All Regulations (updated March 2004)
(Updated effective 3-5-04, 109-3-2)

109-1-1 Definitions
109-1-2 Medical Advisor

109-2-1 Service Director
109-2-2 Application for ambulance service permit and ambulance vehicle license, permit renewal and license renewal
109-2-3 Revoked
109-2-4 Display of permits, licenses, and certificates
109-2-5 Ambulance service operational standards
109-2-6 Classes of ambulance services
109-2-7 Ground and Air Ambulance staffing
109-2-8 Standards for type I and II ambulance vehicles and equipment
109-2-9 Variances
109-2-10 Revoked
109-2-11 Standards for type V ambulance vehicles and equipment
109-2-12 Standards for rotorwing ambulance aircraft and equipment
109-2-13 Standards for fixed-wing ambulance aircraft and equipment
109-2-14 Temporarily certified attendants
109-2-15 Ambulances based outside of Kansas

109-3-1 Standards for ambulance attendants and drivers
109-3-2 Outpatient medical emergencies

109-4-1 - 109-4-3 Revoked

109-5-1 Continuing Education
109-5-2 Documentation for continuing education
109-5-3 Continuing Education approval for providers
109-5-4 Regaining expired certification

109-6-1 Minimum training requirements for temporary certification
109-6-2 Renewal of attendant, training officer, and instructor-coordinator certificates
109-6-3 Attendant cerfification expiration and renewal

109-7-1 Schedule of Fees

109-8-1 Examinations

109-9-1 Instructor-Coordinator Certification
109-9-2 - 109-9-3 Revoked
109-9-4 Requirements for acceptance into an instructor-coordinator initial course of instruction
109-9-5 Revoked

109-10-1 Curriculum approval
109-10-2 Long-term accreditation of training programs conducting initial courses
109-10-3 Late enrollment
109-10-4 Student transfers
109-10-5 Inter-active television
109-10-6 Requiring training equipment and supplies

109-11-1 First Responder course approval
109-11-2 Revoked
109-11-3 Emergency medical technician course approval
109-11-4 Emergency medical technician-intermediate course approval
109-11-5 Emergency medical technician-defibrillator course approval
109-11-6 Mobile intensive care technician course approval
109-11-7 Instructor-coordinator course approval
109-11-8 Successful completion of a course of instruction
109-11-9 Instructor qualifications
109-11-10 Emergency medical technician-basic bridge course approval

109-12-1 - 109-12-2 Revoked

109-13-1 Training Officers
109-13-2 - 109-13-3 Revoked

109-14-1 Certification of entities which distribute DNR identifiers

Article 1.--DEFINITIONS

 

109-1-1 Definitions.  The following words and phrases shall have the following meanings as used in this agency’s regulations.

 (a) “Administrator” means the administrator of the emergency medical services board.

 (b) “Air ambulance” means a fixed-wing or rotorwing aircraft that is specially designed, constructed or modified, maintained, and equipped to provide air medical transportation of patients.

 (c) “Air medical advisor” means a physician as defined by K.S.A. 65-6112, and amendments thereto, who meets these requirements:

 (1)  Is trained and experienced in care consistent with the air ambulance service’s mission statement; and

 (2)  is knowledgeable in altitude physiology and the complications that may arise due to air medical transport.

 (d) “Air medical personnel” means the attendants listed with the air ambulance service, specialty patient care providers specific to the mission, and the pilot or pilots necessary for the operation of the aircraft.

 (e) “Airway maintenance” as used in K.S.A. 65-6121 and amendments thereto, and as applied to the authorized activities of an emergency medical technician-intermediate, is the use of any invasive oral equipment and procedures necessary to assure the adequacy and quality of ventilation and oxygenation.

 (f) “CECBEMS” means the national Continuing Education Coordinating Board for Emergency Medical Services.

 (g) “Class” means the period during which a group of students meets.

 (h) “Clinical preceptor” means an individual who is responsible for supervision and evaluation of students in clinical training in a health care facility.

 (i) “Continuing education” means a formally organized learning experience that has education as its explicit principal intent and is oriented towards the enhancement of emergency medical services practice, values, skills, and knowledge.

