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 submitted to the Department is true and correct; and

4. 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. Before providing a course not listed by the Department on a training program certificate, a training program certificate holder shall:

1. Submit to the Department an application for the new course that includes the information in R9-25-302; and

2. Gain approval of the new course from the Department.

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).

R9-25-304. Course and Examination Requirements (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. For each session of a course provided, a training program certificate holder shall:

1. Designate a training program medical director qualified under R9-25-310 and ensure that the training program medical director fulfills all responsibilities established in R9-25-310;

2. Designate a training program director qualified under R9-25-311 and ensure that the training program director fulfills all responsibilities established in R9-25-311;

3. Assign a lead instructor qualified under R9-25-312;

4. Ensure that clinical training and field training are provided under the supervision of a preceptor qualified under R9-25-312;

5. Meet all requirements that are established for the course as prescribed in this Article;

6. For clinical training in the course, have a maximum ratio of four students to one preceptor or instructor;

7. For field training in the course, have a maximum ratio of one student to one preceptor or instructor; and

8. Not allow a student more than six months from the official session completion date to complete all course requirements.

B. For a course's clinical training or field training that is not provided directly by a training program, the training program shall have a written agreement between the training program and each health care institution, emergency medical services provider, or ambulance service providing the training that:

1. Requires that all training be provided under the supervision of a preceptor qualified under R9-25-312; and

2. Contains a termination clause that provides sufficient time for students to complete the training upon termination of the agreement.

C. A certified training program authorized to provide the Arizona EMT-B refresher may administer an Arizona EMT-B refresher challenge examination to an individual eligible for admission into the Arizona EMT-B refresher. The certified training program shall limit the individual to one attempt to pass the Arizona EMT-B refresher challenge examination.

D. A certified training program authorized to provide the Arizona ALS refresher may administer an Arizona ALS refresher challenge examination to an individual eligible for admission into the Arizona ALS refresher. The certified training program shall limit the individual to one attempt to pass the Arizona ALS refresher challenge examination.

E. A training program certificate holder shall ensure that:

1. The training program director for a specific session of a course does not:

a. Enroll in that session of the course as a student or allow an instructor for that session of the course to enroll in that session of the course as a student,

b. Issue to himself or herself or to an instructor for that session of the course a certificate of completion for that session of the course,

c. Administer to himself or herself or to an instructor for that session of the course a refresher challenge examination,

d. Allow an instructor for that session of the course to administer to himself or herself a refresher challenge examination, or

e. Issue to himself or herself or to an instructor for that session of the course a certificate of completion for a refresher challenge examination;

2. During a final examination or refresher challenge examination, a student does not receive verbal or written assistance from any other individual or use notes, books, or documents of any kind as an aid in taking the examination;

3. The identity of each student taking a final examination or refresher challenge examination is verified through photo identification before the student is permitted to take the examination;

4. A student who violates subsection (E)(2) is not permitted to complete the examination or to receive a certificate of completion for the course or refresher challenge examination;

5. An instructor who allows a student to violate subsection (E)(2) or assists a student in violating subsection (E)(2) is no longer permitted to serve as an instructor;

6. Each examination for a course is completed onsite at the training program or at a facility used for course instruction;

7. Each final examination for a course is proctored; and

8. Each individual who proctors or administers a final examination for a course is neither the training program director nor an instructor 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). Amended by final rulemaking at 12 A.A.R. 4404, effective January 6, 2007 (Supp. 06-4).

R9-25-305. Arizona EMT-B Course (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. "Arizona EMT-B course" means the United States Department of Transportation, National Highway Traffic Safety Administration, Emergency Medical Technician-Basic: National Standard Curriculum (1994):

1. Incorporated by reference and on file with the Department and the Office of the Secretary of State, including no future editions or amendments; and available from the National Highway Traffic Safety Administration, 400 Seventh Street, SW, Washington, DC 20590; from the Department's Bureau of Emergency Medical Services and Trauma System; and on http://www.nhtsa.gov by going to the Quick Link for Emergency Medical Services Program;

2. Modified in subsection (B); and

3. Provided by a training program certified under this Article or by an ALS base hospital authorized under R9-25-210(C).

B. The Arizona EMT-B course is modified as follows:

1. No more than 24 students shall be enrolled in each session of the course;

2. The following prerequisites are required:

a. Prerequisites identified in the course introductory materials under the heading "Prerequisites"; and

b. Prerequisites listed for lessons 1-1, 1-2, 1-3, 1-4, 1-5, 1-6, 1-7, 2-1, 2-2, 2-3, 3-1, 3-2, 3-3, 3-4, 3-5, 3-6, 3-7, 3-8, 3-9, 3-10, 4-1, 4-2, 4-3, 4-4, 4-5, 4-6, 4-7, 4-8, 4-9, 4-10, 4-11, 5-1, 5-2, 5-3, 5-4, 5-5, 5-6, 6-1, 6-2, 6-3, 7-1, 7-2, 7-3, and 7-4;

3. The minimum course length is 110 contact hours;

4. Modules 1 through 7 are required;

5. Module 8 is deleted;

6. EMS equipment listed for lessons 1-2, 1-3, 1-4, 1-5, 1-6, 1-7, 2-1, 2-2, 2-3, 3-1, 3-2, 3-3, 3-4, 3-5, 3-6, 3-8, 3-9, 3-10, 4-1, 4-2, 4-3, 4-4, 4-5, 4-6, 4-7, 4-8, 4-9, 4-10, 4-11, 5-1, 5-2, 5-3, 5-4, 5-5, 5-6, 6-1, 6-2, 6-3, 7-1, 7-2, 7-3, and 7-4 is required and shall be available before the start of each course session and during the course session as needed to meet the needs of each student enrolled in the course session;

7. Facility recommendations identified in the course introductory materials under the headings "Environment" and "Facilities" are requirements;

8. In addition to modules 1 through 7, the course shall also contain additional instruction and skills training in:

a. Blood glucose monitoring that provides information and hands-on training on the equipment and procedures necessary to evaluate blood sugar levels;

b. Intravenous monitoring that provides information and hands-on training on transporting a patient with an established intravenous or patient controlled analgesic pump; and

c. Administration of epinephrine by auto-injector, including:

i. The epidemiology and physiology of anaphylaxis and allergic reaction;

ii. Common methods of entry of substances into the body;

iii. Common antigens most frequently associated with anaphylaxis;

iv. Physical examination of patients with complaints associated with anaphylaxis or allergic reaction;

v. Signs and symptoms of anaphylaxis, allergic reaction, and respiratory distress associated with anaphylaxis;

vi. Differentiating between anaphylaxis and other medical conditions that may mimic anaphylaxis;

vii. The following information about epinephrine by auto-injector:

(1) Class,

(2) Mechanism of action,

(3) Indications and field use,

(4) Contraindications,

(5) Adverse reactions,

(6) Incompatabilities and drug reactions,

(7) Adult and pediatric dosages,

(8) Route and method of administration,

(9) Onset of action,

(10) Peak effects,

(11) Duration of action,

(12) Dosage forms and packaging,

(13) Minimum supply requirements under R9-25-503,

(14) Special considerations, and

(15) Proper storage conditions; and

viii. A practical skills demonstration of competency in administering epinephrine by auto-injector;

9. A final closed book written course examination is required and shall:

a. Include 150 multiple-choice questions with one absolutely correct answer, one incorrect answer, and two distractors, neither of which is "all of the above" or "none of the above";

b. Cover the learning objectives of the course with representation from each of the course modules; and

c. Require a passing score of 75% or better in no more than three attempts; and

10. A final comprehensive practical skills examination is required and shall:

a. Evaluate a student's technical proficiency in skills identified in Appendix H; and

b. Enable a student to meet NREMT-Basic registration requirements.

C. A training program certified under this Article or an ALS base hospital providing a course as authorized under R9-25-210(C) may combine the students from more than one Arizona EMT-B course session for didactic instruction.

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). Amended by final rulemaking at 13 A.A.R. 3014, effective October 6, 2007 (Supp. 07-3).

Exhibit F. Repealed

Historical Note

Exhibit F 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).

R9-25-306. Arizona EMT-B Refresher, Arizona EMT-B Refresher Challenge Examination (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. "Arizona EMT-B refresher" means the United States Department of Transportation, National Highway Traffic Safety Administration, Emergency Medical Technician: Basic Refresher Curriculum Instructor Course Guide, (1996):

1. Incorporated by reference and on file with the Department, including no future editions or amendments; and available from the National Highway Traffic Safety Administration, 400 Seventh St., SW, Washington, DC 20590; from the Department's Bureau of Emergency Medical Services and Trauma System; and on http://www.nhtsa.gov by going to the Quick Link for Emergency Medical Services Program;

2. As modified in subsection (B); and

3. Provided by a training program certified under this Article or by an ALS base hospital authorized under R9-25-210(C).

B. The Arizona EMT-B refresher is modified as follows:

1. No more than 32 students shall be enrolled in each session of the course;

2. The minimum admission requirements are:

a. One of the following:

i. Current EMT-B or higher level certification in this state or certification, recertification, or licensure at the basic emergency medical technician level or higher level in any other state or jurisdiction;

ii. Current NREMT-Basic or higher level registration; or

iii. Being required by NREMT to complete the Arizona EMT-B refresher to become eligible to seek NREMT-Basic registration; and

b. Proficiency in cardiopulmonary resuscitation;

3. The minimum course length is 24 contact hours;

4. Modules 1 through 6 are required;

5. EMS equipment listed for Modules II, III, IV, V, and VI is required and shall be available before the start of each course session and during the course session as needed to meet the needs of each student enrolled in the course session;

6. Facility recommendations identified for the Arizona EMT-B course are requirements;

7. The course shall include instruction on administration of epinephrine by auto-injector that meets the requirements described in R9-25-305(B)(8)(c);

8. For a student who has not completed the Arizona EMT-B course, the course shall contain additional instruction and skills training in:

a. Blood glucose monitoring that provides information and hands-on training on the equipment and procedures necessary to evaluate blood sugar levels, and

b. Intravenous monitoring that provides information and hands-on training on transporting a patient with an established intravenous or patient controlled analgesic pump;

9. A final closed book written course examination is required and shall:

a. Include 150 multiple-choice questions with one absolutely correct answer, one incorrect answer, and two distractors, neither of which is "all of the above" or "none of the above";

b. Cover the learning objectives of the course with representation from each of the course modules; and

c. Require a passing score of 75% or better in no more than three attempts; and

10. A final comprehensive practical skills examination is required and shall:

a. Evaluate a student's technical proficiency in skills identified as psychomotor objectives in modules 1 through 6; and

b. Enable a student to meet NREMT-Basic registration or reregistration requirements.

C. "Arizona EMT-B refresher challenge examination" means competency testing prescribed in the Arizona EMT-B refresher that is administered by a training program certified under this Article or by an ALS base hospital authorized under R9-25-210(C).

D. The Arizona EMT-B refresher challenge examination shall consist of:

1. The EMT-B refresher final written course examination, required in subsection (B)(9); and

2. The EMT-B refresher final comprehensive practical skills examination, required in subsection (B)(10).

E. A training program certified under this Article or an ALS base hospital providing a course as authorized under R9-25-210(C) may combine the students from more than one Arizona EMT-B refresher session for didactic instruction.

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 11 A.A.R. 553, effective March 5, 2005 (Supp. 05-1). Amended by final rulemaking at 12 A.A.R. 4404, effective January 6, 2007 (Supp. 06-4). Amended by final rulemaking at 13 A.A.R. 3014, effective October 6, 2007 (Supp. 07-3).

R9-25-307. Arizona EMT-I Course (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. "Arizona EMT-I course" means the United States Department of Transportation, National Highway Traffic Safety Administration, EMT-Intermediate: National Standard Curriculum (1999):

1. Incorporated by reference and on file with the Department, including no future editions or amendments; and available from the National Highway Traffic Safety Administration, 400 Seventh St., SW, Washington, DC 20590; from the Department's Bureau of Emergency Medical Services and Trauma System; and on http://www.nhtsa.gov by going to the Quick Link for Emergency Medical Services Program;

2. As modified in subsection (B); and

3. Provided by a training program certified under this Article or by an ALS base hospital authorized under R9-25-210(C).

B. The Arizona EMT-I course is modified as follows:

1. No more than 24 students shall be enrolled in each session of the course;

2. Prerequisites identified in the course introductory materials under the headings "The EMT-Intermediate: National Standard Curriculum" and "Prerequisites" are required;

3. The minimum course length is 400 contact hours, including:

a. A minimum of 280 contact hours of didactic instruction and practical laboratory, and

b. A minimum of 120 contact hours of clinical training and field training;

4. Modules 1 through 7 are required;

5. EMS equipment required for the course is listed in Exhibit A of this Article and shall be available before the start of each course session and during the course session as needed to meet the needs of each student enrolled in the course session;

6. Facility recommendations identified in the course introductory materials under the headings "EMT-Intermediate Education," "Program Evaluation," and "Facilities" are requirements;

7. A final closed book written course examination is required and shall:

a. Include 150 multiple-choice questions with one absolutely correct answer, one incorrect answer, and two distractors, neither of which is "all of the above" or "none of the above";

b. Cover the learning objectives of the course with representation from each of the course modules; and

c. Require a passing score of 75% or better in no more than three attempts; and

8. A final comprehensive practical skills examination is required and shall:

a. Evaluate a student's technical proficiency in skills identified as psychomotor objectives in modules 1 through 7; and

b. Enable a student to meet NREMT-Intermediate registration requirements.

C. A training program certified under this Article or an ALS base hospital providing a course as authorized under R9-25-210(C) may combine the students from more than one Arizona EMT-I course session for didactic instruction.

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). Amended by final rulemaking at 13 A.A.R. 3014, effective October 6, 2007 (Supp. 07-3).

Exhibit H. Repealed

Historical Note

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).

R9-25-308. Arizona EMT-P Course (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. "Arizona EMT-P course" means the United States Department of Transportation, National Highway Traffic Safety Administration, EMT-Paramedic: National Standard Curriculum (1998):

1. Incorporated by reference and on file with the Department, including no future editions or amendments; and available from the National Highway Traffic Safety Administration, 400 Seventh St., SW, Washington, DC 20590; from the Department's Bureau of Emergency Medical Services and Trauma System; and on http://www.nhtsa.gov by going to the Quick Link for Emergency Medical Services Program;

2. As modified in subsection (B); and

3. Provided by a training program certified under this Article or by an ALS base hospital authorized under R9-25-210(C).

B. The Arizona EMT-P course is modified as follows:

1. No more than 24 students shall be enrolled in each session of the course;

2. The following course prerequisites are required:

a. Prerequisites identified in the course introductory materials under the heading "The EMT-Paramedic: National Standard Curriculum, Prerequisites"; and

b. Completion of a minimum of 24 clock hours of hazardous materials training that meets the requirements of the National Fire Protection Association's NFPA 472: Standard for Professional Competence of Responders to Hazardous Materials Incidents, 2002 Edition; Competencies for First Responders at the Operational Level; incorporated by reference and on file with the Department, including no future editions or amendments; and available from the National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169-747 and from the Department's Bureau of Emergency Medical Services and Trauma System;

3. The minimum course length is 1000 contact hours, including:

a. A minimum of 500 contact hours of didactic instruction and practical laboratory, and

b. A minimum of 500 contact hours of clinical training and field training;

4. Modules 1 through 8 are required;

5. Equipment required for the course is listed in Exhibit A and shall be available before the start of each course session and during the course session as needed to meet the needs of each student enrolled in the course session;

6. Facility recommendations on page 32 of the introductory material are requirements;

7. Each student shall complete the competencies in Exhibit C during clinical training and field training;

8. A final closed book written course examination is required and shall:

a. Include 150 multiple-choice questions with one absolutely correct answer, one incorrect answer, and two distractors, neither of which is "all of the above" or "none of the above";

b. Cover the learning objectives of the course with representation from each of the course modules; and

c. Require a passing score of 75% or better in no more than three attempts; and

9. A final comprehensive practical skills examination is required and shall:

a. Evaluate a student's technical proficiency in skills identified as psychomotor objectives in modules 1 through 8; and

b. Enable a student to meet NREMT-Paramedic registration requirements.

C. A training program certified under this Article or an ALS base hospital providing a course as authorized under R9-25-210(C) may combine the students from more than one Arizona EMT-P course session for didactic instruction.

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). Amended by final rulemaking at 13 A.A.R. 3014, effective October 6, 2007 (Supp. 07-3).

R9-25-309. Arizona ALS Refresher; Arizona ALS Refresher Challenge Examination (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. "Arizona ALS refresher" means the U.S. Department of Transportation, National Highway Traffic Safety Administration, EMT-Paramedic: NSC Refresher Curriculum (2001):

1. Incorporated by reference and on file with the Department, including no future editions or amendments; and available from the National Highway Traffic Safety Administration, 400 Seventh St., SW, Washington, DC 20590; from the Department's Bureau of Emergency Medical Services and Trauma System; and on http://www.nhtsa.gov by going to the Quick Link for Emergency Medical Services Program;

2. As modified in subsection (B); and

3. Provided by a training program certified under this Article or by an ALS base hospital authorized under R9-25-210(C).

B. The Arizona ALS refresher is modified as follows:

1. No more than 32 students shall be enrolled in each session of the course;

2. The minimum admission requirements are:

a. One of the following:

i. Current certification as an EMT-I(99) or EMT-P in this state or certification, recertification, or licensure at the intermediate emergency medical technician level or paramedic level in any other state or jurisdiction;

ii. Current NREMT-Intermediate or NREMT-Paramedic registration; or

iii. Being required by NREMT to complete the Arizona ALS refresher to become eligible to seek NREMT-Intermediate or NREMT-Paramedic registration; and

b. Proficiency in cardiopulmonary resuscitation and proficiency in advanced emergency cardiac life support;

3. The minimum course length is 48 contact hours;

4. Modules 1 through 6 are required;

5. For a student at the intermediate emergency medical technician level, lessons, tasks, and objectives shall not exceed the intermediate emergency medical technician skill level;

6. Equipment required for the course is listed in Exhibit A and shall be available before the start of each course session and during the course session as needed to meet the needs of each student enrolled in the course session;

7. Facility recommendations identified for the Arizona EMT-P course are requirements;

8. A final closed book written course examination is required and shall:

a. Include 150 multiple-choice questions with one absolutely correct answer, one incorrect answer, and two distractors, neither of which is "all of the above" or "none of the above";

b. Cover the learning objectives of the course with representation from each of the course modules; and

c. Require a passing score of 75% or better in no more than three attempts; and

9. A final comprehensive practical skills examination is required and shall:

a. Evaluate a student's technical proficiency in skills identified as psychomotor objectives in modules 1, 2, 4, 5, and 6; and

b. Enable a student to meet NREMT-Intermediate or NREMT-Paramedic registration or reregistration requirements.

