16 DEPARTMENT OF PUBLIC SAFETY

163 BUREAU OF EMERGENCY MEDICAL SERVICES (MAINE EMS)

CHAPTER 3: GROUND AMBULANCE SERVICE AND NON-TRANSPORTING

1. SERVICE LICENSES

1. No ground ambulance service or non-transporting service shall operate unless it is duly licensed by the Board under these Rules.
2. License Factors - A ground ambulance service license or a non-transporting service license is issued for a specific:
   1. Service Type - which may be:
      1. A Non-Transporting Service; or
      2. A Ground Ambulance Service
   2. License Level - which may be:
      1. Emergency Medical Responder (EMR) - (only if the service is licensing as a Non-Transporting Service type); or
      2. Emergency Medical Technician (EMT); or
      3. Advanced EMT (AEMT); or
      4. Paramedic
   3. Permit Level – which may be:
      1. Emergency Medical Technician (EMT) (only if a service is licensing as a Non-Transporting Service type); or
      2. Advanced Emergency Medical Technician (AEMT); or
      3. Paramedic
   4. Ownership
      1. Upon request of the Board, an applicant for, or licensee of, a ground ambulance service or non-transporting service license must provide the Board with the identity and legal status (e.g., municipality, corporation, limited liability company, sole proprietorship) of the person or entity that holds or is making application for the license. Failure to provide this information may result in an application being treated as incomplete
   5. 9-1-1 Primary Response Area
      1. A service receiving a request to respond to an emergency medical call outside of its 9-1-1 Primary Response Area shall coordinate with that 9-1-1 Primary Response Area’s ground ambulance service to ensure the most appropriate response based on patient status.
      2. A 9-1-1 Primary Response Area does not include the area to which the service may be made available for interfacility transfer operations.
      3. A 9-1-1 Primary Response Area as determined by this section shall not be construed as prohibiting a service from responding to a request from another licensed service authorized in that 9-1-1 Primary Response Area.
   6. Notwithstanding paragraph(s) one (1) through four (4) above, an applicant for a ground ambulance service may be issued a license without a 9-1-1 Primary Response Area to perform interfacility transfer operations. A service is not required to list a 9-1-1 Primary Response Area to receive licensure. A service without a 9-1-1 Primary Response Area may not provide primary response to a scene location for an emergency medical call unless in the presence of extraordinary circumstances and that service meets the provision of this chapter, §2(5)(A).
   7. Base Location.
      1. A service must be separately licensed for each base location from which it operates, except that a service may apply for a single license to operate from multiple locations provided it has a Service-Level Medical Director and a single Quality Assurance / Quality Improvement program that is approved by the Board and the State Medical Director.
3. Change in License Factors.
   1. A service must apply for and receive a new license in order to change one or more licensing factors. However, a service may apply for a new permit level, or the removal of a 9-1-1 Primary Response Area, on a renewal application form.
4. Approval of License.
   1. Once a service's application for a new or renewed license has been accepted as complete by Maine EMS, Maine EMS shall grant, deny, or conditionally grant the license within seventy days.
   2. The Board shall issue a license with a defined 9-1-1 Primary Response Area when a need is demonstrated based on the following criteria:
      1. The Board finds the applicant’s proposed response time(s), enroute time(s), transport time(s), and time-tolerance(s) are sufficient to protect the health, welfare, and safety of the public within the 9-1-1 Primary Response Area based on evidence provided;
      2. If the 9-1-1 Primary Response Area is currently served by a licensed ground ambulance or non-transporting service, the proposed times above are maintained or improved;
      3. Public comment(s) received;
      4. Discipline undertaken by the Board and any Letters of Guidance that have not expired for the ambulance service currently serving the 9-1-1 Primary Response Area, and the service applying to serve the 9-1-1 Primary Response Area;
      5. An evaluation of the potential impact upon existing ground ambulance and non-transporting services; and,
      6. The character of the ownership of a proposed service.
   3. The Board’s decision constitutes final agency action, appealable to the Superior Court in accordance with the Maine Administrative Procedure Act, 5 M.R.S. Ch. 375 Subchapter VII.
5. Licensing Standards
   1. An application will not be accepted as complete unless it includes all materials required to be evaluated for licensure. To obtain a new license, a service applicant must:
      1. Apply on forms available from Maine EMS.
      2. Submit a fee of $100.00
      3. Demonstrate to Maine EMS that:
         1. The applicant has placed a notice, approved by Maine EMS, in the most widely circulated newspaper(s) serving the proposed 9-1-1 Primary Response Area, unless the applicant is applying for licensure without a 9-1-1 Primary Response Area for interfacility transport operations only. The notice must state:
            1. The name and legal status of the entity making application;
            2. The name of the proposed service;
            3. The type of service proposed;
            4. The proposed license level to be provided;
            5. The name(s) of the geopolitical subdivision(s) within the proposed 9-1-1 Primary Response Area;
            6. That the public is invited to make comment to Maine EMS regarding the proposed application, and that comments must be received by Maine EMS within 30 calendar days after the date of the notice's publication; and,
            7. The current mailing address of the Maine EMS office.
         2. The applicant possesses the equipment required by these Rules for the type of service and license level proposed.
         3. The applicant can provide personnel required by these Rules for the type of service and license level proposed.
