1. (a) Application. An application for the issuance or renewal of an air ambulance vehicle permit shall be made to the Department of Health with required documentation and payment of fees.

2. (b) Air ambulance vehicle general standards.

   1. (1) Air ambulance vehicles shall:

      1. (A) Be configured to allow the air medical personnel to treat the patient, including advanced life support procedures;
      2. (B) Ensure that all outdated, misbranded, adulterated, or deteriorated fluids, supplies, and medications are removed from the aircraft immediately;
      3. (C)

3. (i) Carry the minimum approved supplies and equipment for the level of licensure of the air ambulance.

   1. (ii) All equipment and supplies shall be:
4. (a) (a) Clean;

5. (b) (b) Sanitary; and

   1. (c) (c) In good working order; and

      1. (D) Be properly climate controlled at a temperature range of fifty degrees to eighty-five degrees Fahrenheit (50°F – 85°F).
   2. (2) All pharmaceuticals shall be kept within the recommended temperature range as established by the manufacturer.

   3. (3)

      1. (A) Each air ambulance service shall have in force and effect malpractice insurance coverage in the amount of no less than one million dollars ($1,000,000) per occurrence and no less than three million dollars ($3,000,000) aggregate for all air medical personnel.

      2. (B) The service shall maintain proof of the current insurance policy.

         1. (c) Air ambulance vehicle specific standards.

   4. (1) Rotor-wing and rotor-wing specialty vehicles shall:

      1. (A) Have communication capabilities for 123.05 MHz, 155.340 MHz, 155.235 MHz, and 155.280 MHz radio frequencies; and

      2. (B) Have a two-way radio with the ability to communicate:

         1. (i) Between the pilot and air medical personnel;
         2. (ii) With:
6. (a) (a) Physicians who are responsible for directing patient care in transit; and

7. (b) (b) Ground personnel who coordinate the transfer of the patient;

   1. (iii) Air-to-air and air-to-ground; and

      1. (iv) In the trauma system utilizing a trauma Arkansas Wireless Information Network (AWIN) radio or another suitable medium capable of real-time, direct communication with the Arkansas Trauma Communications Center (ATCC).

   2. (2) Fixed-wing vehicles:

      1. (A) Shall have communication capabilities for 123.05 MHz and other nationwide frequencies; and

      2. (B) Can communicate:

         1. (i) Between the pilot and air medical personnel;
         2. (ii) With:
8. (a) (a) Physicians who are responsible for directing patient care in transit; and

9. (b) (b) Ground personnel who coordinate the transfer of the patient;

   1. (iii) Air-to-air and air-to-ground; and

      1. (iv) Capable of real-time, direct communication with the ATCC when transporting trauma patients.

         1. (d) Air ambulance staffing requirements.

   2. (1) Air medical rotor-wing.

      1. (A) All flights shall be staffed by a minimum of two (2) air medical personnel, one (1) of whom must be a flight nurse or physician.
      2. (B) The physician may be the medical director or their designee who meets the appropriate air medical training requirement.
      3. (C) The air ambulance service medical director may select other crew members at their discretion from the following — paramedic, respiratory therapist, RN, or physician — if the personnel meet the minimum training requirements.

   3. (2) Air medical rotor-wing specialty.

      1. (A) All flights shall be staffed by a minimum of two (2) air medical personnel, one of whom must be a flight nurse or physician.
      2. (B) The physician may be the medical director or their designee who meets the appropriate air medical training requirement.
      3. (C) The air ambulance service medical director may select other crew members at their discretion from the following — paramedic, respiratory therapist, RN, or physician — if the personnel meet the minimum training requirements.

   4. (3) Air medical fixed-wing.

      1. (A) All flights shall be staffed by a minimum of one (1) medical crew member that shall be a licensed EMSP, critical care nurse, flight physician, or other appropriate medical personnel selected by the air ambulance service medical director.
      2. (B) If a physician is on the flight, the minimum crew members shall be a flight nurse or paramedic.

10. (e) Air medical personnel training requirements — Prehospital air medical rotor-wing, nonphysician crew. Minimum orientation and recurrent training in the following areas:

    1. (1) Prehospital environment. Will be covered by EMT licensure requirement as referenced in the Department of Health’s Emergency Medical Services Accreditation Manual;

    2. (2) Air medical environment.

       1. (A) Aircraft safety issues to include, as required by the Federal Aviation Administration, annual recurrent training, including crew resource management.
       2. (B) Air medical patient transport considerations (preparation, handling, and equipment).
       3. (C) Altitude physiology and stressors of flight, one (1) hour initially and annually.
       4. (D) Day and night flying protocols, to be included in the Federal Aviation Administration annual safety inspection.
       5. (E) EMS communications (radios) and familiarization with EMS system, one (1) hour initially.
       6. (F) Invasive procedures, or manikin equivalent, for competency maintenance, four (4) intubations/year, recommended one (1) successful intubation/quarter.
       7. (G) Quality management, one (1) hour yearly;

    3. (3) Preparatory, mandatory for both the flight nurse and paramedic. Minimum experience for flight nurses and paramedics:

       1. (A) Minimum of three (3) years of current registered nursing experience in critical care, emergency nursing, or both (for example, ICU, CVICU, ER, or CCU).

