Rule 511-9-2-.06 - Licensure of Air Ambulance Services(1) Applicability (a) No person shall operate, advertise, or hold themselves out to be an Air Ambulance Service in the state of Georgia without being in compliance with the provisions of O.C.G.A. Chapter 31-11 and these rules and regulations and without being duly licensed by the Department. However, this Rule shall not apply to the following: 1. An air ambulance or air ambulance service operated by an agency of the United States government;2. A vehicle rendering assistance temporarily in the case of a declared major catastrophe, disaster, or public health emergency which is beyond the capabilities of available Georgia licensed Air Ambulance Services;3. An air ambulance operated from a location outside of Georgia and transporting patients picked up beyond the limits of Georgia to locations within Georgia;4. An air ambulance service licensed to operate in another state and transporting patients picked up at a medical facility within the limits of Georgia to locations outside the limits of Georgia, unless such air ambulance is pre-positioned within the limits of Georgia prior to receiving the request for transport;5. An air ambulance licensed in a state adjacent to Georgia that is responding to a request from a Georgia licensed EMS Agency;6. An air ambulance or air ambulance service owned and operated by a governmental entity whose primary role is not to transport patients by air ambulance, and who is not receiving payment for such services;7. An air ambulance or air ambulance service owned and operated by a bona fide non-profit charitable institution and that is not for hire.(2) Application for a license or provisional license shall be made to the license officer in the manner and on the forms approved by the Department, to include at a minimum the name, address, email address, and employer identification number of the owner(s).(3) Renewal of License. Renewal of any license issued under the provisions of O.C.G.A. Chapter 31-11 shall require conformance with all the requirements of these rules and regulations as upon original licensing.(4) Air Ambulance Services must have appropriate and current Federal Aviation Administration (FAA) approval to operate an Air Ambulance Service or Helicopter Air Ambulance Operation, as defined in 14 CFR § 135.(5) Standards for Air Ambulances(a) General: 1. Air Ambulances must have appropriate and current FAA approval (pursuant to 14 CFR § 135 and other applicable federal regulations) to operate as an Air Ambulance;2. Air Ambulances must be maintained on suitable premises that meet the county health code and the Department's specifications. The Department is authorized to establish policy to define minimal standards for suitable premises and base of operations.3. The Air Ambulance must be properly equipped, maintained, and operated in accordance with other rules and regulations contained herein and be maintained and operated so as to contribute to the general well-being of patients. The aircraft must have an appropriate system for ensuring an adequate temperature environment suitable for patient transport.4. All Air Ambulances must be equipped with approved safety belts and restraints for all seats.5. Prior to use, Air Ambulances must be inspected and approved by the Department and so registered by affixing a Department decal at a location specified by the Department.6. Prior to disposal by sale or otherwise, an Air Ambulance removed from service must be reported to the Department.7. The Department shall utilize the airframe's "N" number issued by the FAA to identify each registered Air Ambulance.8. Whenever an Air Ambulance Service utilizes an unregistered air ambulance as a backup air ambulance, the Air Ambulance Service must contact the Department within forty-eight hours of placing said air ambulance in service to provide the following information: (i) Make and model of aircraft,(iii) Color and any descriptive markings, and(iv) Expected length of service.(b) Insurance:1. The Air Ambulance Service must have bodily injury, property damage, and professional liability insurance coverage that meets or exceeds 14 C.F.R. § 205.5.2. No Air Ambulance shall be registered nor shall any registration be renewed unless the Air Ambulance has current insurance coverage as required by this section. A certificate of insurance or satisfactory evidence of self-insurance shall be submitted to the license officer for approval prior to the issuance or renewal of each Air Ambulance license or registration. Satisfactory evidence that such insurance is at all times in force and effect shall be furnished to the license officer, in such form as he may specify, by all licensees required to provide proof of such insurance under this section. Any lapse in insurance coverage will be grounds for immediate revocation of the Air Ambulance Service license.3. Air Ambulance Services must maintain files as required by the FAA.4. The Air Ambulance shall list the Georgia Office of EMS and Trauma as an additional certificate holder for the vehicle insurance with the insurance company.(c) Service License Fee: 1. Every Air Ambulance Service, whether privately operated or operated by any political subdivision of the state or any municipality, as a condition of maintaining a valid license shall pay an annual license fee, to include an agency license fee and a per-ambulance license fee, in an amount to be determined by the Board of Public Health. The amount of said license fee may be periodically revised by said Board, and shall be due upon the initial issuance of the license and each year thereafter on the anniversary date of the initial license issuance.(d) Communication: 1. Each registered Air Ambulance shall be equipped with a two-way communication system that provides air ambulance-to-hospital communications.2. Each registered Air Ambulance shall have two-way communication with the location receiving requests for emergency service.(e) Infectious Disease Exposure Control:1. Each Air Ambulance Service shall have a written exposure control plan approved by their Medical Director.2. Air Ambulance Services and Emergency Medical Services Personnel shall comply with all applicable local, state, and federal laws and regulations in regard to infectious disease control procedures.(f) Equipment and Supplies: 1. All equipment and supplies must be maintained in working order and shall be stored in an orderly manner so as to protect the patient.2. No supplies may be used after their expiration date.3. In order to substitute any item for the required items, written approval must be obtained from the Department. The Department shall have authority to grant exceptions and substitutions and shall maintain and distribute an up-to-date policy listing of all approved exceptions and substitutions.4. The Department shall establish through policy the minimum equipment and supplies required on each Air Ambulance; however, other equipment and supplies may be added as desired.