         4. The applicant, if applying for a license that includes a 9-1-1 Primary Response Area, has made adequate arrangements for full-time dispatch.
         5. The applicant possesses two-way radio communications equipment and frequencies for the proposed type of service, including, but not limited to the hospital-ambulance frequencies utilized in the service area(s) pursuant to these Rules and the designated Maine EMS statewide frequency "155.385."
         6. If the application is for a new service or a change of service ownership: the applicant, if an individual is of good character, and if a partnership or corporation, its partners or principal officers are of good character. Four character references, written within the past year, must be submitted as a condition of meeting this requirement; none may be from a relative or employee of the applicant.
         7. If the application is for a non-transporting service, the non-transporting service has either;
            1. Entered into written agreements with the ambulance services which will transport its patients, guaranteeing continuity of care for the patient and simultaneous dispatch of the non-transporting and ambulance services; or,
            2. Otherwise addresses these concerns in a plan as approved by Maine EMS which includes as a component a written agreement of this nature with at least one (1) ambulance service.
            3. An ambulance service is not required to approve of or enter into a written agreement with a non-transporting EMS service.
            4. A service licensed without a 9-1-1 Primary Response Area may not serve as the ambulance service transporting a non-transporting EMS service’s patients.
         8. The applicant has established a service level Quality Assurance/Quality Improvement Committee (for approval under 32 M.R.S. §92-A) or has identified a Board-approved Quality Assurance/Quality Improvement committee in which the service will participate, and has submitted a quality assurance plan that is subject to Maine EMS approval.
         9. The applicant meets the quality assurance/quality improvement requirements of Chapter 18 of these Rules.
         10. The applicant has designated a service director, who shall act as the point of contact for the service.
         11. The applicant has designated a person whose serves as the training and education point of contact for the service.
         12. The applicant has identified the designated infection control officer for the proposed service. Pursuant to 42 U.S.C. §300ff-136, each employer of emergency response employees in the State of Maine must have a designated infection control officer (ICO) for the purposes of receiving notifications and responses and making requests under 42 U.S.C. Chapter 6A, Subchapter XXIV, Part G. The licensee shall provide the ICO name and contact information to Maine Emergency Medical Services, and promptly notify Maine EMS of any changes in ICO during the term of its license. Maine EMS will provide this information to the Department of Health and Human Services, Maine Center for Disease Control, Division of Infectious Disease.
         13. The applicant, if applying for a license or permit to the Advanced EMT (AEMT) or Paramedic levels, has a service-specific medical director.
         14. If the applicant lists a service-level medical director, the application must include a medical director agreement.
         15. The applicant has in the case of a proposed service requesting a license or permit to administer drugs/medications entered into a written contract with a single hospital which has a pharmacy, several hospitals with either individual or central supply points, or some other source approved by the Board which will provide a system of control and accountability of drugs/medications pursuant to these Rules.
         16. If the applicant intends to provide Paramedic Inter--Facility Transfers (PIFT), a separate application must be submitted to and approved by Maine EMS before the service performs such transfers. Personnel providing PIFT treatment on behalf of the service must successfully complete a Maine EMS-approved PIFT course prior to performing such treatment.
         17. The applicant has submitted a safety program that addresses its patients, personnel, and the general public during operations.
      4. If applying for licensure with a 9-1-1 Primary Response Area, the applicant must define their proposed en-route time(s), response time(s), transport time(s), and time tolerance(s) for each geopolitical subdivision(s) in the proposed service area, based on and including the following;
         1. Population count within the proposed service area;
         2. Square miles within the proposed service area;
         3. Availability of ambulance and crew;
         4. Number of anticipated requests for each type and level of ground ambulance transport service in the proposed service area;
         5. Available routes of travel within the proposed service area;
         6. Dispatch agreement/response plan, including details about the level of response;
         7. Geographic features and environmental conditions within the proposed service area; and,
         8. Healthcare entities within the proposed service area and Healthcare Receiving Facilities that will likely receive transports from the proposed service area.
      5. If the 9-1-1 Primary Response Area is currently served by a licensed ground ambulance service AND:
         1. The current ground ambulance service is voluntarily relinquishing that 9-1-1 Primary Response Area, the applicant must provide a signed and notarized letter from the service director of the ground ambulance service currently licensed for that 9-1-1 Primary Response Area indicating their intent to relinquish that area; OR,
         2. If the current ground ambulance service is NOT voluntarily relinquishing that 9-1-1 Primary Response Area, the applicant must provide:
            1. A signed and notarized letter from the geopolitical subdivision(s) within a pre-existing 9-1-1 Primary Response Area who are seeking to replace the authorized ground ambulance service; and,
            2. A Consultancy Report.

