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

Affected: IC 4-21.5; 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-intermediate provider organization unless the person is certified as an emergency medical technician-intermediate provider organization.

(b) If the emergency medical technician-intermediate provider organization also provides transportation of emergency patients, the emergency medical technician-intermediate provider organization shall be certified as an ambulance service provider organization in accordance with the requirements specified in 836 IAC 1 under IC 16-31. The emergency medical technician-intermediate nontransport provider organizations shall meet the requirements specified in 836 IAC 1-1-4 through 836 IAC 1-1-8.

(c) The emergency medical technician-intermediate 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 emergency medical technician-intermediate 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) Provisions to allow the emergency medical technician-intermediates affiliated with the supervised emergency medical technician- intermediate 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-intermediate 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-intermediate 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 emergency medical technician-intermediate provider organization shall have a medical director provided by the emergency medical technician-intermediate 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 medical director and chief executive officer of the emergency medical technician-intermediate provider organization have the duty to enact the policy within the emergency medical technician-intermediate 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 emergency medical technician-intermediate provider organization.
4. (3) Monitor and evaluate day-to-day medical operations of emergency medical technician-intermediate provider organizations.
5. (4) Assist in the provision and coordination of continuing education.
6. (5) Provide individual consultation to emergency medical technician-intermediates.
7. (6) Participate in at least quarterly audit and review of cases treated by emergency medical technician-intermediates of the supervising hospital.
8. (7) Attest to the competency of emergency medical technician-intermediates affiliated with the emergency medical technician- intermediate provider organization to perform skills required of an emergency medical technician-intermediate under 836 IAC 4- 7.1.
9. (8) Establish protocols for basic life support and advanced life support.
10. (9) Establish and publish a list of medications, including minimum quantities and dosages to be carried on the vehicle.

11. (10) Provide liaison between the:

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

(f) The emergency medical technician-intermediate provider organization shall do the following:

1. (1) Maintain a communications system that shall be available twenty-four (24) hours a day between the emergency medical technician- intermediate provider organization and the emergency department, or equivalent, of the supervising hospital using UHF (ultrahigh frequency) and cellular voice communications. The communications system shall be licensed by the Federal Communications Commission.
2. (2) Maintain an adequate number of trained personnel and emergency response vehicles to provide continuous, twenty-four (24) hour advanced life support services.
3. (3) Notify the commission in writing within thirty (30) days of assigning any individual to perform the duties and responsibilities required of an advanced emergency medical technician-intermediate. This notification shall be signed by the provider organization and medical director of the provider organization.

(g) An emergency medical technician-intermediate ambulance service provider organization must be able to provide an emergency medical technician-intermediate level response. For the purpose of this subsection, "emergency medical technician-intermediate response" consists of the following:

1. (1) An emergency medical technician-intermediate.
2. (2) An emergency medical technician or higher.
3. (3) An ambulance in compliance with the requirements of section 3(d)(2) of this rule.

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

   1. (A) If 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.

   2. (B) 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.

(h) For an emergency medical technician-intermediate provider organization, when an advanced life support nontransport vehicle is dispatched emergency medical technician-intermediate response, it shall, at a minimum, be staffed by an emergency medical technician- intermediate.

(i) The emergency medical technician-intermediate provider organization shall do the following:

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

(j) All ambulances and nontransport vehicles used by the emergency medical technician-intermediate provider organization shall meet the insurance requirements under 836 IAC 1-3-6.

(Indiana Emergency Medical Services Commission; 836 IAC 2-7.2-1; filed Feb 20, 2003, 8:00 a.m.: 26 IR 2353; filed Jun 11, 2004, 1:30 p.m.: 27 IR 3542; 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)