(6) General Provisions for Air Ambulance Services (a) Each Air Ambulance while in service shall be staffed by two Georgia licensed healthcare providers: 1. When responding to an emergency scene at least one of the personnel shall be a registered nurse, physician's assistant, nurse practitioner, or physician and the second person must be a Paramedic, both of whom must be licensed in Georgia;2. When responding for an interfacility transfer, at least one of the personnel shall be a registered nurse, nurse practitioner, physician's assistant, or physician and the second person must be at least a Paramedic or other non-EMS licensed healthcare provider as approved by either the transferring or receiving physician, both of whom must be licensed in Georgia;3. Personnel shall have successfully completed training specific to the air ambulance environment;4. Personnel shall neither be assigned, nor assume the cockpit duties of the flight crew members concurrent with patient care duties and responsibilities;5. Personnel shall have documentation of successful completion of training specific to patient care in the air ambulance transport environment in general and licensee's operation, in specific, as required by the Department; and6. If a Paramedic possesses an additional Georgia healthcare provider license, then the Paramedic may perform to the higher level of training for which he or she is qualified under that license when directed to do so by a physician, either directly or by approved protocols.(b) If an air ambulance transport is requested for an inter-hospital transfer, then such transfer shall be conducted by licensed Air Ambulance Services utilizing registered Air Ambulances.(c) Air Ambulance Services shall be provided on a twenty-four hour a day, seven day a week basis unless weather or mechanical conditions prevent safe operations.(d) Personnel shall be available at all times to receive emergency telephone calls and provide two-way communications.(e) Medical Direction for Air Ambulance Services1. The Air Ambulance Service Medical Director shall be a physician licensed to practice medicine in the state of Georgia and subject to approval by the Department. The Air Ambulance Service Medical Director must agree in writing to provide medical direction to that particular Air Ambulance Service.2. The Air Ambulance Service Medical Director shall serve as medical authority for the Air Ambulance Service, serving as a liaison between the Air Ambulance Service and the medical community, medical facilities and governmental entities.3. It will be the responsibility of the Air Ambulance Service Medical Director, to provide for medical direction, specifically to ensure there is a plan to provide medical oversight of patient care delivered by air medical personnel during transport, to include on-line medical control or off-line medical control (through written guidelines or policies) and also to participate in training for the air ambulance personnel, in conformance with acceptable air ambulance emergency medical practices and procedures.4. Duties of the Air Ambulance Service Medical Director shall include, but not be limited to, the following:(i) The approval of policies and procedures affecting patient care;(ii) The development and approval of medical guidelines or protocols;(iii) The formulation and evaluation of training objectives;(iv) Continuous quality improvement of patient care.5. All Air Ambulance personnel shall comply with appropriate policies, protocols, requirements, and standards of the Air Ambulance Service Medical Director, provided such policies and protocols are not in conflict with these Rules and Regulations, the Department-specified Scope of Practice, or other state statutes.(f) Control of patient care at the scene of an emergency shall be the responsibility of the individual in attendance most appropriately trained and knowledgeable in providing prehospital emergency stabilization care and transportation. When a Medic arrives at the scene of a medical emergency, the Medic may act as an agent of a physician when a physician-patient relationship has been established. 1. For purposes of this section, a physician-patient relationship has been established when: (i) A Medic utilizes medical control, either through direct on-line medical control or off-line medical control, by the use of medical protocols established by the local Medical Director; or(ii) A physician is on the scene and demonstrates a willingness to assume responsibility for patient management or purports to be the patient's personal physician and the Medic takes reasonable steps to immediately verify the medical credentials of the physician.2. Once a physician-patient relationship has been established, the Medic must follow the medical direction of that physician. In the event of a conflict between the medical direction given and the medical protocols established by the local Medical Director, the Medic should immediately contact their local Medical Director.(g) Air Ambulance Services and applicants for Air Ambulance Services shall not misrepresent or falsify any information, applications, forms or data filed with or submitted to the Department.(h) Air Ambulance Services shall not employ, continue in employment, or use as Medics any individuals who are not properly licensed under the applicable provisions of O.C.G.A. Chapter 31-11 and these rules and regulations.(7) CLIA Certification (a) All Air Ambulance Services must maintain current CLIA certification as a laboratory that is permitted to perform waived tests, as defined in 42 CFR § 493.2. 1. Documentation regarding this certification must be submitted to the Department in a manner and on forms specified by the Department.Ga. Comp. R. & Regs. R. 511-9-2-.06
O.C.G.A. §§ 31-2A-3, 31-2A-6, 31-9-2, 31-9-3, 31-11-5 to 31-11-11, 31-11-30 to 31-11-36, 31-11-50 to 31-11-55, 31-11-60.1, 31-12-8.
Original Rule entitled "Licensure of Air Ambulance Services" adopted. F. December 14, 2011; eff. January 3, 2012.Note: Correction of non-substantive typographical error in History, original Rule title "Licensure of Ground Ambulance Services" corrected to "Licensure of Air Ambulance Services." Effective May 17, 2016.Amended: F. Apr. 27, 2016; eff. May 17, 2016.Amended: F. Sep. 29, 2021; eff. Oct. 27, 2021, as specified by the Agency.