202 Ky. Admin. Regs. 7:550

Current through Register Vol. 51, No. 6, December 1, 2024

Section 202 KAR 7:550 - Required equipment and vehicle standards

RELATES TO: KRS 13B, 311A.030, 311A.180, 311A.190, 29 C.F.R. 1910.135

NECESSITY, FUNCTION, AND CONFORMITY: KRS 311A.020 requires the Board of Emergency Medical Services to exercise all administrative functions in the regulation of the emergency medical services system and the licensing of ambulance services and medical first response agencies, except those regulated by the Board of Medical Licensure or the Cabinet for Health and Family Services. KRS 311A.030 requires the board to promulgate administrative regulations for the licensing, inspection, and regulation of ambulance providers and medical first response agencies. This administrative regulation establishes the required equipment to operate an ambulance service.

Section 1. Ground Ambulance Specifications.

(1) Ground ambulances utilized by Class I, II, III, and IV agencies shall:

(a) Have the name of the provider permanently affixed by paint, decal, or wrap on both sides of the exterior surface of the vehicle.

1. The name shall be the incorporated name or the name under which the provider does business and as it appears on the provider's license.

2. This requirement shall not preclude a provider from adding additional names from another entity on the vehicle due to a joint venture, if the name as licensed by the board is larger, and visible and legible by the public.

3. A vehicle operated by an agency shall not be marked with the words "advanced life support", "paramedic," or similar words that convey essentially the same meaning on the vehicle's exterior surface visible to the public unless the:

a. Vehicle is always staffed at an Advanced Life Support level; or

b. Agency was licensed by the board prior to January 1, 2018.

(b) Be maintained in good operating condition and in full repair without obvious apparent problems relating to tires, exhaust, body integrity, warning devices, or mechanical reliability, which would be recognized by the average lay person who is not an automotive mechanic.

(c) Be designed to provide for the medical care or transportation of patients.

(d) Stow all equipment weighing three (3) pounds or more in an enclosure, bracket, mount, or other appropriate securing device.

(e) Have tires that meet the manufacturer's standards for the gross vehicle weight of the vehicle.

1. A tire shall not display exposed tire cord or have tread depth less than 2/32 on back tires and 4/32 on front tires if measured in any two (2) adjacent grooves at three (3) locations spaced equally around the tire.

2. Retread tires shall not be used on ground vehicles.

3. Internal patches may be utilized for tire repairs if necessary.

4. More than two (2) patches shall not be used on any one (1) defective tire.

5. Plugs shall not be used for the repair of defective ambulance tires.

(2) All Class I, II, III, and IV ground ambulances shall meet or exceed the minimum physical characteristics established in paragraphs (a) through (d) of this subsection.

(a) An ambulance manufactured prior to January 1, 2019 shall meet or exceed the standards established in the U.S. General Services Administration Federal Specification for the Star-of-Life Ambulance (GSA KKK-A-1822) in effect on the original date of manufacture.

(b) For a unit in which the chassis of an ambulance is later replaced, the agency shall require the conversion company to supply a letter to verify that no modification exists that was contained in GSA KKK-A-1822 on the original date of module manufacture.

(c) A new production ground ambulance that is ordered after January 1, 2019 shall comply fully with the ambulance design criteria contained in the Commission on Accreditation of Ambulance Services Ground Vehicle Standard for Ambulances (GVS), 7/2022. A decal or letter of verification from the manufacturer certifying that the vehicle meets the GVS standard, if ordered after January 1, 2019, shall be made available upon inspection.

(d) For any GVS certified vehicle in which the chassis of an ambulance is later replaced, the agency shall require the conversion company to supply a letter to verify that no modification exists that was contained in the GVS standard on the original date of module manufacture.

(3) In addition to the GSA KKK-A-1822 or the GVS standards, additional requirements shall be met as established in paragraphs (a) through (d) of this subsection.

(a) The air-conditioning system shall minimally deliver a temperature of sixty-five (65) degrees Fahrenheit or less from the vent or vents in the driver and patient compartments in warm weather conditions as determined by a standard automotive testing thermometer.

(b) The heating system shall minimally deliver a temperature of eighty-five (85) degrees Fahrenheit or more from the vent or vents in the driver and patient compartments in cool weather conditions as determined by a standard automotive testing thermometer.

