Header:
KANSAS ADMINISTRATIVE REGULATIONS
AGENCY 109 BOARD OF EMERGENCY MEDICAL SERVICES
ARTICLE 2. AMBULANCE SERVICES; PERMITS AND REGULATIONS
Date:
01/16/2014
Document:
109-2-5. Ambulance service operational standards.
(a) Each ground ambulance shall have a two-way, interoperable communications system to allow contact with the ambulance service's primary communication center and with the medical facility, as defined by K.S.A. 65-411 and amendments thereto, to which the ambulance service most commonly transports patients.
(b) Smoking shall be prohibited in the patient and driver compartments of each ambulance at all times.
(c) Each operator shall ensure that the interior and exterior of the ambulance are maintained in a clean manner and that all medications, medical supplies, and equipment within the ambulance are maintained in good working order and according to applicable expiration dates.
(d) Each operator shall ensure that freshly laundered linen or disposable linen is on cots and pillows and ensure that the linen is changed after each patient is transported.
(e) When an ambulance has been utilized to transport a patient known or suspected to have an infectious disease, the operator shall ensure that the interior of the ambulance, any equipment used, and all contact surfaces are disin-fected according to the ambulance service's infectious disease control policies and procedures. The operator shall place the ambulance out of service until a thorough disinfection according to the ambulance service's infection control policies and procedures has been completed.
(f) Each operator shall ensure that all items and equipment in the patient compartment are placed in cabinets or properly secured.
(g) Each operator shall park all ground ambulances in a completely enclosed building with a solid concrete floor. Each operator shall maintain the interior heat of the enclosed building at no less than 50 degrees Fahrenheit. Each operator shall ensure that the interior of the building is kept clean and has adequate lighting. Each operator shall store all supplies and equipment in a clean and safe manner.
(h) Each licensed ambulance shall meet all regulatory requirements for the ambulance license type, except when the ambulance is out of service.
(i) If an operator is unable to provide service for more than 24 hours, the operator or agent shall notify the execu-tive director and submit an alternative plan, in writing and within 72 hours, for providing ambulance service for the operator's primary territory of coverage. The alternative plan shall be subject to approval by the executive director and shall remain in effect no more than 30 days from the date of approval. Approval by the executive director shall be based on whether the alternate plan will provide sufficient coverage to transport and provide emergency care for persons within the operator's primary territory. A written request for one or more extensions of the alternative plan for no more than 30 days each may be approved by the executive director if the operator has made a good faith effort but, due to circumstances beyond the operator's control, has been unable to completely remedy the problem.
(j) Each operator subject to public call shall have a telephone with an advertised emergency number that is an-swered by an attendant or other person designated by the operator 24 hours a day. Answering machines shall not be permitted.
(k) Each operator shall produce the ambulance service permit and service records upon request of the board.
(l) Each operator shall maintain service records for three years.
(m) Each operator shall ensure that documentation is completed for each request for service and for each patient receiving patient assessment, care, or transportation. Each operator shall furnish a completed copy or copies of each patient care report form upon request of the board.
(n) Each operator shall maintain a daily record of each request for ambulance response. This record shall include the date, time of call, scene location, vehicle number, trip number, caller, nature of call, and disposition of each patient.
(o) Each operator shall maintain a copy of the patient care documentation for at least three years.
(p) Each operator shall ensure that a copy of the patient care documentation for initial transport of emergency patients is made available to the receiving medical facility, within 24 hours of the patient's arrival.
(q) Each operator shall maintain a current duty roster that demonstrates compliance with K.S.A. 65-6135, and amendments thereto. The duty roster shall reflect appropriate staffing for the service and ambulance type as specified in K.A.R. 109-2-6 and 109-2-7.
(r) Each operator shall provide a quality improvement or assurance program that establishes medical review pro-cedures for monitoring patient care activities. This program shall include policies and procedures for reviewing patient care documentation. Each operator shall review patient care activities at least once each quarter of each calendar year to determine whether the ambulance service's attendants are providing patient care commensurate with the at-tendant's scope of practice and local protocols.
(1) Review of patient care activities shall include quarterly participation by the ambulance service's medical di-rector in a manner that ensures that the medical director is meeting the requirements of K.S.A. 65-6126, and amend-ments thereto.
(2) Each operator shall, upon request, provide documentation to the executive director demonstrating that the operator is performing patient care reviews and that the medical director is reviewing, monitoring, and verifying the activities of the attendants pursuant to K.S.A. 65-6126, and amendments thereto, as indicated by the medical director's electronic or handwritten signature.
(3) Each operator shall ensure that documentation of all medical reviews of patient care activities is maintained for at least three years.
(4) Within 60 days after completion of the internal review processes of an incident, each operator shall report to the board on forms approved by the board any incident indicating that an attendant or other health care provider functioning for the operator met either of the following conditions:
(A) Acted below the applicable standard of care and, because of this action, had a reasonable probability of causing injury to a patient; or
(B) acted in a manner that could be grounds for disciplinary action by the board or other applicable licensing agency.
(s) Each ambulance service operator shall develop and implement operational policies or guidelines, or both, that have a table of contents and address policies and procedures for each of the following topics:
(1) Radio and telephone communications;
(2) interfacility transfers;
(3) emergency driving and vehicle operations;
(4) do not resuscitate (DNR) orders, durable powers of attorney for health care decisions, and living wills;
(5) multiple-victim and mass-casualty incidents;
(6) hazardous material incidents;
(7) infectious disease control;
(8) crime scene management;
(9) documentation of patient reports;
(10) consent and refusal of treatment;
(11) management of firearms and other weapons;
(12) mutual aid, which means a plan for requesting assistance from another resource;
(13) patient confidentiality;
(14) extrication of persons from entrapment; and
(15) any other procedures deemed necessary by the operator for the efficient operation of the ambulance ser-vice.
(t) Each ambulance service operator shall provide the operational policies to the executive director, upon request.
(u) Each ambulance service operator shall adopt and implement medical protocols developed and approved in accordance with K.S.A. 65-6112, and amendments thereto. The medical protocols shall be approved annually.
(v) Each operator's medical protocols shall include a table of contents and treatment procedures at a minimum for the following medical and trauma-related conditions for pediatric and adult patients:
(1) Diabetic emergencies;
(2) shock;
(3) environmental emergencies;
(4) chest pain;
(5) abdominal pain;
(6) respiratory distress;
(7) obstetrical emergencies and care of the newborn;
(8) poisoning and overdoses;
(9) seizures;
(10) cardiac arrest;
(11) burns;
(12) stroke or cerebral-vascular accident;
(13) chest injuries;
(14) abdominal injuries;
(15) head injuries;
(16) spinal injuries;
(17) multiple-systems trauma;
(18) orthopedic injuries;
(19) drowning; and
(20) anaphylaxis.
(w) Each operator shall make available a current copy of the ambulance service's operational policies or guidelines and medical protocols to any person listed as an attendant and any other health care provider on the ambulance ser-vice's attendant roster.
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