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

Sec. 2. (a) Application for certification as an emergency medical technician-intermediate provider organization shall be made on forms provided by the agency and shall include, but not be limited to, the following:

1. (1) An applicant shall complete and submit the required forms to the agency at least sixty (60) days before the requested effective date of the certificate.

2. (2) Each application shall include a narrative summary of plans for providing advanced life support services, including the following:

   1. (A) Defined primary area of response, including location of advanced life support response vehicles.
   2. (B) A listing of all emergency medical technician-intermediates, including certification numbers, to be affiliated by the emergency medical technician-intermediate provider organization.
   3. (C) The staffing pattern of personnel.
   4. (D) Base of operations.

   5. (E) Organizational structure, including name, address, and phone numbers for the:

      1. (i) owner;
      2. (ii) chief executive officer;
      3. (iii) chief operations officer;
      4. (iv) training officer; and
      5. (v) medical director.
   6. (F) Location of emergency medical technician-intermediate provider organizations records.
   7. (G) Proof of insurance coverage for emergency medical service vehicles as required by 836 IAC 1-3-6.
   8. (H) Plans and methodologies to ensure that the trained personnel are provided with supervised continuing education to maintain proficiency. Continuing education is under the direct supervision of the emergency medical technician-intermediate provider organization medical director with the cooperation of the supervising hospital.
   9. (I) A listing of medications and special onboard life support equipment to be carried on board each vehicle as approved by the medical director.
   10. (J) All scheduled medications shall be stored in a locked container within a locked compartment. Medications storage shall be approved in writing by medical director or issuing pharmacy.

   11. (K) Letter of approval from the supervising hospital stating acceptance of the:

       1. (i) emergency medical technician-intermediates;
       2. (ii) compatibility of the UHF communications with the emergency medical technician-intermediate provider organization's vehicles; and
       3. (iii) agreement to fulfill the responsibilities of the supervising hospital.
   12. (L) Certification required in section 1(d) of this rule.
   13. (M) Other information as required by the agency.

(b) Emergency medical technician-intermediate provider organizations that do not also provide transportation of emergency patients shall submit and maintain a copy of a current written agreement between the nontransporting emergency medical technician-intermediate provider organization and an ambulance service provider organization certified under IC 16-31. The agreement shall:

1. (1) ensure that the nontransporting emergency medical technician-intermediate provider organization can be assured that patients treated shall be transported in a timely and safe manner; and
2. (2) not preclude another ambulance service provider organization, if available, from transporting the patients.

(c) Upon approval, an emergency medical technician-intermediate provider organization shall be issued certification for the provisions of advanced life support certification.

(d) The certificate:

1. (1) expires on the date appearing in the expiration date section of the certificate; and
2. (2) shall be prominently displayed at the place of business.

(e) An application for an emergency medical technician-intermediate provider organization certification renewal shall be made at least sixty (60) days before the expiration date of the current certification. Application for renewal shall:

1. (1) be made on forms provided by the agency; and
2. (2) show evidence of compliance with the requirements as set forth for original certification.

(Indiana Emergency Medical Services Commission; 836 IAC 2-7.2-2; filed Feb 20, 2003, 8:00 a.m.: 26 IR 2355; filed Jun 11, 2004, 1:30 p.m.: 27 IR 3544; 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)