(c) There shall not be more patients, personnel, and other persons than can be safely secured by means of permanently installed safety belts in the vehicle while the vehicle is in motion.

(d) The patient care area lighting shall be fully functional.

(4) A preventive maintenance program shall be maintained for each vehicle and its equipment to keep them in optimum working order to protect the health and safety of the patient and ambulance personnel.

(5) Documentation shall be maintained by the agency to support evidence of periodic inspections as recommended by the manufacturer, including calibrations required for maintenance and operation of the vehicle and its equipment.

(6) Unless precluded by emergency conditions, each vehicle and its equipment shall be checked after each use to ensure that it is in a clean and sanitary condition.

(7)

(a) Except as established in paragraph (b) of this subsection, all linen used for patient care including sheets, blankets, pillowcases, pillows, towels, and washcloths shall be stowed in a separate cabinet and secured from body fluids.

(b) One (1) pillow, one (1) pillow-case, one (1) fitted sheet, two (2) flat sheets, one (1) towel, and two (2) blankets may be utilized on the stretcher that is in-service and shall not require stowing.

Section 2. Class I, II, and IV Basic Life Support Ambulance Equipment and Supplies.

(1) Each BLS agency shall maintain evidence in the form of a letter that adult and pediatric medical protocols have been reviewed and approved by the board pursuant to KRS 311A.180. A hard copy or electronic equivalent of approved protocols shall be accessible to each provider throughout each call.

(2) Each Class I, II, and IV BLS agency shall carry and maintain, in full operational order, the following minimum basic life support equipment and supplies:

(a) Suction, ventilation, and blood pressure equipment, which shall include:

1. Two (2) sources of suction apparatus, one (1) of which shall be mechanically operated;

2. Rigid catheters;

3. Flexible catheters in adult, pediatric, and infant sizes;

4. Bulb syringe for infant and neonate suction;

5. Disposable adult and pediatric bag-valve-mask with a pediatric pop-off valve with oxygen reservoir, oxygen tubing, and adult, pediatric, infant, and neonate masks;

6. Nasopharyngeal airways (16F-34F; adult and child sizes) with water-soluble lubricant;

7. Oropharyngeal airways (sizes 0-5; adult, child, and infant sizes);

8. Blind-Insertion Airway Device (BIAD) (adult and pediatric); and

9. Manual pediatric and adult regular and large sphygmomanometer cuffs with stethoscope;

(b) Oxygen equipment, including:

1. A fixed oxygen system for each ambulance;

2. Two (2) portable, adequately filled, secured oxygen tanks that are minimally size D;

3. Pressure gauge and flow rate regulator for fixed and portable units with a range of zero to fifteen (15) liters per minute; and

4. Transparent non-rebreather oxygen masks and nasal cannulas for adults and pediatrics;

(c) Bandages, bandaging supplies, and tape, including:

1. Triangular bandages;

2. Dressings of the following types:

a. Sterile dressings, including gauze sponges of suitable size; and

b. Abdominal dressings;

3. Gauze rolls, various sizes;

4. Occlusive dressing, or equivalent;

5. Adhesive tape of various sizes (including one (1) inch and two (2) inch);

6. A minimum of four (4) arterial tourniquets; and

7. Shears for bandages;

(d) Miscellaneous supplies, including:

1. Handheld flashlight capable of providing adequate lighting to assess a scene or a patient away from the vehicle;

2. Penlight;

3. A copy or electronic equivalent of the most recent version of the U.S. Department of Transportation, Emergency Response Guidebook;

4. A minimum of ten (10) triage tags consistent with a commercial system of triage;

5. Obstetrical supplies that shall include at a minimum:

a. Sterile scalpels or scissors;

b. Sterile gloves;

c. Bulb suction;

d. Two (2) umbilical clamps; and

e. Thermal absorbent blanket and head cover, aluminum foil roll, or appropriate heat-reflective material sufficient to cover a newborn infant;

6. Sterile irrigation fluids;

7. Glucometer or blood glucose measuring device with reagent strips and lancets for obtaining a blood glucose sample;

8. Oral glucose;

9. Cold packs;

10. Heat packs;

11. An AED with a minimum of two (2) complete sets of pads suitable for adult and pediatric populations for all non-ALS vehicles;