C. "Arizona ALS refresher challenge examination" means competency testing prescribed in the Arizona ALS refresher that is administered by a training program certified under this Article or by an ALS base hospital authorized under R9-25-210(C).

D. The Arizona ALS refresher challenge examination shall consist of:

1. The ALS refresher final written course examination, required in subsection (B)(8); and

2. The ALS refresher final comprehensive practical skills examination, required in subsection (B)(9).

E. A training program certified under this Article or an ALS base hospital providing a course as authorized under R9-25-210(C) may combine the students from more than one Arizona ALS refresher session for didactic instruction.

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 11 A.A.R. 553, effective March 5, 2005 (Supp. 05-1). Amended by final rulemaking at 12 A.A.R. 4404, effective January 6, 2007 (Supp. 06-4). Amended by final rulemaking at 13 A.A.R. 3014, effective October 6, 2007 (Supp. 07-3).

R9-25-310. Training Program Medical Director (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. A training program certificate holder shall ensure that a training program medical director:

1. Is a physician or exempt from physician licensing requirements under A.R.S. §§ 32-1421(A)(7) or 32-1821(3); 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. A training program medical director designated for a course session shall:

1. Before the start date of the course session, ensure that the course has a course content outline and final examinations that are consistent with:

a. Requirements established in the course; and

b. The scope of practice of the EMT level to which the course corresponds; and

2. During the course session, ensure that the course content outline is followed and that the final examinations are given.

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).

R9-25-311. Training Program Director (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. A training program certificate holder shall ensure that a training program director is:

1. A physician with at least two years emergency medical services experience as a physician;

2. A doctor of allopathic medicine or osteopathic medicine licensed in another state or jurisdiction with at least two years emergency medical services experience as a doctor of allopathic medicine or osteopathic medicine;

3. A registered nurse licensed under A.R.S. Title 32, Chapter 15 or licensed in another state or jurisdiction with at least two years emergency medical services experience as a registered nurse;

4. A physician's assistant licensed under A.R.S. Title 32, Chapter 25 or licensed in another state or jurisdiction with at least two years emergency medical services experience as a physician's assistant;

5. An EMT-P with at least two years experience as an EMT-P;

6. An EMT-I(99) with at least two years experience as an EMT-I(99), only if acting as a training program director for the Arizona EMT-I course, EMT-I Arizona ALS refresher, Arizona EMT-Intermediate transition course, Arizona EMT-B course, or Arizona EMT-B refresher; or

7. An EMT-B with at least two years experience as an EMT-B, only if acting as a training program director for the Arizona EMT-B course or Arizona EMT-B refresher.

B. A training program director designated for a course session shall:

1. Supervise the day-to-day operation of the course session;

2. Supervise and evaluate the course session lead instructor and all preceptors providing clinical training or field training;

3. Ensure that policies and procedures established for the course pursuant to R9-25-313 are followed;

4. Ensure that true and accurate records for each student enrolled in the course session are kept pursuant to R9-25-315;

5. Ensure that a refresher challenge examination is administered and graded pursuant to the requirements established in R9-25-306 or R9-25-309;

6. Ensure that a student is assisted in making reservations to take NREMT written examinations required for NREMT registration;

7. Ensure that a student is assisted in completing application forms required for NREMT registration;

8. Ensure that a student is assisted in completing application forms required for certification in this state;

9. Ensure that forms required pursuant to R9-25-316(B) or (C) are completed and submitted to the Department;

10. For a student who completes a course, issue a certificate of completion containing:

a. Identification of the training program;

b. The name of the course completed;

c. The name of the student who completed the course;

d. The date the student completed all course requirements;

e. Attestation that the student has met all course requirements; and

f. The signature or electronic signature of the training program director and the date of signature or electronic signature; and

11. For an EMT who passes a refresher challenge examination, issue a certificate of completion containing:

a. Identification of the training program;

b. The name of the refresher challenge examination administered;

c. The name of the EMT who passed the refresher challenge examination;

d. The dates the EMT took the refresher challenge examination;

e. Attestation that the EMT has passed the refresher challenge examination; and

f. The signature or electronic signature of the training program director and the date of signature or electronic signature.

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).

Exhibit D. Repealed

Historical Note

Exhibit D 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).

Exhibit C. Repealed

Historical Note

Exhibit C 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).

Exhibit E. Repealed

Historical Note

Exhibit E 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).

R9-25-312. Lead Instructor; Preceptor (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. A training program certificate holder shall ensure that a lead instructor is:

1. A physician with at least two years emergency medical services experience;

2. A doctor of allopathic medicine or osteopathic medicine licensed in another state or jurisdiction with at least two years emergency medical services experience;

3. A registered nurse licensed under A.R.S. Title 32, Chapter 15 or licensed in another state or jurisdiction with at least two years emergency medical services experience;

4. A physician's assistant licensed under A.R.S. Title 32, Chapter 25 or licensed in another state or jurisdiction with at least two years emergency medical services experience;

5. An EMT-P with at least two years experience as an EMT-P;

6. An EMT-I(99) with at least two years experience as an EMT-I(99), only if acting as a lead instructor for the Arizona EMT-I course, EMT-I Arizona ALS refresher, Arizona EMT-Intermediate transition course, Arizona EMT-B course, or Arizona EMT-B refresher; or

7. An EMT-B with at least two years experience as an EMT-B, only if acting as a lead instructor for the Arizona EMT-B course or Arizona EMT-B refresher.

B. A lead instructor shall have completed 24 hours of training related to instructional methodology including:

1. Organizing and preparing materials for didactic instruction, clinical training, field training, and skills practice;

2. Preparing and administering tests and practical examinations;

3. Using equipment and supplies;

4. Measuring student performance;

5. Evaluating student performance;

6. Providing corrective feedback; and

7. Evaluating course effectiveness.

C. A lead instructor assigned to a course session shall:

1. Be present or have a substitute lead instructor present during all course hours established for the course session; and

2. Ensure that course instruction is provided and is consistent with the course content outline and final examinations established for the course.

D. A training program certificate holder shall ensure that a preceptor is:

1. A physician or a doctor of allopathic medicine or osteopathic medicine licensed in another state or jurisdiction;

2. A registered nurse licensed under A.R.S. Title 32, Chapter 15 or licensed in another state or jurisdiction;

3. A physician's assistant licensed under A.R.S. Title 32, Chapter 25 or licensed in another state or jurisdiction;

4. An EMT-P with at least two years experience as an EMT-P;

5. An EMT-I(99) with at least two years experience as an EMT-I(99), only if acting as a preceptor for the Arizona EMT-I course, EMT-I Arizona ALS refresher, Arizona EMT-B course, or Arizona EMT-B refresher; or

6. An EMT-B with at least two years experience as an EMT-B, only if acting as a preceptor for the Arizona EMT-B course or Arizona EMT-B refresher.

E. A preceptor shall provide training consistent with the clinical training or field training established in a course and, if applicable, a written agreement required in R9-25-304(B).

Historical Note

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).

R9-25-313. Training Program Policies and Procedures (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A training program certificate holder shall establish, implement, and annually review policies and procedures for:

1. Student enrollment, including verification that a student has proficiency in reading at the 9th grade level and meets all course admission requirements;

2. Student attendance, including leave, absences, make-up work, tardiness, and causes for suspending or expelling a student for unsatisfactory attendance;

3. Grading, including the minimum grade average considered satisfactory for continued enrollment and standards for suspending or expelling a student for unsatisfactory grades;

4. Administration of final examinations;

5. Student conduct, including causes for suspending or expelling a student for unsatisfactory conduct; and

6. Maintenance of student records and medical records, including compliance with all applicable state and federal laws governing confidentiality, privacy, and security.

Historical Note

New Section made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-314. Training Program Disclosure Statements (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A training program certificate holder shall provide all course applicants with the following documentation before the start date of a course session:

1. A description of requirements for admission, course content, course hours, course fees, and course completion;

2. A list of books, equipment, and supplies that a student is required to purchase for the course;

3. Notification of requirements for a student to begin any part of the course, including physical examinations, immunizations, tuberculin skin tests, drug screening, and the ability to perform certain physical activities;

4. A copy of training program policies and procedures required under R9-25-313;

5. A copy of Article 4 of this Chapter; and

6. A copy of NREMT policies and requirements governing:

a. NREMT practical and written examinations, and

b. NREMT registration.

Historical Note

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).

R9-25-315. Training Program Student Records (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. A training program certificate holder shall keep the following records for each student enrolled in a course session:

1. The student's name;

2. A copy of the student's enrollment agreement or contract;

3. The name of the course in which the student is enrolled;

4. The student's attendance records;

5. The student's clinical training records;

6. The student's field training records;

7. The student's grades;

8. Documentation of scores for each final written examination attempted or completed by the student; and

9. Documentation of each final practical examination attempted or completed by the student, including all forms used as part of the final practical examination.

B. A training program certificate holder shall retain student records required under subsection (A) for three years from the start date of a student's course session.

C. A training program certificate holder shall keep records for each EMT to whom a refresher challenge examination is administered, including:

1. The EMT's name;

2. The challenge examination taken;

3. The challenge examination date;

4. The final written examination attempted or completed by the student and the written examination numeric grade; and

5. Documentation of each practical examination attempted or completed by the student, including all forms used as part of the practical examination.

D. A training program certificate holder shall retain records required under subsection (C) for three years from the date a refresher challenge examination is administered.

Historical Note

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).

R9-25-316. Training Program Notification and Recordkeeping (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. At least 10 days before the start date of a course session, a training program certificate holder shall submit to the Department a completed form provided by the Department containing:

1. Identification of the training program,

2. The course name,

3. The name of the course session's training program medical director and attestation that the training program medical director is qualified under R9-25-310,

4. The name of the course session's training program director and attestation that the training program director is qualified under R9-25-311,

5. The name of the course session's lead instructor and attestation that the lead instructor is qualified under R9-25-312,

6. The course session start date and end date, and

7. The main location at which instruction for the course session will be provided.

B. No later than 10 days after the date a student completes all course requirements, a training program certificate holder shall submit to the Department, the following information on a completed form provided by the Department:

1. The course name and the start date and end date of the course session completed;

2. Name, Social Security number, and mailing address of the student who has completed the course;

3. Date the student completed all course requirements; and

4. Signed and dated attestation of the training program director designated for the course session that the student has met all course requirements.

C. No later than 10 days after the date a certified training program administers a refresher challenge examination, the training program certificate holder shall submit to the Department a completed form provided by the Department containing:

1. Identification of the refresher challenge examination administered;

2. Name, Social Security number, and address of the EMT who passed the refresher challenge examination;

3. Refresher challenge examination date; and

4. Signed and dated attestation of the training program director designated for the course session that the EMT has passed the refresher challenge examination.

D. A training program certificate holder shall maintain for Department review and inspection all documents and records as required under this Article.

Historical Note

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).

R9-25-317. Training Program Enforcement Actions (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. The Department may take an action listed in subsection (B) against a training program certificate holder who:

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

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

B. The Department may take the following action against a training program 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 opportunity to be heard is provided pursuant to A.R.S. Title 41, Chapter 6, Article 10, suspend the training program certificate; or

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

Historical Note

New Section made by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-318. Arizona EMT-I(99)-to-EMT-P Transition Course (Authorized by A.R.S. §§ 36-2202(A)(3) and (A)(4) and 36-2204(1) and (3))

A. "Arizona EMT-I(99)-to-EMT-P transition course" means the U.S. Department of Transportation, National Highway Traffic Safety Administration, EMT-Paramedic: National Standard Curriculum (1998):

1. Incorporated by reference in R9-25-308,

2. As modified in subsection (B), and

3. Provided by a training program certified under this Article or by an ALS base hospital authorized under R9-25-210(C).

B. The Arizona EMT-I(99)-to-EMT-P transition course is modified as follows:

1. No more than 24 students shall be enrolled in each session of the course;

2. Each student enrolled shall have current certification as an EMT-I(99);

3. The following course prerequisites are required:

a. Completion of a minimum of 24 clock hours of hazardous materials training that meets the requirements of the National Fire Protection Association's NFPA 472: Standard for Professional Competence of Responders to Hazardous Materials Incidents, 2002 Edition; Competencies for First Responders at the Operational Level, incorporated by reference in R9-25-308; and

b. Evidence of proficiency in cardiopulmonary resuscitation and proficiency in advanced emergency cardiac life support;

4. In addition to the minimum contact hours of didactic instruction required under subsection (B)(5), each student shall complete at least 60 hours of training in anatomy and physiology that:

a. Is completed either:

i. As a prerequisite to the course,

ii. As preliminary instruction completed at the beginning of the course session before the units of instruction required under subsection (B)(6), or

iii. Through integration of the anatomy and physiology material with the units of instruction required under subsection (B)(6); and

b. Covers the anatomy and physiology prerequisite objectives listed in Appendix E to the course materials;

5. The minimum course length is 600 contact hours, including:

a. A minimum of 220 contact hours of didactic instruction and practical laboratory, and

b. A minimum of 380 contact hours of clinical training and field training;

6. The following units of instruction are required:

a. In Module 1, units 1-2, 1-3, 1-4, 1-5, 1-6, 1-9, and 1-10;

b. In Module 3, units 3-1, 3-2, 3-3, 3-4, and 3-5;

c. In Module 4, units 4-3, 4-4, 4-5, 4-8, and 4-9;

d. In Module 5, units 5-1, 5-3, 5-4, 5-5, 5-6, 5-7, 5-8, 5-9, 5-10, 5-11, 5-12, 5-13, and 5-14;

e. In Module 6, units 6-1, 6-3, 6-4, 6-5, and 6-6;

f. In Module 7, unit 7-1; and

g. In Module 8, units 8-2, 8-3, 8-4, and 8-5;

7. Equipment required for the course is listed in Exhibit A and shall be available before the start of each course session and during the course session as needed to meet the needs of each student enrolled in the course session;

8. Facility recommendations on page 32 of the introductory material are requirements;

9. Each student shall complete the competencies in Exhibit C during clinical training and field training;

10. A final closed book written course examination is required and shall:

a. Include 150 multiple-choice questions with one absolutely correct answer, one incorrect answer, and two distractors, neither of which is "all of the above" or "none of the above";

b. Cover the learning objectives of the course with representation from each of the required units of instruction; and

c. Require a passing score of 75% or better in no more than three attempts; and

11. A final comprehensive practical skills examination is required and shall:

a. Evaluate a student's technical proficiency in skills identified as psychomotor objectives in the units of instruction required under subsection (B)(6), and

b. Enable a student to meet NREMT-Paramedic registration requirements.

C. A training program certified under this Article or an ALS base hospital providing a course as authorized under R9-25-210(C) may combine the students from more than one Arizona EMT-I(99)-to-EMT-P transition course session for didactic instruction.

Historical Note

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

Exhibit A. Equipment Minimum Standards for the Arizona EMT-I Course, EMT-P Course, ALS Refresher, and EMT-I(99)-to-EMT-P Transition Course

Historical Note

New Exhibit 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).

Exhibit B. Arizona EMT-Intermediate Transition Course

Admission Requirements:

1. Current and valid certification in Arizona as an EMT-I(85), and

2. Evidence of proficiency in cardiopulmonary resuscitation.

Course Hours:

The minimum course length is 80 contact hours. In addition, sufficient time shall be provided to administer the final written examination and the final practical examination.

Equipment and Facilities:

Equipment required for the course is listed in Exhibit A and shall be available before the start of each course session and during the course session as needed to meet the needs of each student enrolled in the course session. Facility recommendations identified for the Arizona EMT-P course are requirements for the Arizona EMT-Intermediate Transition Course.

Examinations:

1. A final written course examination is required and shall:

a. Include 150 multiple-choice questions with one absolutely correct answer, one incorrect answer, and two distractors, neither of which is "all of the above" or "none of the above";

b. Cover the learning objectives of the course with representation from each of the course modules; and

c. Require a passing score of 75% or better in no more than three attempts.

2. A final comprehensive practical skills examination is required and shall enable a student to meet NREMT-Intermediate/99 registration or reregistration requirements.

Competencies:

1. Describe the scope of the duties of the advanced emergency medical technician (Intermediate and Paramedic).

2. Identify signs and symptoms of patients with a communicable disease and list the appropriate body substance isolation procedures.

3. Identify the initial, focused, and continuing processes of assessment, medical history, vital signs, communications, and documentation.

4. Apply the procedures of identifying and treating hypoperfusion states including intravenous (IV) and intraosseous (IO) fluid therapy.

5. Describe the actions, indications, contraindications, precautions, side effects, and dosages of the agents included in Table 1 in R9-25-503.

6. Given a patient scenario, identify and treat emergencies and relate proposed field interventions for each of the body systems.

7. Given a patient scenario, identify and relate proposed field interventions for patient with obstetrical emergencies.

8. Given a patient scenario, identify and relate proposed field interventions for patient with neonatal and pediatric emergencies.

