1. (a) Application. An application for the issuance or renewal of an emergency vehicle permit shall be made on forms provided by the Department of Health.

2. (b) Ground vehicle general standards.

   1. (1) Each vehicle of a licensed ground ambulance service shall be issued a permit in one (1) of the classifications set forth below:

      1. (A) Paramedic;
      2. (B) Community Paramedic;
      3. (C) AEMT;
      4. (D) EMT;
      5. (E) Advanced Response;
      6. (F) EMT — Volunteer (EMT-V);
      7. (G) EMT — Special Purpose (EMT-S); and
      8. (H) Stretcher.

   2. (2) A vehicle may not be permitted by the Department of Health or operated as an ambulance prior to the submission and approval of:

      1. (A) All required documentation and fees; and
      2. (B) A Department of Health inspection.
   3. (3) Vehicles must meet applicable requirements set forth in this part prior to receiving or retaining a vehicle permit.
   4. (4) Permits shall be for a period not to exceed one (1) year.
   5. (5) New ambulances replacing a permitted vehicle or being added to an existing service license must be inspected and permitted prior to being placed in service.

   6. (6)

      1. (A) Any medical equipment carried on an ambulance outside the approved equipment list shall have prior written approval by the Department of Health.
      2. (B) No equipment or supplies shall be carried on an ambulance that would permit an EMSP to render care beyond the scope of practice and/or violate this part, excluding community paramedic vehicles.
   7. (7) Ambulances used for the transportation of patients must have supplies and equipment for the protection of personnel and patients from infectious diseases and for personal safety.

   8. (8)

      1. (A) Ambulances shall be equipped with fasteners of the quick-release type to secure the cot to the floor or side walls that meet Ambulance Manufacturers Division (AMD) Standard 004.
      2. (B) Stretcher mounts must be capable of fastening the stretcher to the vehicle to prevent any movement of the stretcher when in its fastened position.
   9. (9) Only ambulances of a paramedic or AEMT service shall be equipped with ALS equipment as defined by their level of care unless a prior request for an upgrade has been made and approved by the Department of Health.

   10. (10)

       1. (A) Temporary upgrades and downgrades of permitted ambulances:

3. (i) Are for mechanical and staffing purposes; and

   1. (ii) Must be for a temporary period.

      1. (B) Notice shall be made in writing on approved forms to the Department of Health prior to any changes in equipment or staffing of permitted ambulances.
      2. (C) Permanent upgrades and downgrades shall follow the same guidelines as a new vehicle permit.
      3. (D) Advanced life support equipment and medications shall not be stored on a licensed EMT ambulance.

   2. (11)

      1. (A) Each permitted ambulance must have the ambulance service name clearly displayed in a contrasting color or colors on each side and rear of the ambulance such that it is easily identifiable by the general public.

      2. (B) The following identifiers shall also be displayed in a contrasting color or colors:

         1. (i) The Star of Life emblem must be displayed on the top of the new ambulance; and
         2. (ii) The new permit sticker issued by the Department of Health will be displayed on the rear lower-left corner of the ambulance vehicle.

      3. (C) The following identifiers may also be displayed in contrasting colors:

         1. (i) The permitted level of the ambulance may be displayed on the front two (2) fenders of the ambulance; and
         2. (ii) The word “Ambulance” is labeled in a mirror image located on the front of the ambulance hood and the word “Ambulance” on the rear of the ambulance.

   3. (12)

      1. (A) Each ambulance shall be equipped with a siren capable of emitting sound audible under normal conditions from not less than five hundred feet (500’).
      2. (B) The warning device shall not be used except when the ambulance is operated in response to an emergency call, reference Arkansas Code § 27-37-202.
      3. (C) Community paramedic vehicles may not be equipped with audible warning devices.

   4. (13)

      1. (A) Each ambulance shall be equipped with an emergency lighting system that shall provide three hundred sixty degrees (360°) of conspicuity for safety during all missions.

