(a) Ambulance service classifications.

1. (1)

   1. (A) Licensed community paramedic services shall have vehicles permitted at the community paramedic level.
   2. (B) Only licensed paramedic services may operate a community paramedic program or vehicles.
   3. (C) Ambulances may not be permitted or utilized as a community paramedic vehicle.

2. (2)

   1. (A) Licensed paramedic services shall have fifty percent (50%) or more ambulances permitted at the paramedic level.
   2. (B) Only licensed paramedic services may operate paramedic ambulances.

3. (3)

   1. (A) Licensed advanced emergency medical technician (AEMT) services shall have fifty percent (50%) or more ambulances permitted at the AEMT level.
   2. (B) Only AEMT and paramedic services may operate AEMT ambulances.

4. (4)

   1. (A) Licensed emergency medical services technician (EMT) services shall have ambulances permitted only at the EMT level.
   2. (B) Paramedic and AEMT services may also operate EMT ambulances.
5. (5) Licensed advanced response services shall only have vehicles permitted at the advanced response level.
6. (6) Licensed special purpose services shall only have ambulances permitted at the EMT specialty level.
7. (7) Licensed emergency medical technician volunteer services shall only have ambulances permitted at the EMT volunteer level.
8. (8) A licensed ambulance service with multiple levels of permitted vehicles, if not meeting the requirement for tiered response, shall respond to each emergency request with the highest permitted vehicle at the time of the request until those resources are depleted or are not available.

9. (9) Tiered response.

   1. (A) A licensed ambulance service that has either its own dispatch center or utilizes an outsourced or commercial dispatch service.
   2. (B) The dispatch service must use a dispatch process that is:

(i) Approved by the Department of Health; and

1. (ii) Reliably able to:

(b) Medical direction.

1. (1) Each licensed EMS service shall have a medical director.
2. (2) This medical director must provide the Drug Enforcement Administration license for the service.

3. (3) The medical director shall:

   1. (A)

      1. (i) Delegate other physicians or qualified healthcare professionals designated by the medical director to monitor and supervise the medical field performance of each Arkansas EMS agency’s EMSPs.
      2. (ii) However, the medical director shall retain ultimate authority and responsibility for:

(b) (b) Establishing protocols and standing orders; and

1. (c) (c) The competency of the performance of authorized medical acts;

   1. (B)

      1. (i) Annually review all service protocols and ensure that they are appropriate for the licensure level of each EMSP to whom the performance of medical acts is delegated and authorized, compliant with accepted standards of medical practice and in line with the Department of Health’s minimum patient care guidelines.
      2. (ii) The medical director shall be familiar with the knowledge, training, and competence of each of the EMSPs to whom the performance of such acts is delegated;
   2. (C) Notify the Department of Health within fourteen (14) business days prior to his or her cessation of duties as medical director;
   3. (D) Ensure the licensed ambulance services for which direction is provided are in compliance with this part;

   4. (E)

      1. (i) Have the authorization to limit the scope of practice or remove their affiliation with any EMSP under their direction.
      2. (ii) Medical directors who limit or remove their affiliation from an EMSP shall immediately notify the Department of Health in writing outlining why these steps were taken;
   5. (F) Physicians acting as medical directors for EMS education programs recognized by the Department of Health that require clinical and field internship performance by students shall be permitted to delegate authority to a student-in-training during their performance of program-required medical acts and only while under the control of the education program; and

   6. (G) Have knowledge and oversight of their EMS service that is participating in EMSP field and clinical times and ensure that students are always under the direct supervision of an Arkansas-licensed EMSP at or above the level of the EMSP’s course of training.

      1. (c) Quality assurance and service records.

2. (1)

   1. (A) Each licensed EMS agency shall conduct a quality assurance program.

   2. (B) The quality assurance program shall evaluate patient care and personnel performance for compliance with the current standards of practice as set forth in the:

      1. (i) Service’s medical protocols; and
      2. (ii) Current standards of the National Highway Traffic Safety Administration’s National EMS Scope of Practice Model.
   3. (C) Reviews should be conducted at least quarterly to assess, monitor, and evaluate the quality of patient care provided.

