Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Amended by exempt rulemaking at 7 A.A.R. 4888, effective November 1, 2001 (Supp. 01-4). Amended by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). Amended by final rulemaking at 12 A.A.R. 4404, effective January 6, 2007 (Supp. 06-4).

ARTICLE 2. MEDICAL DIRECTION; ALS BASE HOSPITAL CERTIFICATION

R9-25-201. Required Medical Direction (A.R.S. §§ 36-2201, 36-2202(A)(3) and (A)(4), 36-2204(5), (6), and (7) and 36-2205(A) and (E))

A. An EMT-B authorized to perform an advanced procedure shall not perform an advanced procedure unless the EMT has administrative medical direction and is able to receive on-line medical direction.

B. An EMT-I or EMT-P shall not act as an EMT-I or EMT-P unless the EMT has administrative medical direction and is able to receive on-line medical direction.

C. An emergency medical services provider or an ambulance service shall ensure that an EMT acting as an EMT for the emergency medical services provider or the ambulance service has administrative medical direction and is able to receive on-line medical direction, if required in subsections (A) or (B).

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Former R9-25-201 renumbered to R9-25-207; new R9-25-201 made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-202. General Requirements for Provision of Administrative Medical Direction (A.R.S. §§ 36-2201, 36-2202(A)(3) and (A)(4), 36-2204(5), (6), and (7), 36-2204.01, and 36-2205(A) and (E))

An emergency medical services provider, an ambulance service, an ALS base hospital, or a centralized medical direction communications center that provides administrative medical direction shall:

1. Provide administrative medical direction:

a. Through an administrative medical director qualified under R9-25-204, and

b. As required in R9-25-204;

2. Maintain for Department review:

a. The name, address, and telephone number of each administrative medical director;

b. Documentation that an administrative medical director is qualified under R9-25-204; and

c. Policies, procedures, protocols, and documentation required under R9-25-204;

3. Notify the Department in writing no later than ten days after the date the emergency medical services provider, ambulance service, ALS base hospital, or centralized medical direction communications center providing administrative medical direction to an EMT:

a. Withdraws the EMT's administrative medical direction, or

b. Reinstates the EMT's administrative medical direction; and

4. Notify the Department in writing no later than ten days after the date the emergency medical services provider, ambulance service, ALS base hospital, or centralized medical direction communications center providing administrative medical direction to an EMT becomes aware that the EMT:

a. Is incarcerated or is on parole, supervised release, or probation for a criminal conviction;

b. Is convicted of a crime listed in R9-25-402(A)(2), a misdemeanor involving moral turpitude, or a felony in this state or any other state or jurisdiction;

c. Is convicted of a misdemeanor identified in R9-25-403(A) in this state or any other state or jurisdiction;

d. Has registration revoked or suspended by NREMT; or

e. Has EMT certification, recertification, or licensure revoked or suspended in another state or jurisdiction.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Former R9-25-202 renumbered to R9-25-208; new R9-25-202 made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

Exhibit A. Repealed

Historical Note

Exhibit A adopted effective October 15, 1996 (Supp. 96-4). Exhibit repealed by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-203. General Requirements for Provision of On-line Medical Direction (A.R.S. §§ 36-2201, 36-2202(A)(3) and (A)(4), 36-2204(5), (6), and (7), 36-2204.01, and 36-2205(A) and (E))

A. An emergency medical services provider, an ambulance service, an ALS base hospital, or a centralized medical direction communications center that provides on-line medical direction shall:

1. Provide on-line medical direction:

a. Through an on-line physician qualified under R9-25-205, and

b. As required in R9-25-205; and

2. Maintain for Department review:

a. The name, address, and telephone number of each on-line physician; and

b. Documentation that an on-line physician is qualified under R9-25-205.

B. An emergency medical services provider, an ambulance service, an ALS base hospital, or a centralized medical direction communications center that provides on-line medical direction shall:

1. Have operational and accessible communication equipment that will allow an on-line physician to give on-line medical direction.