      2. (B) This includes, at a minimum:

         1. (i) A flashing emergency light bar or equivalent; and
         2. (ii) Two (2) alternating flashing red lights located at the same level on the:
4. (a) (a) Front;

5. (b) (b) Sides; and

   1. (c) (c) Rear.

      1. (C) These lights shall have sufficient intensity to be visible at five hundred feet (500’) in normal sunlight.
      2. (D) Community paramedic vehicles may not be equipped with warning lights.
   2. (14) All lighting, both interior and exterior, shall be fully operational, including lens caps.
   3. (15) Electrically powered suction aspirator systems shall be installed and fully functional.
   4. (16) Each ambulance shall be equipped with a minimum of two (2) fire extinguishers.

   5. (17)

      1. (A) Each ambulance shall be equipped with a:

         1. (i) Backup alert alarm (audible warning device) that is activated when the vehicle is shifted into reverse; and
         2. (ii) Load management system to ensure power to essential patient care equipment is protected.
      2. (B) Community paramedic vehicles do not need to be equipped with a backup alert alarm.

   6. (18)

      1. (A) All designated seating positions in the patient compartment shall be:

         1. (i) Equipped with safety restraint systems appropriate for each type of seating configuration; and
         2. (ii) Fully operational.
      2. (B) There shall be no less than forty-three inches (43”) of seat-to-ceiling space for all personnel sitting positions.

   7. (19)

      1. (A) All oxygen tanks shall be secured, with the main oxygen tank’s regulator indicating the cylinder pressure visible from within the patient compartment.
      2. (B) The oxygen tank retention system shall meet AMD Standard 003.
      3. (C) Oxygen must be medical-grade and the tank must always contain at least five hundred pounds per square inch (500 psi).

   8. (20)

      1. (A) Each permitted ambulance shall have two-way direct communication with dispatch centers, base stations, other emergency medical service vehicles, and receiving hospitals.

      2. (B) The following frequencies are mandated:

         1. (i) 155.280 MHz;
         2. (ii) 155.235 MHz; and
         3. (iii) 155.340 MHz.
      3. (C) All permitted ambulances of licensed services that are participating in the Arkansas Trauma System must have a Trauma AWIN radio that is in operating condition.

   9. (21)

      1. (A) All ambulances permitted by the Department of Health shall carry the minimum approved supplies and equipment for the level of licensure of the ambulance.

      2. (B) All equipment and supplies shall be:

         1. (i) In date;
         2. (ii) Clean;
         3. (iii) Sanitary; and
         4. (iv) In good working order.

   10. (22) Each ambulance shall have no structural or functional defects that may adversely affect the patient, EMSPs, or the safe operation of the vehicle, including:

       1. (A) Steering systems;
       2. (B) Brakes; and
       3. (C) Seatbelts.

   11. (23) Tires:

       1. (A) Shall be appropriate for the gross vehicle weight of the vehicle; and
       2. (B) Shall not be damaged or have excessive tread wear.
   12. (24) The ambulance exhaust system, as well as the gaskets surrounding the vehicle's exterior doors and windows, shall be in good condition and free of leaks, and the vehicle exhaust system shall extend beyond the sides of the patient compartment and away from doors.

   13. (25) The patient compartment of all ambulances shall be adequately:

       1. (A) Heated;
       2. (B) Air-conditioned; and
       3. (C) Ventilated.
   14. (26) The interior of the ambulance and all storage areas shall be maintained in a manner that is safe, clean, and in good working order always.
   15. (27) Each ambulance shall be equipped with functioning windshield wipers.
   16. (28) All doors and door latches, both inside and outside of the vehicle, shall be fully functional.
   17. (29) Licensed services shall ensure that all outdated, misbranded, adulterated, or deteriorated fluids, supplies, and medications are removed from an ambulance immediately.

