HomeMy WebLinkAboutResolution_20-92/93_08/12/1993 RESOLUTION NO. 20 - 92/93
A RESOLUTION OF THE VILLAGE COUNCIL OF THE
VILLAGE OF TEQUESTA, PALM BEACH COUNTY, FLORIDA,
APPROVING A CONTRACT BETWEEN THE VILLAGE OF
TEQUESTA AND JUPITER AMBULANCE, INC., d /b /a NORTH
COUNTY AMBULANCE, INC. FOR THE PROVISION OF
ADVANCED LIFE SUPPORT SERVICES AND AUTHORIZING THE
VILLAGE MANAGER TO EXECUTE THE SAME ON BEHALF OF
THE VILLAGE.
BE IT RESOLVED BY THE VILLAGE COUNCIL OF THE VILLAGE OF
TEQUESTA, PALM BEACH COUNTY, FLORIDA, AS FOLLOWS:
Section 1. The Contract between the Village of Tequesta and
Jupiter Ambulance Service, Inc., d /b /a/ North County
Ambulance, Inc., for the provision of advanced life support
services attached hereto as Exhibit "A" and incorporated by
reference as a part of this Resolution is hereby approved and
the Village Manager is authorized to execute the same on
behalf of the Village of Tequesta.
THE FOREGOING RESOLUTION was offered by Councilmember
F1 i zabetlh A. Schauer who moved its adoption. The motion
was seconded by Councilmember Earl L. Collings and
upon being put to a vote, the vote was as follows:
FOR ADOPTION AGAINST ADOPTION
Ron T. Mackail
Earl L. Collings
Elizabeth A. Schauer
The Mayor thereupon declared the Resolution duly passed and
adopted this 12th day of August , A.D., 1993.
MAYOR OF TEQUESTA
' Ron T. Mackail
ATTEST:
iann ManganiejAo
Village Clerk
CONTRACT l�
THIS CONTRACT made on this 2D� day of n 0 5 L) 19 q3 ,
by and between JUPITER AMBULANCE SERVICE, INC., d /b /a North County
Ambulance, a Florida non - profit corporation, hereinafter referred
to as "Provider ", and the VILLAGE OF TEQUESTA, FLORIDA, hereinafter
referred to as "Village ".
W I T N E S S E T H:
WHEREAS, Provider conducts an emergency medical service system
employing paramedics and emergency medical technicians to perform
basic (BLS) and advanced life support (ALS) procedures and
ambulance transport services; and
WHEREAS, Provider provides the plan and equipment to provide
these services to the geographic area of Palm Beach County known as
Zone 1, which includes the Village of Tequesta, Florida; and
WHEREAS, Village is desirous of entering into an Agreement
with the Provider for providing basic life support, advanced life
support and ambulance transport services within the Village limits
and contractual service areas external to the Village limits; and
WHEREAS, Provider and Village wish to outline in writing the
relationship and terms under which Provider will provide said
services to and for Village; and
WHEREAS, the parties are desirous of entering into this
Contract in order to provide a full statement of their respective
covenants and agreements in respect to said relationship.
NOW, THEREFORE, for and in consideration of the mutual
covenants and agreements herein contained, it is understood and
agreed by and between the parties hereto as follows:
ARTICLE I - TERM OF CONTRACT
This Contract is for a three (3) year period of time. The
Provider shall commence services herein further described on first
day of October, 1993.
ARTICLE II - MINIMUM LEVEL OF SERVICE
A. Provider during the term of this Contract shall, at all
times, provide one (1) State Licensed ALS equipped transport
capable emergency vehicle staffed with two (2) state licensed
paramedics in operation and dedicated to the service area under
this Contract, being the Village limits of the Village of Tequesta,
Florida, Jupiter Inlet Colony and any areas external to the Village
wherein Tequesta contracts for providing fire - rescue services that
are mutually agreeable to the Parties.
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B. Based upon the Village's current boundary and external
service areas, the Provider agrees to maintain an average response
time of no more than 5.0 (five) minutes in response to emergency
calls as defined herein and shall respond only to 911 calls or
their equivalent. Within thirty (30) days after the effective date
of any annexation, this time may be adjusted by common agreement of
both Parties.
C. In the event an emergency vehicle must leave the Village
for repairs, Provider agrees to promptly provide a back -up vehicle
to Village's service area. In the event a vehicle must leave
Village to transport a 911 patient to an out of Village medical
facility, Provider agrees to provide back up from Provider's
Central station.
D. Further, said vehicles may leave the Village limits to be
utilized under emergency conditions as "back -up" under the Northern
Area Mutual Aid Consortium (NAMAC) Agreement when so requested by
the Village.
E. Provider further agrees that each in- service unit shall
be equipped with at least the minimum equipment and supplies
required under current Florida law (see Addendum A attached hereto
and made a part hereof).
ARTICLE III - PAYMENTS TO PROVIDER
The Village agrees to pay Provider for the services rendered
$146,264.50 Dollars for the first year of this Contract. The fee
for each subsequent year shall be the fee for the immediately
preceding year multiplied by a fraction determined as follows: The
numerator of the fraction shall be the Index Figure (as defined
below) for the month of May immediately preceding the Contract
anniversary date and the denominator shall be the Index Figure for
the same month one year prior thereto. The term "Index Figure"
means the consumer price index, medical care, for the United
States, U.S. City Average. for All Urban Consumers as published by
the U.S. Department of Labor's Bureau of Statistics, or any
official replacement thereof. Provider agrees to bill the Village
on a monthly basis for services to be rendered the next calendar
month. The amount billed shall be for one - twelfth (1 /12th) of the
annual amount as stated above. Said amounts shall be paid on or
before the tenth (10th) of the month for which services are to be
rendered.
ARTICLE IV - ADDITIONAL CONSIDERATION
In addition to the amounts provided for under ARTICLE III,
Village agrees to provide the following:
A. For an additional aggregate payment of $19,781.00 per
year (payable in equal monthly installments payable at the times
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specified in ARTICLE III), Provider agrees to accept the private
insurance payments for residents of the Village and Jupiter Inlet
Colony, on all 911 transportation services originating within the
• municipal limits of either referenced municipality (does not cover
non - emergency transport or additional external areas contracted for
under ARTICLE II A). Those insurance payments, which are in
addition to amounts paid by Village as provided for in ARTICLE III
above, will be accepted as payment in full for Provider's charges.
If the resident does not have insurance coverage and confirms no
coverage to the receiving facility, there shall be no further
charge to such resident. Although Provider may not bill any such
resident directly, Provider may write or call the resident
requesting insurance information.
B. All non - residents of the Village shall be billed at
Provider's then current BLS and /or ALS charges in effect when
services are rendered. A copy of the current rate schedule is
attached hereto as Addendum B. As the schedule is updated,
Provider agrees to furnish Village with a copy of the new schedule.
C. The Village shall give the Provider a copy of any
complaints from the service area filed against the Provider. The
legitimacy of challenged complaints shall be determined on the
basis of joint inspection by the Village Manager or his designee
and a representative of the Provider. Disputes shall be referred
to the Village Manager, and his decision shall be final.
ARTICLE V - PERSONNEL
The Provider represents that it has, or will secure at its own
expense, all necessary personnel required to perform the services
in this Contract, including a licensed Medical Director as further
required under Florida law.
All of the services required hereunder shall be performed by
the Provider or under its direct supervision, and all personnel
engaged in performing the services shall be fully qualified; and,
if required, authorized or licensed under state and local law to
perform such services.
ARTICLE VI - LICENSES AND PERMITS
The Provider shall be responsible for all licenses and permits
required at no additional cost to the Village during the duration
of this Contract, as set forth under Florida Statutes, county or
municipal ordinances. Licenses and permits shall be in the name of
the Provider and /or its Medical Director. State of Florida license
for emergency medical services is attached hereto.
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ARTICLE VII - MONITORING SERVICE REPORTS
The Provider shall furnish to the Village within ten (10) days
• after the Zone 1 consolidated report is received by Provider from
Palm Beach County Emergency Medical Services or its successor a
report showing individual and average response time for the prior
month. In addition, the Village shall have the right to audit the
books and records of the Provider that pertain to the payments and
services under this Agreement.
ARTICLE VIII - DEFAULT
Upon a material default of this Contract by either party, the
non - defaulting party shall provide written notice of the default to
the defaulting party specifying a reasonable time to cure the
default. If the default is not cured within the specified period,
the non - defaulting party shall, at this option, have the right to
terminate this Contract and shall have such other remedies against
the defaulting party as may be provided by law.
ARTICLE IX - INDEMNIFICATION AND INSURANCE
Provider shall indemnify the Village and hold it harmless from
any and all claims, actions, suits, proceedings, costs, expenses,
damages and liabilities, including attorneys' fees, resulting from,
arising out of or connected with Provider's failure to comply with
the provisions of this agreement, as well as liability arising
solely through the negligence of Provider.
The Provider shall not commence work under this agreement
until it has obtained the following insurance coverage and
submitted evidence of same to the Village on an annual basis or as
the Contract is renewed in the form of a Certificate of Insurance:
A. All insurance policies shall be issued by companies
authorized to do business under the laws of the State of Florida.
B. The Provider shall maintain, during the life of this
Contract, comprehensive general liability in the amount of ONE
MILLION AND N01100 DOLLARS ($1,000,000.00) per occurrence to
protect it from claims for damages for bodily injury, including
wrongful death, as well as from claims of property damages which
may arise from any operation under this Contract, whether such
operation be by the Provider or by anyone directly employed by or
contracting with the Provider.
C. The Provider shall maintain, during the life of this
Contract, comprehensive automobile liability insurance in the
amount of THREE HUNDRED THOUSAND AND NO 1100 DOLLARS ($300,000.00)
combined single limit bodily injury per accident, bodily injury per
person in the amount of ONE HUNDRED THOUSAND AND N01100 dollars
($100,000.00) and FIFTY THOUSAND AND N01100 DOLLARS ($50,000.00)
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property damage to protect the Provider from claims for damages for
bodily injury, including wrongful death, as well as from claims for
property damage which may arise from ownership, use or maintenance
of owned and non -owned automobiles, including rented automobiles
whether such operation be by the Provider or by anyone directly or
indirectly.
D. The Provider shall maintain, during the life of this
Contract, adequate workman's compensation insurance in at least
such amounts as are required by law for all of its employees
performing work for the Village pursuant to this Contract.
E. The Provider shall provide Professional Liability
Insurance in the amount of ONE MILLION AND N01100 DOLLARS
($1,000,000.00).
F. The policies of insurance so required by ARTICLE IX shall
include the Village as an additional insured. The required
Certificate of Insurance shall indicate the Village to be an
additional insured. All required policies of insurance shall
contain a provision or endorsement that the coverage afforded will
not be cancelled, materially changed or renewal refused until at
least thirty (30) days' prior written notice has been given to the
Provider and to each additional insured, which shall include the
Village, to whom a Certificate of Insurance has been issued.
G. In the event any of the above - required insurance
policies, in the amount stated, shall not be kept in legal force
and effect, it shall be cause for the Village to declare immediate
termination of this agreement.
ARTICLE X - TERMINATION
This agreement may be terminated without cause by either
party, by notice in writing of termination delivered to the other
party twelve (12) months prior to the effective date of
termination. Upon the effective date of termination, each party
shall be relieved of any and all obligations incurred pursuant to
the terms of this Contract except the Village shall remain liable
to Provider for the costs of services incurred during the effective
dates of the Contract, and Provider's insurance for acts conducted
by Provider during the effective dates of the Contract shall remain
in full force and effect to cover said acts.
ARTICLE XI - SUCCESSORS AND ASSIGNS
The Village and the Provider each bind themselves and their
successors and assigns to the other party to this contract and to
the successors and assigns of such other party, in respect to all
covenants in this Contract.
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ARTICLE XII - REMEDIES
This Contract shall be governed by the laws of the State of
Florida. Any and all legal actions necessary to enforce this
Contract will be held in Palm Beach County, and the Contract will
be interpreted according to the laws of the State of Florida. No
remedy herein conferred upon any party is intended to be exclusive
of any other remedy, and each and every such remedy shall be
cumulative and shall be in addition to every other remedy given
hereunder or now or hereafter existing at law or in equity or by
statute or otherwise. No single or partial exercise by any party
of any right, power or remedy hereunder shall preclude any other or
further exercise thereof.
In any action brought by either party for the enforcement of
the obligation of the other party, the prevailing party shall be
entitled to recover costs, including reasonable attorneys' fees.
ARTICLE XIII - UNIFORM COMMERCIAL CODE
The Uniform Commercial Code (Florida Statute, Chapter 672)
shall prevail as the basis for contractual obligations between the
Provider and the Village for any terms and conditions not
specifically stated in this Contract.
ARTICLE XIV - NON - DISCRIMINATION PARAGRAPH
The Provider warrants and represents that all of its employees
are treated equally during employment without regard to race,
color, religion, sex, age or national origin.
ARTICLE XV - ENTIRETY OF CONTRACTUAL AGREEMENT
The Village and the Provider agree that this Contract sets
forth the entire agreement between the parties and that there are
no promises or understandings other than those stated herein. None
of these provisions, terms and conditions contained in this
Contract may be added to, modified, superseded or otherwise
altered, except by a written instrument executed by the parties
hereto.
ARTICLE XVI - LIABILITY
Nothing in this agreement shall be construed as expanding or
contracting the limits of liability afforded Village for immunity
for suit under the common law, Florida Constitution or Florida
Statutes.
All notices required in this Contract shall be sent by
certified mail, return receipt requested, and if sent to the
Village shall be mailed to: Village of Tequesta, Attn: Village
Manager, P. O. Box 3273, Tequesta, Florida 33469 and if sent to
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the Provider shall be mailed to: Chief Executive officer, Jupiter
Ambulance Service, Inc., 1210 South Old Dixie Highway, Jupiter,
Florida 33458.
IN WITNESS WHEREOF, �NQIM�S � UXLL -A&c A7 4#J R-
on behalf of the Village of Tequesta, Florida, has made and
executed this Contract; and on behalf of
Jupiter Ambulance Service, Inc.,` has made and executed this
Contract on the day and year first above written.
VILLAGE OF TEQUESTA
_ By:
1 T / Its
JUPI AMBULANCE SERVICE, INC.
By:
Its
jh stequesta.con
July 12, 1993
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ADDENDUM A
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
December 10, 1992
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SUBJECT: Amended and Effective Rules, Chapter 1OD -66, Florida
Administrative Code
TO: See Distribution
Attached is the revised version of Chapter 1OD -66, Florida
Administrative Code which became effective on December 10.
Please replace any previous versions you may have and ensure that
those you employ (if applicable) are provided with a copy.
Carefully review these rules as many changes were made in the
course of a massive promulgation process.
We appreciate your involvement and patience in the two -year effort
promulgating these rules.
� &'OS
PAM LESLEY
Senior Management Analyst
Emergency Medical Services
Attachment
1. Effective Rules
Distribution
AIG 02A Acute Care Hospitals
AIG 03 Trauma Centers and Agencies
AIG 04 Air Ambulance Providers
AIG 05A Florida Training Center Coordinators
AIG 13 Florida Association of Medical Directors
AIG 15 Rules Mailing List
AIG 18 ALS Providers
AIG 24 BLS Providers
AIG 25A Advisory Council Members
AIG 25B Constituency Presidents
AIG 25C Courtesy List
AIG 39 Medical Directors of Licensed Services
• AIG 55 American College of Surgeons, Committee on Trauma
1317 WINEWOOD BOUL • TALLAHASS FLORIDA 32399 -0700
LANN70N CHILES, GOVERNOR
•
EFFECTIVE 12/10/92
EMERGENCY MEDICAL SERVICES CHAPTER 1 OD -66
RULES
OF THE
DEPARTMENT OF HEALTH AND
• REHABILITATIVE SERVICES
CHAPTER 10D -66, FLORIDA ADMINISTRATIVE CODE (F.A.C.)
EMERGENCY MEDICAL SERVICES
1OD- 66.001 Purpose (Repealed) 1OD- 66.045 Emergency Medical Technician
10D- 66.002 Sanitation and Maintenance (Repealed)
(Repealed) 1OD- 66.046 Paramedic (Repealed)
10D- 66.003 Records (Repealed) 1OD- 66.047 Replacement of Lost Certification
1OD- 66.004 Air Ambulances (Repealed) (Repealed)
10D- 66.005 Insurance and Accidents (Repealed) 1OD- 66.048 Purpose
1OD- 66.006 Equipment and Driver Certification 1013- 66.0485 Definitions
(Repealed) 1OD- 66.049 Basic Life Support Service License
1OD- 66.007 Equipment, Supplies and - Ground
Communication Effective July 1, 1974 1 OD- 66.050 Advanced Life Support Service
(Repealed) License - Ground
1OD- 66.008 Vehicle Design and Construction 1OD- 66.0501 Medications, Fluids, and Controlled
(Repealed) Substances Inventory, Storage and
1 OD- 66.009 Reserved Security Procedures
thru 1OD- 66.0505 Medical Direction
1013- 66.030 1013- 66.051 Air Ambulances
1 OD- 66.031 Purpose (Repealed) 1 OD- 66.0515 Air Ambulance Service Broker
1 OD- 66.032 Sanitation and Maintenance 1 OD- 66.052 Interfacility Transfers
(Repealed) 1OD- 66.053 Vehicle Permits
1013- 66.033 Records (Repealed) 1OD- 66.054 Vehicle Design and Construction
10D- 66.034 Special Ambulances (Repealed) - Ground Vehicles
1OD- 66.035 Insurance and Accidents (Repealed) 1OD- 66.055 Ground Vehicle and Service Standards
1OD- 66.036 Emergency Medical Technician 1OD- 66.0555 ALS Equipment and Medications
and Driver Certification (Repealed) 1013- 66.056 Emergency Medical Technician
1OD- 66.037 Equipment, Supplies and 1OD- 66.057 Paramedic
Communications (Repealed) 1OD- 66.0571 Impaired Practitioners
1OD- 66.038 Vehicle Design and Construction 1OD- 66.0572 Convicted Felons Applying for EMT
(Repealed) or Paramedic Certification or
1OD- 66.039 Paramedic Certification, Recertification
Recertification and Training 1OD- 66.0575 Examinations
Requirements (Repealed) 1OD- 66.058 Training Center Standards (Repealed)
1OD- 66.040 Application Requirements for 10D- 66.0585 EMT Training Standards and
Advanced Life Support Provider Procedures (Repealed)
Certification (Repealed) 1OD- 66.0586 EMS Training Center Programs
1013- 66.041 Standard and Requirements for 1OD- 66.059 Drivers
Certification as an Advanced 1OD- 66.060 Records and Reports
• Life Support Provider (Repealed) 1 OD- 66.061 Insurance
10D- 66.042 Advanced Life Support Operating 1 OD- 66.062 Complaint Confidentiality; Waiver
Procedures (Repealed) 1013- 66.063 Variances (Repealed)
1OD- 66.043 Reserved 1OD- 66.0635 Variances and Exceptions
1OD- 66.044 Ambulance Driver, Emergency Medical 1OD- 66.064 Forms
Technician /Ambulance Driver, 1OD- 66.0645 Schedule of Fees
Paramedic /Ambulance Driver 1OD- 66.065 Emergency Medical Services Advisory
(Repealed) Council
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1013- 66.066 Watercraft Medical Services Matching Grant ,
10D- 66.100 Prehospital Requirements for Trauma and Emergency Services County Grant
Care 10D- 66.242 Matching Grant Amendments
10D- 66.101 Trauma Transport Protocols Approval 10D- 66.245 Monitoring
and Denial Process 10D- 66.250 Award Procedures, Grant •
10D- 66.102 Trauma Scorecard Methodology Requirements and Conditions
10D- 66.103 Trauma Registry 10D- 66.255 Adjustments to Applications
10D- 66.104 Trauma Agency Formation 10D- 66.300 Administration of Epinephrine by
Requirements Certified Individuals
10D- 66.105 Agency Plan Criteria (Repealed)
10D- 66.106 Trauma Agency Plan Approval and IOD- 66.001 Purpose.
Denial Process Specific Authority 401 FS. Law Implemented 401.22,
10D- 66.1065 Trauma Agency Implementation and 401.31, 401.40 FS. History -New 11- 17 -73,
Operation Requirements Repromulgated 1 -1 -75, Repealed by 20.19 FS., 1 -1 -77,
tOD- 66.107 Agency Plan Exceptions (Repealed) Formerly IOD- 66.01.
10D- 66.1075 Apportionment of State - Approved
Trauma Centers (SATC) or State- IOD- 66.002 Sanitation and Maintenance.
Approved Pediatric Trauma Referral Specific Authority 401 FS. Law Implemented 401.31,
Centers (SAPTRC) within a 401.35 FS. History -New 11- 17 -73, Revised 1 -1 -75,
Trauma Service Area (TSA) Repealed by 20.19 FS., 1 -1 -77, Formerly IOD- 66.02.
10D- 66.108 SATC and SAPTRC Requirements
10D- 66.109 Process for the Approval of SATCs IOD- 66.003 Records.
and SAPTRCs Specific Authority 401 FS. Law Implemented 401.25,
10D- 66.1095 Extension of Application Period 401.31, 401.35 FS. History -New 11- 17 -73, Revised
10D- 66.110 Certificate of State - Approval 1 -1 -75, Repealed by 20.19 FS., 1 -1 -77, Formerly
10D- 66.111 Process for Re- Approval of SATCs IOD- 66.03.
and SAPTRCs
10D- 66.112 Site Visits and Approval IOD- 66.004 Air Ambulances.
10D- 66.113 Application by Hospitals Denied Specific Authority 401 FS. Law Implemented 401.23 FS.
Approval History -New 11- 17 -73, Revised 1 -1 -75, Repealed by
10D- 66.114 Application for Reclassification 20.19 FS., 1 -1 -77, Formerly IOD- 66.04.
(Repealed)
10D- 66.115 Requirements for Discontinuation or IOD- 66.005 Insurance and Accidents.
Substantial Reduction of Trauma Specific Authority 401 FS. Law Implemented 401.23,
Services 401.31, 401.35 FS. History -New 11- 17 -73, Revised
10D- 66.200 Eligibility Requirements for Emergency 1 -1 -75, Repealed by 20.19 FS., 1 -1 -77, Formerly
Medical Services County Grant IOD- 66.05.
10D- 66.205 Emergency Medical Services County
Grant Application Procedures IOD- 66.006 Attendant and Driver
10D- 66.210 Review of Emergency Medical Certification.
Services County Grant Application Specific Authority 401 FS. Law Implemented 401 .27,
Procedure 401.31, 401.35 FS. History -New 11- 17 -73, Revised
10D- 66.215 Distribution of Emergency Medical 1 -1 -75, Repealed by 20.19 FS., 1 -1 -77, Formerly
Services County Grant Monies IOD- 66.06.
10D- 66.220 Eligibility Requirements for Emergency
Medical Services Matching Grant 10D- 66.007 Equipment, Supplies and
10D- 66.225 Projects Eligible for Emergency Communications Effective .luly, 1974. •
Medical Services Matching Grant Specific Authority 401 FS. Law Implemented 401.31,
10D- 66.230 Emergency Medical Services Matching 401.35 FS. History -New 11- 17 -73, Revised 1 -1 -75,
Grant Application Procedure Repealed by 20.19 FS., 1 -1 -77, Formerly IOD- 66.07.
10D- 66.235 Review of Emergency Medical
Services Matching Grant Application 10D- 66.008 Vehicle Design and
10D- 66.240 Documentation of Expenditures and Construction.
Accomplishments of Emergency
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Specific Authority 401 FS. Law Implemented 401.31, Specific Authority 401.35, 381.031(1)(g), 20.05(5) FS.
401.35 FS. History -New 11- 17 -73, Revised 1 -1 -75, Law Implemented 401.31, 401.38 FS. History -New 1 -1-
Repealed by 20.19 FS., 1 -1 -77, Formerly IOD- 66.08. 77, Amended 9- 10 -78, Repealed 11- 29 -82, Formerly
• 1013 66.38.
1013- 66.009 thru 1013 -66.30 Reserved.
1OD- 66.039 Paramedic Certification,
10D- 66.031 Purpose. Recertification and Training Requirements.
Specific Authority 401.35, 381.0310)(8), 20.05(5) FS. Specific Authority 401.35, 401.47, 381.031(1)(g),
Law Implemented 401.22, 401.31, 401.40 FS. History- 20.05(5) FS. Law Implemented 401.47 FS. History -New
New 1 -1 -77, Amended 9- 10 -76. Repealed 11- 29 -82, 9- 10 -78, Repealed 7- 21 -81, Formerly 10D- 66.39.
Formerly IOD- 66.31.
10D- 66.040 Application Requirementss
10D- 66.032 Sanitation and Maintenance. for Advanced Life Support Provider Certification.
Specific Authority 401.35, 381.031(1)(g), 20.05(5) FS. Specific Authority 401.35, 381.0310)(8), 20.05(5) FS.
Law Implemented 401.31 FS. History -New 1 -1 -77, Law Implemented 401.46 FS. History-New 9 -10 -78
Amended 9- 10 -76. Repealed 11- 29 -82, Formerly Repealed 11 -29 -82 Formerly 10D- 66.40.
IOD- 66.32.
10D- 66.041 Standard and Requirements
10D- 66.033 Records. for Certification as an Advanced Life Support Provider.
Specific Authority 401.35, 381.0310)(g), 20.05(5) FS. Specific Authority 401.35, 381.031(1)(g), 20.05(5) FS.
Law Implemented 401.35 FS. History-New 1 -1 -77, Law Implemented 401.46, 401.47 FS. History -New 9-10 -
Amended 9- 10 -78, Repealed 11- 29 -82, Formerly 10D- 78 Repealed 11 -29 -82 Formerly 10D- 66.041.
66.33.
IOD- 66.042 Advance Life Support
10D- 66.034 Special Ambulances. Operating Procedures.
Specific Authority 401.35 FS. Law Implemented 401.23, Specific Authority 401.35 FS. Law Implemented 401.46
401.25, 383.15, 383.16, 383.17 FS. History-New 1 -1- FS. History -New 9- 10 -78, Repealed 11- 29 -82, Formerly
77, Amended 9- 10 -78, Repealed 11- 29 -82, Formerly IOD- 66.42.
10D- 66.38.
IOD- 66.043 Reserved.
10D- 66.035 Insurance and Accidents.
Specific Authority 401.35, 381.0310)(8), 20.05(5) FS. IOD- 66.044 Ambulance Driver,
Law Implemented 401.23(3)(b), 401.25(3)(c) FS. History- Emergency Medical Technician Ambulance Driver,
New 1 -1 -77, Amended 9- 10 -78, Repealed 11- 29 -82, Paramedic Ambulance Driver.
Formerly 1013- 66.035. Specific Authority 401.24, 401.35, 401.47 FS. Law
Implemented 401 .27(2),(3),(4),(5), 401.31, 401.47 FS.
10D- 66.036 Emergency Medical History -New 7- 21 -81, Repealed 11-29-82, Formerly
Technician and Driver Certification. IOD- 66.44.
Specific Authority 401.35, 381.0310)(8), 20.05(5) FS.
Law Implemented 401.27, 401.31 FS. History -New 1 -1- IOD- 66.045 Emergency Medical
77; Joint Administrative Procedures Committee Objection Technician.
Withdrawn - See FAW Vol. 3. No. 30, July 29, 1977, Specific Authority 401.24, 401.35 FS. Law Implemented
Amended 9- 10 -78, Repealed 7- 21 -81, Formerly 10D- 401.27(2),(3),(4),(5),(7), 401.31 FS. History -New
66.036. 8 -5 -81, Repealed 11- 29 -82, Formerly IOD- 66.45.
• 10D- 66.037 Equipment, Supplies and IOD- 66.046 Paramedic.
Communications. Specific Authority 401.24, 401.35, 401.47 FS. Law
Specific Authority 401.35(3), 381.0310)(8 ), 20.05(5) Implemented 401 .27(3),(4),(5),(7), 401.47 FS. History -
FS. Law Implemented 401.31, 401.26(2), 401.25(3)(b) New 8 -4-81, Repealed 11- 29 -82, Formerly IOD- 66.46.
FS. History -New 1 -1 -77, Amended 9 -1078, Repealed 11-
29-82, Formerly 1OD- 66.37. IOD- 66.047 Replacement of Lost
Certification.
10D- 66.038 Vehicle Design and
Construction.
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Specific Authority 401.35 FS. Law Implemented 401.32
FS. History -New 7- 21 -81, Repealed 11- 29 -82, Formerly
IOD- 66.47.
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RULES
OF THE
DEPARTMENT OF HEALTH AND
REHABILITATIVE SERVICES
CHAPTER 10D -66, FLORIDA ADMINISTRATIVE CODE
EMERGENCY MEDICAL SERVICES
• 10D- 66.048 Purpose. These rules are issued under system that classifies individual injuries by body
the provisions of sections 381.001 1, 381.0205, region on a 6 -point ordinal severity scale ranging
381.704, 395.0146, 395.018, 395.031, from 1 to 6. The methodology for determining AIS-
395.032, 395.033, 395.0335, 395.034, 90 Code is found in the "Abbreviated Injury Scale
395.035, 395.036, 395.037, 409.901- 409.920 1990 Revision," which is incorporated by reference
and the "Florida Emergency Medical Services Act," and is available from the Association for the
chapter 401, parts II and III, Florida Statutes (F.S.), Advancement of Automotive Medicine, 2340 Des
to establish standards for a trauma care system, Plaines River Road, Des Plaines, IL 60018 at a cost
emergency medical services grants program, and of $40
prehospital care and transportation of persons (2) Air Ambulance Service Broker -
needing emergency medical attention. Moreover means a person, firm, corporation, association, or
these rules are promulgated to implement and governmental entity who for compensation or with
interpret the above referenced statutes. These an intent to collect or receive compensation, acts
rules must be used in conjunction with chapters as an agent for the owner of any business or
395, 401, and 409, FS., to determine complete service which furnishes, operates, conducts,
requirements for the establishment and maintains, advertises, engages in, or professes to
maintenance of state, and local or regional trauma engage in the business or service of transporting by
systems; the regulation of state - approved trauma air ambulance any person who may need medical
centers, state - approved pediatric trauma referral attention during transport.
centers, emergency medical services providers and (3) Application - means a completed
other entities within a coordinated trauma system; application form, as specified by the department,
to determine eligibility requirements and procedures together with all documentation required by these
for requesting, evaluating, selecting, awarding, and rules and the required fee.
managing emergency medical services grants; and, (4) Automatic Defibrillator - means a
for the regulation of emergency medical services cardiac defibrillator that is capable of rhythm
and personnel, as the rules do not generally repeat analysis and which will charge and deliver a
requirements which are specific in chapters 395, countershock after electronically detecting the
401, and 409, FS. Definitions provided in chapters presence of cardiac arrhythmia. The defibrillator
395 and 401, parts II and III, FS., shall apply to this shall be capable of continuous recording of an
rule. electrocardiogram of the patient on which it is
being used and shall be capable of producing a hard
Specific Authority 381.0001, 381.0205, copy of the electrocardiogram.
