Wyo. Code R. 048-0023-7
Emergency Medical Services - General
Chapter 7: Advanced Ambulance Systems
Effective Date: 06/08/1998 to 01/26/2004
Rule Type: Superceded Rules & Regulations
Reference Number: 048.0023.7.06081998
Section 1. Operation Approval. Before engaging or employing EMT-I (Intermediate) or Paramedic personnel, all ambulance services shall establish a system in accordance with this Chapter and obtain operational approval from the Division. A system shall consist of one (1) or more ambulance services, a physician medical director, and a sponsor hospital.
(a) 'EMT-I (Intermediate) system' means an ambulance service that has been authorized by the Board and the Division to utilize EMT-Intermediate personnel in accordance with the guidelines established by the Board and the Division.
(b) 'Paramedic system' means an ambulance service that has been authorized by the Board and the Division to utilize Paramedic personnel in accordance with the guidelines established by the Board and the Division.
(a) The physician medical director shall submit an application to the Division. The application for an ambulance system shall contain:
(i) A description of the medical need for the proposed system, including any supporting documentation; and
(ii) A proposed operations manual.
(b) The application shall be reviewed by the Division and the Task Force on Prehospital Care. The Task Force shall provide a recommendation to the Board for final review.
(a) An ambulance service shall obtain the commitment of a sponsor hospital.
(b) The system shall be approved by the hospital administrator and chief of the medical staff of the sponsor hospital.
(c) Eligibility requirements. The sponsor hospital:
(i) For an EMT-I (Intermediate) system, shall have a registered nurse on duty for the emergency room twenty-four (24) hours a day.
(ii) For a paramedic system, shall have a registered nurse, on duty in the emergency room twenty-four (24) hours a day and capable of constant voice communication coverage with a physician.
(A) The registered nurse shall be:
(I) Current in Advanced Cardiac Life Support with the standards of the American Heart Association;
(II) Supervised in accordance with the Wyoming Nursing Act. W.S. 33-21-119, et seq; and
(III) Immediately available at all times to communicate with EMT-I (Intermediate) or Paramedic personnel in the field.
(B) The physician shall:
(I) Be current in Advanced Cardiac Life support with the standards of the American Heart Association;
(II) Be available to communicate with the EMT-I (Intermediate) or Paramedic personnel in the field;
(III) Explain the medical role of EMT-I (Intermediate) and Paramedic personnel to appropriate hospital staff;
(IV) Cooperate with the Division in the collection of statistical data;
(V) Maintain direct communications capability between the sponsor hospital and the ambulance(s);
(VI) Provide clinical experience with supervision for trainees during the training program and for continuing medical education;
(VII) Provide for audit in review of EMT-I (Intermediate) cases quarterly and Paramedic advanced life support cases monthly. All concerned EMT-I (Intermediate) or Paramedic personnel shall attend the meetings; and
(VIII) Practice in a hospital which has an intensive care unit or a monitored bed unit (MBU).
Section 4. Physician Medical Director. Both EMT-I (Intermediate) and Paramedic systems shall be supervised by a physician medical director. The physician medical director shall be a physician licensed to practice medicine in this state. The physician medical director’s duties shall include at a minimum:
(a) Filing with the Division copies of current protocols and authorizations, that have been reviewed and approved by the Division and the Task Force, for EMT-I (Intermediate) or paramedic systems;
(b) Monitoring trip reports where EMT-I (Intermediate) activities were carried out. The trip reports must be monitored quarterly;
(c) Monitoring Paramedic trip report forms where advanced life support activities were carried out. The trip reports shall be monitored each month; and
(d) Reviewing reports of EMT-I (Intermediate) defibrillation, multi-lumen lower airway insertions, intraosseous infusion initiations, and oral endotracheal intubations attempts with all concerned personnel, then submitting reports to the Division no later than December 31st of each year.
Section 5. Communications Systems. All ambulance service systems shall maintain a communications system capable of:
(a) Voice communication between the ambulance and the sponsor hospital and physicians; and
(b) Voice and/or EKG recording tape units for services utilizing manual, automatic or semi-automatic defibrillation certified personnel.
Biomedical or cellular telemetry is not mandatory. In situations where the sponsor hospital does not feel telemetry is needed, it is not required, but it must be agreed by the sponsor hospital that the paramedic be authorized to read and interpret electrocardiograms in the field. Where telemetry is not used, each ambulance must have an EKG strip chart writer in the field, and advanced life support treatment tapes will be reviewed for purpose of medical audit by the local committee, the Division and the Physician’s Task Force, as deemed necessary.
Section 6. Decision. Upon receipt of all required information, the Division shall notify the Program Committee within ten (10) working days following its decision. The Division shall approve the system if it meets the requirements of this Chapter. If the proposed system does not meet the requirements of this Chapter, the Division shall not approve the system. If the Division does not approve the application for the system it shall provide recommendations for future compliance and the applicant may reapply.