TITLE 18 TRANSPORTATION AND HIGHWAYS
CHAPTER 3 MOTOR CARRIER GENERAL
PROVISIONS
PART 14 AMBULANCE SERVICES
18.3.14.1 ISSUING AGENCY: New Mexico Public Regulation Commission
(NMPRC).
[18.3.14.1
NMAC - Rp, 18.3.14.1 NMAC, 2/13/2015]
18.3.14.2 SCOPE:
A. This
rule applies to all ambulance services
subject to the jurisdiction of the
commission and is
in addition to all other applicable requirements of these rules.
B. In addition
to the exemptions stated in 65-2A-38 and 65-6-6
NMSA 1978, this rule does not apply to:
(1) agencies of the United States government or
(2) ambulance
services authorized in another state or country that
are engaged in interstate transportation of patients into or out
of New Mexico.
C. The
director shall determine, on a
case-by-case basis, whether this
rule applies to New
Mexico state agencies operating ambulance
services.
[18.3.14.2
NMAC - Rp, 18.3.14.2 NMAC, 2/13/2015]
18.3.14.3 STATUTORY AUTHORITY: Sections 65-2A-4
and 65-6-4 NMSA 1978.
[18.3.14.3 NMAC - Rp, 18.3.14.3
NMAC, 2/13/2015]
18.3.14.4 DURATION: Permanent.
[18.3.14.4
NMAC - Rp, 18.3.14.4 NMAC, 2/13/2015]
18.3.14.5 EFFECTIVE
DATE:
February 13,
2015, unless a later date is cited within a section.
[18.3.14.5
NMAC - Rp, 18.3.14.5 NMAC, 2/13/2015]
18.3.14.6 OBJECTIVE: The purpose
of this rule is to establish requirements for ambulance
services.
[18.3.14.6
NMAC - Rp, 18.3.14.6 NMAC, 2/13/2015]
18.3.14.7 DEFINITIONS:
In addition to the definitions in Sections 24-10B-3
and 65-6-2, and 7.27.2
NMSA 1978 and 18.3.1 NMAC, as used in this
rule:
A. advanced levels
means emergency
medical services above the New
Mexico Emergency Medical Technician (EMT) basic level including EMT intermediate, EMT paramedic, and special
skills which include
enhanced emergency
medical
services and critical care transport;
B. critical care transport (CCT) means
the inter-facility ambulance
transportation of patients whose needs require the continuation of critical
care and medical interventions or equipment ordered by
a licensed physician. CCT may be
provided only by an ambulance agency that has received special skill approval
by the department of health (DOH) emergency medical services (EMS) bureau and
EMS medical direction committee for CCT.
Examples of critical care include specialized ventilators, multiple
medications being monitored via intravenous (IV) pumps, intra-aortic balloon
pumps, external pacemakers and other medications and procedures as determined
by the department of health EMS bureau and the EMS medical direction committee.
C. emergency medical technician basic (EMT
basic) means
the pre-hospital
and
inter-facility care and treatment prescribed in the EMS scope of
practice found in 7.27.11 NMAC, Supplemental Licensing Provisions, that
can be performed by all licensed emergency
medical technicians;
D. emergency medical technician intermediate (EMT intermediate) means certain advanced pre-hospital
and
inter-facility care and treatment
prescribed in the
EMS scope of practice found in 7.27.11 NMAC, Supplemental Licensing Provisions, that may
be performed only by a person licensed by the EMS bureau as
an EMT intermediate and only under medical direction;
E. emergency medical services paramedic (EMT paramedic) means advanced pre-hospital assessment, and inter-facility care
and
treatment prescribed in the EMS scope of practice found in 7.27.11 NMAC, Supplemental Licensing Provisions, that
may be performed only by a
person licensed by the EMS bureau as an EMT paramedic and only under
medical direction;
F. emergency means the sudden occurrence or onset of what reasonably
appears to be a traumatic or medical
condition that manifests itself by symptoms of sufficient severity,
which may include
severe pain, that the
absence
of immediate medical
attention could reasonably be expected by a lay person to result in;
(1) jeopardy
of the person’s physical and or mental health;
(2) serious impairment of bodily
functions;
(3) serious dysfunction of any
bodily organ or part; or
(4) disfigurement to the person.
G. EMS means emergency
medical services.
H. EMS bureau is the emergency medical systems bureau in the New Mexico department of
health.
I. inter-facility transfer means
the transportation of a person between health care
facilities with the concurrence of a sending
and a receiving physician;
J. mutual aid means a written
agreement between
one municipality, county or emergency medical
service and other municipalities, counties or emergency medical
services for the purpose of ensuring
that adequate emergency medical
services exist throughout the state;
K. NEMSIS
means the national emergency medical services information system, the
federal EMS data collection system administered by the United State department
of transportation national highway traffic safety administration (NHTSA).
