Section 172-12-006 - STANDARDS FOR EMERGENCY MEDICAL SERVICESAll applicants and licensees who own or lease an ambulance must meet the standards as set forth below:
006.01AMBULANCE STANDARDS. Ambulance standards are available on the Department's website or may be requested from the Department at 301 Centennial Mall South, Lincoln, NE 68509. Licensees must have documentation of the date an ambulance was acquired. Ambulances and aircraft must: (A) After the effective date of the regulations, meet the National Fire Protection Association (NFPA) 1917 Standard for Automotive Ambulances that is current on the effective date of these regulations or the Commission on Accreditation of Ambulance Services (CAAS) Ground Vehicle Standard for Ambulances that is current on the effective date of these regulations;(B) After the effective date of the regulations, remounted ambulances must meet the requirements of 172 NAC 12-005.01(A);(C) Aircraft used for the transportation of patients must comply with Federal Aviation Administration Regulations 14 CFR 135 that is current on the effective date of these regulations and related bulletins and supplements; or(D) Ambulances, including remounted ambulances, that are owned by a licensed emergency medical service on the effective date of these regulations may continue to be used as ambulances.(i) If the ownership of an ambulance meets the requirements of 172 NAC 12-005.01(D) is transferred to another emergency medical service after the effective date of these regulations, then the ambulance cannot be used as an ambulance. unless the ambulance:(1) Meets the requirements of 172 NAC 12-005.01(A) or (B); or(2) The ambulance is fifteen years of age or less; and,(3) Meets or exceeds the Federal Specifications for Ambulances, KKK-A-1822C.(ii) Section 005.01(D)(i) (2) and (3) terminate ten years after effective date of these regulations.006.02STANDARDS FOR EMERGENCY MEDICAL SERVICES EQUIPMENT. Ambulances and non-transporting emergency medical services must carry supplies and equipment, approved by the physician medical director for providing care to pediatric and adult patients. The equipment and supplies must include:(A) Equipment that can be used to provide the following procedures as authorized by the service's license:(i) Patient assessment and diagnostic measurements;(iii) Bleeding control and wound management;(iv) Extremity fracture immobilization;(v) Cervical and spinal motion restriction;(viii) Obstetrics and gynecology care;(ix) Intravenous administration sets and fluids; and(x) Administration of medications and controlled substances;(B) Patient transport and comfort supplies;(C) Supplies and equipment for the protection of personnel and patients from infectious diseases and for personal safety; and(D) Equipment and supplies appropriate for a critical care transport.006.03DRUG ENFORCEMENT AGENCY CONTROLLED SUBSTANCE REGISTRATION. An advanced life support emergency medical service must have a Drug Enforcement Agency Controlled Substance Registration to deliver, store, or otherwise handle controlled substances.006.04CLINICAL LABORATORY IMPROVEMENT AMENDMENTS. An emergency medical service must have a current Clinical Laboratory Improvement Amendments (CLIA) certificate for all levels of point-of-care testing utilized by the service.006.05COMMUNICATION SYSTEMS. Each licensee must have a communications system that is capable of two-way communications with receiving hospitals, dispatchers, and medical control authorities.006.06AMBULANCE MAINTENANCE STANDARDS. Each licensee must meet the maintenance standards set out below:(A) Ambulances must be maintained as specified in the chassis manufacturer owner's manual and the recommendations of the ambulance manufacturer;(B) Aircraft must be maintained in accordance with Federal Aviation Regulation 14 CFR Part 135 and 14 CFR Part 91 and related bulletins, and supplements as required by this chapter;(C) Equipment used for patient care or support must be maintained in accordance with the manufacturer's recommended procedures; and(D) The licensee must keep and maintain all ambulance and operational equipment owner manuals and maintenance procedure manuals for the life of the ambulance or operational equipment or as long as the equipment is owned or used by the emergency medical service.006.07INFECTION CONTROL STANDARDS. The licensee must follow written policies, approved by its physician medical director, concerning sanitation and infection control and the following:(A) Pre-exposure precautions;(B) Post-exposure procedures for personnel. Such procedures must be in accordance with Neb. Rev. Stat. §§ 71-506 to 71-514.05;(C) Procedures for decontamination and cleaning of the ambulance;(D) Procedures for the decontamination and cleaning of equipment; and(E) Procedures for the disposal of contaminated or single use equipment and supplies.006.08AMBULANCE INSPECTION STANDARDS. A licensee which transports patients must establish and perform, at a minimum, monthly vehicle inspections to assure the vehicle's emergency warning devices, electrical systems, engine, and fuel systems are in proper working order. Operational equipment, used