1. (1) Definitions - The terms used in this rule shall be defined as follows:

   1. (a) Emergency Medical Responder (First Responder) means a person who has completed required training and who participates in an organized program of mobile pre-hospital emergency medical care.
   2. (b) Emergency Medical Responder (First Responder) Certification means successful participation and completion of the Emergency Medical Responder Course and certifying examinations.
   3. (c) Emergency Medical Responder (First Responder) Course means instruction in basic knowledge and skills necessary to provide emergency medical care to the sick and injured individuals who may respond before licensed Basic or Advanced Life Support units arrive.
   4. (d) First Responder Service - shall mean a service providing capabilities for mobile pre- hospital emergency medical care using emergency medical response vehicles.

2. (2) Operation of First Responder Services. A licensed ambulance service classified as a primary provider shall coordinate first response services within its service area. If the primary provider is a contracted ambulance service, the county or local government may designate a representative who shall coordinate first responder services within the service area of its jurisdiction. First responder services shall meet the following standards for participation in the community EMS system. To participate in the community EMS system, each First Responder Service shall:

   1. (a) Be a state-chartered or legally recognized organization or service sanctioned to perform emergency management, public safety, fire fighting, rescue, ambulance, or medical functions.

   2. (b) Provide a member on each response who is certified as a First Responder, Emergency Medical Technician, or EMT-Paramedic in Tennessee.

      1. 1. Personnel may provide the following additional procedures with devices and supplies consigned under medical direction:
   3. (i) First Responders and Emergency Medical Technicians trained in an appropriate program authorized by the Division may perform defibrillation in a pulseless, nonbreathing patient with an automated mode device.

   4. (ii) Emergency Medical Technicians-IV and EMT-Paramedics may administer:

      1. (I) Intravenous fluids with appropriate administration devices.
      2. (II) Airway retention with Board-approved airway procedures.
   5. (iii) EMT-Paramedics and advanced life support personnel trained and authorized in accordance with these rules may perform skills or procedures as adopted in Rule 1200-12-01-.04(3).

   6. (iv) First Responders and Emergency Medical Technicians participating in a recognized first responder organization within the community EMS system may, upon completion of the approved training, periodic review training, and concurrent quality assurance of the local EMS system Medical Director, utilize a dual-lumen airway device (such as the Combitube or Pharyngeal Tracheal Lumen airway) that has been approved by the EMS Board.

      1. 2. Such procedures shall be consistent with protocols or standing orders as established by the ambulance service medical director.
      2. 3. Services shall provide at least six (6) hours of annual in-service training to all EMS First Responder personnel, in a plan and with instructors approved by the medical director.
   7. (c) Provide services twenty-four (24) hours a day, seven (7) days a week, and notify the primary service and dispatching agent of any time period in which the service is not available or staffed for emergency medical response.

   8. (d) Provide minimum equipment and supplies and such other equipment and supplies as shall be mutually adopted under the agreement with the primary ambulance service and medical director. The following minimum equipment shall be provided:

      1. 1. Emergency Medical Care (Jump) Kit containing:
   9. (i) Dressings and bandaging supplies, with adhesive tape, adhesive bandages, sterile 4” gauze pads, sterile ABD pads, 3” or wider gauze roller bandages, bandage shears, occlusive dressing materials, at least four triangular bandages, and burn sheets.

   10. (ii) Patient assessment and protective supplies including a flashlight, disposable gloves, antibacterial wipes or solution with tissues, trash bags, an adult blood pressure cuff with manometer and a stethoscope.

       1. 2. Resuscitative devices including oral airways in at least five sizes, a pocket mask, suction device capable of 12 inches vacuum with suction tips for oropharyngeal suction, and an oxygen administration unit capable of 2 to 15 liters per minute flow rate with a minimum 150 liter supply.
       2. 3. Splints for upper and lower extremities.
       3. 4. Patient handling equipment including a blanket and appropriate semi-rigid extrication collars.

   11. (e) Develop and maintain a memorandum of understanding or agreement of coordination within the service area with the primary provider of emergency ambulance services. If the primary provider is a contracted ambulance service, said agreement shall be developed and maintained with the designated representative of the county or local government. Such agreement will provide for policies and procedures for the following:

       1. 1. Personnel and staffing, including a roster of response personnel and approved procedures for such personnel, and the crew component operational for emergency medical response.
       2. 2. Designation of vehicles to be operated as pre-hospital emergency response vehicles, including unit identifiers and station or location from which vehicles will be operated.
       3. 3. Nature of calls for which first response services will be dispatched, and dispatch and notification procedures that assure resources are simultaneously dispatched and that ambulance dispatch is not deferred or delayed.
       4. 4. Radio communications and procedures between medical response vehicles and emergency ambulance services.
       5. 5. On-scene coordination, scene control and responsibilities of the individuals in attendance by level of training.
       6. 6. Medical direction and protocols and/or standing orders under the authority of the ambulance service medical director.
       7. 7. Exchange and recovery of required minimum equipment and supplies and additional items adopted for local use.
       8. 8. Exchange of patient information, records and reports, and quality assurance procedures.
       9. 9. Terms of the agreement including effective dates and provisions for termination or amendment.
   12. (f) First responder services shall maintain professional liability insurance providing indemnity to emergency care personnel and the organization. Each first responder service shall maintain the minimum liability coverage which is set forth in T.C.A. § 29- 20-403.

3. (3) Emergency Medical Responder (First Responder) Training Programs:

   1. (a) Shall utilize texts and curriculums approved by the Board.
   2. (b) Class size shall not exceed twenty-five (25) students per instructor.
   3. (c) Course must be conducted by an instructor authorized by the Division.
   4. (d) Shall obtain course approval from the Division.
   5. (e) Shall provide an attendance policy acceptable to the Division.
   6. (f) Shall maintain accurate attendance records.
   7. (g) Must maintain student records, such as exams, attendance records and skills verification for 5 years.
   8. (h) Must provide documentation of a student’s successful completion of course, attendance, and verification of skills competency to the Division.
   9. (i) Must provide adequate classroom space with adequate lighting and ventilation.
   10. (j) Must provide adequate lab space for skills practice.
   11. (k) Must assure adequate audio visual instructional aids and supplies are available.
   12. (l) Must provide adequate equipment for skills training.
4. (4) Official response shall be performed only as assigned upon the specific policy guidelines of the coordinating dispatch agency responsible for dispatching emergency ambulances and/or an emergency (911) communications district. No emergency medical first responder or emergency medical response vehicle shall be authorized to make an unofficial response on the basis of information obtained by monitoring a radio frequency of a law enforcement, ambulance service, fire department, rescue squad, or public safety agency.

Authority: §§ 4-5-202, 4-5-204, 68-140-304, 68-140-504, 68-140-504(1) and (2), 68-140-506, 68-140- 506(c), 68-140-507, 68-140-508, 68-140-508(a) & (b), and 68-140-517. Administrative History: Original rule filed March 25, 1987; effective May 9, 1987. Amendment filed March 7, 1989; effective April 21, 1989. Amendment filed March 7, 1994; effective May 21, 1994. Amendment filed January 9, 1997; effective March 25, 1997. Amendment filed November 16, 2005; effective January 30, 2006. Amendment filed December 16, 2005; effective March 1, 2006. Amendment filed April 6, 2010; effective July 5, 2010. Amendments filed January 11, 2013; effective April 11, 2013.