L. patient catchment
area means an area outside the territory
authorized by the operating
authority
issued by the commission that an ambulance service
is permitted to serve
in emergencies
or
pursuant to mutual aid agreements;
M. pre-hospital response time means the period in minutes that measures from the
time a dispatch agency has the necessary
information to dispatch an ambulance
service until the time an EMS
crew arrives at the scene
of
the emergency;
N. special event ambulance means an ambulance staffed with a minimum of two
licensed EMT’s, working under agreement or contract, in dedicated stand-by status
at a special event such as a football
game, concert, wildland fire event,
rodeo, movie set, or other event that will, under their public regulation
commission ((PRC) granted emergency transport authority for the
territory/catchment area, transport event participants, attendees, or workers.
[18.3.14.7
NMAC - Rp, 18.3.14.7 NMAC, 2/13/2015]
18.3.14.8 DUTY TO PROVIDE
SERVICE:
A. It
shall be unlawful for an ambulance
service, or any of its
personnel or agents, to refuse to provide service to a person in need of emergency medical
treatment or transportation, or to require advance payment prior to rendering such service.
An ambulance service and its personnel or agents may accept a refusal
for treatment or transport from a patient who has been informed of the
potential consequences of such a refusal.
B. When ambulance transport is requested or
determined to be necessary, an ambulance
service shall transport a patient requiring medical treatment to the
closest appropriate facility capable
of
providing definitive care and treatment, as determined by the
service’s medical director through
local EMS system protocol.
C. An ambulance service
shall give priority to
emergency response calls.
D. An ambulance service
shall be available twenty four
(24) hours a day, three hundred sixty five (365) days a year a year.
[18.3.14.8
NMAC - Rp, 18.3.14.8 NMAC, 2/13/2015]
18.3.14.9 MUTUAL
AID: Ambulance services
shall develop mutual aid plans with all
appropriate entities that may be implemented
anytime an ambulance service cannot respond to a call or if a disaster
or emergency occurs. Mutual aid may be provided:
A. in an emergency or disaster situation when requested by state or local
authorities;
B. when requested
by another EMS service, an EMT, or healthcare
facility during an emergency
and in accordance with established mutual aid agreements;
C. when requested
by a law enforcement agency or officer; or
D. when requested
by an official of a political subdivision of the state.
[18.3.14.9
NMAC - Rp, 18.3.14.9 NMAC, 2/13/2015]
18.3.14.10 OPERATIONS PLAN: Each ambulance
service shall have a written operations plan setting forth
its policies and procedures. The plan shall be periodically
updated and shall be available for inspection
by the EMS bureau and the commission
at all times. Such
a plan shall include at a minimum:
A. copies of all
operational guidelines and medical
protocols;
B. a
quality assurance plan;
C. personnel
requirements, to include a policy on
drug and alcohol testing for employees reporting for duty impaired or who have
been involved in a vehicle accident or other work related event;
D. copies
of all mutual aid agreements;
E. a
disaster or mass casualty plan;
F. infection
control procedures;
G. a
description of emergency medical dispatch capabilities;
H. standards for personnel
duty time and assuring a rested and
fit-for-duty-staff; and
I. anticipated pre-hospital
response times in the ambulance service’s
territory or patient catchment area, and a discussion of factors that
can cause delays in meeting anticipated response
times. Such factors may include:
(1) the geography
of
the territory;
(2) whether the service
uses volunteer or paid drivers;
(3) whether the territory
is urban or rural or both;
(4) stationing points for ambulances and crews;
(5) weather.
[18.3.14.10
NMAC - Rp, 18.3.14.10 NMAC, 2/13/2015]
18.3.14.11 MINIMUM
PERSONNEL REQUIREMENTS:
A. Ambulances:
(1) A minimum of two licensed EMTs from
the ambulance service shall be present at the scene of the emergency, except
that two EMTs need not be present at the scene for prearranged transfers of a
stable patient or in those situations where there are overlapping calls,
disasters, or similar circumstances which result in an insufficient number of
EMTs being available.
(2) A minimum of one EMT shall be in the
patient compartment at all times during patient care and transport.
B. Exceptions:
(1) An EMT is required to be aboard the ambulance but is
not required in the patient compartment of the ambulance when a member of a
neonatal intensive care team is attending a patient in a self- contained
newborn intensive care isolette.
(2) Subject to the policies of the service, additional
non-EMT medical personnel, functioning within the scope of their licensure and
the scope of skills and medications approved for the service by the EMS Bureau
and EMS medical direction committee, may accompany a patient in an ambulance
patient compartment, as long as one EMT is also present in the patient
compartment.
(3) For ambulances with special skill approval as critical
care units, one special skill critical care certified paramedic must be in the
patient compartment along with at least one other advanced provider; the second
advanced provider may be:
(a) a special skill critical care paramedic; or
(b) a nurse with appropriate training as approved by the
EMS agency medical director for the scope of skills and medications listed in
the critical care special skills application; or
(c) other advanced care provider, such as a physician,
certified nurse practitioner, physician assistant, respiratory therapist, or
other specially trained advanced caregiver appropriate for the care being
delivered, as approved by the ambulance service medical director for the scope
of skills and medications listed in the critical care special skills
application.