2. Have a written plan for alternative communications with an EMT in the event of disaster, communication equipment breakdown or repair, power outage, or malfunction; and

3. Have an on-line physician qualified under R9-25-205 available to give on-line medical direction to an EMT 24 hours a day, seven days a week.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Section repealed; new Section made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-204. Administrative Medical Director Qualifications and Responsibilities (Authorized by A.R.S. §§ 36-2201; 36-2202(A)(3) and (A)(4); 36-2204(5), (6), and (7); 36-2204.01; 36-2208(A); and 36-2209(A)(2))

A. An individual shall not act as an administrative medical director unless the individual:

1. Is a physician; and

2. Meets one of the following:

a. Has emergency medicine certification from a specialty board recognized by the Arizona Medical Board or the Arizona Board of Osteopathic Examiners in Medicine and Surgery;

b. Has completed an emergency medicine residency training program accredited by the Accreditation Council for Graduate Medical Education or approved by the American Osteopathic Association; or

c. Is practicing emergency medicine and has:

i. Proficiency in advanced emergency cardiac life support,

ii. Proficiency in advanced trauma life support, and

iii. Proficiency in pediatric emergency care.

B. An administrative medical director shall act only on behalf of:

1. An emergency medical services provider;

2. An ambulance service;

3. An ALS base hospital certified under this Article;

4. A centralized medical direction communications center; or

5. The Department, as provided in A.R.S. § 36-2202(J).

C. An administrative medical director:

1. Shall coordinate the provision of administrative medical direction to EMTs; and

2. May delegate responsibilities to an individual as necessary to fulfill the requirements in this Section, if the individual is:

a. A physician,

b. A physician assistant,

c. A registered nurse practitioner,

d. A registered nurse,

e. A practical nurse, or

f. An EMT-I or EMT-P.

D. An administrative medical director shall:

1. Ensure that an EMT receives administrative medical direction as required under A.R.S. Title 36, Chapter 21.1 and this Chapter;

2. Approve, ensure implementation of, and annually review treatment protocols, triage protocols, and communications protocols for an EMT to follow that are consistent with:

a. A.R.S. Title 36, Chapter 21.1 and this Chapter; and

b. The EMT's scope of practice as identified under Article 5 of this Chapter;

3. Approve, ensure implementation of, and annually review policies and procedures that an EMT shall follow for medical recordkeeping, medical reporting, and completion and processing of prehospital incident history reports that are consistent with:

a. A.R.S. Title 36, Chapter 21.1 and this Chapter; and

b. The EMT's scope of practice as identified under Article 5 of this Chapter;

4. Approve, ensure implementation of, and annually review policies and procedures governing the administrative medical direction of an EMT, including policies and procedures for:

a. Monitoring and evaluating an EMT's compliance with treatment protocols, triage protocols, and communications protocols;

b. Monitoring and evaluating an EMT's compliance with medical recordkeeping, medical reporting, and prehospital incident history report requirements;

c. Monitoring and evaluating an EMT's performance as authorized by the EMT's scope of practice as identified under Article 5 of this Chapter;

d. Ensuring that an EMT receives ongoing education, training, or remediation necessary to promote ongoing professional competency and compliance with EMT standards of practice established in R9-25-410;

e. Withdrawing an EMT's administrative medical direction; and

f. Reinstating an EMT's administrative medical direction; and

5. Approve, ensure implementation of, and annually review policies and procedures for a quality assurance process to evaluate the effectiveness of the administrative medical direction provided to EMTs.

E. An administrative medical director shall:

1. Annually document that the administrative medical director has reviewed A.R.S. Title 36, Chapter 21.1 and this Chapter; and

2. Ensure that an individual to whom the administrative medical director delegates authority to fulfill the requirements in this Section annually documents that the individual has reviewed A.R.S. Title 36, Chapter 21.1 and this Chapter.

F. An administrative medical director for an emergency medical services provider shall ensure that:

1. Each EMT for whom the administrative medical director provides administrative medical direction administers an agent only if the EMT is authorized to administer the agent under Article 5 of this Chapter;

2. Each EMT for whom the administrative medical director provides administrative medical direction monitors an agent only if the EMT is authorized to monitor or administer the agent under Article 5 of this Chapter;

3. Each EMT for whom the administrative medical director provides administrative medical direction assists in patient self-administration of an agent only if:

a. The EMT is authorized either to assist in patient self-administration of the agent or to administer the agent under Article 5 of this Chapter;

b. The agent is supplied by the patient;

c. The patient or, if the patient is a minor or incapacitated adult, the patient's health care decision maker indicates that the agent is currently prescribed for the patient's symptoms; and

d. The agent is in its original container and not expired;

