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ALABAMA STATE BOARD OF HEALTH
ALABAMA DEPARTMENT OF PUBLIC HEALTH
ADMINISTRATIVE CODE
CHAPTER 420-2-1
EMERGENCY MEDICAL SERVICES
TABLE OF CONTENTS
420-2-1-.01 General Provisions
420-2-1-.02 Definitions
420-2-1-.03 Research and Data
420-2-1-.04 Portable Physician Do Not Attempt Resuscitation (DNAR)
and Pediatric Palliative and End of Life (PPEL) Care
Orders
420-2-1-.05 Medical Direction Facility
420-2-1-.06 Medical Direction
420-2-1-.07 Licensure Status Categories
420-2-1-.08 Initial Licensure Qualifications for EMS Personnel
420-2-1-.09 Licensure for Out-of-State EMS Personnel
420-2-1-.10 License Expiration, Renewal, and Reinstatement for EMS
Personnel
420-2-1-.11 Licensure for Emergency Medical Provider Services
420-2-1-.12 Advanced Life Support Personnel Scope of Practice
420-2-1-.13 Critical Care
420-2-1-.14 EMT-Intermediates (I-85)
420-2-1-.15 Emergency Vehicle Operator Qualifications
420-2-1-.16 Emergency Medical Dispatch
420-2-1-.17 Ground Provider Services, Equipment, Fluids, and
Medications
420-2-1-.18 Air Provider Services, Equipment, Fluids, and
Medications
420-2-1-.19 Provider Service Staffing
420-2-1-.20 Responsibility for Patient
420-2-1-.21 Patient Care Reporting
420-2-1-.22 Provider Service Record Keeping
420-2-1-.23 Controlled Substance Plan
420-2-1-.24 Patient Transfers
420-2-1-.25 Out-of-State Ambulance Contracts for Disaster
Assistance
420-2-1-.26 Exemptions
420-2-1-.27 Variances
420-2-1-.28 Compliance and Enforcement for Licensed Provider
Services
420-2-1-.29 Standards of Conduct
420-2-1-.30 Impaired EMSP
420-2-1-.31 Complaint/Disciplinary Procedures
420-2-1-.32 Education Standards and Procedures
420-2-1-.33 Continuing Education
420-2-1-.34 Tactical Paramedic
420-2-1-.35 Community Paramedic
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420-2-1-.01 General Provisions.
(1) Purpose. The purpose of these rules is to protect the
health of the public by establishing standards for the training,
qualification, scope of practice, and licensing of emergency medical
services personnel and for the operation, design, equipment, and
licensing of ambulances and ambulance service operators. These rules
shall be interpreted and applied to protect the public health.
(2) Statutory Authority. The State Board of Health is
authorized to adopt and promulgate these rules under and by virtue of
the authority of §22-18-1, et seq., Code of Ala. 1975.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: Filed September 1, 1982. Amended:
Filed
May 24, 1984;
September 19, 1990. Amended:
Filed
January 20, 1995; effective
February 24, 1995. Repealed
and
Replaced: Filed September 20, 1996;
effective October 24,
1996.
Amended: Filed March 20, 2001; effective
April 24,
2001.
Repealed and New Rule: December 17, 2007;
effective
January 21, 2008. Repealed and New Rule: Filed April 20,
2011;
effective May 25,
2011.
Repeal and New Rule: Filed March 16, 2017;
effective April 30, 2017. Repeal and New Rule: Filed February 20,
2019; effective April 6, 2019. Repeal and New Rule: Filed April 7,
2020; effective June 14, 2020. Repeal and New Rule: Filed February 17,
2022; effective April 14, 2022.
420-2-1-.02 Definitions.
(1) “Abandonment” means the unilateral termination of the
provider/patient relationship at a time when continuing care is still
needed. This includes the termination of care without the patient's
consent.
(2) “Academic Dishonesty” means any emergency medical
services (EMS)student who submits a license or test application, a
report of continuing education requirements, student record, clinical
rotation record, intent to train form, self-study document, or any
other document which is material to those of a student in an emergency
medical services personnel (EMSP) training program and which is
fraudulent or knowingly false in any respect.
(3) “Accreditation” means the educational program meets or
exceeds the educational standards specified in the "ADPH, OEMS
Credentialing Manual for Accreditation of Levels 1 and 2 education
programs."
(4) “Accreditation Withdrawn” means accreditation may be
withdrawn from a program with Probationary Accreditation or
Administrative Probation, if at the conclusion of the specified
probationary period, the accreditation review process confirms that the
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program is not in compliance with the administrative requirements for
maintaining accreditation.
(5) “Accreditation Withheld” means that the program is not
in substantial compliance with the essential elements of an education
program.
(6) “Advanced Cardiac Life Support (ACLS)” means an
approved course of instruction which follows the American Heart
Association’s Emergency Cardiac Care guidelines.
(7) “Advanced Emergency Medical Technician (AEMT)” means
any individual who is an emergency medical services personnel and is 18
years of age or older who has successfully completed the AEMT course of
instruction, or its equivalent, as approved by the State Board of
Health or its designee, and has passed the state approved AEMT
certification exam, and who has been granted a current, valid AEMT
license by the State Board of Health.
(8) “Advanced Life Support (ALS)” means the treatment
of potentially life-threatening medical emergencies through the use of
invasive medical techniques specified as advanced life support
techniques in these rules which would ordinarily be performed or
provided by physicians but may be performed by active licensed EMSP
pursuant to these rules.
(9) “Advanced Trauma Life Support (ATLS)” means the
course of instruction developed and sponsored by the American College
of Surgeons.
(10) “Air Ambulance” means an aircraft approved by the
Federal Aviation Administration (FAA), licensed by the Office of
Emergency Medical Services (OEMS), and intended to be used for and
maintained or operated for the transportation of sick or injured
persons to a medical care facility.
(11) “Alabama Department of Public Health (ADPH or the
Department)” means the State of Alabama Department of Public Health,
as defined by §22-1-1, Code of Ala. 1975, and any officer, agent, or
employee of the Department that is authorized to act for the Department
with respect to the enforcement and administration of these rules.
(12) “Alabama EMS Critical Care Patient Care Protocols”
means a written document approved by the State Board of Health for
Critical Care Paramedics working for a Critical Care licensed provider
service which specifies adult and pediatric patient treatment
procedures, medication administration, and other administrative and
organizational guidelines that shall be followed upon assessment and
treatment of an adult or pediatric patient.
(13) “Alabama EMS Patient Care Protocols” means a
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written document approved by the State Board of Health for each
emergency medical technician licensure level which specifies adult and
pediatric patient treatment procedures, medication administration, and
other administrative and organizational guidelines that shall be
followed upon assessment and treatment of an adult or pediatric
patient.
(14) “Alabama Trauma Communications Center (ATCC)” means a
central communication facility with the capability to constantly
communicate with all pre-hospital providers and hospitals that have
been designated by the Department as trauma centers. The ATCC’s
capabilities include the ability to immediately and directly link the
pre-hospital providers to the trauma centers.
(15) “Alabama Trauma System” means an organized system
designed to ensure that severely injured adult and pediatric patients
are promptly transported and treated at trauma centers that are
appropriate to the severity of the injury.
(16) “ALS Level 1 Authorization” means all fluids or
medications described within the scope of practice of the Paramedic as
approved by the State Board of Health.
(17) “ALS Level 1 – Critical Care Authorization” means all
fluids or medications described within the Critical Care practice of
the Critical Care Paramedic as approved by the State Board of Health.
(18) “ALS Level 2 Authorization” means all fluids or
medications described within the scope of practice of the Advanced EMT
as approved by the State Board of Health.
(19) “ALS Level 3 Authorization” means all fluids or
medications described within the scope of practice of the EMT-
Intermediate (I-85) as approved by the State Board of Health.
(20) “Automated External Defibrillator (AED)” means a
cardiac defibrillator that is a sophisticated, reliable computerized
device that uses voice and visual prompts to guide healthcare providers
to safely defibrillate ventricular fibrillation sudden cardiac arrest.
(21) “Basic Life Support (BLS)” means non-invasive life
support measures provided to patients.
(22) “Board" or "State Board of Health" means the Board of
Health of the State of Alabama as defined by §22-2-1, Code of Ala.
1975, or the State Health Officer, or his or her designee, when acting
for the Board.
(23) “Certification” means a demonstration such as, but not
limited to, the issuance of a card or certificate by which an
organization provides public information concerning individuals who
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have successfully completed a certification process and demonstrated an
ability to perform competently.
(24) “Clinical Preceptor” means an individual who, under
the direction of the program director, supervises and evaluates the
students during clinical rotations in a controlled environment such as
a hospital or urgent care clinic.
(25) “CoAEMSP” means the Committee on Accreditation for the
Emergency Medical Services Professions.
(26) “Cohort” means the period of time it takes to complete
course work for one EMS level without interruption. As a student
progresses from Level 3 to Level 1, the cohort time frame will increase
relative to the amount of course work.
