Authority: IC 16-31-2-7; IC 16-31-3-14; IC 16-31-3-14.5; IC 16-31-3-20

Affected: IC 16-31-3; IC 16-41-10

Sec. 1. (a) A person shall not:

1. (1) furnish;
2. (2) operate;
3. (3) maintain;
4. (4) advertise; or
5. (5) otherwise engage in providing;

emergency medical services as an emergency medical technician-basic advanced provider organization unless the person is certified by the commission as an emergency medical technician-basic advanced provider organization.

(b) An emergency medical technician-basic advanced provider organization certification provides authority to perform skills set forth and approved by the commission for which certification is granted. The medical director may limit the skills according to local protocols.

(c) If an emergency medical technician-basic advanced provider organization also provides transportation of emergency patients, the emergency medical technician-basic advanced provider organization shall be certified as an ambulance service provider organization under 836 IAC 1-2.

(d) The chief executive officer of an emergency medical technician-basic advanced provider organization shall certify that the provider organization has an agreement, or interdepartmental memo if hospital based, with one (1) or more supervising hospitals for the following services:

1. (1) Continuing education.
2. (2) Audit and review.
3. (3) Medical control and direction.
4. (4) Provision to allow the emergency medical technician-basic advanced affiliated with the supervised emergency medical technician- basic advanced provider organization to function within the appropriate hospital department in order to obtain continuing practice in their clinical skills.

The agreement or interdepartmental memo shall include a detailed description of how such services shall be provided to the emergency medical technician-basic advanced provider organization. In those cases where more than one (1) hospital enters into an agreement, or seeks to enter into an agreement, with an emergency medical technician-basic advanced provider organization as a supervising hospital, the interhospital agreement shall clearly define the specific duties and responsibilities of each hospital to ensure medical and administrative accountability of system operation.

(e) All ambulances used by the emergency medical technician-basic advanced provider organization shall be certified under 836 IAC 1-3.

(f) All nontransport vehicles used for the provision of emergency medical technician-basic advanced services shall meet all of the following requirements:

1. (1) Each nontransport vehicle shall carry the following assembled and readily accessible minimum rescue equipment:

   1. (A) Equipment for safeguarding personnel, including one (1) fire extinguisher with an Underwriters Laboratory rating of not less than a five (5) pound rating for 2A:4-B; C, that shall have a current inspection date and be mounted so that it is readily accessible.

   2. (B) Equipment for release from entrapment or confinement, including the following:

      1. (i) One (1) hammer, four (4) pound, fifteen (15) inch handle (hammer weight and length are minimums).
      2. (ii) One (1) wrecking bar, twenty-four (24) inch combination tool minimum.
      3. (iii) One (1) self-contained portable light source.

2. (2) Each nontransport vehicle shall wrap, properly store, and handle all the single-service implements inserted into the patient's nose or mouth. Multiuse items are to be kept clean and sterile when indicated and properly stored. The vehicle shall carry the following assembled and readily accessible minimum equipment:

   1. (A) Respiratory and resuscitation equipment as follows:

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

         1. (AA) wide-bore tubings;
         2. (BB) rigid catheters;
         3. (CC) soft pharyngeal suction tips in child size; and
         4. (DD) soft pharyngeal suction tips in adult size.

      2. (ii) Bag-mask ventilation units, hand operated, one (1) unit in each of the following sizes, each equipped with clear face masks and oxygen reservoirs with oxygen tubing:

         1. (AA) Adult.
         2. (BB) Child.
         3. (CC) Infant.
         4. (DD) Neonatal (mask only).
      3. (iii) Oropharyngeal airways, two (2) each of adult, child, and infant.
      4. (iv) One (1) pocket mask with one-way valve.

      5. (v) Portable oxygen equipment of at least three hundred (300) liters capacity (D size cylinder) with:

         1. (AA) yoke;
         2. (BB) medical regulator;
         3. (CC) pressure gauge; and
         4. (DD) nondependent flowmeter.

      6. (vi) Oxygen delivery devices shall include the following:

         1. (AA) High concentration devices, two (2) each, adult, child, and infant.
         2. (BB) Low concentration devices, two (2) each, adult.

      7. (vii) Nasopharyngeal airways, two (2) each of the following with water soluble lubricant:

         1. (AA) Small (20-24 french).
         2. (BB) Medium (26-30 french).
         3. (CC) Large (31 french or greater).
      8. (viii) Bulb syringe individually packaged in addition to obstetrics kit.
      9. (ix) Nonvisualized airway minimum of two (2) with water soluble lubricant.
      10. (x) Portable defibrillator equipped with defibrillation pads or paddles appropriate for defibrillation.

   2. (B) Wound care supplies as follows:

      1. (i) Airtight dressings, four (4), for open chest wounds.
      2. (ii) Assorted bandaging supplies for the care of soft tissue injuries.