12. Pulse oximeter with pediatric and adult probes;

13. Reference material or a guide that shall be assigned to the ambulance and may be in an electronic or physical format that provides appropriate guidance for pediatric drug dosing and equipment sizing based on age, length, or weight;

(e) Splints, including:

1. Lower extremity mechanical traction splint in adult and pediatric sizes; and

2. Upper and lower extremity rigid splint devices for adult and pediatric patients;

(f) Immobilization devices, including:

1. One (1) adult and one (1) pediatric impervious long spine board, scoop stretcher, or other full body device that provides spinal protection with a minimum of three (3) appropriate restraint cross-straps;

2. Cervical collars in the following sizes:

a.

(i) Cervical collars for pediatric patients ages two (2) years or older; and

(ii) Cervical collars for adults in small, medium, large, and other available sizes; or

b. Pediatric and adult adjustable cervical collars; and

3. Towel rolls or other commercially available cervical immobilization devices for adults and pediatrics;

(g) Two (2) currently certified five (5) pound size or larger, secured, ABC multipurpose fire extinguishers, approved by Underwriters Laboratory, Coast Guard, or Factory Mutual. One (1) shall be accessible to the driver and the other to the attendant or attendants in the patient compartment in the ambulance;

(h) Multi-position stretcher with wheels and a minimum of three (3) cross-straps in addition to one (1) set of shoulder straps for securing the patient to the stretcher and a fixed mechanism to secure the stretcher while in transit;

(i) Until January 1, 2025, a pediatric transport device with a minimum weight range of ten (10) to forty (40) pounds;

(j) On and after January 1, 2025, a pediatric transport device with a minimum weight range of five (5) to ninety-nine (99) pounds; and

(k) A stair chair for the movement of patients in a seated position.

(3) Personal protective equipment shall be available to each staff member responding on the vehicle, including:

(a) One (1) clean scrub gown (or substitute, such as disposable coveralls);

(b) Simple disposable face mask;

(c) Clear protective goggles or safety glasses;

(d) Disposable gloves;

(e) One (1) particulate filter mask rated at N95 or better without an exhaust port for patient use;

(f) One (1) particulate filter mask rated at N95 or better with or without an exhaust port for protection of crew members; and

(g) A means of cleansing the hands, such disposable towelettes or other solutions.

(4) Cleaning materials shall be available including:

(a) Hospital grade disinfectants;

(b) Trash bags for disposal of nonbiohazard waste materials;

(c) Biohazard bags for the disposal of biohazard waste; and

(d) Puncture resistant containers for disposal of sharp objects that are secured to the vehicle.

(5) Patient comfort items shall be available including:

(a) Two (2) clean blankets, sheets, pillows, and pillowcases;

(b) A disposable urinal;

(c) A disposable bed pan; and

(d) An emesis container or similar substitute.

(6) All items with an expiration date shall not be expired.

Section 3. Class I ALS, Class III ACC, Class III PSC, and Class IV Advanced Life Support Ambulance Equipment and Supplies.

(1) Each ALS agency shall maintain evidence in the form of a letter that adult and pediatric medical protocols have been reviewed and approved by the board pursuant to KRS 311A.180. A hard copy or electronic equivalent of approved protocols shall be accessible to each provider throughout each call.

(2) In addition to the BLS equipment required in Section 2 of this administrative regulation, each Class I ALS, Class III ACC, Class III PSC, and Class IV ALS vehicle shall maintain, in fully operational order, supplies and equipment required by the agency's protocols, including a minimum of:

(a) Endotracheal intubation equipment consisting of:

1. Laryngoscope handle with extra batteries, bulbs, or blades if applicable;

2. At least four (4) laryngoscope blades to allow intubation of patients in accordance with agency protocols, including a minimum of:

a. 0-4, straight Miller; or

b. 2-4, curved Macintosh;

3. Endotracheal tubes in the following sizes:

a. 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, and 5.5 cuffed or uncuffed; or

b. If intubation is not included in the agency's protocols for pediatric patients, supraglottic airways in all available sizes per the manufacturer of the specific device chosen; and

c. 6.0, 6.5, 7.0, 7.5 and 8.0 cuffed;

