(a)

1. (1) No person shall furnish, operate, maintain, conduct, advertise, or in any way engage in or profess to engage in the business of providing transport of patients upon the streets and highways of Arkansas unless that person holds a valid ambulance service license issued by the Department of Health.
2. (2) This section shall not operate to alter the application of the act under Arkansas Code § 17-95-101.

(b) General standards.

1. (1)

   1. (A) An application for the issuance or annual renewal of an ambulance service license shall be made to the Department of Health and shall be accompanied by an applicable fee.
   2. (B) All documentation and fees must be submitted to the Department of Health before an EMS service or vehicle permit is issued.
   3. (C) No license shall be issued until all licensure requirements have been met.

2. (2) Patient's choice of the nearest appropriate medical facility.

   1. (A) A patient who is diagnosed with a specific health condition that is listed as rare by the National Institutes of Health and that could be fatal, for which a patient seeks specialized care, may request to be transported to an alternative destination facility that is farther away than the nearest facility as set forth in Arkansas Code § 20-13-218.
   2. (B) A licensed ambulance service may transport any patient to the care facility of the patient's choice if the licensee considers service area limitations, and subject to applicable federal law and the licensee's local protocol.
   3. (C) If the patient is unable to make a choice, and if the attending physician is present and has expressed a choice of care facility, the licensee may comply with the attending physician’s choice if the licensee considers service area limitations and subject to applicable federal law.
   4. (D) If the patient is unable to make a choice, or if the attending physician is not present or has not expressed a choice of facility, the licensee may transport the patient to the nearest appropriate care facility subject to applicable federal law.

3. (3) Reports to medical facilities.

   1. (A) Each ground and air ambulance service shall notify the receiving medical facility by radio or by a means agreed upon by the receiving facility.
   2. (B) The notification shall include, at minimum:

(i) Impending arrival;

1. (ii) Patient condition; and

   1. (iii) Care rendered to the patient.
   2. (C) The ambulance service shall, at the time of transfer of care, leave a completed encounter form or a completed Department of Health-approved short form.
   3. (D) If a short form is left with the medical facility, the ambulance service shall submit a completed encounter form to the medical facility within twenty-four (24) hours from the transfer of care.
   4. (E) Ambulance services shall comply with all official requests for patient care records from medical facilities for patients that were transported to that medical facility.
   5. (F) The Department of Health may inspect the patient encounter forms of any service covered by this part.

2. (4) Reports to the Department of Health.

   1. (A) Each licensee shall report EMS data as required by the Department of Health for every request that results in the dispatch of a vehicle.

   2. (B) All submissions shall:

      1. (i) Be complete;
      2. (ii) Reflect accurate information; and
      3. (iii) Be submitted to the Department of Health within seven (7) days of the dispatch of the call.

   3. (C) All services shall have a quality assurance process to ensure that:

      1. (i) Each run has been submitted; and
      2. (ii) The data being submitted are complete and accurate.

3. (5) Insurance requirements.

   1. (A) Each licensee shall have in force and effect general liability insurance coverage and liability insurance coverage for each vehicle owned and operated by or for the applicant or licensee.
   2. (B) All policies shall be issued by an insurance company licensed to do business in the State of Arkansas.
   3. (C) Proof of current general liability insurance and coverage for each vehicle shall be submitted to the Department of Health on initial application and renewal of service license.
   4. (D) Each air ambulance service shall have in force and effect liability insurance coverage for each aircraft owned and operated by or for the applicant or licensee as required by the Federal Aviation Administration.
   5. (E) The service shall maintain evidence of proof of current liability insurance coverage for each aircraft.
   6. (F) A license holder shall immediately notify the Department of Health and cease operations if the coverage required by this section is canceled or suspended.

4. (6) Service license.

   1. (A) Each service shall be issued a license in at least one (1) of the classifications set forth by the Department of Health.
   2. (B) Each licensee, including air ambulance services, shall be required to obtain a separate service license in each county where the ambulance service has an operational base.
   3. (C) Each service shall always display a copy of the ambulance service license in a prominent location on the premises of the ambulance service’s operational base at all times.

5. (7) Issuance of licenses.

   1. (A) EMS agencies must have a software system in place that maintains compatibility with the Department of Health’s software vendor to submit data to the Department of Health as required by this part.
   2. (B) All documentation and applicable fees must be submitted to the Department of Health prior to any license being issued.
   3. (C) No license shall be issued until all licensure requirements have been met.
6. (8) Transferability of license. Service licenses shall only be transferable if all initial licensure paperwork and fees are submitted to the Department of Health prior to operation, unless otherwise approved by the Department of Health.
7. (9) Change in information. Service license holders shall notify the Department of Health by certified mail within ten (10) days after any of the information contained in the application changes or becomes inaccurate.
8. (10) Advertising. An ambulance service shall not advertise to the general public any skills, procedures, staffing, or personnel licensure levels that cannot be provided for every emergency request, twenty-four (24) hours a day, seven (7) days a week.