The applicant must provide a report from a third-party, disinterested consultant, with experience evaluating the efficiency and delivery of emergency medical services that:

Indicates changing ground ambulance services is in the best interest of the residents of the geopolitical subdivision(s);

Acknowledges and defends that the change(s) will maintain and/or improve patient care quality;

Acknowledges and defends that the change(s) will improve system efficiencies and use of resources; and,

Acknowledges and defends that the change(s) maintain and/or enhance response efficiencies.

The above report must be dated within sixty (60) business days of the application’s acceptance by Maine EMS as complete.

1. 1. A service license is issued for a period of up to 12 months, with a November 30 expiration.
   2. Notwithstanding the notice requirements of §5(1)(C)(1), Maine EMS may issue a temporary service license for up to 60 days to an applicant if Maine EMS determines that issuance of the temporary license will avert the disruption of emergency medical services in the 9-1-1 Primary Response Area(s) listed in the applicant’s application.

1. Renewal of Service License
   1. A licensee shall submit an application for renewal prior to the expiration date of the license.
      1. An application will not be accepted as complete unless it includes all materials required to be evaluated for licensure.
         1. The application shall not require a service applying for licensure renewal to comply with this chapter §4(2) and §5(1)(D).
      2. A service may apply for a renewal license for up to ninety (90) days after the date of expiration. The ninety-day period does not postpone the expiration date of the license. A service with an expired license cannot act as an ambulance or non-transporting service until a renewed license has been issued. An application submitted more than 90 days after the license expiration date shall be considered an application for a new license and subject to all requirements governing new applications.
      3. In order to obtain a license renewal, a service must:
         1. Apply on forms available from Maine EMS.
         2. Submit a fee of $100.00.
         3. If the applicant intends to provide Paramedic Inter-Facility Transfers (PIFT), a separate application must be submitted to and approved by Maine EMS before the service performs such transfers. Personnel providing PIFT treatment on behalf of the service must successfully complete a Maine EMS-approved PIFT course prior to performing such treatment.
      4. Demonstrate, as may be required by Maine EMS, that it meets the licensure requirements called for in these Rules.
2. Personnel Requirements for Ground Ambulance Service or Non-Transporting Service Licensees
   1. A ground ambulance service or non-transporting service will be licensed at the level at which it agrees to provide, on all emergency medical calls, at least one emergency medical services person who is licensed and able to provide care at or above the service license level, except:
      1. When the service’s response is in accordance with a Maine EMS-approved Response Assignment Plan.
   2. The phrase “able to provide care” means that the EMS person who is licensed at or above the service license level must be in the ambulance. If the higher-level EMS person is in the ambulance, he or she is able to render care. The higher-level EMS person must assess the patient prior to transport and determine that the lower-level EMS person can appropriately provide care during transport. In addition, the higher-level EMS person who is driving the vehicle needs to have the ability to communicate constantly with the lower-level EMS person who is caring for the patient. If the patient’s needs change, the higher-level EMS person must switch roles with the lower-level EMS person.