4. Stylettes in adult and pediatric sizes;

5. 10-mL syringes;

6. Magill forceps in adult and pediatric sizes;

7. Water-soluble lubricant for lubrication of endotracheal and nasotracheal tubes;

8. End-Tidal CO₂detection capability (adult and pediatric);

9. One-half (1/2) inch wide twill tape or equivalent for securing endotracheal tubes;

10. Equipment necessary to perform emergency percutaneous cricothyrotomy;

11. Disposable nebulizer; and

12. Continuous waveform capnography;

(b) A portable, battery-operated monitor defibrillator that:

1. Has a tape write-out or recorder, hands-free defibrillator pads, electrocardiogram monitoring leads, and electrodes for adults and pediatrics;

2. Is capable of delivering direct current energy over a variable range, which is suitable for pediatric and adult usage;

3. Has synchronized counter-shock capability for cardioversion;

4. Has a transcutaneous cardiac pacemaker, including adult and pediatric pads and cables; and

5. Has 12-Lead ECG capability if the vehicle is staffed to provide ALS services;

(c) Vascular Access supplies consisting of:

1. Isotonic crystalloid solutions;

2. Antiseptic solution (alcohol wipes and providone-iodine wipes);

3. Intravenous catheters, 14G-24G;

4. Long-large bore needles or angiocatheters (at least 3.25 inches in length for needle chest decompression in large patients);

5. Intraosseous needles or intraosseous devices appropriate for children and adults; and

6. Latex-free tourniquet;

(d) Needles of various sizes, including suitable sizes for intramuscular injections;

(e) Intravenous macrodrip and microdrip administrations sets; and

(f) Intravenous arm boards, adult and pediatric, or appropriate substitute.

(3) An ALS agency shall stock and maintain drugs and medications as required by the master drug list contained in protocols established in accordance with this section.

(4) Controlled drugs shall be stored in a locked storage box in a locked compartment on the vehicle that is immediately accessible to personnel.

(5) This administrative regulation shall not prevent an agency from maintaining other supplies or equipment that are required to carry out its protocols as approved by the board in accordance with KRS 311A.180.

(6) All items with expiration dates shall not be expired.

Section 4. Class III Adult Critical Care (ACC) Transport Equipment.

(1) Each Class III ACC agency shall maintain evidence in the form of a letter that medical protocols have been reviewed and approved by the board in accordance with KRS 311A.180. A hard copy or electronic equivalent of approved protocols shall be accessible to each provider throughout each call.

(2) In addition to the BLS equipment required in Section 2 of this administrative regulation and the ALS equipment required in Section 3 of this administrative regulation, Class III Adult Critical Care agencies shall carry on each vehicle and maintain in fully operational order all supplies and equipment required by the agency's protocols, including at a minimum:

(a) A portable transport ventilator, the capabilities of which shall include:

1. Controlling rate;

2. Volume;

3. FiO2 up to 100 percent;

4. I:E ratio;

5. PEEP;

6. Volume control;

7. Pressure control;

8. SIMV mode;

9. NPPV mode; and

10. Low- and high-pressure warning alarms;

(b) Two (2) portable transport ventilator circuits appropriately sized for the patient being transported;

(c) Continuous Positive Airway Pressure (CPAP) ventilation portable equipment;

(d) Electronic waveform capnography, intubated patient, capable of waveform display;

(e) Difficult airway equipment in the form of a bougie gum elastic ET introducer;

(f) Sterile cricothyrotomy set, surgical or needle;

(g) Invasive pressure monitoring capability electronic waveform available on two (2) channels;

(h) An infusion pump or pumps capable of infusing three (3) separate medications simultaneously;

(i) Six (6) IV infusion pump tubing sets;

(j) Two (2) blood infusion sets; and

(k) A device to monitor core body temperature through rectal or esophageal probe.

Section 5. Class III Pediatric Specialty Care (IIIPSC) Transport Equipment.

(1) Each Class III Pediatric Specialty Care agency shall maintain evidence in the form of a letter that all medical protocols have been reviewed and approved by the board in accordance with KRS 311A.180. A hard copy or electronic equivalent of approved protocols shall be accessible to each provider throughout each call.

