All applications for certification as an air ambulance shall contain the following:

1. A. service name;
2. B. ownership structure: sole proprietor, partnership, corporation, etc.;
3. C. service mailing address;
4. D. physical location of facilities: use additional sheets as necessary;

5. E. communications;

   (1) business telephone;

   (2) facsimile number;

   (3) dispatch center telephone;

   (4) emergency point of contact;

   (5) operations telephone;

   (6) cellular telephone;

   (7) pager number;

6. F. communications center: physical location of the communications center;

7. G. medical service management personnel:

   (1) program administrator: name, telephone, facsimile, and other contact information as applicable;

   (2) medical director: name, license number, telephone, facsimile, and other contact information as applicable;

   (3) clinical care supervisor: name, telephone, facsimile, and other contact information as applicable;

8. H. hours of operations: 24 hour, 7 days a week, other (please explain);

9. I. type of air ambulance certificate requested:

   (1) fixed wing only;

   (2) rotor wing only;

   (3) combination service;

10. J. level of service requested:

    (1) advanced life support;

    (2) critical care;

    (3) specialty care;

11. K. service affiliation:

    (1) private or government service;

    (2) hospital, police, independent, or municipal;

12. L. aircraft certificate holder:

    (1) service name;

    (2) contact person;

    (3) address;

    (4) business telephone;

    (5) facsimile;

    (6) certificate number;

13. M. type of aircraft: for fixed and rotor wing, the following information is required:

    (1) make of aircraft(s);

    (2) model of aircraft(s);

    (3) tail number(s);

14. N. level of staffing: For both fixed and rotor wing, please attach a copy of your staffing plan to include the following:

    (1) EMS personnel: EMT-P and the number of each;

    (2) nursing personnel: number and type;

    (3) physician(s): number and type;

    (4) other personnel: number and type;

15. O. emergency information: emergency contact information shall be provided for the service director, clinical care supervisor, medical director, and dispatch agency;

16. P. all applicants shall meet the CAMTS accreditation standards for the level of service of the air ambulance service; some CAMTS accreditation standards may be waived by the bureau for initial certification since new start-up air ambulance services cannot achieve CAMTS accreditation without being in service for a period of time; some CAMTS accreditation standards have exceptions that are listed in 7.27.5.16 NMAC; in general the initial application for air ambulance certification shall include the following:

    Standards Reference Number Medical Section Capabilities and Resources of the Medical Transport Service and receiving hospitals 01.00.00 Medical Personnel 02.00.00 Medical Director 02.01.00 Medical Control Physician 02.02.00 Clinical Care Supervisor 02.03.00 Staffing 02.04.00 Mission Types 02.05.00 Training and Continuing Education 02.06.00 Aircraft/Ambulance Section Medical Configuration 03.00.00 Operational Issues 04.00.00 Aircraft/Ambulance Equipment 05.00.00 Communications 06.00.00 Management and Administrative Responsibilities Management Policies 07.00.00 Utilization Review 07.01.08 Quality Management 08.00.00 Infection Control 09.00.00 Rotor Wing Standards Certificate of the Aircraft Operator 10.00.00 Weather and Weather Minimums 11.00.00 Pilot Personnel 12.00.00 Maintenance 13.00.00 Helipad 14.00.00 Refueling 15.00.00 Community Outreach 16.00.00 Fixed Wing Standards Certificate of the Aircraft Operator 17.00.00 Aircraft 18.00.00 Weather 19.00.00 Pilot Personnel 20.00.00 Policies 21.00.00 Maintenance 22.00.00 Refueling 26.00.00 Community Outreach 27.00.00 Ground Inter-facility Standards: Not Applicable. N/A Addendums Addendum A - Rationale for Change - Critical Care Alternative Addendum B - Education Matrix ALS-BLS Ground Standards: Not Applicable N/A Medical Escort Standards: Not Applicable N/A

    Standards

    Reference Number

    Medical Section

    Capabilities and Resources of the Medical Transport Service and receiving hospitals

    01.00.00

    Medical Personnel

    02.00.00

    Medical Director

    02.01.00

    Medical Control Physician

    02.02.00

    Clinical Care Supervisor

    02.03.00

    Staffing

    02.04.00

    Mission Types

    02.05.00

    Training and Continuing Education

    02.06.00

    Aircraft/Ambulance Section

    Medical Configuration

    03.00.00

    Operational Issues

    04.00.00

    Aircraft/Ambulance Equipment

    05.00.00

    Communications

    06.00.00

    Management and Administrative Responsibilities

    Management Policies

    07.00.00

    Utilization Review

    07.01.08

    Quality Management

    08.00.00

    Infection Control

    09.00.00

    Rotor Wing Standards

    Certificate of the Aircraft Operator

    10.00.00

    Weather and Weather Minimums

    11.00.00

    Pilot Personnel

    12.00.00

    Maintenance

    13.00.00

    Helipad

    14.00.00

    Refueling

    15.00.00

    Community Outreach

    16.00.00

    Fixed Wing Standards

    Certificate of the Aircraft Operator

    17.00.00

    Aircraft

    18.00.00

    Weather

    19.00.00

    Pilot Personnel

    20.00.00

    Policies

    21.00.00

    Maintenance

    22.00.00

    Refueling

    26.00.00

    Community Outreach

    27.00.00

    Ground Inter-facility Standards: Not Applicable.

    N/A

    Addendums

    Addendum A - Rationale for Change - Critical Care Alternative

    Addendum B - Education Matrix

    ALS-BLS Ground Standards: Not Applicable

    N/A

    Medical Escort Standards: Not Applicable

    N/A

[7.27.5.19 NMAC - Rp, 7.27.5.19 NMAC, 01/01/06]