 (j) “Contrived experience” as used in K.A.R. 109-11-3, means a simulated ambulance call to include dispatch communications, responding to the scene, assessment and management of the scene and patient or patients, biomedical communications with medical control, ongoing assessment, care and transportation of the patient or patients, transference of the patient or patients to the staff of the receiving facility, completion of records, and preparation of the ambulance for return to service.

 (k) “Course of instruction” means a body of prescribed EMS studies constituting a curriculum.

 (l) “Critical care transport” means transport by a type V ambulance of a patient who receives care commensurate with the scope of practice of a physician or a licensed professional nurse.

 (m) “Emergency care” means the services provided after the onset of a medical condition of sufficient severity that the absence of immediate medical attention could reasonably be expected to cause any of the following:

 (1) Place the patient’s health in serious jeopardy;

 (2) seriously impair bodily functions; or

 (3) result in serious dysfunction of any bodily organ or part.

 (n) “ EMS ” means emergency medical services.

 (o) “EMT” means emergency medical technician.

 (p) “EMT-D means emergency medical technician-defibrillator.

 (q) “EMT-I” means emergency medical technician-intermediate.

 (r) “Field internship preceptor” means an individual who is responsible for supervision and evaluation of students in field training with an ambulance service.

 (s) “Incompetence” as applied to attendants and as used in K.S.A. 65-6133 and amendments thereto, means a demonstrated lack of ability, knowledge, or fitness to perform patient care according to applicable medical protocols or as defined by the authorized activities of the attendant’s level of certification.

 (t) “Incompetence” as applied to instructor-coordinators and training officers and as used in K.S.A. 65-6133 and K.S.A. 65-6129c and amendments thereto, means a pattern of practice or other behavior that demonstrates a manifest incapacity or inability to instruct.

 (u) “Incompetence” as applied to an operator and as used in K.S.A. 65-6132 and amendments thereto, means an inability to provide the level of service required for the class of permit held.

 (v) “Instructor-coordinator (I-C)” means any of the following individuals who are certified to instruct and coordinate attendant training programs:

 (1) Emergency medical technician;

 (2) emergency medical technician-intermediate;

 (3) emergency medical technician-defibrillator;

 (4) mobile intensive care technician;

 (5) physician; or

 (6) registered professional nurse.

 (w) “Lab assistant” means an individual who is assisting a primary instructor in the instruction and evaluation of students in classroom laboratory training sessions.

 (x) “Long-term provider approval” means that the provider has been approved by the administrator or the administrator’s designee to provide any continuing education program.  Long-term provider approval may be granted for a one-year probationary period to new applicants.  After completion of the probationary year, long-term providers may reapply for approval every five years.

 (y) “MICT” means mobile intensive care technician.

 (z) “Primary instructor” means an instructor-coordinator or training officer II who is listed by the provider of training as the individual responsible for the effective delivery of cognitive, psychomotor, and affective objectives of an approved initial course of instruction and who is the person primarily responsible for evaluating student performance and developing student competency.

 (aa) “Prior-approved continuing education” means material submitted by a provider, to the board, that is reviewed and subsequently approved by the administrator or the administrator’s designee, in accordance with criteria established by regulations, and that is assigned a course identification number.

 (bb) “Providers of continuing education” means professional associations, accredited postsecondary educational institutions, permitted ambulance services, fire departments, other officially organized public safety agencies, hospitals, corporations, or emergency medical services regional councils, approved by the administrator to offer continuing education programs on either a long-term provider basis or a single-program provider basis.

 (cc) “Public call” means the request for an ambulance to respond to the scene of a medical emergency or accident by an individual or agency other than any of the following:

 (1) A type I or type II ambulance service;

 (2) the Kansas highway patrol or any law enforcement officer certified as an attendant who is at the scene of an accident or medical emergency;

 (3) a physician who is at the scene of an accident or medical emergency; or

 (4) an attendant who has been dispatched to provide emergency first response and who is at the scene of an accident or medical emergency.

 (dd) “Retroactively approved continuing education” means credit issued to the attendant after attending the workshop, conference, seminar, or other offering that is reviewed and subsequently approved by the administrator or the administrator’s designee, in accordance with criteria established by the board.

 (ee) “Single-program provider approval” means that the provider has been granted approval to offer a specific continuing education program.