(27) “Community Paramedic” means an individual who is an
emergency medical services personnel and is 18 years of age or older,
and who is currently licensed as a paramedic, has at least 2 years of
full-time service, has successfully completed a community paramedic
training program from an accredited college or university approved by
the Board, has passed the state community paramedic examination and has
met the requirements for becoming a licensed community paramedic, and
who has been granted a current, valid Community Paramedic license by the
Board.
(28) “Community Paramedicine Program” means the provision of
episodic care, patient evaluation, advice, and treatment directed at
preventing or improving a particular medical condition, within the scope
of practice of the emergency medical services personnel.
(29) “Controlled Substance Oversight Coordinator (CSOC)”
means a Paramedic who is responsible for all aspects of the controlled
substance plan of a provider service and is the designated contact
person for any issues pertaining to the service's controlled
substances.
(30) “Controlled Substance Plan (CSP)” means the plan
written by each ALS fluid/drug service which specifies the method of
ownership, security, drug testing for employees, quality assurance, and
tables to be used for accounting logs. The CSP also contains original
signatures from the service medical direction physician, the pharmacist
from the medical direction hospital, and the controlled substance
coordinator. This plan shall be submitted to and approved by the OEMS.
(31) “Course Instructor” means an individual who is
authorized by the appropriate entity to present and assess competence
in all subject matter contained in a curriculum. This person, along
with the program director, makes final evaluations concerning student
competence.
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(32) “Criminal History Release Authorization” means a
signed form that authorizes the OEMS to review and utilize the criminal
history of an EMSP, or EMSP applicant, for licensure purposes.
(33) “Critical Care Paramedic” means a paramedic endorsed
by the OEMS, certified by the International Board of Specialty
Certifications (IBSC) as Critical Care Paramedic – Certified (CCP-C) or
Flight Paramedic – Certified (FP-C) or by the Board of Certification
for Emergency Nursing as a Certified Flight Registered Nurse (CFRN) or
Certified Transport Registered Nurse (CTRN).
(34) “Critical Care Practice” means an expanded scope of
practice within the State of Alabama that may be practiced by
paramedics who have a current endorsement on their emergency medical
services personnel (EMSP) license and who must be working for a
provider service that is currently licensed at the Critical Care level.
(35) “Definitive Care Facility” means a facility that has
the capability to render care to conclusively manage a patient's
current medical condition. This may include, but is not limited to,
facilities such as urgent care facilities, family practice facilities,
doctor’s offices, and emergency departments.
(36) “Dereliction of Duty” means that person willfully or
negligently failed to perform his or her duties or performed them in a
culpably inefficient manner.
(37) “Drug Diversion” means the transfer of any legally
prescribed substance from the individual for whom it was prescribed, to
another person for any illicit or unintended use.
(38) “Duty to Act” means a legal and moral obligation
requiring an EMSP to take necessary action to prevent harm to another
person or to the general public, while on duty at a licensed provider
service to include, but not limited to: responding to calls in an
expeditious but safe manner; performing a thorough assessment of both
the patient and the emergency scene; providing appropriate treatment to
a patient; and transporting to an appropriate receiving facility when
transport is warranted and consented.
(39) “Education Level 1” means a course of instruction that
provides an individual with the knowledge and clinical skills of
emergency medical care necessary to function at the approved EMT,
Advanced EMT, and Paramedic levels of care.
(40) “Education Level 2” means a course of instruction that
provides an individual with the knowledge and clinical skills of
emergency medical care necessary to function at the approved EMT or
Advanced EMT levels of care.
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(41) “Education Level 3” means a course of instruction that
provides an individual with the knowledge and clinical skills of
emergency medical care necessary to function at the approved EMT level
of care.
(42) “Electronic Patient Care Report (e-PCR)” means a Board
approved method of electronic recording of an occurrence by emergency
or non-emergency response EMS personnel where a medical or injured
patient was encountered, evaluated, treated, or transported.
(43) “Emergency Medical Dispatcher (EMD)” means an
individual who has received certification from the Alabama Statewide
911 Board and the Alabama Department of Public Health’s EMD program
(the Alabama EMD program) or a nationally recognized EMD certification
course.
(44) “Emergency Medical Provider Service” means any
emergency medical service properly licensed to provide out-of-hospital
emergency medical response services within the State of Alabama. These
include basic life support (BLS) transport, ALS transport, and ALS non-
transport.
(45) “Emergency Medical Responder (EMR)” means any person
18 years of age or older who has successfully completed the Emergency
Medical Responder course of instruction, or its equivalent, as approved
by the Board or its designee, who has passed the State approved EMSP
certification exam, and who has been granted a current, valid EMSP
license by the Board.
(46) “Emergency Medical Services” means a system of
coordinated medical assistance and care provided by emergency medical
services personnel, including the transportation and medical care of
sick or injured individuals before arrival at a definitive care
facility, continuation of care within a definitive care facility
subject to the approval from that facility, and integrated medical care
with the oversight of a medical director.
(47) “Emergency Medical Services Education Program” means
any approved or credentialed program that provides education for EMR or
EMS personnel for Level I, II, or III.
(48) “Emergency Medical Services Educational Institution”
means a single institution or site of higher learning which meets the
EMS educational requirements of the OEMS and that has approval from the
Alabama Community College System or the Alabama Commission on Higher
Education to offer EMS educational programs for the recognized levels
of licensure.
(49) “Emergency Medical Services Personnel (EMSP)” means
all recognized National Highway Traffic Safety Administration (NHTSA)
levels of personnel licensed by the Board, who have met all primary
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and/or renewal educational requirements of these rules, and are allowed
to provide medical care within the level of their scope of practice
granted by the OEMS.
50) “Emergency Medical Technician (EMT)” means any person
18 years of age or older who has successfully completed the EMT course
of instruction, or its equivalent, as approved by the Board or its
designee, who has passed the State approved EMT certification exam, and
who has been granted a current, valid EMT license by the Board.
(51) “Emergency Medical Technician-Intermediate” means any
person 18 years of age or older who has successfully completed the 1985
EMT-Intermediate course of instruction, or its equivalent, as approved
by the Board, who has passed the State approved EMT-Intermediate
certification exam, and who has been granted a current, valid license
by the Board.
(52) “Emergency Vehicle Operator” means an individual who
has met the requirements of the Board to operate an ambulance.
(53) “Emergency Vehicle Operators Course (EVOC)” means the
national standard curriculum developed by the NHTSA and conducted by an
authorized OEMS instructor. This course may be substituted with the
Alabama Fire College Apparatus Operator Course or Emergency Vehicle
Driver Course, or the NAEMT Emergency Vehicle Operator Safety Course.
(54) “Federal Aviation Regulations (FAR)” means rules
prescribed by the FAA governing all aviation activities in the United
States. The FAR’s are part of Title 14 of the Code of Federal
Regulations.
(55) “Field Preceptor” means an individual, who under the
direction of the program director, supervises and evaluates the
students during clinical rotations on an ambulance in the prehospital
environment.
(56) “Ground Ambulance” means a motor vehicle intended to
be used for and maintained or operated for the transportation of
persons who are sick or injured to a medical care facility.
(57) “Guest Lecturer” means an individual with specialized
subject matter expertise, who on occasion, instructs a specific topic
of curriculum under the direction of the program director.
(58) “Impaired EMS Personnel” means an individual licensed
under these rules who misuses or abuses alcohol, drugs, or both, or who
has a mental or behavioral issue which could affect the individual's
judgment, skills, and abilities to practice.
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(59) “Industry Standard Stretcher Locking Device” means a
stretcher locking device permanently affixed to the vehicle which meets
or exceeds the standards as adopted by the State Board of Health.
(60) “Industry Standard Wheelchair Locking Device” means a
wheelchair locking device permanently affixed to the vehicle for use in
Demand Responsive Systems under Title III of the Americans with
Disabilities Act (ADA) which meets or exceeds the Department of
Transportation (DOT) specifications for Ground Ambulances under
Guideline Specifications for Wheelchair Securement Devices. When the
wheelchair is secured in accordance with the manufacturer’s
instructions, the securement systems, recognized by the ambulance
industry to provide the capability of securing the wheelchair in the
vehicle, shall limit the movement of an occupied wheelchair to no more
than 2 inches in any direction under normal operating conditions. All
wheelchair locking devices shall be affixed to the vehicle so as to
secure the wheelchair in a forward or rear facing position. Side
facing securement is not permitted under any circumstances. This does
not negate the necessity for providing a separate seatbelt and shoulder
harness for each wheelchair or wheelchair user as specified elsewhere
in these rules.
(61) “Licensure” means the state’s grant of legal authority
to perform skills within a designated scope of practice. Under the
licensure system, states define, by statute, the tasks and function or
scope of practice of a profession and provide that these tasks may be
legally performed only by those who are licensed. As such, licensure
prohibits anyone from practicing the profession who is not licensed,
regardless of whether or not the individual has been certified by a
private organization.
(62) “MDPID” means the Medical Direction Physician
Identification Number.
(63) “Medical Direction” means directions and advice
provided from a designated medical direction physician.