(2) In addition to the BLS equipment required in Section 2 of this administrative regulation, the ALS equipment required in Section 3 of this administrative regulation, and the Critical Care equipment listed in Section 4 of this administrative regulation, each Class III Pediatric Specialty Care agency shall carry on each vehicle and maintain in fully operational order supplies and equipment required by the agency's protocols, including:

(a) Two (2) 250 ml bags of normal saline or lactated ringers;

(b) Twelve (12) syringes assorted from 1cc to 2cc;

(c) Four (4) three-way stopcocks;

(d) A needle cricothyrotomy kit for children from the ages of twenty-nine (29) days until twenty-one (21) years of age; and

(e) A blind-insertion airway device (BIAD) in appropriate sizes for children from the ages of twenty-nine (29) days until twenty-one (21) years of age.

Section 6. Class III Neonatal Specialty Care (III NSC) Transport Equipment.

(1) Each Class III Neonatal Specialty Care agency shall maintain evidence in the form of a letter that all medical protocols have been reviewed and approved by the board in accordance with KRS 311A.180. A hard copy or electronic equivalent of approved protocols shall be accessible to each provider throughout each call.

(2) In addition to compliance with Section 1 of this administrative regulation, each Class III Neonatal Specialty Care agency shall carry on each vehicle and maintain in fully operational order all supplies and equipment required by the agency's protocols, including:

(a) Direct two-way communications with the designated neonatologist, attending physician, or receiving NICU;

(b) A standby or backup power source other than the one (1) contained in the isolette;

(c) A source of electrical power sufficient to operate the isolette and ancillary electrically powered equipment;

(d) A transport incubator with portable power supply, portable oxygen tanks, or liquid oxygen, and a source of compressed air, including appropriate valves, meters, and fittings. The transport incubator shall be secured in the vehicle using a manufacturer-approved vehicle-mounting device;

(e) One (1) portable heart rate monitor with visual or audible display and alarm system per patient;

(f) One (1) portable blood pressure monitor with an assortment of cuff sizes suitable for infants;

(g) Three (3) battery powered mechanical IV pumps capable of delivering as low as 1cc increments for IV fluids;

(h) A battery or self-powered oxygen sensor and transcutaneous oxygen monitor or oxygen saturation monitor;

(i) Oxygen delivery devices and tubing capable of administering high concentrations of oxygen;

(j) A temperature-monitoring device;

(k) A portable ventilator appropriate for neonatal patients;

(l) An anesthesia or self-inflating bag with an oxygen reservoir of less than 750 ml, a manometer pressure gauge, and premature newborn and infant size clear masks;

(m) A laryngoscope handle;

(n) Laryngoscope Blades in Miller sizes 00, 0, 1, 2, 3;

(o) Two (2) bulbs;

(p) Two (2) batteries;

(q) Endotracheal tubes in various sizes;

(r) Two (2) stylets;

(s) Two (2) meconium aspirators;

(t) Oral airways in various sizes;

(u) Suction equipment with low suction capabilities of less than eighty (80) mmHg;

(v) Two (2) suction catheters in sizes 5.0, 6, 6.5, 8, and 10 each;

(w) Syringes sizes 1 cc through 60 cc in various sizes;

(x) Two (2) medication access devices;

(y) 23-27 gauge vascular access devices in various sizes;

(z) Sterile gloves in various sizes and sufficient quantity for all crewmembers;

(aa) Medications as required by the master drug list contained in protocols established in accordance with this section;

(bb) IV extension tubing in sufficient length to administer IV fluids or medications;

(cc) IV securing devices in various sizes;

(dd) Two (2) IV filters;

(ee) Two (2) umbilical catheters, sizes 3.5 and 5;

(ff) Ten (10) antiseptic solution wipes;

(gg) One (1) blood glucose-monitoring device;

(hh) Five (5) lancets for obtaining a blood glucose sample;

(ii) One (1) neonatal stethoscope;

(jj) One (1) flashlight;

(kk) Gauze pads;

(ll) One (1) No. 5 and one (1) No. 8 French feeding tube;

