Section 170.385 - Service Availability and Backup(A)(1) Each EFR service at the EMS first response and BLS levels shall ensure that the level of service for which it is licensed is available to the public within the service's regular operating area 24 hours per day, seven days per week, by providing the service's own personnel and EMS vehicles, or supplementing its own EMS staff through written agreement(s) with other service(s).(2) Each ambulance service licensed to operate and maintain Class I or IV ambulances shall ensure that BLS emergency ambulance service is available to the public within the service's regular operating area 24 hours per day, seven days per week, by providing the service's own personnel and EMS vehicles, or by written agreement(s) with other service(s).(3) Adequate backup for ambulance services shall consist of, at a minimum, both first and second backup as defined in 105 CMR 170.385(A)(3)(a) and (b), and shall meet any additional requirements of the applicable service zone plan. First and second backup vehicles shall be at least two separate ambulances. (a)First Backup. 1. First backup for a Class I ambulance shall be either a Class I or II ambulance;2. First backup for a Class IV air ambulance shall be another Class IV air ambulance, a Class I ambulance, or a Class II ambulance.(b)Second Backup.1. Second backup for a Class I ambulance shall be either a Class I, II, or V ambulance.2. Second backup for a Class IV air ambulance shall be either a Class IV, a Class I ambulance, a Class II ambulance, or a Class V ambulance.(B)Exception: An ambulance service that responds only to calls from a unique population is exempt from the requirements of 105 CMR 170.385(A). However, the ambulance service shall provide service either with its own personnel and ambulance(s) or by written arrangements for adequate backup during the hours when the unique population it serves might require service.(C)(1) Each service licensed to provide advanced life support service shall ensure that ALS service is available to the public within the service's regular operating area, in accordance with the applicable service zone plan, 24 hours per day, seven days per week, by providing the service's own personnel and EMS vehicles, or by written agreement(s) with other service(s).(2) Adequate ALS backup for ambulance services shall consist of the following minimum requirements, and shall meet any additional requirements of the applicable service zone plan. (a) For a Class I ambulance, a Class I or II ambulance, operated by an ALS licensed ambulance service staffed and equipped to provide ALS at a level of service equal to or greater than the ALS service being backed up;(b) For a Class IV ambulance, another Class IV ambulance, a Class I ambulance or a Class II ambulance operated by an ALS licensed ambulance service staffed and equipped to provide ALS at a level of service equal to or greater than the ALS service being backed up.(3)(a) Each service applying for an initial ALS license shall have three years from the date the ALS license is first issued within which to meet the standards of ALS service delivery in 105 CMR 170.385(C)(1).(b) Each ALS-Advanced service applying for an upgrade in license to the ALS-Paramedic level shall have three years from the date the ALS-Paramedic license is issued within which to meet the standards of 105 CMR 170.385(C)(1) as it applies to ALS-Paramedic service.(c) In the interim period, each service included in 105 CMR 170.385(2)(a) or (b) shall ensure that ALS service at the level of licensure for which it is applying is available to the public within its regular operating area at a minimum eight hours per day, seven days per week.(4)Exceptions: (a) An ambulance service that responds only to calls from a unique population is exempt from the requirements of 105 CMR 170.385(C)(1) and (2). However, the ambulance service shall provide service either with its own personnel and ambulance(s) or by written arrangements for adequate backup during the hours when the unique population it serves might require service.(b) If no ALS ambulance service exists in an adjacent city or town, the ambulance service is exempt from the ALS backup requirements of 105 CMR 170.385(C)(1) and (2).Amended, Mass Register Issue 1257, eff. 3/28/2014.Amended by Mass Register Issue 1486, eff. 1/6/2023.