   3. A ground ambulance service or non-transporting service must notify Maine EMS of the addition of any licensed EMS person to its roster of responding personnel prior to that person responding on behalf of the service and must report the termination or resignation of any EMS provider from its service within 5 days of the termination or resignation of the provider. Notification to Maine EMS may be made electronically or by mail.
   4. A ground ambulance service or non-transporting service may obtain Maine EMS permission to provide on some calls, based on personnel availability, a higher level of care than that for which it is licensed. In order to obtain this permission, a service must:
      1. Apply on forms available from Maine EMS
      2. Submit a fee of $100. This fee is waived if the service is simultaneously applying for this permission and for a service license and is submitting the fee required for licensure.
      3. Show that it can satisfy the requirements of these Rules (except that for numbers of personnel, the applicant must demonstrate that at least one Maine EMS licensed provider, licensed at the permit application level being sought, is affiliated with the applicant service).
      4. Renew its permission request when it applies for license renewal, demonstrating to Maine EMS that it continues to satisfy the requirements set forth in these Rules.
      5. Apply for new permission to provide a higher level of care by notifying Maine EMS.
   5. A ground ambulance service or non-transporting service shall not advertise (in newspapers, telephone directories, on television or commercial radio, on billboards or vehicles, or by other means of public promotion) themselves as providing a level of care other than that at which they are licensed under this section. A board permit to provide a higher level of care is not a license for advertising purposes. The Board may prohibit advertising language from any medium listed above if it deems such language to be potentially deceptive or confusing to the public with regard to the services offered.
   6. A ground ambulance service or non-transporting service shall not allow persons less than 18 years of age to participate in medical response operations or medical response observation, except when Maine EMS has approved the service’s supervision plan for such persons and in accordance with Maine Department of Labor rules governing employment for minors.
   7. A ground ambulance service or non-transporting service must establish a written driver training program and/or standard operating procedure(s) for the operation of Ambulances and Emergency Medical Service Vehicles licensed by Maine EMS, that at a minimum includes the following:
      1. Use of Seatbelts
      2. Emergency Vehicle Response to:
         1. Emergency Medical Call(s); and,
         2. Non-Emergency Medical Call(s)
      3. Operator Requirements for Program Participation:
         1. Must hold a valid state driver’s license
      4. Initial Training:
         1. Initial training must consist of the following, and the Operator is not permitted to operate independently during patient transport and/or in emergent mode until the requirements of this section have been met:
            1. The Operator has completed a review of all applicable sections of 29-A M.R.S;
            2. Completion of on-road driving skills with a service’s designee, to include:

Emergent mode; and,

Non-emergent mode.

1. 1. 1. 1. 1. An evaluation of the Operator’s proficiency, knowledge, and proper operation of the specific vehicle(s) and equipment;

A satisfactory evaluation must be achieved by the Operator to meet this requirement

1. 1. 1. 1. 1. Successful completion of an Ambulance Vehicle Operator Course, or a course that has been approved by the Board as an equivalent, according to 32 M.R.S. §86(6).
      1. Service Administrator Review
         1. The Service Director or designee must review all Operator’s motor vehicle driving history on an annual basis.
      2. Record Keeping
         1. Services will maintain a record of such training and will make it available to Maine EMS upon request.
      3. §7(7) of this chapter is effective six (6) months after publication of this amended rule by the Secretary of State’s Office.