(mm) One (1) high intensity light capable of transillumination;

(nn) A biomedical waste plastic bag or impervious container;

(oo) Puncture resistant containers for disposal of sharp objects that shall be secured to the vehicle;

(pp) Gloves made of nitrile or other suitable materials in sufficient quantity for all crewmembers;

(qq) Respiratory face masks in sufficient quantity for all crew members;

(rr) Special procedure trays or instruments capable of performing umbilical catheterization, venous cutdown, and thoracostomy in accordance with established protocol;

(ss) One (1) bulb syringe;

(tt) One (1) cord clamp;

(uu) One (1) age appropriate chest tube evacuation device; and

(vv) Needle aspiration device or chest tubes in appropriate sizes for a neonate patient.

Section 7. Class VI and Class VIII BLS Agency Equipment.

(1) Each Class VI and VIII BLS agency shall maintain evidence in the form of a letter that all medical protocols have been reviewed and approved by the board in accordance with KRS 311A.180. A hard copy or electronic equivalent of approved protocols shall be accessible to each provider throughout each call.

(2) Each Class VI and VIII BLS agency shall be exempt from the ground ambulance requirements established in Sections 1 through 6 of this administrative regulation.

(3) Each Class VI and VIII BLS agency shall provide ready access to and maintain in fully operational order all supplies and equipment required by the agency's protocols.

(4)

(a) Each Class VIII BLS agency shall have ready access to and maintain in operational order, two (2) complete sets of equipment required by the agency's protocols and this administrative regulation.

(b) Each Class VI BLS agencies shall be required to maintain one (1) complete set of equipment.

(5) Each basic life support non-transport vehicle shall wrap, properly store, and handle all single-service implements to be inserted into the patient's nose or mouth.

(6) Each Class VI and VIII BLS agency shall properly store and keep multiuse items clean and sterile if indicated.

(7) Each Class VI and VIII BLS agency shall carry the following assembled and readily accessible equipment:

(a) Respiratory and resuscitation equipment, including:

1. Portable suction apparatus, capable of a minimum vacuum of 300 millimeters mercury, equipped with two (2) each of the following:

a. Wide-bore tubing;

b. Rigid catheters;

c. Soft pharyngeal suction tips in child size; and

d. Soft pharyngeal suction tips in adult size;

2. One (1) hand-operated bag-mask ventilation unit equipped with clear facemasks and oxygen reservoirs with oxygen tubing in each of the following sizes:

a. Adult;

b. Child;

c. Infant; and

d. Neonatal mask only;

3. Two (2) oropharyngeal airways in each of the following sizes:

a. Adult;

b. Child; and

c. Infant;

4. Blind-Insertion Airway Devices (BIAD) in adult and pediatric sizes; and

5. Portable oxygen equipment of at least 300 liters capacity and D size cylinder with a regulator capable of delivering 25LPM;

(b) Oxygen delivery devices, including:

1. Two (2) non-rebreathing oxygen masks in both adult and pediatric sizes;

2. Two (2) nasal cannula in both adult and pediatric sizes;

3. Two (2) nasopharyngeal airways with water-soluble lubricant in each of the following sizes:

a. Adult;

b. Child; and

c. Infant;

(c) Wound care supplies, including:

1. Two (2) airtight dressings for open chest wounds;

2. Assorted bandaging supplies for the care of soft tissue injuries; and

3. Sterile water for irrigation;

(d) An AED with a minimum of two (2) complete sets of pads for all non-ALS providers and vehicles;

(e) Patient stabilization equipment, including:

1. Two (2) upper and two (2) lower extremity-splinting devices; and

2. Two (2) cervical collars in each of the following sizes or adjustable equivalents:

a. Pediatric;

b. Small;

c. Medium;

d. Large; and

e. No-Neck;

(f) Personal protection and body substance isolation equipment, including at least one (1) of each of the following for each EMS provider:

1. Gown;

2. Face mask and shield;

3. Gloves;

4. Biohazard bag;

5. Puncture resistant container for the disposal of sharp objects; and

6. Antimicrobial hand cleaner; and

(g) Miscellaneous items, including:

1. Obstetrical supplies, including:

a. Sterile scalpels or scissors;

b. Sterile gloves;

c. Bulb suction; and

d. Two (2) umbilical clamps;

2. One (1) blood pressure sphygmomanometer in each of the following cuff sizes:

a. Large adult;

b. Adult; and

c. Pediatric;

3. One (1) stethoscope in each of the following sizes:

a. Adult; and

b. Pediatric; and

4. A glucometer or blood glucose-measuring device with reagent strips and lancets for obtaining a blood glucose sample.

Section 8. Class VI and VIII ALS Agency Equipment.