381.704, 395.0146, 395.018, 395.031, (5) Burn - means a tissue injury
395.032, 395.033, 395.0335, 395.034, resulting from excessive exposure to thermal,
395,035, 395.036, 395.037, 401.121, 401.35, chemical, electrical or radioactive agents.
409.901- 409.920 FS. Law Implemented (6) Controlled Substances - means
381.0001, 381.0205, 381.704, 395.0146, those drugs listed in chapter 893, FS.
395.018, 395.031, 395.032, 395.033, (7) Council - means the State of
395.0335, 395.034, 395,035, 395.036, Florida Emergency Medical Services Advisory (EMS)
395.037, 401.121, 401.211, 401.35, 409.901- Council.
409.920 FS. History Formerly 10D- 66.48, (8) Critical Care - means those
• Amended 4- 26 -84, 4- 12 -88, 8 -3 -88, 12- 10 -92. categories of medical care that require specialized
equipment and personnel to adequately treat a
1OD- 66.0485 Definitions. In addition to the patient's critical medical needs. Critical care
definitions provided in sections 395.031, 401.107, categories will, at a minimum, include: pediatric -
and 401.23, FS., the following definitions apply to neonatal intensive care; poisons and toxicology;
these rules: psychiatric -drug and alcohol; cardiac; and trauma,
including spinal or head injury and burns.
(1) Abbreviated Injury Score (AIS -90)
means a consensus derived, anatomically based
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(9) Department - means the Florida SAPTRC which has the capability to provide the
Department of Health and Rehabilitative Services specialized medical care which the patient requires.
(HRS). (20) Expand - means an increase in the
(10) Director - means the director of extent, size, or number of existing prehospital EMS
the department's Office of EMS. activities or services. •
0 1) Dispatch - means the process of (21) FAA - means the Federal Aviation
receiving a request for emergency medical Administration.
assistance and the act of sending an EMS vehicle (22) FAR - means Federal Aviation
or air ambulance in response to each such request. Regulation.
(12) Emergency Medical Services (23) FCC - means the Federal
County Grant - means funds awarded to each Communications Commission.
county according to the respective proportion of (24) Glasgow Coma Score - means the
each county's annual contribution to the EMS neurological assessment developed by G. Teasdale
grants program. The EMS grants program is a and B. Jennitte in "Assessment of Coma and
portion of the EMS Trust Fund. Impaired Consciousness: A Practical Scale"
(13) Emergency Medical Services Lancet, 1974; 2: 81 -84, which is incorporated by
Matching Grant - means funds awarded to eligible reference and available from the department.
agencies and organizations for the purpose of (25) Grant Money - means money
conducting research, increasing existing levels of deposited into the state EMS Trust Fund for
EMS, evaluation, community education, training in distribution under chapter 401, part II, FS.
cardiopulmonary resuscitation (CPR) and other (26) Hospital - means any hospital
lifesaving and first aid techniques. licensed under chapter 395, FS.
(14) Emergency Medical Services (27) ICD -9 -CM - means the
Matching Grant Evaluation Team - means a group "International Classification of Disease, 9th
or groups of individuals who review and evaluate Revision, Clinical Modification," March 1989, U.S.
EMS matching grant applications received by the Department of Health and Human Services
department. Publication No. (PHS) 89 -1260; an internationally
(15) Emergency Medical Services applied method by which diseases or groups of
Organizations - means public or private entities medical conditions or injuries are coded for the
involved in EMS systems. purpose of statistical analyses.
(16) Emergency Medical Services (28) Impaired EMTs and Paramedics -
Provider - means any entity licensed in the State of means an individual certified under the provision of
Florida to provide air, or ground ambulance, chapter 401, FS., who misuses or abuses alcohol,
whether basic life support (BLS) or advanced life drugs, or both or has a mental condition, which
support (ALS), and whether a non - transportation or could affect the certificate holder's ability to
a transportation service. practice as an EMT or paramedic, and there is no
(17) Emergency Medical Services complaint against the EMT or paramedic other than
System - means the arrangement of personnel, the impairment.
facilities and equipment for the effective and (29) Improve - means to advance or
coordinated delivery of EMS required in prevention make better the existing quality of prehospital EMS
and management of incidents occurring either as a activities or services, or to decrease patient
result of a medical emergency, injury, natural mortality or morbidity.
disaster or similar situation. (30) In- hospital Trauma Alert - means
(18) Emergency Medical Technician an alert issued by the SATC or SAPTRC to all
(EMT) or Paramedic Training Course - means any trauma team members to respond to the
single course of study conducted under an EMT or emergency department to meet the trauma alert
paramedic training program authorized by the patient at the time of, or before, the patient's •
department. arrival at the SATC or SAPTRC. This alert is issued
(19) Emergency Trauma Interhospital immediately by hospital designated personnel after
Transfer - means the transportation of a trauma the SATC or SAPTRC is notified by EMS that a
patient, by a permitted ground or air ambulance, as trauma alert patient is en route to the SATC or
rapidly as possible from a hospital which has SAPTRC or a trauma alert patient presents to the
provided emergency care, to a hospital, SATC or emergency department without prior notification.
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(31) Injury Severity Score (ISS) - (41) Prehospital Air Ambulance Service
means the sum of the squares of the highest AIS- means any service which provides emergency
90 code in each of the three most severely injured medical transport of a patient by air ambulance
• body regions. The method for computing ISS is from the scene of an incident, injury or illness to an
found in the "Abbreviated Injury Scale 1990 appropriate health care facility.
Revisions." (42) Run Report means the written
(32) Interfacility Air Ambulance Service record described in section IOD- 66.060, F.A.C.
- means any air ambulance service which provides (43) Semi - automatic Defibrillator -
inter - hospital, hospital to other health care facility means a cardiac defibrillator that is capable of
licensed under chapter 393, 395, or 400, FS., or rhythm analysis, but requires user action in order to
similar transport. deliver a countershock after the presence of cardiac
(33) Licensed Air Ambulance - means arrhythmia is detected. The semiautomatic
any permitted fixed -wing or rotary-wing aircraft defibrillator shall be capable of continuous recording
used for, or intended to be used for, air of the electrocardiogram at the scene and shall be
transportation of sick or injured persons who may capable of producing a hard copy of the
need medical attention during transport. electrocardiogram.
(34) Non- Transport Vehicle - means (44) Training Program - means a single
any vehicle operated with the intent to provide ALS program designed and organized for the purpose of
stabilization on scene, but not intended as the conducting one or more EMT or paramedic training
vehicle that will actually transport the patient. courses having one designated program director,
(35) Pediatric Trauma Alert Patient - one designated medical director, a single budget
means a trauma alert patient with anatomical and entity and a single advisory committee.
physical characteristics of a person 15 years or (45) Trauma - means a blunt,
younger. penetrating or burn injury caused by external force
(36) Pediatric Trauma Patient - means or violence.
a trauma patient with anatomical and physical (46) Trauma Agency - means the
characteristics of a person 15 years of age or department approved entity responsible for the
younger. operation and administration of an organized
(37) Plan - means a written program of system of trauma medical services in a defined
proposed action for the purpose of establishing and geographic area. The agency may be established
administering a trauma system. and operated by a county or counties or an entity
(38) Provisional State - Approved with which the county or counties contracts for the
Pediatric Trauma Referral Center (PSAPTRC) - purposes of local trauma medical services
means a hospital licensed under chapter 395, FS., administration.
which submits an application indicating that the (47) Trauma Alert - means a
hospital meets the requirements provided in notification initiated by EMS informing a hospital
sections 10D- 66.108 and .109, F.A.C., and is that they are en route with a patient meeting the
approved by the department to provide pediatric trauma alert criteria in section 10D- 66.102, F.A.C.
trauma care services until approval or denial as a (48) Trauma Alert Patient - means a
SAPTRC. person whose primary physical injury is a blunt,
(39) Provisional State - Approved penetrating or burn injury, and who meets one or
Trauma Center (PSATC) - means a hospital licensed more of the criteria in section 1013- 66.102, F.A.C.
under chapter 395, FS., which submits an Whenever reference is made to a trauma alert
application indicating that the hospital meets the patient, it includes a pediatric trauma alert patient.
requirements provided in sections 10D- 66.108 and (49) Trauma Patient - means any
.109, F.A.C., and is approved by the department to person who has incurred a physical injury or wound
• provide trauma care services until approval or denial caused by trauma and who has accessed an
as a SATC. emergency medical services system.
(40) Prehospital Air Ambulance - (50) Trauma Registry - means a
means any aircraft used to conduct patient statewide database which integrates medical and
transports from the scene of an incident, injury or system information related to trauma patient
illness of a patient to an appropriate health care diagnosis and the provision of trauma care by
facility. prehospital, hospital, SATC, SAPTRC, providers and
medical examiners. The data is used to monitor
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trauma patient outcomes and SATCs and SAPTRCs (2) The department shall , issue a
substantial compliance with sections 395.031, license to any applicant who has:
395.032, 395.033, 395.034, 395.035, 395.036, (a) Paid the required fees.
395.037, FS., and these rules. (b) Met the vehicle, equipment,
(51) Trauma Service Area (TSA) - personnel and service requirements of chapter 401, •
means a geographic area designated by chapter part III, FS., and these rules.
395, FS., for the purpose of developing a system of (c) Furnished evidence of insurance
SSTCs and SSPTRCs. coverage for claims arising out of injury or death of
(52) Trauma System - means the persons and damage to the property of others
organization and utilization of personnel, facilities, resulting from any cause for which the owner of
and equipment for the purpose of providing said business or service would be liable. The
effective and coordinated trauma care. applicant shall provide insurance in such sums and
(53) Trauma Transport Protocols under such terms as required in section
(TTPs) - means a document which describes the 10D- 66.061, F.A.C.
policies, processes and procedures governing the (d) Staffed vehicles in accordance
dispatch of vehicles, and the triage and transport of with the standards established in chapter 401, part
trauma patients or pediatric trauma patients. III, FS. Every ambulance in which a patient is being
(54) Water Ambulance - means any transported shall have in addition to the driver at
privately or publicly owned nautical vessel that is least one certified EMT attending the patient.
designed, constructed, reconstructed, maintained, (e) Obtained a certificate of public
equipped or operated for the primary purpose of convenience and necessity (COPCN) from the
transportation of sick or injured people who need, governing body of each county in which the
or are likely to need, in transit medical attention. applicant maintains a service location.
(f) Obtained department approval of
Specific Authority 381.0001, 381.0205, trauma transport protocols, as required in section
381.704, 395.0146, 395.018, 395.031, 10D- 66.100, F.A.C.
395.032, 395.033, 395.0335, 395.034, (3) Licenses issued in accordance
395,035, 395.036, 395.037, 401.121, 401.35, with the provisions of this section will
409.901- 409.920 FS. Law Implemented automatically expire 2 years after the date of
381.0001, 381.0205, 381.704, 395.0146, issuance.
395.018, 395.031, 395.032, 395.033, (4) To renew a BLS license, the
395.0335, 395.034, 395,035, 395.036, applicant shall submit to the department HRS Form
395.037, 401.25, 401.27, 401.35, 409.901- 631B, February 89, Basic Life Support License
409.920 FS. History New 11- 29 -82, Amended 4- Application; HRS Form 631C, February 85,
26 -84, 3- 11 -85, 11 -2 -86, 4- 12 -88, 8 -3 -88, 8 -7- Emergency Medical Services Vehicle Roster; HRS
89, 6 -6 -90, Formerly 10D- 66.485, Amended 12- Form 631D, November 90, Ground Personnel
10 -92. Roster; and, a copy of the applicant's up -to -date
trauma transport protocols, so as to be received at
10D- 66.049 Basic Life Support Service License least 60 days but no more than 90 days prior to the
- Ground. expiration of the license. Any applicant for license
renewal whose application is received by the
(1) Any person desiring to provide department less than 60 days before, but prior to
BLS transport service must first obtain a license the expiration date of the license shall pay an
pursuant to this section prior to operation. To administrative fine of $50 in addition to any license
obtain a license each applicant shall submit an fees. The requirements for renewal of the license
application to the department on HRS Form 631B, shall be the same as the requirements of sections
February 89, BLS License Application; HRS Form 10D- 66.049(1)(2)(3), F.A.C., and shall include a •
631C, February 85, Emergency Medical Services statement attesting whether or not the provider
Vehicle Roster; and, HRS Form 631D, November meets the requirements for operation provided by
90, Ground Personnel Roster. Each of these forms these rules and chapter 401, part III, FS.
are incorporated by reference and are available from (5) A medical director employed by
the department. The applicant shall submit with its the BLS applicant or contracting with the BLS
application an up -to -date copy of the applicant's applicant shall review and approve the proposed
TTPs as required in section 10D- 66.100, F.A.C. TTPs prior to submission for department approval.
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Any provision of this chapter to the contrary not (3) Each ALS provider shall employ or
withstanding a BLS applicant employ or contract contract with a medical director prior to licensure
with a medical director. and continuously thereafter. It is the responsibility
• (6) Each BLS provider shall ensure of the ALS provider to provide evidence to the
and document in its employee records that each of department that it has employed or contracted with
its EMTs and paramedics hold a current certification a medical director, such as a copy of a currently
from the department and are trained in the use of executed contract.
the trauma scorecard methodology as provided in (4) Each ALS provider shall provide
section 10D- 66.102, F.A.C. evidence to the department of authorization to have
(7) Each BLS Provider shall be in access to controlled substances, such as a copy of
continuous operation providing 24- hour - per -day, 7- the current registration of the medical director or
day - per -week BLS transportation services within 30 pharmacist, with the U.S. Department of Justice,
days of its receipt from the department of its initial Drug Enforcement Administration (DEA), for each
(first) license to operate as a BLS provider. location where controlled substances are stored,
(8) Except as provided for in section excluding vehicles operated by the provider.
10D- 66.052, F.A.C. and section 401.252, FS., a (5) The medical director of the ALS
BLS provider shall not transport a patient receiving provider will function in accordance with section
ALS care in a BLS permitted ambulance from the 10D- 66.0505, F.A.C.
emergency scene to a hospital or other facility. (6) Each ALS provider shall ensure
and document in its employee records that each of
Specific Authority 381.001 1, 395.031, 395.032, its EMTs or paramedics hold a current certification
395.033, 395.0335, 395.034, 395.035, from the department and are trained in the use of
395.036, 395.037, 401.23, 401.24, 401.25, the trauma scorecard methodology as provided in
401.26, 401.27, 401.281, 401.30, 401.34, rule 10D- 66.102, F.A.C.
401.35, 401.41, 401.411 FS. Law Implemented (7) Each ALS provider shall ensure
381.0011, 395.031, 395.032, 395.033, that a current copy of all standing orders authorized
395.0335, 395.034, 395.035, 395.036, by the medical director are available in each of the
395.037, 401.23, 401.24, 401.25, 401.26, provider's vehicles; for review by the department;
401.27, 401.281, 401.30, 401.34, 401.35, to each of the provider's paramedics; and supplied
401.41, 401.411 FS. History-New 11- 29 -82, to each physician designated by the medical
Amended 4- 26 -84, 3-11-85, Formerly 10D- 66.49, director to receive a copy.
Amended 4- 12 -88, 8 -3 -88, 12- 10 -92. (8) Each ALS provider shall staff each
ALS permitted vehicle in use with a minimum of
10D- 66.050 Advanced Life Support Service two individuals; one of whom shall be a paramedic
License - Ground. or licensed physician who shall attend the patient
throughout transport, the other shall be certified as
(I) Any person desiring to provide a paramedic, EMT, or licensed physician.
ALS transport service must first obtain a license (9) Each ALS provider shall be in
pursuant to this section prior to operation. To continuous operation providing 24- hour - per -day, 7-
obtain a license each applicant for an ALS license day - per -week ALS transportation services within
shall submit to the department HRS Form 1037, 30 days of its receipt from the department of its
March 88, Advanced Life Support Service License initial license to operate as an ALS provider.
Application, which is incorporated by reference and (10) Except as provided for in section
available from the department; HRS Form 631C, 10D- 66.052, F.A.C. and section 401.252, FS., an
February 85, Emergency Medical Services Vehicle ALS provider shall not transport a patient receiving
• Roster; HRS Form 631D, November 90, Ground ALS care in a BLS permitted ambulance from the
Personnel Roster; and, a copy of the applicant's up- emergency scene to a hospital or other facility.
to -date trauma transport protocols, as required by 01) The medical director may
section 10D- 66.100, F.A.C. authorize an EMT instead of the paramedic or
(2) The department shall issue a licensed physician to attend a BLS patient on an
license to any applicant who meets the ALS permitted ambulance under the following
requirements in this section and sections conditions:
10D- 66.049(2)(a), (b),(c),(e) and (f), F.A.C. (a) The medical director determines
what type of BLS patient may be attended by an
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EMT and develops standing orders for use by the pro -rated ALS licensure fee. The pro -rated ALS
EMT when attending the type of BLS patients license will be valid for the balance of the BLS
identified. The on -scene paramedic shall conduct licensure period and will then automatically expire.
the primary survey of the patient to determine if (16) A licensed ALS service which also
the patient's condition meets the criteria in the conducts BLS services shall be required to pay only •
standing orders for BLS care. This survey shall be the license fee for an ALS service together with
documented on the run report and shall identify by applicable vehicle permit fees.
name the paramedic who conducted the survey.
(b) The run report for any patient Specific Authority 381.001 1, 395.031, 395.032,
transport must clearly state whenever an EMT 395.033, 395.0335, 395.034, 395.035,
attends the patient. 395.036, 395.037, 401.23, 401.24, 401.25,
(c) The provider shall maintain 401.26 401.265, 401.27, 401.281, 401.30,
documentation of compliance with the above 401.34, 401.35, 401.41, 401.411 FS. Law
requirements on file and accessible for review by Implemented 381.001 1, 395.031, 395.032,
the department. 395.033, 395.0335, 395.034, 395.035,
(12) To renew an ALS license, the 395.036, 395.037, 401.23, 401.24, 401.25,
applicant shall submit to the department, HRS Form 401.26, 401.27, 401.281, 401.30, 401.34,
1037, March 88, Advanced Life Support License 401.35, 401.41, 401.411 FS. History - New
Application; HRS Form 631C, February 85, 11- 29 -82, Amended 4- 26 -84, 3- 11 -85, Formerly
Emergency Medical Services Vehicle Roster; HRS 1013- 66.50, Amended 4- 12 -88, 8 -3 -88, 8 -7 -89,
Form 631D, November 90, Ground Personnel 12- 10 -92.
Roster; and, a copy of the applicant's up -to -date
trauma transport protocols, as required in section 10D- 66.0501 Medications, Fluids and Controlled
10D- 66.100, F.A.C., so as to be received at least Substances Inventory, Storage and Security
60 days but no more than 90 days prior to the Procedures.
expiration of the license. Any applicant for license
renewal whose application is received by the (1) It is the responsibility of each ALS
department less than 60 days before, but prior to and each air ambulance provider to secure, against
the expiration date of the license, shall pay an unauthorized entry, the areas where medications,
administrative fine of $50 in addition to any license fluids and controlled substances are stored.
fees. The requirements for renewal of the license Security procedures shall include:
shall be the same as the requirements of section (a) All I.V. fluids and medications
10D- 66.050(1) through (10), F.A.C., and shall- shall be stored in an area of the establishment that
include a statement attesting whether or not the is secured by a locking mechanism.
provider meets the requirements for operation (b) Controlled substances shall be
provided by these rules and chapter 401, part III, stored only at locations for which the medical
FS. director is registered with the U.S. Department of
(13) Licenses issued in accordance Justice, DEA.
with the provisions of this section will (c) All controlled substances shall be
automatically expire 2 years after the date of stored in a locked container within an area of the
issuance. establishment that is secured by a locking
(14) Security of medications, fluids and mechanism.
controlled substances shall be maintained by each (d) Only state licensed paramedic,
ALS provider. Security procedures shall be nurse, pharmacist, physician employees of the
approved by the medical director and be in provider, or the medical director designee as
compliance with chapters 499, and 893, FS., and specified in writing, shall have access to controlled
section 1013- 66.0501, F.A.C. Medication inventory substances. •
techniques and schedules shall be maintained in (e) The provider shall examine all
compliance with all applicable federal and state items no less than once a month and shall remove
drug laws and as provided in section 1013- 66.0501, any deteriorated item, and any item which has
F.A.C. exceeded its expiration date.
(15) A licensed BLS service that (f) The provider shall maintain a
upgrades to an ALS licensed service may use the quarantine area for all items which are deteriorated,
remainder of the BLS licensure period to calculate a outdated, misbranded, adulterated or otherwise
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unfit for use. This area shall be separate and apart The log shall have consecutively and permanently
from other areas where the same type items are numbered pages. Any errors made in the log, or
stored so that products therein shall not be any pages discovered missing, shall be reported
• confused with usable products. Security immediately to the shift supervisor, the service
procedures for quarantined medications, fluids and director, and the medical director. The log shall
controlled substances shall be the same as for specify:
usable supplies. (a) The vehicle or unit number.
(g) The provider shall maintain a (b) The name of the employee
written log to include date of inventory, quantities conducting the inventory.
of any addition or deletion from stock, and the (c) The date and time of the
legible name of the person completing the inventory.
inventory. (d) The name; weight, volume, or
(2) Each ALS or air ambulance quantity; and expiration date of each controlled
provider shall ensure that all medications, fluids, substance.
and controlled substances are stored under such (e) The run report number (if
conditions that ensure appropriate sanitation, applicable).
temperature and ventilation and are in an area of (f) Each amount administered.
the establishment offering space to ensure (g) The printed name and signature of
adequate, safe, and accurate handling of each of the administering paramedic or other authorized
these items. licensed professional.
(3) Evidence of compliance with the (h) The printed name and signature of
requirements listed in (1) and (2) above shall a person witnessing the disposal of each unused
include, but not be limited to, written operating portion.
procedures signed by the medical director for the (5) All controlled substances shall be
storage, handling, use and disposal of all controlled kept in an interior or exterior locked compartment
substances, medications, and fluids. These of the vehicle, at a minimum locked in the patient
procedures shall include, at a minimum, storage compartment itself. All van and walk through
procedures and inventory schedules for stocking of model vehicle doors shall be kept locked to secure
drugs and fluids and security procedures for the patient compartment. The vehicle may be
controlled substances kept in stock and on the unlocked when responding to a call for service to
vehicles. Written operating procedures for the avoid any delay in patient treatment at the scene.
security of controlled substances stored on the An acceptable alternative is to seal each controlled
premises and in any vehicle of the provider shall substance in an impenetrable container before that
include: controlled substance is assigned to a vehicle. The
(a) Who, by position, has access to seal shall be broken only if a need arises during a
the controlled substances. call. The container shall then be returned for
(b) Shift change inventory procedures restocking and resealed before being issued again.
for all controlled substances carried on any vehicle Each controlled substance shall be removed from
of the provider. any vehicle to which a crew is not assigned.
(c) Documentation of the use, (6) Each ALS and air ambulance
disposal of excess, and resupply of controlled provider shall obtain controlled substances through
substances carried on any vehicle of the provider. only its medical director and shall maintain records
(d) How each discrepancy found on file at each location where the provider
during the inventory is to be handled and reported. maintains a controlled substance excluding
(e) The medical director shall vehicles. All required inventories and records shall
• authorize the amounts of controlled substances to be maintained for at least 2 years from the date of
be carried on board any vehicle. such inventory or record. The record of each
(4) Each ALS or air ambulance Schedule II substance (as outlined in chapter 893,
provider shall maintain a written log in each vehicle FS.), such as morphine, shall be maintained
for inventory of each controlled substance placed separately from all other records of the provider.
on or removed from any vehicle. An inventory shall The inventory and record of each Schedule III and
be conducted at the beginning and end of each shift each Schedule IV substance (as outlined in chapter
of the individual responsible for drug security during 893, FS.), such as Valium, shall be maintained
that shift and for each instance of use during a call. either separately from all other records of the
7
provider or in such a form that the information of the aeromedical requirements of patients and
required is readily retrievable from the ordinary shall evaluate each patient in person or by written
business records of the provider. The provider shall protocol prior to each interfacility transfer flight for
maintain complete, accurate and up -to -date records the purpose of determining that the aircraft, flight
for each controlled substance that is received, and medical crew, and equipment meet the •
delivered or otherwise disposed of by the provider. patient's needs.
(c) A medical director shall be from a
Specific Authority 381.001 1, 395.031, 395.032, broad -based medical specialty such as emergency
395.033, 395.0335, 395.034, 395.035, medicine, internal medicine, anesthesiology, or
395.036, 395.037, 401.23, 401.24, 401.25, other surgical specialty, with demonstrated
401.26, 401.27, 401.281, 401.30, 401.34, experience in prehospital care and hold an ACLS
401.35, 401.41, 401.411, 499.005, 499.006, certificate of successful course completion or be
499.007, 499.066, 499.067, 893.03, 893.04, board certified in emergency medicine. Prehospital
893.05, 893.07, 893.09, 893.13 FS. Law care experience shall be documented by the
Implemented 381.001 1, 395.031, 395.032, provider.
395.033, 395.0335, 395.034, 395.035, (d) A medical director shall
395.036, 395.037, 401.23, 401.24, 401.25, demonstrate and have available for review by the
401.26, 401.27, 401.281, 401.30, 401.34, department documentation of active participation in
401.35, 401.41, 401.411, 499.005, 499.006, a regional or statewide physician group involved in
499.007, 499.066, 499.067 FS. History-New 12- prehospital care.
10 -92. (4) Duties and Responsibilities of the
Medical Director:
10D- 66.0505 Medical Direction. (a) Supervise and accept direct
responsibility for the medical performance of the
(1) Each ALS, BLS or air ambulance paramedics and EMTs working for emergency
provider shall maintain on file for inspection and medical services providers.
copying by the department its current contract for a (b) Develop medically correct
medical director by which it employs or standing orders or protocols which permit specified
independently contracts with a physician qualified ALS and BLS procedures when communication
pursuant to this section to be its medical director. cannot be established with a supervising physician
(2) There is no standard format for a or when any delay in patient care would potentially
medical director's contract, however, in drafting threaten the life or health of the patient. The
such an instrument, the following provisions may medical director shall issue standing orders and
be addressed: protocols to the provider to ensure that the provider
(a) Name and relationship of the transports each of its patients to facilities that offer
contracting parties. a type and level of care appropriate to the patient's
(b) A list of contracted services medical condition if available within the service
inclusive of medical direction, administrative region. The medical director or his appointee shall
responsibilities, professional membership, basic and provide continuous 24- hour - per -day, 7- day -per-
advanced life support review responsibilities, and week medical direction which shall include in
reporting requirements. addition to the development of protocols and
(c) Monetary consideration inclusive standing orders, direction to personnel of the
of fees, expenses, reimbursement, fringe benefits, provider as to availability of medical director
clerical assistance and office space. "off -line" service to resolve problems, system
(d) Termination clause. conflicts, and provide services in an emergency as
(e) Renewal clause. that term is defined by section 252.34(2), FS.
(f) Provision for liability coverage. (c) Develop and implement a patient •
(g) Effective dates of the contract. care quality assurance system to assess the
(3) Qualifications: medical performance of paramedics and EMTs. The
(a) A medical director shall be a medical director shall audit the performance of
Florida licensed M.D. or D.O. system personnel by use of a quality assurance
(b) In addition to all other provisions program to include but not limited to a prompt
applicable to medical directors in this rule, an air review of run reports, direct observation, and
ambulance medical director shall be knowledgeable comparison of performance standards for drugs,
8
equipment, system protocols and procedures. The jm) Participate as a crew member on
medical director shall be responsible for an EMS vehicle for a minimum of 10 hours per year
participating in quality assurance programs and complete a minimum of 10 hours per year of
• developed by the department, continuing medical education related to prehospital
(d) With the exception of BLS medical care or teaching or a combination of both.
directors each ALS or air ambulance service (n) If he is a medical director of a
medical director shall possess proof of current training program:
registration as a medical director, either individually 1. Be responsible for the instruction
or through a hospital, with the U.S. Department of of the Department of Transportation (DOT)
Justice, DEA, to provide controlled substances to approved training program for EMTs and
an EMS provider. DEA registration shall include paramedics.
each address at which controlled substances are 2. Have substantial knowledge of the
stored. Proof of such registration shall be qualifications, training, protocols, and
quality
maintained on file with each ALS or air ambulance assurance programs for the training facility.
provider and shall be readily available for 3. Maintain current instructor level
inspection. training in advanced cardiac life support (ACLS) or
(e) Ensure and certify that security advanced trauma life support (ATLS), maintain
procedures of the EMS provider for medications, provider level training in basic trauma life support
fluids and controlled substances are in compliance (BTLS) or prehospital trauma life support (PHTLS);
with chapters 499 and 893, FS., and section 10D- or advanced pediatric life support (APLS).
66.0501, F.A.C. 4. Act as a liaison between training
(f) Create, authorize and ensure centers, local EMS providers and hospitals.
adherence to, detailed written operating procedures 5. Participate in state and local
regarding all aspects of the handling of quality assurance and data collections programs.
medications, fluids and controlled substances by 6. The EMS training center shall by
the provider. contract, require such medical director to be
(g) Notify the department in writing available 4 hours per month for classroom teaching
when the use of telemetry is not necessary. or review of student performance, be available for
(h) Notify the department in writing 4 hours per month for EMS provider field time,
of each substitutions by the EMS provider of participate as a crew member on an EMS vehicle
equipment or medication. for a minimum of 10 hours per year, and complete
(i) Assume direct responsibility for: a minimum of 10 hours per year of continuing
the use by an EMT of an automatic or medical education related to prehospital care or
semi - automatic defibrillator; the performance of teaching or a combination of both.
esophageal intubation by an EMT; and on routine 7. Participate in the recruitment,
interfacility transports, the monitoring and selection, and orientation of instructors and
maintenance of non - medicated I.V.s by an EMT. preceptors.
