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 a paramedic provider organization unless the person is certified by the commission as a paramedic provider organization.

(b) If the paramedic provider organization also provides transportation of emergency patients, the paramedic provider organization shall be certified as an ambulance service provider organization in accordance with the requirements specified in 836 IAC 1. The paramedic nontransport provider organizations shall meet the requirements specified in 836 IAC 1-1-5 through 836 IAC 1-1- 8.

(c) The paramedic provider organization shall ensure the following:

1. (1) Ambulances used are certified and meet the requirements specified in 836 IAC 1-3.
2. (2) All nontransport emergency medical services vehicles used for the provision of advanced life support meet all of the requirements in 836 IAC 2-14.

(d) The chief executive officer of each paramedic provider organization shall certify that the provider organization has an agreement, or interdepartmental memo if hospital based, with one (1) or more supervising hospitals that agree [sic] agrees to provide the following services:

1. (1) Continuing education.
2. (2) Audit and review.
3. (3) Medical control and direction.
4. (4) Provision to allow the paramedics affiliated with the supervised paramedic provider organization to function within the appropriate hospital department in order to obtain continuing practice, remediation, and continuing education in their clinical skills.

The agreement or interdepartmental memo shall include a detailed description of how such services shall be provided to the paramedic provider organization. In those cases where more than one (1) hospital enters into an agreement, or seeks to enter into an agreement, with a paramedic 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) The paramedic provider organization shall have a medical director provided by the paramedic provider organization or jointly with the supervising hospital. The medical director is responsible for providing competent medical direction as established by the medical control committee. Upon establishment of a medical control policy, the paramedic provider organization medical director and the chief executive officer have the duty to enact the policy within the paramedic provider organization and accordingly enforce the policy. The duties and responsibilities of the medical director include, but are not limited to, the following:

1. (1) Provide liaison with physicians and the medical community.

2. (2) Assure that the:

   1. (A) drugs;
   2. (B) medications;
   3. (C) supplies; and
   4. (D) equipment;
3. are available to the paramedic provider organization.
4. (3) Monitor and evaluate day-to-day medical operations of paramedic provider organizations.
5. (4) Assist the supervising hospital in the provision and coordination of continuing education.
6. (5) Provide individual consultation to paramedics.
7. (6) Participate in at least quarterly audit and review of cases treated by paramedics of the provider organization.
8. (7) Attest to the competency of paramedics affiliated with the paramedic provider organization to perform skills required of a paramedic under 836 IAC 4-9-5.
9. (8) Establish protocols for basic and advanced life support in cooperation with the medical control committee of the supervising hospital.
10. (9) Establish and publish a list of medications, including minimum quantities and dosages to be carried on the emergency medical services vehicle.

11. (10) Provide liaison between the:

    1. (A) emergency medical service provider organization; the [sic]
    2. (B) emergency medical service personnel; and the [sic]
    3. (C) hospital;
12. in regards to communicable disease testing under IC 16-41-10.

(f) The paramedic provider organization shall maintain a communications system that shall be available twenty-four (24) hours a day between the paramedic provider organization and the emergency department, or equivalent, of the supervising hospital using UHF (ultrahigh frequency) or cellular voice communications. The communications system shall be licensed by the Federal Communications Commission.

(g) Each paramedic provider organization shall do the following:

1. (1) Maintain an adequate number of trained personnel and emergency response vehicles to provide continuous, twenty-four (24) hour advanced life support services.
2. (2) Notify the commission in writing within thirty (30) days of assigning any individual to perform the duties and responsibilities required of a paramedic. This notification shall be signed by the provider organization and medical director of the provider organization.

(h) A paramedic ambulance service provider organization must be able to provide a paramedic level response. For the purpose of this subsection, "paramedic response" consists of the following:

1. (1) A paramedic.
2. (2) An emergency medical technician or higher.
3. (3) An ambulance in compliance with the requirements of section 3(e) of this rule.

4. (4) During transport of the patient, the following are the minimum staffing requirements:

   1. (A) If paramedic level advanced life support treatment techniques have been initiated or are needed:

      1. (i) the ambulance must be staffed by at least a paramedic and an emergency medical technician; and
      2. (ii) a paramedic shall be in the patient compartment.

   2. (B) If an emergency medical technician-intermediate level advanced life support treatment techniques have been initiated or are needed:

      1. (i) the ambulance must be staffed by at least an emergency medical technician-intermediate and an emergency medical technician; and
      2. (ii) an emergency medical technician-intermediate shall be in the patient compartment.

   3. (C) If advanced life support treatment techniques have not been initiated and are not needed:

      1. (i) the ambulance must be staffed by at least an emergency medical technician; and
      2. (ii) an emergency medical technician shall be in the patient compartment.

(i) For a paramedic provider organization, when an advanced life support nontransport vehicle is dispatched for a paramedic response, it shall, at a minimum, be staffed by a paramedic.

(j) The paramedic provider organization shall do the following:

1. (1) Notify the agency in writing within thirty (30) days of any changes in the operation as stated in the application.
2. (2) With medical director and chief executive officer approval, allow a student or graduate of an Indiana approved paramedic course to perform advanced life support under the direction of a preceptor. This person shall be actively pursuing certification as an Indiana certified paramedic. This provision shall be limited from one (1) year from date of course completion as indicated on course report.
3. (3) Show proof of insurance coverage as required by 836 IAC 1-3-6.

(Indiana Emergency Medical Services Commission; Advanced Life Support Rule I, A; filed Jan 21, 1977, 11:30 a.m.: Rules and Regs. 1978, p. 200; filed Dec 15, 1977: Rules and Regs. 1978, p. 250; filed Nov 3, 1980, 3:55 p.m.: 3 IR 2216; filed Oct 13, 1981, 10:05 a.m.: 4 IR 2434; errata, 5 IR 400; filed Dec 2, 1983, 2:43 p.m.: 7 IR 364; errata, 7 IR 1254; filed Dec 13, 1985, 9:13 a.m.: 9 IR 1062; filed Aug 18, 1986, 1:00 p.m.: 10 IR 41; filed Oct 11, 1988, 11:05 a.m.: 12 IR 358; filed May 15, 1998, 10:25 a.m.: 21 IR 3892; filed Jun 30, 2000, 4:18 p.m.: 23 IR 2733; filed Apr 4, 2002, 9:15 a.m.: 25 IR 2512; filed Feb 20, 2003, 8:00 a.m.: 26 IR 2348; errata, 26 IR 2624; filed Jun 11, 2004, 1:30 p.m.: 27 IR 3535; 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)