution

650mg Aspirin

4,000cc Ringers Lactate or Normal Saline

OPTIONAL DRUGS

Acetaminophen elixir 160mg/5ml

Adenosine

Fentanyl

Furosemide

Promethazine

Zofran

Nerve Agent Antidote kits (Mark I Kits or DuoDote)

CyanoKit

EQUIPMENT AND SUPPLIES FOR PARAMEDIC SERVICES

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

1 Thermometer or equivalent

1 Glucose measuring device

2 Head immobilization devices or equivalent

2 Lower extremity traction splints or equivalent, one adult and one pediatric

2 Non-traction extremity splints, one upper, one lower, or PASG pants

2 Spine boards, one short and one long. Wooden boards must be coated or sealed

1 Full body pediatric immobilization device. (Paramedic transfer units excluded)

2 Heavy duty shears

2 Blankets

2 Towels

2 Universal sterile dressings, 9"x5", 10"x8", 8"x 9", or equivalent

12 Gauze pads, sterile, 4" x 4".

8 Bandages, self-adhering, soft roller type, 4"x 5 yards or equivalent

2 Rolls of tape

4 Cervical collars, three adult and one pediatric or equivalent

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

2 Pairs Sterile gloves

1 Obstetrical kits, sterile

4 Occlusive sterile dressings or equivalent

1 Portable jump kit stocked with appropriate medical supplies

2 Emesis basins, emesis bags, or large basins

1 Printed Pediatric Reference Material

AIRWAY EQUIPMENT AND SUPPLIES

1 Portable or fixed suction, with wide bore tubing and rigid pharyngeal suction tip

1 Oxygen saturation monitor

1 Baby syringe, bulb type separate from the OB kit

1 Laryngoscope with batteries curved and straight blades with bulbs and two extra batteries and two extra bulbs

1 Water based lubricant, one tube or equivalent

18 Endotracheal tubes, two each, uncuffed 3, 4 and 5, cuffed 5.5, 6, 6.5, 7, 7.5, 8

1 Device for securing the endotracheal tube

2 Endotracheal tube confirmation devices

2 Flexible sterile endotracheal suction catheters from 5-12 french

3 Oropharyngeal airways, one adult, one child, and one infant size

3 Nasopharyngel airways, one adult, one child, and one infant size

2 Magill forceps, one child and one adult

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

2 Oro-nasogastric tubes, one adult, and one pediatric

4 Non-rebreather or partial non-rebreather oxygen masks, two adult and two pediatric

2 Nasal cannulas, adult

2 Bag mask ventilation units, one adult, one pediatric, with adult, child, and infant size masks

2 Stylettes, one pediatric and one adult

2 Tongue blades

1 Meconium aspirator

1 Cricothyroidotomy kit or equivalent

2 Small volume nebulizer container for aerosol solutions

DEFIBRILLATOR EQUIPMENT AND SUPPLIES

1 Portable cardiac monitor/defibrillator/pacer with adult and pediatric capabilities

2 Sets Electrodes or equivalent

2 Sets Combination type defibrillator pads or equivalent

2 Sets Electrode wire sets or equivalent. (One only for paramedic transfer service)

2 Combination type TCP Pads or equivalent

IV SUPPLIES

10 Alcohol or iodine preps

2 IV start kits or equivalent

12 Over-the-needle catheters, two each, sizes 14g, 16g, 18g, 20g, 22g, 24g

4 Intraosseous needles, two each, 15 or 16 gauge and two 18 guage

2 Arm boards, two different sizes

2 IV tubings with micro drip chambers

3 IV tubings with standard drip chambers

2 IV tubings with blood administration sets

5 Extension tubings

6 Syringes with luer lock, two each 3cc, 10cc, 60cc

1 Cath tipped syringe, 30cc or 60cc

2 Three-way stopcocks

1 Sharps container

1 Vacutainer holder

2 Vacutainer multiple sample luer adapters

4 Vacutainer tubes

SAFETY AND PERSONAL PROTECTION EQUIPMENT

2 Preventive T.B. transmission masks

2 Protective eye wear (goggles or face shields)

2 Biohazard bags

2 Full body substance isolation protection or one for each crew member

1 Disinfecting agent for cleaning vehicle and equipment of body fluids

2 Protective headware

2 Pair leather gloves

2 Reflective safety vests or equivalent

REQUIRED DRUGS

2 Activated Charcoal 25gm each

2 Albuterol Sulfate 2.5mg pre-mixed

2 Atropine Sulfate 1mg

650mg Aspirin

2 Dextrose 50% or Glucagon (must have at least 1 D50)

2 10 mg of either Diazepam or Midazolam, or both. However, Diazepam is not required after July 1, 2008.