4. Each agent to which an EMT has access while on duty for the emergency medical services provider is obtained only from a person authorized by law to prescribe the agent or with a current and valid permit, issued by the Arizona State Board of Pharmacy, authorizing the person to operate a drug wholesaler or a pharmacy;

5. Each transfer of an agent between the emergency medical services provider and another emergency medical services provider is documented as required by the Arizona State Board of Pharmacy and the U.S. Drug Enforcement Administration;

6. The emergency medical services provider establishes, implements, and complies with a written standard operating procedure, applicable to each EMT for whom the administrative medical director provides administrative medical direction, that requires:

a. A written chain of custody for each supply of agents, including at least the following:

i. The name, EMT certification number, or employee identification number of each individual who takes custody of the supply of agents; and

ii. The time and date that each individual takes custody of the supply of agents;

b. Each individual who takes custody of a supply of agents to do the following:

i. Upon initially taking custody of the supply of agents, inspect the supply of agents for expired agents, deteriorated agents, damaged or altered agent containers or labels, and depleted or missing agents;

ii. Upon determining that any of the conditions described in subsection (F)(6)(b)(i) exists, document the condition, notify the administrative medical director if a controlled substance is depleted or missing, and obtain a replacement for each affected agent for which the minimum supply is not present; and

iii. Record each administration of an agent on a prehospital incident history report, as defined in A.R.S. § 36-2220;

c. Each EMT on duty for the emergency medical services provider to have access to at least the minimum supply of agents required for the highest level of service to be provided by the EMT;

d. That, except while in use, each agent to which an EMT has access while on duty for the emergency medical services provider is:

i. Secured in a dry, clean, washable receptacle;

ii. While on a motor vehicle or aircraft, secured in a manner that restricts movement of the agent and its receptacle; and

iii. If a controlled substance, locked in a substantially constructed cabinet; and

e. That each agent to which an EMT has access while on duty for the emergency medical services provider is kept inaccessible to unauthorized individuals at all times;

7. Each EMT for whom the administrative medical director provides administrative medical direction has access to a copy of the emergency medical services provider's written standard operating procedure required under subsection (F)(6) while on duty for the emergency medical services provider;

8. The administrative medical director notifies the Department in writing within 10 days after the administrative medical director receives notice, as required under subsection (F)(6)(b)(ii), that any quantity of a controlled substance is missing; and

9. The administrative medical director complies with all Arizona State Board of Pharmacy and U.S. Drug Enforcement Administration requirements related to the control of agents.

G. Subsections (F)(4)-(9) do not apply to an administrative medical director for an emergency medical services provider if:

1. The emergency medical services provider obtains all of its agents from an ALS base hospital pharmacy, and

2. The agents provided to the emergency medical services provider are owned by the ALS base hospital that provides them.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Former R9-25-204 renumbered to R9-25-209; new R9-25-204 made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). Amended by final rulemaking at 12 A.A.R. 4404, effective January 6, 2007 (Supp. 06-4).

R9-25-205. On-line Medical Director Qualifications and Responsibilities (A.R.S. §§ 36-2202(A)(3) and (A)(4), 36-2204(5), (6), and (7), and 36-2204.01)

A. An individual shall not act as an on-line physician unless the individual:

1. Is a physician; and

2. Meets one of the following:

a. Has emergency medicine certification from a specialty board recognized by the Arizona Medical Board or the Arizona Board of Osteopathic Examiners in Medicine and Surgery;

b. Has completed an emergency medicine residency training program accredited by the Accreditation Council for Graduate Medical Education or approved by the American Osteopathic Association; or

c. Is practicing emergency medicine and has:

i. Proficiency in advanced emergency cardiac life support,

ii. Proficiency in advanced trauma life support, and

iii. Proficiency in pediatric emergency care.

B. An individual shall act as an on-line physician only on behalf of:

1. An emergency medical services provider,

2. An ambulance service,

3. An ALS base hospital certified under this Article, or

4. A centralized medical direction communications center.

C. An on-line physician shall give on-line medical direction to an EMT:

1. As required under A.R.S. Title 36, Chapter 21.1 and 9 A.A.C. 25;

2. Consistent with the EMT's scope of practice as identified under Article 5 of this Chapter;

3. Consistent with treatment protocols, triage protocols, and communication protocols approved by the EMT's administrative medical director; and

4. Consistent with medical recordkeeping, medical reporting, and prehospital incident history report requirements approved by the EMT's administrative medical director.