(4) For EMS Bureau approved community EMS or advanced
paramedic practice programs, at least one caregiver with the appropriate
training and certification as determined by the EMS bureau and approved by the
service medical director must attend and assess the patient.
C. Training coordinator required. Each ambulance service shall
designate an individual who shall coordinate the availability of appropriate
training programs and continuing education for ambulance service personnel.
D. Medical director required: Each ambulance service shall designate a medical director,
working under agreement or contract, who is trained and meets the requirements
for a medical director prescribed in 7.27.3 NMAC, Medical Direction for
Emergency Medical Services. If an
ambulance service is temporarily without a medical director, it shall make arrangements to establish temporary medical direction
with a local, regional or state EMS medical director. The service shall be limited to the skills
and medications allowed to be administered without medical direction by the EMS
scope of practice (7.27.11 NMAC) until appropriate medical direction is
established.
[18.3.14.11
NMAC - Rp, 18.3.14.11 NMAC, 2/13/2015; A,10/24/2023]
18.3.14.12 VEHICLE
LIST:
A. Each ambulance
service shall maintain at its operating location a list
of ambulances used in
its authorized operations. The list shall identify each ambulance by type (I, II, III), manufacturer, serial number, registration number, and other descriptive
information sufficient for
identification, and shall state whether the ambulance
is leased or owned.
B. An
ambulance service may only use ambulances on the vehicle
list for its regulated operations, unless the service is temporarily utilizing
a borrowed vehicle due to unusual and unforeseen circumstances (repair of
vehicles or other situations).
C. An ambulance service
shall update the list and
submit it to the commission within ten (10)
days of the date
on which an ambulance is either put
into service or taken out of service.
[18.3.14.12
NMAC - Rp, 18.3.14.12 NMAC, 2/13/2015]
18.3.14.13 VEHICLE STANDARDS: All ambulances
purchased, acquired, or placed into service
by an authorized EMS service after the effective
date of this rule shall meet or exceed
the General Services Administration (GSA) standards for operation, crash performance and safety
as defined in a national standard approved by the commission.
[18.3.14.13
NMAC - Rp, 18.3.14.13 NMAC, 2/13/2015]
18.3.14.14 REQUIRED EQUIPMENT:
When an ambulance is dispatched, it shall carry and have readily available in good working
order:
A. one semi-automatic defibrillator
for EMT basic and EMT intermediate use or one semi-automatic/manual
defibrillator monitor for paramedic use, as specified in the EMS scopes
of practice and local medical
protocol; (note: these devices
require specific training
and medical director approval
prior
to use);
B. suction
systems, which include:
(1) on-board suction
unit that meets GSA standards;
(2) portable,
manual
- or
battery - powered suction unit;
C. oxygen delivery and patient ventilation devices, which include:
(1) fixed, on-board
oxygen supply which meets GSA specifications;
(2) portable oxygen devices
which are capable of delivering at least sixty (60) minutes of oxygen at a flow rate of 10 liters per minute, or at a minimum, two D cylinders; at least one
cylinder will be designated primary and configured with a yoke type regulator, liter control and contents
supply gauge;
(3) ventilation devices
including manual, self-filling, bag-valve-mask (BVM) ventilation devices,
in adult, child, infant and
neonatal sizes; the BVM shall be equipped with a sufficient supply of see through adult, child, infant, and neonatal masks; electronic or colormetric end
tidal carbon dioxide detection equipment for adults and pediatric patients are
also required;
D. Splints, including
as a minimum:
(1) one adult traction splint with limb
supporting slings, padded ankle hitch and traction device;
(2) two sets of rigid
splinting devises, or equivalents, suitable for the immobilization of upper or
lower extremities, in adult, child and infant sizes;
E. spine immobilization devices, one half-body device and two full-body devices, with suitable strapping, and head immobilization devices; commercial devices that
stabilize head, neck, and back as one
unit, may be substituted;
F. one commercially available obstetrical kit, or equivalent;
G. one sphygmomanometer in adult, child and infant sizes, or one sphygmomanometer capable of accepting various
sizes of cuffs (adult, child, and
infant); in the latter case, a sufficient supply of cuffs in each of the identified
sizes shall be available;
H. one stethoscope;
I. two double D-cell, or equivalent, flashlights with batteries;
J. one all-purpose multi-level
ambulance stretcher,
with safety straps and crash-resistant locking/securing mechanism; the locking
mechanism in the vehicle shall be the mechanism
designed for the
stretcher being used; locking mechanisms for other stretchers or locally produced
mechanisms are not allowed; in addition, the mattress
shall be fluid impervious;
K. one minimum
ten (10)-pound, or two minimum five
(5)-pound 1A20BC, or equivalent, fire extinguisher; a current inspection
tag will be displayed on all fire extinguishers;
L. one two-way mobile
radio capable of direct communication between
the EMT and the receiving medical facility, on ultra-high frequency, on federal communications commission-designated
emergency medical radio service
(EMRS) frequencies, and which is
compatible
with the state emergency
medical services radio communications system (EMSCOM), and is
approved by the emergency medical services bureau (EMSB) and a copy
of the EMSB/DOH “EMS communications
system (EMSCOM) manual;”
M. scene safety protective equipment including:
(1) six (6)
highly visible lighted electric or chemical warning devices
suitable for nighttime use;
(2) reflective apparel
meeting American National Standards Institute
standards for all personnel;
(3) a current edition of the “North American emergency response guidebook,” a guidebook for first
responders during the initial phase of a hazardous materials/dangerous goods incident;
N. uniforms or other apparel
or means of identification of a distinct
design or fashion to be worn
by ambulance service personnel when on duty
to identify
them
as EMS providers and to identify
the
level of EMS care for which the providers are licensed.