   4. (D) Documentation for the quality assurance program and review shall include the following:

      1. (i) The criteria used to select audited runs;
      2. (ii) Ambulance encounter form review;
      3. (iii) Problem identification and resolution;
      4. (iv) Investigation of complaints or incident reports;
      5. (v) Date of review;
      6. (vi) Attendance at the review; and
      7. (vii) A summary of the review discussion.

3. (2)

   1. (A) Any authorized representative of the Department of Health shall have the right to enter the premises of any service or permitted ambulance at any time in order to make whatever inspection necessary in accordance with the minimum standards and rules prescribed herein.

   2. (B) Each service shall maintain and make available during normal business hours to the Department of Health for inspection records including, but not limited to:

      1. (i) Patient care records;
      2. (ii) Equipment checks;
      3. (iii) Personnel certifications, continuing education, and credentialing;
      4. (iv) Policies and procedures;
      5. (v) Controlled substance wastage and reconciliation documentation; and
      6. (vi) Any documents related to service licensure.
      7. (d) Specific standards.

4. (1) Licensed paramedic services shall:

   1. (A)

      1. (i) Provide twenty-four-hour emergency ambulance service coverage.
      2. (ii) All services shall always have a documented plan ensuring coverage within the service’s service area at all times;
   2. (B) Meet the two-minute reaction time;

   3. (C) Maintain a register of legend drugs to include:

      1. (i) Type;
      2. (ii) Quantity;
      3. (iii) Date received;
      4. (iv) Date of expiration; and
      5. (v) Physician authorizing purchase and usage;
   4. (D) Maintain a copy of the Department of Health-approved medication policy and procedure that meets the requirements of the Division of Pharmacy Services and Drug Control;
   5. (E) Have an Arkansas-licensed medical director as defined in 20 CAR § 81-102(42); and
   6. (F) Maintain a copy of the physician Drug Enforcement Administration registration to be utilized in acquiring controlled drugs.

5. (2) Licensed community paramedic services may provide care/services to:

   1. (A) Discharged patients who have been screened for home health or hospice and:

      1. (i) Do not qualify for home health or hospice services; or
      2. (ii) Are documented as having declined home health or hospice services;
   2. (B) Discharged emergency department patients and prehospital patients;

   3. (C) A community paramedic may only participate in care of a patient under the care of a home health agency with the following conditions:

      1. (i) Have a formal request from the home health agency;
      2. (ii) Have clear communications between the community paramedic service and the home health agency; and
      3. (iii) Only act:

(b) (b) Under the scope of practice of the community paramedic;

1. (D) Discharged emergency department patients and prehospital patients;

   1. (E) Community paramedic care/services are limited to:

      1. (i)

(b) (b) Community paramedic services shall have a resource management manual;

1. (ii) Chronic disease care, monitoring, and education;

   1. (iii) Health assessment;

      1. (iv) Hospital discharge follow-up care;
      2. (v) Laboratory specimen collection; and
      3. (vi) Medication compliance; and

   2. (F)

      1. (i) Each licensed community paramedic service shall have a medical director.
      2. (ii) This medical director must provide the Drug Enforcement Administration license for the service.
      3. (iii) The medical director shall:

(b)

1. (1) (b)(1) Be either American Board of Emergency Medicine-certified or American Board of Emergency Medicine-eligible in a specialty that is involved in direct patient contact.

2. (2) (2) Each medical director shall be approved by the Department of Health;

   1. (c) (c) Provide monitoring and supervision of the medical field performance of each community paramedic and be actively involved in all aspects of the program, including but not limited to:
3. (1) (1) Training;
4. (2) (2) Provider selection;
5. (3) (3) Quality assurance; and

6. (4) (4) Evaluation of the program's goals and objectives;

   1. (d) (d) Retain ultimate authority and responsibility for:
7. (1) (1) The monitoring and supervision;
8. (2) (2) Establishing protocols and standing orders; and
9. (3) (3) The competency of the performance of authorized medical acts;

(h) (h) Ensure the licensed service for which direction is provided is in compliance with this part.