1. Availability for Emergency Response
   1. Any ground ambulance service offering response to emergency medical calls in the service’s 9-1-1 Primary Response Area must be available twenty-four hours a day, every day, with full-time dispatch capability, and written mutual aid arrangements as necessary, and must also provide a detailed plan to its primary dispatch agency indicating its mutual aid agencies and the order of contact of those mutual aid agencies.
      1. Failure of a ground ambulance service to comply with these emergency response requirements will be reviewed by Maine EMS to determine if corrective action is required. Maine EMS shall notify the service of any required corrective action and shall set a reasonable amount of time for the service to carry out this action.
   2. A non-transporting service providing response to emergency medical calls must submit with its initial license application a letter of understanding if the service’s hours of availability will be other than twenty-four hours a day, every day. This letter of understanding must be approved by Maine EMS and signed by an authorized representative of the non-transporting service, and an authorized representative of the transporting service. Changes to the letter of understanding may be accomplished by written agreement of the aforementioned parties.
   3. Non-transporting services must have a full-time dispatch capability, written mutual aid arrangements as necessary and assure an annual average response time during their hours of availability of twenty minutes or less from the "call for emergency medical assistance" to "arrival at scene" and shall not deny treatment resulting from an emergency medical call if treatment is indicated.
2. Patient Care Report
   1. For each request for service, or for each patient when more than one patient is involved in a call, a service must complete and submit an electronic Maine EMS patient care report, as specified by Maine EMS, within twenty-four hours.
3. Pilot Projects
   1. For the purpose of evaluating the workability and appropriateness of incorporating a particular emergency medical treatment technique or a type of equipment into any licensure level, the Board may elect to exempt a service from the requirements of the relevant licensure level so as to permit the service to utilize the designated techniques or equipment on an experimental basis. Such authorizations may be continued at the discretion of the Board. Such authorizations should not be construed as levels of licensure.
4. Vehicles – General
   1. Except as otherwise exempted by 32 M.R.S. §82, no vehicle shall be operated as an ambulance (from within Maine) or emergency medical services vehicle unless it is licensed or authorized in accordance with these Rules.
   2. A vehicle license or authorization is valid for a period of one year, starting from the month the service license is issued.
      1. Maine EMS will prorate the vehicle licensing fee for a service licensing a new vehicle within its one-year service license period to ensure concurrent expiration dates for service and vehicle licenses.
   3. A vehicle license or authorization is issued to a particular service and for a particular vehicle, except as permitted in Chapter 3 §12 of these Rules. If a service is required to relicense under Chapter 3 §2 because of a change of ownership, then all of the service’s vehicle licenses and authorizations end, and the service must apply for new vehicle licenses and/or authorizations. The fee for licensing a vehicle is $60.00.
   4. When a service acquires a new or used vehicle under Chapter 3 §12 of these Rules, it shall apply to Maine EMS on forms available from Maine EMS and shall pay the applicable vehicle licensing fee. Within 45 days, Maine EMS shall issue, or decline to issue, a license for the vehicle.
   5. Vehicles licensed under this chapter must:
      1. Display the name of the service operating the vehicle on the left (driver) and right (passenger) side of the vehicle in letters no less than 6 inches high or display a logo that adequately identifies the service. Vehicles temporarily transferred to a service under the provision of Chapter 3 §12 are exempt from this requirement
      2. Be exclusively leased or owned and operated by a service licensed by Maine EMS or by an agency designated by Maine EMS.
