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, 2-13-15]
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, 2-13-15]
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, 2-13-15]
18.3.14.4 DURATION: Permanent.
[18.3.14.4 NMAC - Rp, 18.3.14.4 NMAC, 2-13-15]
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, 2-13-15]
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, 2-13-15]
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 (2)
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, 2-13-15]
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, 2-13-15]
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, 2-13-15]
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, 2-13-15]
18.3.14.11 MINIMUM PERSONNEL
REQUIREMENTS:
A. Ambulances.
(1) A minimum of two (2) licensed
EMTs from the ambulance service shall be present at the scene of the emergency, except that two (2) EMTs need not
be present at the scene for prearranged transfers of a stable patient or in those unusual situations where there are overlapping calls, disasters, or similar unforeseen
circumstances which result
in
an insufficient
number of EMTs being available.
(2) A
minimum of one (1)
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 (1) EMT is also present
in the
patient compartment.
(3) For
ambulances with special skill approval as critical care units, one (1) special
skill critical care certified paramedic must be in the patient compartment
along with at least one (1) 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 (1) 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, 2-13-15]
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, 2-13-15]
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, 2-13-15]
18.3.14.14 REQUIRED EQUIPMENT: When an ambulance is
dispatched, it shall carry and have readily available in good working
order:
A. one
(1) semi-automatic
defibrillator for
EMT basic and EMT intermediate use or
one (1) 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 (2) D cylinders;
at least one (1) 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 (1) adult
traction splint with limb supporting slings, padded ankle hitch and traction
device;
(2) two (2) 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 (1) half-body
device and two (2) full-body devices, with suitable strapping, and head immobilization devices; commercial devices that
stabilize head, neck, and back as one
(1) unit, may be
substituted;
F. one (1)
commercially
available obstetrical kit, or equivalent;
G. one (1) sphygmomanometer in adult, child and infant
sizes, or one (1) 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 (1) stethoscope;
I. two (2) double D-cell,
or equivalent, flashlights with batteries;
J. one (1)
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 (1) minimum ten (10)-pound, or two (2) minimum five
(5)-pound 1A20BC, or equivalent, fire extinguisher; a current inspection
tag will be displayed on all fire extinguishers;
L. one (1) 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, 2-13-15]
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 (1) box adhesive bandages;
D. one (1) pair trauma shears
and one (1) penlight (either in the ambulance
or on the EMT’s person);
E. one (1) 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
(2) sterile burn sheets,
individually wrapped;
K. four (4) sterile burn dressings;
L. two (2) sets of oropharyngeal
airways in sizes zero (0)
through five (5) (infant through adult), and one (1) set of nasopharyngeal
airways (28FR, 32FR, 34FR, and 36FR, all for adult use);
M. three (3) sterile
suitable occlusive dressings;
N. two (2) 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 (2) disposable
high-concentration oxygen masks and two (2) disposable
nasal cannulas in adult and
child sizes and at
least two (2) packages of oxygen supply
tubing;
Q. appropriate large and small bore
tip suction catheters
(6f-14f), rigid tip suction catheter, and hoses;
R. one (1) bulb suction
device;
S. one (1) emesis basin or large plastic bag;
T. two (2) liters of sterile
water, normal saline, or other appropriate irrigation solution; and
U. two (2) clean sets of linen, including at least two (2) blankets
and
pillows (or suitable pillow substitutes) at all times.
[18.3.14.15 NMAC - Rp, 18.3.14.15 NMAC, 2-13-15]
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, 2-13-15]
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 (1) 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 (1) sphygmomanometer in adult,
child and infant
sizes, or one (1) 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 (1) stethoscope;
C. four (4) soft roller, self-adhering type bandages;
D. three (3) triangular bandages or equivalent product/substitute;
E. two (2) trauma
dressings;
F. ten (10) 4"
x 4" gauze sponges;
G. one (1) roll adhesive tape;
H. one (1) pair of trauma
shears (either in the ambulance or on the EMT’s person);
I. one (1) penlight (either in the ambulance or on the EMT’s person);
J. two
(2) sterile burn dressings;
K. one (1) 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 (1) set of oropharyngeal
airways, sizes 0 through 6 (neonatal
through adult);
M. Two (2) 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, 2-13-15]
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, 2-13-15]
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 (1) person trained and licensed
at that advanced level shall respond to the scene; an advanced provider may be one
(1) of the two (2) 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 (1)
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 (2)
intra-osseous access devices;
(7) one (1) 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 (1) laryngoscope
with straight or curved blades in infant, child and adult
sizes; spare bulbs and batteries
shall be readily available;
(10) two (2) adult stylets for endotracheal tubes; if
service has special skill approval for pediatric (under age 12) intubation, two
(2) pediatric stylets must be in stock;
(11) one (1) 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, 2-13-15]
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 (1)
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, 2-13-15]
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 (2) 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, 2-13-15]
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, 2-13-15]
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, 2-13-15]
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, 2-13-15]
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, 2-13-15]
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, 2-13-15]
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 2-13-15.
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 2-13-15.