The medical director shall ensure that the EMT is 8. Participate in student selection,
trained to perform these procedures; shall establish mid -term evaluation and final practical examination
written protocols for the performance of these of students.
procedures; and shall provide written evidence to
the department documenting compliance with Specific Authority 395.031, 395.032, 395.033,
provisions of this paragraph. 395.0335, 395.034, 395.035, 395.036,
(j) Review, and if appropriate, 395.037, 401.23, 401.24, 401.25, 401.26,
approve a 30 -hour EMT refresher course for which 401.261, 401.265, 401.27, 401.281, 401.30,
the medical director is contracted. 401.34, 401.35, 401.41, 401.411, 499.005 FS.
(k) Ensure that all EMTs and Law Implemented 395.031, 395.032, 395.033,
paramedics are trained in the use of the trauma 395.0335, 395.034, 395.035, 395.036,
scorecard methodology as provided in section 395.037, 401.23, 401.24, 401.25, 401.26,
10D- 66.102, F.A.C. 401.261, 401.265, 401.27, 401.281, 401.30,
(1) Develop and revise when 401.34, 401.35, 401.41, 401.411, 499.005 FS.
necessary TTPs for submission to the department History-New 8 -7 -89, Amended 6 -6 -90, 12- 10 -92.
for approval.
10D- 66.051 Air Ambulances.
9
(1) Any person desiring to provide air
ambulance services shall prior to operation obtain a
license from the department. To obtain such
license, each applicant for an air ambulance license .
shall pay the required fee and submit an application
to the department on HRS Form 1575, January 89,
Application for Air Ambulance Licensure; HRS Form
631F, April 84, Emergency Medical Services
Aircraft Roster; and HRS Form 631E, June 86, Air
Ambulance Personnel Roster, which are
incorporated by reference and available from the
department. If the applicant operates or intends to
operate prehospital or interfacility rotary wing
aircraft, the applicant shall submit a copy of the
applicant's up -to -date trauma transport protocols as
required in section 1013- 66.100, F.A.C. The air
ambulance license shall automatically expire 2
years from the date of issuance.
(2) The department shall issue a
license to each applicant meeting the requirements
established in this section and chapter 401, FS.
Each air ambulance provider shall designate that the
service qualifies as either an interfacility service, a
prehospital service, or both. If interfacility, the
designation shall further state whether the service
is fixed wing, rotary wing, or both. Prior to
operation, the applicant shall also obtain a permit
for each of its aircraft and each permitted aircraft
shall be designated as fixed wing, or rotary wing.
(3) Each air ambulance provider shall
employ or contract with a medical director who
shall be qualified as specified in and shall function
in accordance with section 10D- 66.0505, F.A.C.
The provider shall maintain on file for inspection
and copying by the department its current contract
for a medical director.
(4) Security of medications, fluids and
controlled substances shall be maintained by each
air ambulance provider. Security procedures shall
be approved by the service's medical director and
be in compliance with chapters 499, and 893, FS.,
and section 10D- 66.0501, F.A.C. Medication
inventory techniques and schedules shall be
maintained in compliance with all applicable federal
and state drug laws as provided in section 10D-
66.0505, F.A.C.
(5) Each provider shall provide air
ambulance service 24- hour - per -day, 7- day - per -week
within 30 days after receipt from the department of
its initial license to operate as an air ambulance.
(6) Each air ambulance shall meet the
structural, equipment and supply requirements
listed in Table I.
10
TABLE I
• (Reference Section 10D- 66.051(3)(a))
AIR AMBULANCE
Structural, Equipment and Supply Requirement
ITEM QTY.
1. Entrance large enough to allow
safe loading of a patient on a
stretcher without rotating more
than 10 degrees about the
longitudinal axis or 45 degrees
about the lateral axis.
2. Interior large enough for two
medical crew members in the area
where the patient shall be attended
during the flight. Accessible
storage or supplies and medical
equipment, and adequate space
for patient to receive proper
care.
3. Cabin illumination of 40
foot- candles at patient level.
4. Stretcher with two patient
securing straps. Stretcher
installation including points
of attachment of the stretcher
to the aircraft, the stretcher
itself and the straps attaching
the patient to the stretcher
must meet FAR Part 23 restraint
requirements. One per patient.
5. Emesis basins. Two.
6. Bags for air sickness. Four.
7. Blankets. Available on an as needed basis.
8. Pillow with waterproof cover
and pillow case. Available on an as needed basis.
9. Sheets. Two per patient.
10. Urinal and one bedpan. Available on an as needed basis.
11. Communication capability- -Each
aircraft shall be equipped with
communication equipment that
meets FAA approval and is operated
on frequencies licensed by the
FCC. This equipment shall function
so that the medical attendant can
communicate at all times during the
flight with ground medical facilities
exclusive of the air traffic control
radio system.
12. No smoking sign. One.
11
13. Cardiac backboard. One.
14. Oxygen sufficient for duration
of flight. All necessary
regulators, gauges A minimum of two
and humidity accessories to separate containers, one •
deliver oxygen. of which shall be
portable.
15. Oxygen administration equipment. Adequate length tubing
and masks, transparent
and non - rebreathing in
adult, child and infant
sizes. Two each.
16. Oropharyngeal airways. Assorted sizes.
17. Hand operated bag -valve mask
resuscitators, with accumulator
including adult, child and
infant transparent masks, capable
of use with supplemental One adult and one
oxygen. pediatric.
18. Portable suction unit with wide
bore tubing and tips, electric or
gas powered, which meets the minimum
standards as published by the General
Services Administration (GSA) in
KKK-A-1 822C specifications.
19. Equipment suitable to determine
blood pressure of the adult and
pediatric patient during the flight.
20. Approved biohazardous waste
plastic bag or impervious
container and sharps container
per chapter 10D -104, F.A.C. One Each.
12
(7) Each prehospital air ambulance
service applicant shall obtain a COPCN from the
governing body of each county in which the
• applicant maintains a service location. Each
applicant may operate in other counties upon
request of the licensed EMS provider responsible for
the jurisdictional area within the requesting county
or by entering into a mutual aid agreement
approved by the county. This does not prohibit a
licensed air ambulance service provider from
crossing county lines in response to mass casualty
incidents or periodically assisting service providers
in other counties when requested by the other
county provided that the provider is able to respond
in a timely manner.
(8) Each provider shall ensure and
shall document in its employee records that each
EMT and paramedic which it employs holds a
current certification from the department and is
trained in the use of the trauma scorecard
methodology as provided in section 10D- 66.102,
F.A.C.
(9) Each prehospital rotary wing air
ambulance shall meet the requirements listed in
Table II.
(10) Each service that operates a
prehospital or interfacility rotary wing aircraft shall
obtain department approval of TTPs.
is
13
TABLE II
(Reference Section 10D- 66.051)
Prehospital Rotary Wing Air Ambulances •
ITEM QTY.
A. General Requirements: Each
rotary wing air ambulance
shall:
1. Provide headset
communication between pilot
and all medical crew;
2. Have an external search
light with a minimum of 400,000
candlepower illumination at 200
feet, separate from the aircraft
landing lights, movable 90 degrees
longitudinally, and 180 degrees
laterally, and capable of being
controlled from inside the
aircraft;
3. Be kept clean and orderly
in the patient and medical supply
areas; and,
4: Be staffed with at least one
paramedic or physician.
B. Prehospital Requirements:
1. Multitrauma dressings. Two.
2. ABD pads. Four.
3. Sterile gauze pads. Fifteen.
4. Adhesive tape. Assorted sizes.
5. Bite sticks or blocks. Two.
6. Triangular bandages. Three.
7. Patient restraints, both
wrist and ankle. One each.
8. Soft roller bandages. Four.
9. Bandage shears. One.
10. Patient rain cover. One.
11. Long spine board and
three straps.(or equivalent) One.
12. Short spine board and two
straps or equivalent. One.
13. Extremity immobilization
devices, including any device •
that immobilizes the joint
above and below the fracture
and shall include splints to
immobilize all long bone injuries.
14. Lower extremity traction
splint with support sling and
ankle strap. One.
14
15. Sterile obstetrical kit. One.
16. Burn sheets. Two.
• 17. Flashlight, minimum two D
cells. One.
18. Compartmentalized pneumatic
trousers in adult and pediatric
sizes. Acceptable equivalent of
the pediatric size may be an
additional adult size, if the
adult size is manufactured to be
downsized to a pediatric size. One each.
19. Vaseline gauze. Minimum of four.
20. D.C. battery powered portable
monitor - defibrillator with EKG
printout and, when applicable,
spare battery. One.
21. Butterfly or scalp vein
needles between 19 and 25 gauge. Total of six.
22. I.V. cannulae between 14
and 22 gauge. Eight.
23. Macro drip sets. Two.
24. Micro drip sets. Two.
25. Needles between 18 and 25
gauge. Six.
26. Tourniquets Three.
27. Laryngoscope handle with
batteries. One.
28. Laryngoscope blades; adult,
child and three infant sizes. Five.
29. Disposable endotracheal
tubes; adult, child and infant
sizes. Six (2 each; 3.0 mm - 5.0
mm, 2 each; 5.5 mm - 7.0
mm, 2 each; 7.5 mm, - 11.0 mm).
30. Suitable equipment and
supplies to allow for the
collection and temporary
storage of two blood samples.
31. Syringes. Two 1 ml., two 2 1/2 or
3 ml., and four 10 ml.
32. Telemetry capability is
required on board any prehospital
air ambulance unless all of the
following are met:
• a. The medical director
determines that telemetry
is not necessary.
b. The monitor - defibrillator
equipment utilized by the
provider has the capability
of producing a hard copy of
patient's EKG.
C. The hard copy shall be
15
available to the provider's
medical director.
d. The provider notifies the
department in writing and
provides documentation, signed •
by the provider's medical director,
stating his approval.
33. I.V. pressure infuser. One.
34. Standing orders.
35. Positive locking devices
for I.V. containers. Two.
36. Approved biohazardous waste One Each.
plastic bag or impervious
container and used sharps
container per chapter 1013-104,
F.A.C.
37. Gloves - latex or other Sufficient quantity
suitable material - readily for all crew members.
available on the unit for
all crew members.
38. Respiratory Face Masks - Sufficient quantity
readily available on the unit for all crew members.
for all crew members.
39. Nasopharyngeal airways. Assorted sizes.
40. Safety Goggles or One per crew member.
equivalent meeting A.N.S.I. Z87.1
Standard.
C. Medication and I.V. Solution
Requirements:
MEDICATION WTNOL QTY.
1. Atropine sulfate .5 mg. per amp. 2 mg. Total.
Total. (4/.5 mg. amps.)
2. Dextrose 25 gm. per 50
50 percent. ml. 2.
3. Epinephrine HCL. 1:1,000 1
mg. /ml. 2.
4. Epinephrine HCL. 1:10,000 1
Mg./mi. 4.
5. Lidocaine HCL. 100 mg. per 5
MI. 2.
6. Lidocaine HCL
In any of the
following •
combinations: 2 gm. vials or 4 gms. Total.
pre - filled syringes;
or 1 gm. vials or pre -
filled syringes;
or pre -mixed solutions 2 pre -mix.
of 4 mg. per ml. in a
500 ml. bag.
16
7. Sodium Bicarbonate. 50 mEq. or 44.6.
mEg. 2 amps.
8. Naloxone (Narcan). 1 mg. /ml. 2 mg.
• amp. 2 amps.
9. Nitroglycerin tabs. 0.4 mg. /tablet or
0.4 mg. spray
pump. 1 pump sprayer.
I.V. Solutions Minimum Minimum
Amount Quantity
a. Dextrose 5 percent 2,000 ml. In any
in Water (D5W). combination.
b. Lactated Ringers 4,000 ml. In any
or Normal Saline. combination.
10. The medical director of the air ambulance
EMS provider may substitute medications listed in Table II
provided that he submits written notification to the
department. The written approval must be maintained on
file.
•
17
01) Each air ambulance provider shall (1) Anyone who acts as an agent for
possess a valid permit from the department for an air ambulance service shall be licensed as an air
each aircraft which it uses or intends to use as an ambulance service. To be licensed under this
air ambulance prior to the provider's use of that provision, applicants shall submit an application to
aircraft as an air ambulance. Application for such the department on HRS Form 1575, January 89, •
permits shall be made on HRS Form 1576, Air Ambulance Service License Application, and pay
December 87, Application for Air Ambulance the required fee.
Permit, which is incorporated by reference and (2) Each provider shall conspicuously
available from the department. The aircraft permit display the following statement in all advertising
issued by the department shall expire concurrent and promotional materials: "Air Ambulance Service
with the provider's service license. Substitute Broker."
aircraft may be used without the required permit for (3) An air ambulance service broker
a period not to exceed 30 days when the permitted shall use air ambulance services licensed by the
aircraft is out of service for aircraft maintenance. department or those exempt from licensure under
The provider must substantiate the need for such the provisions of section 401.33(3), FS.
substitution. Each provider shall maintain accurate (4) Licenses issued in accordance
records on the maintenance of all the aircraft it with the provisions of this section shall
uses for patient transport. automatically expire 2 years after the date of
(12) To renew an air ambulance issuance.
license, the applicant shall submit to the (5) To renew an air ambulance
department HRS Form 1575, January 89, Air service license, the applicant shall submit to the
Ambulance Service License Application; HRS Form department a renewal application, HRS Form 1575,
631 F, April 84, Emergency Medical Services January 89, Air Ambulance Service License
Aircraft Roster; and, HRS Form 631E, June 86, Air Application, so as to be received at least 60 days
Ambulance Personnel Roster; and, a copy of the but no more than 90 days prior to the expiration of
applicant's up -to -date TTPs, as required in section the license and pay the required fee. Any applicant
1013- 66.100, F.A.C., so as to be received at least for license renewal whose application is received by
60 days but no more than 90 days prior to the the department less than 60 days prior to the
expiration of the license, and pay the required fee. expiration date of the license shall pay an
Any applicant for license renewal whose application administrative fine of $50 in addition to any license
is received by the department less than 60 days fees. The requirement for renewal of the license
prior to the expiration date of the license shall pay shall be the same as the requirements for original
an administrative fine of $50 in addition to any licensure.
license fees. The requirements of section 10D-
66.051(1) through (11), F.A.C. and section Specific Authority 401.34, 401.35 FS. Law
401.18, FS., for renewal of the license shall be the Implemented 401.48, 401.481, 401.35, 401.25
same as the requirements for original licensure. FS. History-New 4- 12 -88, Amended 12- 10 -92.
Specific Authority 381.0011,395.031, 395.032, 10D- 66.052 Interfacility Transfers.
395.033, 395.0335, 395.034, 395.035,
395.036, 395.037, 401.23, 401.24, 401.25, (1) No person or facility of any type
401.26, 401.27, 401.281, 401.30, 401.34, shall order, arrange or conduct an interfacility
401.35, 401.41, 401.411 FS. Law Implemented transfer unless transport of the patient is done by
381.001 1, 395.031, 395.032, 395.033, an EMS provider licensed by the department in an
395.0335, 395.034, 395.035, 395.036, ambulance permitted in accordance with the level
395.037, 401.23, 401.24, 401.25, 401.26, of care (ALS or BLS) of the patient whenever the
401.27, 401.281, 401.30, 401.34, 401.35, patient needs, or is likely to need, medical attention •
401.41, 401.411 FS. History-New 11- 29 -82, during transport. Persons with heparin locks need
Amended 4- 26 -84, 3-11-85, Formerly 10D- 66.51, not be transported to or from facilities or residences
Amended 4- 12 -88, 8 -3 -88, 8 -7 -89, 12- 10 -92. by an EMS provider if the heparin lock has been
stabilized prior to transport and the person is
10D- 66.0515 Air Ambulance Service Broker. medically stable and does not need, nor is likely to
need medical attention during transport. A critical
care patient shall be transported in a permitted air
18
ambulance or ground ambulance that is staffed and I. Special procedure trays with
equipped to provide patient care as needed by the capability for performing umbilical catheterization,
patient. The sending physician and medical venous cutdown and thoracostomy.
director, where applicable, will ensure that the level (b) Each neonatal interfacility
• of patient care established in the originating transport vehicle shall be staffed with a minimum
hospital or other facility is appropriately provided of one registered nurse (RN) or paramedic; and one
for by the transporting service. registered respiratory therapist (RT) on each
(2) Interfacility neonatal intensive neonatal transport, as determined by the provider's
care transports. medical director or attending physician. A physician
(a) Each provider transferring may be substituted for either the RN, paramedic or
between facilities any neonatal patient requiring RT. The RN and RT must be qualified as follows:
intensive care shall have the following on board the 1. An RN attending the neonate, who
permitted ambulance or air ambulance used to shall: be licensed in Florida in accordance with
transport the patient: chapter 464, FS.; have a minimum of 2 years RN
1. Direct two -way communications experience, which includes 12 months of Neonatal
with the designated neonatologist or attending Intensive Care Unit (NICU) nursing experience; have
physician. American Heart Association (AHA) ACLS
2. A standby or backup power Certification or an equivalent certification gained by
source other than the one contained in the isolette. successfully completing an equivalent program
3. A source of electrical power approved in writing by a medical director; and,
sufficient to operate the isolette and ancillary accompany a minimum of two neonatal transports
electrically powered equipment. prior to staffing a neonatal transport as the only RN
4. A minimum of equipment listed in attendance.
below: 2. The RT shall be registered by the
a. An approved transport incubator National Board of Respiratory Care with a minimum
isolette with portable power supply, portable of 12 months of NICU experience or be certified as
oxygen tanks or liquid oxygen, and a source of a RT with a minimum of 3 years of NICU
compressed air, including appropriate valves, experience; have AHA ACLS Certification or an
meters, and fittings. equivalent certification gained by successfully
b. Portable heart rate monitor with completing an equivalent program approved in
visual or audible display and alarm system. writing by a medical director; and, accompany a
C. Portable blood pressure monitors minimum of two neonatal transports prior to
suitable for infants. d. Portable pressure staffing a transport as the only RT in attendance.
infuser for I.V. fluids. (3) A neonatologist responsible for
e. Battery or self - powered oxygen the transport may make medical staff substitutions
sensor and transcutaneous oxygen monitor. for any neonatal transport.
f. A device such as the oxyhood for (4) Treatment protocols for the
the administration of high concentrations of management of the patient from the responsible
oxygen. neonatologist must accompany each neonatal
g. Thermistor type temperature transport.
monitor.
h. Portable ventilator and Specific Authority 383.15 -.21, 395.031, 395.032,
self - inflating resuscitating bag and clear mask with 395.033, 395.0335, 395.034, 395.035,
sleeve and oxygen adapter for delivering high 395.036, 395.037, 401.24, 401.25, 401.26,
oxygen content. 401.27, 401.281, 401.30, 401.34, 401.35,
i. Laryngoscope and blades, 401.41, 401.411 FS. Law Implemented 383.15-
• endotracheal tubes, adapters, and airways of .21, 395.031, 395.032, 395.033, 395.0335,
appropriate sizes. 395.034, 395.035, 395.036, 395.037, 401.24,
j. Portable suction equipment 401.25, 401.26, 401.27, 401.281, 401.30,
appropriate for infants. 401.34, 401.35, 401.41, 401.411 FS. History -
k. Necessary drugs, suction cups, New 11-29-82, Amended 4- 26 -84, 3-11-85,
suction catheters, syringes, needles, sterile gloves, Formerly IOD- 66.52, Amended 4- 12 -88, 12- 10 -92.
I.V. extension tubing, adhesive tape, etc.
19
10D- 66.053 Vehicle Permits. at the ALS level, unless it is replacing a vehicle that
has been temporarily taken out of service for
(1) Every BLS transport and every maintenance. When such a substitution is made,
ALS vehicle shall possess a valid permit issued by the following information shall be maintained by the
the department. Vehicles maintained by an ALS or provider and shall be accessible to the department: •
BLS provider in a back -up or reserve status and (a) Identification of permitted vehicle
used by the provider only to replace permitted taken out of service.
vehicles taken out of service for routine (b) Identification of substitute vehicle.
maintenance or repairs for less than 14 days need (c) The date on which the substitute
not be permitted. Each application for a ground vehicle was placed into service and the date on
vehicle permit shall be on HRS Form 1510, May which it was removed from service and the date on
88, Application for Vehicle Permit. Each which the permitted vehicle was returned to
application for an aircraft permit shall be on HRS service.
Form 1576, December 87, Application for Air (4) Prior to placing a new vehicle in
Ambulance Permit. These forms are incorporated service or upgrading a vehicle's level of care (e.g.
by reference and available from the department. BLS to ALS), the provider shall first obtain a permit
All applications shall be accompanied by the from the department and affix that permit to the
required fee. All permits issued by the department vehicle's windshield.
for a vehicle pursuant to this rule shall be displayed (5) BLS and ALS vehicle permits are
by the provider on the passenger side of the not transferable.
vehicle's windshield. (6) Replacement vehicle permits may
(2) The department shall issue a be obtained by submitting a written request to the
permit to the provider when the provider initially department. The request shall include a signed
places the vehicle into service or when the provider statement by the provider certifying that the
changes the level of service relative to that vehicle. original permit has been lost, destroyed or rendered
The permit shall remain valid as long as the vehicle unusable.
is owned by the provider subject to the following (7) Each provider shall obtain a new
conditions: vehicle permit from the department prior to
(a) the provider submits a vehicle returning a vehicle to service following a chassis
permit application for the vehicle and pays the remount or a remount of the modular ambulance
required fees consistent with the provider's current body or any renovation that results in a change in
license cycle; the vehicle identification number.
(b) except as provided for in section
10D- 66.052, F.A.C., each provider shall at all Specific Authority 401.24, 401.25, 401.26,
times staff and equip the ambulance at the level of 401.27, 401.281, 401.30, 401.34, 401.35,
care (ALS or BLS) for which it is permitted, and; 401.41, 401.411 FS. Law Implemented 401.24,
(c) only the provider to which the 401.25, 401.26, 401.27, 401.281, 401.30,
initial department permit was issued shall operate 401.34 401.35, 401.41, 401.411 FS. History -
the vehicle. If ownership of any permitted vehicle New 11-29-82, Amended 4- 26 -84, 3-11-85,
is transferred to any other person or entity, the Formerly IOD- 66.53, Amended 4- 12 -88, 12- 10 -92.
permit is void and the provider shall remove the
department permit from the vehicle at the time the IOD- 66.054 Vehicle Design and Construction -
vehicle is transferred and return the permit to the Ground Vehicles.
department within 5 days of the transfer.
(3) When it is necessary for a (1) All transporting ALS or BLS
permitted vehicle to be out of service for routine ambulances shall, at a minimum, meet GSA
maintenance or repairs, a substitute vehicle specifications for ambulances unless a variance in •
meeting the same transport capabilities and accordance with 10D- 66.0635, F.A.C., is
equipment specifications as the out -of- service approved, in writing, by the department. All
vehicle may be used for a period of time not to permitted non - transport ALS vehicles and vehicles
exceed 14 days. If the substitute vehicle is in of fire service EMS providers are exempt from
service for longer than 14 days, this vehicle shall meeting the federal specifications regarding color
be permitted. An unpermitted vehicle cannot be scheme, emblems, and markings.
placed into service, nor can a BLS vehicle be used
20
(2) The department shall issue 1. Installed suction apparatus.
permits for specialty transport vehicles that do not 2. Heat and air conditioning with fan.
meet current vehicle design and construction 3. Primary stretcher and two straps.
requirements when the application for such permits 4. Auxiliary stretcher and two
• is accompanied by written justification for any straps.
noncompliance items. 5. Two permanently mounted I.V.
(3) BLS vehicles shall not have holders.
exterior wording which could be misinterpreted to 6. Two non- smoking signs; one in
represent an ALS unit, for example, "mobile the patient compartment and one in the driver's
coronary care unit" or "mobile intensive care unit ". compartment.
(4) Effective October 1, 1993, all 7. Overhead grab rail in the patient
ground vehicles permitted by the department under compartment.
these rules or subject to these rules shall have 8. Squad bench with three sets of
exterior lettering a minimum of two inches in height seat belts.
above the parallel stripe on each side of the
ambulance that identifies the name of the provider
and the unit number. The name of provider shall be
the predominant lettering on each side of the
ambulance.
(5) Each ambulance permitted by the
department under these rules may be used to
provide transportation to persons confined to
wheelchairs provided that the ambulance is
equipped with:
(a) Wheelchair locking devices
permanently affixed to the vehicle capable of
securing the wheelchair so as not to permit
longitudinal movement in excess of 2 inches
forward and backward and without any lateral
movement.
(b) Separate restraints for securing
patient in the wheelchair during transportation.
Specific Authority 401.24, 401.25, 401.26,
401.27, 401.281, 401.30, 401.34, 401.35,
401.41, 401.411 FS. Law Implemented 401.24,
401.25, 401.26, 401.27, 401.281, 401.30,
401.31, 401.34 401.35, 401.41, 401.411 FS.
History -New 1 1- 29 -82, Amended 4- 26 -84, 3 -11-
85, Formerly IOD- 66.54, Amended 4- 12 -88, 12-
10 -92.
IOD- 66.055 Ground Vehicle and Service
Standards.
(1) Equipment and Supplies.
• (a) Each ALS vehicle permitted by the
department as a non - transport unit shall be
equipped and maintained as listed in Table 111 and
Table IV.
(b) Each emergency medical service
vehicle permitted by the department as a transport
unit shall be equipped and maintained as listed in
Table III and Table IV and have in addition:
21
TABLE III
(Reference Section I013- 66.0550))
GROUND VEHICLE AND SERVICE STANDARDS •
MEDICAL EQUIPMENT AND SUPPLIES
ITEM QTY.
1. Multitrauma dressings. Two.
2. ABD pads. Six.
3. Sterile gauze pads.
4. Adhesive tape, assorted sizes.
5. Bite sticks or blocks. Two.
6. Triangular bandages. Eight.
7. Patient restraints (not required Wrist and Ankle.
for watercraft).
8. Soft roller bandages. Ten.
9. Bandage shears. One.
10. Pediatric blood pressure cuff. One.
11. Adult blood pressure cuff. One.
12. Adult stethoscope. One.
13. Pediatric stethoscope. One.
14. Blankets. Two.
15. Sheets (not required for Two.
non - transport vehicle or watercraft).
16. Pillows with waterproof covers Two.
and pillow cases (not required
for non - transport vehicle or
watercraft).
17. Patient raincover. One.
18. Long spine board and three straps. One.
19. Short spine board and two straps or One.
equivalent (not required for
watercraft).
20. Adult and Pediatric cervical Each.
immobilization devices (CID),
approved by the medical director of
the service which prevents the
anterior, posterior and lateral movement
of the head and neck region. This
approval must be in writing and made
available by the provider for the department
to review (not required for watercraft).
21. Portable oxygen tanks, "D" or "E"
cylinders, with une regulator and gauge. •
Each tank must have a minimum
pressure of 1000 psi. Two.
22. Transport oxygen masks; adult, child
and infant sizes, with tubing. Two each.
23. Sets of nasal cannulae with tubing. Two.
24. Hand operated bag -valve mask
resuscitators, adult and pediatric
22
accumulator, including adult, child
and infant, transparent masks capable
of use with supplemental oxygen.
• 25. Portable suction, electric or gas
powered, with wide bore tubing and
tips which meets the minimum standards
as published by the GSA in KKK -A 1822C
specifications. One.
26. Extremity immobilization devices,
any device that immobilizes Two each of arm,
the joint above and below the leg, hand and wrist,
fracture, must include splints foot and ankle.
to immobilize all long bone fractures.
27. Lower extremity traction splint with One.
support slings and ankle strap
(not required for watercraft).
28. Sterile obstetrical kit. One.
29. Burn sheets. Two.
30. Flashlight; minimum two "D"
cells (not required for watercraft). One.
31. Compartmentalized pneumatic (MAST) One each.
trousers, adult and pediatric sizes.
Acceptable equivalent of the pediatric
size may be an additional adult size,
if the adult size is manufactured to
be downsized to a pediatric size. A
BLS permitted vehicle is
exempt from this requirement, if
the vehicle is operating in a
two tier response system whereby
an ALS permitted vehicle is the
first responder and provides the
required MAST trousers as needed.
32. Vaseline gauze. Four.
33. Oropharyngeal airways. Assorted sizes.
34. Installed oxygen with regulator One.
gauge and wrench, minimum "m" size
cylinder (minimum 500 PSI) with
oxygen flowmeter (not required for
non - transport vehicles, watercraft and
aircraft).
35. Gloves - latex or other suitable Sufficient
material - readily available on the quantity
unit for all crew members. for all crew
members.
• 36. Face Masks - readily available on Sufficient
the unit for all crew members. quantity
for all crew
members.
37. Rigid cervical collars Assorted sizes.
which prevent the anterior,
posterior and lateral movement
of head and neck region, as
approved in writing by the
23
medical director.
38. Nasopharyngeal airways. Assorted sizes.
39. Approved biohazardous wastes One each.
plastic bag or impervious
container per chapter •
1013-104, F.A.C.
40. Safety goggles or equivalent One per crew
meeting A.N.S.I. Z87.1 standard. member.
TABLE IV
(Reference Section 1013-66-0550))
GROUND VEHICLE AND SERVICE STANDARDS
RESCUE AND EXTRICATION EQUIPMENT
ITEM QTY.
1. Triangular reflectors,
minimum 10 inches in height
or highway flares in good working
order with a minimum burning period
of 15 minutes. Three.
2. Wrench, 12 inch with
adjustable open end. One.
3. Screwdriver, 12 inch with
straight blade. One.
4. Screwdriver, 8 inch with Phillips
head. One.
5. Hacksaw with 12 inch blade, oil can
with light grade oil and extra blades. One.
6. Locking pliers, minimum 10 inch. One.
7. Three lb. hammer with a 15 inch
handle. One.
8. Fire axe with 24 inch handle. One.
9. Wrecking bar, minimum 24 inches
in length. One.
10. Partner pry-axe or haligen tool is
an acceptable substitute for
items 7, 8 and 9.
11. Crowbar, minimum 51 inch length,
with pinchpoint. One.
12. Bolt cutter, with a minimum length
of 36 inches and 9/16 inch jaw opening. One.
13. Shovel with pointed blade or folding
heavy -duty entrenching tool. One.
14. Double action tin snips. One. •
15. Rope at least one half inch in 100 feet.
diameter.
16. Hard hats, meeting A.N.S.I. Z89.1
standard. Two.
17. Safety goggles or equivalent face
shields, meeting A.N.S.I. Z87.1
standard. Two pair.
24
18. Fire blanket, minimum 60 inches X 72
inches. Blanket material shall be
flame retardant. One.
• 19. Mastic knife. One.