[18.3.14.14
NMAC - Rp, 18.3.14.14 NMAC, 2/13/2015]
18.3.14.15 REQUIRED SUPPLIES: When an ambulance is dispatched, it shall
carry adequate quantities of readily available equipment and supplies to ensure
the level of care described in the ambulance service protocols signed by the
physician medical director, including but not limited to:
A. twelve (12) sterile
bandages, soft roller, self-adhering type, or equivalent
to a total length of 24 yards;
B. six (6) triangular bandages or equivalent product or
substitute;
C. one box adhesive bandages;
D. one pair
trauma
shears and one penlight (either in the ambulance or on the EMT’s person);
E. one pair sterile
scissors used for cutting the umbilical
cord during a delivery;
commercially available sterile cutting devices
may be
substituted;
F. six (6)
sterile trauma dressings in large and small
sizes;
G. fifty
(50), or adequate supply, sterile
4" x 4", or larger,
sponges;
H. four (4) rolls
of adhesive tape;
I. four (4) cold packs and four (4) heat packs;
J. two sterile burn sheets,
individually wrapped;
K. four (4) sterile
burn dressings;
L. two sets of oropharyngeal airways in sizes zero (0) through five (5) (infant through adult),
and one set of nasopharyngeal airways (28FR, 32FR, 34FR, and 36FR, all for
adult use);
M. three (3) sterile
suitable occlusive dressings;
N. two sets of rigid cervical collars of plastic, not foam, construction in various sizes for
adult, child and infant;
commercially
available immobilization devices
are allowed;
O. a sufficient quantity of appropriate airborne and blood-borne infection control supplies, as recommended by
the
centers for disease
control and prevention, including gloves,
masks, gowns, caps, eye protection, sharps containers, and
other equipment to protect all patient care providers
dispatched with the ambulance;
in addition, appropriate hand-washing supplies and disinfectant
shall be available on the vehicle;
P. at least two disposable high-concentration oxygen masks and two disposable
nasal cannulas in adult and
child sizes and at
least two packages of oxygen supply
tubing;
Q. appropriate large and small bore
tip suction catheters
(6f-14f), rigid tip suction catheter, and hoses;
R. one bulb suction device;
S. one emesis basin or large plastic bag;
T. two liters of sterile
water, normal saline, or other appropriate irrigation solution; and
U. two clean sets of linen, including at
least two blankets and pillows
(or suitable pillow
substitutes) at all times.
[18.3.14.15
NMAC - Rp, 18.3.14.15 NMAC, 2/13/2015]
18.3.14.16 MEDICATIONS:
An ambulance
service shall adhere to the appropriate
EMS
scopes of practice for EMS personnel
regarding approved medications, provided the medications are
listed in the service’s treatment guidelines or protocols and approved by the
local physician medical director for use by the ambulance service. In some
cases the medical direction committee
may authorize special skills that allow unique medications not found in the scopes of practice. In such cases, these medications are allowed on the vehicle
for use by the authorized personnel, as specified
by the special skills approval
letter provided by the
EMS medical direction committee
and
the EMS bureau.
In all cases, medications shall only
be administered under medical
direction, as specified in the scopes of practice and any
special skills approval letters.
[18.3.14.16
NMAC - Rp, 18.3.14.16 NMAC, 2/13/2015]
18.3.14.17 PORTABLE
MEDICAL KITS: In addition
to the equipment and
supplies required by this
rule, every ambulance shall carry at
least one or more portable medical
kits, consistent with medical
protocol. Each
portable medical
kit shall contain the items listed below, or their appropriate
equivalent, although an ambulance
service may add other items
based on training levels and local
protocols.
A. One sphygmomanometer in
adult, child and infant sizes, or one sphygmomanometer capable of accepting various
sizes of cuffs (adult, child, and infant).
In the latter case, a sufficient supply of cuff in each of the identified sizes shall be available.