9. Given a patient scenario, identify and relate proposed field interventions for patient with behavioral emergencies, preserving personal safety and well being.

10. Demonstrate trauma victim assessment, airway management, control of hemorrhage and hypoperfusion states.

11. Demonstrate 80 percent proficiency on a written examination and 80 percent accuracy of practical skills in selected EMS scenarios.

Course Outline:

I. Advanced Emergency Medical Technician

A. Roles and responsibilities

B. Rules, regulations, and EMS systems

II. Human Systems and Patient Assessment

A. Scene management and body substance isolation

B. Human systems in health and disease

C. Initial, focused, and ongoing processes of assessment

1. Vital signs

2. History taking, interviewing, and communications

3. Terminology

D. Documentation

III. Hypoperfusion States

A. Shock/Disorders of hydration

B. Devices and techniques

C. Trauma

D. Thermal injuries

E. Communications and documentation

IV. Pharmacology

A. Basic and advanced pharmacokinetics

B. Updated agent information

C. Action of agents

D. Techniques of administration

1. Oral

2. Rectal

3. Parenteral

4. Intraosseous

5. Intralingual

E. Table 1 in R9-25-503

V. Illness, Injury, and the Body's Systems

A. Respiratory

1. LMA

2. Combitube

3. Endotracheal and nasal tracheal intubation

4. Surgical cricothyrotomy

5. Needle thoracostomy

B. Cardiovascular

1. Ecg rhythm identification

2. Pacemaker rhythm identification

3. 12-lead ecg application and analysis

4. Defibrillation and cardioversion procedures

C. Central nervous system

D. Endocrine

E. Musculoskeletal emergencies

F. Soft tissue emergencies

G. Acute abdominal emergencies

H. Genito-urinary emergencies

I. Gynecological emergencies

J. Anaphylactic reactions

K. Toxicology, alcoholism, and substance abuse

L. Poisoning and overdose

M. Submersion incidents

N. Emergencies in the geriatric patient

O. Techniques of management

P. Communications and documentation

VI. Obstetrical Emergencies

A. Maternal assessment

B. Delivery techniques

C. Care of the newborn

D. Ectopic pregnancy

E. Infectious diseases

F. Rape and abuse

G. Communications and documentation

VII. Neonatal and Pediatric Emergencies

A. Approach to the pediatric patient

B. Related pathologies

C. Techniques of management

D. Communications and documentation

VIII. Behavioral Emergencies

A. Behavioral disorders

B. Hostile environments

C. Therapeutic communications

D. Restraint

IX. Trauma and Disaster

A. START Triage

B. Incident command

C. Age considerations

1. Infant

2. Pediatric

3. Adult

4. Geriatric

X. Evaluation

A. Written

B. Skills

Historical Note

New Exhibit 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).

Exhibit C. Arizona EMT-P Course and Arizona EMT-I(99)-to-EMT-P Transition Course Clinical Training and Field Training Competencies

A. PSYCHOMOTOR SKILLS

1. The student shall demonstrate the ability to safely administer agents: The student shall safely, and while performing all steps of each procedure, properly administer agents at least 10 times to live patients.

2. The student shall demonstrate the ability to safely perform endotracheal intubation: The student shall safely, and while performing all steps of each procedure, successfully intubate at least one live patient or cadaver.

3. The student shall demonstrate the ability to safely gain venous access in all age group patients: The student shall safely, and while performing all steps of each procedure, successfully access the venous circulation at least 17 times on live patients of various age groups.

4. The student shall demonstrate the ability to effectively ventilate unintubated patients of all age groups: The student shall effectively, and while performing all steps of each procedure, ventilate at least 12 unintubated live patients.

B. AGES

1. The student shall demonstrate the ability to perform a comprehensive assessment on pediatric patients: The student shall perform a comprehensive patient assessment on at least 20 pediatric patients, including newborns, infants, toddlers, and school-age.

2. The student shall demonstrate the ability to perform a comprehensive assessment on adult patients: The student shall perform a comprehensive patient assessment on at least 20 adult patients of various age groups, including young, middle, and older patients.

C. PATHOLOGIES

1. The student shall demonstrate the ability to perform a comprehensive assessment on obstetric patients: The student shall perform a comprehensive patient assessment on at least 5 obstetric patients.

2. The student shall demonstrate the ability to perform a comprehensive assessment on trauma patients: The student shall perform a comprehensive patient assessment on at least 20 trauma patients.

3. The student shall demonstrate the ability to perform a comprehensive assessment on behavioral patients: The student shall perform a comprehensive patient assessment on at least 10 behavioral patients.

D. CHIEF COMPLAINTS

1. The student shall demonstrate the ability to perform a comprehensive assessment on and formulate and implement a treatment plan for patients with chest pain: The student shall perform a comprehensive patient assessment on and formulate and implement a treatment plan for at least 20 patients with chest pain.

2. The student shall demonstrate the ability to perform a comprehensive assessment on and formulate and implement a treatment plan for patients with dyspnea/respiratory distress:

a. The student shall perform a comprehensive patient assessment on and formulate and implement a treatment plan for at least 15 adult patients with dyspnea or respiratory distress; and

b. The student shall perform a comprehensive patient assessment on and formulate and implement a treatment plan for at least 5 pediatric patients, including infants, toddlers, and school-age, with dyspnea or respiratory distress.

3. The student shall demonstrate the ability to perform a comprehensive assessment on and formulate and implement a treatment plan for patients with abdominal complaints: The student shall perform a comprehensive patient assessment on and formulate and implement a treatment plan for at least 15 patients with abdominal complaints such as abdominal pain, nausea or vomiting, gastrointestinal bleeding, and gynecological complaints.

4. The student shall demonstrate the ability to perform a comprehensive assessment on and formulate and implement a treatment plan for patients with altered mental status: The student shall perform a comprehensive patient assessment on and formulate and implement a treatment plan for at least 15 patients with altered mental status.

E. TEAM LEADER SKILLS

The student shall demonstrate the ability to serve as a team leader in a variety of prehospital emergency situations: The student shall serve as the team leader for at least 25 prehospital emergency responses.

Historical Note

New Exhibit made by final rulemaking at 12 A.A.R. 4404, effective January 6, 2007 (Supp. 06-4). Amended by final rulemaking at 13 A.A.R. 3014, effective October 6, 2007 (Supp. 07-3).

ARTICLE 4. EMT CERTIFICATION

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

R9-25-401. EMT General Requirements (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), (A)(4), (A)(6), and (G) and 36-2204(1), (6), and (7))

A. Except as provided in R9-25-406(G), an individual shall not act as an EMT-B, EMT-I, or EMT-P unless the individual has current certification or recertification from the Department.

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

C. If the Department denies an application for certification or recertification, the applicant may request a hearing pursuant to A.R.S. Title 41, Chapter 6, Article 10.

D. The Department shall certify or recertify an EMT for two years:

1. Except as provided in R9-25-405; or

2. Unless revoked by the Department pursuant to A.R.S. § 36-2211.

E. An individual whose EMT certificate is expired shall not apply for recertification, unless the individual has been granted an extension to file an application for EMT recertification under R9-25-407 or submits an application for recertification, with a certification extension fee, within 30 days after the expiration date of the EMT certification as provided in R9-25-406.

F. An individual whose EMT certificate is expired or denied by the Department may apply for certification pursuant to R9-25-404 or, if applicable, R9-25-405.

G. The Department shall keep confidential all criminal justice information received from the Department of Public Safety or any local, state, tribal, or federal law enforcement agency and shall not make this information available for public record review.

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. 1713, effective June 30, 2007 (Supp. 07-2).

R9-25-402. EMT Certification and Recertification Requirements (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), (A)(4), and (A)(6), 36-2202(G), and 36-2204(1), (6), and (7))

A. The Department shall not certify an EMT if the applicant:

1. Is currently:

a. Incarcerated for a criminal conviction,

b. On parole for a criminal conviction,

c. On supervised release for a criminal conviction, or

d. On probation for a criminal conviction;

2. Within 10 years before the date of filing an application for certification required by this Article, has been convicted of any of the following crimes, or any similarly defined crimes in this state or in any other state or jurisdiction, unless the conviction has been absolutely discharged, expunged, or vacated:

a. 1st or 2nd degree murder;

b. Attempted 1st or 2nd degree murder;

c. Sexual assault;

d. Attempted sexual assault;

e. Sexual abuse of a minor;

f. Attempted sexual abuse of a minor;

g. Sexual exploitation of a minor;

h. Attempted sexual exploitation of a minor;

i. Commercial sexual exploitation of a minor;

j. Attempted commercial sexual exploitation of a minor;

k. Molestation of a child;

l. Attempted molestation of a child; or

m. A dangerous crime against children as defined in A.R.S. § 13-604.01;

3. Within five years before the date of filing an application for certification required by this Article, has been convicted of a misdemeanor involving moral turpitude or a felony in this state or any other state or jurisdiction, other than a misdemeanor involving moral turpitude or a felony listed in subsection (A)(2), unless the conviction has been absolutely discharged, expunged, or vacated;

4. Within five years before the date of filing an application for certification required by this Article, has had EMT certification or recertification revoked in this state or EMT certification, recertification, or licensure revoked in any other state or jurisdiction; or

5. Knowingly provides false information in connection with an application required by this Article.

B. The Department shall not recertify an EMT, if:

1. While certified, the applicant has been convicted of a crime listed in subsection (A)(2), or any similarly defined crimes in this state or in any other state or jurisdiction, unless the conviction has been absolutely discharged, expunged, or vacated; or

2. The applicant knowingly provides false information in connection with an application required by this Article.

C. The Department shall certify or recertify an EMT who:

1. Is at least 18 years of age;

2. Is not ineligible for:

a. Certification pursuant to subsection (A), or

b. Recertification pursuant to subsection (B); and

3. Meets the applicable requirements in R9-25-404, R9-25-405, or R9-25-406.

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).

R9-25-403. EMT Probationary Certification (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), (A)(4), and (A)(6), 36-2202(G), and 36-2204(1), (6), and (7))

A. The Department shall make probation a condition of certification under R9-25-404 or temporary certification under R9-25-405, if within two years before the date of filing an application for certification required by this Article, an applicant who is not ineligible for certification under R9-25-402 has been convicted of a misdemeanor in this state or in any other state or jurisdiction, involving:

1. Possession, use, administration, acquisition, sale, manufacture, or transportation of an intoxicating liquor, dangerous drug, or narcotic drug, unless the conviction has been absolutely discharged, expunged, or vacated; or

2. Driving or being in physical control of a vehicle while under the influence of an intoxicating liquor, a dangerous drug, or a narcotic drug, unless the conviction has been absolutely discharged, expunged, or vacated.

B. The Department shall fix the period and terms of probation that will:

1. Protect the public health and safety, and

2. Remediate and educate the applicant.

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).

R9-25-404. Application Requirements for EMT Certification (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), (A)(4), and (G) and 36-2204(1) and (6))

A. An applicant for initial EMT certification shall submit to the Department an application including:

1. An application form provided by the Department containing:

a. The applicant's name, address, telephone number, date of birth, and Social Security number;

b. Responses to questions addressing the applicant's criminal history pursuant to R9-25-402(A) and R9-25-403(A);

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

d. The applicant's signature and date of signature;

2. For each affirmative response to a question addressing the applicant's criminal history pursuant to R9-25-402(A) or R9-25-403(A), a detailed explanation and supporting documentation; and

3. If applicable, a copy of EMT certification, recertification, or licensure issued to the applicant in another state or jurisdiction.

B. In addition to the application, the following are required:

1. For EMT-B certification, both:

a. A certificate of course completion signed by the training program director designated for the course session for either the:

i. Arizona EMT-B course, as defined in R9-25-305; or

ii. Arizona EMT-B refresher, as defined in R9-25-306, if the applicant has current certification, licensure, NREMT registration, or NREMT reregistration eligibility at the basic emergency medical technician level or higher level; and

b. Evidence of current NREMT-Basic registration;

2. For EMT-I(99) certification, both:

a. A certificate of course completion signed by the training program director designated for the course session for either the:

i. Arizona EMT-I course, as defined in R9-25-307; or

ii. Arizona ALS refresher, as defined in R9-25-309, if the applicant has current certification, licensure, NREMT registration, or NREMT reregistration eligibility at the intermediate emergency medical technician level or higher level; and

b. Evidence of current NREMT-Intermediate registration; or

3. For EMT-P certification, both:

a. A certificate of course completion signed by the training program director designated for the course session for the:

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

ii. Arizona ALS refresher, as defined in R9-25-309, if the applicant has current certification, licensure, NREMT registration, or NREMT reregistration eligibility at the paramedic emergency medical technician level; or

iii. Arizona EMT-I(99)-to-EMT-P transition course; and

b. Evidence of current NREMT-Paramedic registration.

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).

R9-25-405. Application Requirements for Temporary Nonrenewable EMT-B or EMT-P Certification (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), and (A)(4), 36-2202(G), and 36-2204(1), (6), and (7))

A. An individual who holds current NREMT-Basic registration, but does not meet requirements in R9-25-404(B)(1)(a), may apply for one temporary six-month EMT-B certification.

B. An individual who holds current NREMT-Paramedic registration, but does not meet application requirements in R9-25-404(B)(3)(a), may apply for one temporary six-month EMT-P certification.

C. An applicant for temporary certification shall submit to the Department a copy of current NREMT registration and an application required in R9-25-404(A).

D. The Department shall certify an applicant who meets certification requirements under this Section for six months.

E. The Department shall automatically certify an EMT who holds a six month certificate for an additional 18 months, if the EMT:

1. Continues to hold current NREMT-Basic registration or current NREMT-Paramedic registration; and

2. Before the expiration of the six month certificate, meets the applicable application requirements in R9-25-404(B).

F. The Department shall issue an EMT who complies with subsection (E) a new certificate that expires 24 months from the date the six month certificate is issued.

G. An EMT who is not certified under subsection (E):

1. Shall not act as an EMT after the expiration date of the six month certificate,

2. Is not eligible to apply for another six month certificate under this Section,

3. Shall not apply for recertification, and

4. May apply for certification pursuant to R9-25-404.

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).

R9-25-406. Application Requirements for EMT Recertification (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), (A)(4), (A)(6), and (G) and 36-2204(1), (4), and (6))

A. An individual who holds current and valid certification as an EMT in Arizona may, before the expiration date of the individual's current EMT certification, apply for recertification at the same level of EMT certification currently held or at a lower level of EMT certification.

B. An individual whose certification as an EMT in Arizona has an expiration date within the past 30 days may apply for recertification at the same level of EMT certification or at a lower level of EMT certification.

C. To apply for recertification, an applicant shall submit to the Department an application including:

1. An application form provided by the Department containing:

a. The applicant's name, address, telephone number, date of birth, and Social Security number;

b. Responses to questions addressing the applicant's criminal history pursuant to R9-25-402(A)(3), R9-25-402(B)(1), and R9-25-411(A);

c. An indication of the level of EMT certification currently held or with an expiration date within the past 30 days and of the level of EMT certification for which recertification is requested;

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

e. The applicant's signature and date of signature;

2. For each affirmative response to a question addressing the applicant's criminal history pursuant to R9-25-402(A)(3), R9-25-402(B)(1), and R9-25-411(A), a detailed explanation and supporting documentation; and

3. If applicable, a copy of each EMT certification, recertification, or licensure issued to the applicant in another state or jurisdiction that the applicant holds.

D. In addition to the application, an applicant shall submit the following to the Department:

1. For EMT-B recertification, either:

a. A certificate of course completion signed by the training program director designated for the course session showing that within two years before the expiration date of the applicant's current certificate, the applicant completed either the:

i. Arizona EMT-B refresher, as defined in R9-25-306; or

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

b. Evidence of current NREMT-Basic registration;

2. For EMT-I(99) recertification, either:

a. Attestation that the applicant:

i. Has completed continuing education as required under subsection (E), and

ii. Has and will maintain for Department review documentation verifying completion of continuing education as required under subsection (E); or

b. Evidence of current NREMT-Intermediate registration;

3. For EMT-P recertification, either:

a. Attestation that the applicant:

i. Has completed continuing education as required under subsection (E), and

ii. Has and will maintain for Department review documentation verifying completion of continuing education as required under subsection (E); or

b. Evidence of current NREMT-Paramedic registration; and

4. For an application submitted within 30 days after the expiration date of EMT certification, a nonrefundable certification extension fee of $150 in the form of a certified check, business check, or money order made payable to the Arizona Department of Health Services.

E. An EMT required to attest to completion of continuing education under subsection (D)(2)(a) or (D)(3)(a) shall complete 60 clock hours of continuing education in the two years before the expiration date of the EMT's current certification or, if applicable, before the end of an extension period granted under R9-25-407, as follows:

1. Seven clock hours through proficiency in cardiopulmonary resuscitation and proficiency in advanced emergency cardiac life support;

2. No more than 48 clock hours for completion of the Arizona ALS refresher;

3. No more than 12 clock hours for passing the Arizona ALS refresher challenge examination;

4. No more than 20 clock hours of training in a single subject covered in the Arizona EMT-I course, the Arizona EMT-P course, or the Arizona ALS refresher;

5. No more than 20 clock hours of teaching in a single subject covered in the Arizona EMT-I course, the Arizona EMT-P course, or the Arizona ALS refresher;

6. No more than 20 clock hours of training related to skills, procedures, or treatments authorized under Article 5 of this Chapter;

7. No more than 20 clock hours of teaching related to skills, procedures, or treatments authorized under Article 5 of this Chapter;

8. No more than 20 clock hours of training in current developments, skills, procedures, or treatments related to the practice of emergency medicine or the provision of emergency medical services;

9. No more than 20 clock hours of participation in or attendance at meetings, conferences, presentations, seminars, or lectures designed to provide understanding of current developments, skills, procedures, or treatments related to the practice of emergency medicine or the provision of emergency medical services;

10. No more than 16 clock hours of training in advanced trauma life support;

11. No more than 16 clock hours of training in pediatric emergency care; and

12. If the individual is certified as an EMT-I(85) and desires to apply for recertification as an EMT-I(99) as provided under R9-25-412, by completing the Arizona EMT-Intermediate transition course, defined in R9-25-301.