D. An on-line physician may allow an individual acting under the supervision of the on-line physician to relay on-line medical direction, if the individual is:

1. A physician,

2. A physician assistant,

3. A registered nurse practitioner,

4. A registered nurse,

5. A practical nurse, or

6. An EMT-I or EMT-P.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Section repealed; new Section made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). Amended by final rulemaking at 13 A.A.R. 3014, effective October 6, 2007 (Supp. 07-3).

R9-25-206. Centralized Medical Direction Communications Center (A.R.S. §§ 36-2201, 36-2202(A)(3) and (A)(4), and 36-2204.01)

A. Pursuant to A.R.S. § 36-2204.01, an emergency medical services provider or an ambulance service may provide centralized medical direction by:

1. Solely operating one or more centralized medical direction communications centers;

2. Joining with one or more emergency medical services providers or ambulance services to operate one or more centralized medical direction communications centers; or

3. Entering into an agreement with one or more centralized medical direction communications centers to provide medical direction to EMTs acting as EMTs for the emergency medical services provider or the ambulance service.

B. For the purposes of A.R.S. § 36-2201(7), a "freestanding communications center":

1. May be housed within one or more physical facilities, and

2. Is not limited to a single physical location.

C. For the purposes of A.R.S. § 36-2201(7)(b), a centralized medical direction communications center shall be "staffed" if an on-line physician qualified under R9-25-205 is available to give on-line medical direction to an EMT 24 hours a day, seven days a week.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Amended effective November 30, 1998; filed in the Office of the Secretary of State November 24, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to A.R.S. § 36-2205(C) (Supp. 98-4). Amended by exempt rulemaking at 7 A.A.R. 4888, effective November 1, 2001 (Supp. 01-4). Former R9-25-206 renumbered to R9-25-210; new R9-25-206 made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

The following Exhibit was repealed under an exemption from the provisions of A.R.S. Title 41, Chapter 6, pursuant to A.R.S. § 36-2205(C). Exemption from A.R.S. Title 41, Chapter 6 means that the Department did not submit this change to the Secretary of State's Office for publication in the Arizona Administrative Register as proposed rules; the Department did not submit the change to the Governor's Regulatory Review Council for review; and the Department was not required to hold public hearings on the repealing of this Exhibit (Supp. 98-4).

Exhibit B. Repealed

Historical Note

Exhibit B adopted effective October 15, 1996 (Supp. 96-4). Repealed effective November 30, 1998; filed in the Office of the Secretary of State November 24, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to A.R.S. § 36-2205(C) (Supp. 98-4).

R9-25-207. ALS Base Hospital General Requirements (Authorized by A.R.S. §§ 36-2201, 36-2202(A)(3) and (A)(4), and 36-2204(5), (6), and (7))

A. A person shall not operate as an ALS base hospital without certification from the Department.

B. The Department shall not certify an ALS base hospital if:

1. Within five years before the date of filing an application required by this Article, the Department has decertified the ALS base hospital; or

2. The applicant knowingly provides false information on or with an application required by this Article.

C. The Department shall certify an ALS base hospital if the applicant:

1. Is not ineligible for certification under subsection (B);

2. Is licensed as a general hospital under 9 A.A.C. 10, Article 2 or is a general hospital operated in this state by the United States federal government or by a sovereign tribal nation;

3. Has at least one written agreement that meets the requirements of A.R.S. § 36-2201(2); and

4. Meets the application requirements in R9-25-208.

D. An ALS base hospital certificate is valid only for the name and address listed by the Department on the certificate.

E. An ALS base hospital certificate holder shall:

1. Conspicuously post the original or a copy of the ALS base hospital certificate in the emergency room lobby or emergency room reception area of the ALS base hospital; and

2. Return an ALS base hospital certificate to the Department immediately upon decertification by the Department pursuant to R9-25-211 or upon voluntarily ceasing to act as an ALS base hospital.

F. Every 24 months after certification, the Department shall inspect, pursuant to A.R.S. § 41-1009, an ALS base hospital to determine ongoing compliance with the requirements of this Article.