          1. (i) If an RN has two (2) years of critical care, emergency nursing experience, or both, and three (3) years of EMS experience at the paramedic level, they may be considered eligible for flight nurse status.
          2. (ii) A paramedic with three (3) years of flight experience may be allowed to transition into the flight nurse role if they successfully complete a program-specific flight nurse orientation; and
       2. (B) Minimum experience for paramedics conducting air ambulance transport, minimum of three (3) years’ current paramedic experience with a paramedic ambulance service;
    4. (4) Trauma.
    5. (1) Disaster and triage, two (2) hours initially and annually.
    6. (2) Thermal, chemical, and electrical, two (2) hours initially and annually; and

    7. (5) Certifications required.

       1. (A) Neonatal Resuscitation Program (NRP) or equivalent course;
       2. (B) Pediatric Advanced Life Support (PALS) course or Pediatric Education for Prehospital Providers (PEPP) course or equivalent course;
       3. (C) Advanced Cardiac Life Support (ACLS) or equivalent course;
       4. (D) Prehospital Trauma Life Support (PHTLS), International Trauma Life Support (ITLS), Trauma Nurse Core Course (TNCC), or equivalent course; and
       5. (E) FEMA ICS 100, 200, 700, and 800.

11. (f) Air medical personnel training requirements — Prehospital air medical rotor-wing conducting specialty flights (high-risk obstetrics and neonatal transports).

    1. (1) High-risk obstetrical.

       1. (A) Basic fetal monitoring class, four (4) hours initially and one (1) hour annually.

       2. (B) The following didactic topics shall be covered annually:

          1. (i) Fetal assessment;
          2. (ii) Triage and assessment of the pregnant patient;
          3. (iii) Conditions warranting transport and stabilization;
          4. (iv) Emergency childbirth and complications of delivery;
          5. (v) Placenta previa and placental abruption;
          6. (vi) Prolapsed cord;
          7. (vii) Preeclampsia;
          8. (viii) Postpartum hemorrhage;
          9. (ix) OB trauma; and
          10. (x) Medications.

       3. (C) Certifications required:

          1. (i) Advanced Cardiac Life Support (ACLS) or equivalent; and
          2. (ii) Neonatal Resuscitation Program (NRP) or equivalent.

    2. (2) Neonatal transport.

       1. (A) The following didactic topics shall be covered annually:

          1. (i) Maternal physiologic and pharmacologic factors affecting the neonate;
          2. (ii) Physical examination;
          3. (iii) Gestational age assessment;
          4. (iv) Interpretation of clinical, laboratory, radiographic, and other diagnostic data;
          5. (v) Thermoregulation;
          6. (vi) Oxygen monitoring;
          7. (vii) Fluid and electrolyte therapy; and
          8. (viii) Pharmacology, including drug dose calculations.

       2. (B) Anatomy, pathophysiology, assessment, and treatment of:

          1. (i) Acute and chronic respiratory diseases;
          2. (ii) Cardiovascular abnormalities;
          3. (iii) Surgical emergencies;
          4. (iv) Infectious diseases;
          5. (v) Musculoskeletal abnormalities;
          6. (vi) Neurological and spinal cord injuries;
          7. (vii) Prematurity and postmaturity;
          8. (viii) Hematologic disorders;
          9. (ix) Metabolic and endocrine disorders;
          10. (x) Disorders of the:
12. (a) (a) Head;

13. (b) (b) Eyes;

    1. (c) (c) Nose; and

       1. (d) (d) Throat;

          1. (xi) Genetic disorders, congenital heart disease;
          2. (xii) Psychosocial and bereavement support; and
          3. (xiii) Mechanical ventilation techniques during transport.

       2. (C) The following clinical areas shall be covered:

          1. (i) Oxygen administration;
          2. (ii) Anesthesia bag and mask ventilation;
          3. (iii) Application of Nasal Continuous Positive Airway Pressure (CPAP);
          4. (iv) Endotracheal intubation;
          5. (v) Ventilation;
          6. (vi) Inhaled;
          7. (vii) Nitric oxide, if indicated;
          8. (viii) IV and intraarterial access;
          9. (ix) Intraosseous access;
          10. (x) Venipuncture for lab specimen collection;
          11. (xi) Cardiopulmonary resuscitation (CPR);
          12. (xii) Hemorrhage control; and
          13. (xiii) Radiographic interpretation.
       3. (D) Certifications required, Neonatal Resuscitation Program (NRP) or equivalent.