 (ff) “Site coordinator” means a person supervising, facilitating, or monitoring students, facilities, faculty, or equipment at a training site.

 (gg) “Sufficient application” means that the information requested on the application form is provided in full, no additional information is required to complete the processing of the application, and any applicable fee has been paid.

 (hh) “Training officer I” means a person who has been certified by the board to coordinate attendant continuing education training programs for accredited postsecondary educational institutions, permitted ambulance services, fire departments, other officially organized public safety agencies, hospitals, corporations, professional associations, or emergency medical services regional councils.

 (ii) “Training officer II” means a person who is certified by the board to function as a continuing education training program coordinator and as a primary instructor of first responder initial courses of instruction.

 (jj) “Training program accreditation” means accredited postsecondary educational institutions, permitted ambulance services, fire departments, other officially organized public safety agencies, hospitals, or corporations approved by the administrator or the administrator’s designee to conduct EMS initial courses of instruction on a long-term provider basis.

 (kk) “Type I ambulance service” means a ground-based service that provides emergency response and advanced life support, as described in the authorized activities of mobile intensive care technicians in K.S.A. 65-6119, and amendments thereto.

 (ll) “Type II ambulance service” means a ground-based service that provides emergency response and basic life support, as described in authorized activities of emergency medical technicians in K.S.A. 65-6121, and amendments thereto. A Type II ambulance service may provide advanced life support when staffed with any of these individuals:

 (1) Emergency medical technicians-intermediate;

 (2) emergency medical technicians-defibrillator;

 (3) mobile intensive care technicians;

 (4) registered professional nurses;

 (5) registered physician's assistants; or

 (6) physicians.

 (mm) “Type V ambulance service” means an air or ground-based ambulance service that provides critical care transport, as defined in K.A.R. 109-1-1, and is not subject to public call.

 (nn) “Unprofessional conduct” as applied to attendants and as used in K.S.A. 65-6133, and amendments thereto, means conduct that violates those standards of professional behavior that through professional experience have become established by the consensus of the expert opinion of the members of the emergency medical services profession as reasonably necessary for the protection of the public.  This conduct shall include any of the following:

 (1) Failing to take appropriate action to safeguard the patient;

 (2) performing acts beyond the activities authorized for the level at which the individual is certified;

 (3) falsifying a patient’s or an ambulance service’s records;

 (4) verbally, sexually, or physically abusing a patient;

 (5)  violating statutes or regulations concerning the confidentiality of medical records or patient information obtained in the course of professional work;

 (6) diverting drugs or any property belonging to a patient or an agency;

 (7) making a false or misleading statement on an application for certification renewal or any agency record;

 (8) engaging in any fraudulent or dishonest act that is related to the qualifications, functions, or duties of an attendant; or

 (9) failing to cooperate with the board and its agents in the investigation of complaints or possible violations of the emergency medical services statutes or board regulations, including failing to furnish any documents or information legally requested by the board.  Attendants who fail to respond to requests for documents or requests for information within 30 days from the date of request shall have the burden of demonstrating that they have acted in a timely manner.

 (oo) “Unprofessional conduct” as applied to instructor-coordinators and training officers and as used in K.S.A. 65-6133 and K.S.A. 65-6129c, and amendments thereto, means any of the following:

 (1) Engaging in behavior that demeans a student.  This behavior shall include ridiculing a student in front of other students or engaging in any inhumane or discriminatory treatment of any student or group of students;

 (2) verbally or physically abusing a student;

 (3) failing to take appropriate action to safeguard a student;

 (4) falsifying any document relating to a student or the emergency medical services agency;

 (5) violating any statutes or regulations concerning the confidentiality of student records;

 (6) obtaining or seeking to obtain any benefit, including a sexual favor, from a student through duress, coercion, fraud, or misrepresentation, or creating an environment that subjects a student to unwelcome sexual advances, which includes physical touching or verbal expressions;

 (7) an inability to instruct because of alcoholism, excessive use of drugs, controlled substances or any physical or mental condition;

 (8) reproducing or duplicating a state examination for certification without board authority;

 (9) engaging in any fraudulent or dishonest act that is related to the qualifications, functions, or duties of an instructor-coordinator or training officer;