   18. (30)

       1. (A) The Department of Health may, at its sole discretion, inspect each permitted ambulance subject to the requirements of this part.
       2. (B) The Department of Health may inspect an ambulance or its maintenance records at any time or place to determine if the ambulance is being operated safely and in compliance with this part.
   19. (31) If an ambulance service does not provide extrication services, an extrication agreement with a rescue department or team shall be submitted to the Department of Health with the ambulance service’s initial and annual renewal application.
   20. (32) Each permitted vehicle shall keep a current copy, either in print or electronic, of the service’s medical director-approved protocols in the ambulance always.

   21. (33) EMSPs shall perform only those skills at the level of the permitted vehicle.

       1. (c) Ambulance staffing requirements.

   22. (1) Paramedic-permitted ambulances.

       1. (A) Each paramedic-permitted ambulance shall be always staffed by a minimum of two (2) licensed and certified individuals, one (1) of whom shall be a licensed paramedic.

       2. (B) The remaining individual may be a:

          1. (i) Paramedic;
          2. (ii) AEMT;
          3. (iii) EMT;
          4. (iv) EMR; or
          5. (v) EVO.
       3. (C) The paramedic shall always staff the patient compartment during patient transport.
       4. (D) Only licensed EMRs may participate in the 911 primary system on a permitted paramedic ambulance.
       5. (E) Certified EVOs may not participate in the 911 primary system on a permitted paramedic ambulance.

   23. (2) AEMT-permitted ambulances.

       1. (A) Each AEMT-permitted ambulance always shall be staffed by a minimum of two (2) licensed and certified individuals, one (1) of whom shall be a licensed paramedic or AEMT.

       2. (B) The remaining individual may be a:

          1. (i) Paramedic;
          2. (ii) AEMT;
          3. (iii) EMT;
          4. (iv) EMR; or
          5. (v) EVO.
       3. (C) The AEMT or paramedic shall always staff the patient compartment at all times during patient transport.
       4. (D) Only licensed EMRs may participate in the 911 primary system on a permitted AEMT ambulance.
       5. (E) Certified EVOs may not participate in the 911 primary system on a permitted AEMT ambulance.

   24. (3) EMT-permitted ambulances.

       1. (A) Each permitted ambulance shall be staffed by two (2) licensed and certified individuals.

       2. (B) Each EMT-permitted ambulance shall always be staffed by a licensed:

          1. (i) Paramedic;
          2. (ii) AEMT; or
          3. (iii) EMT.
       3. (C) The remaining individual may be a licensed EMR or certified EVO.
       4. (D) The paramedic, AEMT, or EMT shall always staff the patient compartment during patient transport.
       5. (E) Licensed EMRs and certified EVOs may participate in the primary 911 system on a permitted EMT ambulance.

   25. (4) Advanced response-permitted vehicles.

       1. (A) Vehicles shall:

          1. (i) Be permitted at the paramedic level only; and
          2. (ii) Always be staffed by a minimum of one (1) licensed paramedic.

       2. (B)

          1. (i) Patient care must be transferred to a licensed transporting service.
          2. (ii) Paramedic level of care must be maintained throughout transport if paramedic level of care is initiated.

   26. (5) EMT — Volunteer permitted ambulances.

       1. (A) Each EMT — Volunteer-permitted ambulance shall always be staffed by a minimum of two (2) individuals, one (1) of whom shall be a licensed physician, paramedic, AEMT, RN, or EMT, with any of the above in the patient compartment always during patient transport.
       2. (B) The second individual must at minimum be certified in cardiopulmonary resuscitation (CPR) (basic life support).

   27. (6) Special purpose ambulances.

       1. (A) Each special purpose-permitted ambulance shall always be staffed by a minimum of two (2) individuals, one (1) of whom shall be a licensed:

          1. (i) Physician;
          2. (ii) Paramedic;
          3. (iii) AEMT;
          4. (iv) RN; or
          5. (v) EMT.
       2. (B) The patient compartment must always be staffed by the highest licensed level of care during patient transport.
       3. (C) The second individual must at minimum be certified in CPR (basic life support).

Codification Notes: “ALS” means advanced life support. "AWIN" means Arkansas Wireless Information Network. "RN" means registered nurse.