20. Spring - loaded center punch. One.
21. Gauntlet gloves, leather. One pair.
22. Heavy duty pruning saw. One.
•
25
(2) Rescue equipment listed in Table construction. All interior equipment shall- be clean
IV shall be carried on each vehicle. An acceptable and in good working order.
alternative to this requirement is the immediate (c) All equipment in the patient
availability, as documented in writing, of all compartment shall be safely secured, sanitary, and
equipment on a separately dispatched vehicle. This clean. •
vehicle shall be available to respond to each (d) Clean sheets shall be used for
emergency call that might require patient each patient.
disentanglement. If such a written agreement is in (e) Pillows and mattresses shall be
effect, each permitted BLS and AILS vehicle shall clean, in good repair and covered with moisture
carry the following rescue equipment: spring - loaded proof material.
center punch; partner pry-axe or equivalent; one (f) Soiled supplies shall be placed in
pair safety goggles which meet A.N.S.I. Z87.1 moisture proof covered containers, sealable plastic
standard; and, one pair leather gauntlet gloves. bags or compartments and removed from the
Each vehicle shall carry battery jumper cables, a ambulance upon the completion of the ambulance
spare tire, and equipment to change tires unless a run. Used sharps shall be placed in a container
service vehicle or a back -up unit is immediately designed for such purpose.
available as documented in writing. (g) Biohazardous waste shall be
(3) Communications. disposed according to sanitary practices prescribed
(a) Each BLS, ALS, and prehospital air in chapters 17 -712 and 10D -104, F.A.C.
ambulance providers shall possess radio 1. Biohazardous or infectious waste,
communications systems that conform to the State as defined in chapters 17 -712 and 10D -104,
EMS Communications Plan. F.A.C., means any solid or liquid waste which may
(b) Each provider shall provide and present a threat of infection to humans. The term
maintain two -way radio communications between includes, but is not limited to, non - liquid human
the provider's base station and each of its vehicles. tissue and body parts, discarded sharps containers,
(c) Each provider shall provide human blood and body fluids. Also included are
continuous telephone access to the public. The absorbent materials such as bandages, gauzes or 16
service shall dispatch, or cause to be dispatched, sponges that are supersaturated and have the
an ambulance on each emergency call. potential to drip or splash blood or body fluids.
(d) Each provider shall maintain Body fluids are those fluids that have the potential
two -way communications capability between each to harbor pathogens, such as human lymph, semen,
vehicle and at least one hospital that has a vaginal secretions, cerebrospinal, synovial, pleural,
continuously functioning emergency facility. pericardial and amniotic fluids.
(e) Telemetry capability is required of 2. Disposing of biohazardous waste
any AILS provider unless all of the following are may be done by leaving it at the hospital where it
met: can be combined with the hospital's biohazardous
1. The medical director of the waste for disposal. If this is not possible, the
provider determines that telemetry is not provider shall take the biohazardous waste to its
necessary. base station or substation and place this waste in a
2. The monitor defibrillator red plastic bag. This bag shall be labeled,
equipment utilized by the provider has the capability "BIOHAZARDOUS WASTE" or "INFECTIOUS
of producing a hard copy of a patient's EKG. WASTE" and disposed according to paragraph 3
3. The hard copy shall be available to below.
the provider's medical director. 3. Biohazardous waste shall not be
4. The provider notifies the stored longer than 30 days from the time it is
department, in writing, and provides generated before being removed to a treatment
documentation, signed by the provider's medical facility permitted by DER to accept such waste. If •
director, stating his approval. more than 25 pounds of biohazardous waste has
(4) Sanitation and Maintenance. been accumulated, it shall be transported by a
(a) All spaces used for storage of lawfully registered biohazardous transporter.
supplies shall be maintained in a clean and orderly (h) Ambulance exterior body shall be
condition. free of dents and rust which interfere with the safe
(b) Each ambulance interior shall have operation of the vehicle.
equipment which is smooth and of easily cleanable
26
(i) Each door shall open properly and
close securely with all handles in proper working
order.
• (j) Windows and windshields shall be
clean and free of cracks which impair the driver's
vision.
(k) Rear -view mirrors shall be in
proper functioning order.
(1) Exterior surfaces of the
ambulance shall be clean.
Specific Authority 401.24, 401.25, 401.26,
401.27, 401.281, 401.30, 401.34, 401.35,
401.41, 401.411 FS. Law Implemented 401.24,
401.25, 401.26, 401.27, 401.281, 401.30,
401.31, 401.34 401.35, 401.41, 401.411 FS.
History-New 11- 29 -82, Amended 4- 26 -84, 3 -1 1-
85, Formerly 10D- 66.55, Amended 4- 12 -88, 12-
10 -92.
10D- 66.0555 ALS Equipment and Medications.
(1) In addition to the equipment and
supplies listed in Tables III and IV, the medications
and I.V. solutions and equipment listed in Table V
are required on each ALS permitted vehicle.
Substitutions are allowed with signed approval from
the medical director and written notification to the
department.
•
27
TABLE V
(Reference Section 1013- 66.0555)
ALS EQUIPMENT AND MEDICATIONS •
MEDICATION WT /VOL QTY
1. Atropine Sulfate. .5 mg. per amp. 2 mg. Total.
2. Dextrose, 25 gm. per Two.
50 percent. 50 ml.
3. Epinephrine HCL. 1:1,000 1 mg. Two.
/m I.
4. Epinephrine HCL. 1:10,000 1 mg. Four.
/10CC
5. Lidocaine HCL. 100 mg. per Two.
5 ml.
6. Lidocaine HCL.
In any of the following combinations:
2 gm. vials or 4 gms. Total.
pre -mixed Two.
syringes; or
1 gm. vials or Four.
pre - filled syringes;
or pre -mixed Two.
solutions
of 4 mg. per ml.
in a 500 ml. bag.
7. Sodium Bicarbonate. 50 mEq. or 44.6 2 amps.
mEq.
8. Naloxone (Narcan). 1 mg. /ml. 2 mg. 4 mg.
amp.
9. Nitroglycerin. 0.4 mg. /tablet or 1 pump.
0.4 mg. spray pump sprayer.
(I.V.) Solutions Minimum Minimum
Amount Quantity
1. Dextrose 5 percent 2,000 ml. In any
in water (D5W). combination.
2. Lactated Ringers or 4,000 ml. In any
Normal Saline. combination.
•
EQUIPMENT QTY.
(a) Laryngoscope handle with One.
batteries.
(b) Laryngoscope blades; adult, One each.
28
child and infant sizes. One.
(c) Disposable endotracheal Six.
tubes adult, child and infant
• sizes. (2 within the range;
3mm - 5mm, 2 within the range;
5.5mm - 7mm, 2 within the range;
7.5mm - 11 mm.
(d) Tourniquets. Three.
(e) Butterfly or scalp vein Total of Six.
needles between 19 and 25 gauge
(f) I.V. cannulae between 14 Eight.
and 22 gauge.
(g) Micro drip sets. Three.
(h) Macro drip sets. Three.
(i) I.V. pressure infuser One.
(j) Needles between 18 and 25 gauge. Six.
(k) 1 ml. syringes. Two.
(1) 2 1/2 ml. to 6 ml. syringes. Six.
(m) 10 ml. to 20 ml. syringes. Four.
(n) Suitable equipment and supplies
to allow for collection and temporary
storage of two blood samples.
(o) D.C. battery powered portable One.
monitor defibrillator with EKG printout
and spare battery. Not required on
watercraft.
(p) Approved sharps container per One.
1013-104, F.A.C.
•
29
Specific Authority 401.24, 401.25, 401.26, (d) Complete the patient information
401.27, 401.281, 401.30, 401.34, 401.35, and the trauma scorecard sections of HRS Form
401.41, 401.411 FS. Law Implemented 401.24, 1728, August 91, Trauma /Head Injury/Spinal Cord
401.25, 401.26, 401.27, 401.281, 401.30, Injury Registry, which is incorporated by reference
401.31, 401.34 401.35, 401.41, 401.411 FS. and available from the department, as required in •
History-New 11-29-82, Amended 4- 26 -84, section 1013- 66.100, .102, and .103, F.A.C.
Formerly 1013- 66.555, Amended 4- 12 -88, 12 -10- (e) Deliver HRS Form 1728 August
92. 91, as required in section 1 OD- 66.100, F.A.C.
(f) Not smoke while transporting any
10D- 66.056 Emergency Medical Technician. patient or while attending any patient.
(g) Maintain a current American Heart
(1) Definition and Functions - An EMT Association (AHA) Cardiopulmonary Resuscitation
is an individual trained in basic emergency medical (CPR) BLS Course C or American Red Cross (ARC)
procedures and certified by the department to CPR BLS for the Professional Rescuer successful
perform these procedures in emergency situations. course completion certificate.
The procedures an EMT is qualified to perform are (h) Maintain current EMT certification
defined in the U. S. Department of Transportation from the department.
(DOT) EMT - Ambulance National Standard (i) Carry the following items while on
curriculum. duty:
(2) An EMT may use an automatic or 1. EMT certification card or copy
semi - automatic defibrillator, perform esophageal thereof;
intubation, and monitor and maintain non - medicated 2. A current AHA CPR BLS Course C
I.V. on routine interfacility transports provided the successful course completion certificate card or a
EMT is authorized to do so by the EMS provider's current ARC CPR BLS for the Professional Rescuer
medical director. The medical director shall certify certification card or copy thereof.
that the EMT is trained to perform these (4) Qualifications, Examination and
procedures; establish a written protocol for the Certification - To be eligible for certification as an
performance of each of these procedures; and EMT, and to take the EMT certification
provide written evidence to the department prior to examination, an individual shall comply with the
implementation, documenting compliance with this provisions of chapter 401, part III, FS., and shall
section. The provider shall keep such written apply for the state EMT certification examination on
evidence on file and accessible for review by the HRS Form 1583, September 92, Application Data
department. Form: EMT /Paramedic Certification by Examination,
(3) Responsibilities. The EMT shall: which are incorporated by reference and available
(a) Upon arrival at the scene of a from the department. Applications and the required
medical emergency, assess the condition of and fee must be received by the department no later
promptly treat any sick or injured person unless the than 30 calendar days prior to the date of the
health or safety of the EMT is jeopardized. certification examination for which the applicant
(b) Upon arrival at the scene of a desires to be scheduled. Any application received
medical emergency, assess the condition of each less than 30 days prior to the examination may
trauma patient in the absence of a paramedic using cause the applicant to be scheduled for the next
the trauma scorecard methodology to determine the available examination.
transport destination, as required in section (5) Recertification - To be eligible for
10D- 66.102, F.A.C. - recertification as an EMT, an individual shall:
(c) Report all suspected child and (a) Possess a current AHA CPR
elder abuse to the department, and transmit a Course C successful course completion certificate
written report within 48 hours of the initial verbal or a current ARC CPR Course for the Professional •
report. The EMT shall make the initial verbal report Rescuer Certification and within 2 years prior to the
to the department via the department's statewide expiration date of his EMT certification, complete a
toll -free telephone number (1- 800 - 926 - 2873). The 32 -hour minimum EMT Refresher Course which
EMT shall prepare and send the written report to shall:
the Department's Florida Abuse Registry, 1317 1. Meet or exceed the current 30-
Winewood Boulevard, Tallahassee, Florida 32399- hour DOT -EMT Refresher Training Program and
0700. shall include an additional 2 hours of
immunodeficiency virus and acquired immune
30
deficiency syndrome (HIV AIDS) training. The HIV option, the student must obtain a letter of
AIDS training shall include, but not be limited to the authorization on training center letterhead signed by
following minimum course content requirements: the paramedic program director. The letter of
modes of transmission, infection control authorization must be submitted along with the
procedures, clinical management, prevention of HIV EMT renewal application and must contain the
AIDS, information on current Florida law on following information:
acquired immune deficiency syndrome and its 1. Verification that the first semester
impact on blood testing, confidentiality of tests of a paramedic course, the student completed, was
results, and treatment of patients; and, equivalent to the 30 -hour U.S. DOT EMT refresher
2. Be completed at a department course; or,
approved EMT or paramedic training center; or 2. A description of how EMT
3. Have been approved by the equivalency training was determined, such as, the
medical director of a licensed EMS provider; or, student was administered a final written and
(b) Possess a current AHA CPR practical examination which covered material
Course C successful course completion certificate routinely taught in a regular EMT refresher course
or ARC CPR Course for the Professional Rescuer or primary EMT course is incorporated into the
certification and complete the required 2 hours of paramedic course; and,
HIV AIDS training described in section 10D- 3. The beginning and ending date of
66.056(5)(a)1, F.A.C., and, in one attempt, pass the semester in which the student completed the
the EMT certification examination prior to the equivalent EMT refresher course. This method may
expiration date of his current EMT certification. be used only once for recertification; or
Prior to taking the examination, a candidate shall (e) Possess a current AHA CPR
submit a HRS Form 622, August 92, Application Course C Successful Course Completion Certificate
for EMT Recertification, which is incorporated by or ARC CPR for the Professional Rescuer
reference and available from the department and Certification, and within 2 years prior to the
HRS Form 1583, September 92, Application Data expiration date of his certification, complete 32
Form: EMT /Paramedic Certification by Examination, hours of EMT work - related continuing education
to the department so as to be received by the including the required 2 hours of HIV AIDS training
department no later than 30 calendar days prior to described in section 10D- 66.056(5 )(a)1, F.A.C.,
the date of the certification examination for which which shall:
the applicant desires to be scheduled, and pay the 1. Be provided by the licensed EMS
required fees. Any application received less than provider which employs or utilizes the EMT; or
30 days prior to the examination may cause the 2. Be provided by a department
applicant to be scheduled for the next available approved EMS training center; and
examination. If a candidate fails the examination 3. Be signed by the medical director
he is ineligible for recertification and must complete of the licensed BLS or AILS service which employs
initial certification requirements of section 1013- or utilizes the EMT; and
66.056(4), F.A.C.; or, 4. Be signed by the individual EMT
(c) Possess a current AHA CPR who is expected to complete the work - related
Course C successful course completion certificate program.
or ARC CPR Course for the Professional Rescuer (6) To be recertified on or prior to his
Certification and within 2 years prior to the expiration date, the applicant for EMT
expiration date of his certification successfully recertification shall have completed the
complete the DOT Paramedic Course at a recertification requirements and shall submit HRS
department approved training center. This method Form 622, August 92, Application for EMT
may be used only once for recertification; or Recertification, so as to be received by the
• (d) Possess a current AHA CPR department no earlier than 180 calendar days nor
Course C successful course completion certificate less than 60 calendar days prior to the expiration
or ARC CPR Course for the Professional Rescuer date of his current certification, and pay the
Certification and complete the required 2 hours of required fee. If the application is received by the
HIV AIDS training described in section 1013- department less than 60 days prior to the
66.056(5)(a)1, F.A.C., and within the last 2 years applicant's expiration date, the department cannot
have successfully completed the first semester of guarantee that it will have completed its review of
the DOT Paramedic Course at a department the application and notified the applicant of its
approved training center. To recertify using this
31
determination prior to the automatic expiration of 10D- 66.56, Amended 11 -2 -86, 4- 12 -88, 8 -3 -88,
the certification. 12- 10 -92.
(7) All EMT certifications
automatically expire at midnight on the expiration 10D- 66.057 Paramedic.
date listed on the certificate. Any EMT whose
certification expires shall not function as an EMT (1) Definition and Functions - In
until he has been recertified by the department. addition to performing EMT procedures as outlined
(8) A request for an amended in section 10D- 66.056, F.A.C., a paramedic may
certificate indicating a name change shall be made perform ALS procedures. ALS is defined as
in writing and accompanied by a copy of a legal treatment of life threatening medical emergencies
document verifying the change. A request for through the use of techniques such as: intubation,
replacement of a lost certificate shall be made to administration of drugs and intravenous fluids,
the department in writing and accompanied by a $6 telemetry, and cardiac defibrillation. The paramedic
fee. shall perform these procedures only under medical
(9) Late Recertification. direction. The procedures that a paramedic may
(a) Any individual whose perform are defined in the DOT National Training
recertification application is received by the Course EMT - Paramedic curriculum. The paramedic
department after his certification expiration date may also perform other procedures deemed
shall complete the recertification requirements necessary by the ALS medical director of the
contained in section 10D- 66.056(5), F.A.C., within licensed EMS provider where the paramedic is
180 days after the expiration date of his current employed.
certification, and pay an administrative fine of $25 (2) Responsibilities. The paramedic
in addition to the required recertification fee. shall:
(b) Any EMT whose application for (a) Upon arrival at the scene of a
recertification is received more than 180 days after medical emergency, assess the condition of and
expiration of his certification, shall not be eligible promptly treat any sick or injured person unless the
for rec ertification unlessthe EMT: health or safety of the paramedic is jeopardized.
1. Successfully completes one of the (b) Upon arrival at the scene of a
recertification requirements as specified in section medical emergency, assess the condition of each
10D- 66.056(5)(a), or (c)(d) or (e), F.A.C., and, trauma patient using the trauma scorecard
2. Successfully completes, in one methodology to determine the transport destination
attempt, the state EMT certification examination. If as required in section 10D- 66.102, F.A.C.
the applicant fails the examination he will be (c) Report all suspected child and
required to complete initial certification elder abuse to the department and transmit a
requirements and will be ineligible for written report within 48 hours of the initial verbal
recertification, and report. The paramedic shall make the initial verbal
3. Pays an administrative fine of $25 report to the department via the department's
in addition to the required recertification fee and statewide toll -free telephone number (1- 800 -962-
examination fee. 2873). The paramedic shall prepare and send the
(10) In the event an applicant or written report to the department's Florida Abuse
certified EMT changes the mailing address he has Registry, 1317 Winewood Boulevard, Tallahassee,
provided the department, the applicant or certified Florida 32399 -0700.
EMT shall notify the department within 10 days of (d) Complete the patient information
the change. and the trauma scorecard sections of HRS Form
1728, August 91, Trauma /Head Injury/Spinal Cord
Specific Authority 395.031, 395.032, 395.033, Injury Registry, as required in sections
395.0335, 395.034, 395.035, 395.036, 1 OD-66.1100-102 and .103, F.A.C.
395.037, 401.24, 401.25, 401.26, 401.27, (e) Deliver HRS Form 1728, August •
401.281, 401.30, 401.34, 401.35, 401.41, 91, as required in section 10D- 66.100, F.A.C.
401.411 FS. Law Implemented 395.031, (f) Not smoke while transporting any
395.032, 395.033, 395.0335, 395.034, patient or while attending any patient.
395.035, 395.036, 395.037, 401.24, 401.25, (g) Possess a current AHA Advanced
401.26, 401.27, 401.281, 401.30, 401.34, Cardiac Life Support (ACLS) certification or its
401.35, 401.41, 401.411 FS. History-New equivalent.
11- 29 -82, Amended 4- 26 -84, 3-11-85, Formerly
32
(h) Maintain current paramedic 3. Have been approved by the
certification. medical director of a licensed EMS provider; or,
(i) Carry the following items while on (b) Possess a current AHA ACLS
• duty: successful course completion certificate, or its
1. Paramedic state certification card equivalent and complete the required 2 hours of
or copy thereof; HIV AIDS training described in- section 1013-
2. A current AHA ACLS Course 66.057(5)(a)1, F.A.C., and in one attempt, pass
Completion Certification or copy. the paramedic certification examination prior to the
(3) Qualifications, Examination and expiration date of his current paramedic
Certification - To be eligible for certification as a certification. Prior to taking the paramedic
paramedic and to take the paramedic certification examination, a candidate shall submit a HRS Form
examination, an individual shall comply with the 622, August 92, Application for Recertification,
provisions of chapter 401, part III, FS., and shall which is incorporated by reference and available
apply on HRS Form 1583, September 92, from the department, and a HRS Form 1583,
Application Data Form: EMT /Paramedic September 92, Application Data Form:
Certification by Examination which is incorporated EMT /Paramedic Certification by Examination, to the
by reference and available from the department. department so as to be received no later than 30
Applications and the required fee must be received calendar days prior to the certification examination
by the department no later than 30 calendar days date for which the applicant desires to be
prior to the date of the certification examination for scheduled and pay the required fee. Any
which the applicant desires to be scheduled. Any application received less than 30 days prior to the
application received less than 30 days prior to the exam may cause the applicant to be scheduled for
exam may cause the applicant to be scheduled for the next available exam. If the candidate fails the
the next available exam. examination, he is ineligible for recertification and
(4) To be eligible for certification as a shall complete initial certification requirements; or
paramedic, a Florida registered nurse, a Florida (c) Possess a current AHA ACLS
licensed dentist, or a Florida licensed physician shall certification or its equivalent and within 2 years
be a current certified Florida EMT and meet the prior to the expiration date of his certification,
requirements of section 10D- 66.057(2) and- (3), _ complete 32 hours of EMS work - related continuing
F.A.C., and possess a current AHA ACLS education including -the . required 2 hours of HIV== ,-
successful course completion certificate or its AIDS - training - described,,, - - in section 1013 --
equivalent. 66.057(5)(a)1, F.A.C., which shall:
(5) Recertification - To be eligible for 1. Be provided by the licensed EMS
recertification as a paramedic, an individual shall: provider which employs or utilizes the paramedic;
(a) Possess a current AHA ACLS or
successful course completion certificate or its 2. Be provided by a department
equivalent, and within 2 years prior to the approved EMS training center; and
expiration date of his certification, complete a 32- 3. Be signed by the medical director
hour minimum paramedic refresher course which of the licensed EMS provider which employs or
shall: utilizes the paramedic; and
1. Meet or exceed the current 32- 4. Be signed by the individual
hour DOT - Paramedic Refresher Training Program paramedic who is expected to complete the work -
and shall include an additional 2 hours of HIV AIDS related program.
training. The HIV AIDS training shall include, but (6) To be recertified by his expiration
not be limited to the following minimum course date, the applicant for paramedic recertification
content requirements: modes of transmission, shall have completed the recertification
infection control procedures, clinical management, requirements and shall submit a HRS Form 622,
prevention of HIV AIDS information on current August 92, Application for Recertification, so as to
Florida law on acquired immune deficiency be received by the department no earlier than 180
syndrome and its impact on blood testing, calendar days nor less than 60 calendar days prior
confidentiality of test results, and treatment of to the expiration date of his current certification,
patients; and, and pay the required fee. If the application is
2. Be completed at a department received by the department less than 60 days prior
approved paramedic training center; or, to the applicant's expiration date, the department
cannot guarantee that it will have completed its
33
review of the application and notified the applicant paramedic shall notify the department within 10
of its determination prior to the automatic days of the change.
expiration of the certificate.
(7) Each paramedic certification Specific Authority 381.0011, 395.031, 395.032,
automatically expires at midnight on the expiration 395.033, 395.0335, 395.034, 395.035,
date listed on the certificate. Any paramedic who 395.036, 395.037, 401.23, 401.24, 401.25, •
allows his certification to expire shall not function 401.26, 401.27, 401.281, 401.30, 401.34,
as a paramedic until he has been recertified by the 401.35, 401.41, 401.411 FS. Law Implemented
department. 381.0011, 395.031, 395.032, 395.033,
(8) A request for an amended 395.0335, 395.034, 395.035, 395.036,
certificate indicating a name change shall be made 395.037, 401.23, 401.24, 401.25, 401.26,
in writing and accompanied by a copy of a legal 401.27, 401.281, 401.30, 401.34, 401.35,
document verifying the change. A request for 401.41, 401.411 FS. History-New 11-29-82,
replacement of a lost certificate shall be made to Amended 4- 26 -84, 3- 11 -85, Formerly 1013- 66.57,
the department in writing and accompanied by a $6 Amended 4- 12 -88, 8 -3 -88, 12- 10 -92.
fee.
(9) Late Recertification. 1013- 66.0571 Impaired EMTs or Paramedics.
(a) Any individual whose
recertification application is received by the (1) Any department certified EMT or
department after his certification expiration date paramedic who becomes impaired as a result of
shall complete the recertification requirements drug or alcohol use or addiction may avoid
contained in section 10D- 66.057(6), F.A.C., within administrative action by the department if that EMT
180 days after the expiration date of his current or paramedic performs all of the following:
certification, and pay an administrative fine of $25 (a) Voluntarily enters a drug or
in addition to the required recertification fee. alcohol rehabilitation program acceptable to the
(b) Any paramedic whose application department.
for recertification is received more than 180 days (b) The employer confirms for the
after expiration of his certificate shall not be eligible department that while in the program the
for recertification unless the paramedic: individual's professional competence is not
1. Successfully completes one of the impaired.
recertification requirements as specified in section (c)_ " Have no` adjudications of guilt nor
10D- 66.057(5)(a) or (c), F.A.C., and any convictions, nor plead nolo contendere to any
2. Successfully complete, in one charge relating to drug or alcohol abuse.
attempt, the state paramedic certification (2) If the above criteria are met, the
examination. If the applicant fails the examination individual may then qualify to enter into a
he shall be ineligible for recertification and shall be stipulation with the department in which the EMT
required to complete the initial certification or paramedic agrees to the following conditions:
requirements. (a) Participation in and successful
3. Pays an administrative fine of $25 completion of an inpatient care program for
in addition to the required recertification fee and substance abuse.
examination fee. (b) Participation in and successful
(10) Any currently certified paramedic completion of an aftercare treatment program.
may obtain an EMT certification by submitting a (c) Waiver of confidentiality so that
completed application accompanied by the required the department -can access his patient records in
fee. both the inpatient and aftercare programs.
01) A paramedic may be recertified as (d) Ensure all follow -up treatment
an EMT in lieu of a paramedic by submitting a reports and drug screening tests are sent to the
completed application for EMT recertification department for review.
accompanied by the required fee and by meeting (e) If aftercare treatment is not
the EMT recertification requirements of section completed, or if the individual is found not to be
10D- 66.056, F.A.C. drug free prior to the completion of the aftercare
(12) In the event an applicant or program, or if the individual tests positive on any of
certified paramedic changes the mailing address he the random drug screenings, the individual will be
has provided the department, the applicant or subject to the revocation or suspension of his
certificate.
34
(3) The department reserves the right (2) A physically disabled person shall
to review each case individually, taking into be allowed to take the written portion of the EMT
consideration extenuating circumstances which or paramedic certification examination and shall be
• may alter the terms of the above required provided with the results, provided that no special
conditions. assistance is required in completing the written
portion of the examination and the applicant
Specific Authority 395.031, 395.032, 395.033, complies with the requirements of section
395.0335, 395.034, 395.035, 395.036, 10D- 66.056(4) or 10D- 66.057(3), F.A.C.
395.037, 401.23, 401.24, 401.25, 401.26, (3) The department shall be
401.27, 401.281, 401.30, 401.34, 401.35, responsible for the administration and grade
401.41, 401.411 FS. Law Implemented notification of the EMT and paramedic certification
381.001 1, 395.031, 395.032, 395.033, examinations. The department shall notify the
395.0335, 395.034, 395.035, 395.036, applicant of the time, place and date of the
395.037, 401.23, 401.24, 401.25, 401.26, examination and provide the applicant with an
401.27, 401.281, 401.30, 401.34, 401.35, official admission notice which shall be required for
401.41, 401.411 FS. History-New 12- 10 -92. admission to sit for the examination. Information
contained on the official admission notice shall
10D- 66.0572 Convicted Felons Applying for supersede any other information issued by the
EMT or Paramedic Certification or Recertification. department. The applicant shall take the
examination at the assigned examination location.
(1) An applicant with a felony The notice shall also inform the applicant of the
conviction may become certified as an EMT or length of the examination, subject content of the
paramedic provided that he has met all other examination, and any special equipment or
requirements for initial certification or the materials needed for the examination.
requirements for recertification in these rules and (4) Examination Administration.
the applicant's civil rights have been restored. (a) The state examination shall be
(2) Applicants whose civil rights have administered in accordance with departmental
not been restored may become certified as an EMT procedures established by these rules.
or paramedic under the following conditions:- __ _ .. ( h)___ _ ,_", During the examination, the
(a) The felony conviction was, over. 3..,.: , examinees shall abide by the instructions of the
years prior to the date of receipt of the application examiners or_ proctors. Specific instructions for
for certification, completion of the examination shall be read by the
(b) The felony conviction was not examiners and the candidates shall be permitted to
directly related to the practice of an EMT or ask reasonable questions relating to the
paramedic, instructions. Examinees shall not give or receive
(c) There have been no additional help from other examinees. There shall be no
arrests or convictions, talking nor communicating by examinees while the
(d) The nature of the crime of which examination is in process. Reference materials
the individual was convicted does not indicate that shall not be permitted in the examination room
the applicant would potentially endanger the health, unless specifically authorized in the instructions.
safety and welfare of the public, and (c) If the candidate arrives at the
(e) The applicant has completed all assigned examination location after the designated
sentences and supervisory sanctions imposed by starting time, he shall be permitted to take the
the court, Parole Commission and by law. examination only after he has signed a statement
clearly indicating his late arrival time, and agreeing
• Specific Authority 401.35, 401.411 FS. Law that he shall have only the remaining time in the
Implemented 401.35, 401.411 FS. History-New examination period to complete the examination. If
12- 10 -92. the candidate refuses to sign such a statement, he
shall be disqualified from the examination and will,
10D- 66.0575 Examinations. upon reapplication be scheduled for the next
available examination. However, no candidate shall
(1) An applicant trained in Florida be admitted to the examination if any other
must successfully complete the certification candidate has completed the examination and left
examination within 1 year of successful course the examination room.
completion.
35
(d) The following conduct by any the time allowed for the original administration of
candidate shall result in immediate removal from the examination.
the examination room: (e) A representative of , the
1. Unnecessary noise that interferes department shall remain with the candidate
with the examination process. throughout the review process.
2. Cheating or attempting to cheat. (f) The candidate shall be instructed •
3. Helping another examinee cheat. that he is exercising his right of review. A
4. Observing an examination answer representative of the department shall explain that
of any other candidate being tested. he is not going to defend the examination or
(e) When the proctor observes attempt to answer or refute any questions.
conduct that is grounds for exclusion, the proctor (g) The candidate shall not copy
shall ask the violator to leave the examination questions from the examination booklet. The
room. The proctor shall contact a local law candidate may write on a separate paper in the
enforcement agency to have the violator removed presence of a representative of the department, any
from the examination room if the violator does not objection or question concerning the examination.
leave voluntarily. (h) The candidate shall leave the
(5) Grade Notification. written objections and questions with a
(a) The department shall notify the representative of the department when he leaves
candidate of the results of his examination as soon the review room but he may keep a listing of the
as possible after the examination date. question numbers he finds to be controversial.