 (10) willfully failing to adhere to the course syllabus; or

 (11) failing to cooperate with the board and its agents in the investigation of complaints or possible violations of the emergency medical services statutes or board regulations, including failing to furnish any documents or information legally requested by the board.  Instructor-coordinators and training officers who fail to respond to requests for documents or requests for information within 30 days of the request shall have the burden of demonstrating that they have acted in a timely manner.  (Authorized by K.S.A. 1998 Supp. 65-6110, 65-6111; implementing K.S.A. 1998 Supp. 65-6110, 65-6111, 65-6121, 65-6129, 65-6129b, and 65-6129c, K.S.A. 65-6132, and K.S.A. 1998 Supp. 65-6133; effective May 1, 1985; amended May 1, 1986; amended, T-88-12, May 18, 1987; amended, T-88-24, July 15, 1987; amended May 1, 1988; amended July 17, 1989; amended March 16, 1992; amended Jan. 31, 1994; amended Jan. 30, 1995; amended Jan. 31, 1997; amended Nov. 12, 1999.)

109-1-2 Medical advisor. Each air ambulance service shall have an air medical advisor who is responsible for advising the air ambulance service on policies and procedures which assure that the appropriate aircraft, medical personnel, and equipment are provided during air ambulance transport.  When necessary, the air medical advisor may designate another licensed physician to perform the air medical advisor’s duties.  (Authorized by K.S.A. 1995 Supp. 65-6110; implementing K.S.A. 65-6126; effective Jan. 31, 1997.)

 

Article 2.--AMBULANCE SERVICES; PERMITS AND REGULATIONS

 

109-2-1 Service director. Each operator shall designate a person as the service director.  The service director shall be responsible for the operation of the ambulance service, and shall be available to the board regarding permit and regulatory matters.  (Authorized by K.S.A. 1995 Supp. 65-6110; implementing K.S.A. 65-6127; effective May 1, 1985; amended July 17, 1989; amended Jan. 31, 1997.)

 

109-2-2 Application for ambulance service permit and ambulance vehicle license; permit renewal and license renewal. (a) (1) An applicant may apply for only one ambulance service permit for each ambulance service that the applicant seeks to operate.  Each applicant shall indicate the class of service for the permit requested.

 (2) An applicant may apply for only one ambulance vehicle license for each ambulance that the applicant seeks to operate.  Each applicant shall indicate the type of ambulance for the license requested.

 (b) All ambulance service permit and ambulance vehicle license application and renewal forms shall be submitted on the original forms provided by the administrator.  Copies, facsimiles, electronic filings, and other reproductions shall not be accepted.

 (c) (1) Except as provided in paragraph (c) (2), each ambulance service permit and ambulance vehicle license shall expire on April 30 of each year and may be renewed annually in accordance with this regulation.

 (2) If the board receives an application for renewal of an ambulance service permit on or before April 30, the existing ambulance service permit shall not expire until the board has taken final action upon the renewal application or, if the board’s action is unfavorable, until the last day for seeking judicial review of the board’s action or a later date fixed by the reviewing court.

 (d) Each application for renewal of an ambulance service permit and for renewal of an ambulance vehicle license shall be provided to the administrator no later than 30 days before expiration of the permit and license.

 (e) If the board receives an insufficient application or renewal, the applicant or operator shall be notified by the board of any errors or omissions.  If the applicant or operator fails to correct the deficiencies and submit a sufficient application within 30 days from the date of written notification, the application may be considered by the board as withdrawn.

 (f) An application for ambulance service permit or permit renewal shall be deemed sufficient when both of the following conditions are met:

 (1) The applicant or operator completes all forms provided with the application for ambulance service permit or permit renewal, and no additional information is required by the board to complete the processing of the application.

 (2) The applicant or operator submits payment of the fee in the correct amount for the ambulance service permit or permit renewal.

 (g) An application for ambulance vehicle license or license renewal shall be deemed sufficient when both of the following conditions are met:

 (1) The applicant or operator completes all forms provided with the application for an ambulance vehicle license or license renewal, and no additional information is required by the board to complete the processing of the application.