B. one stethoscope;
C. four (4) soft roller, self-adhering type bandages;
D. three (3) triangular bandages or equivalent product/substitute;
E. two trauma dressings;
F. ten (10) 4"
x 4" gauze sponges;
G. one roll adhesive tape;
H. one pair of trauma shears
(either in the ambulance or on the EMT’s person);
I. one penlight (either in the ambulance or on the EMT’s person);
J. two
sterile burn dressings;
K. one adult-size bag-valve-mask (BVM)
ventilation device. Neonate, infant and child BVM
must be incorporated in the kit
or
readily available aboard the vehicle;
L. One set of oropharyngeal airways, sizes 0 through 6 (neonatal through adult);
M. Two sterile, petroleum gel-impregnated gauze dressings, or other suitable
occlusive dressings;
N. Multiple pair of disposable assessment and treatment gloves;
[18.3.14.17
NMAC - Rp, 18.3.14.17 NMAC, 2/13/2015]
18.3.14.18 SPECIAL
SKILLS; Critical Care Transport (CCT),
and PRC certified services providing Advanced Practice/Community EMS: An ambulance service
wishing to provide special
skills of EMS shall:
A. For special skills, submit
a special skills application to the
EMS bureau, as provided in 7.27.2 NMAC,
Licensing of Emergency Medical Services Personnel; if the
special skills application is
approved and changes the potential level of reimbursement
sought, for example when a basic EMT ambulance service will now perform an
advanced level medical intervention, the service must file an application for a change in tariff
with the commission if it seeks reimbursement for
advanced levels service. Personnel performing special skills for an
ambulance service must be an employee or a volunteer for the service and listed
as an employee or volunteer on the annual service report.
B. For
a service with EMS bureau and EMS medical direction approval to provide CCT,
the ambulance service must file an application with the commission for the
appropriate tariff(s) to seek reimbursement for CCT.
[18.3.14.18
NMAC - Rp, 18.3.14.18 NMAC, 2/13/2015]
18.3.14.19 ADDITIONAL REQUIREMENTS FOR ADVANCED LEVEL SERVICES:
A. Additional requirements. An ambulance
service shall meet the following additional requirements
before
it provides any advanced level treatments
or
procedures, including special
skills.
(1) If an ambulance
service represents itself or labels
its vehicles as a provider of service at any level above EMT basic, that advanced level of care and treatment
shall be appropriately provided twenty four (24) hours a day, three hundred sixty five (365) days
a year, except in
those unusual situations where there are overlapping calls, disasters, or similar unforeseen circumstances.
(2) When
advanced level care and treatment is provided by an ambulance service, at least one person trained and licensed
at that advanced level shall respond to the scene; an advanced provider may be one
of the two minimum EMT responders to the emergency,
and an advanced level provider must accompany the patient in the patient compartment of the ambulance
during transport.
(3) If advanced level services are to be provided, the ambulance
shall, in addition to other requirements, carry
supplies and equipment appropriate
to the level of
service and consistent with the relevant EMS scopes of practice
and medical director approved local protocols.
B. Additional supplies and equipment. The following additional items are required for advanced level ambulance services:
(1) one semi-automatic monitor-defibrillator for
EMT intermediate or manual/semi automatic monitor
- defibrillator for EMT paramedic,
as specified in the EMS scopes
of
practice and local
medical
protocol;
(note: these devices require
specific training and medical director approval prior to use);
(2) assorted arm boards in infant,
child and adult
sizes;
(3) assorted intravenous catheters
in sizes 14-24 gauge;
(4) assorted macro-drip IV devices to infuse intravenous
fluids into adults
(fifteen (15) drop per cc or
better);
(5) assorted micro-drip IV devices to manage IV administration to infants and children;
thesemay be burettes, micro-drip tubing or in-line volume controllers;
(6) two
intra-osseous access devices;
(7) one pediatric
drug dosage chart or
tape; this may include charts listing the drug dosages
in milliliters
or
milligrams per kilogram,
pre-calculated doses based on weight,
or
a tape that generates appropriate equipment sizes and drug
doses based on the patient's height or weight;
(8) assorted intravenous (IV) fluids that
comply
with the EMS scopes of practice;
these fluids shall be stored within the manufacturers recommended temperature range at
all times until use;
(9) one laryngoscope with straight
or curved blades in infant, child and adult sizes; spare bulbs and batteries shall be
readily available;
(10) two adult
stylets for endotracheal tubes; if service has special skill approval for
pediatric (under age 12) intubation, two pediatric stylets must be in stock;
(11) one each pediatric and adult magill forceps;
(12) assorted endotracheal tubes in sizes: uncuffed
2.5-6.0 if service has special skill approval for pediatric (under age twelve
(12)) intubation and cuffed 6.0-8.0;
(13) assorted medications and resuscitation medications that
are allowed in the EMS scopes of
practice and local medical protocol; these medications shall be stored within the manufacturer's recommended temperature range at
all times;
(14) adult and pediatric
sized supraglottic/laryngeal airways, and multi-lumen airways as approved by
service medical director.
[18.3.14.19
NMAC - Rp, 18.3.14.19 NMAC, 2/13/2015]
18.3.14.20 NON-EMERGENCY
AND SCHEDULED AMBULANCE TRANSPORT SERVICE:
An ambulance
service may provide
scheduled pre-hospital or inter-facility
transport of patients,
including physically or mentally impaired patients or non-ambulatory patients, who cannot be transported by common means of transportation and who
require the attending care of qualified medical personnel. Vehicles that are capable of
transporting gurneys, but are not certified ambulances, shall not transport
recumbent patients requiring medical monitoring. An ambulance
service providing such service shall:
A. transport
patients in ambulances that
meet the requirements
of
this rule; and
B. provide, at a minimum, one EMT of the appropriate level for the
transport and one qualified driver; the EMT shall
be in the patient compartment attending the patient whenever a patient
is being cared for or transported.