F. The Department shall not issue recertification as an EMT-I(85).

G. If an individual submits an application for recertification, with a certification extension fee, within 30 days after the expiration date of the individual's EMT certification, the individual:

1. Was authorized to act as an EMT during the period between the expiration date of the individual's EMT certification and the date the application was submitted, and

2. Is authorized to act as an EMT until the Department makes a final determination on the individual's application for recertification.

H. If an individual does not submit an application for recertification before the expiration date of the individual's EMT certification or, with a certification extension fee, within 30 days after the expiration date of the individual's EMT certification, the individual:

1. Was not authorized to act as an EMT during the 30-day period after the expiration date of the individual's EMT certification, and

2. Is not eligible for recertification.

I. The Department may deny, based on failure to meet the standards for recertification in A.R.S. Title 36, Chapter 21.1 and this Article, an application submitted with a certification extension fee.

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). Amended by final rulemaking at 13 A.A.R. 1713, effective June 30, 2007 (Supp. 07-2).

R9-25-407. Extension to File an Application for EMT Recertification (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), (A)(4), and (6), 36-2202(G), and 36-2204(1), (4), (5), and (7))

A. Before the expiration of a current certificate, an EMT who is unable to meet the recertification requirements in R9-25-406 because of personal or family illness, military service, or authorized federal or state emergency response deployment may apply to the Department in writing for one extension of time to file for recertification.

B. The Department may grant one extension of time to file for recertification:

1. For personal or family illness, for no more than 180 days; or

2. For military service or authorized federal or state emergency response deployment, for the term of service or deployment plus 180 days.

C. An individual applying for or granted an extension of time to file for recertification remains certified pursuant to the conditions of A.R.S. § 41-1092.11.

D. An EMT who does not meet the recertification requirements in R9-25-406 within the extension period or has the application for recertification denied by the Department:

1. Is not eligible to apply for recertification; and

2. May apply for certification pursuant to R9-25-404, or if applicable, R9-25-405.

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).

R9-25-408. Requirements for Downgrading of Certification (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), (A)(4), and (G) and 36-2204(1) and (6))

A. An individual who holds current and valid EMT certification at a level higher than EMT-B and who is not under investigation pursuant to A.R.S. § 36-2211 may apply for continued certification at a lower EMT level for the remainder of the certification period by submitting to the Department:

1. A written request containing:

a. The EMT's name, address, telephone number, date of birth, and Social Security number;

b. The lower EMT-level requested;

c. Attestation that the applicant has not committed an act or engaged in conduct that would warrant revocation of a certificate under A.R.S. § 36-2211;

d. Attestation that all information submitted is true and accurate; and

e. The applicant's signature and date of signature; and

2. Either:

a. A written statement from the EMT's administrative medical director attesting that the EMT is able to perform at the lower level of certification requested; or

b. If applying for continued certification as an EMT-B, an Arizona EMT-B refresher certificate of completion or an Arizona EMT-B refresher challenge examination certificate of completion signed by the training program director designated for the Arizona EMT-B refresher session.

B. An individual who holds current and valid EMT certification at a level higher than EMT-B and who is not under investigation pursuant to A.R.S. § 36-2211 may apply for recertification at a lower level pursuant to R9-25-406.

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).

R9-25-409. Notification Requirements (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3) and (A)(4), 36-2204(1) and (6), and 36-2211)

A. No later than 30 days after the date an EMT's name legally changes, the EMT shall submit to the Department:

1. A completed form provided by the Department containing:

a. The name under which the EMT is currently certified by the Department;

b. The EMT's address, telephone number, and Social Security number; and

c. The EMT's new name; and

2. Documentation showing that the name has been legally changed.

B. No later than 30 days after the date an EMT's address changes, the EMT shall submit to the Department a completed form provided by the Department containing:

1. The EMT's name, telephone number, and Social Security number; and

2. The EMT's new address.

C. An EMT shall notify the Department in writing no later than 10 days after the date the EMT:

1. Is incarcerated or is placed on parole, supervised release, or probation for any criminal conviction;

2. 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;

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

4. Has registration revoked or suspended by NREMT; or

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

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).

R9-25-410. EMT Standards of Practice (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), (A)(4), and (A)(6), 36-2202(G), 36-2204(1), (6) and (7), 36-2205, and 36-2211)

An EMT shall act as an EMT only:

1. As authorized under the EMT's scope of practice as identified under Article 5 of this Chapter; and

2. For an EMT required to have medical direction pursuant to A.R.S. Title 36, Chapter 21.1 and R9-25-201, as authorized under;

a. Treatment protocols, triage protocols, and communication protocols approved by the EMT's administrative medical director; and

b. Medical recordkeeping, medical reporting, and prehospital incident history report requirements approved by the EMT's administrative medical director.

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).

R9-25-411. Enforcement Actions (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), (A(4), and (A)(6), 36-2202(G), 36-2204(1), (6) and (7), and 36-2211)

A. For purposes of A.R.S. § 36-2211(A)(1), unprofessional conduct is an act or omission made by an EMT that is contrary to the recognized standards or ethics of the EMT profession or that may constitute a danger to the health, welfare, or safety of a patient or the public, including but not limited to:

1. Impersonation of an EMT of a higher level of certification or impersonation of a health professional as defined in A.R.S. § 32-3201;

2. Permitting or allowing another individual to use the EMT certification for any purpose;

3. Aiding or abetting an individual who is not certified pursuant to this Chapter in acting as an EMT or in representing that the individual is certified as an EMT;

4. Engaging in or soliciting sexual relationships, whether consensual or nonconsensual, with a patient while acting as an EMT;

5. Physically or verbally harassing, abusing, threatening, or intimidating a patient or another individual while acting as an EMT;

6. Making false or materially incorrect entries in a medical record or willful destruction of a medical record;

7. Failing or refusing to maintain adequate records on a patient;

8. Soliciting or obtaining monies or goods from a patient by fraud, deceit, or misrepresentation;

9. Aiding or abetting an individual in fraud, deceit, or misrepresentation in meeting or attempting to meet the application requirements for EMT certification or EMT recertification contained in this Article, including the requirements established for:

a. Completing and passing a course provided by a training program; and

b. The NREMT examination process and NREMT registration process;

10. Providing false information or making fraudulent or untrue statements to the Department or about the Department during an investigation conducted by the Department;

11. Being incarcerated or being placed on parole, supervised release, or probation for any criminal conviction;

12. Being convicted of a misdemeanor identified in R9-25-403(A), which has not been absolutely discharged, expunged, or vacated;

13. Having NREMT registration revoked or suspended by NREMT for material noncompliance with NREMT rules or standards; and

14. Having EMT certification, recertification, or licensure revoked or suspended in another state or jurisdiction.

B. Under A.R.S. § 36-2211, physical or mental incompetence of an EMT is the EMT's lack of physical or mental ability to provide emergency medical services as required under this Chapter.

C. Under A.R.S. § 36-2211 gross incompetence or gross negligence is an EMT's willful act or willful omission of an act that is made in disregard of an individual's life, health, or safety and that may cause death or injury.

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).

Exhibit I. Repealed

Historical Note

Exhibit I 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).

Exhibit J. Repealed

Historical Note

Exhibit J 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).

Exhibit K. Repealed

Historical Note

Exhibit K 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).

R9-25-412. Special EMT-I Certification and Recertification Conditions (Authorized by A.R.S. §§ 36-2202(A)(2), (A)(3), (A)(4), (A)(6), and (G) and 36-2204(1), (4), and (6))

A. Before December 31, 2007, an individual certified as an EMT-I(85) shall do one of the following:

1. Complete the Arizona EMT-Intermediate transition course, defined in R9-25-301, and apply for recertification as an EMT-I(99) under subsection R9-25-406(B) and (C)(2);

2. Apply for recertification as an EMT-B, as provided under R9-25-408(B) and R9-25-406(A);

3. Apply for downgrading of certification to become an EMT-B, as provided under R9-25-408(A); or

4. Allow the individual's EMT-I(85) certification to expire and cease to be a certified EMT.

B. Each EMT-I(85) certification expires on the expiration date shown on the certificate issued by the Department or on December 31, 2007, whichever is sooner.

Historical Note

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).

ARTICLE 5. MEDICAL DIRECTION PROTOCOLS FOR EMERGENCY MEDICAL TECHNICIANS

Article 5, consisting of R9-25-501 through R9-25-508, recodified from Article 8 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

Article 5 repealed by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-501. Protocol for Administration of a Tuberculin Skin Test by an EMT-I(99) or EMT-P

A. After meeting the training requirement in subsection (B), an EMT-I(99) or EMT-P may administer a tuberculin skin test.

B. An EMT-I(99) or EMT-P shall not administer a tuberculin skin test until the EMT-I(99) or EMT-P has completed training that:

1. Includes at least two clock hours covering:

a. The supplies needed to perform tuberculin skin testing;

b. Storage and handling of tuberculin solution, including the need to verify that the tuberculin solution is the correct strength, is not expired, and was not opened more than 30 days before tuberculin skin testing;

c. Preparation of an individual for tuberculin skin testing, including:

i. Verifying the individual's identity;

ii. Determining whether the individual has any allergies or contraindications for tuberculin skin testing; and

iii. Verifying that the individual is available to report to a specific location to have the tuberculin skin test read within 48-72 hours after the tuberculin skin test is administered;

d. Administration of the tuberculin skin test, including preparation of the test site, preparation of the appropriate dosage, and the technique for administration;

e. Documentation of tuberculin skin test administration;

f. Post-administration instructions to be provided to an individual being tested; and

g. A practical skills exercise that includes performance of the skill using sterile saline in the arm of a volunteer;

2. Includes a post-training written evaluation and a practical skills evaluation to ensure that the EMT-I(99) or EMT-P demonstrates competency in the subject matter listed in subsection (B)(1) and in correctly administering a tuberculin skin test, with a score of at least 80% required to demonstrate competency on the written evaluation; and

3. Is approved by the EMT-I(99)'s or EMT-P's administrative medical director.

C. An EMT-I(99) or EMT-P who completes the tuberculin skin test training required in subsection (B) shall submit written evidence to each emergency medical services provider or ambulance service the EMT-I(99) or EMT-P is employed by or volunteers for, that the EMT-I(99) or EMT-P has completed the tuberculin skin test training required in subsection (B), that includes:

1. The name of the tuberculin skin test training,

2. The date the tuberculin skin test training was completed, and

3. A signed and dated attestation from the administrative medical director that the tuberculin skin test training is approved by the administrative medical director.

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). New R9-25-501 recodified from R9-25-801 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). Amended by exempt rulemaking 14 A.A.R. 3491, effective August 14, 2008 (Supp. 08-3).

R9-25-502. EMT's Scope of Practice

An EMT shall perform a medical treatment, procedure, or technique and administer a medication only:

1. Under medical direction if required in A.R.S. Title 36, Chapter 21.1 and R9-25-201;

2. As prescribed in the EMT-B, EMT-I, or EMT-P training curriculum required for Arizona certification or NREMT registration;

3. In a manner consistent with R9-25-410; and

4. According to protocols established in this Article.

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). New R9-25-502 recodified from R9-25-802 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

R9-25-503. Protocol for an EMT to Administer, Monitor, or Assist in Patient Self-Administration of an Agent

A. An EMT may administer an agent to a patient or other individual if:

1. Table 1 indicates that an EMT with the certification held by the EMT may administer the agent;

2. The EMT's administration of the agent complies with any requirements included in this Article related to administration of the agent;

3. The EMT is authorized to administer the agent by:

a. The EMT's administrative medical director; or

b. For an EMT-B who does not have an administrative medical director, the emergency medical services provider the EMT-B is employed by or volunteers for ; and

4. Administering the agent to the patient or other individual is consistent with any administrative medical direction and on-line medical direction received by the EMT.

B. Except as provided in subsection (F), when an EMT administers an agent, the EMT shall document the administration on a prehospital incident history report, as defined in A.R.S. § 36-2220, including at least:

1. Patient name, if available;

2. Agent name;

3. Indications for administration;

4. Dose administered;

5. Route of administration;

6. Date and time of administration; and

7. Observed patient response to administration of the agent.

C. An EMT shall comply with the written standard operating procedure adopted by the emergency medical services provider the EMT is employed by or volunteers for as required under R9-25-204(F)(6) or R9-25-210(D)(3), if applicable.

D. An EMT may monitor an agent listed in Table 1 if:

1. Table 1 indicates that an EMT with the certification held by the EMT may monitor or administer the agent;

2. The EMT has completed training in administration of the agent that included at least the following information about the agent:

a. Class,

b. Mechanism of action,

c. Indications and field use,

d. Contraindications,

e. Adverse reactions,

f. Incompatibilities and drug interactions,

g. Adult dosage,

h. Pediatric dosage,

i. Route of administration,

j. Onset of action,

k. Peak effects,

l. Duration of action,

m. Dosage forms and packaging,

n. Required Arizona minimum supply, and

o. Special considerations;

3. If the agent is administered via an infusion pump, the EMT has completed training in the operation of the infusion pump;

4. If the agent is administered via a small volume nebulizer, the EMT has completed training in the operation of the small volume nebulizer; and

5. If the agent is administered via a central line, the EMT is an EMT-P.

E. An EMT who completes the training required in subsections (D)(2) through (D)(4) shall submit written evidence to each emergency medical services provider or ambulance service the EMT is employed by or volunteers for, that the EMT has completed the training required in subsections (D)(2) through (D)(4), that includes:

1. The name of the training,

2. The date the training was completed, and

3. A signed and dated attestation from the administrative medical director that the training is approved by the administrative medical director.

F. An EMT may assist in patient self-administration of an agent if:

1. Table 1 indicates that an EMT with the certification held by the EMT may administer or assist in patient self-administration of the agent;

2. The agent is supplied by the patient;

3. 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

4. The agent is in its original container and not expired.

G. Before administering an immunizing agent to an individual, an EMT-I(99) or EMT-P shall:

1. Receive written consent consistent with the requirements in 9 A.A.C. 6, Article 7;

2. Provide immunization information and written immunization records consistent with the requirements in 9 A.A.C. 6, Article 7; and

3. Provide documentary proof of immunity to the individual consistent with the requirements in 9 A.A.C. 6, Article 7.

H. "Immunizing agent" means an immunobiologic recommended by the Advisory Committee on Immunization Practices of the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

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). New R9-25-503 recodified from R9-25-803 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). Amended by exempt rulemaking at 13 A.A.R. 27, effective January 6, 2007 (Supp. 06-4). Amended by exempt rulemaking at 13 A.A.R. 578, effective January 31, 2007 (Supp. 07-1). Amended by exempt rulemaking 14 A.A.R. 3491, effective August 14, 2008 (Supp. 08-3).

Table 1. Authorization for Administration, Monitoring, and Assistance in Patient Self-Administration of Agents by EMT Certification; Identification of Transport Agents; Administration Requirements; and Minimum Supply Requirements for Agents

KEY:

A = Authorized to administer the agent

M = Authorized to monitor IV administration of the agent during interfacility transport, if the IV was started at the sending health care institution

PA = Authorized to assist in patient self-administration of the agent

TA = Transport agent for an EMT with the specified certification

IFIP = Agent shall be administered by infusion pump on interfacility transports

IP = Agent shall be administered by infusion pump

SVN = Agent shall be administered by small volume nebulizer

SVN or MDI = Agent shall be administered by small volume nebulizer or metered dose inhaler

* = Optional agent for a BLS ambulance that is not primarily serving as the first emergency medical services provider arriving on scene in response to an emergency dispatch

** = The minimum supply for an EMT assigned to respond by bicycle or on foot is 2 cubic feet.

*** = An EMT-B may administer if authorized under R9-25-505.

[ ] = Minimum supply required if an EMS provider chooses to make the optional agent available for EMT administration.

Historical Note

Table 1 adopted by exempt rulemaking at 13 A.A.R. 27, effective January 6, 2007 (Supp. 06-4). Amended by exempt rulemaking at 13 A.A.R. 578, effective January 31, 2007 (Supp. 07-1). Historical note added to Table 1; amended by exempt rulemaking 14 A.A.R. 3491, effective August 14, 2008 (Supp. 08-3).

Exhibit 1. Repealed

Historical Note

New Exhibit 1 recodified from Article 8, Exhibit 1 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). Amended by exempt rulemaking at 11 A.A.R. 1438, effective March 25, 2005 (Supp. 05-1). Amended by exempt rulemaking at 11 A.A.R. 2379, effective June 8, 2005 (Supp. 05-2). Amended by exempt rulemaking at 11 A.A.R. 3177, effective September 1, 2005 (Supp. 05-3). Exhibit 1 repealed by exempt rulemaking at 13 A.A.R. 27, effective January 6, 2007 (Supp. 06-4).

Exhibit 2. Repealed

Historical Note

New Exhibit 2 recodified from Article 8, Exhibit 2 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). Amended by exempt rulemaking at 11 A.A.R. 1438, effective March 25, 2005 (Supp. 05-1). Exhibit 2 repealed by exempt rulemaking at 13 A.A.R. 27, effective January 6, 2007 (Supp. 06-4).

Exhibit 3. Repealed

Historical Note

Exhibit made by exempt rulemaking at 11 A.A.R. 1438, effective March 25, 2005 (Supp. 05-1). Exhibit 3 repealed by exempt rulemaking at 13 A.A.R. 27, effective January 6, 2007 (Supp. 06-4).

R9-25-504. Protocol for Selection of a Health Care Institution for Emergency Medical Patient Transport

A. In this Section:

1. "Emergency receiving facility" means the same as in A.R.S. § 36-2201.