 (2) The applicant or operator submits payment of the fee in the correct amount for each ambulance vehicle.  (Authorized by K.S.A. 1999 Supp. 65-6110 and K.S.A. 1999 Supp. 65-6111; implementing K.S.A. 65-6127 and 65-6128, as amended by L. 2000, Ch. 117, ;st 1; effective May 1, 1985; amended July 17, 1989; amended Jan. 31, 1997; amended Dec. 29, 2000.)

 

109-2-3 (Authorized by and implementing K.S.A. 1984 Supp. 65-4318; effective May 1, 1985; revoked Jan. 31, 1997.)

 

109-2-4 Display of permits, licenses, and certificates. (a) Each operator shall prominently display the ambulance service permit at the service’s administrative office.

 (b) Each operator shall maintain a current list of the service’s attendants, and shall maintain a current copy of each attendant’s certification or renewal card.

 (c) Each ambulance shall have the ambulance license prominently displayed in the patient compartment.  (Authorized by and implementing K.S.A. 1995 Supp. 65-6110, 65-6111, K.S.A. 65-

6127 and 65-6128; effective May 1, 1985 ; amended July 17, 1989 ; amended Jan. 31, 1997 .)

 

109-2-5 Ambulance service operational standards. (a) Each ambulance service  in a county which has been assigned to the emergency medical services communications system by the board and which operates ambulances that are required to have direct, two-way radio communications shall fully participate in the operation and maintenance of that communications system.

 (b) No person who boards an ambulance shall carry on board or wear any firearm, whether concealed or visible while the ambulance is operating in any patient transport function within the state.  However, the prohibition shall not apply to law enforcement officers as defined in K.S.A. 74-5602 or corrections officers as defined in K.S.A. 75-5202.

 (c) Smoking shall be prohibited in the patient and driver compartments at all times.

 (d) Each operator shall clean and maintain in good working order the interior and exterior of the ambulance and any medical supplies and equipment within the ambulance, except when the vehicle has been placed “out of service.”

 (e) Each operator shall use freshly laundered linen or disposable linen on cots and pillows, and the linen shall be changed after each patient is transported.

 (f) When an ambulance has been utilized to transport a patient known to have an infectious disease, the operator shall disinfect the ambulance, any equipment used, and all contact surfaces according to the service’s infectious disease exposure plan.  The operator shall place the ambulance “out of service” until a thorough cleansing is conducted.

 (g) Each operator shall place in cabinets or properly secure all equipment in the patient compartment while the vehicle is in motion.

 (h) Each ground ambulance shall receive a mechanical and safety inspection prior to December 1st of each year.  Each operator shall provide a report of the inspection results to the board on forms provided by the administrator.  An operator shall correct all deficiencies determined by the inspection prior to submitting the inspection form.

 (i) Each operator shall submit the mechanical and safety inspection forms to the board with the application for ambulance vehicle licensure or renewal.

 (j) Each operator shall park all ground ambulances in a completely enclosed building with a solid concrete floor.  Each operator shall maintain the interior heat 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 safe manner.

 (k) Each licensed ambulance shall meet all regulatory requirements for the ambulance license type, except when the operator has notified the administrator that the ambulance is out of service.

 (l) An operator may apply for a temporary license for an ambulance.  Each temporary license shall be valid for 60 days and may be approved for additional time by the administrator.

 (m) If an operator has only one licensed ambulance, and this ambulance is out of service for more than 24 hours due to mechanical failure, maintenance, or repair, the operator shall notify the administrator and submit an alternative plan for providing ambulance service for the operator’s primary territory of coverage.  The alternative plan shall be subject to approval by the administrator and shall remain in effect no more than 15 days from the date of approval.

 (n) Each operator shall have a telephone with an advertised emergency number which is answered by an attendant or other person designated by the operator 24 hours a day.  Answering machines shall not be permitted.

 (o) Each operator shall maintain a place of business at an identified street address where the permit is posted and service records are kept.

 (p) Each operator shall maintain a current call schedule or duty roster which demonstrates compliance with K.S.A. 65-6135.  The duty roster shall reflect appropriate staffing for the service and ambulance type as defined in K.A.R. 109-2-6 and 109-2-7.

 (q) A patient care report form shall be completed for each patient receiving pre-hospital assessment, care or transportation either to or from a medical facility.  Each operator shall furnish a completed copy or copies of each patient care report form to the board on request.