9. (11) Service area.

   1. (A) The service area of each licensed ambulance service shall be:

      1. (i) Clearly identified on a map provided by the Department of Health; and
      2. (ii) Submitted annually to the Department of Health.

   2. (B) A licensed service may cross county lines to serve a portion of an adjoining county:

      1. (i) With an agreement with the licensed service or services in the adjoining county; and
      2. (ii) In accordance with written contracts or agreements between the ambulance service and city or county governments as they may exist.
   3. (C) This agreement shall be submitted to the Department of Health annually with the service area map.
   4. (D) This excludes air ambulance services.
10. (12) Securing patients. An ambulance service shall only transport patients who are properly secured based upon the ambulance manufacturer’s recommendations and/or federal requirements.

11. (13) Patient consent.

    1. (A) It is recognized and established that, in addition to such other persons as may be so authorized and empowered, any one (1) of the following persons is authorized and empowered to consent, either orally or otherwise, to any surgical or medical treatment or procedures not prohibited by law that may be suggested, recommended, prescribed, or directed by a licensed physician:

       1. (i) Any adult, for himself or herself;
       2. (ii) Any parent, whether an adult or an unemancipated minor, for a minor child or for an adult child of unsound mind, whether the child is of the parent's blood, is an adopted child, is a stepchild, or is a foster child, provided, however, the father of an illegitimate child cannot consent for the child solely on the basis of parenthood;
       3. (iii) Any married person, whether an adult or a minor, for self;
       4. (iv) Any female, regardless of age or marital status, for herself when given in connection with pregnancy or childbirth, except the unnatural interruption of pregnancy;
       5. (v) Any person standing in loco parentis, whether formally serving or not, and any guardian, conservator, or custodian, for his or her ward or other charge under disability;
       6. (vi) Any emancipated minor, for himself or herself;
       7. (vii) Any unemancipated minor of sufficient intelligence to understand and appreciate the consequences of the proposed surgical or medical treatment or procedures, for himself or herself;
       8. (viii) Any adult, for his or her minor sibling or his or her adult sibling of unsound mind;
       9. (ix) During the absence of a parent so authorized and empowered, any maternal grandparent and, if the father is so authorized and empowered, any paternal grandparent, for his minor grandchild or for his or her adult grandchild of unsound mind;
       10. (x) Any married person, for a spouse of unsound mind;
       11. (xi) Any adult child, for his or her mother or father of unsound mind; and
       12. (xii) Any minor incarcerated in the Department of Corrections or the Division of Community Correction, for himself or herself.

    2. (B) In addition to any other instances in which consent is excused or implied at law, consent to surgical or medical treatment or procedures suggested, recommended, prescribed, or directed by a licensed physician will be implied in the following circumstances:

       1. (i) Where an emergency exists and there is no one immediately available who is authorized, empowered to, or capable of consent, an emergency is defined as a situation wherein, in competent medical judgment, the proposed surgical or medical treatment or procedures are immediately or imminently necessary and any delay occasioned by an attempt to obtain a consent would reasonably be expected to:

(b) (b) Result in disfigurement or impaired faculties; and

1. (ii) Where any emergency exists, there has been a protest or refusal of consent by a person authorized and empowered to do so, and there is no other person immediately available who is authorized, empowered, or capable to consent but there has been a subsequent material and morbid change in the condition of the affected person.
2. (14) Prohibition. Ambulance services shall not carry nor dispense any drugs or medications or perform any procedure that is outside of the service level and EMSP’s scope of practice.

3. (15) Out-of-state ambulance contracts for disaster assistance.

   1. (A) Ambulance services shall contact the Department of Health prior to deploying or sending any current Arkansas permitted ambulances to another state or states to fulfill obligations of a state/federal/private contract or agreement for a disaster.
   2. (B) The ambulance service shall contact the Department of Health during regular business hours or the Emergency Communication Center of the Department of Health after hours.

4. (16) Mutual aid.

   1. (A) A prearranged mutual aid agreement with another Arkansas-licensed service shall be in place or by activation of a mass casualty incident through the Department of Health.
   2. (B) Mutual aid agreements must be updated annually.

5. (17) Primary responder or responders.

   1. (A) Ground ambulance services are the primary prehospital emergency responder for each emergency scene request within their service area.
   2. (B) Air ambulance services are considered secondary emergency responders when requested by a patient, bystander, or responders at the scene.
   3. (C) In the event of a mass casualty incident or an extenuating circumstance, an air ambulance service may be considered a primary responder if access to patients is delayed or inaccessible by ground ambulances.
   4. (D) If an air ambulance service is notified by a patient, bystander, or responder prior to the arrival of ground ambulance service, the air ambulance service shall immediately activate the ground ambulance service within that service area.

6. (18) Transportation of nonpatient care equipment.

   1. (A) Items not related to patient care may only be transported in an ambulance that is considered out of service.
   2. (B) This excludes service/guide dogs as defined by Arkansas Code § 20-14-308.