All air ambulance service providers and crew members operating in Tennessee must comply with Chapter 140 of Title 68 of the Tennessee Code Annotated and this rule. Failure to comply shall subject the service provider and/or its personnel to disciplinary action pursuant to T.C.A. § 68-140-311.

1. (1) Definitions - As used in this rule, the following terms shall have the following meanings:

   1. (a) “Air Medical Communications Specialist” means any person employed by an air ambulance service coordinating acknowledgment of medical requests, medical destination, and medical communications during an air medical response and patient transfer.
   2. (b) “Medical Crew Member” means a registered nurse licensed or authorized to practice as a registered nurse in the State of Tennessee, a physician licensed under either Title 63, Chapter 6 or, Chapter 9, or a paramedic licensed or authorized to practice in the State of Tennessee employed by an air ambulance service for the purpose of providing care to patients transported by and receiving medical care from an air ambulance service.
   3. (c) “Special Medical Equipment” means any device which shall be approved by the air ambulance service medical director for the medical care of an individual patient on an air ambulance.
   4. (d) “Specialty Crew Member” means any person the service medical director assigns as a regular medical crew member for a specialty transport in addition to a medical crew member.
   5. (e) “Specialty Transport” means an air ambulance service assignment necessitating the medical director to substitute Specialty Crew Members and/or equipment to meet the specified needs of an individual patient.
   6. (f) “Utilization Review” means the critical evaluation of health care processes and services delivered to patients to ensure appropriate medical outcome, safety and cost effectiveness.

2. (2) Each air ambulance service provider shall maintain the required equipment, medications and supplies for air ambulance transport to provide emergency care and, where applicable, patient care during transport on each permitted aircraft. It is anticipated that changes in equipment, medications and supplies may be necessary and will, at a minimum, be reviewed annually. This rule hereby adopts the Air Ambulance Equipment, Medications and Supplies Specifications posted on the Office of Emergency Medical Service’s web page or any successor web page, as those specifications may from time to time be amended.

   1. (a) As used in this section, the following terms and abbreviations shall have the following meanings:

      1. 1. “Critical” or “(C)” means any equipment, medication or supplies critical for lifesaving patient care and which by its absence would jeopardize patient care.
      2. 2. “Specifications” refers to federal standards and performance requirements for equipment, medications and supplies recognized within the emergency medical services industry and adopted by the Board. The current “Air Ambulance Equipment, Medications and Supplies Specifications” can be found at https://www.tn.gov/health/health-program-areas/health-professional-boards/ems- board/ems-board/general-information.html.
   2. (b) In order to help ensure patient comfort and medical care as well as the safety of patients, crew members and ground personnel, each air ambulance the Board permits shall have an environmental control system with factory-installed or Federal Aviation Administration (“FAA”) approved add-on air conditioner and heater.
   3. (c) The air ambulance service shall have a written policy which addresses avoidance of adverse effects of temperature extremes on patients and personnel on board in the event of a non-functioning air conditioner when cabin temperatures are ninety-five (95) degrees Fahrenheit or greater or in the event of a non-functioning heater when the cabin temperature is fifty (50) degrees Fahrenheit or lower.
3. (3) Each air ambulance service shall offer its instruction materials to other EMS providers within its response area to familiarize other EMS providers with the air ambulance service’s requirements for control of helicopter access and ground to air communications on the scene.

4. (4) Air Ambulance Personnel Qualifications and Duties.

   1. (a) Medical director qualifications and duties.