2. "Transfer care" means to relinquish to the control of another the ongoing medical treatment of an emergency medical patient.

3. "Special hospital" means the same as in A.A.C. R9-10-201.

B. An EMT shall, except as provided in subsection (C), transport an emergency medical patient to :

1. An emergency receiving facility, or

2. A special hospital that is physically connected to an emergency receiving facility.

C. Under A.R.S. §§ 36-2205(E) and 36-2232(F), an EMT who responds to an emergency medical patient who has accessed 9-1-1 or a similar public dispatch number may refer, advise, or transport the emergency medical patient to the most appropriate health care institution, if the EMT:

1. Determines, based upon medical direction, that the emergency medical patient's condition does not pose an immediate threat to life or limb;

2. Provides the emergency medical patient with a written list of health care institutions that are available to deliver emergency medical care to the emergency medical patient. The list shall:

a. Include the name, address, and telephone number of each health care institution;

b. If a health care institution is licensed under A.R.S. Title 36, Chapter 4, identify the classification or subclassification of the health care institution assigned under 9 A.A.C. 10; and

c. Only include a health care institution that the administrative medical director has determined is able to accept an emergency medical patient; and

3. Determines, based upon medical direction, the health care institution to which the emergency medical patient may be transported, based on the following:

a. The patient's:

i. Medical condition,

ii. Choice of health care institution, and

iii. Health care provider; and

b. The location of the health care institution and the emergency medical resources available at the health care institution.

D. Before initiating transport of an emergency medical patient, an EMT, emergency medical services provider, or ambulance service shall notify, by radio or telephone communication, a health care institution that is not an emergency receiving facility of the EMT's intent to transport the emergency medical patient to the health care institution.

E. An EMT transporting an emergency medical patient to a health care institution that is not an emergency receiving facility shall transfer care of the emergency medical patient to a designee authorized by:

1. A physician licensed under A.R.S. Title 32, Chapter 13 or 17;

2. A physician assistant licensed under A.R.S. Title 32, Chapter 25; or

3. A registered nurse licensed under A.R.S. Title 32, Chapter 15.

F. Before implementing this rule, an emergency medical services provider or an ambulance service shall notify the Department in writing of the intent to implement the rule.

G. An emergency medical services provider or an ambulance service that implements this rule shall make available for Department review and inspection written records relating to the transport of an emergency medical patient under subsections (C), (D), and (E).

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). New R9-25-504 recodified from R9-25-804 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). Amended by exempt rulemaking at 14 A.A.R. 3124, effective July 9, 2008 (Supp. 08-3).

R9-25-505. Protocol for IV Access by an EMT-B

A. In this Section, unless the context otherwise requires, "EMS provider agency" means the emergency medical services provider or the ambulance service for whom the EMT-B is acting as an EMT-B.

B. An EMT-B is authorized to perform IV access only after completing training that meets all requirements established in Exhibit 1.

C. Before performing IV access, an EMT-B trained in IV access shall have received prior written approval from the EMT-B's EMS provider agency and from an administrative medical director who agrees to provide medical direction for the EMT-B.

D. An EMT-B shall perform IV access only under "on line" medical direction, under standing orders approved by the administrative medical director, or under the direction of a currently certified EMT-I or EMT-P who is also attending the patient upon whom the EMT-B is to perform the procedure.

E. The administrative medical director shall be responsible for quality assurance and skill maintenance, and shall record and maintain a record of the EMT-B's IV access attempts.

F. An EMT-B trained in this optional procedure shall have a minimum of 5 IV starts per year. If less than 5, the EMT-B shall participate in a supervised base hospital clinical experience in which to obtain the minimum of 5 IV starts.

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). New R9-25-505 recodified from R9-25-805 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

Historical Note

New Exhibit 1 recodified from Article 8, Exhibit 1 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

Historical Note

New Exhibit 2 recodified from Article 8, Exhibit 2 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

R9-25-506. Testing of Medical Treatments, Procedures, Medications, and Techniques that May Be Administered or Performed by an EMT

A. Under A.R.S. § 36-2205, the Department may authorize the testing and evaluation of a medical treatment, procedure, technique, practice, medication, or piece of equipment for possible use by an EMT or an emergency medical services provider.

B. Before authorizing any test and evaluation pursuant to subsection (A), the Department director shall approve the test and evaluation according to subsections (C), (D), (E).

C. The Department director shall consider approval of a test and evaluation conducted pursuant to subsection (A), only if a written request for testing and evaluation:

1. Is submitted to the Department director from:

a. The Department,

b. A state agency other than the Department,

c. A political subdivision of this state,

d. An EMT,

e. An emergency medical services provider,

f. An ambulance service, or

g. A member of the public; and

2. Includes:

a. A cover letter, signed and dated by the individual making the request;

b. An identification of the person conducting the test and evaluation;

c. An identification of the medical treatment, procedure, technique, practice, medication, or piece of equipment to be tested and evaluated;

d. An explanation of the reasons for and the benefits of the test and evaluation;

e. The scope of the test and evaluation, including the:

i. Projected number of individuals, EMTs, emergency medical services providers, or ambulance services involved; and

ii. Proposed length of time required to complete the test and evaluation; and

f. The methodology to be used to evaluate the test's and evaluation's findings.

D. The Department director shall approve a test and evaluation if:

1. The test and evaluation does not pose a threat to the public health, safety, or welfare;

2. The test is necessary to evaluate the safest and most current advances in medical treatments, procedures, techniques, practices, medications, or equipment; and

3. The medical treatment, procedure, technique, practice, medication, or piece of equipment being tested and evaluated may:

a. Reduce or eliminate the use of outdated or obsolete medical treatments, procedures, techniques, practices, medications, or equipment;

b. Improve patient care; or

c. Benefit the public's health, safety, or welfare.

E. Within 180 days of receiving a written request for testing and evaluation that contains all of the information in subsection (C), the Department director shall send written notification of approval or denial of the test and evaluation to the individual making the request.

F. Upon completion of a test and evaluation authorized by the Department director, the person conducting the test and evaluation shall submit a written report to the Department director that includes:

1. An identification of the test and evaluation;

2. A detailed evaluation of the test; and

3. A recommendation regarding future use of the medical treatment, procedure, technique, practice, medication, or piece of equipment tested and evaluated.

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). New R9-25-506 recodified from R9-25-806 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

R9-25-507. Protocol for an EMT-P to Practice Knowledge and Skills in a Hazardous Materials Incident

A. In this Section:

1. "Hazardous materials" has the same meaning as in A.R.S. § 26-301.

2. "Hazardous materials incident" has the same meaning as in A.R.S. § 26-301.

3. "Drug" has the same meaning as in A.R.S. § 32-1901.

B. An EMT-P is authorized to perform a medical treatment or administer a drug when responding to a hazardous materials incident only after meeting the hazardous materials training requirements in subsection (C) or (D).

C. An EMT-P shall complete hazardous materials training that:

1. Includes at least 16 clock hours covering the:

a. Principles of managing a hazardous materials incident;

b. Role of medical direction in the management of a hazardous materials incident;

c. Human and material resources necessary for the management of a hazardous materials incident;

d. Procedures and equipment necessary for personal protection in a hazardous materials incident;

e. Medical monitoring of emergency workers responding to a hazardous materials incident;

f. Types of hazardous materials to which an emergency medical patient may be exposed, including the toxicity and the signs and symptoms of each type;

g. Routes by which an emergency medical patient may be exposed to a hazardous material;

h. Decontamination of an emergency medical patient exposed to a hazardous material;

i. Assessment of an emergency medical patient exposed to a hazardous material, including a patient history and a physical examination of the patient;

j. Medical management of an emergency medical patient exposed to each type of hazardous material;

k. Possible contents of a hazardous materials drug box; and

l. Pharmacokinetics of drugs which may be included in a hazardous materials drug box;

2. Requires the EMT-P to demonstrate competency in the subject matter listed in subsection (C)(1); and

3. Is approved by the EMT-P's administrative medical director based upon a determination that the hazardous materials training meets the requirements in subsections (C)(1) and (C)(2).

D. Every 24 months after meeting the requirements in subsection (C), an EMT-P shall complete hazardous materials training that:

1. Includes subject matter listed in subsection (C)(1),

2. Requires the EMT-P to demonstrate competency in the subject matter completed, and

3. Is approved by the EMT-P's administrative medical director based upon a determination that the hazardous materials training meets the requirements in subsections (D)(1) and (D)(2).

E. An administrative medical director of an EMT-P who completes hazardous materials training required in subsection (C) or (D) shall:

1. Maintain for Department review and inspection written evidence that the EMT-P has completed hazardous materials training required in subsection (C) or (D), including at least:

a. The name of the hazardous materials training,

b. The date the hazardous materials training was completed, and

c. A signed and dated attestation from the administrative medical director that the hazardous materials training is approved; and

2. Ensure that the EMT-P submits to each emergency medical services provider or ambulance service for which the EMT-P is acting as an EMT-P, the written evidence specified in subsections (E)(1)(a) and (E)(1)(b).

F. An EMT-P authorized under this Section to perform a medical treatment or administer a drug when responding to a hazardous materials incident may carry and administer drugs authorized under medical direction.

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). New R9-25-507 recodified from R9-25-807 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

R9-25-508. Protocol for an EMT-B to Perform Endotracheal Intubation

A. Endotracheal intubation performed by an EMT-B is an advanced procedure that requires medical direction.

B. An EMT-B is authorized to perform endotracheal intubation only after completing training that:

1. Meets all requirements established in the EMT-B Endotracheal Intubation Training Curriculum, dated January 1, 2004, incorporated by reference and on file with the Department, including no future editions or amendments; and available from the Department's Bureau of Emergency Medical Services; and

2. Is approved by the EMT-B's administrative medical director.

C. An EMT-B shall perform endotracheal intubation as:

1. Prescribed in the EMT-B Endotracheal Intubation Training Curriculum, and

2. Authorized by the EMT-B's administrative medical director.

D. The administrative medical director shall be responsible for quality assurance and skill maintenance, and shall record and maintain a record of the EMT-B's performance of endotracheal intubation.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Subsection (A)(2) corrected to reflect adopted rules on file with the Office of the Secretary of State, effective October 15, 1996 (Supp. 97-1). Section repealed by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). New R9-25-508 recodified from R9-25-808 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

R9-25-509. 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). New Section made by exempt rulemaking at 11 A.A.R. 2379, effective June 8, 2005 (Supp. 05-2). Section repealed by exempt rulemaking at 13 A.A.R. 3038, effective October 6, 2007 (Supp. 07-3).

R9-25-510. Protocol for EMT-B Carrying and Administration of Aspirin (A.R.S. §§ 36-2202, 36-2204, 36-2205, and 36-2209)

A. An EMT-B is authorized to carry aspirin for administration as described in subsection (B).

B. An EMT-B is authorized to administer aspirin only to an adult patient who is suffering from chest pain or other signs or symptoms suggestive of acute myocardial infarction.

C. An EMT-B's administration of aspirin to an adult patient who is suffering from chest pain or other signs or symptoms suggestive of acute myocardial infarction is not an advanced procedure that requires the EMT-B to have administrative medical direction and on-line medical direction.

D. For purposes of this Section, "adult" means 18 years of age or older.

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). New Section made by exempt rulemaking at 11 A.A.R. 1502, effective April 1, 2005 (Supp. 05-1). Amended by exempt rulemaking at 11 A.A.R. 2379, effective June 8, 2005 (Supp. 05-2).

Exhibit P. Repealed

Historical Note

Exhibit P 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).

R9-25-511. Protocol for EMT-B Use of an Esophageal Tracheal Double Lumen Airway Device (ETDLAD) (A.R.S. §§ 36-2202, 36-2204, 36-2205, and 36-2209)

A. For an EMT-B, the ability to use an esophageal tracheal double lumen airway device (ETDLAD) is an optional skill attained by completing training for the use of an ETDLAD as prescribed in this Section.

B. Use of an ETDLAD is an advanced procedure, as defined in R9-25-101, that requires an EMT-B to have administrative medical direction and the ability to receive online medical direction.

C. An EMT-B shall not use an ETDLAD until the EMT-B has completed training that:

1. Includes at least four clock hours covering:

a. Respiratory anatomy and physiology;

b. Respiratory assessment and basic airway management techniques;

c. The requirements of this Section;

d. The design and function of an ETDLAD;

e. The indications and contraindications for using an ETDLAD;

f. The advantages of and potential complications from using an ETDLAD;

g. The correct technique for inserting and managing an airway with an ETDLAD; and

h. Documenting the use of an ETDLAD;

2. Includes a post-training written evaluation and a practical skills evaluation to ensure that the EMT-B demonstrates competency in the subject matter listed in subsection (C)(1) and in correctly inserting and managing an airway with an ETDLAD, with a score of at least 80% required to demonstrate competency on the written evaluation; and

3. Is approved by the EMT-B's administrative medical director.

D. An EMT-B who has completed initial training as described in subsection (C) and who desires to maintain authorization to use an ETDLAD shall complete refresher training that complies with subsection (C) at least once every 24 months after completing the initial training.

E. An EMT-B shall use an ETDLAD only as authorized by the EMT-B's administrative medical director.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Subsection (C) corrected to reflect adopted rules on file with the Office of the Secretary of State, effective October 15, 1996 (Supp. 97-3). Section repealed by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). New Section made by exempt rulemaking at 11 A.A.R. 4982, effective November 1, 2005 (Supp. 05-4).

R9-25-512. Grace Period for EMT-I(99)s Certified Before January 6, 2007

A. Except as provided in subsection (C), an individual currently and validly certified as an EMT-I(99) in Arizona as of January 5, 2007, is authorized, until January 6, 2009, to administer, monitor, assist in patient self-administration of, and use as transport agents the agents authorized in Table 1 for an "EMT-I(99) Certified Before 1/6/07."

B. An individual who becomes certified as an EMT-I(99) in Arizona on or after January 6, 2007, is authorized to administer, monitor, assist in patient self-administration of, and use as transport agents the agents authorized in Table 1 for an "EMT-I(99) Certified On or After 1/6/07."

C. If an individual described under subsection (A) allows the individual's EMT-I(99) certification to expire before January 6, 2009, the individual no longer qualifies under subsection (A) and instead shall comply with subsection (B).

D. Effective January 6, 2009, an individual described under subsection (A) is authorized to administer, monitor, assist in patient self-administration of, and use as transport agents only the agents authorized in Table 1 for an "EMT-I(99) Certified On or After 1/6/07."

E. For purposes of this Section, "currently and validly certified" means holding certification issued by the Department that is not expired, suspended, or otherwise restricted.

Historical Note

Adopted effective October 15, 1996 (Supp. 96-4). Subsection (A) corrected to reflect adopted rules on file with the Office of the Secretary of State, effective October 15, 1996 (Supp. 97-1). Subsection (A) corrected again to reflect adopted rules on file with the Office of the Secretary of State, effective October 15, 1996 (Supp. 97-3). Section repealed by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4). New Section made by exempt rulemaking at 13 A.A.R. 27, effective January 6, 2007 (Supp. 06-4).

R9-25-513. Supplemental Skill Training Instructor Requirements

A. A person who provides or oversees supplemental skill training to an EMT shall ensure that each individual who serves as an instructor for the supplemental skill training either:

1. Meets the qualifications for an instructor specified in the supplemental skill training curriculum or rule; or

2. If there are not qualifications for an instructor specified in the supplemental skill training curriculum or rule, meets the following:

a. Would qualify, under R9-25-312(D), to serve as a preceptor for a course at the level of EMT certification held by the EMT; and

b. If an EMT, is authorized to perform the supplemental skill as provided under this Article.

B. For purposes of this Section, "supplemental skill" means a proficiency acquired through additional training authorized under this Article.

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). New Section made by exempt rulemaking at 13 A.A.R. 3038, effective October 6, 2007 (Supp. 07-3).

R9-25-514. Repealed

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

R9-25-515. 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).

ARTICLE 6. REPEALED

Article 6 repealed by final rulemaking at 9 A.A.R. 5372, effective January 3, 2004 (Supp. 03-4).

R9-25-601. 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).

R9-25-602. 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).

R9-25-603. 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).

R9-25-604. 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).

R9-25-605. 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).

R9-25-606. 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).

R9-25-607. 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).

R9-25-608. 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).

R9-25-609. 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).

Exhibit R. Repealed

Historical Note

Exhibit R 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).

R9-25-610. 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).

R9-25-611. 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).

R9-25-612. 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).

R9-25-613. 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).

R9-25-614. 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).

R9-25-615. Repealed

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

R9-25-616. 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).

Exhibit S. Repealed

Historical Note

Exhibit S 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).

Exhibit G. Repealed

Historical Note

Exhibit G 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).

Exhibit L. Repealed

Historical Note

Exhibit L 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).

Exhibit M. Repealed

Historical Note

Exhibit M 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).

Exhibit N. Repealed

Historical Note

Exhibit N 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).

Exhibit O. Repealed

Historical Note

Exhibit O 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).

Exhibit Q. Repealed

Historical Note

Exhibit Q 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).

ARTICLE 7. AIR AMBULANCE SERVICE LICENSING

R9-25-701. Definitions (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), 36-2212, 36-2213, 36-2214, and 36-2215)

In addition to the definitions in A.R.S. § 36-2201, the following definitions apply in this Article and in Article 8 of this Chapter, unless otherwise specified:

1. "Advanced life support" means pertaining to a patient whose condition requires care commensurate with the scope of practice of an EMT-P.

2. "Air ambulance" means an aircraft that is an "ambulance" as defined in A.R.S. § 36-2201.

3. "Air ambulance service" means an ambulance service that operates an air ambulance.

4. "Applicant" means an owner requesting:

a. An initial or renewal air ambulance service license under Article 7 of this Chapter,

b. An initial or renewal air ambulance certificate of registration under Article 8 of this Chapter, or

c. Transfer of an air ambulance service license under R9-25-706.