(64) “Medical Direction Hospital” means a hospital which
has properly credentialed and licensed medical direction physician
coverage in the emergency department 24 hours per day, 7 days a week;
assists with the initial and ongoing training of emergency medical
provider services; maintains a communication system capable of serving
the EMS providers for the areas served; and conducts continuing quality
improvement of patient care to include the identification of
deficiencies in procedures or performance among participating out-of-
hospital provider services. The medical direction hospital provides
logistical and/or supervising responsibilities for active licensed EMS
personnel.
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(65) "Moral Turpitude" means an act or behavior that
gravely violates moral sentiment or accepted moral standards of
society, as further defined by state law.
(66) “Non-Transport ALS Provider Service” means a non-
transporting emergency medical provider service that is licensed by the
OEMS and that provides ALS services.
(67) “Non-Transport BLS Provider Service” means a non-
transporting service that provides BLS services that is recognized, but
not licensed by the OEMS.
(68) “Non-Transport vehicle” means a vehicle operated with
the intent to provide BLS or ALS on-scene stabilization, but not
intended to transport a patient.
(69) “NREMT” means the National Registry of Emergency
Medical Technicians.
(70) “Office of Emergency Medical Services (OEMS)” means
the subdivision of the Department charged with the enforcement and
administration of these rules.
(71) “On-Line Medical Director” means a licensed physician
who has completed and maintains a current certification in ACLS and
ATLS or maintains board certification in emergency medicine or
pediatric medicine if the physician works in a designated pediatric
specialty hospital, and shall have successfully completed the approved
Alabama EMS Medical Directors Course, the annual refresher course, and
been issued a MDPID number.
(72) “Paramedic” means any person 18 years of age or older
who has successfully completed the paramedic course of instruction, or
its equivalent, as approved by the Board, and who has passed the State
approved paramedic certification exam, and who has been granted a
current, valid paramedic license by the Board.
(73) “Patient” means a person who receives or requests
medical care or for whom medical care is requested because such
individual is sick or injured.
(74) “Pediatric Palliative and End of Life (PPEL) Care
Order” means a directive that, once executed by the representative of a
qualified minor and entered into the medical record by the attending
physician of the qualified minor in accordance with Section 22-8A-15,
Code of Alabama 1975, becomes the medical order for all health care
providers with respect to the extent of use of emergency medical
equipment and treatment, medication, and any other technological or
medical interventions available to provide palliative and supportive
care to the qualified minor.
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(75) “Permitted Vehicle” means any vehicle to be used for
the response to and care of patients that has been inspected, approved,
and issued a decal by the OEMS.
(76) “Physician” means an individual currently licensed to
practice medicine or osteopathy by the Medical Licensure Commission of
Alabama.
(77) “Portable Physician Do Not Attempt Resuscitation
(DNAR) Order” means a physician’s written order, in a form prescribed
by Rule 420-5-19-.02, that resuscitative measures not be provided to a
person under a physician’s care in the event the person is found with
cardiopulmonary cessation. A DNAR order includes, without limitation,
physician orders written as “do not resuscitate,” “do not allow
resuscitation,” “do not allow resuscitative measures,” “DNAR,” “DNR,”
“allow natural death,” or “AND.”
(78) “Practical Skills Proctor” means an individual who
assists with practical skills instruction under the direction of the
course instructor and/or program director.
(79) “Preceptor” means an individual with a higher level of
licensure who is responsible for the supervision and instruction of an
EMS student on a clinical rotation.
(80) “Probationary Accreditation” indicates a program is
presently accredited; however, there is evidence that the program has
substantial deficiencies that threaten the capability of the program to
provide acceptable educational experiences for the students. The site
visit usually produces the necessary evidence; however, an onsite
review is not required for this action to be recommended if the facts
are not in dispute.
(81) “Program Director” means an individual who is
responsible for managing administrative details of a program and its
courses under the policies, procedures, and rules as stated herein and
as otherwise referred to by the ADPH, OEMS. This person oversees all
instructional courses and staffing administration and is not limited to
the description above. Regional Directors are considered Program
Directors for approved off site Level 2 or 3 EMS education courses
within their respective region.
(82) “Program Medical Director” means the Alabama licensed
physician who provides medical direction for all didactic and clinical
instruction and clinical practice experience.
(83) “Provider Services” means an organization which
provides either air or ground emergency medical services to the public.
(84) “Quality Improvement Education” means the remedial or
ongoing education determined necessary by an emergency medical provider
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service’s and/or the OEMS’ quality assurance reviews and offered to
improve the delivery of care of an individual emergency medical
provider service or active licensed EMS personnel.
(85) “Recumbent Position” means a position whereby a
patient is placed in a prone, supine, lying down, reclining or leaning
back position, or angle of 20 degrees or more from the upright or
vertical angle of 90 degrees.
(86) “Regional Agency” means a contractor located in a
specific geographic area of the state that provides services specified
in a contract. These agencies have no regulatory authority other than
that conferred by the OEMS.
(87) “Resuscitative Measures” means cardiopulmonary
resuscitation, cardiac compression, endotracheal intubation and other
advanced airway management, artificial ventilation, cardiac
resuscitation medications, and cardiac defibrillation delivered by any
means. This term does not mean and shall not be deemed to include such
medical interventions as intravenous fluids, oxygen, suction, control
of bleeding, administration of pain medication by properly licensed and
authorized personnel, and the provision of support and comfort to
patients, family members, friends, and other individuals.
(88) “Scope of Practice” means clearly defined levels of
skills and roles allowed for each level of emergency medical services
personnel.
(89) “Service Area” means 90 nautical miles from an air
ambulance provider service’s base of operation.
(90) “Service Medical Director” means a physician who holds
a current MDPID number and is responsible for medical direction and
oversight for the day-to-day operations of a licensed emergency medical
provider service(s).
(91) “Shall” means a mandatory requirement.
(92) “Site Visit Team Member” means an individual who has
been approved to be a participant in the site visit of an EMS education
program seeking accreditation from the OEMS.
(93) "Specialty Care Ambulance" means a transport vehicle
that is utilized for the interfacility transport of a critically ill
or injured patient or one that requires specific monitoring or
interventions and incorporates specialized staffing.
(94) “State Emergency Medical Control Committee (SEMCC)”
means a committee authorized by §22-18-6, Code of Ala. 1975, to assist
in formulating rules and policies pertaining to EMS.
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(95) “Stretcher” means a cot, gurney, litter, or stretcher
device of the type that can be used for and is maintained solely for
the transportation of patients in a vehicle in a recumbent position.
Either one or both of the patient’s legs shall be maintained in a
horizontal position or angle of 180 degrees at the foot of the
stretcher, unless it is medically necessary to do otherwise, or to
maintain any other position of either one or both of the legs above the
horizontal angle 180 degrees. The stretcher shall be capable of being
locked solely into an ambulance by an industry standard stretcher or
cot locking device as defined by the rules.
(96) “Tactical Paramedic” means a paramedic endorsed by the
OEMS and certified by the International Board of Specialty
Certifications (IBSC) as a Tactical Paramedic-Certified (TP-C). This
certification grants all current protocols to be Category A, with the
utilization of an expanded scope of practice and medication formulary
only when the individual has received the current endorsement on his
or her EMSP license issued by the OEMS and is actively engaged in a
tactical operation with a law enforcement agency.
(97) “Wheelchair” means a specialty chair or mobility aid
that belongs to a class of three or four wheeled devices, usable
indoors, usually designed for and used by persons with mobility
impairments. Wheelchairs, as defined in these rules, shall not exceed
30 inches in width and 48 inches in length, as measured 2 inches above
the ground, and shall not weigh more than 600 pounds when occupied.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: Filed September 1, 1982. Amended:
Filed
May 24, 1984.
Amended: Filed January 20, 1995;
effective
February 24, 1995.
Repealed and Replaced:
Filed
September 20, 1996; effective
October 24, 1996. Amended:
Filed
March 20, 2001; effective
April 24, 2001. Amended:
Filed
June 23, 2004; effective July 28,
2004. Repealed and New
Rule:
December 17, 2007; effective
January 21, 2008. Repealed and
New
Rule: Filed April 20, 2011;
effective May 25, 2011.
Amended:
January 17, 2013; effective
February 21,
2013.
Repeal and New Rule: Filed March 16, 2017;
effective April 30, 2017. Repeal and New Rule: Filed February 20,
2019; effective April 6, 2019. Amended: Filed September 18, 2019;
effective November 2, 2019. Emergency Rule Filed: March 23, 2020;
effective March 23, 2020. Repeal and New Rule: Filed April 7, 2020;
effective June 14, 2020. Repeal and New Rule: Filed February 17,
2022; effective April 14, 2022.
420-2-1-.03 Research and Data.
(1) Records and data may be released as needed to the
principal investigators associated with a valid scientific study
provided that the protocols for release and handling of such records
and data shall be approved in advance by a duly constituted
institutional review board for the protection of human subjects.
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(2) All data requests shall be made to the OEMS by
submitting a Data Request application.