   6. Upon request by Maine EMS, a service shall make its licensed and/or authorized vehicle(s) available for inspection to ensure that each vehicle is safe, clean, and otherwise in conformity with these Rules. If a licensed or authorized vehicle does not pass inspection and its continued operation presents a hazard to health or safety, the Board may suspend its license to provide emergency medical services at once consistent with Maine Law (See 5 M.R.S. §10004 and 4 M.R.S. §184). Alternatively, if the continued operation of the licensed and/or authorized vehicle at the level which the service is permitted pursuant to Chapter 3 §7(3) of these rules presents a hazard to health or safety, the Board may immediately suspend the service’s permit consistent with Maine Law (see 5 M.R.S. §10004 and 4 M.R.S §184) and allow the service to operate at the next lowest level for which it is properly equipped. If the deficiencies are not such as to require the vehicle’s immediate removal from service or the immediate suspension of the service’s permit, then Maine EMS shall notify the service of the deficiencies and set a reasonable amount of time in which the service may continue to provide emergency medical services while bringing it into conformity with the law and Rules. If the licensed and/or authorized vehicle is not brought into conformity within the time set, Maine EMS may refuse to renew, or seek revocation of, the licensed and/or authorized vehicle’s license to provide emergency medical services.
5. Ground Vehicles – Licensing and Authorization Requirements
   1. Ground Ambulance Vehicles
      1. If control of a ground ambulance vehicle passes from one ambulance service to another, or from an ambulance manufacturer or its representative to an ambulance service, through any means, the ground ambulance vehicle must be licensed to the recipient service prior to the recipient service’s operation of that vehicle as an ambulance. If temporary control of a licensed ground ambulance vehicle, which is owned by a licensed service, is passed to another ambulance service, the ground ambulance vehicle transferred under this subsection will be considered licensed pursuant to these Rules.
      2. Emergency Medical Services Vehicles
         1. Any vehicle operated by a licensed service that is not already licensed as a fire department vehicle or ambulance, may be authorized by Maine EMS as an emergency medical services vehicle, consistent with 29-A M.R.S. §2054 provided that vehicle:
            1. Is operated in emergency response mode on public ways solely for the purpose of carrying personnel and equipment to the scene of an emergency medical call.
            2. Meets Maine’s periodic motor vehicle inspection requirements.
            3. Is operated in accordance with all applicable Maine Laws, including, but not limited to Title 29-A.
            4. Is made available for inspection when requested by Maine EMS in order to ensure conformity with the Rules.
            5. Displays the name of the service operating the vehicle on the left (driver) and right (passenger) side of the vehicle in letters no less than 6 inches high or displays a logo that adequately identifies the service. Vehicles temporarily transferred to a service are exempt from this requirement.
            6. Is exclusively leased or owned and operated by a service licensed by Maine EMS or by an agency designated by Maine EMS.
6. Ground Ambulance Design Requirements
   1. A ground ambulance vehicle must meet the following standards to be licensed:
      1. Federal/state safety requirements. It must meet the applicable federal and Maine safety requirements including the State's periodic motor vehicle inspection requirements listed in the current edition of the Maine State Police Motor Vehicle Inspections Manual.
      2. Interior size. It must meet the chassis manufacturer's specifications and must have a minimum inside height of 60 inches at the center of the patient compartment, a minimum width of 48 inches at the center of the patient compartment, a walkway parallel to the length of the primary cot adequate to allow an attendant to walk from head to foot of the cot; and a minimum inside patient compartment length of 122 inches at the cot level.
      3. Interior storage accommodations. The interior of the patient compartment must provide adequate stowage space for medical supplies, devices, and installed systems. For purposes of this paragraph, "stowage" is defined as the storing, packing, or arranging of ambulance contents in a secure manner so as to protect the contents from damage and the personnel from injury. Interior compartment doors, latches and operating mechanisms must operate in accordance with the manufacturer's design.
      4. Seat belts. Seat belts shall be provided in all permanent seat positions in the vehicle, including the squad bench. For purposes of this paragraph, "squad bench" is defined as a permanent, non-removable seat that is located in the patient compartment and which can serve as a seat for crew members or as a surface on which a patient may lie down.