5. "Base location" means a physical location at which a person houses an air ambulance or equipment and supplies used for the operation of an air ambulance service or provides administrative or other support for the operation of an air ambulance service.

6. "Basic life support" means pertaining to a patient whose condition requires care commensurate with the scope of practice of an EMT-B.

7. "Business organization" means an entity such as an association, cooperative, corporation, limited liability company, or partnership.

8. "Call number" means a unique identifier used by an air ambulance service to identify a specific mission.

9. "CAMTS" means the Commission on Accreditation of Medical Transport Systems, formerly known as the Commission on Accreditation of Air Medical Services.

10. "Change of ownership" means a transfer of controlling legal or controlling equitable interest and authority in an air ambulance service.

11. "Convalescent transport" means conveyance of a patient at a prearranged time when either the patient's original location or destination is not a health care institution.

12. "Critical care" means pertaining to a patient whose condition requires care commensurate with the scope of practice of a physician or registered nurse.

13. "Current" means up-to-date and extending to the present time.

14. "EMT" means "certified emergency medical technician," as defined in A.R.S. § 36-2201.

15. "EMT-B" means "basic emergency medical technician," as defined in A.R.S. § 36-2201.

16. "EMT-I" means "intermediate emergency medical technician," as defined in A.R.S. § 36-2201.

17. "EMT-P" means "emergency paramedic," as defined in A.R.S. § 36-2201.

18. "Estimated time of arrival" means the number of minutes from the time that an air ambulance service agrees to perform a mission to the time that an air ambulance arrives at the scene.

19. "Health care institution" has the same meaning as in A.R.S. § 36-401.

20. "Holds itself out" means advertises through print media, broadcast media, the Internet, or other means.

21. "Interfacility" means between two health care institutions.

22. "Licensed respiratory care practitioner" has the same meaning as in A.R.S. § 32-3501.

23. "Maternal" means pertaining to a woman whose pregnancy is considered by a physician to be high risk, who is in need of critical care services related to the pregnancy, and who is being transferred to a medical facility that has the specialized perinatal and neonatal resources and capabilities necessary to provide an appropriate level of care.

24. "Medical direction" has the same meaning as in R9-25-101.

25. "Medical team" means personnel whose main function on a mission is the medical care of the patient being transported.

26. "Mission" means a transport job that involves an air ambulance service's sending an air ambulance to a patient's location to provide transport of the patient from one location to another, whether or not transport of the patient is actually provided.

27. "Neonatal" means pertaining to an infant who is 28 days of age or younger and who is in need of critical care services.

28. "On-line medical direction" has the same meaning as in R9-25-101.

29. "On-line medical guidance" means emergency medical services direction or information provided to a non-EMT medical team member by a physician through two-way voice communication.

30. "Operate an air ambulance in this state" means:

a. Transporting a patient via air ambulance from a location in this state to another location in this state;

b. Operating an air ambulance from a base location in this state; or

c. Transporting a patient via air ambulance from a location in this state to a location outside of this state more than once per month.

31. "Owner" means a person that holds a controlling legal or equitable interest and authority in a business enterprise.

32. "Patient" has the same meaning as in R9-25-101.

33. "Patient reference number" means a unique identifier used by an air ambulance service to identify an individual patient.

34. "Pediatric" means for use in the treatment of children or other individuals whose size falls within the scope of a pediatric equipment sizing reference guide.

35. "Pediatric equipment sizing reference guide" means a chart or device, such as a Broselow? tape, used to determine the size of medical equipment to be used for a patient who is a child or of small stature, generally based on either patient length or age and weight.

36. "Person" means:

a. An individual;

b. A business organization; or

c. An administrative unit of the U.S. government, state government, or a political subdivision of the state.

37. "Personnel" means individuals who work for an air ambulance service, with or without compensation, whether as employees, contractors, or volunteers.

38. "Premises" means each physical location of air ambulance service operations and includes all equipment and records at each location.

39. "Proficiency in neonatal resuscitation" means current and valid certification in neonatal resuscitation obtained through completing a nationally recognized training program such as the American Academy of Pediatrics and American Heart Association NRP: Neonatal Resuscitation Program.

40. "Publicizes" means makes a good faith effort to communicate information to the general public through print media, broadcast media, the Internet, or other means.

41. "Registered nurse" has the same meaning as in A.R.S. § 32-1601.

42. "Regularly" means at recurring, fixed, or uniform intervals.

43. "Rescue situation" means an incident in which:

a. An individual's life, limb, or health is imminently threatened; and

b. The threat may be reduced or eliminated by removing the individual from the situation and providing medical services.

44. "Scene" means the location of the patient to be transported or the closest point to the patient at which an air ambulance can arrive.

45. "Subspecialization" means:

a. For a physician board certified by a specialty board approved by the American Board of Medical Specialties, subspecialty certification;

b. For a physician board certified by a specialty board approved by the American Osteopathic Association, attainment of either a certification of special qualifications or a certification of added qualifications; and

c. For a physician who has completed an accredited residency program, completion of at least one year of training pertaining to the specified area of medicine.

46. "Two-way voice communication" means that two individuals are able to convey information back and forth to each other orally, either directly or through a third-party relay.

47. "Valid" means that a license, certification, or other form of authorization is in full force and effect and not suspended.

48. "Working day" means the period between 8:00 a.m. and 5:00 p.m. on a Monday, Tuesday, Wednesday, Thursday, or Friday that is not a state holiday.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-702. Applicability (A.R.S. §§ 36-2202(A)(4) and 36-2217)

This Article and Article 8 of this Chapter do not apply to persons and vehicles exempted from the provisions of A.R.S. Title 36, Chapter 21.1 as provided in A.R.S. § 36-2217(A).

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-703. Requirement and Eligibility for a License (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), 36-2212, 36-2213, 36-2214, and 36-2215)

A. A person shall not operate an air ambulance in this state unless the person has a current and valid air ambulance service license and, except as provided in A.R.S. § 36-2212(C), a current and valid certificate of registration for the air ambulance as required under Article 8 of this Chapter.

B. To be eligible to obtain an air ambulance service license, an applicant shall:

1. Hold current and valid Registration and Exemption under 14 CFR 298, as evidenced by a current and valid OST Form 4507 showing the effective date of registration;

2. Hold the following issued by the Federal Aviation Administration:

a. A current and valid Air Carrier Certificate authorizing common carriage under 14 CFR 135;

b. If operating a rotor-wing air ambulance, current and valid Operations Specifications authorizing aeromedical helicopter operations;

c. If operating a fixed-wing air ambulance, current and valid Operations Specifications authorizing airplane air ambulance operations;

d. A current and valid Certificate of Registration for each air ambulance to be operated; and

e. A current and valid Airworthiness Certificate for each air ambulance to be operated;

3. Have applied for a certificate of registration, issued by the Department under Article 8 of this Chapter, for each air ambulance to be operated by the air ambulance service;

4. Hold a current and valid registration, issued by the Arizona Department of Transportation under A.R.S. Title 28, Chapter 25, Article 4, for each air ambulance to be operated by the air ambulance service;

5. Have current and valid liability insurance coverage for the air ambulance service that complies with A.R.S. § 36-2215 and that has at least the following maximum liability limits:

a. $1 million for injuries to or death of any one person arising out of any one incident or accident;

b. $3 million for injuries to or death of more than one person in any one incident or accident; and

c. $500,000 for damage to property arising from any one incident or accident;

6. Have current and valid malpractice insurance coverage for the air ambulance service that complies with A.R.S. § 36-2215 and that has a maximum liability limit of at least $1 million per occurrence; and

7. Comply with all applicable requirements of this Article, Articles 2 and 8 of this Chapter, and A.R.S. Title 36, Chapter 21.1.

C. To maintain eligibility for an air ambulance service license, an air ambulance service shall meet the requirements of subsections (B)(1)-(2) and (4)-(7) and hold a current and valid certificate of registration, issued by the Department under Article 8 of this Chapter, for each air ambulance operated by the air ambulance service.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-704. Initial Application and Licensing Process (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), 36-2213, 36-2214, and 36-2215)

A. To obtain an initial license, an applicant shall submit to the Department an application completed using a Department-provided form and including:

1. The applicant's name; mailing address; fax number, if any; and telephone number;

2. Each business name to be used for the air ambulance service;

3. The physical and mailing addresses to be used for the air ambulance service, if different from the applicant's mailing address;

4. The name, title, address, and telephone number of the applicant's statutory agent or the individual designated by the applicant to accept service of process and subpoenas for the air ambulance service;

5. If the applicant is a business organization:

a. The type of business organization;

b. The following information about the individual who is to serve as the primary contact for information regarding the application:

i. Name;

ii. Address;

iii. Telephone number; and

iv. Fax number, if any;

c. The name, title, and address of each officer and board member or trustee; and

d. A copy of the business organization's articles of incorporation, articles of organization, or partnership or joint venture documents, if applicable;

6. The name and Arizona license number for the physician who is to serve as the medical director for the air ambulance service;

7. The intended hours of operation for the air ambulance service;

8. The intended schedule of rates for the air ambulance service;

9. The scope of the mission types to be provided, including whether each of the following is to be provided:

a. Emergency medical services transports;

b. Interfacility transports;

c. Interfacility maternal transports;

d. Interfacility neonatal transports; and

e. Convalescent transports;

10. A copy of a current and valid OST Form 4507 showing the effective date of registration and exemption under 14 CFR 298;

11. A copy of the following issued by the Federal Aviation Administration:

a. A current and valid Air Carrier Certificate authorizing common carriage under 14 CFR 135;

b. If intending to operate a rotor-wing air ambulance, current and valid Operations Specifications authorizing aeromedical helicopter operations;

c. If intending to operate a fixed-wing air ambulance, current and valid Operations Specifications authorizing airplane air ambulance operations;

d. A current and valid Certificate of Registration for each air ambulance to be operated; and

e. A current and valid Airworthiness Certificate for each air ambulance to be operated;

12. For each air ambulance to be operated for the air ambulance service:

a. An application for registration that includes all of the information and items required under R9-25-802(C); and

b. A copy of a current and valid registration, issued by the Arizona Department of Transportation under A.R.S. Title 28, Chapter 25, Article 4;

13. A certificate of insurance establishing that the applicant has current and valid liability insurance coverage for the air ambulance service as required under R9-25-703(B)(5);

14. A certificate of insurance establishing that the applicant has current and valid malpractice insurance coverage for the air ambulance service as required under R9-25-703(B)(6);

15. If the applicant holds current CAMTS accreditation for the air ambulance service, a copy of the current CAMTS accreditation report;

16. Attestation that the applicant knows all applicable requirements in this Article, Articles 2 and 8 of this Chapter, and A.R.S. Title 36, Chapter 21.1;

17. Attestation that the information provided in the application, including the information in the documents accompanying the application form, is accurate and complete; and

18. The dated signature of:

a. If the applicant is an individual, the individual;

b. If the applicant is a corporation, an officer of the corporation;

c. If the applicant is a partnership, one of the partners;

d. If the applicant is a limited liability company, a manager or, if the limited liability company does not have a manager, a member of the limited liability company;

e. If the applicant is an association or cooperative, a member of the governing board of the association or cooperative;

f. If the applicant is a joint venture, one of the individuals signing the joint venture agreement;

g. If the applicant is a governmental agency, the individual in the senior leadership position with the agency or an individual designated in writing by that individual; and

h. If the applicant is a business organization type other than those described in subsections (A)(18)(b) through (f), an individual who is a member of the business organization.

B. Unless an applicant establishes that it holds current CAMTS accreditation as provided in subsection (C) or is applying for an initial license because of a change in ownership as described in R9-25-706(D), the Department shall conduct an inspection, as required under A.R.S. § 36-2214(B) and R9-25-708, during the substantive review period for the application for an initial license.

C. To establish current CAMTS accreditation, an applicant shall submit to the Department a copy of its current CAMTS accreditation report, as provided in subsection (A)(15).

D. The Department shall review and approve or deny each application as described in Article 12 of this Chapter.

E. The Department may deny an application if an applicant:

1. Fails to meet the eligibility requirements of R9-25-703(B);

2. Fails or has failed to comply with any provision in A.R.S. Title 36, Chapter 21.1;

3. Fails or has failed to comply with any provision in this Article or Article 2 or 8 of this Chapter;

4. Knowingly or negligently provides false documentation or false or misleading information to the Department; or

5. Fails to submit to the Department documents or information requested under R9-25-1201(B)(1) or (C)(3), as required under R9-25-1201(D), and requests a denial as permitted under R9-25-1201(E).

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-705. Renewal Application and Licensing Process (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), 36-2213, 36-2214, and 36-2215)

A. Before the expiration date of its current license, an air ambulance service shall submit to the Department a renewal application completed using a Department-provided form and including:

1. The information and items listed in R9-25-704(A)(1)-(11), (12)(b), and (13)-(18); and

2. For each air ambulance operated or to be operated by the air ambulance service:

a. A copy of a current and valid certificate of registration issued by the Department under Article 8 of this Chapter; or

b. An application for registration that includes all of the information and items required under R9-25-802(C).

B. Unless an air ambulance service establishes that it holds current CAMTS accreditation as provided in subsection (C), the Department shall conduct an inspection, as required under A.R.S. § 36-2214(B) and R9-25-708, during the substantive review period for the renewal application.

C. To establish current CAMTS accreditation, an air ambulance service shall submit to the Department, as part of the application submitted under subsection (A), a copy of the air ambulance service's current CAMTS accreditation report.

D. The Department shall review and approve or deny each application as described in Article 12 of this Chapter.

E. The Department may deny an application if an applicant:

1. Fails to meet the eligibility requirements of R9-25-703(C);

2. Fails or has failed to comply with any provision in A.R.S. Title 36, Chapter 21.1;

3. Fails or has failed to comply with any provision in this Article or Article 2 or 8 of this Chapter;

4. Knowingly or negligently provides false documentation or false or misleading information to the Department; or

5. Fails to submit to the Department documents or information requested under R9-25-1201(B)(1) or (C)(3), as required under R9-25-1201(D), and requests a denial as permitted under R9-25-1201(E).

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-706. Term and Transferability of License (A.R.S. §§ 36-2202(A)(4), 36-2209(A)(2), 36-2213, 36-2214, and 41-1092.11)

A. The Department shall issue an initial license:

1. When based on current CAMTS accreditation, with a term beginning on the date of issuance and ending on the expiration date of the CAMTS accreditation upon which licensure is based; and

2. When based on Department inspection, with a term beginning on the date of issuance and ending three years later.

B. The Department shall issue a renewal license with a term beginning on the day after the expiration date shown on the previous license and ending:

1. When based on current CAMTS accreditation, on the expiration date of the CAMTS accreditation upon which licensure is based; and

2. When based on Department inspection, three years after the effective date.

C. If an applicant submits an application for renewal as described in R9-25-705 before the expiration date of the current license, the current license does not expire until the Department has made a final determination on the application for renewal, as provided in A.R.S. § 41-1092.11.

D. A person wanting to transfer an air ambulance service license shall submit to the Department before the anticipated change of ownership:

1. A letter that contains:

a. A request that the air ambulance service license be transferred,

b. The name and license number of the currently licensed air ambulance service, and

c. The name of the person to whom the air ambulance service license is to be transferred; and

2. An application that complies with R9-25-704(A) completed by the person to whom the license is to be transferred.

E. A new owner shall not operate an air ambulance in this state until the Department has transferred an air ambulance service license to the new owner.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-707. Changes Affecting a License (A.R.S. §§ 36-2202(A)(4), 36-2209(A)(2), and 36-2213)

A. At least 30 days before the date of a change in an air ambulance service's name, the air ambulance service shall send the Department written notice of the name change.

B. At least 90 days before an air ambulance service ceases to operate, the air ambulance service shall send the Department written notice of the intention to cease operating, effective on a specific date, and the desire to relinquish its license as of that date.

C. Within 30 days after the date of receipt of a notice described in subsection (A) or (B), the Department shall:

1. For a notice described in subsection (A), issue an amended license that incorporates the name change but retains the expiration date of the current license; and

2. For a notice described in subsection (B), send the air ambulance service written confirmation of the voluntary relinquishment of its license, with an effective date consistent with the written notice.

D. An air ambulance service shall notify the Department in writing within one working day after:

1. A change in its eligibility for licensure under R9-25-703(B) or (C);

2. A change in the business organization information most recently submitted to the Department under R9-25-704(A)(5) or R9-25-705(A);

3. A change in its CAMTS accreditation status, including a copy of its new CAMTS accreditation report, if applicable;

4. A change in its hours of operation or schedule of rates; or

5. A change in the scope of the mission types provided.

E. Before the date of an anticipated change of ownership, a person wanting to transfer an air ambulance service license shall submit to the Department the documents required under R9-25-706(D).

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-708. Inspections and Investigations (A.R.S. §§ 36-2202(A)(4), 36-2209(A)(2), 36-2213, and 36-2214)

A. Except as provided in subsections (D) and (F), the Department shall inspect an air ambulance service before issuing an initial or renewal license, as required under A.R.S. § 36-2214(B), and as often as necessary to determine compliance with this Article, Articles 2 and 8 of this Chapter, and A.R.S. Title 36, Chapter 21.1.

B. A Department inspection may include the premises and each air ambulance operated or to be operated for the air ambulance service.

C. If the Department receives written or verbal information alleging a violation of this Article, Article 2 or 8 of this Chapter, or A.R.S. Title 36, Chapter 21.1, the Department shall conduct an investigation.

1. The Department may conduct an inspection as part of an investigation.

2. An air ambulance service shall allow the Department to inspect the premises and each air ambulance and to interview personnel as part of an investigation.

D. As required under A.R.S. § 36-2213(8), the Department shall accept proof of current CAMTS accreditation in lieu of the licensing inspections otherwise required before initial and renewal licensure under subsection (A) and A.R.S. § 36-2214(B).