(3) All approved data requests or studies involving any
information collected through the OEMS shall require that the published
results contain a statement acknowledging the efforts and cooperation
by the OEMS.
(4) All published results of a data request shall be
submitted to the OEMS within a reasonable time.
(5) Any licensee who is, or contemplates being, engaged in
a bona fide research program which may be in conflict with one or more
specific provisions of these rules may make application for a variance
of the specific provisions in conflict. Application for a variance
shall be made to the OEMS which shall, upon completion of its
investigation and recommendation of the SEMCC, send its findings,
conclusions, and recommendations to the State Health Officer for final
action.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed April 20, 2011;
effective
May 25,
2011.
Repeal and New Rule: Filed March 16, 2017; effective April 30, 2017.
Repeal and New Rule: Filed February 20, 2019; effective April 6, 2019.
Repeal and New Rule: Filed April 7, 2020; effective June 14, 2020.
Repeal and New Rule: Filed February 17, 2022; effective April 14,
2022.
420-2-1-.04 Portable Physician Do Not Attempt Resuscitation (DNAR)
and Pediatric Palliative and End of Life (PPEL) Care Orders.
EMSP are authorized to follow Portable Physician DNAR and PPEL
Care Orders that are available, known to them, and executed in
accordance with Rules 420-5-19-.02 and -.03. In honoring such orders,
EMSP shall not withhold comfort care, such as I.V. fluids, oxygen,
suction, control of bleeding, administration of pain medication, and
the provision of palliative and supportive care. In no event shall an
EMSP honor such orders for any patient who is able to, and does
express to such personnel the desire to be provided resuscitative
measures.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et. seq.
History: Repeal and New Rule: Filed March 16, 2017; effective
April 30, 2017. Repeal and New Rule: Filed February 20, 2019;
effective April 6, 2019. Amended: Filed September 18, 2019; effective
November 2, 2019. Repeal and New Rule: Filed April 7, 2020; effective
June 14, 2020. Repeal and New Rule: Filed February 17, 2022; effective
April 14, 2022.
15
420-2-1-.05 Medical Direction Facility.
Medical direction facilities shall:
(1) Provide properly credentialed and licensed medical
direction physician coverage in the emergency department 24 hours per
day, 7 days a week, 365 days a year.
(2) Provide on-line medical direction to EMSP for out of
hospital care on a 24 hour per day, 7 day a week, 365 days a year basis
in accordance with approved operations, treatment, triage, and transfer
protocols.
(3) Complete and sign a Memorandum of Understanding (MOU)
with the OEMS. The agreement shall include a list of all licensed
emergency medical direction physicians who give medical orders to EMSP.
The list shall also include the full name of each physician and his or
her MDPID.
(4) Maintain a Hospital Emergency Administrative Radio
(HEAR) communication system capable of serving the emergency medical
provider services’ needs for the areas served.
(5) Ensure that all on-line medical direction physicians
communicate directly with emergency medical provider services and EMSP
when providing orders unless the physician is providing other critical
medical duties which can only be provided by a physician.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21,
2008.
Repeal and New Rule: Filed
March 16, 2017; effective April 30, 2017. Repeal and New Rule:
Filed February 20, 2019; effective April 6, 2019. Repeal and New Rule:
Filed April 7, 2020; effective June 14, 2020. Repeal and New Rule:
Filed February 17, 2022; effective April 14, 2022.
420-2-1-.06 Medical Direction.
(1) Service Medical Directors shall:
(a) Sign a written agreement outlining accepted
responsibilities to provide emergency medical provider service medical
oversight.
(b) Have experience, training, and a current or previous
board certification from a recognized broad-based medical specialty
organization such as emergency medicine, internal medicine, surgery,
family practice, general practice (if current MDPID number issued prior
to January 1, 2011), or pediatrics (in combination with an adult
16
specialty, unless service is licensed with the OEMS as a pediatric
specialty care transport service).
(c) Hold and maintain a current ACLS certificate or be
board certified in emergency medicine. Pediatric physicians shall hold
and maintain a current Pediatric Advanced Life Support (PALS)
certificate or be board certified in pediatric emergency medicine.
(d) Complete the Alabama EMS Medical Director Course and
be issued an OEMS MDPID number.
(e) Possess a current license to practice medicine from
the Medical Licensure Commission of Alabama and a current unrestricted
Drug Enforcement Agency (DEA) number and an unrestricted Alabama
controlled substances certificate or obtain a variance as provided for
within these rules.
(f) Provide oversight to ensure that all EMSP, for which
he or she provides direction, are properly educated and licensed
pursuant to these rules.
(g) Provide oversight to ensure that all EMSP, for which
he or she provides direction, are following the Board approved Alabama
EMS Patient Care Protocols.
(h) Provide oversight to ensure that an effective method
of quality assurance and improvement is integrated into the emergency
medical provider services for which he or she provides direction, day-
to-day patient care delivery.
(i) Provide oversight to ensure that the emergency medical
provider services for which he or she provides direction, are in
compliance with these rules.
(j) Have authority to remove and provide remedial
education to any EMSP working under his or her license, and notify the
OEMS of each occurrence.
(2) On-line Medical Directors shall:
(a) Complete the Alabama EMS Medical Directors Course and
be issued an OEMS MDPID number.
(b) Hold and maintain a current ACLS and ATLS certificate
or be board certified in emergency medicine by a board recognized by
the American Board of Medical Specialties (ABMS). Pediatric physicians
shall hold and maintain a current PALS certificate or be board
certified in pediatric emergency medicine. An individual who is
considered board eligible may complete the Alabama EMS Medical
Directors Course and be issued an OEMS MDPID number but his or her
MDPID number will only remain valid for up to 5 years, at which time
17
the individual must submit his or her certificate after completion of
residency to remain current.
(c) Possess a current license to practice medicine from
the Medical Licensure Commission of Alabama and a current unrestricted
DEA number and an unrestricted Alabama controlled substances
certificate or obtain a variance as provided for within these rules.
(d) Report improper care or complaints regarding licensed
EMSP and/or emergency medical provider services directly to the OEMS.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et seq.
History: Filed September 1, 1982. Amended: Filed September 19, 1990.
Amended: Filed August 21, 1995; effective September 25, 1995.
Repealed and Replaced: Filed September 20, 1996; effective October 24,
1996. Amended: Filed March 20, 2001; effective April 24, 2001.
Repealed and New Rule: December 17, 2007; effective January 21, 2008.
Repealed and New Rule: Filed April 20, 2011; effective May 25, 2011.
Ed. Note: Rule .06 was renumbered .15 and the original
Rule
420-2-1-.15 Ambulance Driver was repealed as per
certification
filed April 20, 2011; effective May 25,
2011.
Repeal and New
Rule: Filed March 16, 2017; effective April 30, 2017. Repeal and
New Rule: Filed February 20, 2019; effective April 6, 2019. Repeal
and New Rule: Filed April 7, 2020; effective June 14, 2020. Repeal
and New Rule: Filed February 17, 2022; effective April 14, 2022.
420-2-1-.07 Licensure Status Categories.
(1) Active - A license that allows an EMSP or provider
service the privilege to practice all duties within the scope defined
pursuant to the level of licensure.
(a) Restricted – A restricted license may be granted by
the Board to an individual who no longer meets the essential functions
of an EMSP as outlined in the Functional Job Analysis available at
https://one.nhtsa.gov/people/injury/ems/EMT-P/disk_1%5B1%5D/Intro-C.pdf
in the National Highway Traffic and Safety Administration, National
Standard Curriculum. An individual with a restricted license status may
not perform the functions of an active EMSP until such time as the
individual completes an essential job functions analysis form that
states the EMSP is able to perform the duties set forth in the
Functional Job Analysis.
(b) Probationary - At its discretion, the Board may grant
a probationary license or downgrade an unrestricted license, for a
specific period which shall not exceed 1 year, when it determines that
the EMSP or provider service has engaged in one or more deficient
practices which are serious in nature, chronic in nature, or which the
EMSP or provider service has failed to correct. This failure could lead
to additional licensure actions including suspension or revocation.
18
(2) Expired – A license that has not been renewed upon its
stated expiration date.
(3) Revoked – A license terminated due to a violation of
these rules, or state or federal law.
(4) Suspended – A license that has had its associated
privileges temporarily removed.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21, 2008. Repealed and New
Rule: Filed
April 20, 2011; effective May 25, 2011. Amended:
Filed
January 17, 2013; effective February 21,
2013.
Ed. Note: Rule 420-2-1-.17 was repealed as per
certification
Filed March 20, 2001; effective April 24, 2001. As a result
of
this, Rule 420-2-1-.19 was renumbered to
420-2-1-.18.
Repeal and
New Rule: Filed March 16, 2017; effective April 30, 2017.
Repeal and New Rule: Filed February 20, 2019; effective April 6,
2019. Repeal and New Rule: Filed April 7, 2020; effective
June 14, 2020. Repeal and New Rule: Filed February 17, 2022;
effective April 14, 2022.
420-2-1-.08 Initial Licensure Qualifications for EMS Personnel.