      1. 1. Each air ambulance service shall designate a medical director who is responsible for providing medical direction for the air ambulance service.
      2. 2. The medical director for an air ambulance service must be a physician having each of the following qualifications:
   2. (i) Currently licensed in the State of Tennessee under either Title 63, Chapter 6 or Title 63, Chapter 9;
   3. (ii) Board certified or eligible for Board certification by a professional association or society in General or Trauma Surgery, Family Practice, Internal Medicine, Pediatrics, Emergency Medicine, or Emergency Medical Services;
   4. (iii) Certification in Advanced Cardiac Life Support (unless Board certified or eligible for Board certification in Emergency Medicine);
   5. (iv) Certification in Advanced Trauma Life Support;
   6. (v) Certification in Pediatric Advanced Life Support or equivalent (unless Board certified or eligible for Board certification in Emergency Medicine);
   7. (vi) Certification in a Neonatal Resuscitation Program; and

   8. (vii) Possess adequate knowledge regarding altitude physiology/stressors of flight.

      1. 3. Duties of the medical director for an air ambulance service shall include the following:
   9. (i) Active involvement in the Quality Improvement process;
   10. (ii) Active involvement in the hiring, training and continuing education of all medical personnel for the service; and

   11. (iii) Responsibility for on-line medical control or involved in orienting and collaborating with physicians providing on-line medical direction according to the policies, procedures and patient care protocols of the medical transport service.

       1. 4. The air ambulance service medical director shall establish patient care guidelines. The air ambulance service medical director shall require each medical crew member to complete and maintain documentation of initial and annual training in such procedures, which shall at least include didactic and hands-on components for the following clinical procedures:
   12. (i) Pharmacological Assisted Intubation - Adult and Pediatric;
   13. (ii) Emergency cricothyrotomy;
   14. (iii) Alternative airway management - Adult and Pediatric;
   15. (iv) Chest decompression; and
   16. (v) Intraosseous Access - Adult and Pediatric.

   17. (b) Medical crew staffing.

       1. 1. Each air ambulance transporting a patient from a scene response shall be staffed by two medical crew members.
       2. 2. An air ambulance transporting a patient from an interfacility response shall be staffed with either:
   18. (i) A registered nurse licensed or authorized to practice as a registered nurse in the State of Tennessee or a physician licensed under either Title 63, Chapter 6 or Title 63, Chapter 9, and an additional medical crew member; or

   19. (ii) Upon approval from the air ambulance service medical director in real- time, two paramedics licensed or authorized to practice in Tennessee.

       1. 3. The composition of the medical team may be altered for specialty transports upon an order of the air ambulance service medical director.
       2. 4. For a non-emergent, scheduled fixed-wing transport only, the service medical director may allow transport of patients in the presence of only one medical professional; the minimum level of licensure in such a situation would be that of a paramedic.
   20. (c) Medical crew members shall not be scheduled on an air ambulance more than twenty- four (24) consecutive hours. A medical crew member shift may be extended for up to twelve (12) additional hours in accordance with an air ambulance service duty extension hold-over policy that addresses fatigue. The air ambulance service shall provide the medical flight crew with adequate rest and mealtime during a shift when circumstances allow for rest and mealtime.
   21. (d) Personnel must have at least ten (10) hours of rest with no work-related interruptions prior to any scheduled shift of twelve (12) hours or more in the air transport environment.

   22. (e) Medical crew training and qualifications.

       1. 1. The air ambulance service medical director shall make a determination that each regular medical crew member serving on an air ambulance is physically fit for duty by ensuring the air ambulance service has documentation that each regular crew member has had a pre-employment and annual medical examination.
       2. 2. A Registered Nurse serving as a medical crew member on an air ambulance shall meet the following qualifications:
   23. (i) Have three years of registered nursing experience in critical care nursing in a critical care unit or an emergency department, or two years’ fulltime flight paramedic experience and one year critical care nursing experience in a critical care unit or an emergency department;
   24. (ii) Possess a current nursing license issued by either the Tennessee Board of Nursing or the home state of the registered nurse which grants a multi- state privilege, unless exempted by T.C.A. § 63-7-102(8);
   25. (iii) Obtain license or authorization to work as an Emergency Medical Technician in Tennessee as an Emergency Medical Technician within twelve (12) months of employment; and

   26. (iv) Obtain Board of Certification for Emergency Nursing certification within twelve (12) months of employment as one of the following:

       1. (I) Certified Emergency Nurse;
       2. (II) Critical Care Registered Nurse;

       3. (III) Certified Flight Registered Nurse; or

          1. (IV) Certified Transport Registered Nurse.
       4. 3. A paramedic serving as a medical crew member on an air ambulance shall meet the following qualifications:
   27. (i) Possess a current paramedic license or authorization to practice in Tennessee and have three years of experience as a paramedic in an advanced life support service;

   28. (ii) Obtain one of the following within twelve (12) months of employment:

       1. (I) International Board of Specialty Certification certified Critical Care Paramedic;
       2. (II) International Board of Specialty Certification Certified Flight Paramedic; or
       3. (III) Critical care license endorsement pursuant to Tenn. Comp. R. and Regs. 1200-12-05.
       4. 4. A physician serving as a medical crew member on an air ambulance shall possess a current unencumbered Tennessee physician license issued under Title 63, Chapter 6 or Chapter 9 and possess one (1) of the following:
   29. (i) Hold the title of medical director for an air ambulance service pursuant to the qualifications listed in 1200-01-.05(2);or
   30. (ii) Hold a certification or received additional training in the specialty of Emergency Medicine or general surgery as a R3 or higher;
   31. (iii) Hold the title of Fellow in Emergency Medicine, Emergency Medical Services Surgical Critical Care; or

   32. (iv) Hold a certification or eligibility for board certification in Emergency Medicine, Emergency Medical Services, Surgery Critical Care or Trauma Surgery.

       1. 5. Each medical crew member on an air ambulance shall have and maintain certification in Advanced Cardiac Life Support, Pediatric Advanced Life Support, and in Neonatal Resuscitation.
       2. 6. Each medical crew member on an air ambulance shall attend and maintain training in one of the following:
   33. (i) Transport Professional Advanced Trauma Course;
   34. (ii) International Trauma Life Support;
   35. (iii) Prehospital Trauma Life Support;
   36. (iv) Trauma Nurse Core Course (Provided, however, that this course shall be accepted only up until twenty-four (24) months after promulgation of this rule); or
   37. (v) Advanced Trauma Life Support (for physicians only).
   38. (f) Each service shall have a Medical Control Physician who shall be available to provide online medical control continuously via radio or telephone who shall be board certified or eligible for board certification by a professional association or society in General or Trauma Surgery, Internal Medicine, Pediatrics, Emergency Medicine, Family Practice, or Emergency Medical Services.

   39. (g) Air medical communications specialist qualifications and duties.

       1. 1. Air medical communications specialists shall be certified through the International Association of Medical Transport Communication Specialists or obtain such certification within six (6) months of employment;
       2. 2. Each air medical communications specialist shall have initial and recurrent training for medical coordination and telecommunications;
       3. 3. Each air ambulance transport shall be coordinated by an air medical communications specialists; and
       4. 4. Air medical communications specialists shall not work more than sixteen (16) hours in any one twenty-four (24) hour period.

5. (5) Flight Coordination.

   1. (a) Each air ambulance service shall maintain policies and procedures which shall include:

      1. 1. Criteria for medical conditions including indications or contraindications for transfer;
      2. 2. Procedures for call verification and advisories to the requesting party;
      3. 3. Radio and telephone communications procedures;
      4. 4. Policies and procedures for accidents and incidents;
      5. 5. Procedures for informing the requesting party of operations procedure, ambulance arrival, termination of mission and delayed responses, including the following:
   2. (i) Estimated Time Enroute (“ETE”) inclusive of time from acceptance to time of landing at the pickup location; and

   3. (ii) Any deviation from ETE greater than five (5) minutes will be reported to the requesting agency;

      1. 6. Procedures shall be established for communications failure or overdue transports;
      2. 7. Emergency protocols for alerting search and rescue; and
      3. 8. Procedures to assess previous flights which have been denied upon request by reasons of weather or other special circumstances, otherwise known as a “turn- down,” or multiple air agency response to the same transport request.