E. To establish current CAMTS accreditation, an applicant or air ambulance service shall submit to the Department a copy of its current CAMTS accreditation report as required under R9-25-704(C), R9-25-705(C), or R9-25-707(D).

F. When an application for an air ambulance service license is submitted along with a transfer request due to a change of ownership, the Department shall determine whether an inspection is necessary based upon the potential impact to public health, safety, and welfare.

G. The Department shall conduct each inspection in compliance with A.R.S. § 41-1009.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-709. Enforcement Actions (A.R.S. §§ 36-2202(A)(4), 36-2209(A)(2), 36-2213, 36-2214, 36-2215, 41-1092.03, and 41-1092.11(B))

A. The Department may take an action listed in subsection (B) against an air ambulance service that:

1. Fails to meet the eligibility requirements of R9-25-703(B) or (C);

2. Fails or has failed to comply with any provision in A.R.S. Title 36, Chapter 21.1;

3. Fails or has failed to comply with any provision in this Article or Article 2 or 8 of this Chapter; or

4. Knowingly or negligently provides false documentation or false or misleading information to the Department.

B. The Department may take the following actions against an air ambulance service:

1. Except as provided in subsection (B)(3), after notice and an opportunity to be heard is provided under A.R.S. Title 41, Chapter 6, Article 10, suspend the air ambulance service license;

2. After notice and an opportunity to be heard is provided under A.R.S. Title 41, Chapter 6, Article 10, revoke the air ambulance service license; and

3. If the Department determines that the public health, safety, or welfare imperatively requires emergency action and incorporates a finding to that effect in its order, summarily suspend the air ambulance service license pending proceedings for revocation or other action, as permitted under A.R.S. § 41-1092.11(B).

C. In determining whether to take action under subsection (B), the Department shall consider:

1. The severity of each violation relative to public health and safety;

2. The number of violations relative to the transport volume of the air ambulance service;

3. The nature and circumstances of each violation;

4. Whether each violation was corrected and, if so, the manner of correction; and

5. The duration of each violation.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-710. Minimum Standards for Operations (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), and 36-2213)

A. An air ambulance service shall ensure that:

1. The air ambulance service maintains eligibility for licensure as required under R9-25-703(C);

2. The air ambulance service publicizes its hours of operation;

3. The air ambulance service makes its schedule of rates available to any individual upon request and, if requested, in writing;

4. The air ambulance service provides an accurate estimated time of arrival to the person requesting transport at the time that transport is requested and provides an amended estimated time of arrival to the person requesting transport if the estimated time of arrival changes;

5. The air ambulance service transports only patients for whom it has the resources to provide appropriate medical care, unless subsection (B) or (D) applies;

6. The air ambulance service does not perform interfacility transport of a patient unless:

a. The transport is requested by:

i. A physician; or

ii. A qualified medical person, as determined by the sending health care institution's bylaws or policies, after consultation with and approval by a physician; and

b. The destination health care institution confirms that a bed is available for the patient;

7. The air ambulance service creates a prehospital incident history report, as defined in A.R.S. § 36-2220, for each patient;

8. The air ambulance service creates a record for each mission that includes:

a. Mission date;

b. Mission level--basic life support, advanced life support, or critical care;

c. Mission type--emergency medical services transport, interfacility transport, interfacility maternal transport, interfacility neonatal transport, or convalescent transport;

d. Aircraft type--fixed-wing aircraft or rotor-wing aircraft;

e. Name of the person requesting the transport;

f. Time of receipt of the transport request;

g. Departure time to the patient's location;

h. Address of the patient's location;

i. Arrival time at the patient's location;

j. Departure time to the destination health care institution;

k. Name and address of the destination health care institution;

l. Arrival time at the destination health care institution;

m. Patient reference number or call number; and

n. Aircraft tail number for the air ambulance used on the mission; and

9. The air ambulance service submits to the Department by the 15th day of each month, either in an electronic format approved by the Department or in hard copy, a run log of the previous month's missions that includes the information required under subsections (A)(8)(a)-(d), (f), (g), (i), (j), (l), and (m) in a cumulative tabular format.

B. In a rescue situation, when no other practical means of transport, including another air ambulance service, is available, an air ambulance service may deviate from subsection (A)(5) to the extent necessary to meet the rescue situation.

C. An air ambulance service that completes a mission under subsection (B) shall create a record within five working days after the mission, including the information required under subsection (A)(8), the manner in which the air ambulance service deviated from subsection (A)(5), and the justification for operating under subsection (B).

D. An air ambulance service may provide interfacility transport of a patient for whom it does not have the resources to provide appropriate medical care if the sending health care institution provides medically appropriate life support measures, staff, and equipment to sustain the patient during the interfacility transport.

E. An air ambulance service shall ensure that each staff member provided by a sending health care institution under subsection (D) has completed training in the subject areas listed in R9-25-713(A) before serving on a mission.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-711. Minimum Standards for Mission Staffing (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), and 36-2213)

A. An air ambulance service shall ensure that, except as provided in subsection (B):

1. Each critical care mission is staffed by a medical team of at least two individuals with at least the following qualifications:

a. A physician or registered nurse, and

b. An EMT-P or licensed respiratory care practitioner;

2. Each advanced life support mission is staffed by a medical team of at least two individuals with at least the following qualifications:

a. An EMT-P, and

b. Another EMT-P or a licensed respiratory care practitioner; and

3. Each basic life support mission is staffed by a medical team of at least two individuals, each of whom has at least the qualifications of an EMT-B.

B. If the pilot on a mission using a rotor-wing air ambulance determines, in accordance with the air ambulance service's written guidelines required under subsection (C), that the weight of a second medical team member could potentially compromise the performance of the rotor-wing air ambulance and the safety of the mission, and the use of a single-member medical team is consistent with the on-line medical direction or on-line medical guidance received as required under subsection (C), an air ambulance service may use a single-member medical team consisting of an individual with at least the following qualification:

1. For a critical care mission, a physician or registered nurse;

2. For an advanced life support mission, an EMT-P; and

3. For a basic life support mission, an EMT-B.

C. An air ambulance service shall ensure that:

1. Each air ambulance service rotor-wing pilot is provided written guidelines to use in determining when the weight of a second medical team member could potentially compromise the performance of a rotor-wing air ambulance and the safety of a mission, including the conditions of density altitude and weight that warrant the use of a single-member medical team;

2. The following are done, without delay, after an air ambulance service rotor-wing pilot determines that the weight of a second medical team member could potentially compromise the performance of a rotor-wing air ambulance and the safety of a mission:

a. The pilot communicates that information to the medical team;

b. The medical team obtains on-line medical direction or on-line medical guidance regarding the use of a single-member medical team; and

c. The medical team proceeds in compliance with the on-line medical direction or on-line medical guidance;

3. A single-member medical team has the knowledge and medical equipment to perform one-person cardiopulmonary resuscitation;

4. The air ambulance service has a quality management process to review regularly the patient care provided by each single-member medical team, including consideration of each patient's status upon arrival at the destination health care institution; and

5. A single-member medical team is used only when no other transport team is available that would be more appropriate for delivering the level of care that a patient requires.

D. An air ambulance service that uses a single-member medical team as authorized under subsection (B) shall create a record within five working days after the mission, including the information required under R9-25-710(A)(8), the name and qualifications of the individual comprising the single-member medical team, and the justification for using a single-member medical team.

E. An air ambulance service shall create and maintain for each personnel member a file containing documentation of the personnel member's qualifications, including, as applicable, licenses, certifications, and training records.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-712. Minimum Standards for Air Ambulance Safety, Equipment, and Supplies (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), and 36-2213)

An air ambulance service shall ensure that:

1. Each air ambulance in use meets the standards in R9-25-807;

2. The equipment and supplies on an air ambulance are secured, stored, and maintained in a manner that prevents hazards to personnel and patients; and

3. After each mission, an air ambulance's equipment and supplies are checked and replenished as necessary to be in compliance with R9-25-807.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-713. Minimum Standards for Training (A.R.S. §§ 36-2202(A)(4), 36-2209(A)(2), and 36-2213)

A. An air ambulance service shall ensure that each medical team member completes training in the following subjects before serving on a mission:

1. Aviation terminology;

2. Physiological aspects of flight;

3. Patient loading and unloading;

4. Safety in and around the aircraft;

5. In-flight communications;

6. Use, removal, replacement, and storage of the medical equipment installed on the aircraft;

7. In-flight emergency procedures;

8. Emergency landing procedures; and

9. Emergency evacuation procedures.

B. An air ambulance service shall document each medical team member's completion of the training required under subsection (A), including the name of the medical team member, each training component completed, and the date of completion.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-714. Minimum Standards for Communications (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), and 36-2213)

An air ambulance service shall ensure that, while on a mission, two-way voice communication is available:

1. Between and among personnel on the air ambulance, including the pilot; and

2. Between personnel on the air ambulance and the following persons on the ground:

a. Personnel;

b. Physicians providing on-line medical direction or on-line medical guidance to medical team members; and

c. For a rotor-wing air ambulance mission:

i. Emergency medical services providers, and

ii. Law enforcement agencies.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-715. Minimum Standards for Medical Control (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), and 36-2213)

A. An air ambulance service shall ensure that:

1. The air ambulance service has a medical director who:

a. Meets the qualifications in subsection (B);

b. Supervises and evaluates the quality of medical care provided by medical team members;

c. Ensures the competency and current qualifications of all medical team members;

d. Ensures that each EMT medical team member receives medical direction as required under Article 2 of this Chapter;

e. Ensures that each non-EMT medical team member receives medical guidance through:

i. Written treatment protocols; and

ii. On-line medical guidance provided by:

(1) The medical director;

(2) Another physician designated by the medical director; or

(3) If the medical guidance needed exceeds the medical director's area of expertise, a consulting specialty physician; and

f. Approves, ensures implementation of, and annually reviews treatment protocols to be followed by medical team members;

2. The air ambulance service has a quality management program through which:

a. Data related to patient care and transport services provided and patient status upon arrival at destination are:

i. Collected continuously, and

ii. Examined regularly, on at least a quarterly basis; and

b. Appropriate corrective action is taken when concerns are identified; and

3. The air ambulance service documents each concern identified through the quality management program and the corrective action taken to resolve each concern and provides this information, along with the supporting data, to the Department upon request.

B. A medical director shall:

1. Be a physician, as defined in A.R.S. § 36-2201; and

2. Comply with one of the following:

a. If the air ambulance service provides emergency medical services transports, meet the qualifications of R9-25-204(A)(2); or

b. If the air ambulance service does not provide emergency medical services transports, meet the qualifications of R9-25-204(A)(2) or one of the following:

i. If the air ambulance service provides only interfacility maternal missions, have board certification or have completed an accredited residency program in one of the following specialty areas:

(1) Obstetrics and gynecology, with subspecialization in critical care medicine or maternal and fetal medicine; or

(2) Pediatrics, with subspecialization in neonatal-perinatal medicine;

ii. If the air ambulance service provides only interfacility neonatal missions, have board certification or have completed an accredited residency program in one of the following specialty areas:

(1) Obstetrics and gynecology, with subspecialization in maternal and fetal medicine; or

(2) Pediatrics, with subspecialization in neonatal-perinatal medicine, neonatology, pediatric critical care medicine, or pediatric intensive care; or

iii. If neither subsection (B)(2)(b)(i) or (ii) applies, have board certification or have completed an accredited residency program in one of the following specialty areas:

(1) Anesthesiology, with subspecialization in critical care medicine;

(2) Internal medicine, with subspecialization in critical care medicine;

(3) If the air ambulance service transports only pediatric patients, pediatrics, with subspecialization in pediatric critical care medicine or pediatric emergency medicine; or

(4) If the air ambulance service transports only surgical patients, surgery, with subspecialization in surgical critical care.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-716. Minimum Standards for Recordkeeping (A.R.S. §§ 36-2202(A)(4), 36-2209(A)(2), and 36-2213)

An air ambulance service shall retain each document required to be created or maintained under this Article or Article 2 or 8 of this Chapter for at least three years after the last event recorded in the document and shall produce each document for Department review upon request.

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-717. Minimum Standards for an Interfacility Neonatal Mission (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), and 36-2213)

An air ambulance service shall ensure that:

1. Each interfacility neonatal mission is staffed by a medical team that complies with the requirements for a critical care mission medical team in R9-25-711(A)(1) and that has the following additional qualifications:

a. Proficiency in pediatric emergency care, as defined in R9-25-101; and

b. Proficiency in neonatal resuscitation and stabilization of the neonatal patient;

2. Each interfacility neonatal mission is conducted using an air ambulance that has the equipment and supplies required for a critical care mission in Table 1 of Article 8 of this Chapter and the following:

a. A transport incubator with:

i. Battery and inverter capabilities,

ii. An infant safety restraint system, and

iii. An integrated neonatal-capable pressure ventilator with oxygen-air supply and blender;

b. An invasive automatic blood pressure monitor;

c. A neonatal monitor or monitors with heart rate, respiratory rate, temperature, non-invasive blood pressure, and pulse oximetry capabilities;

d. Neonatal-specific drug concentrations and doses;

e. Umbilical catheter insertion equipment and supplies;

f. Thoracostomy supplies;

g. Neonatal resuscitation equipment and supplies;

h. A neonatal size cuff (size 2, 3, or 4) for use with an automatic blood pressure monitor; and

i. A neonatal probe for use with a pulse oximeter;

3. On-line medical direction or on-line medical guidance provided to an interfacility neonatal mission medical team member is provided by a physician who meets the qualifications of R9-25-715(B)(2)(b)(ii); and

4. An individual does not serve on an interfacility neonatal mission medical team unless the air ambulance service's medical director has verified and attested in writing to the individual's having the proficiencies described in subsections (1)(a) and (b).

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-718. Minimum Standards for an Interfacility Maternal Mission (A.R.S. §§ 36-2202(A)(3) and (4), 36-2209(A)(2), and 36-2213)

A. This Section applies to an air ambulance service that holds itself out as providing interfacility maternal missions.

B. An air ambulance service shall ensure that:

1. Each interfacility maternal mission is staffed by a medical team that complies with the requirements for a critical care mission medical team in R9-25-711(A)(1) and that has the following additional qualifications:

a. Proficiency in advanced emergency cardiac life support, as defined in R9-25-101;

b. Proficiency in neonatal resuscitation; and

c. Proficiency in stabilization and transport of the maternal patient;

2. Each interfacility maternal mission is conducted using an air ambulance that has the equipment and supplies required for a critical care mission in Table 1 of Article 8 of this Chapter and the following:

a. A Doppler fetal heart monitor;

b. Unless use is not indicated for the patient as determined through on-line medical direction or on-line medical guidance provided as described in subsection (B)(3), an external fetal heart and tocographic monitor with printer capability;

c. Tocolytic and anti-hypertensive medications;

d. Advanced emergency cardiac life support equipment and supplies; and

e. Neonatal resuscitation equipment and supplies;

3. On-line medical direction or on-line medical guidance provided to an interfacility maternal mission medical team member is provided by a physician who meets the qualifications of R9-25-715(B)(2)(b)(i); and

4. An individual does not serve on an interfacility maternal mission medical team unless the air ambulance service's medical director has verified and attested in writing to the individual's having the proficiencies described in subsections (B)(1)(a), (b), and (c).

Historical Note

New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

ARTICLE 8. AIR AMBULANCE REGISTRATION

Article 8, consisting of R9-25-801 through R9-25-808, recodified to Article 5 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

Editor's Note: Article 8, consisting of Sections R9-25-801 through R9-25-803 and Exhibits, was recodified from A.A.C. R9-13-1501 through R9-13-1503. These recodified Sections were originally filed under an exemption from A.R.S. Title 41, Chapter 6. Refer to the historical notes in 9 A.A.C. 13 for adoption dates (Supp. 98-1).

Article 8, consisting of Section R9-25-805 and Exhibits 1 through 3, was adopted 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 these rules to the Secretary of State's Office for publication in the Arizona Administrative Register; the Department did not submit the rules to the Governor's Regulatory Review Council for review; and the Department was not required to hold public hearings on this Section. Under A.R.S. § 36-2205(D) a person may petition the Director to amend an adopted protocol pursuant to A.R.S. § 41-1033 (Supp. 97-2).

R9-25-801. Definitions (A.R.S. §§ 36-2202(A)(4), 36-2209(A)(2), and 36-2212)

In addition to the definitions in R9-25-701, the following definitions apply in this Article, unless otherwise specified:

1. "Certificate holder" means a person who holds a current and valid certificate of registration for an air ambulance.

2. "Drug" has the same meaning as in A.R.S. § 32-1901.

Historical Note

R9-25-801 recodified from A.A.C. R9-13-1501 (Supp. 98-1). Amended by exempt rulemaking at 7 A.A.R. 4895, effective October 5, 2001 (Supp. 01-4). Amended by exempt rulemaking at 10 A.A.R. 239, effective January 3, 2004 (Supp. 03-4). Section recodified to R9-25-501 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-802. Requirement, Eligibility, and Application for an Initial or Renewal Certificate of Registration for an Air Ambulance (A.R.S. §§ 36-2202(A)(4) and (5), 36-2209(A)(2), 36-2212, 36-2213, 36-2214, and 36-2240(4))

A. A person shall not operate an air ambulance in this state unless the person has a current and valid air ambulance service license as required under Article 7 of this Chapter and, except as provided in A.R.S. § 36-2212(C), a current and valid certificate of registration for the air ambulance as required under this Article.

B. To be eligible to obtain a certificate of registration for an air ambulance, an applicant shall:

1. Hold a current and valid air ambulance service license issued under Article 7 of this Chapter;

2. Hold the following issued by the Federal Aviation Administration for the air ambulance:

a. A current and valid Certificate of Registration, and

b. A current and valid Airworthiness Certificate;

3. Hold a current and valid registration for the air ambulance, issued by the Arizona Department of Transportation under A.R.S. Title 28, Chapter 25, Article 4; and

4. Comply with all applicable requirements of this Article, Articles 2 and 7 of this Chapter, and A.R.S. Title 36, Chapter 21.1.