(1) Initial EMSP qualifications are:
(a) The license candidate shall be 18 years of age within
1 year of the course completion date of the entry level course.
(b) The license candidate shall meet the essential
functions of an EMSP as outlined in the Functional Job Analysis. The
Functional Job Analysis was developed and adopted for the State
examination accommodations to meet the requirements of the ADA. A copy
of these functions may be reviewed in the U.S. Department of
Transportation, National Highway Traffic Safety Administration’s
Emergency Medical Technician: EMT, National Standard Curriculum:
Appendix A.
(c) The license candidate shall disclose any convictions
during enrollment procedures and gain clearance through the OEMS prior
to beginning any classes.
(d) The license candidate shall complete the current
National Standard Curriculum approved by the Board.
(2) Initial application procedure:
19
(a) All licensure candidates must have a current NREMT
certification, a current Alabama Protocols certificate, a current
approved CPR card, and a declaration of citizenship form to be issued
an active license.
(b) The fee for a license shall accompany the application
in the form of a check, money order, credit card, debit card, or cash.
(c) The licensure candidate shall complete a fingerprint-
based state and national criminal background check through the Alabama
State Law Enforcement Agency and pay all costs associated with the
background check. All fingerprint-based background checks must be
completed in accordance with OEMS policy.
(3) No individual may perform EMSP duties prior to
obtaining a license, except under the guidelines of the EMSP field
internship.
(4) In the event an applicant or licensed EMSP changes the
contact information that he or she has provided to the OEMS, the
applicant or licensed EMSP shall notify the OEMS within 10 days of any
change. This notification shall be made in writing by utilizing the
Information Update Form which can be found on the OEMS website at
http://www.alabamapublichealth.gov/ems.
(5) If an individual answers “yes” to being diagnosed
with, or currently has a medical, physical, mental, emotional, or
psychiatric condition that may affect his or her ability to safely
practice as an EMS professional, then an Essential Job Function
Analysis Form must be submitted with the application.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21, 2008. Repealed and New Rule:
Filed
April 20, 2011; effective May 25,
2011.
Ed. Note: Rule 420-2-1-.17 was repealed as per
certification
Filed March 20, 2001; effective April 24, 2001. As a result
of
this, Rule 420-2-1-.21 was renumbered to
420-2-1-.20.
Repeal and
New Rule: Filed March 16, 2017; effective April 30, 2017. Repeal
and New Rule: Filed February 20, 2019; effective April 6, 2019.
Repeal and New Rule: Filed April 7, 2020; effective June 14, 2020.
Repeal and New Rule: Filed February 17, 2022; effective April 14,
2022.
420-2-1-.09 Licensure for Out-of-State EMS Personnel.
(1) All applicants shall have a current NREMT certificate,
a current approved CPR card, a declaration of citizenship form, and
20
verification of current Alabama protocol education to be issued an
active license.
(2) All persons possessing a current NREMT EMT
Intermediate certificate will be eligible for an EMT license provided
all other application requirements are met.
(3) An additional Interfacility Transfer Course will be
required for the individual to receive the Interfacility endorsement on
the license, which allows for the EMSP to transfer patients out of a
requesting facility.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21, 2008. Repealed and New Rule:
Filed
April 20, 2011; effective May 25,
2011.
Ed. Note: Rule 420-2-1-.17 was repealed as per
certification
Filed
March 20, 2001; effective April 24, 2001. As a result
of
this, Rule
420-2-1-.23 was renumbered to
420-2-1-.22.
Repeal and New Rule:
Filed March 16, 2017; effective April 30, 2017. Repeal and New Rule:
Filed February 20, 2019; effective April 6, 2019. Repeal and New Rule:
Filed April 7, 2020; effective June 14, 2020. Repeal and New Rule:
Filed February 17, 2022; effective April 14, 2022.
420-2-1-.10 License Expiration, Renewal, and Reinstatement for EMS
Personnel.
(1) Prior to license expiration, the OEMS will attempt to
notify each licensed individual utilizing the most recent contact
information that has been provided. If an individual fails to receive
this notice, it will not relieve him or her of the responsibility for
license renewal.
(2) Renewal applications received after March 1 will not
guarantee the applicant’s license will be processed in time to avoid
expiring. All individual licenses expire on March 31 of a given year.
(3) Any applicant who submits an application attesting
that all continuing education requirements have been met, when they
have not, will be subject to disciplinary action for falsification of
records.
(4) All individuals are subject to an audit of all
information attested to on the application. All applicants who are
selected for audit have 72 hours to submit their documentation. Failure
to provide the requested documentation will result in disciplinary
action for falsification of records.
21
(5) An individual who was licensed prior to 1986 and was
not required to obtain NREMT certification for initial licensure will
be granted amnesty for the requirement of maintaining NREMT
certification. In lieu of the NREMT certification requirement, these
individuals may submit current OEMS continuing education requirements
and OEMS approved adult and pediatric protocol education. If NREMT
certification is obtained, it must be maintained for continued
licensure.
(6) An individual whose license has been revoked may
reapply for licensure no less than 2 years after the licensure action
was taken.
(7) An individual whose application was denied and whose
denial was unsuccessfully appealed at a hearing may reapply for
licensure no less than 2 years after the date the final order was
rendered.
(8) An individual who chose to consent to surrender his or
her license to avoid a hearing and possible adverse licensure action
may reapply for licensure no less than 2 years after the surrender was
approved and accepted by the Board.
(9) The license renewal fees for the OEMS are listed in
Rule 420-1-5-.08 (3), Ala. Admin. Code.
(10) Renewal Level Requirements:
(a) Emergency Medical Responder (EMR):
1. A completed application and the 2-year license renewal
fee in the form of a check, money order, credit card, debit card, or
cash.
2. Current NREMT certification.
(b) EMT:
1. A completed application and the 2-year license renewal
fee in the form of a check, money order, credit card, debit card, or
cash.
2. OEMS approved adult and pediatric protocols update.
3. Current NREMT certification.
(c) EMT-Intermediate (I-85):
1. A completed application and the 2-year license renewal
fee in the form of a check, money order, credit card, debit card, or
cash.
22
2. OEMS approved adult and pediatric protocols update.
3. Meet the OEMS continuing education requirements.
(d) Advanced EMT:
1. A completed application and the 2-year license renewal
fee in the form of a check, money order, credit card, debit card, or
cash.
2. OEMS approved adult and pediatric protocols update.
3. Current NREMT certification.
(e) Paramedic:
1. A completed application and the 2-year license renewal
fee in the form of a check, money order, credit card, debit card, or
cash.
2. OEMS approved adult and pediatric protocols update.
3. Current NREMT certification.
(11) Duplicate license.
(a) A completed application.
(b) A license fee in the form of a check, money order,
credit card, debit card, or cash.
(12) Renewal applications may be paid by credit card or
debit card through the OEMS on-line process, but each EMSP shall meet
the same requirements as listed above.
(13) For license reinstatement, an application must be
resubmitted to the OEMS.
(14) All licenses expire at midnight on March 31 in the
stated year of their expiration.
(15) All EMSP who fail to renew their license shall follow
the guidelines established by the NREMT. This information may be found
at http://www.nremt.org.
(16) An individual who was licensed prior to 1986 and was
not required to obtain NREMT certification for initial licensure may
reinstate his or her license through April 30, providing the current
OEMS educational requirements of the license expiration year have been
met. Those individuals who have not been reinstated by May 1 will be
subject to the OEMS initial licensure process.
23
(17) All EMSP whose license expires will be required to pay
an additional $50.00 late fee and complete a fingerprint-based state
and national criminal background check through the Alabama State Law
Enforcement Agency and pay all costs associated with the background
check. All fingerprint-based background checks must be completed in
accordance with OEMS policy.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21, 2008. Repealed and New
Rule: Filed
April 20, 2011; effective May 25, 2011. Amended:
Filed
January 17, 2013; effective February 21,
2013.
Ed. Note: Rule 420-2-1-.17 was repealed as per
certification
Filed
March 20, 2001; effective April 24, 2001. As a result
of
this, Rule
420-2-1-.24 was renumbered to
420-2-1-.23.
Repeal and New Rule:
Filed March 16, 2017; effective April 30, 2017. Repeal and New Rule:
Filed February 20, 2019; effective April 6, 2019. Repeal and New Rule:
Filed April 7, 2020; effective June 14, 2020. Repeal and New Rule:
Filed February 17, 2022; effective April 14, 2022.
420-2-1-.11 Licensure for Emergency Medical Provider Services.
(1) No person shall operate an emergency medical
provider service until obtaining a license. All emergency medical
provider service licenses are issued by the OEMS under the authority of
the Board. Each emergency medical provider service license will be
issued with the appropriate level of authorization.
(2) Categories of emergency medical provider service
licenses.
(a) ALS Transport (ground or air)
(b) ALS Non-transport
(c) BLS Transport
(3) Classification of emergency medical provider
services licenses.
(a) Unrestricted – An unrestricted license may be
granted by the Board after it has determined that the EMS provider is
willing and capable of maintaining compliance with these rules.