   3. (C) Patient stabilization equipment as follows:

      1. (i) Upper and lower extremity splinting devices, two (2) each.

      2. (ii) Rigid extrication collar, two (2) each capable of the following sizes:

         1. (AA) Pediatric.
         2. (BB) Small.
         3. (CC) Medium.
         4. (DD) Large.

   4. (D) Personal protection/universal precautions equipment, minimum of one (1) each, including the following:

      1. (i) Gowns.
      2. (ii) Face masks and shields.
      3. (iii) Gloves.
      4. (iv) Biohazard bags.
      5. (v) Antimicrobial hand cleaner.

   5. (E) Miscellaneous items as follows:

      1. (i) Obstetrical kit, sterile, one (1).

      2. (ii) Blood pressure manometer, one (1) each in the following cuff sizes:

         1. (AA) Large adult.
         2. (BB) Adult.
         3. (CC) Pediatric.

      3. (iii) Stethoscopes, one (1) each in the following sizes:

         1. (AA) Adult.
         2. (BB) Pediatric.
      4. (iv) Sharps collector, one (1) being a minimum of seven (7) inches in height.
      5. (v) Intravenous fluids and administration supplies approved by the medical director.

      6. (vi) Medication as approved by the medical director limited to the following:

         1. (AA) Baby aspirin, eighty-one (81) milligrams each.
         2. (BB) Activated charcoal.
         3. (CC) Instant glucose.
         4. (DD) Epinephrine auto-injector or auto-injectors.
3. (3) A current copy of protocols shall be maintained on board the nontransport vehicle at all times.
4. (4) A copy of the medication list, including quantities and concentrations approved by the medical director.

(g) An emergency medical technician-basic advanced provider organization shall have a medical director. The duties and responsibilities of the medical director are as follows:

1. (1) Provide liaison between the local medical community and the emergency medical service provider organization.
2. (2) Assure that appropriate intravenous solution, supplies, and equipment are available to the emergency medical technician-basic advanced provider organization.
3. (3) Monitor and evaluate the day-to-day medical operations of the provider organization.
4. (4) Assist the supervising hospital in the coordination of in-service training programs.
5. (5) Assure continued competence of emergency medical technician-basic advanced affiliated with, or employed by, the emergency medical technician-basic advanced provider organization.
6. (6) Participate in the quarterly audit and review of cases treated by emergency medical technician-basic advanced of the provider organization.
7. (7) Establish protocols for emergency medical technician-basic advanced.
8. (8) Establish and publish a list of intravenous fluids and administration supplies, including minimum quantities to be carried on the vehicle.

9. (9) Provide liaison between the:

   1. (A) emergency medical service provider organization;
   2. (B) emergency medical service personnel; and
   3. (C) hospital;
10. in regards to communicable disease testing under IC 16-41-10.
11. (10) Provide individual consultation to the emergency medical personnel affiliated with the ambulance service provider organization.

(h) Each emergency medical technician-basic advanced provider organization shall notify the agency in writing within thirty (30) days of any changes in the operation as outlined in the application for which certification was granted.

(i) When services administered by an emergency medical technician-basic advanced at the scene of an accident or illness are continued en route to an emergency facility, as a minimum, the patient compartment of the ambulance shall be staffed by not fewer than one (1) person certified as:

1. (1) an emergency medical technician-basic advanced;
2. (2) an emergency medical technician-intermediate; or
3. (3) a paramedic.

(j) Provide for a periodic maintenance program to assure that:

1. (1) all emergency medical service vehicles, including equipment, are maintained in good working condition at all times; and
2. (2) equipment, medication, and supplies have not exceeded the manufacturer's specified expiration date.

(k) Each emergency medical technician-basic advanced provider organization shall show proof of insurance coverage as required by 836 IAC 1-3-6.

(l) The emergency medical technician-basic advanced provider organization shall maintain a communications system established under 836 IAC 1-4.

(m) Each nontransport vehicle used for the purpose of providing emergency medical technician-basic advanced services when dispatched for the purpose of an emergency medical run shall be staffed, as a minimum, by a certified emergency medical technician-basic advanced.

(Indiana Emergency Medical Services Commission; 836 IAC 1-12-1; filed Jun 11, 2004, 1:30 p.m.: 27 IR 3530; filed Jul 31, 2007, 10:01 a.m.: 20070829-IR-836060011FRA; readopted filed Jul 29, 2010, 8:07 a.m.: 20100825-IR- 836100267RFA; readopted filed Oct 31, 2016, 1:48 p.m.: 20161130-IR-836160328RFA; readopted filed Nov 28, 2022, 2:51 p.m.: 20221228-IR-836220299RFA; readopted filed Jul 24, 2024, 3:48 p.m.: 20240821-IR-836230827RFA)