6. (6) Telecommunications.

   1. (a) The operations center for an air ambulance service operating in Tennessee shall include radio and telephone equipment to enable personnel to contact the helicopters and crew. Telecommunications devices shall include the following:

      1. 1. EMS Communications on the established frequencies of 155.205 MHz, 155.340 MHz, and/or upon such specific channels or frequencies as may be designated within each region as approved and published as a supplement to the State EMS Telecommunications Plan;
      2. 2. Direct telephone circuits accessible by air communication; and
      3. 3. Recording equipment for both telephone and radio messages and instant message recall.

7. (7) Records and Reports.

   1. (a) The air ambulance service shall maintain records including the following:

      1. 1. A record for each patient transported including:
   2. (i) Name of the person transported;
   3. (ii) Date of transport;
   4. (iii) Origin and destination of transport;
   5. (iv) Presenting illness, injury, or medical condition necessitating air ambulance service;
   6. (v) Attending and medical personnel;
   7. (vi) Accessory ground ambulance services;

   8. (vii) Medical facilities transferring and receiving the patient;

      1. (viii) Documentation of treatment during transport; and

   9. (ix) A copy shall be provided to the receiving facility.

      1. 2. Each air ambulance service shall report the number of air ambulance transfers performed annually on the form provided for such purposes to the Office of Emergency Medical Services.
   10. (b) Each air ambulance service shall retain patient records for at least ten years.

8. (8) Utilization Review (UR).

   1. (a) The air ambulance service management shall ensure appropriate utilization review process with a structured, periodic review of transports being performed at least semi- annually and resulting in a written report.
   2. (b) The service shall maintain records of such reviews for two years.

9. (9) Quality Improvement (QI).

   1. (a) The service shall have an established Quality Improvement program, including, at a minimum, the medical director(s) and management.
   2. (b) The service shall conduct an ongoing Quality Improvement program designed to assess and improve the quality and appropriateness of patient care provided by the air medical service.
   3. (c) The service shall have established patient care guidelines/standing orders. The QI committee and medical director(s) shall periodically review such guidelines/standing orders.
   4. (d) The medical director(s) is responsible for ensuring timely review of patient care, utilizing the medical record and pre-established criteria.

   5. (e) Operational criteria shall include at least the following quantity indicators:

      1. 1. Number of completed transports;
      2. 2. Number of air medical missions aborted and canceled due to weather; and
      3. 3. Number of air medical missions aborted and canceled due to patient condition and use of alternative modes of transport.
10. (10) For both QI and utilization review programs, the air ambulance service shall record procedures taken to improve problem areas and the evaluation of the effectiveness of such action.
11. (11) For both QI and utilization review programs, the air ambulance service shall report results to its sponsoring institution(s) or agency (if applicable) indicating that there is integration of the medical transport service’s activities with the sponsoring institution or agency (if applicable).
12. (12) Compliance. Compliance with the foregoing regulations shall not relieve the air ambulance operator from compliance with other statutes, rules, or regulations in effect for medical personnel and emergency medical services, involving licensing and authorizations, insurance, prescribed and proscribed acts and penalties.
13. (13) Separation of Services. Air ambulance service shall constitute a separate class of license and authorization from the Board and Office of EMS.

Authority: T.C.A. §§ 68-140-304 and 68-140-307. Administrative History: Original rule filed March 20, 1974; effective April 19, 1974. Amendment filed November 30, 1984; effective February 12, 1985. Amendment filed February 4, 1988; effective March 20, 1988. Amendment filed June 28, 1988; effective August 12, 1988. Amendment filed August 11, 1993; effective October 25, 1993. Amendment filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed January 7, 1997; effective March 23, 1997. Repeal and new rule filed June 30, 2011; effective September 28, 2011. Amendment filed October 4, 2012; effective January 2, 2013. Amendments filed March 25, 2026; effective June 23, 2026.