(b) Probationary – At its discretion, the Board may
grant a probationary license or downgrade an unrestricted license, for
a specific period which shall not exceed 1 year, when it determines
that the provider has engaged in one or more deficient practices which
24
are serious in nature, chronic in nature, or which the provider has
failed to correct. This failure could lead to additional licensure
actions including suspension or revocation.
(4) Categories of ALS emergency medical provider service
license authorizations.
(a) ALS Level 1: Paramedic authorization
(b) ALS Level 1-Critical Care: Paramedic authorization
(c) ALS Level 2: Advanced EMT authorization
(d) ALS Level 3: Intermediate authorization
(5) Licensure applications shall be submitted to and
approved by the OEMS prior to an emergency medical provider service
conducting operations. All licenses are valid for a period that shall
not exceed 12 months. Applications are available upon request or may be
obtained at http://www.alabamapublichealth.gov/ems. In order to apply
for licensure, the emergency medical provider service shall submit the
following:
(a) Completed license application
(b) Plans to describe: (initial and when changes occur)
1. Infection control
2. Fluid and medication security
3. Controlled substance (if applicable)
4. Employee drug screening
5. Emergency Vehicle Operator training (ground providers
only)
6. Quality Assurance / Quality Improvement
(c) Declaration of Citizenship Form, if applicable
(d) The following agreements:
1. Emergency Medical Dispatch
2. Alabama Incident Management System (AIMS)
3. ALS
25
4. Pharmacy or Pharmaceutical
5. Service Medical Director
6. e-PCR conforming to National EMS Information System
(NEMSIS) and Alabama validation requirements available at
http://www.alabamapublichealth.gov/ems.
(e) Proof of a minimum of $1,000,000 liability insurance
from a carrier licensed by the Alabama Department of Insurance. This
includes all transport, non-transport vehicles, and professional
liability on all EMSP employed or volunteering for duty. Alternatively,
a licensed provider service may be self-insured in the same amount
through a plan approved by the OEMS. This liability insurance coverage
shall be binding and in force prior to the service being issued a
license or authorization.
(f) An application fee as provided in Rule 420-1-5-.08
(3).
(g) A roster of active licensed EMSP appropriate for the
category of service desired.
(h) Demonstration of an ability to comply with the
OEMS patient care reporting requirements.
(i) Prior to approval for a license, the OEMS will inspect
the proposed emergency medical provider service to determine compliance
with §22-18-1, et seq., Code of Ala. 1975, and the requirements of
these rules.
(6) Emergency medical provider service licenses shall be
renewed before the expiration date provided on the current license. Any
service with an expired license shall immediately cease all operations.
On the date of expiration, the OEMS will notify all third-party payors
and pharmaceutical suppliers regarding the affected service’s license
status.
(7) Each licensed emergency medical provider service shall
obtain a separate license for each county in which a ground ambulance,
or service area in which an air ambulance, is based. The license shall
be displayed in a conspicuous place in the emergency medical provider’s
main office in the county or service area.
(8) The emergency medical provider service license and
ALS authorization are nontransferable and shall be granted only to the
service operator named on the application.
(9) Within 60 calendar days of receipt from the State
Board of Health of its initial (first) license to operate as a provider
service from a base within a ground provider’s licensed county or an
26
air provider’s licensed service area, each licensed provider service
shall be in continuous operation in the county in which it is licensed,
providing emergency response 24 hours a day, 7 days a week, 365 days a
year for any emergency medical service request issued within the
licensed county. Mutual aid response to other counties is not required
but is recommended if resources are available. ALS Non-Transport
services and all fully volunteer services are exempt from this
requirement, but a fully volunteer transport service must ensure
coverage when service is not available.
(10) Licensed emergency medical provider services shall
ensure:
(a) The highest level EMSP provides patient care when
treating and transporting any unstable patient.
(b) The highest level EMSP has the responsibility to
provide care for patients until care is transferred to appropriate
medical personnel.
(c) Acknowledgement of the ability to respond within
2 minutes of initial dispatch of an emergency call (ground and air
providers).
(d) An EMS response unit is en route within 7 minutes of
the initial dispatch (excluding air medical).
(e) The execution of mutual aid and dispatch agreements so
that no emergency calls are purposefully delayed.
(f) Continuous telephone service with the capability to
record or forward calls so that the service is accessible by phone to
the public at all times (non-emergency calls).
(g) A written roster for an ALS transport service of at
least six properly licensed EMSP with a minimum of three at the ALS
level of license. ALS non-transport shall have at least one properly
licensed EMSP at the level of provider license. A written roster for a
BLS transport service of at least three properly licensed EMSP.
(h) The provision of immediate verbal notification to
the OEMS of any civil or criminal action brought against the service,
or any criminal action brought against an employee, and the submission
of a written report within 5 working days of the provider becoming
aware.
(i) The provision of immediate verbal notification to the
OEMS and a written report within 5 working days of any accident
involving an ambulance that was responding to an emergency, that
injured any crew members, or that had a patient on board. A copy of the
27
accident police report must be provided to the OEMS as soon as it
becomes available.
(j) The provision of an Ambulance Add/Remove via EMS Web
Management to the OEMS immediately for any permitted vehicle added or
removed from service for any reason other than scheduled maintenance.
Information shall include the disposition of the removed vehicle.
(11) Compliance with all statewide system components (i.e.,
Trauma, Stroke, and Cardiac) as written in the Alabama OEMS Patient
Care Protocols.
(12) Licensed emergency medical provider services shall
not:
(a) Transfer a provider service license certificate or
ALS authorization.
(b) Self-dispatch or cause a vehicle to be dispatched on a
call in which another provider service has been dispatched.
(c) Allow EMSP to exceed their scope of practice as
outlined within these rules.
(d) Intentionally bill or collect from patients or third-
party payors for services not rendered.
(e) Refuse to provide appropriate treatment or transport
for an emergency patient for any reason including the patient’s
inability to pay.
(f) Allow any ALS equipment, fluids, or medications to
remain unsecured on a permitted vehicle without the appropriate
licensed EMSP on board.
(g) Allow EMSP to respond to a medical emergency with the
intent to treat or transport a patient unless the EMSP is clean and
appropriately dressed.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: Filed September 1, 1982. Amended:
Filed
May 24, 1984.
Repealed and Replaced: Filed September 20,
1996;
effective
October 24, 1996. Amended: Filed March 20,
2001;
effective
April 24, 2001. Repealed and New
Rule:
December 17, 2007;
effective January 21, 2008. Repealed and
New
Rule: Filed April 20,
2011; effective May 25, 2011.
Amended:
January 17, 2013; effective
February 21,
2013.
Repeal and New Rule: Filed March 16, 2017;
effective April 30, 2017. Repeal and New Rule: Filed February 20,
2019; effective April 6, 2019. Repeal and New Rule: Filed April 7,
2020; effective June 14, 2020. Repeal and New Rule: Filed
February 17, 2022; effective April 14, 2022.
28
420-2-1-.12 Advanced Life Support Personnel Scope of
Practice.
(1) All advanced EMS licensure levels shall have the
ability to provide ALS medical treatments and interventions as
described in the Alabama EMS Patient Care Protocols as applicable to
their level of licensure if the following criteria are met:
(a) The individual has a valid Alabama EMSP license.
(b) The individual is current on all applicable protocol
updates approved by the Board.
(c) The individual is listed on a licensed ALS emergency
medical provider service’s personnel roster.
(2) No individual licensed at any level shall transport
ALS equipment, fluids, or medications for the purpose of rendering ALS
care in any vehicle not listed on the provider service’s vehicle
roster.
(3) All advanced EMS licensure levels shall comply with
all state-wide system components (i.e., Trauma, Stroke, and Cardiac) as
written in the Alabama EMS Patient Care Protocols.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed April 20, 2011;
effective
May 25,
2011.
Repeal and New Rule: Filed March 16, 2017; effective April 30, 2017.
Repeal and New Rule: Filed February 20, 2019; effective April 6, 2019.
Repeal and New Rule: Filed April 7, 2020; effective June 14, 2020.
Repeal and New Rule: Filed February 17, 2022; effective April 14,
2022.
420-2-1-.13 Critical Care.
(1) To become Critical Care licensed, a provider service
must:
(a) Submit a Critical Care Practice application.
(b) Follow the approved Alabama EMS Critical Care Patient
Care Protocols in addition to the Alabama EMS Patient Care Protocols.
(2) To be eligible for a Critical Care license, each
provider service medical director must attend, or call in for, the
majority of the quarterly quality assurance meetings.
(3) Each provider service shall:
(a) Carry all required equipment listed on the Critical
Care Equipment List.
29
(b) Carry only the medications that are listed in the
Critical Care medication formulary that has been approved by the OEMS.
(4) To obtain a Critical Care endorsement, a paramedic
must:
(a) Present a Board approved application and proof of the
IBSC CCP or FP certification, or hold a valid, unencumbered Alabama
registered nurse license and certification from the Board of
Certification for Emergency Nursing as a Certified Flight Registered
Nurse (CFRN) or Certified Transport Registered Nurse (CTRN).