2 Diphenhydramine 50mg each

2 either Dopamine HCL 400mg each or 2 mics/mil Epinephrine drip (2cc Epinephrine 1:1000 to 1000cc LR or NS), or both

1 Epinephrine 1:1,000 15mg

2 Epinephrine 1:10,000 1mg each

Fentanyl 200 mcg

2 Lidocaine 100mg each or 450mg Amioderone or both

1 Lidocaine IV drip 2g

2 Morphine Sulfate 10mg each

4 Naloxone HCL 2mg each

1 Bottle Nitroglycerine 0.4mg (tablets or spray)

2 Promethazine HCL 25mg each or Zofran 8mg, or both

1 Sodium Bicarbonate 10mEq

2 Sodium Bicarbonate 50mEg each

1 Irrigation solution, 500cc

4,000cc Ringers Lactate or Normal Saline

4 Normal Saline for injection/inhalation

OPTIONAL DRUGS

Acetaminophen 160mg/5ml

Adenosine

Atrovent

Calcium Chloride

Furosemide

Haldol

Lorazapam

Magnesium Sulfate

Meperidine

Oxytocin

Vasopressin

Nerve Agent Antidote kits (Mark I Kits or DuoDote)

CyanoKit

(2) If a licensed or designated agency desires to carry different equipment, supplies, or medication from the vehicle supply requirements, it must submit a written request from the off-line medical director to the Department requesting the variance. The request shall include:

(a) a detailed training outline;

(b) protocols;

(c) proficiency testing;

(d) support documentation;

(e) local EMS Council or committee comments; and

(f) a detailed letter of justification.

(3) All equipment, except disposable items, shall be so designed, constructed, and of such materials that under normal conditions and operations, it is durable and capable of withstanding repeated cleaning. The permittee:

(a) shall clean the equipment after each use in accordance with OSHA standards;

(b) shall sanitize or sterilize equipment prior to reuse;

(c) may not reuse equipment intended for single use;

(d) shall clean and change linens after each use; and

(e) shall store or secure all equipment in a readily accessible and protected manner and in a manner to prevent its movement during a crash.

(4) The permittee shall have all equipment tested, maintained, and calibrated in accordance with the manufacturer's standards.

(a) the permittee shall document all equipment inspections, testing, maintenance, and calibrations. Testing or calibration conducted by an outside service shall be documented and available for Department review.

(b) a permittee required to carry any of the following equipment shall perform monthly inspections to ensure its ability to function correctly:

(i) defibrillator, manual or automatic;

(ii) autovent;

(iii) infusion pump;

(iv) glucometer;

(v) flow restricted, oxygen-powered ventilation devices;

(vi) suction equipment;

(vii) electronic Doppler device;

(viii) automatic blood pressure/pulse measuring device;

(ix) pulse oximeter.

(c) for all pieces of required equipment that require consumables for the operation of the equipment; power supplies; electrical cables, pneumatic power lines, hydraulic power lines, or related connectors, the permittee shall perform monthly inspections to ensure their correct function.

(5) A licensee shall:

(a) store all medications according to the manufacturers' recommendations for temperature control and packaging requirements; and

(b) return to the supplier for replacement any medication known or suspected to have been subjected to temperatures outside the recommended range.

 

R426-15-204. Insurance.

(1) An ambulance licensee shall obtain insurance to respond to damages due to operation of the vehicle, in the manner and minimum amounts specified below:

(a) liability insurance in the amount of $300,000 for each individual claim and $500,000 for total claims for personal injury from any one occurrence.

(b) liability insurance in the amount of $100,000 for property damage from any one occurrence.

(2) The ambulance licensee shall obtain the insurance from an insurance company authorized to write liability coverage in Utah or through a self-insurance program. The ambulance licensee shall provide the Department with a copy of its certificate of insurance demonstrating compliance with this section.

(3) The ambulance licensee shall report any coverage change and reportable vehicle accident occurring during the provision of emergency medical services to the Department within 60 days after the change or reportable vehicle accident. The ambulance licensee must direct the insurance carrier or self-insurance program to notify the Department of all changes in insurance coverage.