 (r) 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, patient’s name, agency or person calling, nature of call and disposition of each patient.

 (s) Each operator shall maintain a copy of each patient care record for a period of not less than three years.

 (t) An attendant shall leave a copy of the patient care report form for each patient transported by ambulance at the hospital receiving the patient.

 (u) In the event that an attendant is unable to complete a patient care report form before leaving the receiving hospital, an attendant shall provide a copy of the patient care report form to the receiving hospital within 24 hours of the patient's arrival.

 (v) Each publicly subsidized operator shall provide the following statistical information to the board before March 1st of each calendar year:

 (1) the number of emergency and non-emergency ambulance responses and the number of patients transported for the previous calendar year;

 (2) the operating budget and tax subsidy;

 (3) the charge for emergency and non-emergency patient transports, including mileage fees; and

 (4) the number of full-time, part-time, and volunteer staff.

 (w) Each operator shall provide a quality improvement program which establishes medical review procedures for monitoring patient care activities.  This program shall include policies and procedures for reviewing patient care report forms.  Each operator shall review patient care activities on at least a quarterly basis each year to determine whether the service’s attendants are providing appropriate patient care.

 (1) Review of patient care activities shall include quarterly participation by the service’s medical advisor in a manner that assures the medical advisor is meeting the requirements of K.S.A. 65-6126.

 (2) Each operator shall, upon request, provide documentation to the administrator or the administrator’s designee demonstrating that the operator is performing patient care reviews.

 (3) Each operator shall maintain documentation of all medical reviews of patient care activities at least two years.

 (4) Each operator shall have the duty to report to the board any finding that an attendant or other health care provider functioning for the operator:

 (A) acted below the applicable standard of care, and because of such action, had a reasonable probability of causing injury to a patient; or

 (B) acted in a manner which may be grounds for disciplinary action by the board or appropriate licensing agency.

 (x) Each ambulance service operator shall develop and implement operational protocols which shall have a table of contents and address policies and procedures for each of the following topics:

 (1) radio and telephone communications;

 (2) inter-hospital transfers;

 (3) emergency driving and vehicle operations;

 (4) do not resuscitate orders (DNR) and living wills;

 (5) multiple victim and mass casualty incidents;

 (6) hazardous material incidents;

 (7) infectious disease exposure;

 (8) crime scene management;

 (9) documentation of patient reports;

 (10) consent and refusal of treatment; and

 (11) any other procedures deemed necessary by the operator for the efficient operation of the ambulance service.

 (y) Each air ambulance service operator shall develop an air safety training program for all regularly scheduled air medical personnel by July 1, 1997 .  The program shall be tailored to the air ambulance service’s specific needs and approved by the service’s air medical advisor.  The program shall include the following:

 (1) air medical and altitude physiology;

 (2) aircraft orientation, including specific capabilities, limitations, and safety measures for each aircraft used;

 (3) depressurization procedures for fixed-wing aircraft;

 (4) safety in and around the aircraft, including FAA rules and regulations pertinent to safety for all air medical personnel, patients, and lay individuals;

 (5) rescue and survival techniques appropriate to the terrain and the conditions under which the air ambulance service operates;

 (6) hazardous scene recognition and response for rotorwing aircraft;

 (7) aircraft evacuation procedures, including rapid loading and unloading of patients;

 (8) refueling procedures for normal and emergency situations; and

 (9) in-flight emergencies and emergency landing procedures.

 (z) Each air ambulance service operator shall maintain documentation demonstrating the initial completion and annual review of the air safety training program for all regularly scheduled air medical personnel, and shall provide this documentation to the board on request.

 (aa) Each air ambulance service operator shall, by July 1, 1997 , provide an informational publication which promotes the proper use of air medical transport.  This publication shall be provided, on request, to all ground-based ambulance services, law enforcement agencies, and hospitals which use the air ambulance service.  Each manual shall address the following topics:

 (1) availability, accessibility, and scope of care of the air ambulance service;

 (2) capabilities of air medical personnel and patient care modalities afforded by the air ambulance service;

 (3) patient preparation before air medical transport;

 (4) landing zone designation and preparation;

 (5) communication and coordination between air and ground medical personnel; and

 (6) safe approach and conduct around the aircraft.