(b) Have 3 years licensed at the paramedic level.
(c) Medical Director shall verify skill competencies.
(5) The critical care endorsement shall be valid so long
as the paramedic maintains:
(a) Current licensure as a paramedic by the Board.
(b) Current certification through the IBSC or a valid,
unencumbered Alabama registered nurse license and certification from
the Board Certification for CFRN or CTRN.
(6) A paramedic with a Critical Care endorsement shall be
authorized to perform the skills and procedures included in the Alabama
EMS Critical Care Patient Care Protocols in addition to the Alabama EMS
Patient Care Protocols.
(7) A licensed paramedic with a Critical Care endorsement
shall be responsible for providing the OEMS with copies of his or her
current IBSC or Board Certification in Emergency Nursing certification.
(8) Provider services must keep all training documents on
file for auditing purposes and made available to the OEMS upon request.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et. seq.
History: Repeal and New Rule: Filed March 16, 2017; effective
April 30, 2017. Repeal and New Rule: Filed February 20, 2019;
effective April 6, 2019. Repeal and New Rule: Filed April 7, 2020;
effective June 14, 2020. Repeal and New Rule: Filed February 17,
2022; effective April 14, 2022.
420-2-1-.14 EMT-Intermediates (I-85).
NOTE: This section only applies to current licensed Alabama
EMT-Intermediates.
30
(1) The OEMS discontinued licensing EMT-Intermediates (I-
85) in 2003. All existing EMT-Intermediates (I-85) will continue to be
licensed as such so long as their licenses are properly renewed each
license cycle.
(2) The EMT-Intermediate (I-85) shall have the ability to
provide medical treatment skills and interventions as described in the
Alabama EMS Patient Care Protocols for the EMT-Intermediate (I-85) that
are modified as needed based on changes granted by the Board.
(3) The license certification examination is not
applicable in Alabama for this level. This does not affect
EMT-Intermediates (I-85) already licensed in Alabama. (See Reciprocity
for Out of State EMT-Intermediates (I-85.))
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21, 2008. Repealed and New Rule:
Filed
December 17, 2007; effective January 21, 2008. Repealed and
New
Rule: Filed April 20, 2011; effective May 25,
2011.
Ed. Note: Rule 420-2-1-.17 was repealed as per
certification
Filed March 20, 2001; effective April 24, 2001. As a result
of
this, Rule 420-2-1-.26 was renumbered to 420-2-1-.25.
Rule
420-2-1-.24 Credentialing was repealed therefore
Rule
420-2-1-.25 was renumbered 420-2-1-.24 as per
certification
filed
December 17, 2007; effective January 21,
2008.
Repeal and New Rule:
Filed March 16, 2017; effective April 30, 2017. Repeal and New Rule:
Filed February 20, 2019; effective April 6, 2019. Repeal and New Rule:
Filed April 7, 2020; effective June 14, 2020. Repeal and New Rule:
Filed February 17, 2022; effective April 14, 2022.
420-2-1-.15 Emergency Vehicle Operator Qualifications.
(1) A valid driver license.
(2) A current emergency vehicle operations certificate
from an approved course that shall be maintained in the emergency
medical provider service’s employee file.
(3) A current approved CPR card.
(4) A certificate of completion from a Department of
Transportation Emergency Medical Responder Curriculum Course or higher,
or from the Alabama Fire College Emergency Care Provider Course.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed April 20, 2011;
effective
May 25,
2011.
Repeal and New Rule: Filed March 16, 2017; effective April 30, 2017.
Repeal and New Rule: Filed February 20, 2019; effective April 6, 2019.
31
Repeal and New Rule: Filed April 7, 2020; effective June 14, 2020.
Repeal and New Rule: Filed February 17, 2022; effective April 14,
2022.
420-2-1-.16 Emergency Medical Dispatch.
(1) All emergency calls received for emergency medical
provider services shall be processed by a certified EMD which will
provide pre-arrival medical care instructions to the caller.
(2) All EMDs must have:
(a) A current designation of EMD from the Alabama EMD
program or a nationally recognized EMD certification course approved
by the Alabama Statewide 911 Board and the Alabama Department of
Public Health, OEMS (A list of approved courses may be found at
http://www.alabamapublichealth.gov/ems).
(b) A current CPR certification.
(3) Dispatch centers shall provide the OEMS with a
continuously monitored email address and telephone number.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: Filed February 20, 2019; effective April 6, 2019. Repeal and
New Rule: Filed April 7, 2020; effective June 14,2020. Repeal and New
Rule: Filed February 17, 2022; effective April 14, 2022.
420-2-1-.17 Ground Provider Services, Equipment, Fluids, and
Medications.
(1) Ground Provider Services are subject to all rules in
this chapter except Rule 420-2-1-.08.
(2) No unlicensed emergency medical provider service or
personnel shall transport a patient from one point within Alabama to
another point within Alabama.
(3) All permitted vehicles listed on an emergency medical
provider service’s application shall meet the Minimum Equipment
Standards and Supplies for Licensed EMS Provider Services that pertain
to their type of provider service and vehicles. The Minimum Equipment
Standards and Supplies for Licensed EMS Provider Services will be
maintained by the OEMS for each type of vehicle and will be available
upon request or can be found posted at
http://www.alabamapublichealth.gov/ems.
(4) Permitted ambulances may utilize locking wheelchair
devices for restricted patients and the device shall be secured
appropriately and permanently in accordance with the manufacturer’s
instructions. Safety harnesses and belts for the patient shall
32
comply with all provisions contained in the Federal Motor Vehicle
Safety Standards (FMVSS) at 49 CFR Part 571.
(5) Seat belts and shoulder harnesses shall not be used in
lieu of a device which secures the wheelchair or mobility aid itself.
(6) All ambulances shall meet or exceed the federal trade
industry specifications or standards for ambulance vehicles.
(7) Ambulances shall not have exterior wording which may
mislead the public as to the type of service that the emergency medical
provider service is licensed to provide.
(8) All ambulances shall have the same color schemes,
lettering, and striping which shall be approved by the OEMS prior to
being placed in service.
(9) All provider service names as designated on the
license issued by the OEMS shall be displayed prominently on each
side of the ambulance as outlined in the current OEMS approved
specifications.
(10) All permitted vehicles are subject to inspection by
the OEMS.
(11) All provider service ground ambulances shall have two
forms of communication capabilities that provide vehicle-to-hospital
communications and for entry of patients into ATCC. Additionally, all
ground ambulances shall have radio communication capabilities with the
following Very High Frequencies (VHF) frequencies to be used for mutual
aid and disaster responses.
(a) 155.175 EMS-TAC-1
(b) 155.205 EMS-TAC-2
(c) 155.235 EMS-TAC-3
(d) 155.265 EMS-TAC-4
(e) 155.340 Hospital 1 (HEAR) (VMED28)
(f) 155.3475 (VMED 29)
(12) Medications and fluids shall be approved by the
Board and listed on the Formulary for EMS. These medications and
fluids shall be properly stored and inventoried in a fluid
and medication container. Medication containers shall be kept properly
secured and accessible only by authorized EMSP.
33
(13) All fluids and medications shall be stored in a locked
(keyed or combination) compartment when not in use by appropriately
licensed EMSP.
(14) The individual ALS EMSP is responsible for ensuring
that all fluids and medications are present and have not expired.
(15) The Board approved Formulary for EMS medications is
available upon request or can be found at
http://www.alabamapublichealth.gov/ems.
(16) All pre-hospital medical personnel shall provide
medical treatments and interventions as described in the Alabama EMS
Patient Care Protocols as applicable to their level of licensure.
(17) Medications, I.V. fluids, and other ALS equipment
supply or resupply system for approved ALS certificate holders shall
be established and maintained with an approved pharmacy or a
pharmaceutical distributor. The OEMS will conduct periodic inspections
of medications, I.V. fluids, and ALS equipment. All sources of supply
or resupply for each ALS service participating in the medication, I.V.
fluid, and other ALS equipment supply or resupply program must be
submitted and approved by the OEMS.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Amended: Filed June 23, 2004;
effective
July 28, 2004. Repealed and New Rule: December 17,
2007;
effective January 21,
2008.
Repeal and New Rule: Filed
March 16, 2017; effective April 30, 2017. Repeal and New Rule: Filed
February 20, 2019; effective April 6, 2019. Repeal and New Rule: Filed
April 7, 2020; effective June 14, 2020. Repeal and New Rule: Filed
February 17, 2022; effective April 14, 2022.
420-2-1-.18 Air Provider Services, Equipment, Fluids, and
Medications.
(1) Air Ambulance Providers are subject to all rules in
this chapter except Rule 420-2-1-.17.
(2) No unlicensed emergency medical provider service or
personnel shall transport a patient from one point within Alabama to
another point within Alabama.