(1) Each Class VI and VIII ALS agency shall maintain evidence in the form of a letter that medical protocols have been reviewed and approved by the board in accordance with KRS 311A.180. A hard copy or electronic equivalent of approved protocols shall be accessible to each provider throughout each call.

(2) Each Class VI and VIII ALS agency shall be exempt from the ambulance requirements established in Sections 1 through 6 of this administrative regulation.

(3)

(a) Each Class VIII ALS agency shall have ready access to and maintain in operational order, two (2) complete sets of equipment required by the agency's protocols and this administrative regulation.

(b) Each Class VI ALS agency shall be required to maintain one (1) complete set of equipment.

(4) In addition to the BLS equipment required in Section 7 of this administrative regulation, each Class VI and VIII ALS agency shall provide ready access to and maintain in fully operational order, supplies and equipment required by the agency's protocols, including a minimum of:

(a) Endotracheal intubation equipment consisting of:

1. Laryngoscope handle;

2. Various laryngoscope blades in adult, pediatric, and infant sizes;

3. Extra batteries and bulbs for handles or blades;

4. A minimum of seven (7) different sizes of endotracheal tubes for oral and nasal placement in adult, pediatric, and infant sizes;

5. Equipment necessary to perform emergency cricothyrotomy;

6. An end tidal carbon dioxide detection device;

7. Stylettes in adult and pediatric sizes;

8. Magill forceps in adult and pediatric sizes;

9. One-half (1/2) inch wide twill tape or equivalent for securing endotracheal tubes; and

10. Water-soluble lubricant for lubrication of endotracheal and nasotracheal tubes;

(b) A portable monitor defibrillator that:

1. Is capable of displaying a visual display of cardiac electrical activity;

2. Is capable of providing a hard copy of cardiac electrical activity measure;

3. Is capable of delivering direct current energy over a variable range, which is suitable for pediatric and adult usage;

4. Is capable of providing external cardiac pacing;

5. Has adult and pediatric external pads, capable of utilization for immediate monitoring of heart activity and delivery of counter shock in both the adult and pediatric patient;

6. Is capable of being operated from internal rechargeable batteries;

7. Has synchronized counter shock capability for cardioversion; and

8. Has a patient monitoring cable with electrode pads or equivalent for use with the patient monitoring cable;

(c) Sterile, disposable needles, in types and sizes sufficient for personnel to administer medications and perform procedures allowed by the agency's patient treatment protocols;

(d) Disposable syringes in types and sizes sufficient for personnel to administer medications and perform procedures allowed by the agency's patient treatment protocols;

(e) Restriction band appropriate for use with venipuncture procedure;

(f) Disposable, individually packaged antiseptic wipes;

(g) Intravenous fluids as required by the agency's protocol, with macrodrip and microdrip fluid sets, and accessory items including over the needle catheter devices in sizes fourteen (14) to twenty-four (24) gauge;

(h) Intraosseous needles or intraosseous devices appropriate for children and adults; and

(i) Pediatric drug dosage tape or equivalent that provides easy reference for pediatric and infant treatment and drug dosages.

(5) All items with expiration dates shall not be expired.

(6) An ALS agency shall stock and maintain drugs and medications as required by the master drug list contained in protocols established in accordance with this section.

(7) Controlled drugs shall be stored in a locked storage box in a locked compartment that is immediately accessible to personnel.

(8) This administrative regulation shall not prevent an agency from maintaining other supplies or equipment that are required to carry out its protocols as approved by the board in accordance with KRS 311A.180.

Section 9. Safety Equipment.