 (bb) Each ambulance service operator shall develop and implement medical protocols.

 (1) Each operator’s medical protocols shall receive annual written approval by the emergency committee of the county medical society.

 (2) In those counties where there is no emergency committee of the county medical society, medical protocols shall be approved by the medical staff of the hospital to which the ambulance service primarily transports patients.

 (cc) Each operator’s medical protocols shall include treatment procedures for the following medical and trauma-related conditions:

(1)diabetic emergencies;

(2)shock;

(3)environmental emergencies;

(4)chest pain;

(5)abdominal pain;

(6)respiratory distress;

(7)obstetrical emergencies;

(8)poisoning;

(9)seizures;

(10)cardiac arrest (code blue);

(11)burns;

(12)stroke (CVA);

(13)chest injuries;

(14)abdominal injuries;

(15)head injuries;

(16)spinal injuries;

(17)multiple systems trauma;

(18)orthopedic injuries;

(19)drowning; and

(20)anaphylaxis.

 (dd) Each service operator shall make available a current copy of the service’s operational protocols and medical protocols to any person listed as an attendant on the service’s attendant roster.  (Authorized by and implementing K.S.A. 1995 Supp. 65-6110, 65-6111, K.S.A. 65-6113, 65-6128 and 65-6130; effective May 1, 1985; amended, T-88-24, July 15, 1987; amended May 1, 1988; amended Aug. 27, 1990; amended Aug. 16, 1993 ; amended Jan. 31, 1997 .)

 

109-2-6 Classes of ambulance services. Permits shall be issued for three classes of ambulance service.  These classes shall be known as type I, type II, and type V.

 (a) Each type I service operator shall:

 (1) provide advanced life support as described in K.A.R. 109-1-1;

 (2) have at least one licensed ambulance which meets all requirements of K.A.R. 109-2-8.  Each type I service operator may also operate type II ambulances;

 (3) maintain a staff of currently certified mobile intensive care technicians and emergency medical technicians which is adequate to meet all applicable requirements of K.A.R. 109-2-7; and

 (4) have a method of receiving calls and dispatching ambulances which ensures that an ambulance leaves the station within an annual average of five minutes of the time an emergency call is received.

 (b) Each type II service operator shall:

 (1) provide basic life support;

 (2) have at least one licensed ambulance which meets all requirements of K.A.R. 109-2-8;

 (3) maintain a staff of currently certified emergency medical technicians which is adequate to meet all requirements of K.A.R. 109-2-7; and

 (4) have a method of receiving calls and dispatching ambulances which ensures that an ambulance leaves the station within an annual average of five minutes of the time an emergency call is received.

 (c) Each type II service operator may provide advanced life support as described in K.S.A. 65-

6123, 65-6120 and 65-6119 when approved by medical protocols or when in direct voice contact with a physician or a licensed professional nurse who is authorized by a physician.

  (d) Each type V service operator shall:

 (1) provide “critical care transport” as defined in K.A.R. 109-1-1;

 (2) not be subject to public call, as defined in K.A.R. 109-1-1 (b);

 (3) have at least one ground or air ambulance which meets all requirements of either K.A.R. 109-2-11, K.A.R. 109-2-12 or K.A.R. 109-2-13 as applicable;

 (4) license only type V ambulances;

 (5) license rotorwing aircraft, fixed wing aircraft or ground-based vehicles as ambulances;

 (6) have a staff which is adequate to provide the level of care described in paragraph (l) of this subsection and as described in K.A.R. 109-2-7;

 (7) have a method of receiving and relaying calls that ensures that any request for emergency response is immediately and properly relayed to the nearest type I or type II ambulance service; and

 (8) have all air and ground ambulance inter-facility transports reviewed and approved by the service’s medical advisor prior to transport, or conducted in accordance with the service’s medical and operational protocols.  (Authorized by K.S.A. 1995 Supp. 65-6110; implementing K.S.A. 1995 Supp. 65-6110, K.S.A. 65-6128, and 65-6135; effective May 1, 1985; amended May 1, 1987; amended, T-88-24, July 15, 1987; amended May 1, 1988; amended July 17, 1989; amended Jan. 31, 1997.)