      5. Patient restraint. The ambulance must be equipped with a multilevel patient stretcher designed for ambulances, mounted in, and detachable from the vehicle. The head of the stretcher must elevate. At least three strap-type restraining devices (chest, hip, lower extremity), not less than 2 inches wide, shall be provided for each stretcher, cot, or litter. Additionally, the head of the cot shall be furnished with upper torso (over the shoulder) restraints designed to prevent motion of the patient during severe braking or in an accident. Restraining straps shall incorporate metal-to-metal quick release buckles. The use of all lateral and shoulder straps is required while transporting a patient.
      6. Stretcher fasteners.  The installed stretcher fastener device(s) for wheeled stretchers shall meet the performance requirements of the following two standards, which this rule incorporates by reference:
         1. Ambulance Litter Integrity, Retention, and Patient Restraint Fasteners, (J3027), July 14, 2014, edition, which is available at cost from SAE International, 400 Commonwealth Drive, Warrendale, PA 15096; or,
         2. Chapter 6 (6.22) “Patient Cot Retention” of Standard for Automotive Ambulances (NFPA 1917), 2019 edition, published May 24, 2018, which is available at cost from the National Fire Protection Association, 1 Batterymarch Park, Quincy, MA.
         3. Provision shall be made for the required portable stretchers to be secured in safe positions for transport. Stretcher fasteners must be installed according to the stretcher fastener manufacturer’s directions. All ambulances licensed after July 1, 2030 will need to meet these requirements.
      7. Patient compartment environmental equipment. The patient compartment shall be adequately heated, air-conditioned, and ventilated to provide for patient comfort.
      8. Communications equipment shall be adequate to allow the vehicle to contact on the regional radio frequency the hospitals to which it regularly takes patients. The ambulance shall also be able to maintain two-way communications contact with a full-time dispatching facility. All vehicles licensed or authorized by Maine EMS shall be capable of communications utilizing the designated Maine EMS statewide frequency, 155.385
      9. Attendants/driver communication. The driver and the attendants, in their working positions, must be able to speak to one another.
      10. Warning devices. All ambulances shall be equipped with a functional siren and with functional emergency warning lights, rotating, or flashing, visible from 360 degrees at all times. Colors of ambulance lights are fixed by 29-A M.R.S. §2054.
      11. Patient compartment illumination. Normal white illumination shall be provided in the patient area so as to provide a minimum of 35-foot candles of illumination measured on at least 90 percent of the cot's surface area.
      12. Name of service. Ground vehicles must display the name of the service licensing the vehicle on the left (driver) and right (passenger) side of the vehicle in letters no less than 6 inches high or display a logo that adequately identifies the service. Vehicles temporarily transferred to a service under the provision of Chapter 3 §12 are exempt from this requirement.
      13. Main oxygen supply. The ambulance shall have a hospital type piped medical oxygen system capable of storing and supplying a minimum of 3,000 liters ("M" size tank). The oxygen pressure regulator must be a medical oxygen pressure reducing and regulator valve with an inlet filter at the cylinder and shall have a line relief valve set at 1378 kPa (200 psi) maximum, and a gauge range of 0 to 17225 kPa (0 to 2500 psi). The flow meter must be a pressure compensated type.
      14. Suction aspirator permanently mounted. The ambulance vehicle shall have an electrically or (engine) vacuum-powered suction unit capable of providing a free air flow of at least 20 L.P.M. and achieving a minimum of 300 mm Hg within 4 seconds after the suction tube is closed.
      15. Exterior compartments and doors. Exterior compartments, exterior compartment doors and exterior patient/passenger doors must be equipped with latches, gaskets and operating mechanisms which operate in accordance with the manufacturer's design.
   2. All ambulances newly manufactured after July 1, 2021, must at a minimum comply with one of the following standards, which this rule incorporates by reference:
      1. National Fire Protection Agency (NFPA) NFPA 1917 (2019)
         1. Standard for Automotive Ambulances (NFPA 1917), 2019 edition, published May 24, 2018, which is available at cost from the National Fire Protection Association, 1 Batterymarch Park, Quincy, MA.
      2. Federal Specification for Star-Of-Life Ambulances (KKK-A-1822F through Change notices 13) July 2020
         1. Federal Specifications for Star-Of-Life Ambulances (KKK-A-1822F (August 2007) with change notices; #8 July 2015, #9 July 2016, #10 July 2017, #11 July 2018, #12 July 2019, & #13 July 2020), which is available at cost from the Office of Motor Vehicle Management, Vehicle Publishing Division