1. (3) Licensed AEMT services shall:

   1. (A)

      1. (i) Provide twenty-four-hour emergency ambulance service coverage.
      2. (ii) All services shall have a documented plan ensuring AEMT coverage within the service’s service area;
   2. (B) Meet the two-minute reaction time;
   3. (C) Have a medical director as defined in 20 CAR § 81-102(35); and
   4. (D) Maintain on file with the Department of Health a copy of the medication policy and procedures that meets the requirements of the Division of Pharmacy Services and Drug Control if medications or the expanded skills are in the AEMT service’s protocols.

2. (4) Licensed EMT services shall:

   1. (A)

      1. (i) Provide twenty-four-hour ambulance service coverage.
      2. (ii) All services shall have a documented plan always ensuring EMT coverage within the service’s service;
   2. (B) Meet a two-minute reaction time;
   3. (C) Have a medical director as defined in 20 CAR § 81-102 if medications or expanded skills are in the EMT service’s protocols; and
   4. (D) Maintain on file with the Department of Health a copy of the medication policy and procedure that meets the requirements of the Division of Pharmacy Services and Drug Control if medications or the expanded skills are in the EMT service’s protocols.

3. (5) Licensed advance response services shall:

   1. (A) Provide emergency care to critically ill or injured patients prior to the arrival of a licensed transporting ambulance service;
   2. (B) Be a government entity or a licensed ambulance service for a service area in which they are currently licensed;
   3. (C) Meet a two-minute reaction time;
   4. (D) Only be permitted at the paramedic level;
   5. (E) Maintain a register of legend drugs to include type, quantity, date received, date of expiration, and physician authorizing purchase and usage if narcotics are carried;

   6. (F)

      1. (i) Have a medical director as defined in 20 CAR § 81-102(42).
      2. (ii) Advanced response services shall have coordinated and agreed upon the agency’s service area guidelines by all transporting agency medical directors within the advanced response service area;
   7. (G) Maintain a copy of the Department of Health-approved Medication Policy and Procedures that meets the requirements of the Division of Pharmacy Services and Drug Control if narcotics are carried;
   8. (H) Staff each vehicle with at least one (1) licensed paramedic;
   9. (I) Only transfer care to a licensed paramedic transporting service or maintain advanced level of care throughout transport if care is rendered to a basic life support transporting ambulance service;

   10. (J)

       1. (i) Agencies not operating on a twenty-four-hour, seven-day-a-week basis shall provide all the licensed transporting ambulance services within their service area a schedule of operation that clearly indicates the levels of coverage and times of availability.
       2. (ii) Agencies are required to immediately notify the licensed transporting ambulance services of any changes to the schedule in real time.
       3. (iii) It is the responsibility of the advanced response agency to notify the local licensed transporting ambulance services of dispatched advanced response vehicles; and
   11. (K) Follow service data reporting to the Department of Health as referenced in 20 CAR § 81-103(b)(3).

4. (6) Licensed special purpose services.

   1. (A) A Special Purpose license shall be issued to an applicant who:

      1. (i) Provides a specific medical service to a limited population group and emergency evacuation services only;
      2. (ii) Does not participate in the business of providing continuous general population response for emergency medical services; and
      3. (iii) Is limited to pediatrics, neonatal, high-risk obstetrics, or the industrial settings.
   2. (B) A special purpose service shall have a medical director as defined in 20 CAR § 81-102 according to the service’s level of care.
   3. (C) A special purpose service shall maintain on file with the Department of Health a copy of the medication policy and procedure that meets the requirements of the Division of Pharmacy Services and Drug Control if medications or the expanded skills are in the EMT service’s protocols.

5. (7) Licensed EMT volunteer services.

   1. (A) An EMT Volunteer Service license shall be issued to an applicant whose ambulances are staffed by personnel who perform and give services without expectation of compensation.
   2. (B) An EMT volunteer service shall have a medical director as defined in 20 CAR § 81-102 if medications or expanded skills are in the EMT service’s protocols.
   3. (C) An EMT volunteer service shall maintain on file with the Department of Health a copy of the medication policy and procedure that meets the requirements of the Division of Pharmacy Services and Drug Control if medications or the expanded skills are in the EMT service’s protocols.