 

R426-15-205. Communications.

All permitted vehicles shall be equipped to allow field EMS personnel to be able to:

(1) Communicate with hospital emergency departments, dispatch centers, EMS providers, and law enforcement services; and

(2) Communicate on radio frequencies assigned to the Department for EMS use by the Federal Communications Commission.

 

R426-15-300. Emergency Medical Dispatch Center.

(1) An emergency medical dispatch center must annually provide organizational information to the Department including:

(a) The number of EMD certified personnel;

(b) Name of the dispatch supervisor;

(c) Name of the agency's off-line medical director; and

(d) Updated address and contact information.

(2) Emergency medical dispatch centers may only provide pre-arrival medical instructions through a certified EMD.

(3) An emergency medical dispatch center must have an offline medical director. The offline medical director must review and approve the emergency medical dispatch center's pre-arrival medical instructions.

 

R426-15-400. Resource Hospital.

(1) A resource hospital must provide on-line medical control for all prehospital EMS providers who request assistance for patient care, 24 hours-a-day, seven days a week. A resource hospital must:

(a) create and abide by written prehospital emergency patient care protocols for use in providing on-line medical control for prehospital EMS providers;

(b) train new staff on the protocols before the new staff is permitted to provide on-line medical control; and annually review with physician and nursing staff

(c) annually provide in-service training on the protocols to all physicians and nurses who provide on-line medical control; and

(d) make the protocols immediately available to staff for reference.

(2) The on-line medical control shall be by direct voice communication with a physician or a registered nurse or physician's assistant licensed in Utah who is in voice contact with a physician.

(3) A resource hospital must establish and actively implement a quality improvement process.

(a) the hospital must designate a medical control committee.

(b) the committee must meet at least quarterly to review and evaluate prehospital emergency runs, continuing medical education needs, and EMS system administration problems.

(i) committee members must include an emergency physician representative, hospital nurse representative, hospital administration representative, and ambulance and emergency services representatives.

(ii) the hospital must keep minutes of the medical control committee's meetings and make them available for Department review.

(c) the hospital must appoint a quality review coordinator for the prehospital quality improvement process.

(d) the hospital must cooperate with the prehospital EMS providers' off-line medical directors in the quality review process, including granting access to hospital medical records of patients served by the particular prehospital EMS provider.

(e) the hospital must assist the Department in evaluating EMS system effectiveness by submitting to the Department, in an electronic format specified by the Department, quarterly data specified by the Department.

 

R426-15-401. Medical Control.

(1) All licensees, designated dispatch centers, and quick response units must enter into a written agreement with a physician to serve as its off-line medical director to supervise the medical care or instructions provided by the field EMS personnel and dispatchers. The physician must be familiar with:

(a) the design and operation of the local prehospital EMS system; and

(b) local dispatch and communication systems and procedures.

(2) The off-line medical director shall develop and implement patient care standards which include written standing orders and triage, treatment, and transport protocols or pre-arrival instructions to be given by designated emergency medical dispatch centers.

(3) The off-line medical director shall ensure the qualification of field EMS personnel involved in patient care and dispatch through the provision of ongoing continuing medical education programs and appropriate review and evaluation;

(4) The off-line medical director shall:

(a) develop and implement an effective quality improvement program, including medical audit, review, and critique of patient care;

(b) annually review triage, treatment, and transport protocols and update them as necessary;

(c) suspend from patient care, pending Department review, a field EMS personnel or dispatcher who does not comply with local medical triage, treatment and transport protocols, pre-arrival instruction protocols, or who violates any of the EMS rules, or who the medical director determines is providing emergency medical serivce in a careless or unsafe manner. The medical director must notify the Department within one business day of the suspension.

(d) attend meetings of the local EMS Council, if one exists, to participate in the coordination and operations of local EMS providers.

 

R426-15-402. Scene and Patient Management.

(1) Upon arrival at the scene of an injury or illness, the field EMS personnel shall secure radio or telephonic contact with on-line medical control as quickly as possible.

(2) If radio or telephonic contact cannot be obtained, the field EMS personnel shall so indicate on the EMS report form and follow local written protocol;

(3) If there is a physician at the scene who wishes to assist or provide on-scene medical direction to the field EMS personnel, the field EMS personnel must follow his instructions, but only until communications are established with on-line medical control. If the proposed treatment from the on-scene physician differs from existing EMS triage, treatment, and transport protocols and is contradictory to quality patient care, the field EMS personnel may revert to existing EMS triage, treatment, and transport protocols for the continued management of the patient.