G. The Department may inspect, pursuant to A.R.S. § 41-1009, an ALS base hospital:

1. As part of the substantive review time-frame required in A.R.S. §§ 41-1072 through 41-1079; or

2. As necessary to determine compliance with the requirements of this Article.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Former R9-25-207 repealed; new R9-25-207 renumbered from R9-25-201 and amended by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-208. Application Requirements for ALS Base Hospital Certification (Authorized by A.R.S. §§ 36-2201, 36-2202(A)(3) and (A)(4), and 36-2204(5))

A. An applicant for ALS base hospital certification shall submit to the Department an application including:

1. An application form provided by the Department containing:

a. The applicant's name, address, and telephone number;

b. The name and telephone number of the applicant's chief administrative officer;

c. The name, address, and telephone number of each administrative medical director;

d. The name, address, and telephone number of each on-line physician;

e. Attestation that the applicant meets the communication requirements in R9-25-203(B);

f. Attestation that the applicant will comply with all requirements in A.R.S. Title 36, Chapter 21.1 and 9 A.A.C. 25;

g. Attestation that all information required as part of the application has been submitted and is true and accurate; and

h. The signature or electronic signature of the applicant's chief administrative officer or the chief administrative officer's designated representative and date of signature or electronic signature;

2. A copy of the applicant's current general hospital license issued under 9 A.A.C. 10, Article 2, if applicable; and

3. A copy of each executed written agreement, including all attachments and exhibits, described in A.R.S. § 36-2201(2).

B. The Department shall approve or deny an application under this Section pursuant to Article 12 of this Chapter.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Former R9-25-208 repealed; new R9-25-208 renumbered from R9-25-202 and amended by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-209. Amendment of an ALS Base Hospital Certificate (Authorized by A.R.S. §§ 36-2201, 36-2202(A)(3) and (A)(4), and 36-2204(5) and (6))

A. No later than 10 days after the date of a change in the name listed on the ALS base hospital certificate, an ALS base hospital certificate holder shall submit to the Department an application form provided by the Department containing:

1. The new name and the effective date of the name change;

2. Attestation that all information submitted to the Department is true and correct; and

3. The signature or electronic signature of the applicant's chief administrative officer or the chief administrative officer's designated representative and date of signature or electronic signature.

B. No later than 10 days after the date of a change in the address listed on an ALS base hospital certificate or a change of ownership, as defined in R9-10-101, an ALS base hospital certificate holder shall submit to the Department an application required in R9-25-208(A).

C. The Department shall approve or deny an application under this Section pursuant to Article 12 of this Chapter.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Former R9-25-209 repealed; new R9-25-209 renumbered from R9-25-204 and amended by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-210. ALS Base Hospital Authority and Responsibilities (Authorized by A.R.S. §§ 36-2201, 36-2202(A)(3) and (A)(4), and 36-2204(5) and (6), 36-2208(A), and 36-2209(A)(2))

A. An ALS base hospital certificate holder shall:

1. Provide both administrative medical direction and on-line medical direction;

2. Comply with the requirements in R9-25-202, R9-25-203, R9-25-204, and R9-25-205;

3. Ensure that personnel are available to provide:

a. Administrative medical direction as required in R9-25-204, and

b. On-line medical direction as required in R9-25-205; and

4. Provide administrative medical direction and on-line medical direction to each EMT pursuant to a written agreement that meets the requirements of A.R.S. § 36-2201(2).

B. An ALS base hospital certificate holder shall:

1. No later than 24 hours after ceasing to meet the requirement in R9-25-207(C)(2) or R9-25-207(C)(3), notify the Department in writing; and

2. No later than 48 hours after terminating, adding, or amending a written agreement required in R9-25-207(C)(3), notify the Department in writing and, if applicable, submit to the Department a copy of the new or amended written agreement that meets the requirements of R9-25-207(C)(3).

C. An ALS base hospital may act as a training program without training program certification from the Department, if the ALS base hospital:

1. Is eligible for training program certification as provided in R9-25-301(C); and

2. Complies with the requirements in R9-25-301(I) and R9-25-304 through R9-25-318 and the Exhibits to Article 3 of this Chapter.