(1) Each ground agency licensed to respond to emergency pre-hospital responses shall provide and maintain in full operational order the following minimum light access and extrication equipment on the ambulance for each staff member:

(a) Eye protection goggles or safety glasses;

(b) Heavy work gloves;

(c) Hard hats that meet ANSI standards, as stated in 29 C.F.R. 1910.135;

(d) Reflective safety wear for each crew member that meet current ANSI standard ANSI 107-2010 or ANSI 207-2011; and

(e) Three (3) reflective triangles or strobes, or equivalent warning devices.

(2) A ground ambulance agency subject to emergency pre-hospital response not equipped to provide extrication and rescue services shall execute an agreement with an agency capable of providing extrication and rescue services to the primary geographic service area.

(3) Each Class II, III ACC, III PSC, III NSC, and VIII agency shall be exempt from the requirements of this section unless emergency pre-hospital response is included in the agency's scope of care.

Section 10. Equipment or Medication Waiver.

(1) The board for good cause shall grant a waiver of any section of this administrative regulation upon request. An applicant for waiver shall submit:

(a) An "EMS Equipment or Staff Waiver Request"; and

(b) A nonrefundable application fee of $500 per waiver request.

(2) The application request shall include:

(a) Evidence of prior good faith efforts to comply with each section for which a waiver is requested;

(b) A written explanation of the agency's inability to comply with each section for which a waiver is requested, including any financial or other significant hardship resulting from the agency's efforts to comply;

(c) A written plan for providing adequate care to patients;

(d) The length of time for which the waiver is requested; and

(e) A plan for compliance with each section of this administrative regulation for which a waiver has been requested.

(3) Requests for waivers shall be submitted to the executive director of the board.

(4) The administrator and medical director of the agency requesting a waiver shall appear before the board's executive committee and the full board at a regularly scheduled meeting to present evidence of hardship that compliance with this administrative regulation may cause.

(5) Waivers shall not be issued for minimum staffing requirements.

(6) Any waiver issued by the board shall expire on December 31 of the year of issue.

(7) Within twenty (20) days of the board's decision, the executive director shall notify the applicant of the decision in writing.

(8) A waiver approved by the board upon a finding of good cause shall be considered a fulfillment of the licensing requirements established in the waiver through December 31 of the year of issue.

(9) The board shall deny the waiver request if, after reviewing the application, it is determined that if the waiver is granted the:

(a) Agency is no longer able to meet the needs of the agency's patients or geographic service area; or

(b) Health or safety of the agency's patients or geographic service area may be jeopardized.

(10) An applicant whose request for waiver is denied may file a written request for a hearing before the board within thirty (30) days of the written notice of denial.

(11) A hearing shall be conducted in accordance with KRS Chapter 13B.

Section 11. Public Notice of Negative Action. The board office shall cause to be published, on the KBEMS Web site or similar publication of the board, or otherwise disseminate, the name of any licensed agency that is fined, placed on probationary status, placed on restricted status, suspended, or had a license revoked.

Section 12. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "EMS Equipment or Staff Waiver Request", (12/2017), http://kemsis.ky.gov/;

(b) "U.S. Department of Transportation, Emergency Response Guidebook", (2020), www.phmsa.dot.gov/sites/phmsa.dot.gov/files/2021-01/ERG2020-WEB.pdf;

(c) "Commission on Accreditation of Ambulance Services Ground Vehicle Standard for Ambulances (GVS)", (7/2022), www.groundvehiclestandard.org/wp-content/uploads/2022/06/CAAS_GVS_V3_Final_07_01_2022_2.pdf; and

(d) "U.S. General Services Administration Federal Specification for the Star-of-Life Ambulance (GSA KKK-A-1822F)", (8/2007), www.ehsf.org/sites/default/files/2017-07/Federal%20Specification%20for%20the%20Star-of-Life%20Ambulance.pdf.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Office of the Kentucky Board of Emergency Medical Services, 500 Mero Street, 5th Floor, 5SE32, Frankfort, Kentucky 40601, Monday through Friday, 8 a.m. to 4:30 p.m.

202 KAR 7:550

44 Ky.R. 1736, 2042, 2196; eff. 5-4-2018; 50 Ky.R. 426, 1251; eff. 12/13/2023.

STATUTORY AUTHORITY: KRS 311A.020, 311A.025, 311A.030, 311A.190