(b) The department shall inform each (i) The candidate's objections shall
passing candidate of his status and provide then be analyzed by a representative of the
necessary instructions for receiving his license. department. If the representative finds that the
(c) If a candidate fails the certification original grade awarded was consistent with the
examination, he will be notified by the department grading criteria, the candidate shall be notified and
of the requirements for regrade, review, and appeal the 30 -day appeal period shall begin.
rights and procedures. (j) If the departmental representative
(6) Examination Regrades - If the finds that the candidate's objection needs further
candidate desires a regrading of his examination, he review, the representative, in consultation with the
must: director, shall review each objection and grade the
(a) Submit a written request to the - items in accordance with the standards established
department for a rescore within 30 days of the date to govern the examination.
indicated on the failure notice. (k) If the departmental representative
(b) Include the date of the finds that the original grade was not rendered in
examination, indicate EMT or paramedic accordance with the grading criteria, he shall
examination, and include the required regrade fee of regrade the examination pursuant to applicable
S 10 payable to the department's Office of EMS. statutes and rules and the candidate's review fee
(7) Examination Review. will be refunded.
(a) The candidate shall notify the (1) At the conclusion of the
department, in writing, that he desires an re- evaluation of the examination, the candidate
examination review within 30 days of the date shall be notified in writing of the decision.
indicated on the failure notice and include the (8) Examination Content - The
required review fee of $30 payable to the certification examination shall consist of a minimum
department's Office of EMS. of 150 written questions. The examination shall
(b) Each candidate who has taken the adhere to the following categories and number of
examination shall have the right to review the items.
examination booklet, answer sheet and grading key.
(c) Examination reviews shall be •
conducted at a designated site. A candidate may
attend only one review per examination
administration.
(d) The candidate shall be allowed a
reasonable amount of time to review the
examination but this time shall not extend beyond
36
(a) EMT Minimum
Categories Number of Items
1. General Information. 27.
2. Respiratory. 18.
3. C.P.R. 10•
4. Shock and Hemorrhage. 11.
5. Soft Tissue, Chest & Abdomen. 15.
6. Brain and Spine. 10.
7. Skeletal Anatomy and Injury. 14.
8. Medical and Environmental. 25.
9. Unscheduled Delivery. 10.
10. Extrication and Transportation. 10.
(b) Paramedic Minimum
Categories Number of Items
1. Paramedic Responsibility. 10.
2. Human Systems and Patient 15.
Assessment.
3. Anatomy, Physiology and 25.
Pathophysiology to include the
Respiratory and Central Nervous Systems.
4. General Pharmacology and the 40.
Cardiovascular System.
5. Trauma Emergencies to include Shock 16.
and Fluid Therapy, Soft Tissue Injuries,
and the Musculoskeletal System.
6. Psychiatric and Other Medical 20•_
Emergencies.
7. Neonatal, Pediatric and Obstetric/ 14.
Gynecologic Emergencies.
8. Routine and Special Operations to 10.
include Rescue Techniques, Telemetry,
and Communications.
•
37
(9) Passing Grade - Individuals b. Woodcock- Johnson , Psycho -
achieving the following grades on the certification Educational Battery- Revised: Tests of Achievement.
examination shall pass: 2. School or work records which
(a) EMT, 70 percent or higher. demonstrate that special education services or
(b) Paramedic, 80 percent or higher. accommodations were provided due to a learning •
(10) Security. and monitoring disability in the area of reading decoding or reading
procedures for certification examination shall be comprehension. Documentation of the learning
conducted in accordance with the department's disability shall be required.
contract with the administrator of the certification (b) Individuals who qualify for special
examination. accommodation on the written examination due to
0 1) To be rescheduled for the a documented learning disability as described above
certification examination, the applicant shall submit shall be permitted to take the standard format of
a HRS Form 1583, September 92, Data Form: the examination, but shall receive an additional hour
EMT /Paramedic Certification by Examination in which to complete the examination.
Application, which is incorporated by reference and (c) Other types of accommodations
available from the department, and pay the required to meet the needs of applicant's documented
fee. Applications shall be submitted so as to be disabilities may be granted with appropriate
received by the department no later than 30 documentation of disability as determined by the
calendar days prior to the date of the scheduled department.
examination. Pursuant to section 10D- 66.056(5)
and (9) and 10D- 66.057(5) and (9), F.A.C., an EMT Specific Authority 395.031, 395.032, 395.033,
or a paramedic seeking recertification by 395.0335, 395.034, 395.035, 395.036,
examination is not eligible to retake the 395.037, 401.23, 401.24, 401.25, 401.26,
examination if he receives a failing grade on his 401.27, 401.281, 401.30, 401.34, 401.35
first attempt until he completes the initial 401.41, 401.411 FS. Law Implemented 395.031,
certification requirements in these rules. 395.032, 395.033, 395.0335, 395.034,
(12) Persons with documented learning 395.035, 395.036, 395.037, 401.23, 401.24,
disabilities in the areas of reading decoding or 401.25, 401.26, 401.27, 401.281, 401.30,
reading comprehension or some form of 401:34, 401.35, 401.41, 40.1.411 FS. History-
documented disability or cognitive processing - -- - New -- 4- 26 -84,- Amended --3-1-1-85, Formerly_
deficit specifically in the reading area which would 10D- 66.575,. Amended 4- 12 -88, 12-10-92.
negatively impact on the candidate's performance
on the written examination may be eligible for 10D- 66.058 Training Center Standards.
special accommodations with the written
certification examination. The person requesting Specific Authority 395.035, 395.036, 401.35,
the accommodation must provide documentation of 401.27 FS. Law Implemented 395.035, 395.036,
the diagnosis before any decision shall be made by 401.27 FS. History-New 11-29-82, Amended
the department regarding the request for special 4- 26 -84, 3-11-85, Formerly 1013- 66.58, Amended
accommodation. 4- 12 -88, 8 -3 -88, Repealed 12- 10 -92.
(a) Documentation of a specific
learning disability shall include one of the following: 1013- 66.0585 EMT Training Standards and
1. Diagnosis of a learning disability in Procedures.
the area of reading decoding or reading
comprehension based upon the results of Specific Authority 401.35 FS. Law Implemented
standardized psycho - educational assessment 401.27, 401.35 FS. History-New 11- 29 -82,
including an appropriate standardized measure of Repealed 4- 26 -84. Formerly 10D- 66.585.
intelligence and an appropriate standardized •
measure of achievement in reading decoding or 10D- 66.0586 EMS Training Center Programs.
reading comprehension. Two recognized
instruments acceptable to the department which (1) Training Center Approval Process.
provide the disability diagnosis and which are (a) Any educational institution
standardized for adults are: desiring approval as an EMS training program shall
a. Wechsler Adult Intelligence Scale- be a post- secondary educational institution that
Revised provides college credit or that has an agreement
38
with a college credit granting institution operated instructional staff. Faculty positions may be
under the administrative rules of the State of combined and faculty members may function in
Florida, Department of Education, and meet the multiple roles. At least one full -time faculty
• requirements established in these rules. member shall be assigned to the EMS training
(b) Any public community college, program. The faculty shall be qualified through
vocational technical school, public university or academic training and experience to teach the
private institution desiring approval of their EMS topics identified in the curriculum. Faculty
training program shall submit to the department qualifications and responsibilities shall include, but
documentation from the appropriate agency as not be limited to, the following:
follows: a. The medical director shall meet or
1. Public community colleges shall exceed the qualifications set forth in sections 10D-
submit a letter of recommendation from the 66.0505(3)(a),(c),(d), and (4)(n), F.A.C. There shall
Regional Coordinating Council for Vocational be a written contractual agreement between the
Education, Adult Education, and Community training center and the medical director which
Instructional Services. incorporates the responsibilities of the medical
2. Public universities shall submit a director.
letter of approval from the president of the b. The program director shall be
university. responsible for the operation, organization, periodic
3. Public vocational- technical centers review, continued administration, continued
shall submit documentation of an articulation development, accreditation and approval,
agreement with a degree - granting, public maintenance of records necessary for accreditation
community college and a letter of recommendation and approval, and general effectiveness of the
from the designated community college. educational program; liaison between students,
4. Private institutions shall submit a program, staff and clinical affiliates; and official
photocopy of a license issued by the Florida State correspondence with the department.
Board of Independent Colleges and Universities. C. Instructional Staff.
(c) Upon receipt of the above (1) EMT and paramedic lead
documentation by the department, HRS Form instructors shall have primary responsibility for
1698, April 90, Application for Approval of an EMS conducting EMS zourses,• shall be responsible - - for
Training Center, which is incorporated by reference` teaching the knowledge and skill competencies
and available from the department, and any other prescribed- in - - the training- program; shall keep
pertinent information shall be sent to the institution records of students' attendance and performance
within 30 days of receipt of the request by the during assigned instruction and practical skills
department. sessions.
(2) Application Process. (11) EMT and paramedic lead
(a) Each applicant for EMS Training instructors shall have a degree in education or have
Center program approval must: 6 college semester hours or 9 college quarter hours
1. Meet the requirements of section 1013- from a post- secondary institution in teaching
66.0586, F.A.C. methodology courses or an equivalent combination
2. Submit a completed HRS Form that includes contact hours from successful
1698; completion of EMS related instructor courses.
3. Submit a copy of a written 6. Submit documentation that the
affiliation agreement(s) with a licensed hospital applicant shall appoint an EMS advisory committee
which has an emergency department staffed by to provide direction and advice regarding the
one or more physicians and one or more registered objectives and operation of the training program.
nurses. The advisory committee shall . be composed of
4. Submit written affiliation individuals from institutions and agencies involved
agreement(s) with licensed EMS provider(s) who in, and affected by, the training program. The
agree to provide the field experience phase of the faculty and the training program staff shall not
EMS training program on a licensed transport EMS comprise more than 25 percent of the regular
vehicle. membership of the advisory committee. Meetings
5. Submit documentation that the of the advisory committee shall be conducted at
EMS faculty of the applicant includes a medical least twice each year.
director, a program director, and qualified
39
7. Submit documentation that the (b) The TCRC shall conduct a site
applicant's EMS curriculum meets, at a minimum, visit to determine the quality of the EMS training
the United States Department of Transportation program to be offered and determine the applicant's
National Standard Curriculum (U.S. DOT NSC) compliance with the applicable standards for an
course guides (Emergency Medical Technician- EMT or paramedic training program as follows:
Ambulance -1984, Emergency Medical Technician- (4) EMT Program Standards:
Paramedic - 1985), lesson plans or equivalent (a) The program is at least 110 hours
syllabus for either an EMT or paramedic or both in length.
EMS training courses. (b) The program follows the U.S.
8. Submit documentation which DOT EMT -A NSC course guide.
demonstrates that the applicant has sufficient (c) The program provides a curriculum
medical and educational equipment and materials in that meets or exceeds the U.S. DOT, EMT -A
reliable working condition to meet the EMS training Instructor's Lesson Plans -Third Edition -1984.
program needs. (d) The curriculum includes at least 4
9. Submit documentation that the hours of instruction on AIDS education as required
curriculum includes at least 2 hours of instruction in section 1013- 93.075, F.A.C.
on the trauma scorecard methodology as required in (e) The program consists of the
sections 1013- 66.102 and .103, F.A.C. following components:
10. Submit documentation that the 1. Didactic - lecture, discussion, and
curriculum includes at least 4 hours of instruction demonstration.
on the Florida HIV AIDS training as required by 2. Skills Practice Laboratory -
chapter 381, FS. and section 10D- 93.075, F.A.C. demonstrations and supervised practice in a
(b) Upon receipt of the above classroom or laboratory setting of emergency
documentation and application the department shall medical skills presented in the didactic phase. The
review the application to determine completeness student shall demonstrate competency in all the
and compliance with the requirements and notify skills presented in the U.S. DOT, EMT -A NSC. The
the applicant of any deficiencies within 30 days. If student to instructor ratio during skills practice
deficiencies are found the applicant must correct laboratory shall not exceed eight to one.
the deficiencies within 60 days after receipt of the 3. _ _ Not less than 20 hours of
notice from the department. Failure to correct the supervised clinical experience to _ include not _less
deficiencies within 60 days shall caus the than 10 hours in a hospital emergency department.
application to be denied. 4. Field experience aboard a
(c) If the application is determined to permitted EMS vehicle with a preceptor as
be complete, the department shall schedule a site indicated in section 10D- 66.0586, F.A.C., which
visit to the applicant's institution within 30 days includes participation - in not less than five
after the application is determined to be complete. emergency calls that result in patient transport.
The site visit shall be conducted by the Training (f) EMT lead instructors are primarily
Center Review Committee (TCRC) as specified in responsible for conducting the basic EMT course
section 1013- 66.0586, F.A.C. and must:
(3) Training Center Site Visits. 1. Have 2 years experience as an
(a) The TCRC shall be comprised of EMT or paramedic.
the following members, all of which have no 2. Be a Florida certified EMT or
financial or statutory gain by the approval or paramedic.
disapproval of the proposed training center: 3. Be certified as a BLS instructor in
1. An EMS medical director affiliated accordance with the American Heart Association or
with an approved training center. American Red Cross standards.
2. An EMS training center program 4. Meet the criteria indicated in •
director. section 1013- 66.0586, F.A.C.
3. A member of the state EMS (5) Paramedic Program Standards:
Educators of Florida Association. (a) Students accepted into the
4. A department staff member. paramedic program are currently certified as a
5. A State of Florida, Department of Florida EMT or have applied for EMT certification.
Education staff member. (b) The paramedic program is at least
700 hours in length.
40
(c) The training center follows the and a copy to the proposed EMS training center's
U.S. DOT Paramedic NSC Course Guide. program director. This report shall include:
(d) The training center provides a 1. A statement of approval or denial
• curriculum that meets or exceeds the U.S. DOT as an EMS training center.
Paramedic Instructor's Lesson Plan -1985. 2. A statement of the institution's
(e) The program shall consist of the areas of strength.
following components: 3. A statement of areas needing
1. Didactic - lecture, discussion, and improvement, including specific comments on any
demonstration. area which may not comply with current applicable
2. Skills Practice Laboratory - standards.
demonstrations and supervised practice in a 4. Suggested means of
classroom or laboratory setting of emergency improvement.
medical skills presented in the didactic phase. The (h) If the sponsoring institution has
student shall demonstrate competency in all the been denied approval, the applicant may:
skills presented in the U.S. DOT, EMT - paramedic 1. Correct the deficiencies noted in
NSC. The student to instructor ratio shall not the letter and resubmit the application, or;
exceed six to one. 2. Appeal the department's action
3. Clinical Experience - as described pursuant to the Administrative Procedures Act,
in the "Essentials and Guidelines of an Accredited chapter 120, FS.
Educational Program for the EMT - paramedic" and (i) Upon approval by the department,
the U.S. DOT, EMT - paramedic, NSC Course Guide. the applicant shall be issued a Certificate of
4. Field Internship Experience - Approval as an EMT Training Center, valid for a
aboard a permitted EMS vehicle with an ALS period of 3 years; or
provider as indicated in section 10D- 66.0586, G) Upon approval by the department,
F.A.C., and conducted as follows: the applicant shall be issued a non - renewable
a. The training program's medical Certificate of Approval as a Paramedic Training
director shall certify that the paramedic student has Center, valid for a period of 2 years. During this 2
successfully completed the didactic and hospital year period the training, center must become -
phases of the training curriculum and is competent accredited the Committee on Allied Heath
in all ALS skills. - Education and. - =Accreditation ° (CAHEA) as
b. Paramedic preceptors shall be recommended by the American Medical
approved by the medical directors of both the ALS Association's Joint Review Committee on
provider and the training center. Educational Programs for the EMT - Paramedic
C. Paramedic lead instructors are following the current standards listed in the
primarily responsible for conducting the paramedic "Essentials and Guidelines for an Accredited
course and shall: Educational Program for the EMT - Paramedic."
(1) Have at least 2 years experience (k) These certificates, identified in (i)
as a paramedic. and (j) above, shall be official notification from the
(11) Be a Florida certified paramedic. department that graduates from the EMT or
(III) Be certified as an ACLS Instructor paramedic program are eligible to take the state
or BTLS Instructor or Prehospital Trauma Life EMT or paramedic certification examination or
Support Instructor or equivalent. National Registry examination.
(IV) Have at least an Associate of (1) Program review, site visits, and
Science degree. program monitoring shall be conducted by the
(V) Meet the criteria indicated in department on an as needed basis.
• section 10D- 66.0586, F.A.C. (6) Requirements of Approved EMS
(f) Within 20 days following the site Training Centers.
visit, a written report from the TCRC will be (a) All approved EMS training centers
submitted to the department indicating the TCRC's shall maintain accurate records and reports that
recommendation for approval or denial. shall be accessible to the department for review.
(g) Within 10 days following the These records and reports shall include, but not be
receipt of the TCRC's recommendation, the limited to the following:
department shall send a written report to the 1. Students:
sponsoring institution's chief administrative officer
41
a. The completed application form whichever is applicable, upon completion of the
for program entry. course.
b. Records of attendance at training 8. Require students accepted into
sessions. the EMS program to meet the basic requirements
C. Records of participation in the for certification listed in chapter 401.27(4), FS. •
hospital clinical and field phases of the training 9. Require that EMT and paramedic
program. students not be subject to call while participating in
d. Medical records. class, clinical or field sessions.
2. Curriculum: 10. Require that EMT and paramedic
a. Course objectives and course students function under the direct supervision of
outline. EMS preceptors, and shall not be in the vehicle's
b. Class schedules. patient compartment alone during patient transport
C. Learner objectives. and shall not be used to fulfill staffing
d. Current, applicable US -DOT NSC requirements.
course guide and lesson plans or equivalent (7) EMT Program Reapproval:
syllabus. (a) Ninety days prior to the expiration
3. Program: date of the EMT training center's Certificate of
a. Number of applicants. Approval, the department shall send a Notice of
b. Number of students accepted into Renewal with an application form, HRS Form 1698,
the program. April 90 and a list of any other materials required to
C. Correspondence between the complete the renewal process.
training center and the department related to (b) The sponsoring institution shall
students. submit the required information to the department,
d. Correspondence between the at least 30 days prior to the expiration date of the
training center and the training center's medical Certificate of Approval.
director. (c) Upon receipt, by the department,
(b) In addition, all approved EMS of all required materials to renew, the department
training centers shall: shall issue a new Certificate of Approval, valid for 3
1. Maintain admission requirements years, to the expiration date of the training
on file, and accessible for review by the center's current Certificate of A -
pproval provided
department. the institution sponsors a paramedic program,
2. Keep on file a description of the accredited by the CAHEA, or
qualifications, duties and responsibilities of faculty (d) Upon receipt by the department of
members. all required materials to renew from an institution
3. Notify the department in writing that does not offer a paramedic program accredited
of any changes in faculty status within 30 days of by the CAHEA, the EMT program shall be renewed
such change. in accordance with section 10D- 66.0586, F.A.C.,
4. Provide verification to students of and in accordance with the timeframes provided in
successful completion of an EMT or paramedic section 120.60, FS.
course or refresher course conducted by the (8) Paramedic Program Reapproval -
institution within 14 days after course completion. Each paramedic program is responsible for
5. Submit a roster of students maintaining its accreditation by the CAHEA,
eligible to take the state certification examination following the standards listed in the most recent
to the department within 30 days after course "Essentials and Guidelines of an Accredited
completion, but not before course completion. This Educational Program for the EMT - paramedic ",
roster shall be signed by the program director. 1989.
6. Maintain written guidelines and (9) Probationary Status of EMS .
procedures for conducting off - campus EMT and Programs.
paramedic courses and refresher courses. (a) An approved EMS training center
7. Require EMT and paramedic shall be placed, by the department, on probationary
students to pass comprehensive final written and status for any of the following reasons:
practical examinations which shall include a 1. It is determined by the
representative sample of those skills described in department, through review of the program, that
the U.S. DOT EMT or EMT - Paramedic, NSC, the program is not being maintained in accordance
42
with published applicable standards including those b. State Board of Independent Post
standards published by the American Medical Secondary Vocational Technical Trade and Business
Association - Committee on Allied Health Education Schools.
• and Accreditation. C. State Board of Independent
2. The overall percentage of students Colleges and Universities.
taking compared to students passing, the state d. State Board of Community
EMT or paramedic examination is below 60 percent Colleges.
in any 1 calendar year. e. The president of the affiliated
3. The sponsoring institution has university. ry
been placed on an ineligible status or a special 9. The sponsoring institution's
program status by the Department of Education. program accreditation is revoked by the applicable
4. A violation of any provision of this agency.
section. 10. Violates any of the provisions of
(b) Written notification from the this section.
department shall be sent to the Chief (b) Written notification shall be sent
Administrative Officer of the sponsoring institution to the chief administrative officer of the sponsoring
with a copy to the EMS training center's program institution with a copy to the training center's
director listing the deficiencies of the program and program director when training center designation is
the change to Probationary Status. withdrawn for any reason. The notification shall
(c) The sponsoring institution shall be list the reason(s) for the withdrawal.
given a reasonable period of time, not to exceed 1 (c) The sponsoring institution shall be
year, to correct the listed deficiencies. given a period of 30 days to respond, correct the
(10) Process for Removal of Approval problem, or appeal the action through the
of EMS Programs. Administrative Procedures Act, chapter 120, FS.
(a) Program approval shall be revoked
for any of the following reasons: Specific Authority 395.031, 395.032, 395.033,
1. There are no students enrolled in 395.0335, 395.034, 395.035, 395.036,
the paramedic program for a period of 2 years and 395.037, 401.23, 401.24, 401.25, 401.26,
the EMT program for a period of 1 year. - 401.27, 401.281, 401.30, 401.34, 401.35,
2. There are no students enrolled in _ 401.41, 40 F _:Law Implemented
the paramedic or EMT refresher course for a period 395.031, _395432, 395.033,
of 2 years. 395.0335, 395.034, 395.035, 395.036,
3: The institution refuses to permit a 395.037, 401.23, 401.24, 401.25, 401.26,
site visit or program evaluation by the department. 401.27, 401.281, 401.30, 401.34, 401.35,
4. An institution on probation does 401.41, 401.411 FS. History-New 12- 10 -92.
not correct its deficiencies within the probationary Formerly 10D- 66.058.
period.
5. The institution refuses to provide 10D- 66.059 Drivers.
requested documentation during a complaint
investigation. (1) Each ALS and BLS provider shall
6. The institution refuses upon ensure that each driver who operates a permitted
request by the department to submit any document vehicle meets the qualifications as listed in section
required by this section. 401.281, FS.
7. The institution requests, in writing (2) Each BLS and ALS provider shall
to the department, to discontinue its EMT or document that each driver has completed at least a
• paramedic training center designation. 16 -hour course of instruction on driving an
8. The sponsoring institution's authorized emergency vehicle, as defined by
program approval is revoked by the applicable section 316.003(1), FS., which includes, at a
agency: minimum, classroom and behind- the -wheel training
a. Regional Coordinating Council for as outlined below:
Vocational Education, Adult Education and (a) Didactic.
Community Instructional Services. 1. Legal aspects of authorized
emergency vehicle operators.
43 -
2. Selecting routes and reporting certification card, and confirmation that each driver
emergency operation. is in compliance with section 401.281, FS.
3. The practice of defensive driving. (d) Copy of up -to -date department
4. Accident avoidance. approved TTPs.
5. Principles of vehicle control. (2) Each EMS provider shall ensure •
6. Routine safety checks of vehicle. that an accurate and complete run report was
(b) Practical. prepared for each instance in which medical care
1. Braking and control braking. was rendered, a patient was transported, patient
2. Backing; road position, fender was pronounced dead at the scene, patient was
judgement and steering technique. transferred to another licensed service, patient was
3. Slalom; steering technique and transferred from one medical facility to another and
chassis set. for instances when the person or persons for whom
4. Steering technique during a skid; a EMS was dispatched refused both treatment or
skid pad is optional. transport. Each run report must be maintained by
5. Turn - around - steering technique; the EMS provider for a period of 5 years. The run
fender judgement, road position, controlled braking, report must include the following elements:
controlled acceleration, understeer, oversteer and (a) The name, home address, age or
chassis set. date of birth, sex, and race of each patient; call
identification number; unit number or permit
Specific Authority 401.24, 401.25, 401.26, number of each responding vehicle and transporting
401.27, 401.281, 401.30, 401.34, 401.35, vehicle, if applicable; location of scene or incident;
401.41, 401.411 FS. Law Implemented 401.24, location of patient; and destination of each call.
401.25, 401.26, 401.27, 401.281, 401.30, (b) The time at which the call was
401.31, 401.34, 401.35, 401.41, 401.411 FS. received by dispatch; the time the vehicle was
History-New 11- 29 -82, Amended 4- 26 -84, 3 -11- underway to the scene; the time the vehicle arrived
85, Formerly 1013- 66.59, Amended 4- 12 -88, 12- at scene; the time the vehicle left scene, the time
10 -92. the vehicle arrived at the hospital and the time the
vehicle was back in service.
10D- 66.060 Records and Reports. (c) A report of patient assessment
such as the methodotogy by which `a patient was
(1) Each provider shall be responsible evaluated; each patient's vital signs with times
for supervising, preparing, filing and maintaining assessed at the scene and en route to the hospital;
records and for submitting reports to the care rendered prior to EMS arrival, at the scene,
department as requested. All records shall be and en route to the hospital.
handled in such a manner as to ensure reasonable (d) Type of call: emergency, transfer,
safety from water and fire damage and to be standby, or dry run.
safeguarded from unauthorized use. Any records. (e) Identification of individual or
maintained by the provider as required by these institution to whom patient care was relinquished.
rules shall be accessible to authorized (f) Your charges to patient.
representatives of the - department and shall be (g) Category of emergency: cardiac,
retained for a period of at least 5 years except as behavioral, environmental, trauma, poisoning, burn,
otherwise specified in this rule. Each provider shall neonatal, or other.
maintain the following administrative records: IN Tail number or F.A.A. number of
(a) Current service license issued by fixed wing or rotary wing aircraft used for
the department which shall be publicly displayed in interfacility patient transport or name of prehospital
the provider's main office. service if rotary wing aircraft is used for prehospital
(b) Vehicle registration, copy of past patient transport. •
department inspection reports, proof of current (i) If an automatic or semi - automatic
vehicle permit, and proof of current insurance defibrillator is used by an EMT, the following
coverage. information is required: name, model number and
(c) Personnel records for each manufacturer of automatic or semi- automatic
employee, to include date of employment, training defibrillator; the nature of any automatic or
records, employee application, copy of current semi - automatic defibrillator malfunction, suspected
cause of the malfunction and actions required to
44
(b) An application for a variance shall which does not comply with the requirements of
also contain the name and address of applicant, this section. Moreover, the department may make
statement of purpose, expected benefits to EMS, periodic evaluations of any variance or exception it
• period of time variance required, number of units or has granted or may revoke a variance or exception
personnel involved, and supportive data which if the information upon which it was based is false,
reflects that the variance shall neither endanger nor inaccurate, or if local conditions upon which it was
increase the risk of public health or safety. based was false, inaccurate, or if local conditions
(c) The department will approve an upon which the application for variance or
application for an exception to any provision of exception was based change, public health, safety
sections 10D- 66.104, 10D- 66.106 or 10D- or welfare is adversely affected by a continuation
66.1065, F.A.C., regulating local or regional trauma of the variance, or if continuation of an exception is
agencies if: not in the best interest of the persons affected by
1. The local or regional trauma the exception.
agency proves by clear and convincing evidence
that compliance with the provision of the rule for Specific Authority 395.031(2)(e), 395.07, 401.35
which the exception is requested would not be in FS. Law Implemented 395.031(2)(e), 395.07,
the best interest regarding the health, safety and 401.35 FS. History-New 12- 10 -92.
welfare of the persons served within the local or
regional trauma area to be affected by the 10D- 66.064 Forms. Copies of forms
exception; incorporated by reference, except as otherwise
2. The applicant meets all of the noted, within this chapter may be obtained without
requirements of this section; and cost from the Emergency Medical Services Office,
3. The application for exception 1317 Winewood Boulevard, Tallahassee, Florida
includes information documenting the need for the 32399 -0700.
exception, including supportive statements from
trauma care resources or persons within the defined Specific Authority 120.55 FS. Law Implemented
geographic area of the proposed trauma agency or 120.550)(a) FS. History-New 11- 29 -82, Formerly
department- approved trauma agency. 1oD- 66.64, Amended- 4- 12 -88, 12- 10 -92.
(d) The department will approve an
application for exception to any provision of section 10D- 66.0645 Schedule of Fees. Each organization
10D- 66.108(1), F.A.C., regulating trauma center or person subject to these regulations shall pay fees
standards provided that the applicant is affected by as provided in section 401.34, F.S.
the provisions, meets all of the requirements of this
section and proves to the department by clear and Specific Authority 401.34, 401.35 FS. Law
convincing evidence that: Implemented 401.34 FS. History-New 3- 11 -85,
1. local conditions are such that the Formerly 10D- 66.645, Amended 4- 12 -88.
applicant cannot or need not meet the provisions
for which the exception is applied, and 10D- 66.065 Emergency Medical Services
2. . public health, safety and welfare Advisory Council.
will not be adversely affected in any respect if the
department approves the exception. (1) The council acts as the
(2) An applicant for a variance or emergency medical services advisory body to the
exception must do so in writing to the department department. Council recommendations are advisory
and must attach all of the supporting documentary and are not binding to the department or agencies
evidence referenced. in the application. The under contract to the department.
• department will process all such applications within (2) Council responsibilities shall
the time established by section 120.60, FS., for include, but not be limited to: -
the approval or denial of an application for a (a) Reviewing and commenting on the
license. state EMS plans, legislative budget requests, state -
(3) The department will deny any approved trauma center programs, and policies
application for a variance or exception of any other which affect those persons, services or agencies
provision of this chapter other than those regulated under chapters 395 and 401, FS.
enumerated in subsection (1) of this section and
will deny any request for a variance or exception
47
(b) Participating as an advocacy body an EMS provider's base station on the provider's
to improve statewide emergency medical services dispatch frequency.
systems. (2) Every watercraft ambulance shall
(c) Recording minutes for all council carry the equipment listed in Table VI.
meetings and filing them with the department's •
Office of Emergency Medical Services.
(3) The membership and terms of
office shall be those established by section
401.245, FS. Reasonable efforts shall be made to
avoid possible conflict of interest involving voting
members.
(4) The council shall elect a vice
chairman and a secretary who shall serve terms of
1 year concurrent with the term of office of the
chairman who is selected by the secretary of the
department. Duties of the officers shall be those
which usually apply to such offices and other duties
as assigned by the director.