14. (g) Air medical personnel training requirements — Air medical rotor-wing specialty. Minimum orientation and recurrent training in the following areas:

    1. (1) Air medical environment:

       1. (A) Aircraft safety issues, to include as required by the Federal Aviation Administration, annual recurrent training to include crew resource management;

       2. (B) Air medical patient transport considerations:

          1. (i) Preparation;
          2. (ii) Handling; and
          3. (iii) Equipment;
       3. (C) Altitude physiology and stressors of flight, one (1) hour initially and annually;
       4. (D) Day and night flying protocols, to be included in the Federal Aviation Administration annual safety inspection;
       5. (E) EMS communications (radios) and familiarization with EMS system, one (1) hour initially;
       6. (F) Invasive procedures, or manikin equivalent, for competency maintenance, four (4) intubations/year recommended, one (1) successful intubation/quarter;
       7. (G) Quality management, one (1) hour yearly; and
       8. (H) Stress recognition and management; and

    2. (2) Preparatory, mandatory for both the flight nurse and paramedic.

       1. (A) Minimum experience for flight nurses. Minimum of three (3) years’ current registered nursing experience in specialty care, for example, NICU, PICU, ICU, labor and delivery, etc., emergency nursing, or other as appropriate to the mission of the air ambulance service.
       2. (B) Minimum experience for paramedics. Minimum of three (3) years’ current paramedic experience with a paramedic ambulance service.

       3. (C) Minimum training requirements for specialty care air medical personnel.

          1. (i) Specialty care air medical personnel must have state licensure or certification requirements by appropriate agencies or governing bodies and have relevant specialty experience as described by program policy.
          2. (ii) At a minimum, these personnel must have the following training as noted in air medical environment.

15. (h) Air medical personnel training requirements — Air medical fixed-wing. Minimum orientation and recurrent training in the following areas:

    1. (1) Air medical environment.

       1. (A) Aircraft safety issues as required by the Federal Aviation Administration annual recurrent training, including crew resource management.

       2. (B) Air medical patient transport considerations:

          1. (i) Preparation;
          2. (ii) Handling; and
          3. (iii) Equipment.
       3. (C) Altitude physiology and stressors of flight, one (1) hour initially and annually.

    2. (2) Preparatory, mandatory for all fixed-wing medical personnel.

       1. (A) Minimum experience for RN and paramedic on a fixed-wing. Minimum of two (2) years’ current RN experience in critical care, emergency nursing, or both, for example, ICU, CVICU, ER, or CCU.
       2. (B) Minimum experience for EMTs or paramedics conducting fixed-wing transport. Minimum of two (2) years’ current EMT or paramedic experience with a paramedic ambulance service.

       3. (C) Minimum experience for specialty care fixed-wing personnel.

          1. (i)
16. (a) (a) Specialty care fixed-wing personnel must have an appropriate state license or certification requirements by appropriate agencies or governing bodies and have relevant specialty experience as described by program policy.

17. (b) (b) At a minimum, this personnel must have the following training as noted in air medical environment.

    1. (ii) For specialty transports, an RN must have a minimum of two (2) years of current registered nursing experience in the specialty of the patient being transported.

    2. (3) Required certifications.

       1. (i) Advanced Cardiac Life Support (ACLS) or equivalent course.

          1. (ii) Pediatric Advanced Life Support (PALS) or Pediatric Education for Prehospital Providers (PEPP) course or equivalent course if transporting pediatric patients.
          2. (iii) Neonatal Resuscitation Program (NRP) or equivalent course if transporting neonatal patients.
          3. (i) Air medical personnel training requirements for air medical rotor-wing air ambulance communication specialists. Minimum initial and recurrent training in the following areas:
    3. (1) Medical terminology;
    4. (2) Knowledge of EMS;
    5. (3) Familiarization with equipment used in the field setting;
    6. (4) FARs pertinent to the medical transport service;
    7. (5) Federal Communications Commission regulations pertinent to the medical transport service;
    8. (6) General safety rules and emergency procedures pertinent to air medical transport service;
    9. (7) Map skills, including the ability to locate an aircraft utilizing coordinates;
    10. (8) Ability to articulate weather radar information to pilots;
    11. (9) Types of radio frequency bands used in air medical EMS;
    12. (10) Assistance with hazardous materials response and recognition procedure using appropriate reference materials;
    13. (11) Stress recognition and management;
    14. (12) Customer service/public relations/phone etiquette;
    15. (13) Quality management;
    16. (14) Crew resource management pertinent to communications;
    17. (15) Computer literacy and software training;
    18. (16) Post-Accident Incident Plan (PAIP); and

    19. (17)

        1. (A) Documentation for recurrent training.
        2. (B) Documentation showing completion of all recurrent training as outlined in subsection (e) of this section shall be submitted to the department annually with the air ambulance service license renewal for all licensed EMSPs and communication specialists.

Codification Notes: “CCU” means critical care unit. "CVICU" means cardiovascular intensive care unit. "ER" means emergency room. "ICU" means intensive care unit. "IV" means intravenous. "OB" means obstetrical. "RN" means registered nurse.