C. Stretcher
vans; wheelchair vans: use; restrictions: A stretcher van may transport a person
who:
(1) Needs
routine transportation to or from a medical appointment or service if that
person is
convalescent
or otherwise non-ambulatory and does not require medical monitoring en route to the destination
facility,
or aid. care or treatment during transport.
(2) Is
an inpatient at a facility and needs transportation to another hospital for
diagnostic tests
if
that person’s physician authorizes the use of a stretcher van.
D. A stretcher van or wheelchair van shall not
transport a person who:
(1) Is being administered intravenous
fluids.
(2) Needs
oxygen unless that person’s physician has prescribed oxygen as a
self-administered therapy.
(3) Needs
suctioning.
(4) Demonstrates
signs of a visible injury and has not yet
been evaluated by a physician.
(5) Is
experiencing an acute condition or the exacerbation of a chronic condition.
(6) Needs
to be transported from one hospital to another hospital if the destination
hospital is
the
same level or a higher level as the hospital of origin.
(7) Is
being medically monitored at the sending facility and will continue to be
medically
monitored at the
destination facility.
[18.3.14.20
NMAC - Rp, 18.3.14.20 NMAC, 2/13/2015]
18.3.14.21 SPECIAL
EVENT AMBULANCE:
A. A dedicated special event ambulance working under agreement or contract with the event organizer or event command at an event such as a football
game, concert, wildland fire event, rodeo, movie set or other event must be staffed
with a minimum of two licensed EMT’s and be properly equipped as described in
this rule; the ambulance may, under their commission granted emergency
transport authority for the territory/catchment area, transport event
participants, attendees, or workers. Transports from
these events are emergency transports, and may not be considered inter-facility
transfers unless the inter-facility transfer definition is met. Dedicated
stand-by status ambulances shall not respond to emergency calls off site of the
event except in cases of disaster or other unusual medical circumstance where
mutual aid is requested and granted. An
EMS agency without commission granted emergency transport authority providing
stand-by EMS for an event shall work with the area’s approved PRC emergency
transport ambulance provider to ensure proper transport of patients, or
transport only in the circumstances found in Paragraph (2) of Subsection B of
7.27.10.16.
B. Non-dedicated stand-by
status units may respond to emergency
calls off site of the event.
[18.3.14.21
NMAC - Rp, 18.3.14.21 NMAC, 2/13/2015]
18.3.14.22 ANNUAL SERVICE
REPORT AND LOCAL FUNDING
PROGRAM APPLICATION: The EMS bureau will mail
an EMS annual service report form including
an EMS Fund Act local funding
program application to all ambulance services
on November 1 each year. Each ambulance service shall complete the
form
and return it to the EMS bureau no later
than
January 15 of the
following year.
The EMS bureau will distribute a copy of the annual service
report from each ambulance
service to the commission. The annual
service report shall contain:
A. the names of all individuals serving as EMS personnel,
including employed or volunteer status as appropriate, this will include their licensure
level and expiration date and the completion date
of the emergency vehicle operator’s course required by this
rule;
B. the names of all
non-EMT drivers and the completion date of
the driving course required by this rule;
C. the name
and physician license number of the
service's medical director; if an ambulance service has
not previously
submitted the
physician's credentials to
the EMS bureau,
it shall include them with
the
annual report; any substantial change
in these credentials shall be forwarded to the EMS bureau for review by the state EMS medical director;
D. the name of the service's training coordinator;
E. a description of all ambulances currently being used to transport patients, including their
dates of manufacture, makes, license
plate numbers and mileage;
F. other information as may
be required by the EMS bureau or the commission;
G. a certification of an annual
safety inspection of all
ambulances including the date, name and location of the
certified mechanic performing the inspection, as outlined in 18.3.4.14 NMAC.
[18.3.14.22
NMAC - Rp, 18.3.14.22 NMAC, 2/13/2015]
18.3.14.23 MAINTENANCE, PRESERVATION, AND RETENTION OF RECORDS:
In addition to the requirements in 18.3.7.14
NMAC, every ambulance service shall maintain accurate and separate records of its services in New Mexico,
including but not limited to:
A. driver records including current licenses, history of department of
transportation (DOT) physical
examinations, approved firefighter fitness exam certification, or
other approved physician
certifications, and emergency
vehicle operator training history;
ambulance services staffed primarily by volunteers may apply for an exemption
to the physical examination requirement if proof of financial hardship is
provided to the commission; B. EMS personnel
licensure;
C. statement of employment or volunteer status,
including employment
start and stop dates;
D. records of equipment, such as reports, repair and maintenance
records, equipment lists, vehicle titles, and registration certificates;
E. complete accounts;
F. organized records of all ambulance runs, including
a copy of the patient care record.