(5) The council may establish and
maintain such standing and special committees as
deemed necessary to carry out the work of the
council; shall meet in accordance with those
requirements established in section 401.245(4),
FS.; shall conduct its business in accordance with
"Robert's Rules of Order, Revised Edition'; and,
may write by -laws to meet its unique requirements,
but such by -laws may not conflict with this rule or
section 401.245, FS.
(6) Council members shall not receive
compensation for services as a council member,
but shall be reimbursed for per diem and travel
expenses in accordance with HRS Regulation No.
40 -1.
Specific Authority 401.245, 401.35 FS. Law
Implemented 401.245 401.35 FS. History - New
4- 26 -84, Formerly 10D- 66.65, Amended 4- 12 -88,
12- 10 -92.
10D- 66.066 Watercraft. To be eligible for an ALS
watercraft permit, the watercraft shall be operated
by an ALS provider and shall be equipped with all
items listed in Table III and: a long spine board with
3 straps compatible with a basket litter; a floatable
cervical immobilization device with reflective
material; one portable folding stretcher; and a
basket litter with flotation device which has •
reflective material. The basket litter shall
automatically float head and face up.
(1) Communications - All transporting
watercraft ambulances shall have a VHF /FM Marine
radio with at least 25 watts of power. In addition,
they shall have the capability to communicate with
48
correct the malfunction; number of countershocks (e) the name and the signature of the
administered; hard copy of cardiac rhythm strip person responsible for the patient's care; and
prior to and immediately following each (f) the medication and the dosage
countershock; and, name of EMT or EMTs who administered; the date and the time administered;
applied the automatic or semi - automatic the route of administration; the signature of the
defibrillator. lead paramedic responsible for administering the
(i) The name of the physician drug or medication.
contacted if telecommunications were established (4) If an EMS provider elects to
with a physician; the name of the EMT or provide the receiving facility with an abbreviated
paramedic on the call; the name of driver on the run report at the time responsibility of the patient is
call; the name of all individuals rendering direct transferred to the receiving facility, the EMS
patient care; and the signature of person with provider must have the complete and accurate run
primary responsibility for patient care. report, as required in section 10D- 66.060(2),
(k) Each provider shall record on the F.A.C., available within 24 hours of the time the
run report the following medication information for vehicle was originally dispatched in response to the
each medication administered on the call: the name request for emergency medical assistance.
of each medication administered; the date and time (5) Non - transporting EMS providers
administered; the dosage; the route of shall provide a complete and accurate run report as
administration; the name of the physician who required in section 10D- 66.060(2), F.A.C., to the
ordered each medication; and the signature of the receiving facility within 8 hours, or they may
lead paramedic responsible for administering the provide an abbreviated run report as discussed in
drug or medication. Medication errors and any section 10D- 66.050(3), F.A.C., to the transport
reaction by the patient to any medication shall be service at the time the responsibility of the patient
reported to the paramedic's supervising physician is transferred to the transporting service.
and to the medical director. (6) Medication errors and reactions en
(1) Record of whether there were any route shall be reported to the physician who
exceptions to department - approved TTPs. ordered the medication, the receiving physician, and
(3) An accurate and complete run the ALS medical director.
report, as required in section 10D- 66.060(2), ;_17) Each provider shall ensure that
F.A.C., shall be provided to the receiving facility at - HRS Form 1728, 1 August 91, Trauma/Head -
the time the EMS provider transfers responsibility Injury/Spinal Cord Injury Registry, and HRS Form
of the patient to the receiving facility. The EMS 1729, August 91, Trauma Transport Log, which
provider may provide to the receiving facility an are incorporated by reference and available from
abbreviated run report in lieu of the complete run the department, are completed and delivered as
report required in section 10D- 66.060(2), F.A.C. If provided in section 10D- 66.100, .102 and .103,
the EMS provider elects to provide the abbreviated F.A.C.
run report before departure, the abbreviated run (8) HRS Form 1728, August 91, shall
report must contain, at a minimum, the following be attached to and filed with the corresponding run
elements: report for each trauma patient transport.
(a) the name, age, or date of birth, (9) Each provider shall maintain a
sex, and race of each patient; and the call written plan, available for review by the
identification number; department, for the proper handling, storage, and
(b) the date and the time the call was disposal of biohazardous wastes in accordance with
received by dispatch; chapter 10D -104, F.A.C.
(c) a report of the patient's (10) Each provider shall return his
• assessment, such as the methodology by which the license to the department within 15 calendar days
patient was evaluated; each patient's vital signs after a change of name or ownership of the service
with the times assessed at the scene and en route or upon permanently ceasing to provide service.
to the hospital; the care rendered prior to EMS
arrival, at the scene and en route to the hospital; Specific Authority 395.031, 395.032, 395.033,
(d) the type of call; the category of 395.0335, 395.034, 395.035, 395.036,
emergency: cardiac, behavioral, environmental, 395.037, 401.23, 401.24, 401.25, 401.26,
trauma, poisoning, burn, neonatal, or other; 401.27, 401.281, 401.30, 401.34, 401.35,
401.41, 401.411 FS. Law Implemented 395.031,
45
395.032, 395.033, 395.0335, 395.034, desires to waive his privilege of confidentiality must
395.035, 395.036, 395.037, 401.23, 401.24, submit to the department a completed HRS Form
401.25, 401.26, 401.27, 401.281, 401.30, 1609, September 84, Waiver of Confidentiality,
401.31, 401.34, 401.35, 401.41, 401.411 FS. which is incorporated by reference and available
History-New 11- 29 -82, Amended 4- 26 -84, 3-11- from the department. Upon receipt of the
85, Formerly 10D- 66.60, Amended 11-2-86, completed form, the department shall forward to
4- 12 -88, 8 -3 -88, 12- 10 -92. the subject of a complaint and any individual who
has requested a copy of the complaint, all
10D- 66.061 Insurance. information in the complaint file which is not
otherwise privileged or confidential. Any additional
(1) Every EMS provider or applicant information received after the initial forwarding
shall carry bodily injury and property damage shall also be forwarded.
insurance with solvent and responsible insurers
licensed to do business in Florida, to secure Specific Authority 395.018, 395.031, 395.032,
payment for any loss or damage resulting from any 395.033, 395.0335, 395.034, 395.035,
occurrence arising out of or caused by the operation 395.036, 395.037, 401.23, 401.24, 401.25,
or use of any of the operator's motor vehicles. 401.26, 401.27, 401.281, 401.30, 401.34,
Each vehicle shall be insured for the sum of at least 401.35, 401.41, 401.411, 401.414 FS. Law
$ 100,000 for injuries to or death of any one person Implemented 395.031, 395.032, 395.033,
arising out of any one accident; the sum of at least 395.0335, 395.034, 395.035, 395.036,
$300,000 for injuries to or death of more than one 395.037, 401.23, 401.24, 401.25, 401.26,
person in any one accident; and, for the sum of at 401.27, 401.281, 401.30, 401.34, 401.35,
least $50,000 for damage to property arising from 401.41, 401.411, 401.414 FS. History-New
any one accident. Government operated service 11- 29 -82, Amended 4- 26 -84, 3- 11 -85, Formerly
vehicles shall be insured for the sum of at least 10D- 66.62, Amended 4- 12 -88, 8 -3 -88, 12- 10 -92.
$ 100,000 for any claim or judgement and the sum
of $200,000 total for all claims or judgements 10D- 66.063 Variances.
arising out of the same occurrence. Every
insurance policy or contract for such insurance shall ,: Specific .Authority 401.35 FS. Law Implemented
provide for the payment and satisfaction of any' - 401.27 FS. History-New Amended
financial judgment entered against the operator and 4- 26 -84, Formerly 10D- 66.63, Amended 4- 12 -88,
present insured, or any person driving the insured Repealed 12- 10 -92.
vehicle. All such insurance policies shall provide for
30 day cancellation notice to the department. 10D- 66.0635 Variances and Exceptions.
(2) In lieu of such insurance, the
provider or applicant may furnish ,a certificate of (1) The department, through its
selfinsurance establishing that the provider or Office of EMS, may approve a variance or
applicant has a self- insurance plan to cover such exception as follows:
risks and that the plan has been approved by the (a) The department will approve a
Department of Insurance. variance to any provision of this chapter, except
any provision which restates a statutory
Specific Authority 401.25, 401.35 FS. Law requirement, states the scope of any section or of
Implemented 401.25 401.35 FS. History-New this chapter, defines any term, or is covered by
11- 29 -82, Amended 3- 11 -85, Formerly (1)(b) or (1)(c) below, provided that the applicant is
10D- 66.61, Amended 4- 12 -88, 12- 10 -92. affected by the provision for which the variance is
requested, meets all of the requirements and proves
10D- 66.062 Complaint Confidentiality; Waiver. to the departmentby clear and convincing evidence •
A complaint and all information obtained pursuant that:
to the department's investigation shall be exempt 1. local conditions are such that the
from section 119.07, FS., as provided for in applicant cannot or need not meet the provision for
section 401.414, FS., and are confidential until 10 which the variance is applied, and
days after probable cause has been found or until 2. public health, safety and welfare
the subject of the complaint waives his privilege of will not be adversely affected in any respect if the
confidentiality. The subject of a complaint who department approves the variance.
46
TABLE VI
(Reference Section 10D- 66.066)
WATERCRAFT EQUIPMENT AND MEDICATIONS
ITEM OTY.
1. Safety equipment and uniform
lighting requirements in
accordance with United States
Coast Guard safety and
lighting requirements, as set
forth in Titles 33 and 46, Code
of Federal Regulations, incorporated
by reference and available from
the U.S. Government Bookstore, P.O.
Box 35089, Jacksonville, Florida
32202; Title 33 cost $35, Title 46
cost $14, unless expressly
exempt by State law.
2. Anchor with line that is three One.
times the maximum depth of water
areas of usual operation.
3. Docking fenders. Two.
4. Mooring lines. Two.
5. Self or mechanical bailer. One.
6. Search light with a minimum of
200,000 candle power of illumination., _ One._ -
7. Swim harness and 75 foot tethering
line. One. -
8. Waterproof flashlight, six volt
minimum. One.
9. Navigational charts for service area
and navigational aids, including a
compass.
10. A cold water protection device for
each crew member. One.
11. Basic tool kit to include at least:
a. Wrench, 12 inch with adjustable
open end. One.
b. Screwdriver, 12 inch with straight
blade. One.
C. Locking pliers, minimum 10 inches. One.
• 12. Extra adult life jackets. Two.
13. Child life jackets: Two.
14. Sheath knife with six inch blade. One.
15. Gallon drinking water. One.
16. Boat hook with minimum of 10 foot One.
capability.
17. A locking mechanism to secure a One.
stretcher or litter below gunwale level.
49
(3) Watercraft Design and Capabilities in the EMS provider's TTPs which shall be
(a) Speed capability of 20 knots per submitted to the department for approval, in
hour. accordance with section 395.4045, FS. and
(b) Engine rating not to exceed section 1013- 66.101, F.A.C.
Boating Industry of America (B.I.A.) standard. (3) A trauma alert patient may be •
(c) Deck area large enough to transported to a hospital other than a SATC or
transport a patient in a supine position in a basket SAPTRC only if the hospital is closer to the scene
litter with at least 18 inches of free space on one of the incident, and the patient's immediate
side of the litter. condition is such that the patient's life will be
(4) ALS watercraft shall be staffed endangered if care is delayed by proceeding directly
with a paramedic, a boat operator, an EMT and a to the SATC or SAPTRC. If an EMS provider
crew member. The EMT may also serve as the intends to transport trauma alert patients to
crew member. hospitals other than SATCs or SAPTRCs under any
(5) The medications, I.V. solutions, other circumstances, those circumstances must be
and equipment listed in Table V are required on described in and authorized by the EMS provider's
each ALS watercraft. Substitutions are allowed department - approved TTPs, as required in this
with signed approval from the service's medical section.
director and the department. (a) An EMS provider must transport a
trauma alert patient to a SATC or SAPTRC, except
Specific Authority 401.25, 401.26, 401.35 FS. as may be provided in the EMS provider's
Law Implemented 401.25, 401.26, 401.35 FS. department - approved TTPS. For situations for
History-New 4- 12 -88. Amended 12- 10 -92. which the EMS provider intends to transport a
trauma alert patient to a hospital other than SATC
1OD- 66.100 Prehospital Requirements for or SAPTRC, as indicated in the provider's
Trauma Care. department - approved TTPs, the EMS provider shall
ensure beforehand that the hospital meets the
(1) Each EMS provider shall ensure following criteria:
that upon arrival at the location of an incident, an 1. Is staffed 24- hours - per -day with a
EMT or paramedic shall assess the condition of physician and other personnel who are qualified in_
each trauma patient using the trauma scorecard _emergency, airway, -_ management, ventilatory
methodology to determine the transport _ support, and control of life threatening circulatory
destination, as provided in section IOD- 66.102, problems which shall include but not be limited to
F.A.C. placement of endotracheal tubes; establishment of
(2) Each EMS provider shall transport, central intravenous lines; and insertion of chest
or cause to be transported, every trauma alert tubes;
patient to a SATC or SAPTRC nearest to the 2. Has equipment and staff in-
location of the incident, unless the distance is not hospital and available to conduct chest and cervical
relevant to the length of time for transport due to spine x -rays;
the use of an air ambulance. Pediatric trauma alert 3. Has laboratory facilities,
patients shall be transported to the nearest equipment and staff in- hospital and available to
SAPTRC or SATC with SAPTRC services even if a analyze and report laboratory results;
SATC without SAPTRC services is nearer to the 4. Has equipment and staff on call
location of the incident, except as provided in and available to initiate definitive care required by a
department - approved TTPs. If a SATC or SAPTRC trauma alert patient within 30 minutes of the
further from the location of the incident has a patient's arrival at the hospital, or can initiate
special resource(s) that the nearest SATC or procedures within 30 minutes of the patients arrival
SAPTRC does not have, such as burn center, which to transfer the trauma alert patient to a SATC or •
is needed for the immediate condition of the trauma SAPTRC; and
alert patient, the EMS provider may transport to the 5. Has a written transfer agreement
SATC or SAPTRC having that special resource(s) with at least one SATC or SAPTRC. The transfer
even if the SATC or SAPTRC is not nearest to the agreement shall provide specific procedures to
incident. These exceptions to transporting to the ensure the timely transfer of the trauma alert
nearest SATC or SAPTRC, or other exceptions the patient to the SATC or SAPTRC.
EMS provider wishes to request, shall be addressed
50
(b) Any exceptions to this (4) Each EMS provider shall ensure
requirement shall be included in the EMS provider's that an EMT or paramedic completes the patient
TTPs and be approved by the department. information and trauma scorecard sections of HRS
• (c) Prior to submitting an application Form 1728, August 91, Trauma/Head Injury/Spinal
for an ALS, BLS or air ambulance license, or to Cord Injury Registry, and delivers the form with the
renew such a license, each EMS provider shall trauma patient to a SATC, SAPTRC, or hospital.
request in writing, from the chief executive officer ALS non - transporting vehicle personnel shall
of each hospital (excluding SATCs and SAPTRCs) provide the completed form to transporting vehicle
to which the EMS provider intends to transport personnel at the time that responsibility for the
trauma alert patient's, written documentation that patient is transferred. The transporting vehicle
verifies that the hospital meets the requirements personnel shall deliver the completed form with the
provided in paragraph (3)(a) of this section. When trauma patient to the SATC, SAPTRC, or hospital.
submitting TTPs for department approval, EMS (5) EMS personnel shall issue a
providers shall include copies of each letter sent to prehospital trauma alert upon determining that a
the chief executive officer of such hospital as well trauma patient meets the requirements of section
as the response, if any, from the chief executive 10D- 66.102, F.A.C. EMS personnel shall use the
officer indicating whether the hospital complies words "trauma alert" when notifying the SATC, or
with paragraph (3)(a) of this section. SAPTRC, or hospital that EMS is en route with a
(d) A trauma agency that has trauma alert patient. EMS personnel shall also
developed uniform TTPs may request written provide the SATC, or SAPTRC, or hospital with
documentation from the hospitals in lieu of each information from the trauma scorecard section of
EMS provider, in accordance with the requirements HRS Form 1728, August 91.
of this section. (6) As rapidly as possible after receipt
(e) If an EMS provider does not of a request for emergency inter - hospital transfer of
receive a response from a hospital, or if the hospital a trauma patient, each EMS provider shall dispatch,
indicates that it is not in compliance with the or cause to be dispatched, an EMS vehicle or air
criteria in paragraph (3)(a) of this section, the EMS ambulance. Each 'EMS provider shall ensure the
provider shall not deliver a trauma alert patient to- - 'delivery of HRS-Form 1728, August 91 with the
that hospital. Any exception must also be included trauma patient to the SATC, SAPTRC or hospital.
in the EMS provider's department - approved TTPs. _ _. -- (7) -- EMS provider shall - have• -
(f) If a hospital's compliance with the department - approved TTPs which include at a
criteria in paragraph (3)(a) of this section changes minimum:
during the EMS provider's biennial licensure period, (a) Dispatch procedures which
the EMS provider shall submit, within 30 days of include:
becoming cognizant of the change, revised TTPs to 1. A description of information to be
the department for approval, in accordance with solicited from the individual requesting emergency
section 10D- 66.101, F.A.C. medical assistance in order to determine the
(g) If a hospital to which an EMS number of patients, location of the incident, and
provider transports trauma alert patients, as extent and severity of reported injuries;
provided in the EMS provider's or trauma agency 2. A description of the method used
department - approved TTPs, becomes a SATC or to ensure that the EMS vehicle most readily
SAPTRC, including those granted provisional status available is identified and dispatched to the location
by the department, the EMS provider shall begin of the incident; and
immediately transporting trauma alert patients to 3. A description of the process used
that SATC or SAPTRC. The EMS provider shall to request assistance from emergency response
• revise and submit TTPs to the department for agencies.
approval within 30 days of the hospital becoming a (b) Prehospital procedures which
SATC or SAPTRC. Within 30 days of an EMS include:
provider or a trauma agency receiving notification 1. Procedure which provides that
that a SATC or SAPTRC intends to discontinue as a upon arrival at the location of the incident, EMTs
SATC or SAPTRC, the EMS provider or trauma and paramedics assess the condition of each
agency shall submit revised TTPs to the trauma patient to determine the transport
department for approval, in accordance with destination, in accordance with section 10D-
section 10D- 66.101, F.A.C. 66.102, F.A.C.;
51
2. Procedure to be followed by EMTs is received on or before the date that the initial or
and paramedics for completion of the patient renewal license, or revised TTPs, are due to the
information and trauma scorecard sections of HRS department.
Form 1728, August 91, and the delivery of the (9) A hospital licensed in another
form with the trauma patient to a SATC, SAPTRC, state which meets the criteria provided in section .
or hospital; 10D- 66.100(3)(c), F.A.C., may be identified in the
3. Criteria used to determine when TTPs as a hospital to which the EMS provider may
transport assistance shall be requested and the transport a trauma alert patient, in accordance with
process used for obtaining such assistance. The the requirements in section 10D- 66.100, F.A.C.
criteria shall include and differentiate between air (10) A hospital in another state which
and ground ambulance services; and has received approval from the appropriate
4. Procedures for issuing a governmental agency in that state to operate as a
prehospital trauma alert. trauma center may be identified in TTPs as an
(c) Transport destination criteria approved trauma center.
which include:
1. The criteria and process used to Specific Authority 395.031, 395.032,
determine the transport destination of trauma alert 395.033, 395.0335, 395.034, 395.035,
patients; and 395.036, 395.037, 401.35 FS. Law Implemented
2. A list of situations, if any, in 395.031, 395.032, 395.033, 395.0335,
which it may be in the best medical interest of the 395.034, 395.035, 395.036, 395.037, 401.35
trauma alert patient to be transported to a FS. History-New 8 -3 -88, Amended 12- 10 -92.
destination other than a SATC or SAPTRC, in
accordance with the requirements of this section. 10D- 66.101 Trauma Transport Protocols
Justification to support each situation shall be Approval and Denial Process.
included.
(d) The procedures for an emergency (1) TTPs shall be approved by the
inter - hospital transfer of a trauma patient. EMS provider's medical director prior to submission
(e) Written documentation that the to the department for approval.
TTPs submitted by the ALS, BLS or air ambulance (2) Revisions to TTPs during the
provider have been approved by the provider's, licensure period:
medical director. (a) Revisions must be submitted to
(f) A list of SATCs, SAPTRCs, and the department, and to the trauma agency if one
hospitals to which the EMS provider intends to exists, for approval at least 60 days prior to the
transport trauma alert patients. proposed implementation date. Other sections that
(g) Written documentation that all mandate earlier submission under special
hospitals, SATCs and SAPTRCs to which the EMS circumstances shall take precedence over this 60
provider routinely transports have been provided a day requirement. The department shall, within 30
copy of the criteria which the EMS provider will days of receipt, review the EMS provider's
follow to determine trauma transport destinations. proposed TTPs to determine compliance with
(h) A description of the methodology section 1013- 66.100, F.A.C. The department will
used to assess the condition of and to measure the also consider the recommendations of the local or
severity of injury of each pediatric trauma patient to regional trauma agency, if one exists, before
determine the transport destination. The advising the EMS provider of any errors or
methodology shall include the anatomy and omissions. If there are any errors or omissions, the
mechanisim of injury criteria described in section department shall request corrections or additional
10D- 66.102(2)(b)2.a. -e., F.A.C. information from the EMS provider.
(8) Any EMS provider located in a (b) The EMS provider shall submit the
trauma service area with a department- approved requested corrections or additional information
local or regional trauma agency shall submit a copy within 15 days of receipt of the notice of errors or
of proposed or revised TTPs to the agency any time omissions.
the EMS provider submits an initial or renewal (c) The department shall deem the
license application, or revised TTPs, to the TTPs complete upon receipt of the corrections or
department. The EMS provider shall ensure that additional information, or upon expiration of the 15-
the agency's copy of the proposed or revised TTPs day time period, whichever occurs first.
52
(d) The department shall review the criteria described in paragraphs (2)(b)2.a. -e., of this
EMS provider's proposed TTPs to determine section; and
compliance with section 1013- 66.100, F.A.C., and (c) Complete the patient information
• will consider the recommendation of the local or and trauma scorecard sections of HRS Form 1728,
regional trauma agency, within 15 days of receipt - August 91.
of the corrections or additional information, or (2) For each trauma patient, the EMT
within 15 days of the TTPs being deemed complete or paramedic shall:
as originally submitted. (a) Assess the condition, determine
(e) The EMS provider may implement the vital signs, determine the Glasgow Coma Scale
proposed changes to TTPs and submit a request for score and the anatomy or mechanism of injury;
department approval within 30 days after a change (b) Identify the trauma patient as a
is implemented if a delay in approval would have an trauma alert patient if the trauma patient meets one
adverse impact on the delivery of patient care. or more of the following criteria:
Changes in TTPs submitted to the department after 1. Severity of injury measurements:
implementation by the EMS provider will be a. Respiratory rate of less than 10
reviewed by the department in accordance with per minute or greater than 29 per minute; or
paragraphs (2)(a)-(d) of this section. b. Systolic blood pressure of less
(3) When submitting TTPs for than 90 mmHg; or
department approval, each EMS provider, or trauma C. Glasgow Coma Scale Score of 12
agency that has developed uniform TTPs, shall or less (excluding patients whose normal Glasgow
include a copy of the letters sent to the hospital's Coma Scale Score is 12 or less, as established by
chief executive officers as well as documentation the patient's medical history or pre- existing_medical
received in response from the hospital's chief condition when known); or
executive officers indicating whether the hospital 2. Anatomy and mechanism of
complies with 10D- 66.100(3)(c), F.A.C. injury:
(4) The department shall issue a letter a. Penetrating injury to head, neck or
of approval to the EMS provider upon determination torso (excluding superficial wounds in which the
that the TTPs are in compliance with section 10D- depth of the wound can be easily determined); or
66.100, F.A.C. b. Second or third degree burns
(5) The department shall issue a involving `15 percent or greater body surface area;-
of denial to the EMS provider upon determination or
that the TTPs are not in compliance with section C. Paralysis; or
10D- 66.100, F.A.C. The letter shall specify the d. Amputation proximal to the wrist
deficiencies in the protocols and shall include or ankle; or
notification of any right to a section 120.57, FS., e. Ejection from a motor vehicle
hearing. (excluding any motorcycle, moped, all terrain
vehicle, bicycle or the open body of a pick -up
Specific Authority 395.036, 395.037, 401.35 FS. truck).
Law Implemented 395.036 395.037, 401.35 FS. C. Transport, or cause to be
History-New 8 -3 -88, Amended 12- 10 -92. transported, the trauma alert patient to a SATC,
SAPTRC, or hospital in accordance with the EMS
10D- 66.102 Trauma Scorecard Methodology. provider's department - approved TTPs.
(3) The severity of injury of a
(1) Each EMS provider shall ensure pediatric trauma patient shall be determined
that upon arrival at the location of an incident, an according to the pediatric trauma alert criteria and
• EMT or paramedic shall: methodology prescribed by the medical director of
(a) Assess the condition of each each EMS service, and the anatomy and
trauma patient using the trauma scorecard mechanism of injury criteria described in paragraph
methodology, as provided in this section, to (2)(b) 2. a.-e. of this section. A pediatric trauma
determine the transport destination or alert patient identified according to these criteria
(b) Assess the condition of each and methodology shall be transported to the
pediatric trauma patient using the methodology nearest SAPTRC or SATC with SAPTRC services,
prescribed by the medical director of the EMS even if a SAPTRC or SATC without SAPTRC
service, and the anatomy and mechanisim of injury
53
service is nearer to the location of the incident, the department on a monthly basis, no later than
except as provided in department - approved TTPs. the 15th of the month following the month in
which the transports occurred. Each transporting
Specific Authority 395.031, 395.032, EMS provider shall maintain a file copy of the form
395.033, 395.0335, 395.034, 395.035, for a period of 7 years and shall make such copy •
395.036, 395.037, 401.35 FS. Law Implemented available to the department upon request.
395.031, 395.032, 395.033, 395.0335, (c) Each SATC, SAPTRC, or hospital
395.034, 395.035, 395.036 395.037, 401.35 shall:
FS. History -New 8 -3 -88, Amended 12- 10 -92. 1. Complete the patient information,
emergency department, and discharge information
10D- 66.103 Trauma Registry. sections of HRS Form 1728, August 91, when the
trauma patient is delivered to the facility by an EMS
(1) The department shall operate and provider. When a trauma patient arrives at a
maintain a statewide trauma registry for the SATC, SAPTRC, or hospital by any means other
purpose of evaluating the operation of trauma than an EMS provider, SATC, SAPTRC, or hospital
systems and assessing the quality of trauma care personnel shall initiate and complete the patient
provided by each EMS provider, SATC, SAPTRC, information, emergency department, and discharge
and hospital. The department may, by contract, or information sections of HRS Form 1728, August
agreement allow a trauma agency or other entity to 91, provided the trauma patient meets trauma alert
collect or receive and review trauma registry data. criteria, as described in section 10D- 66.102(2)(b),
Such a contract or agreement shall be entered into F.A.C., is admitted, dies in the emergency
only when the department determines that the department, or is, transferred to another licensed
trauma agency or entity has the capability of acute care facility.
collecting and transferring data to the department, 2. Complete the name of hospital,
or otherwise using this data for department hospital identification number, and disposition
approved evaluation purposes. elements of Section 111 of HRS Form 1728, August
(2) Each EMS provider, SATC, 91, for each trauma patient transported by EMS
SAPTRC, and hospital shall collect trauma registry who is discharged from the emergency department
data and provide such data to the department, - or to - within 24 hours of arrival. - the trauma agency or entity with which the 3. Submit HRS Form 1728, August =
department has an agreement or contracts; as 91, to the department on a monthly basis, no later
follows: than the 15th of the month following the month the
(a) Each EMS provider shall: trauma patient was discharged from acute care or
1. Complete and deliver HRS Form died in the facility.
1728, August 91, in accordance with section 10D- 4. Maintain a completed copy of
66.100(4) and .102, F.A.C.; each HRS Form 1728, August 91, for a period of at
2. Complete the applicable items in least 7 years. Copies of these completed forms
the patient information and trauma. scorecard shall be submitted to the department upon request.
sections of the form if a trauma patient is dead at (3) A transferring SATC, SAPTRC, or
the location of an incident. The EMS provider shall hospital shall ensure that HRS Form 1728, August
submit HRS Form 1728, August 91, for each of 91, is provided to the EMS personnel conducting an
these patients to the department on a monthly emergency inter - hospital transfer. The EMS
basis, no later than the 15th of the month following personnel shall deliver the form with the trauma
the month in which the incidents occurred; patient to the receiving SATC, SAPTRC or hospital.
3. Maintain a copy of HRS Form (4) Each medical examiner shall, upon
1728, August 91, with the run report for each request and consistent with the provisions of
trauma patient for a period of at least 7 years, and chapter 119, FS., submit a copy - of the complete •
make such copy available to the department upon autopsy report, including investigative notes, for
request. each trauma patient who was provided care by
(b) Each . transporting EMS provider prehospital EMS or by a hospital (includes SATC
shall complete HRS Form 1729, August, 91, and SAPTRC) and who died as a result of the
Trauma Transport Log, for each trauma patient injury.
transported during the preceding month. The (5) Any EMS provider, SATC,
transporting EMS provider shall submit the forms to SAPTRC, hospital or trauma agency which desires
54
to provide trauma registry data in any manner other agency, each major geographical barrier, all medical
than prescribed in this section may submit a facilities, all prehospital ground and air facilities,
request to provide the data by an alternative and all other significant factors that affect the
• method. Any request shall be in accordance with determination of the geographic area boundaries;
the intent of sections 10D- 66.100 and .103, and
F.A.C. 3. Describe the historical patient .
flow, patient referral, and transfer patterns used to
Specific Authority 395.031, 395.032, define the geographic areas of the proposed trauma
395.033, 395.0335, 395.034, 395.035, agency.