(a) if the physician at the scene wishes to continue directing the field EMS personnel's activities, the field EMS personnel shall so notify on-line medical control;

(b) the on-line medical control may:

(i) allow the on-scene physician to assume or continue medical control;

(ii) assume medical control, but allowing the physician at the scene to assist; or

(iii) assume medical control with no participation by the on-scene physician.

(c) if on-line medical control allows the on-scene physician to assume or continue medical control, the field EMS personnel shall repeat the on-scene physician's orders to the on-line medical control for evaluation and recording. If, in the judgment of the on-line medical control who is monitoring and evaluating the at-scene medical control, the care is inappropriate to the nature of the medical emergency, the on-line medical control may reassume medical control of the field EMS personnel at the scene.

(5) A paramedic tactical rescue may only function at the invitation of the local or state public safety authority. When called upon for assistance, it must immediately notify the local ground ambulance licensee to coordinate patient transportation.

 

R426-15-500. Pilot Projects.

(1) A person who proposes to undertake a research or study project which requires waiver of any rule must have a project director who is a physician licensed to practice medicine in Utah, and must submit a written proposal to the Department for presentation to the EMS Committee for recommendation.

(2) The proposal shall include the following:

(a) a project description that describes the:

(i) need for project;

(ii) project goal;

(iii) specific objectives;

(iv) approval by the agency off-line medical director;

(v) methodology for the project implementation;

(vi) geographical area involved by the proposed project;

(vii) specific rule or portion of rule to be waived;

(viii) proposed waiver language; and

(ix) evaluation methodology.

(b) a list of the EMS providers and hospitals participating in the project;

(c) a signed statement of endorsement from the participating hospital medical directors and administrators, the director of each participating paramedic and ambulance licensee, other project participants, and other parties who may be significantly affected.

(d) if the pilot project requires the use of additional skills, a description of the skills to be utilized by the field EMS personnel and provision for training and supervising the field EMS personnel who are to utilize these skills, including the names of the field EMS personnel.

(e) the name and signature of the project director attesting to his support and approval of the project proposal.

(3) If the pilot project involves human subjects research, the applicant must also obtain Department Institutional Review Board approval.

(4) The Department or Committee, as appropriate, may require the applicant to meet additional conditions as it considers necessary or helpful to the success of the project, integrity of the EMS system, and safety to the public.

(5) The Department or Committee, as appropriate, may initially grant project approval for one year. The Department or Committee, as appropriate, may grant approval for continuation beyond the initial year based on the achievement and satisfactory progress as evidenced in written progress reports to be submitted to the Department at least 90 days prior to the end of the approved period. A pilot project may not exceed three years;

(6) The Department or Committee, as appropriate, may only waive a rule if:

(a) the applicant has met the requirements of this section;

(b) the waiver is not inconsistent with statutory requirements;

(c) there is not already another pilot project being conducted on the same subject; and

(d) it finds that the pilot project has the potential to improve pre-hospital medical care.

(7) Approval of a project allows the field EMS personnel listed in the proposal to exercise the specified skills of the participants in the project. The project director shall submit the names of field EMS personnel not initially approved to the Department.

(8) The Department or Committee, as appropriate, may rescind approval for the project at any time if:

(a) those implementing the project fail to follow the protocols and conditions outlined for the project;

(b) it determines that the waiver is detrimental to public health; or

(c) it determines that the project's risks outweigh the benefits that have been achieved.

(9) The Department or Committee, as appropriate, shall allow the EMS provider involved in the study to appear before the Department or Committee, as appropriate, to explain and express its views before determining to rescind the waiver for the project.

(10) At least six months prior to the planned completion of the project, the medical director shall submit to the Department a report with the preliminary findings of the project and any recommendations for change in the project requirements;

 

R426-15-600. Confidentiality of Patient Information.

Licensees, designees, and EMS certified individuals shall not disclose patient information except as necessary for patient care or as allowed by statute or rule.

 

R426-15-700. Penalties.

As required by Subsection 63G-3-201(5): Any person that violates any provision of this rule may be assessed a civil money penalty as provided in Section 26-23-6.

 

KEY: emergency medical services

Date of Enactment or Last Substantive Amendment: March 15, 2010

Notice of Continuation: July 28, 2009

Authorizing, and Implemented or Interpreted Law: 26-8a]