[18.3.14.23
NMAC - Rp, 18.3.14.23 NMAC, 2/13/2015]
18.3.14.24 QUALITY ASSURANCE: Each ambulance service
shall have a written quality assurance program, which shall provide for.
A. patient care records retention: an ambulance
service shall retain pre-hospital patient care records for seven (7) years, as approved
by local medical protocol;
B. reporting: ambulance services
shall complete a patient run report for each patient contacted during an emergency response
or inter-facility transport;
the minimum data elements
from these reports, as identified
by the EMS bureau,
shall be compiled to the extent possible and submitted to the
pre- hospital data collection system at the EMS bureau as prescribed in 7.27.4 NMAC,
Emergency Medical Services Fund Act;
C. minimum patient information required upon patient delivery to the destination facility:
pursuant to ambulance
service protocol, an ambulance
service shall communicate,
electronically or in writing, clinical patient information to the intercepting ambulance or receiving facility at the time of patient transfer
or delivery, if available:
(1) ambulance
unit number, EMT name
and level of licensure;
(2) patient
age and sex;
(3) patient's
chief complaint
or EMT’s primary impression;
(4) a
brief history of the present illness,
including scene assessment and mechanism of injury;
(5) major
past illnesses;
(6) patient's mental
status;
(7) patient's
baseline vital signs;
(8) pertinent findings of the physical examination;
(9) description of emergency medical
care that has been provided
for the patient, including that
provided by any first response units; and
(10) the
patient's response to the emergency medical
care received.
D. completed patient care records: an ambulance service
shall deliver an electronic or written copy of the completed
pre-hospital patient care record to the
receiving facility emergency department
for inclusion in the patient's permanent
medical record upon delivery of the patient
to the hospital; in the event
the
unit is dispatched on another call, the patient
care record shall be delivered as soon as possible
after that call, but not later than the
end of a shift or twenty four
(24) hours after the transportation and treatment of the patient;
E. medical protocols and operational
guidelines: the ambulance service medical director shall develop
and approve medical
protocols and operational
guidelines which should include procedures for obtaining on-line medical direction; service medical
protocols shall not exceed the New Mexico EMS scope of practice, unless a
special skill has been granted; medical protocols and operational guidelines
should be developed in collaboration with receiving hospitals and EMS agencies
within the territory or patient catchment area; adult and pediatric patient protocols
shall be on the unit at all times, in electronic or hard copy form;
F. medical
director review of patient care: an
ambulance service medical director shall review patient care records at least quarterly to determine whether appropriate medical care is being provided; the medical director shall document the
steps taken during the review;
subsequent reviews will include an evaluation of whether appropriate follow-up has been accomplished; receiving hospitals and
other EMS agencies within the patient catchment area should be invited to
participate in these reviews when appropriate;
G. confidentiality of medical records: an ambulance service may
only release patient care records as provided
by state and federal law, including but not limited to the Health
Insurance Portability and Accountability Act (HIPAA).
[18.3.14.24
NMAC - Rp, 18.3.14.24 NMAC, 2/13/2015]
18.3.14.25 REISSUANCE OF CERTIFICATE:
Sixty (60) days prior to expiration of its
certificate, an ambulance service
shall submit to the director
an application for reissuance of its ambulance certificate containing
the information required by Paragraphs (1) through (10) of Subsection A of 18.3.2.13 NMAC. The director shall prepare a notice of application as provided in 18.3.2.15 NMAC. The director shall reissue the certificate for the period of time prescribed in Section
65-6-5 NMSA 1978 unless staff or an interested person objects. If there is an objection, the director shall process the application in accordance with 18.3.2.16 NMAC.
[18.3.14.25
NMAC - Rp, 18.3.14.25 NMAC, 2/13/2015]
18.3.14.26 TRANSITION TO NEW EQUIPMENT
REQUIREMENTS: Ambulance
services utilizing equipment
that does not meet the
requirements of this rule
shall have thirty (30) days from the
effective date of this rule to meet the equipment requirements of this
rule or apply for a variance from or waiver
of such requirements.