395.036, 395.037, 401.35 FS. Law Implemented (c) Organizational Structure:
395.031, 395.032, 395.033, 395.0335, 1. Provide a detailed description of
395.034, 395.035, 395.036, 395.037, 401.35 the managerial and administrative structure of the
FS. History-New 8 -3 -88, Amended 12- 10 -92. proposed agency;
2. Include a table of organization, the
10D- 66.104 Trauma Agency Formation names of the board of directors and each member's
Requirements. affiliation, and identify the individuals who will
administer or operate the trauma agency, if known;
(1) To form a trauma agency, a 3. Provide the names, job
county or counties (if regional), or an entity with descriptions and responsibilities of officials who
which the county or counties contract for the shall be directly responsible for trauma agency
purpose of trauma service administration shall: personnel, and the names, job descriptions and
(a) Obtain formal authority to create responsibilities of individuals who shall be
the agency from the county commission of each of responsible for managing and operating the trauma
the counties in which the agency plans to operate. agency on a daily basis; and
(b) Establish interlocal agreements 4. Describe in detail the specific
between county governments if the proposed authority that trauma agency personnel shall have
agency shall provide service to more than one in directing the operation of prehospital and hospital
county. entities within the purview of the trauma agency, if
(c) Hold a public hearing and give approved, be it a single or multi -county trauma
adequate notice of the hearing to the public in the agency.
county or counties in which the proposed trauma (d) Trauma System Structure:
agency shall operate. Adequate notice shall consist 1. Describe the operational functions
of publishing the notice, at least 30 days prior to of the system; the components of the system; the
the public hearing, in at least one newspaper of integration of the components and operational
general circulation in each affected county. If a functions; and the coordination and integration of
newspaper is not published in a county in which a the activities and responsibilities of SATCs,
proposed trauma agency shall operate, adequate SAPTRCs, hospitals, and prehospital EMS
notice may be given by publishing the notice in at providers; and
least one newspaper of general circulation in 2. Include a list of all participating
adjoining affected counties. and non - participating trauma care resources within
(d) Develop and submit an original the defined geographical area of the proposed
and four copies of the trauma agency plan to the trauma agency and documentation showing that
department for review and approval. these entities have been given the opportunity to
(2) The trauma agency plan shall participate in the system. Trauma care resources
contain the following information in the following shall include, but are not limited to, hospitals,
• order: SATCs, SAPTRCs, prehospital providers, training
(a) Table of Contents; centers, and planning entities; and
(b) Population and Geographic Area to 3. Include the proposed trauma
be Served. agency's recommendation and justification for the
1. Describe the population and number and location of SATCs and SAPTRCs
defined geographic area to be served by the trauma required to serve its defined geographical area.
agency; (e) Objectives, Proposed Actions, and
2. Include a map showing the Implementation Schedule. Provide a description of
defined geographic area of the proposed trauma the objectives of the plan, a detailed list of the
55
proposed actions necessary to accomplish each (k) Emergency Medical
objective, and a timetable for the implementation of Communications:
the objectives and action. The timetable shall 1. Describe the EMS communication
identify the scheduling of the annual audit and system within the proposed trauma agency's
evaluation, including the completion date and trauma service area; and •
submission date to the department. 2. Describe the proposed trauma
(f► Describe the proposed source of agency's compliance with the State of Florida
income and anticipated expenses by category for Communications Plan, requirements for normal
the proposed trauma agency; operating conditions, mass casualty and disaster
(g) Describe the proposed trauma situations in which commercial power, telephone
agency's fiscal impact on the trauma system which lines or telephone services are not available,
includes a description of any increased costs including outages of base stations controlled by
related to providing trauma care. leased telephone lines. The specific areas to be
(h) Transportation System Design: addressed are:
1. Describe the EMS ground, water, a. Statewide medical coordination
and air transportation system design of the trauma (SMC);
system; and b. Local medical coordination (LMC);
2. Include trauma patient flow C. Vehicle dispatch and response
patterns, emergency inter - hospital transfer (VDR);
agreements, and the number, type, and level of d. Medical resource coordination;
service of prehospital EMS providers within the e. Local scene coordination;
trauma system. f. Medical alert paging;
W TTPs: g. Communications coverage;
1. Provide confirmation that existing h. LMC and VDR channels;
department - approved TTPs for each EMS provider, i. SMC channel;
within the defined geographical area of the j. Cellular phone use if applicable;
proposed trauma agency, are accurate and shall be and
adopted by the proposed trauma agency, pending k. Locations and types of
department approval of the plan; _communications - equipment .within the proposed
2. A proposed trauma agency may trauma a geographical area.
develop uniform TTPs for department approval that - - - (1) Data Collection. Describe the
shall be adhered to by all EMS providers that serve trauma data management system developed for the
the geographic area of the proposed trauma purpose of documenting and evaluating the trauma
agency. If uniform TTPs are submitted to the systems operation.
department for approval, the TTPs shall include the (m) Trauma System Evaluation.
name of each EMS provider that shall operate Describe the methodology by which the proposed
according to the uniform TTPs, and proof of trauma agency shall evaluate the trauma system.
consultation with each EMS provider's medical (n) Mass Casualty and Disaster Plan
director. TTPs developed and submitted by a Coordination. Describe the proposed trauma
proposed trauma agency shall be processed in agency's coordination of the prehospital and
accordance with section 10D- 66.101, F.A.C.; and hospital component's mass casualty and disaster
3. The proposed trauma agency shall plan for the defined geographic area it represents.
provide a copy of any county ordinance governing (o) Public Information and Education.
the transport of trauma patients within the defined Describe the proposed trauma agency's programs
geographic area of the proposed trauma agency. designed to increase public awareness of the
(j) Medical Control and trauma system and public education programs
Accountability. Identify and describe the designed to prevent, reduce the incidence of, and •
qualifications, responsibilities and authority of care for traumatic injuries within the defined
individuals and institutions providing off -line geographic area it represents.
(system) medical direction and on -line (direct) (p) Attachments. Include the
medical control of all hospitals and prehospital EMS following:
providers operating under the purview of the 1. A copy of each contract and
trauma agency. agreement entered into by the proposed trauma
agency, pending department approval of the
56
TSA Counties SATC or SAPTRC
1 Escambia; Okaloosa;
Santa Rosa; Walton 2
• 2 Bay; Gulf; Holmes;
Washington 1
3 Calhoun; Franklin;
Gadsden; Jackson;
Jefferson; Leon;
Liberty; Madison;
Taylor; Wakulla 1
4 Alachua; Bradford;
Columbia; Dixie;
Gilchrist; Hamilton;
Lafayette; Levy;
Putnam; Suwannee;
Union 2
5 Baker; Clay;
Duval; Nassau;
St. Johns 2
6 Citrus; Hernando;
Marion 1
7 Flagler; Volusia 2
8 Lake; Orange; Osceola;
Seminole; Sumter 3
9 Pasco; Pinellas 3
10 Hillsborough 2
11 Hardee; Highlands;
Polk - 3
12 Brevard; Indian River
13 DeSoto; Manatee;
Sarasota 3
14 Martin; Okeechobee;
St. Lucie 1
15 Charlotte; Glades;
Hendry; Lee 2
16 Palm Beach 2
17 Collier 1
18 Broward 4
19 Dade; Monroe 6
TOTAL 43
•
59
(4) Any TSA which did not have a organized in the same manner as was required at
hospital approved by the department as a the time of application.
Provisional SATC or Provisional SAPTRC by May 1, (3) To be a Level II SATC, a hospital
1991, will have its assigned number of positions shall:
reduced by one on that date. TSAs that have only (a) Meet and maintain after receiving •
one available position are not affected. The provisional status and during the 7 year state -
additional position(s) will be reserved and assigned approval period the standards for a Level II SATC
at the discretion of the department. Due to an error as provided in HRSP 150 -9, October 91;
in addition, the single trauma center not designated (b) Meet the site visit requirements
by the table contained in "A Report and Proposal described in section 1OD -66.1 12, F.A.C.;
for Funding State - Sponsored Trauma Centers ", (c) Meet and maintain after receiving
February 90, shall be assigned at the discretion of provisional status and during the 7 year state
the department. approval period the requirements provided in
section 10D- 66.103, F.A.C., regarding the
Specific Authority 395.033, 395.037 FS. collecting and reporting of trauma registry data; and
Law Implemented 395.033, 395.037 FS. History- (d) Maintain and update at least
New 12- 10 -92. annually an in- hospital copy of the application that
was approved by the department as described in
10D- 66.108 SATC and SAPTRC Requirements. section 10D- 66.109, F.A.C., so that the application
reflects current and accurate information. The
(1) The standards for Level I and application shall be maintained and updated after
Level 11 SATCs, and SAPTRCs, are published in HRS receiving provisional status and during the 7 year
Pamphlet (HRSP) 150 -9, October 91, State- state - approval period, and organized in the same
Approved Trauma Center and State - Approved manner as was required at the time of application.
Pediatric Trauma Referral Center Approval (4) To be a SAPTRC, a hospital shall:
Standards, which is incorporated by reference and (a) Meet and maintain after receiving
available from the department. provisional status and during the 7 year state -
(2) To be a Level 1 SATC, a hospital approval period the standards for a SAPTRC as
shall be a state licensed general hospital and shall: provided in HRSP 150 -9, October 1991;
(a) Meet and maintain after receiving -- ..(b) Meet , the. site visit requirements
provisional status and during the 7 year state- described in section 1OD -6 6.112, F.A.C.;
approval period the standards for a Level I SATC (c) Meet and maintain after receiving
and the standards for a SAPTRC as provided in provisional status and during the 7 year state -
HRSP 150 -9; approval period the requirements provided in
(b) Meet the site visit requirements section 10D- 66.103, F.A.C., regarding the
described in section 10D- 66.112, F.A.C.; collecting and reporting of trauma registry data; and
(c) Meet and maintain after receiving (d) Maintain and update at least
provisional status and during the 7 year state- annually an in- hospital copy of the application that
approval period the requirements provided in was approved by the department as described in
section 10D- 66.103, F.A.C., regarding the section 1.013- 66.109, F.A.C., so that the application
collecting and reporting of trauma registry data; and reflects current and accurate information.
(d) Maintain and update at least Documentation used by the SATC and SAPTRC to
annually an in- hospital copy of the application that update the application, but maintained elsewhere
was approved by the department as described in between annual application updates shall be
section 1013- 66.109, F.A.C., so that the immediately available for department review at any
application reflects current and accurate time. The application shall be maintained and
information. Documentation used by the SATC or updated after receiving provisional status and •
SAPTRC to update the application, but maintained during the 7 year state - approval period, and
eslewhere between annual application updates shall organized in the same manner as was required at
be immediately available for department review at the time of application.
any time. The application shall be maintained and (5) The standards published in HRSP
updated after receiving provisional status and 150 -9, October 91, are subject to revision at any
during the 7 year state - approval period, and time through rule promulgation. Any hospital that
has been granted Provisional SATC or Provisional
60
proposed trauma agency, for the benefit and notification of any right to a hearing pursuant to
operation of the trauma system; and section 120.57, FS.
2. A copy of the public hearing
• notice and minutes of the hearing. Specific Authority 395.031, 395.032, 395.033,
395.0335, 395.034, 395.035, 395.036,
Specific Authority 395.031, 395.032, 395.037, 401.35 FS. Law Implemented 395.031,
395.033, 395.0335, 395.034, 395.035, 395.032, 395.033, 395.0335, 395.034,
395.036, 395.037, 401.35 FS. Law Implemented 395.035, 395.036, 395.037, 401.35 FS. History -
395.031, 395.032, 395.033, 395.0335, New 8 -3 -88, Amended 12- 10 -92.
395.034, 395.035, 395.036, 395.037, 401.35
FS. History-New 8 -3 -88, Amended 12- 10 -92. 10D- 66.1065 Trauma Agency Implementation
and Operation Requirements
10D- 66.105 Agency Plan Criteria.
(1) To implement a trauma system, a
Specific Authority 395.031, 395.032, department- approved trauma agency shall:
395.035, 395.036 FS. Law Implemented (a) Implement the trauma system in
395.031, 395.032, 395.035, 395.036 FS. accordance with its department- approved planned
History-New 8 -3 -88, Repealed 12- 01 -92. timetable for implementation.
(b) Submit proposed changes to the
10D- 66.106 Trauma Agency Plan Approval and department- approved plan to the department for
Denial Process. approval, as provided in section 10D- 66.106,
F.A.C. The trauma agency may, at its own risk,
(1) The department shall, within 30 institute proposed changes to the plan and submit a
days of receipt, review the proposed trauma request for department approval within 30 days
agency's trauma system plan and notify the after a change is instituted if a delay in approval
proposed trauma agency that the plan is complete, would have an adverse impact on the current level
or that there are omissions. If there are omissions, of care. The trauma agency's requ€;st shall explain
the department shall request the required additional how the delay in approval would have adversely
information to be submitted by the proposed.- affected : the - current .level of care. Each request
trauma agency. shall document that affected trauma -care resources:
(2) The proposed trauma agency shall - - within the ,defined geographical area the agency
submit the requested additional information to the concur with these proposed changes.
department within 30 days of receipt of the notice (2) Each trauma agency shall operate
of omissions. the trauma system in accordance with the
(3) The department shall deem the department- approved plan, and shall:
plan complete upon receipt of the additional (a) Conduct reviews of SATC and
information or the expiration of the 30 -day time SAPTRC applications from any hospital within the
period, whichever occurs first. defined geographic area of the trauma agency.
(4) The department shall review the Submission of an SATC or an SAPTRC application
plan to determine compliance with chapters 395 to the trauma agency by a hospital seeking
and 401, FS., and chapters l OD -28 and 10D -66, approval shall be in accordance with the time
F.A.C., within 60 days of receipt of the additional frames described in section 1 OD- 66.109(1)(c),
information or of the plan being deemed complete. F.A.C. Results of the'trauma agency's review shall
(5) The department shall issue a letter be submitted to the department no later than April
of approval to the proposed trauma agency upon 7 of each year, in order to be considered by the
• determination that the plan is in compliance with department.
chapters 395 and 401, FS., and chapters 10D -28 (b) Conduct reviews of proposed or
and 1013-66, F.A.C. revised TTPs submitted by each EMS provider
(6) The department shall issue a letter within the defined geographic area of the trauma
of denial to the proposed agency upon agency. Results of each review shall be submitted
determination that the plan is not in compliance to the department within 15 days of receipt of the
with chapters 395 and 401, FS., and chapters proposed or revised TTPs, in order to be considered
10D -28 and 1013-66, F.A.C. The letter shall by the department.
specify the deficiencies in the plan and include
57
(c) Conduct annual performance (1) The number and composition of
evaluations of the trauma system and submit the TSAs shall be in accordance with section 395.402,
results to the department for approval, as provided FS.
in section 10D- 66.106, F.A.C. The evaluation (2) The number of SATCs or
report shall be submitted within 60 days after SAPTRCs in each TSA shall be in accordance with •
completion of the evaluation. This evaluation shall the minimum number set forth in the table below
include at least the following: which is replicated from table 3.3 in "A Report and
1. Results of monitoring each EMS Proposal for Funding State - Sponsored Trauma
provider, SATC, SAPTRC and hospital within the Centers," February 1990, except as provided in
defined geographic area of the trauma agency for this section. Each trauma service area shall have at
compliance with trauma scorecard methodology least one Level I or Level II SATC position.
requirements as provided in section 10D- 66.102, (3) The number of SATC or SAPTRC
F.A.C. positions for each TSA is as follows:
2. Results of monitoring each EMS
provider, SATC, SAPTRC and hospital within the
defined geographic area of the trauma agency for
compliance with TTP requirements as provided in
section 10D- 66.100, F.A.C.
(3) Each trauma agency shall have
personnel or arrange for management service
personnel with clear authority and responsibility to
operate the trauma agency. The administrative
function of the trauma agency shall not be carried
out or performed under the direct supervision of
any individual who administers or operates any
health care entity in the trauma system, whether a
single or multi- county system.
(4) The department shall withdraw
trauma agency approval at any time if the trauma -
agency fails to effectively meet the needs of the
persons served by the trauma agency or if the - -
department determines that implementation is
inconsistent with the department- approved trauma
agency plan, chapters 395 and 401, FS. or rules of
the department.
Specific Authority 395.031, 395.032, 395.033,
395.0335, 395.034, 395.035, 395.036,
395.037, 401.35 FS. Law Implemented 395.031,
395.032, 395.033, 395.0335, 395.034,
395.035, 395.036, 401.35 FS. History-New 12-
10 -92.
10D- 66.107 Agency Plan Exceptions
Specific Authority 395.031, 395.032, 395.035,
395.036 FS. Law Implemented 395.031, •
395.032, 395.035, 395.036 FS. History-New 8 -3-
88, Repealed 12- 10 -92.
10D- 66.1075 Apportionment of SATCs or
SAPTRCs within a Trauma Service Area (TSA).
58
SAPTRC status or has been granted a 7 year reference and available from the department. Each
Certificate of State Approval as a SATC or SAPTRC hospital in a TSA with a department- approved local
shall comply with all revisions to the standards or regional trauma agency shall, at the time a SATC
• published in HRSP 150 -9, beginning on the date the or SAPTRC application is submitted to the
amended rule becomes effective. department, submit a duplicate of the application to
the trauma agency for review. Recommendations
Specific Authority 395.031, 395.032, 395.033, from the trauma agency shall be submitted to the
395.0335, 395.034, 395.035, 395.036, department no later than April 7, as provided in
395.037, 401.35 FS. Law Implemented 395.031, section 10D- 66.1065, F.A.C.
395.032, 395.033, 395.0335, 395.034, (d) After considering the results of
395.035, 395.036, 395.037, 401.35 FS. History- the local or regional trauma agency's
New 8 -3 -88, Amended 12- 10 -92. recommendations, the department shall, by April
15, conduct a provisional review to determine
10D- 66.109 Process for the Approval of completeness of the application and the hospital's
SATCs and SAPTRCs. compliance with the critical standards for
provisional status.
(1) Beginning September 1, 1990, 1. The critical standards for
and annually thereafter, the department shall provisional review for Level I and Level II SATC
approve SATCs and SAPTRCs in accordance with applications are specified in HRSP 150 -9, October
the schedule shown in Table VII; (Unless stated 91, as follows:
otherwise all dates given by calendar month and
day refer to that date each year.) STANDARD
(a) The department shall accept a 1. Commitment: A, B & C 1, 3 & 4;
letter of intent, HRS Form 1840, October 91, IV. Surgical Specialties Availabilities: AO)a
"State- Approved Trauma Center Letter of Intent ", & b,(2)a, b, B(7);
which is incorporated by reference and available V. Non - Surgical Specialties Availabilities:
from the department, postmarked no earlier than A;
September 1 and no later than midnight, October 1, VI. Emergency Department; Division;
from any acute care general or pediatric hospital. Service; Section: - A s B(1jf, Of, (3)a, b, c, & f, C 5,
The letter of intent is non - binding, but preserves the 6 & 7;
hospital's right to submit an application by the VII. Operating Suite Special
required due date if an available position, as Requirement: A 1 & 3;
provided in section 10D- 66.1075, F.A.C., exists in IX. Intensive Care Unit: A(1)a, b, & c;
the hospital's TSA. If the hospital does not submit XIII. Radiological Capabilities: C; and
an application by April 1 of the following year, the XVI. Quality Management: A, B, C, D & E.
hospital's letter of intent is void;
(b) By October 15, the department 2. The minimum standards for
shall send to those hospitals submitting a letter of review for Provisional SAPTRCs are the following
intent an application package which will include, as portions of HRSP 150 -9, October 91;
a minimum, instructions for submitting information
to the department for selection as a SATC or STANDARD
SAPTRC, HRSP 150 -9, October 91, and the 1. Type of Hospital;
requested application(s); 11. Surgery Department; Division;
(c) No later than April 1 of the Services; Sections: A;
calendar year following the submission of a letter of Ill. Surgical Specialties Availabilities:
• intent, a hospital seeking approval as a SATC or A 1, 2, 3 & 4;
SAPTRC shall submit to the department an original V. Non - Surgical Specialties
and 3 copies of the application HRS -H Form 2032, Availabilities: 1, 8, & 13;
October 91, Application for Level I State - Approved VI. Emergency Department (ED): A,
Trauma Center, or HRS -H Form 2043, October 91, B, D, & H;
Application for Level 11 State - Approved Trauma VII. Operating Suite Special
Center, or HRS Form 1721, October 91, Requirements: A;
Application for State - Approved Pediatric Trauma IX. Pediatric Intensive Care (P -ICU):
Referral Center, which are incorporated by A, C, 1;
61
XVI. Quality Management: A, B, C, D, SAPTRC that was notified by the deparment on or
& E before October 1 at the conclusion of the in -depth
review that omissions, deficiencies, or problems
(e) No later than April 15, each were not resolved shall be given 30 calendar days
hospital whose application the department finds to from the department's notification following the •
be unacceptable or deficient during the completion of the site visit to provide additional
department's provisional review, will be notified in information, as discussed in section 10D- 66.112,
writing of deficiencies and given the opportunity to F.A.C.
submit additional clarifying or corrective (1) The department shall deny the
information. application of any Provisional SATC or Provisional
(f) The hospital shall submit the SAPTRC that has not corrected the omissions,
requested information to the department by close deficiencies, or problems noted from the in -depth
of business 5 working days after April 15. Failure review within 30 calendar days from the
to provide the requested information, or failure to department's notification following the completion
successfully address the deficiencies identified by of the site visit, as provided in section 10D-
the department, shall result in the denial of the 66.112, F.A.C., regardless of the findings of the
hospital's application. out -of -state review team regarding the quality of
(g) The department shall send written trauma patient care and trauma patient
notification to each applicant on or before May 1: management provided by the Provisional SATC or
1. The department shall notify each Provisional SAPTRC.
hospital whose application it has found acceptable
upon completion of the provisional review that the
hospital shall operate as a Provisional SATC or
Provisional SAPTRC beginning May 1;
2. The department shall inform each
hospital whose provisional application it has denied
of the remaining deficiencies in the application and
shall inform the hospital that it may submit a letter
of intent at the beginning of the next approval
cycle.
(h) The department shall, between
May 1 and June 30, complete an in- depth - review
of all sections of the Provisional SATC's or
Provisional SAPTRC's application. The department
shall notify the hospital of any omissions,
deficiencies, or problems and request additional
information to be submitted by the hospital.
(i) To have additional information
considered during the department's in -depth review
of the application, the Provisional SATC or
Provisional SAPTRC shall submit the requested
additional information to the department no later
than September 1.
(j) By September 30, the department
shall determine whether the omissions,
deficiencies, or problems have been corrected. The
department shall notify each Provisional SATC or •
Provisional SAPTRC on or before October 1 of any
omissions, deficiencies, or problems that were not
resolved by submission of the requested additional
information.
(k) Provisional SATCs and Provisional
SAPTRCs are subject to a site visit from October 1
to May 30. Any Provisional SATC or Provisional
62
TABLE V11
Reference Section 10D•66.109, F.A.C.
PROCESS FOR APPROVAL OF SATC'S AND SAPTRC'S
1----------- --------------------- -- -- - - - --- I - - - -1 _ I ---- I - - -- I - - -- I---- I-- -- I - --- I ---- I-- -- I - - -- I - --- I- - -- I -- -- I---- I-- -- I - - -- I---- I - - -- I - - -- I-- -- I-- -- I -- -- I
Task ISEP IOCT INOV IDEC IJAN IFEB IMAR (APR IMAY IJUN IJUL IAUG ISEP IOCT INOV iDEC IJAN IFEB 1 14AR (APR IMAY IJUN IJUL I
i ------------- ---- ------------------ - ------ i---- I---- I---- 1---- I---- 1---- 1---- I---- 1---- I---- 1-- - -1 - -- I---- I- - - -1 -- -I -- - 1---- I---- I---- I---- 1---- I---- I - - - -I
111ospitals Submit Letters of intent
I I I I I I I I I I I i l l l l l l l l l l l l l
IHRS Sends Applications to Hospitals I I \\ I I I I I I I I I I I I I I I ( I I I I I I
I I I I I I I I I I I i I i l l l l l l l l l l l
111ospitals Complete Applications
111ospitals Submit Applications
I I I I I I I I I I I I I I I I I I I I I I I I I
(Preliminar Review of Applications b IIRS I I I I I I I I \\ I I I I I I I I I I I I I I I I
I I I i l l l I I I I I I I I I I I I I I I I I I
111ospitals Respond to Deficiencies I I I I I I I I\ I 1 I I I I I I I I I I I I I I
I 1 1 1 1 1 1 II I I I I I I I I I I I I I I I I I
o� 111ospitals Informed of Provisional Status I I I I I I I I +
(in -depth Review of Applications b 11RS I I I I I I I I I \ \ \\I \ \ \ \I I I I I I I I I I I I I
(Revised Applications Submitted by
I Provisional SATC's and SAPTRC's
(IIRS Final Review of Applications
IProvislonal SATC's and SAPTRC's I I I I I I I I I I I I + I I I I I I I I I I
Notified of In -depth Review Findings I I I I I I I I I I I I I I I I I I I I I I I
IHRS Conducts Site Visit Qualit of
I Care Assessments I I I I I I I I I I I I I I I I I I I I I I I
(IIRS Approves SATC's and SAPTRC's I I I I I I I I I I I I I I I I I I I I I I \ \ \\I I
(IIRS Notifies Hospitals of Approval
I as SATC's and SAPTRC's I I I I I I I I I I I I I I I I I I I I I I I I
--------------------------------------------- ---- -------- -- -- -- - -- - -- - - ,---------------------------------------------------------- ----- ---------- ------- -- I
(m) By July 1, the department shall (a) the specific date the hospital
approve or deny SATCs and SAPTRCs based upon desires to have the department begin the
the recommendations of the out -of -state review provisional review of the hospital's application;
team, the result of the in -depth review and, if (b) a reference to each standard, or
necessary, upon application of the additional criteria specific part of a standard, in HRSP 150 -9, October
in section 10D- 66.112(10), F.A.C.: 91, that the hospital is unable to meet;
1. The department shall issue the (c) for each standard, or specific part
certificate of state - approval to the hospital upon of a standard, that the hospital is unable to meet, a
approval as a SATC or SAPTRC; detailed and separate explanation as to why the
2. The department shall issue a letter standard, or specific part of a standard, cannot be
of denial to each hospital not approved as a SATC met; and
or SAPTRC, specifying the basis for denial and (d) an action plan that describes the
informing the hospital of the next available approval major activities planned to meet each standard, or
cycle, and the hospital's right to an administrative specific part of a standard, and the completion date
hearing pursuant to sections 120.57 and for each activity.
395.4025, FS. (4) The department shall, by April 15,
(2) Each hospital denied provisional conduct a review of the hospital's extension
status or not approved as a SATC or SAPTRC, request for completeness and to determine any
may, within 30 days of receipt of the denial notice, deficiencies.
request a hearing in which to contest the findings (5) No later than April 15, hospitals
of the department. with extension requests found to be incomplete or
(3) The department may deny, deficient will be notified in writing of the
suspend, or revoke the approval of any Provisional deficiencies or incomplete sections, and shall be
SATC, Provisional SAPTRC, SATC, or SAPTRC given the opportunity to submit additional clarifying
which misrepresents a material fact in its or corrective information.
application for trauma center approval, including the (6) The hospital shall submit the
site survey process. requested information to the department no later
than 5 working days after receipt of the
Specific Authority 395.031, 395.032, department's notification. Failure to provide the
395.033, 395.0335, 395.034, 395:035; °- requested 'information or failure to address the
395.036, 395.037, 401.35 FS. Law Implemented deficiencies or incomplete information identified by
395.031, 395.032, 395.033, 395.0335, the department shall result in the denial of the
395.034, 395.035, 395.036, 395.037, 401.35 hospital's extension request.
FS. History-New 8 -3 -88, Amended 12- 10 -92. (7) The department shall notify the
hospital on or before May 1 of the approval or
t OD- 66.1095 Extension of Application Period. denial of the hospital's extension request. If the
extension is granted, the department shall provide
(1) Any hospital may request that the written notification to the hospital of the beginning
department grant up to 18 months additional time and ending dates of the extension.
to complete its application to become a SATC or (8) The department shall make a final
SAPTRC if the hospital determines prior to determination on whether to approve or deny a
submitting an application that the hospital cannot hospital's extension request only after the
meet all of the critical standards as provided in provisional review of all other SATC or SAPTRC
section 1013- 66.1090)(d), F.A.C. The critical applications in the hospital's TSA are completed,
standards provided in section 10D- 66.109(1)(d), and it has been determined that the number of
F.A.C., are the only standards for which an SATCs, SAPTRCs, Provisional SATCs and
extension shall be considered. The request for Provisional SAPTRCs in the hospital's TSA is less •
extension must also comply with the requirements than the allocated number of positions available for
provided in this section. that TSA.
(2) To be considered for an extension, (9) If the hospital's request for
a hospital must submit an application in accordance extension is denied, the hospital may, within 30
with the requirements in section 1013- 66.109, days of receipt of the notification of denial, request
F.A.C., together with a request for extension. The a hearing to contest the decision of the department,
request for extension must contain the following: in accordance with chapter 120.57, FS.
64
(10) The hospital may modify any date (a) The department shall review the
for completion of a major activity in the application and inform the Provisional SATC or
department- approved action plan discussed in (d) of Provisional SAPTRC of any omissions, deficiencies,
• this section without prior department approval. or problems within 30 days of the date the
When any date for completion of a major activity is department begins the in -depth review;
modified by the hospital, the hospital must provide (b) The Provisional SATC or
an updated action plan to the department. The Provisional SAPTRC may provide additional
hospital must complete all major activities within information in response to the department's notice
the extension period granted by the department. of omissions, deficiencies, or problems within 30
The department will not begin the provisional days of receipt of the department's notification. If
review of the hospital's application for approval at the Provisional SATC or Provisional SAPTRC does
a SATC or SAPTRC at the end of the extension not provide additional information within 30 days,
period, or earlier at the request of the hospital, the department shall inform the Provisional SATC
unless the hospital can substantiate completion of or Provisional SAPTRC of any omissions,
all major activities in the action plan. The deficiencies, or problems that were not corrected at
department may conduct a site visit to determine the conclusion of the in -depth review.
the hospital's compliance with the approved action (c) If the Provisional SATC or
plan. Provisional SAPTRC submits additional information,
(11) The department shall begin a the department shall review the additional
provisional review of the hospital's SATC or information and inform the Provisional SATC or
SAPTRC application on the date the hospital Provisional SAPTRC of any remaining omissions,
specified in the extension request, as approved by deficiencies, or problems that were not corrected at
the department. The hospital may request that the the conclusion of the in -depth review.
department begin the provisional review earlier than J11 5) A hospital approved by the
the date specified in the extension request if the department as a Provisional SATC or Provisional
hospital completes, all action steps before the SAPTRC following an approved extension period,
expiration of the approved extension period. The shall receive a site visit during the next scheduled
department's provisional review of the hospital's site visit phase. The hospital shall operate as a
application shall be conducted in accordance with Provisional SATC or Provisional - SAPTRC no less
the timeframes for processing the application than ,6- consecutive months prior to the site visit.
provided in section 10D- 66.109, F.A.C., but_ will
not coincide with the dates provided in that Specific Authority 395.0335 FS. Law Implemented
section. 395.0335 FS. History-New 12- 10 -92.