C. To obtain an initial or renewal certificate of registration for an air ambulance, an applicant shall submit to the Department an application completed using a Department-provided form and including:

1. The applicant's name, mailing address, fax number, and telephone number;

2. All other business names used by the applicant;

3. The applicant's physical business address, if different from the mailing address;

4. The following information about the air ambulance for which registration is sought:

a. Each mission level for which the air ambulance will be used:

i. Basic life support,

ii. Advanced life support, or

iii. Critical care;

b. Whether a fixed-wing or rotor-wing aircraft;

c. Number of engines;

d. Manufacturer name;

e. Model name;

f. Year manufactured;

g. Serial number;

h. Aircraft tail number;

i. Aircraft colors, including fuselage, stripe, and lettering; and

j. A description of any insignia, monogram, or other distinguishing characteristics of the aircraft's appearance;

5. A copy of the following issued to the applicant, for the air ambulance, by the Federal Aviation Administration:

a. A current and valid Certificate of Registration, and

b. A current and valid Airworthiness Certificate;

6. A copy of a current and valid registration issued to the applicant, for the air ambulance, by the Arizona Department of Transportation under A.R.S. Title 28, Chapter 25, Article 4;

7. The location in Arizona at which the air ambulance will be available for inspection;

8. The name and telephone number of the individual to contact to arrange for inspection, if the inspection is preannounced;

9. Attestation that the applicant knows all applicable requirements in A.R.S. Title 36, Chapter 21.1; this Article; and Articles 2 and 7 of this Chapter;

10. Attestation that the information provided in the application, including the information in the documents accompanying the application form, is accurate and complete;

11. The dated signature of:

a. If the applicant is an individual, the individual;

b. If the applicant is a corporation, an officer of the corporation;

c. If the applicant is a partnership, one of the partners;

d. If the applicant is a limited liability company, a manager or, if the limited liability company does not have a manager, a member of the limited liability company;

e. If the applicant is an association or cooperative, a member of the governing board of the association or cooperative;

f. If the applicant is a joint venture, one of the individuals signing the joint venture agreement;

g. If the applicant is a governmental agency, the individual in the senior leadership position with the agency or an individual designated in writing by that individual; and

h. If the applicant is a business organization type other than those described in subsections (C)(11)(b) through (f), an individual who is a member of the business organization; and

12. Unless the applicant operates or intends to operate the air ambulance only as a volunteer not-for-profit service, a certified check, business check, or money order made payable to the Arizona Department of Health Services for the following fees:

a. A $50 registration fee, as required under A.R.S. § 36-2212(D); and

b. A $200 annual regulatory fee, as required under A.R.S. § 36-2240(4).

D. The Department requires submission of a separate application and fees for each air ambulance.

E. Except as provided under R9-25-805(C), the Department shall inspect each air ambulance to determine compliance with the provisions of A.R.S. Title 36, Chapter 21.1 and this Article before issuing an initial certificate of registration and at least every 12 months thereafter before issuing a renewal certificate of registration.

F. The Department shall review and approve or deny each application as described in Article 12 of this Chapter.

G. The Department may deny a certificate of registration for an air ambulance if the applicant:

1. Fails to meet the eligibility requirements of R9-25-802(B);

2. Fails or has failed to comply with any provision in A.R.S. Title 36, Chapter 21.1;

3. Fails or has failed to comply with any provision in this Article or Article 2 or 7 of this Chapter;

4. Knowingly or negligently provides false documentation or false or misleading information to the Department; or

5. Fails to submit to the Department documents or information requested under R9-25-1201(B)(1) or (C)(3), as required under R9-25-1201(D), and requests a denial as permitted under R9-25-1201(E).

Historical Note

R9-25-802 recodified from A.A.C. R9-13-1502 (Supp. 98-1). Section repealed; new Section made by exempt rulemaking at 7 A.A.R. 4092, effective September 1, 2001 (Supp. 01-3). Amended by exempt rulemaking at 8 A.A.R. 931, effective February 15, 2002 (Supp. 02-1). Amended by exempt rulemaking at 10 A.A.R. 239, effective January 3, 2004 (Supp. 03-4). Section recodified to R9-25-502 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

Exhibit 1. Repealed

Historical Note

Section R9-25-802, Exhibit 1 recodified from A.A.C. R9-13-1502, Exhibit 1 (Supp. 98-1). Exhibit 1 repealed by exempt rulemaking at 7 A.A.R. 4895, effective October 5, 2001 (Supp. 01-4).

Exhibit 2. Repealed

Historical Note

Section R9-25-802, Exhibit 2 recodified from A.A.C. R9-13-1502, Exhibit 2 (Supp. 98-1). Exhibit 2 repealed by exempt rulemaking at 7 A.A.R. 4895, effective October 5, 2001 (Supp. 01-4).

Exhibit 3. Repealed

Historical Note

Section R9-25-802, Exhibit 3 recodified from A.A.C. R9-13-1502, Exhibit 3 (Supp. 98-1). Exhibit 3 repealed by exempt rulemaking at 7 A.A.R. 4895, effective October 5, 2001 (Supp. 01-4).

Exhibit 4. Repealed

Historical Note

Section R9-25-802, Exhibit 4 recodified from A.A.C. R9-13-1502, Exhibit 4 (Supp. 98-1). Exhibit 4 repealed by exempt rulemaking at 7 A.A.R. 4895, effective October 5, 2001 (Supp. 01-4).

R9-25-803. Term and Transferability of Certificate of Registration (A.R.S. §§ 36-2202(A)(4) and (5), 36-2209(A)(2), 36-2212, and 41-1092.11)

A. The Department shall issue an initial certificate of registration:

1. With a term of one year from date of issuance; or

2. If requested by the applicant, with a term shorter than one year that allows for the Department to conduct annual inspections of all of the applicant's air ambulances at one time.

B. The Department shall issue a renewal certificate of registration with a term of one year.

C. If an applicant submits an application for renewal as described in R9-25-802 before the expiration date of the current certificate of registration, the current certificate of registration does not expire until the Department has made a final determination on the application for renewal, as provided in A.R.S. § 41-1092.11.

D. A certificate of registration is not transferable from one person to another.

E. If there is a change in the ownership of an air ambulance, the new owner shall apply for and obtain a new certificate of registration before operating the air ambulance in this state.

Historical Note

Section R9-25-803 recodified from A.A.C. R9-13-1503, (Supp. 98-1). Section repealed; new Section adopted 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). Amended by exempt rulemaking at 8 A.A.R. 2625, effective June 1, 2002 (Supp. 02-2). Section recodified to R9-25-503 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

Exhibit 1. Recodified

Historical Note

Section R9-25-803, Exhibit 1 "EMT-P Drug List" and "EMT-I Drug List" recodified from A.A.C. R9-13-1503, Exhibit 1 "EMT-P Drug List" and "EMT-I Drug List" (Supp. 98-1). Exhibit 1 repealed; new Exhibit 1 adopted 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 under an exemption from the provisions of the Administrative Procedure Act pursuant to A.R.S. § 36-2205(C) at 6 A.A.R. 1507, effective May 1, 2000 (Supp. 00-1). Amended under an exemption from the provisions of the Administrative Procedure Act pursuant to A.R.S. § 36-2205(C) at 6 A.A.R. 3762, effective October 1, 2000 (Supp. 00-3). Amended by exempt rulemaking at 7 A.A.R. 1654, effective March 30, 2001 (Supp. 01-1). Amended by exempt rulemaking at 8 A.A.R. 2625, effective June 1, 2002 (Supp. 02-2). Amended by exempt rulemaking at 9 A.A.R. 1703, effective May 15, 2003 (Supp. 03-2). Exhibit 1 recodified to Article 5, Exhibit 1 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

Exhibit 2. Recodified

Historical Note

Exhibit 2 adopted 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 under an exemption from the provisions of the Administrative Procedure Act pursuant to A.R.S. § 36-2205(C) at 6 A.A.R. 1507, effective May 1, 2000 (Supp. 00-1). Amended under an exemption from the provisions of the Administrative Procedure Act pursuant to A.R.S. § 36-2205(C) at 6 A.A.R. 3762, effective October 1, 2000 (Supp. 00-3). Amended by exempt rulemaking at 7 A.A.R. 1199, effective February 13, 2001 (Supp. 01-1). Amended by exempt rulemaking at 8 A.A.R. 2625, effective June 1, 2002 (Supp. 02-2). Exhibit 2 recodified to Article 5, Exhibit 2 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

R9-25-804. Changes Affecting Registration (A.R.S. §§ 36-2202(A)(4) and (5), 36-2209(A)(2), and 36-2212)

A. At least 30 days before the date of a change in a certificate holder's name, the certificate holder shall send the Department written notice of the name change.

B. No later than 10 days after a certificate holder ceases to operate an air ambulance, the certificate holder shall send the Department written notice of the date that the certificate holder ceased to operate the air ambulance and of the desire to relinquish the certificate of registration for the air ambulance as of that date.

C. Within 30 days after the date of receipt of a notice described in subsection (A) or (B), the Department shall:

1. For a notice described in subsection (A), issue an amended certificate of registration that incorporates the name change but retains the expiration date of the current certificate of registration; and

2. For a notice described in subsection (B), send the certificate holder written confirmation of the voluntary relinquishment of the certificate of registration, with an effective date that corresponds to the written notice.

D. A certificate holder shall notify the Department in writing within one working day after a change in its eligibility to obtain a certificate of registration for an air ambulance under R9-25-802(B).

Historical Note

New Section made by exempt rulemaking at 7 A.A.R. 4888, effective November 1, 2001 (Supp. 01-4). Amended by exempt rulemaking at 10 A.A.R. 239, effective January 3, 2004 (Supp. 03-4). Section recodified to R9-25-504 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-805. Inspections (A.R.S. §§ 36-2202(A)(4) and (5), 36-2209(A)(2), 36-2212, and 36-2232(A)(11))

A. An applicant or certificate holder shall make an air ambulance available for inspection within Arizona at the request of the Department.

B. The Department shall conduct each inspection in compliance with A.R.S. § 41-1009.

C. As permitted under A.R.S. § 36-2232(A)(11), upon certificate holder request and at certificate holder expense, the annual inspection of an air ambulance required for renewal of a certificate of registration may be conducted by a Department-approved inspection facility.

Historical Note

Adopted under an exemption from the Administrative Procedure Act pursuant to A.R.S. § 36-2205(C), effective May 19, 1997; filed in the Office of the Secretary of State May 21, 1997 (Supp. 97-2). Amended by exempt rulemaking at 10 A.A.R. 239, effective January 3, 2004 (Supp. 03-4). Section recodified to R9-25-505 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

Exhibit 1. Recodified

Historical Note

Adopted under an exemption from the Administrative Procedure Act pursuant to A.R.S. § 36-2205(C), effective May 19, 1997; filed in the Office of the Secretary of State May 21, 1997 (Supp. 97-2). Amended by exempt rulemaking at 10 A.A.R. 239, effective January 3, 2004 (Supp. 03-4). Exhibit 1 recodified to Article 5, Exhibit 1 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

Exhibit 2. Recodified

Historical Note

Adopted under an exemption from the Administrative Procedure Act pursuant to A.R.S. § 36-2205(C), effective May 19, 1997; filed in the Office of the Secretary of State May 21, 1997 (Supp. 97-2). Amended by exempt rulemaking at 10 A.A.R. 239, effective January 3, 2004 (Supp. 03-4). Exhibit 2 recodified to Article 5, Exhibit 2 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3).

Exhibit 3. Repealed

Historical Note

Adopted under an exemption from the Administrative Procedure Act pursuant to A.R.S. § 36-2205(C), effective May 19, 1997; filed in the Office of the Secretary of State May 21, 1997 (Supp. 97-2). Exhibit repealed by exempt rulemaking at 10 A.A.R. 239, effective January 3, 2004 (Supp. 03-4).

R9-25-806. Enforcement Actions (A.R.S. §§ 36-2202(A)(4), 36-2209(A)(2), 36-2212, 36-2234(L), 41-1092.03, and 41-1092.11(B))

A. The Department may take an action listed in subsection (B) against a certificate holder's certificate of registration if the certificate holder:

1. Fails or has failed to meet the eligibility requirements of R9-25-802(B);

2. Fails or has failed to comply with any provision in A.R.S. Title 36, Chapter 21.1;

3. Fails or has failed to comply with any provision in this Article or Article 2 or 7 of this Chapter; or

4. Knowingly or negligently provides false documentation or false or misleading information to the Department.

B. The Department may take the following actions against a certificate holder's certificate of registration:

1. After notice and an opportunity to be heard is provided under A.R.S. Title 41, Chapter 6, Article 10, revoke the certificate of registration; and

2. In case of emergency, if the Department determines that a potential threat to the public health and safety exists and incorporates a finding to that effect in its order, immediately suspend the certificate of registration as authorized under A.R.S. § 36-2234(L).

C. In determining whether to take action under subsection (B), the Department shall consider:

1. The severity of each violation relative to public health and safety;

2. The number of violations relative to the transport volume of the air ambulance service;

3. The nature and circumstances of each violation;

4. Whether each violation was corrected and, if so, the manner of correction; and

5. The duration of each violation.

Historical Note

New Section made by exempt rulemaking at 7 A.A.R. 4895, effective October 5, 2001 (Supp. 01-4). Amended by exempt rulemaking at 10 A.A.R. 239, effective January 3, 2004 (Supp. 03-4). Section recodified to R9-25-506 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).

R9-25-807. Minimum Standards for an Air Ambulance (A.R.S. §§ 36-2202(A)(3), (4), and (5); 36-2209(A)(2); and 36-2212)

A. An applicant or certificate holder shall ensure that an air ambulance has:

1. A climate control system to prevent temperature extremes that would adversely affect patient care;

2. If a fixed-wing air ambulance, pressurization capability;

3. Interior lighting that allows for patient care and monitoring without interfering with the pilot's vision;

4. For each place where a patient may be positioned, at least one electrical power outlet or other power source that is capable of operating all electrically powered medical equipment without compromising the operation of any electrical aircraft equipment;

5. A back-up source of electrical power or batteries capable of operating all electrically powered life-support equipment for at least one hour;

6. An entry that allows for patient loading and unloading without rotating a patient and stretcher more than 30 degrees about the longitudinal axis or 45 degrees about the lateral axis and without compromising the operation of monitoring systems, intravenous lines, or manual or mechanical ventilation;

7. A configuration that allows each medical team member sufficient access to each patient to begin and maintain treatment modalities, including complete access to the patient's head and upper body for effective airway management;

8. A configuration that allows for rapid exit of personnel and patients, without obstruction from stretchers and medical equipment;

9. A configuration that protects the aircraft's flight controls, throttles, and communications equipment from any intentional or accidental interference from a patient or equipment and supplies;

10. A padded interior or an interior that is clear of objects or projections in the head strike envelope;

11. An installed self-activating emergency locator transmitter;

12. A voice communications system that:

a. Is capable of air-to-ground communication, and

b. Allows the flight crew and medical team members to communicate with each other during flight;

13. Interior patient compartment wall and floor coverings that are:

a. Free of cuts or tears,

b. Capable of being disinfected, and

c. Maintained in a sanitary manner; and

14. If a rotor-wing air ambulance, the following:

a. A searchlight that:

i. Has a range of motion of at least 90 degrees vertically and 180 degrees horizontally,

ii. Is capable of illuminating a landing site, and

iii. Is located so that the pilot can operate the searchlight without removing the pilot's hands from the aircraft's flight controls;

b. Restraining devices that can be used to prevent a patient from interfering with the pilot or the aircraft's flight controls; and

c. A light to illuminate the tail rotor.

B. An applicant or certificate holder shall ensure that:

1. Except as provided in subsection (C), each air ambulance has the equipment and supplies required in Table 1 for each mission level for which the air ambulance is used; and

2. The equipment and supplies on an air ambulance are secured, stored, and maintained in a manner that prevents hazards to personnel and patients.

C. A certificate holder may conduct an interfacility critical care mission using an air ambulance that does not have all of the equipment and supplies required in Table 1 for the mission level if:

1. Care of the patient to be transported necessitates use of life-support equipment that because of its size or weight or both makes it unsafe or impossible for the air ambulance to carry all of the equipment and supplies required in Table 1 for the mission level, as determined by the certificate holder based upon:

a. The individual aircraft's capabilities,

b. The size and weight of the equipment and supplies required in Table 1 and of the additional life-support equipment,

c. The composition of the required medical team, and

d. Environmental factors such as density altitude;

2. The certificate holder ensures that, during the mission, the air ambulance has the equipment and supplies necessary to provide an appropriate level of medical care for the patient and to protect the health and safety of the personnel on the mission;

3. The certificate holder ensures that, during the mission, the air ambulance is not directed by the air ambulance service or another person to conduct another mission before returning to a base location;

4. The certificate holder ensures that the air ambulance is not used for another mission until the air ambulance has all of the equipment and supplies required in Table 1 for the mission level; and

5. Within five working days after each interfacility critical care mission conducted as permitted under subsection (C), the certificate holder creates a record that includes the information required under R9-25-710(A)(8), a description of the life-support equipment used on the mission, a list of the equipment and supplies required in Table 1 that were removed from the air ambulance for the mission, and the justification for conducting the mission as permitted under subsection (C).

Historical Note

New Section made by exempt rulemaking at 8 A.A.R. 2633, effective June 1, 2002 (Supp. 02-2). Amended by exempt rulemaking at 10 A.A.R. 239, effective January 3, 2004 (Supp. 03-4). Section recodified to R9-25-507 at 10 A.A.R. 4192, effective September 21, 2004 (Supp. 04-3). New Section made by final rulemaking at 12 A.A.R. 656, effective April 8, 2006 (Supp. 06-1).