D. If an ALS base hospital's pharmacy provides all of the agents for an emergency medical services provider, and the ALS base hospital owns the agents provided, the ALS base hospital's certificate holder shall ensure, through the ALS base hospital's pharmacist-in-charge, that:

1. Each agent to which an EMT has access while on duty for the emergency medical services provider is obtained only from a person authorized by law to prescribe the agent or with a current and valid permit, issued by the Arizona State Board of Pharmacy, authorizing the person to operate a drug wholesaler or a pharmacy;

2. Each transfer of an agent between the emergency medical services provider and another emergency medical services provider is documented as required by the Arizona State Board of Pharmacy and the U.S. Drug Enforcement Administration;

3. The emergency medical services provider establishes, implements, and complies with a written standard operating procedure, applicable to each EMT for whom the ALS base hospital supplies agents or provides administrative medical direction, that requires:

a. A written chain of custody for each supply of agents, including at least the following:

i. The name, EMT certification number, or employee identification number of each individual who takes custody of the supply of agents; and

ii. The time and date that each individual takes custody of the supply of agents;

b. Each individual who takes custody of a supply of agents to do the following:

i. Upon initially taking custody of the supply of agents, inspect the supply of agents for expired agents, deteriorated agents, damaged or altered agent containers or labels, and depleted or missing agents;

ii. Upon determining that any of the conditions described in subsection (D)(3)(b)(i) exists, document the condition, notify the ALS base hospital's pharmacist-in-charge if a controlled substance is depleted or missing, and obtain a replacement for each affected agent for which the minimum supply is not present; and

iii. Record each administration of an agent on a prehospital incident history report, as defined in A.R.S. § 36-2220;

c. Each EMT on duty for the emergency medical services provider to have access to at least the minimum supply of agents required for the highest level of service to be provided by the EMT;

d. That, except while in use, each agent to which an EMT has access while on duty for the emergency medical services provider is:

i. Secured in a dry, clean, washable receptacle;

ii. While on a motor vehicle or aircraft, secured in a manner that restricts movement of the agent and its receptacle; and

iii. If a controlled substance, locked in a substantially constructed cabinet; and

e. That each agent to which an EMT has access while on duty for the emergency medical services provider is kept inaccessible to unauthorized individuals at all times;

4. Each EMT for whom the ALS base hospital supplies agents or provides administrative medical direction has access to a copy of the emergency medical services provider's written standard operating procedure required under subsection (D)(3) while on duty for the emergency medical services provider;

5. The ALS base hospital's pharmacist-in-charge notifies the Department in writing within 10 days after the pharmacist-in-charge receives notice, as required under subsection (D)(3)(b)(ii), that any quantity of a controlled substance is missing; and

6. The ALS base hospital's pharmacist-in-charge complies with all Arizona State Board of Pharmacy and U.S. Drug Enforcement Administration requirements related to the control of agents.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Former R9-25-210 repealed; new R9-25-210 renumbered from R9-25-206 and amended by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). Amended by final rulemaking at 12 A.A.R. 4404, effective January 6, 2007 (Supp. 06-4).

R9-25-211. ALS Base Hospital Enforcement Actions (Authorized by A.R.S. §§ 36-2201, 36-2202(A)(3) and (A)(4), and 36-2204(7))

A. The Department may take an action listed in subsection (B) against an ALS base hospital certificate holder who:

1. Does not meet the certification requirements in R9-25-207(C)(2) or R9-25-207(C)(3);

2. Violates the requirements in A.R.S. Title 36, Chapter 21.1 or 9 A.A.C. 25; or

3. Knowingly or negligently provides false documentation or information to the Department.

B. The Department may take the following action against an ALS base hospital certificate holder:

1. After notice is provided pursuant to A.R.S. Title 41, Chapter 6, Article 10, issue a letter of censure,

2. After notice is provided pursuant to A.R.S. Title 41, Chapter 6, Article 10, issue an order of probation,

3. After notice and an opportunity to be heard is provided pursuant to A.R.S. Title 41, Chapter 6, Article 10, suspend the ALS base hospital certificate, or

4. After notice and an opportunity to be heard is provided pursuant to A.R.S. Title 41, Chapter 6, Article 10, decertify the ALS base hospital.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Former R9-25-211 repealed; new R9-25-211 renumbered from R9-25-213 and amended by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-212. Repealed

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Section repealed by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-213. Renumbered

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Section renumbered to R9-25-211 by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

ARTICLE 3. TRAINING PROGRAMS

Article 3 repealed; new Article 3 made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-301. Definitions; Training Program General Requirements (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. In this Article:

1. "Arizona EMT-Intermediate transition course" means the instruction prescribed in Exhibit B to this Article provided by a training program certified under this Article or by an ALS base hospital authorized under R9-25-210(C);

2. "Course" means the:

a. Arizona EMT-B course, defined in R9-25-305;

b. Arizona EMT-B refresher, defined in R9-25-306;

c. Arizona EMT-I course, defined in R9-25-307;

d. Arizona EMT-P course, defined in R9-25-308;

e. Arizona ALS refresher, defined in R9-25-309;

f. Arizona EMT-Intermediate transition course, defined in subsection(A)(1); or

g. Arizona EMT-I(99)-to-EMT-P transition course, defined in R9-25-318;

3. "NREMT-Intermediate practical examination" means the NREMT-Intermediate practical examination required for NREMT-Intermediate registration; and

4. "Refresher challenge examination" means the:

a. Arizona EMT-B refresher challenge examination, defined in R9-25-306; or

b. Arizona ALS refresher challenge examination, defined in R9-25-309.