(12) The hospital shall ensure that the
SATC or SAPTRC application provided at the time 10D- 66.110 Certificate of State - Approval.
the hospital submitted the extension request is
current on the date the department begins the (1) Each hospital approved as a SATC
provisional review. or SAPTRC shall be issued a HRS -H Form 2032A,
(13) A hospital receiving an extension October 91, State - Approved Level I Trauma Center
greater than 12 months shall have its extension Certificate of Approval, HRS -H Form 2043A,
terminated if the number of SATCs, SAPTRCs, October 91, State - Approved Level II Trauma Center
Provisional SATCs or Provisional SAPTRCs in the Certificate of Approval, or HRS Form 1721A,
hospital's TSA equals the number of available October, 91, State - Approved Pediatric Trauma
positions allocated to the TSA, resulting in the Referral Center Certificate of Approval, which are
denial of its application and the department will incorporated by reference and available from the
• inform the applicant of its right to a section department. The certificates shall include:
120.57, FS., hearing regarding this denial. (a) The date effective and the date of
(14) The department shall complete an termination;
in -depth review of the application of each hospital (b) The hospital's name; and
that received an extension and became a (c) The approved trauma center level.
Provisional SATC or Provisional SAPTRC within 90 (2) Unless sooner suspended,
days of the hospital receiving provisional status revoked, or terminated pursuant to section
according to the following schedule: 395.0335 (8), FS, the, certificate shall expire 7
years after the date of issuance.
65
assess the quality of trauma patient ,care and
Specific Authority 395.031, 395.032, trauma patient management by reviewing facility
395.033, 395.0335, 395.034, 395.035, trauma mortality data, by reviewing patient charts
395.036, 395.037, 401.35 FS. Law Implemented and by reviewing trauma case summaries and
395.031, 195.032, 395.033, 395.0335, minutes of trauma quality management committee •
395.034, 395.035, 395.036, 395.037, 401.35 meetings pursuant to Standard XVI of HRSP 150 -9,
FS. History-New 8 -3 -88, Amended 12- 10 -92. October 91.
(5) Evaluation of the Quality of
10D -66.11 1 Process for Re- Approval of SATCs Trauma Patient Care and Trauma Patient
and SAPTRCs. Management:
(a) The reviewers shall judge the
(1) During the 7th year of state- quality of trauma patient care and the quality of
approved status, a SATC or SAPTRC which desires trauma patient management in each Provisional
re- approval shall apply in the same manner as SATC and Provisional SAPTRC by analyzing each
provided for initial approval in section 1013- facility's trauma patient care and trauma patient
66.109(1), F.A.C. outcomes, by reviewing trauma patient charts and
(2) A SATC or SAPTRC seeking re- by evaluating the effectiveness of the trauma
approval shall compete with other hospitals seeking quality management program through reviews of
approval and re- approval for available positions in trauma case summaries and minutes of trauma
the TSA if there are more applicants than available quality management committee meetings.
positions. (b) Evaluations of trauma patient care
(3) A SATC or SAPTRC which does and trauma patient management will also be
not desire to be re- approved shall follow the conducted using trauma patient data collected from
notification provisions of section 1013- 66.115, the hospital trauma registry and the Florida Trauma
F.A.C. Registry from the time the hospital received
provisional trauma center status through the date
Specific Authority 395.031, 395.032, of the on -site review. Trauma patient data may
395.0335, 395.037 FS. Law Implemented also be collected from the emergency department
395.031, 395.032, 395.0335, 395.037 - FS. patient log, audit filter Jog, or quality management
History-New 8 -3 -88, Amended 12- 10 -92. = - .committee minutes. The ,patient population--for-- _ .
- review shall _ be on the basis of . •Injury
1013- 66.112 Site Visits and Approval. Severity Scores (ISS). The ISS shall be determined
using Abbreviated Injury Scaling (AIS -90). If the
(1) Each Provisional SATC and Provisional SATC or Provisional SAPTRC has an in-
Provisional SAPTRC shall receive an on -site hospital trauma registry which computes the ISS
evaluation to determine whether the hospital is in using the International Classification of Disease,
substantial compliance with standards published in 9th Revision, Clinical Modification (ICD- 9 -CM), the
HRSP 150 -9, October 91, and to determine the computer program shall contain AIS -90 as a
quality of trauma care provided by the hospital. component of the program.
(2) The on -site evaluation shall be (c) Patient charts to be reviewed shall
conducted by a review team of out -of -state be selected by the department from cases meeting
reviewers with knowledge of trauma patient the criteria listed in Standard XVI C.2.a -e, published
management as evidenced by experience in trauma in HRSP 150 -9, October 91. A minimum of 75
care at a trauma center approved by the governing cases shall be selected for review in each facility.
body of the state in which they are licensed. If the cases total less than 75, then all cases are
(3) All Provisional SATCs and subject to review.
Provisional SAPTRCs shall receive 3 site visit (d) Patient charts shall be reviewed to •
between October 1 of each year and June 1 of the identify factors related to negative patient outcome
following year. or compromised patient care. When such factors
(4) The reviewers shall assess each are identified, trauma case reviews by the medical
applicant hospital's compliance with the standards director of the trauma service or the trauma nurse
published in HRSP 150 -9, October 91, by means of coordinator, as well as minutes of trauma quality
direct observation, review of call schedules, and management committee meetings, shall be
review of patient charts. Reviewers also shall reviewed to determine if corrective action was
66
taken by the trauma service and appropriate peer (9) Site Visits may be conducted at
review committees within the facility. any reasonable time at the discretion of the
(e) Reviewers shall study the trauma department at any Provisional SATC or Provisional
• case reviews and trauma quality management SAPTRC, or SATC or SAPTRC by the department
committee meeting minutes to evaluate the overall staff or reviewers to:
effectiveness of the quality management program. la) verify information provided
(6) The reviewers shall rate a pursuant to section (8); and
Provisional SATC and Provisional SAPTRC which (b) ensure each SATC or SAPTRC
they have reviewed as either acceptable, maintains substantial compliance with trauma
acceptable with corrections, or unacceptable. The center standards, quality of trauma patient care,
rating shall be based on each facility's substantial and quality of trauma patient management.
compliance with the standards published in HRSP (10) If the number of Provisional
150 -9, October 91, and upon the performance of SATCs or Provisional SAPTRCs found eligible for
each Provisional SATC or Provisional SAPTRC in selection by the department in a given TSA
providing acceptable trauma patient care and exceeds the number permitted, as provided in
trauma patient management which resulted in section 10D- 66.1075(3), F.A.C., the following
acceptable patient outcomes. criteria shall be applied independently and
(7) The department shall evaluate the consecutively to all Provisional SATCs or
results of the site visit review and the in -depth Provisional SAPTRCs in the TSA until application of
application review of each Provisional SATC and the criteria results in the appropriate number of
Provisional SAPTRC between June 1 and July 1. SATCs or SAPTRCs for that TSA. When that
All applicant hospitals shall be notified occurs, the remaining criteria shall not be
simultaneously of their approval or denial to considered. The criteria to be applied are as
become a SATC or SAPTRC on or before July 1. follows:
The department's selection will be based on the (a) A hospital recommended to be a
results of the site visit and the in -depth application SATC or SAPTRC in the department- approved local
review. In those situations in which there are more or regional trauma agency plan pursuant to section
SATCs or SAPTRCs, Provisional SATCs or 1 OD- 66.104(2)(d)3., F.A.G., shall be given approval
Provisional SAPTRCs than available positions in the preference over any hospital which was not
TSA, the criteria in paragraph (10) of this Section recommended.
shall be applied for final selection. - ` (b) A hospital shall be given selection
(8) The department shall notify each preference based on the level of service they intend
Provisional SATC or Provisional SAPTRC of the to provide according to the following sequence:
results of the site visit within 15 working days 1. A Provisional Level I SATC will be
from completion, of the site visit. The department given preference over a Provisional Level 11 SATC
shall include in the notice any problems that the with SAPTRC, a Provisional Level II SATC, and a
Provisional SATC or Provisional SAPTRC was Provisional SAPTRC;
informed of at the conclusion of the department's 2. A Provisional Level 11 SATC with
in -depth application review. If the Provisional SAPTRC will be given preference over a Provisional
SATC or Provisional SAPTRC desires to provide Level II SATC and a Provisional SAPTRC; and
additional information regarding the results of the 3. A Provisional Level II SATC will be
site visit or in -depth application review to the given preference over a Provisional SAPTRC in TSA
department to be considered during the final having only one allocated trauma center position,
evaluation between June 1 and July 1, the and in a TSA with more than one allocated trauma
information must be provided in writing and be center position if there already exist an approved
• received by the department within 30 calendar Level I SATC, Level II SATC with SAPTRC, or a
days of the hospital's receipt of the department's SAPTRC; or if in the instant selection process a
notice. If the Provisional SATC or Provisional Level I SATC, Level II SATC with SAPTRC, or
SAPTRC elects not to respond to the department's SAPTRC is to be selected.
notice within 30 calendar days, the department (c) An applicant hospital in a
shall make the final determination of approval or geographic location that is most conducive to
denial based solely on information collected during access by the greatest number of people to be
the applicant's site visit and in -depth application served within a TSA shall be given preference for
review. selection.
67
(d) A hospital representing the best (a) Any EMS provider which routinely
geographic distribution with respect to terrain, transports trauma patients to the Provisional SATC
population served and projected service population or Provisional SAPTRC;
in a given TSA shall be given preference for (b) Any hospital, SATC, SAPTRC,
selection. Provisional SATC or Provisional SAPTRC which
(e) A hospital which, according to the would be affected by the discontinuation or •
most recent complete year of Agency for Health substantial reduction of trauma services, including
Care Administration data, shows a higher level of those in other TSAs who access the Provisional
commitment of care to the service area, as SATC or Provisional SAPTRC;
evidenced by the ratio of non - paying to paying (c) The trauma agency in which the
patients, shall be given preference for approval. Provisional SATC or Provisional SAPTRC
(11) The department shall inform in participates, if one exists; and
writing each Provisional SATC or Provisional (d) The department's office of
SAPTRC denied approval as a SATC or SAPTRC of Emergency Medical Services.
its opportunity to request a hearing in which to (2) Any hospital approved as a SATC
contest the denial in accordance with section or SAPTRC that intends to discontinue or reduce
120.57, FS. trauma services shall not discontinue or reduce
trauma services for at least 180 days from the date
Specific Authority 395.031, 395.032, 395.033, the entities listed in paragraph (1)(a) -(d) are given
395.0335, 395.034, 395.035, 395.036, written notification:
395.037, 401.35 FS. Law Implemented 395.031,
395.032, 395.033, 395.0335, 395.034, Specific Authority 395.0146, 395.031,
395.035, 395.036, 395.037, 401.35 FS. History- 395.032, 395.033, 395.0335, 395.034,
New 8 -3 -88, Amended 12- 10 -92. 395.035, 395.036, 395.037, 401.35 FS. Law
Implemented 395.0146, 395.031, 395.032,
10D- 66.113 Application by Hospital Denied 395.033, 395.0335, 395.034, 395.035,
Approval. Any hospital that was not approved as a 395.036, 395.037, 401.35 FS. History-New 8 -3-
SATC or SAPTRC based on the application of 88, Amended 12- 10 -92.
criteria in section 10D- 66.112, F.A.C., may
submit a completed Letter of Intent HRS Form 10D- 66.200 -.. Eligibility __, Requirements for.
1840, October 91, postmarked no earlier. than _ Emergency vices Medical Services County Grant.
September 1 and no later than midnight October ' 1
of the following year. (1) Only a county government can
receive an EMS county grant. However, the county
Specific Authority 395.031, 395.032, may distribute the grant funds to local agencies and
395.033, 395.0335, 395.034, 395.035, organizations which will use the funds to improve
395.036, 395.037, 401.35 FS. Law Implemented and expand the EMS system.
395.031, 395.032, 395.033, 395.0335, (2) In order for a county to be eligible
395.034, 395.035, 395.036, 395.037, 401.35 for an EMS county grant, the county's Clerk of the
FS. History-New 8 -3 -88, Amended 12- 10 -92. Court shall forward monies for deposit to the EMS
Trust Fund.
10D -66.1 14 Application for Reclassification. (3) The EMS county grant will be
based on the amount of the county's contribution
Specific Authority 395.031, 395.032 FS. to grant monies on deposit in the EMS Trust Fund.
Law Implemented 395.031, 395.032 FS. History-
New 8 -3 -88. Repealed 12- 10 -92. Specific Authority 401.121 FS. Law Implemented
401.111, 401.121 FS. History-New 6 -6 -90, •
10D- 66.115 Requirements for Discontinuation Amended 12- 10 -92.
or Substantial Reduction of Trauma Services.
10D- 66.205 Emergency Medical Services
(1) A Provisional SATC or Provisional County Grant Application Procedures. In order to
SAPTRC that intends to discontinue or substantially apply for a county grant each county applicant shall
reduce trauma services shall not do so until the submit to the department HRS Form 1684, July
following entities are given written notification: 89, County Emergency Medical Services Grant
68
Application, which is incorporated by reference and deposit and track interest earned and expenditures
available from the department. County grant of the EMS county grant monies.
applications shall be received by the department no
• later than the date and time specified in the Specific Authority 401.121 FS. Law Implemented
department's notice in the Florida Administrative 401.113 FS. History-New 6 -6 -90, Amended 12-
Weekly. 10 -92.
Specific Authority 401.121 FS. Law Implemented 10D- 66.220 Eligibility Requirements for
401.111, 401.113, 401.121 FS. History-New Emergency Medical Services Matching Grant.
6 -6 -90, Amended 12- 10 -92.
(1) The following is a partial listing of
10D- 66.210 Review of Emergency Medical agencies and organizations eligible for EMS
Services County Grant Application. matching grants to improve and expand Florida's
EMS systems:
(1) The department shall complete its la) County governments;
review of each application within 45 days of (b) Municipalities;
receipt of the completed application. (c) Trauma centers; and,
(2) If an application is incomplete or (d) EMS organizations.
does not describe activities which improve and (2) Grants made under section
expand the existing EMS system, the department 401.113(2)(b), FS., require the agency or
shall notify the applicant of any deficiencies and organization to provide a cash sum equal to 25
reqeust correction, additional information, or percent of the approved project's total cost from
justification. any source not otherwise prohibited by law.
(3) The department shall reqeust the (3) Grants made under section
council to review an EMS county grant application 401.113(2)(b), FS., require the agency or
and recommend action if the department organization to provide a cash sum equal to no
determines, upon final review, that the application more than 10 percent of the approved project's
fails in part, or in total, to describe activities which total cost not otherwise prohibited by law.
improve and expand the county's existing. EMS .._..
system. At last 10 days prior to the council's Specific Authority _401_.121 FS. Law Implemented
review of an EMS county grant application, the 401.117, 401.121 FS. History-New 6 -6 -90,
department shall send a letter of notification to the Amended 12- 10 -92.
affected county commissioner's chairman. The
letter shall contain: 10D- 66.225 Projects Eligible for Emergency
(a) Notice of pending review by the Medical Services Matching Grant. Grant funds shall
council; be used solely to improve and expand Florida's EMS
(b) The date, time, and place of the system. Matching grant projects shall be consistent
meeting. with the State EMS Plan, which is incorporated by
reference, and may include the following and other
Specific Authority 401.131 FS. Law Implemented projects:
401.111, 401.121 FS. History-New 6 -6 -90. (1) Research;
(2) Evaluation;
10D- 66.215 Distribution of Emergency Medical (3) Community lay and professional
Services County Grant Monies. education;
(4) CPR training;
• (1) At least once each year the (5) Lifesaving and first aid
department shall distribute EMS county grant techniques; and,
monies from the EMS grant funds collected by the (6) Increasing existing levels of EMS.
state.
(2) The department shall send funds Specific Authority 401.121 FS. Law Implemented
granted under this section to the board of county 401.113, 401.121 FS. History-New 6 -6 -90,
commissioners after approval of its application. Amended 12- 10 -92.
(3) Each county shall designate a
separate account code under which the county will
69
10D- 66.230 Emergency Medical Services (1) An itemized listing of expenditures
Matching Grant Application Procedure. Each of the EMS grant award monies as stated in the
applicant shall submit to the department one final approved application line item budget;
original and copies as required by the department of (2) Other reports and copies of
HRS Form 1767, March 89, EMS Matching Grant documentation as requested in writing by the •
Application, which is incorporated by reference and department.
available from the department. Matching grant
applications shall be received by the department no Specific Authority 401.121 FS. Law Implemented
later than the date and time specified in the 401.121 FS. History-New 6 -6 -90.
department's notice in the Florida Administrative
Weekly. 10D- 66.242 Matching Grant Amendments.
The department may, upon receipt of a written
Specific Authority 401.121 FS. Law Implemented request and justification for an amendment,
401.111, 401.121 FS. History-New 6 -6 -90, approve or deny a funding increase for a previously
Amended 12- 10 -92. awarded matching grant. The department shall
approve such written amendments only if the
10D- 66.235 Review of Emergency Medical applicant clearly demonstrates the funding increase
Services Matching Grant Application. is needed to properly complete the originally funded
project. No grant shall be increased more than a
(1) Applications the department total of 10 percent beyond its original department
receives by the deadline date and time, as approved amount.
advertised in the Florida Administrative Weekly, will
be reviewed by the EMS matching grant evaluation Specific Authority 401.111, 401.113, 401.117,
team using a grant rating sheet. 401.121 FS. Law Implemented 401.111,
(2) The EMS matching grant 401.113, 401.117, 401.121 FS. History-New 12-
evaluation team shall consist of: 10 -92.
(a) Three individuals designated by
the state manager of the EMS matching grant 10D- 66.245 Monitoring. Recipients of EMS
program; matching and EMS county grants shall permit
(b) One individual from each official representatives of the department to
geographical area corresponding to the HRS conduct on -site program and grant monitoring
districts. The representatives from those HRS during normal business hours for the purpose of
district areas shall be selected by their regional ensuring that grantees are in compliance with
EMS council, if available. Individuals from HRS approved revenue expenditures and EMS matching
district areas without a regional EMS council shall or EMS county grant specifications.
be appointed by the state EMS council.
(3) The EMS matching grant Specific Authority 401.121 FS. Law Implemented
evaluation team, in accordance with the time 401.121 FS. History-New 6 -6 -90.
schedule advertised in the Florida Administrative
Weekly, shall make recommendations to the 10D- 66.250 Award Procedures, Grant
department, which has the final authority to award Requirements and Conditions. The department's
EMS matching grants. criteria for awarding or denying any grant
application, award procedures, grant requirements
Specific Authority 401.121 FS. Law Implemented and conditions are contained in the 1992 Florida
401.121 FS. History-New 6 -6 -90, Amended 12 EMS County Grant Program, for county goals; and
10 -92. the 1992 Florida EMS Matching Grant Program, for
matching grants, both of which are incorporated by •
10D- 66.240 Documentation of Expenditures reference and available from the department.
and Accomplishments of Emergency Medical
Services Matching Grant and Emergency Medical Specific Authority 401.111, 401.1 13, 401.1 17,
Services County Grant. All EMS grant recipients 401.121 FS. Law Implemented 401.1 11,
shall submit documentation of expenditures and 401.113, 401.117, 401.121 FS. History-New 12-
accomplishments to the department which shall, at 10 -92.
a minimum consist of:
70
10D- 66.255 Adjustments to Applications. The (e) Use of an autoinjector to
department may increase, decrease, adjust, or administer epinephrine as a result of insect stings
otherwise modify an EMS County or Matching including demonstration verifying correct technique;
• Grant applicant's budget prior to making a final (f) Pharmacology of epinephrine: and,
award. The department may increase, decrease, 1. Indications,
adjust, or otherwise modify an EMS Matching Grant 2. Contraindications,
applicant's budget no more than 10 percent from 3. Side effects;
the originally submitted budget. (g) Instruction that administration of
epinephrine shall be utilized only in the absence of
Specific Authority 401.1 1 1, 401.1 13, 401.1 17, the availability of a physician, paramedic, registered
401.121 FS. Law Implemented 401.1 1 1, nurse or other practitioner who is authorized by law
401.1 13, 401.1 17, 401.121 FS. History-New 12- to administer a prescription drug.
10 -92. (3) To be certified to administer
epinephrine, the individual shall submit
10D- 66.300 Administration of Epinephrine by documentation, HRS Form 1882, April 92,
Certified Individuals. Emergency Medical Services Application for Insect
Sting Emergency Treatment Certification, which is
(1) An individual who desires to be incorporated by reference and available from the
certified to administer epinephrine via autoinjector department, to the department verifying successful
to a person who suffers adverse reactions to insect completion of the training requirements as outlined
stings shall present evidence to the department in this section and pay the required fee of $25.
that such individual has met the following (a) Individual county public health unit
requirements: directors and individual county public school
(a) Be 18 years of age or older; superintendents may enter into a written agreement
(b) Successfully completed a training with each other to train, in accordance with this
program in the appropriate procedures for the rule, non - medical school based personnel to provide
administration of epinephrine via autoinjector to emergency treatment for anaphylactic reaction.
persons who suffer adverse reactions to insect Those personnel trained pursuant to the agreement
stings; and, may elect not to become certified by the
(c) Has, or reasonably expects to department, but must comply with written standing
have as a result of his occupational or volunteer orders (protocols) and can only provide this
status, including a camp counselor, scout leader,_ anaphylactic emergency treatment by autoinjector
school teacher, forest ranger, tour guide, or while on -duty with the school district or county
chaperone, responsibility for at least one other public health unit. Records of training must be
person who has severe adverse reactions to insect maintained by the employer for the duration of
stings. employment.
(2) Epinephrine administration training (4) The department shall issue a
programs shall be conducted by a Florida licensed certificate upon successful completion of the
physician and shall include, at a minimum, 30 training requirements as provided in paragraph (2)
minutes of training in the following: of this section which shall automatically expire
(a) Definition of anaphylaxis; March 1, 1995. Thereafter certification shall
(b) Agents which might cause automatically expire on March 1 of each odd
anaphylaxis and the distinction between them, number year. After March 1, 1995, the training
including: program shall be repeated anytime during the 2
1. Insects stings; year period prior to the next renewal date which
• 2. Drugs; shall be March 1, 1997, and biennially thereafter.
3. Foods; (5) To be eligible for recertification,
4. Inhalants; the individual shall provide documentation of
(c) Recognition of symptoms of recertification training as provided in paragraph 2 of
anaphylaxis; this section, and pay a $25 recertification fee.
(d) Appropriate emergency treatment
of anaphylaxis as a result of insect stings; Specific Authority 402.60 FS. Law Implemented
402.60 FS. History-New 12- 10 -92.
71
•
r
me
Addendum B
CURRENT RATE, SCI ED11L.I; 1992
CODH CIIARCE DESCRIPTION PRICE COST TAX HEDICARR STATE OTHER
- - -- ---- - - - - -- •- ---- - - - - -- - - - - - -- - - - - - -- - -- -- - - - - -- - - - - -- - - - - --
1 911 US DASE 210,00 0,00 11 A0010
2 911 ALS BASE 250.00 0100 11 A0220
9 ULS TRANSPORT 160,00 0100 11 A0160
1 ALS TRANSPORT 200,00 0.00 N ANN
5 DLS HILEAOE 5.60 0.00 N A0020
6 ALS HILEAOE 6150 0100 N A0221
9 MUEN SUPPLY 25.00 0,00 N A0010
8 WAIT TIME /Hill AFTER 30HIll 1,50 0,00 N A0060
•
•
•
�. NEEIL tea_ awW_ vt. WMEL EMIL
• • •
WE 963
STATE OF _ - FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES? i
EMERGtNCY MEDICAL SERVICES
f ADVANCED LIFE SUPPQRT LICENSE
�,' . ib; i i ❑ TRANSPORT ❑ NON - TRANSPORT
I I �• � I
�l This is to Certify that __ JUPITER AMBULANCE SERVICE, INC.
/ II I li Name of Provider I
has complied with Chapter 401, Florida Statutes and Chapter 1OD-66 Florida Administrative Code, and is authorized to
operate as an Advanced Life Support Service in M A R T I N / P A L M B E A C H County(s). Subject to any and all
If
1i r limitations specified in applicable Certificate(s) of Public Convenience and Necessity.
• MICHAEL S. WILLIAMS
ff Emergency Medical Services Administrator
II i
i
93 JANUARY 7,
• ' Date JANUARY 8 , 19 Expires 19 95
i
HRS Form 1181. Sep 87 (Replaces Jun 84 edition) This certificate shall be posted in the above mentioned establishment I
•
•
om
' �j ? r '- .�'�ii „ �fj ► . T ; ` ':..,ear..: +� � S ` � '1 ,y � 1`
EMERGENCY MEDICAL SERVICES c
` CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY_
WHEREAS, the JUPITER AMBULANCE SERVICE INC. has requested authorization to provide
_ Advanced Life Support services to the citizens of Martin County; and
(Advanced Life or Basic Life Support)
WHEREAS, there has been demonstrated there is a need to provide these essential services to `� ~
;-` the citizens of this county; and,
/I WHEREAS, the above named service affirms that it will maintain compliance with the requirements
of the Emergency Medical Services Act (Chapter 901, F.S.) and rules (Chapter lOD -66, F.A.C.).
' g Y t
p p hr's
_ THEREFORE, the Board of County Commissioners of Martin County hereby issues a
,..
•►.3� certificate of Public Convenience and; Necessity to said Company to provide ALS Transport
services with limitations as prescribed on this certificate. (BLS, ALS- transport
s ALS non- transport) `-
�-
T In issuing this certificate, the governing body of Martin County has considered;'
�I recommendations of affected municipalities.
�r
Date Issued December 4, 1992 Date of expiration December 4, 1994 '.
(Unless certificate is sooner revoked or
1 suspended)
Limitations:
/(Chairma Board of County Commissioners)
l Jeff Krausko f 12/4/92
I� 1 . i ty�3 ,„, tl 3> �, w jyf�s• . 6x t . i f•lI
� - , x ,\ .j —a 3 r v -� s a�.�,,,r v ?�j „a * i s,� - .} ,� y... ..s :2 �..�i�-,. .,� � . .
��'�1���, �r �+�. -•': �?� �! i S CAN., ;�� i ..,
� y ."�• -. �� ��/�;e� �'i+1�.. - ;� ;nfk ' �F..• ' n1�R' • ��. -. .,4 - 'nM -' i Lt:..
•
•
C()WN# D
Lk"an first State Insurance Company
INW11T0
Jupiter Hadical Center, Inc. etal. L: American t'zotection Insurance Company
1210 South Old Dixie Highway COMPAW
Jupiter, FL 33458 LITTER
COW'ANY
LIMN
CUVKMAGKS
THIS 19 TO CERTIFY THAT THE POUCIE9 OF INSURANCR UATED BELOW HAVE BEEN ISSUED TO T11E IN8VRED NAMED AWVE FOR THE POuCY PEnlov
INDICATED. NOTWITHSTANMHO ANY R60UIREVENT. TERM On CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH ntepgcT YO WHICH T HIS
CERTIFIDATB MAY Be ISSUED an MAY PERTAIN, TH6 INSURANCE AFFOFVMD BY THA P01.10168 DESCRIBED HFA61N IS SUBJECT 70 ALL THE TVAU
E71CLVIII0411 AND OONOITIONS OP SUCM ►OUCIEB. LIMITS *MOWN MAY HAVII 59EN REMIED BY PMO CLAIPAS
CO TYPE OF INVURARM POLICY NVVM PM 101 IrffOTr4R POUCY IRSRTAT?*A Uw"
LTR DATE (I WM*YY1 IIATA (MMMMYYI
ofHERAIUAMUTY G "POLA GG REGA TE ! OLMA 2
Q 0 0
A x O KCAL CINfRAL LLAINUTY PFlooucTacoM►IoP ADO. I lCK52
CLAIMS VADe x OCCIAL ILK06800528 12/1/92 1211/93 o'MK&L f Avv. +uV "Y ! 1, 000, 000
OMM1144 1 CONTRACTOR'! PROT. EACH OC"WAMI Ca I 1,000,
mw DAM" (Any one fM I 50,000
MM sxry f VM 5,000
AUTONOWL[ UAPRJTY OOMMMM SINGLE I 1,000,000
A X ANY AUTO UUIT
ALL C"RD ALITDf IQDLY INJURY I
RCMDUL® Auto! HKO680052 8 12/1/92 1211193 IPw PM'00
X HIRED AUTOI OWL INJURY I
X NDN4rYACO AUTOS
(PM AuJCAr l
MAPM1 LIABILITY ' PROPERTY DAMAGE I
x Physical Damage- Doductibleo:$1000- Comprehensive /91000 - Collision
RUMN LIANUIV I EACH o=Unarf#CE ! 10, 000, 00(
8 X UMIRILLAFORM ZUO000008 1211192 12/1193 AOO"EGAIE 1 10,000,001
QRIDr THAN UMSNELLI FOA
STATUTORY llMllf
TN9RRG7 COYPOgAT10a
AIM EACH AM IDENi !
[w3m .7!— PoLICY IJWT I
VOPL&VIN ILIAnIJTY
pplAff --IACM GTT'IOTEf !
OTHfR
C Prpperty Coverage 3ZFOD6507 12/1/92 12/1/93 Policy Limit - $111,492,1!
• Agreed Amount
DUMFTWOPOPaunoNI ,IMTIO"SiYemcLDLWC ALTT=m RE; Jupiter Ambulance Service, Inc. Effective 1/1/93.
, Vehicleat 1981 Ford nodular 0IFUMOLSIBRA83269 1986 Ford Modular #1FDKR30L8CBA37200
1985 Ford Van 01FD11534L40015598 1987 Ford Modular /1FDKF3114HNB01950
1969 Ford Modular PIFDKE30MOKUH83639 1991 Ford Modular #1FDKP37M3MNA53412
CLATIF+CAIT[ HCLMkR OANS�LI.AT
State of rloride SHOULD ANY OF THE-ABOVE DESCRIB P01.107E9 BE OANCELLIM 9E1 THE
Health and Rehabilitation Services EXPIRATION DATE THERM(, THE ISSUING COMPANY WILL ENOEJIVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO TM[ CERTIFICATE MOLOER NAMED TO 114E
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO 06LJOAT" OR
LIAIKUTY OF ANY IGNO UPON THE COMPANY. ITS AGENTS OR RlPREBENTATIVi6.
AvrnvRafo� TTrf
ACORD 2" (7190) OIICORO CORPOIIATION III
"i' - •cT7nn_ f!_f►PI6 —1 -4 !o semis uw u EG - -i :,0U 1.. \��
� '