for patient care or support, must be inspected, at a minimum, monthly and tested by the service for proper operation or function. All drugs must be inventoried, at a minimum, monthly. Checklists must be developed and used by the service to conduct these inspections monthly. Completed checklists must be maintained for five years.006.09PERSONNEL STANDARDS. A licensee must meet the statutory requirements and the following personnel standards:(A) Maintain a current roster of the names of its employees and members of the service;(B) Only use licensed emergency care providers and individuals as identified in Neb. Rev. Stat. § 38-1226 to provide patient care:(C) When acting as an emergency care provider for a basic life support service, the provider may only provide the level of care as defined in Neb. Rev. Stat. § 38-1206.01 and 38-1207.01. When acting as an emergency care provider for an advanced life support service, the provider may provide the level of care for a basic life support service and the level of care as defined in Neb. Rev. Stat. § 38-1204.01, 38-1207.01, and 38-1208.01; and(D) Staffing of at least one critical care paramedic or a licensed physician, registered nurse, physician assistant, or advanced practice nurse practitioner when providing critical care transportation.006.10PERSONNEL TRAINING STANDARDS. A licensee must provide training every two years for its members that includes, but is not limited to, the following areas: (A) Emergency vehicle driving for operators of ambulances or aircraft safety for operators of aircraft;(B) Infection control standards;(C) Procedures for dealing with hazardous materials;(D) Health Insurance Portability and Accountability Act (HIPAA) Training;(E) Personal safety issues; and(F) Equipment used in the care of patients.006.11PERSONNEL TRAINING DOCUMENTATION. Training must be documented for each individual that participated in training provided by the licensee. The documentation must be maintained by the service for five years.006.12PHYSICIAN MEDICAL DIRECTION STANDARDS. Every licensee must have a physician medical director who meets the requirements and responsibilities in the Emergency Medical Services Practice Act and this chapter. 006.12(A)PHYSICIAN MEDICAL DIRECTOR QUALIFICATIONS. A physician medical director must have the following:(i) Experience in, and knowledge of, emergency care of acutely ill or traumatized patients;(ii) Be familiar with the design and operation of local, regional, and state emergency medical service systems;(iii) Obtain at least three hours of category one continuing medical education within the subject area of emergency medical services every twenty-four months; and(iv) An advanced life support service providing critical care services shall maintain a physician medical director with specialty board certification in emergency medicine or a critical care subspecialty.006.12(B)PHYSICIAN MEDICAL DIRECTOR RESPONSIBILITIES. A physician medical director is responsible for: (i) Notifying the Department of the name(s) of licensed emergency medical services for which the individual is the physician medical director;(ii) Notifying the Department immediately when responsibility as the physician medical director for an emergency medical service is terminated and the date of the termination;(iii) Development and approval of protocols and standing orders for the emergency medical service;(iv) Ensuring and documenting the competency of each licensed emergency care provider to perform skills used by the emergency medical service and documentation of any limitations on the practice of any emergency care provider;(v) Implementation of a medical quality assurance program. The medical quality assurance program must include: (1) An annual review of protocols and standing orders;(2) Documentation of medical care audits as required by physician medical director; and(3) Continuing medical education for the emergency medical services personnel;(vi) Ultimate authority and responsibility for monitoring and for the overall supervision of the medical aspects of the emergency medical service;(vii) Ensuring each written standing order and protocol is appropriate for the licensure and skill level of each of the individuals to whom the performance of medical acts is delegated and authorized; and(viii) The oversight of the distribution, storage, ownership and security of medications and controlled substances utilized by the emergency medical service.006.13RECORDS MAINTENANCE STANDARDS. Each licensee must maintain records as set out below: 006.13(A)PERSONNEL RECORDS. Current personnel files on each emergency care provider must be maintained. All records must be maintained until superseded. Each file must include the following:(i) Name, address, and telephone number;(ii) Current level of licensure; and(iii) Current cardiopulmonary resuscitation certification.006.13(B)AMBULANCE AND EQUIPMENT RECORDS. A licensee must maintain records of vehicle and equipment maintenance and repair for no less than five years.172 Neb. Admin. Code, ch. 12, § 006
Amended effective 7/20/2020Amended effective 12/9/2021Amended effective 3/5/2022Amended effective 7/15/2023