B. A person shall not provide or offer to provide a course or refresher challenge examination without training program certification from the Department.

C. The Department shall not certify a training program, if:

1. Within five years before the date of filing an application required in R9-25-302, the Department has decertified a training program operated by the applicant; or

2. The applicant knowingly provides false information on or with an application required by this Article.

D. The Department shall certify a training program, if the applicant:

1. Is not ineligible for certification pursuant to subsection (C); and

2. Meets the application requirements in R9-25-302.

E. A training program certificate is valid only for the name, address, and courses listed by the Department on the certificate.

F. A training program certificate holder shall:

1. Maintain with an insurance company authorized to transact business in this state:

a. A minimum single claim professional liability insurance coverage of $500,000; and

b. A minimum single claim general liability insurance coverage of $500,000 for the operation of the training program; or

2. Be self-insured for the amounts in subsection (F)(1).

G. A training program certificate holder shall:

1. Conspicuously post the original or a copy of the training program certificate in the training program administrative office;

2. Return the training program certificate to the Department upon decertification by the Department pursuant to R9-25-317 or upon voluntarily ceasing to act as a training program; and

3. Not transfer the training program certificate to another person.

H. Every 24 months after certification, the Department shall inspect, pursuant to A.R.S. § 41-1009, a training program to determine ongoing compliance with the requirements of this Article.

I. The Department may inspect, pursuant to A.R.S. § 41-1009, a training program:

1. As part of the substantive review time-frame required in A.R.S. §§ 41-1072 through 41-1079; or

2. As necessary to determine compliance with the requirements of this Article.

J. The Department shall approve or deny an application under this Article pursuant to Article 12 of this Chapter.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Section repealed; new Section made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). Amended by final rulemaking at 12 A.A.R. 4404, effective January 6, 2007 (Supp. 06-4).

R9-25-302. Application Requirements for Training Program Certification (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

An applicant for training program certification shall submit to the Department an application including:

1. An application form provided by the Department containing:

a. The applicant's name, address, and telephone number;

b. The name and telephone number of the applicant's chief administrative officer;

c. The name of each course the applicant will provide;

d. Attestation that the applicant will comply with all requirements in A.R.S. Title 36, Chapter 21.1 and 9 A.A.C. 25;

e. Attestation that all information required as part of the application has been submitted and is true and accurate; and

f. The signature or electronic signature of the applicant's chief administrative officer or the chief administrative officer's designated representative and date of signature or electronic signature;

2. A copy of a certificate of insurance or proof of self-insurance required in R9-25-301(F);

3. For each training program medical director, documentation that the individual is qualified under R9-25-310;

4. For each training program director, documentation that the individual is qualified under R9-25-311;

5. For each lead instructor, documentation that the individual is qualified under R9-25-312;

6. If required under R9-25-304(B), a copy of each executed agreement, including all attachments and exhibits, for clinical training and field training;

7. For each course to be provided, copies of policies and procedures required in R9-25-313;

8. For each course to be provided, copies of disclosure statements required in R9-25-314;

9. For each course to be provided, a completed form provided by the Department verifying that the applicant will develop, administer, and grade a final written course examination, a final comprehensive practical skills examination, or a refresher challenge examination that meets the requirements established for the course; and

10. For each course to be provided, a completed form provided by the Department verifying that the applicant has:

a. Equipment that meets equipment requirements established for the course; and.

b. Facilities that meet facility requirements established for the course.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Section repealed; new Section made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-303. Amendment of a Training Program Certificate (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. No later than 10 days after a change in the name or address listed on a training program certificate, the training program certificate holder shall submit to the Department an application form provided by the Department containing:

1. The new name or new address and the date of the name or address change;

2. Attestation that the current insurance required in R9-25-301(F) is valid for the new name or new address;

3. Attestation that all information su