[18.3.14.26
NMAC - Rp, 18.3.14.26 NMAC, 2/13/2015]
HISTORY OF 18.3.14
NMAC:
Pre-NMAC history: The material
in this
rule was previously filed with the state records center as: SCC 68-16, NM Motor Carrier
Act, Rules and Regulations, Effective Sept. 1, 1967, filed 3-14-68; SCC 68-50, General Order No. 38, filed 6-13-68;
SCC 71-3, General
Order No. 40, Docket No. 532, filed 5-24-71;
SCC 71-5, General
Suspension Order No. 41, Docket No. 540, filed 8-20-71;
SCC 71-6, NM Motor Carrier Act, Rules and Regulations, Effective July 1,
1971, filed 9-21-71; SCC-72-13, NM Ambulance Tariff No. 3-B Issued May 8, 1972, filed 10-2-72;
SCC 73-1, NM Motor Carrier Act, Rules and Regulations, filed 6-14-73;
SCC 74-1, NM Motor Carrier Act, Rules and Regulations, Effective July 1,
1973, filed 2-5-74; SCC 75-1, NM Motor Carrier
Act, Rules and Regulations, Effective Jan. 1, 1975, filed 4-17-75;
SCC 75-2, Second Revised
General Order No. 35, In the Matter
of Standards for Ambulance
Operators, filed 7-
11-75;
SCC 75-3, NM Motor Carrier Act, Rules and Regulations (Rev.), Effective Jan. 1, 1975, filed 9-19-75;
SCC 76-1, NM Motor Carrier Act, Rules and Regulations, Effective April 1,
1976, filed 4-15-76;
SCC 77-1, NM Motor Carrier Act, Rules and Regulations, Effective Jan. 1, 1977, filed 1-25-77; SCC-77-4, NM Ambulance Tariff No. 3-B Issued May 8, 1972, (Reissue), filed 6-6-77;
SCC 78-1, Third Revised
General Order No. 35, In the Matter of Standards for Ambulance
Operators, filed 9-
5-78;
SCCMC Rule No. 45, Ambulance Operators
are Authorized to Provide the Following Service
Notwithstanding
Territorial
Restrictions Contained in their Certificates, filed 3-5-82;
SCCMC Rule No. 49, Ambulance Services
- Duty to Provide
Service, filed 3-5-82;
SCC 84-5-TD, Standards for Ambulance
Operators - Seventh
Revised General Order No. 35, filed 6-28-84;
SCC 92-5-TR, Ambulance Standards Rule, filed 8-18-92;
SCC Rule 252, Ambulance Standard,
filed 1-5-93; SCC Rule 252,
Ambulance Standards, filed 10-27-93.
HISTORY OF REPEALED MATERIAL:
SCC 68-16, NM Motor Carrier Act, Rules and Regulations, Effective Sept. 1, 1967 (filed 3-14-68); SCC 68-50, General Order No. 38(filed 6-13-68);
SCC 71-3, General
Order No. 40, Docket No. 532 (filed 5-24-71);
SCC 71-5, General
Suspension Order No. 41, Docket No. 540 (filed 8-20-71);
SCC 71-6, NM Motor Carrier Act, Rules and Regulations, Effective July 1,
1971 (filed 9-21-71); SCC-72-13, NM Ambulance Tariff No. 3-B Issued May 8, 1972 (filed 10-2-72);
SCC 73-1, NM Motor Carrier Act, Rules and Regulations (filed 6-14-73);
SCC 74-1, NM Motor Carrier Act, Rules and Regulations, Effective July 1,
1973 (filed 2-5-74); SCC 75-1, NM Motor Carrier
Act, Rules and Regulations, Effective Jan. 1, 1975 (filed 4-17-75);
SCC 75-2, Second Revised
General Order No. 35, In the Matter of Standards
for Ambulance Operators (filed
7-11-75);
SCC 75-3, NM Motor Carrier Act, Rules and Regulations (Rev.), Effective Jan. 1, 1975 (filed 9-19-75);
SCC 76-1, NM Motor Carrier Act, Rules and Regulations, Effective April 1,
1976 (filed 4-15-76);
SCC 77-1, NM Motor Carrier Act, Rules and Regulations, Effective Jan. 1, 1977 (filed 1-25-77); SCC-77-4, NM Ambulance Tariff No. 3-B Issued May 8, 1972, (Reissue) (filed 6-6-77);
SCC 78-1, Third Revised
General Order No. 35, In the Matter of Standards for Ambulance
Operators (filed 9-
5-78);
SCCMC Rule No. 45, Ambulance Operators
are Authorized to Provide the Following Service
Notwithstanding
Territorial
Restrictions Contained in their Certificates (filed 3-5-82);
SCCMC Rule No. 49, Ambulance Services
- Duty to Provide
Service (filed 3-5-82);
SCC 84-5-TD, Standards for Ambulance
Operators - Seventh Revised
General Order No. 35 (filed 6-28-84); SCC 92-5-TR, Ambulance Standards
Rule (filed 8-18-92);
SCC Rule 252, Ambulance Standard
(filed 1-5-93); SCC Rule 252,
Ambulance Standards
(filed 10-27-93);
18 NMAC 4.2,
Ambulance and Medical Rescue Services (filed 12-16-97)
repealed 1-1-05.
18.3.14
NMAC, Motor Carrier General Provisions - Ambulance Services, filed 12-16-04,
repealed 2/13/2015.
Other history:
SCC Rule 252, Ambulance
Standards (filed 10-27-93)
renumbered, reformatted and replaced by 18 NMAC 4.2, Ambulance and Medical Rescue Services, effective
1-1-98;
18 NMAC 4.2,
Ambulance and Medical Rescue Services (filed 12-16-97) renumbered, reformatted and replaced by 18.3.14 NMAC, Ambulance Services,
effective 1-1-05.
18.3.14
NMAC, Motor Carrier General Provisions - Ambulance Services, filed 12-16-04,
repealed 2/13/2015.