      3. Commission on Accreditation of Ambulance Services, Ground Vehicle Standards 2.0 (July 1, 2019)
         1. Commission on Accreditation of Ambulance Services, Ground Vehicle Standards 2.0 (July 1, 2019) is available at cost from Commission on Accreditation of Ambulance Services
            1926 Waukegan Road – Suite 300, Glenview, IL 60025.
7. Ground Ambulance Vehicle Equipment Requirements
   1. A ground ambulance service must possess, at a minimum, the equipment listed in Chapter 17 of these Rules, for the type of service and license level. A ground ambulance service must maintain a system to ensure the availability of this equipment on any call.
   2. Upon request of Maine EMS, a ground ambulance service shall make its equipment available for inspection in order to ensure conformity with the Rules.
8. Vehicle Operation
   1. A licensed ground ambulance vehicle or authorized emergency medical services vehicle shall operate in a non-emergency response mode to a location to which the ambulance or emergency medical services vehicle has been dispatched except when:
      1. Dispatch or responding personnel do not have adequate information to determine the existence or condition of persons at a scene who may require emergency medical treatment; or,
      2. The ambulance or emergency medical services vehicle is responding in accordance with a Maine-EMS-approved Response Assignment Plan.
   2. A licensed ambulance shall operate in a non-emergency response mode from the scene of a call to a hospital or during the transfer of a patient from a hospital or healthcare facility to another place unless the EMS provider responsible for the care of the patient determines that a threat to the patient’s life or limb exists and necessitates emergency response mode.
9. Non-Transporting Service Requirements
   1. A non-transporting service must possess, at a minimum, the equipment listed in Chapter 17 of these Rules and must maintain a system to ensure the availability of this equipment on any call.
      1. All medical equipment and medical supplies required must be latex free.
      2. The Emergency Medical Responder (EMR) set of equipment is the minimum set of required equipment for a non-transporting service.
      3. If a non-transporting service is licensed at the Emergency Medical Technician (EMT), Advanced EMT or Paramedic level, that service, while responding on an emergency medical call will be equipped on those calls with the equipment and supplies required by these Rules.
      4. If the service is permitted to a given level, it must possess at least one set of equipment and supplies required for that level pursuant to these Rules.
   2. Upon request of Maine EMS, a non-transporting service shall make its equipment available for inspection in order to ensure conformity with the Rules.
10. Termination of Service Licensure
    1. Any ground ambulance service or non-transporting service intending to terminate its license must make written notification to Maine EMS at least 30 days prior to the service termination date. The service shall notify the public at least 30 days prior to the service termination date by placing an advertisement in the most widely circulated newspaper(s) serving the 9-1-1 Primary Response Area. The notice must state:
       1. The name of the service;
       2. The date of service termination; and,
       3. The names of the geopolitical subdivision(s) affected by the service’s termination.
11. Duty to Report
    1. A licensee or an applicant for licensure under this chapter shall notify the Board in writing within 10 days of a:
       1. Change of name or address;
       2. Criminal conviction;
       3. Revocation, suspension, or other disciplinary action taken in this or any other jurisdiction against any occupational or professional license held by the applicant or licensee; or,
       4. Material change in the conditions or qualifications set forth in the original application for licensure submitted to the Board.

AUTHORITY: 32 M.R.S., Chapter 2-B.

EFFECTIVE DATE: July 3, 1978 (EMERGENCY)

AMENDED: April 1, 1982

December 25, 1982 - Sec. 2.31, 3131, 6.311, 6.63 and 6.73

January 1, 1984 - Sec. 1, 2, 3, 5, 6, 8.32, 10.2, 10.3, 11.1066, 11.1067

April 30, 1985 - Sec. 1, 2.846.222, 6.332, 9.313, 8.3216 and 9.11

January 1, 1986 - Sec. 1, 6. 8.15, 8.2, 8.3, 8.4 and 11.103

September 1, 1986

August 25, 1987 - Sec. 5, 6.011 and 12 (added)

July 1, 1988

March 4, 1992

September 1, 1996

1. June 25, 2024 – filing 2024-147

EFFECTIVE DATE (ELECTRONIC CONVERSION):

July 1, 2000

REPEALED AND REPLACED:

July 1, 2000

July 1, 2003

October 1, 2009

May 1, 2013

January 10, 2021

APAO WORD VERSION CONVERSION (IF NEEDED) AND ACCESSIBILITY CHECK: July 18, 2025