 

109-2-7 Ground and air ambulance staffing. Licenses shall be issued for three types of ambulance vehicles and aircraft.  These ambulances shall be known as type I, type II, and type V.  Each ambulance shall be staffed in accordance with these regulations.

 (a) Each type I service operator shall staff each type I ambulance with at least two attendants during patient transport.

 (1) At least one attendant shall be one of the following medical personnel:

 (A) a mobile intensive care technician;

 (B) a physician;

 (C) a registered physician's assistant; or

 (D) a licensed professional nurse.

 (2) The second attendant may be any of the following:

 (A) an emergency medical technician;

 (B) an emergency medical technician intermediate;

 (C) an emergency medical technician defibrillator;

 (D) a mobile intensive care technician;

 (E) a physician;

 (F) a registered physician's assistant; or

 (G) a licensed professional nurse.

 (b) Each type I and type II service operator shall staff each type II ambulance with at least two attendants during patient transport.

 (1) At least one attendant shall be an emergency medical technician.

 (2) One of the following shall be in the patient compartment during patient transport:

 (A) an emergency medical technician;

 (B) an emergency medical technician intermediate;

 (C) an emergency medical technician defibrillator;

 (D) a mobile intensive care technician;

 (E) a physician;

 (F) a registered physician’s assistant; or

 (G) a licensed professional nurse.

 (c) Each type V service operator shall staff each type V ambulance with a driver or pilot and at least two medically trained persons, one of whom shall be a physician or a licensed professional nurse.  Additional staffing shall be commensurate with the patient’s care needs as determined by the service’s medical advisor or as described in the service’s medical protocols.  The medical personnel shall remain in the patient compartment during patient transport.

 (d) At least one of the medical personnel on each type V ambulance shall have completed and be current in “Advanced Cardiac Life support (ACLS)” as in effect on January 1, 1997, which is adopted herein by reference, or the equivalent, as approved by the board.

 (e) When performing neonatal or pediatric missions, at least one of the medical personnel on each type V ambulance shall have completed and be current in “Pediatric Advanced Life Support (PALS)” as in effect on January 1, 1996, which is adopted herein by reference, or the equivalent as approved by the board.

 (f) When responding to the scene of an accident or medical emergency, not including transports between medical facilities, at least one of the medical personnel on each type V ambulance shall have completed and be current in one of the following programs as in effect on January 1, 1996, which are adopted herein by reference:

 (1) “Advanced Trauma Life Support (ATLS)”

 (2) “Flight Nurse Advanced Trauma Course (FNATC)”

 (3) “Trauma Nurse Core Course (TNCC)”

 (4) “Pre-Hospital Trauma Life Support (PHTLS)” or

 (5) an equivalent course as approved by the board.  (Authorized by K.S.A. 1995 Supp. 65-6110; implementing K.S.A. 1995 Supp. 65-6110 and K.S.A. 65-6135; effective May 1, 1985; amended May 1, 1987; amended, T-88-24, July 15, 1987; amended May 1, 1988; amended Aug. 27, 1990; amended Feb. 3, 1992; amended Jan. 31, 1997.)

109-2-8 Standards for type I and II ambulance vehicles and equipment. (a) Each ambulance shall meet the vehicle and equipment standards that are applicable to that class of ambulance.

 (b) The patient compartment size shall meet or exceed the following specifications:

 (1) headroom: 60 inches; and

 (2) length: 116 inches.

 (c) Each ambulance shall have a heating and cooling system which is controlled separately for the patient and the driver compartments.  The air conditioners for each compartment shall have separate evaporators.

 (d) Each ambulance shall have separate ventilation systems for the driver and patient compartments.  These systems shall be separately controlled within each compartment.  Fresh air intakes shall be located in the most practical, contaminant-free air space on the ambulance.  The patient compartment shall be ventilated through the heating and cooling systems.

 (e) The patient compartment in each ambulance shall have adequate lighting so that patient care can be given and the patient’s status monitored without the need for portable or hand-held lighting.  A reduced lighting level shall also be provided.  A patient compartment light and step-well light shall be automatically activated by opening the entrance doors. Interior light fixtures shall be recessed and shall not protrude more than 11 2 inches.

 (f) Each ambulance