(3) All permitted aircraft listed on an emergency
medical provider service’s application shall meet the Minimum Equipment
Standards and Supplies for Licensed EMS Provider Services that pertain
to their type of provider service. The Minimum Equipment Standards and
Supplies for Licensed EMS Provider Services will be maintained by the
34
OEMS and will be available upon request or can be found posted at
http://www.alabamapublichealth.gov/ems.
(4) All permitted aircraft are subject to inspection by
the OEMS.
(5) Air Ambulance Providers shall:
(a) Comply with current applicable provisions of Part
135 FAR and be authorized by the FAA to provide air ambulance
operations.
(b) Cause the interior of the aircraft to be climate
controlled to avoid adverse effects on patients and personnel.
1. The inside cabin shall be capable of maintaining
temperature ranges of no less than 50 degrees Fahrenheit and no greater
than 95 degrees Fahrenheit to prevent adverse effects on the patient.
(This applies when patient is on board in flight - not during take-off
or landing.)
2. Cabin temperatures shall be measured and documented
every 15 minutes during a patient transport. A thermometer shall be
secured inside the cabin.
3. The provider shall have written policies that address
measures to be taken to avoid adverse effects of temperature extremes
on patients and personnel on board.
4. In the event cabin temperatures are less than 50
degrees Fahrenheit or greater than 95 degrees Fahrenheit, the provider
shall require documentation be red flagged for the quality improvement
process to evaluate what measures were taken to mitigate adverse
effects on the patient and crew and what outcomes resulted.
(6) All provider service aircraft shall have two forms of
communication capabilities that provide vehicle-to-hospital
communications and for entry of patients into ATCC. Additionally, all
aircraft shall have radio communication capabilities with the following
VHF to be used for mutual aid and disaster responses.
(a) 155.175 EMS-TAC 1
(b) 155.205 EMS-TAC 2
(c) 155.235 EMS-TAC 3
(d) 155.265 EMS-TAC 4
(e) 155.340 Hospital 1 (HEAR) (VMED28)
35
(f) 155.3475 (VMED 29)
(7) Medications and fluids shall be approved by the Board
and listed on the Formulary for EMS. These medications and fluids shall
be properly stored and inventoried in a fluid and medication container.
Medication containers shall be kept properly secured and accessible
only by authorized EMSP.
(8) All fluids and medications shall be stored in a locked
(keyed or combination) compartment when not in use by appropriately
licensed EMSP.
(9) The individual ALS EMSP is responsible for ensuring
that all fluids and medications are present and have not expired
(regardless of the supply or resupply source).
(10) The Board approved Formulary for EMS medications is
available upon request or can be found at
http://www.alabamapublichealth.gov/ems.
(11) All pre-hospital medical personnel shall provide
medical treatments and interventions as described in the Alabama EMS
Patient Care Protocols as applicable to their level of licensure.
(12) Medications, I.V. fluids, and other ALS equipment
supply or resupply system for approved ALS certificate holders shall
be established and maintained with an approved pharmacy or a
pharmaceutical distributor. The OEMS will conduct periodic inspections
of medications, I.V. fluids, and ALS equipment. All sources of supply
or resupply for each ALS service participating in the medication, I.V.
fluid, and other ALS equipment supply or resupply program must be
submitted and approved by the OEMS.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed April 20, 2011;
effective
May 25,
2011.
Repeal and New Rule: Filed March 16, 2017; effective April 30, 2017.
Repeal and New Rule: Filed February 20, 2019; effective April 6, 2019.
Repeal and New Rule: Filed April 7, 2020; effective June 14, 2020.
Repeal and New Rule: Filed February 17, 2022; effective April 14,
2022.
420-2-1-.19 Provider Service Staffing.
(1) Licensed Ground ALS transport and non-transport
services shall meet the following applicable staffing configurations:
(a) Licensed transport services with an ALS Level 1
Authorization shall, at a minimum, staff one ALS Ground Ambulance with
an emergency vehicle operator and licensed Paramedic.
36
(b) Licensed transport services with an ALS Level 1-
Critical Care Authorization shall, at a minimum, staff each ALS Ground
Ambulance with an emergency vehicle operator, a licensed ALS EMSP, and
a Critical Care Paramedic.
(c) Licensed transport services with an ALS Level 2
Authorization shall, at a minimum, staff one ALS vehicle with an
emergency vehicle operator and licensed Advanced EMT.
(d) Licensed transport services with an ALS Level 3
Authorization shall, at a minimum, staff one ALS vehicle with an
emergency vehicle operator and licensed Intermediate (I-85).
(e) Licensed non-transport services with an ALS Level 1
Authorization shall, at a minimum, staff one ALS vehicle with a
licensed Paramedic.
(f) Licensed non-transport services with an ALS Level 2
Authorization shall, at a minimum, staff one ALS vehicle with a
licensed Advanced EMT.
(g) Licensed non-transport services with an ALS Level 3
Authorization shall, at a minimum, staff one ALS vehicle with a
licensed Intermediate (I-85).
(2) Licensed Air Medical transport services shall meet the
following applicable staffing configurations:
(a) Licensed Air Medical transport services with an ALS
Level 1 Authorization shall be staffed with a licensed pilot and two
Alabama licensed medical professionals capable of providing ALS with
one being a Paramedic.
(b) Licensed Air Medical transport services with an ALS
Level 1-Critical Care Authorization shall be staffed with a licensed
pilot and two Alabama licensed medical professionals capable of
providing ALS with one being a Critical Care Paramedic.
(3) Licensed BLS provider transport services shall, at a
minimum, staff one vehicle with an emergency vehicle operator and a
licensed EMT.
(4) Licensed Provider Services shall not allow EMSP to
respond to a medical emergency with the intent to treat or transport
a patient unless the EMSP are clean and appropriately dressed.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21,
2008.
Repeal and New Rule: Filed
37
March 16, 2017; effective April 30, 2017. Repeal and New Rule:
Filed February 20, 2019; effective April 6, 2019. Repeal and New Rule:
Filed April 7, 2020; effective June 14, 2020. Repeal and New Rule:
Filed February 17, 2022; effective April 14, 2022.
420-2-1-.20 Responsibility for Patient.
(1) In no event shall an emergency medical provider
service responding to the scene of an emergency fail to treat a patient
because of the patient’s inability to pay or perceived inability to pay
for services. Provided, that nothing in the subsection shall be
construed to prohibit any emergency medical provider service from
collecting or attempting to collect a fee by any lawful means. Provided
further, no emergency medical provider service shall threaten to
withhold emergency treatment as a method for the collection of fees.
(2) The highest level EMSP shall provide patient care when
treating and transporting any unstable patient and shall have the
responsibility to provide care until relieved by appropriate medical
personnel.
(3) The transport of a stable patient that does not
require more advanced procedures may be attended by a lower level EMSP
at the discretion of the highest level EMSP as long as the following
conditions exist:
(a) The supervising level EMSP understands that he or she
is responsible for the decision to transfer care to the lower level
EMSP.
(b) Pre-hospital administered medications or procedures
would not exceed the lower level EMSP’s scope of practice.
(c) The lower level EMSP, upon assuming secondary patient
care from a higher level EMSP, understands that a higher level of care
may be needed if the patient becomes unstable or critical in nature
and will, without delay, coordinate the transfer of care back to a
higher level EMSP.
(d) At no time will the above-mentioned transfers of care
delay patient care, continuity of care, or the transport or transfer
of the patient to definitive care.
(4) Licensed EMSP providing care to a patient shall remain
under a continuing duty to provide care to the patient. The
circumstances under which an EMSP may stop providing care are set forth
below:
(a) EMSP providing care to a patient may yield patient
care responsibilities to any other licensed EMSP or licensed physician
who is willing to assume patient care responsibilities. EMSP providing
38
care to a patient shall yield patient care responsibilities to a
licensed physician when directed to do so by the on-line medical
director.
(b) EMSP personnel shall yield patient care
responsibilities to licensed EMSP when directed to do so by licensed
EMSP of a higher level.
(c) EMSP shall discontinue patient care measures when
directed to do so by the on-line medical director.
(5) On-scene disputes regarding patient care
responsibilities shall be referred to the on-line medical director.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975,
§22-18-1.
History: New Rule: Filed May 16, 2007;
effective
June 20, 2007. Repealed and New Rule: December 17,
2007;
effective January 21, 2008. Repealed and New Rule:
Filed
April 20, 2011; effective May 25,
2011.
Ed. Note: Rule 420-2-1-.29 was renumbered 420-2-1-.28 as
per
certification filed December 17, 2007;
effective
January 21,
2008.
Repeal and New Rule: Filed March 16, 2017; effective
April 30, 2017. Repeal and New Rule: Filed February 20, 2019;
effective April 6, 2019. Repeal and New Rule: Filed April 7, 2020;
effective June 14, 2020. Repeal and New Rule: Filed February 17,
2022; effective April 14, 2022.
420-2-1-.21 Patient Care Reporting.
(1) The EMSP providing patient care is responsible for the
completion and submission of an electronic Patient Care Report(e-PCR)
to the emergency medical provider service within 24 hours.
(2) Each emergency medical provider service shall ensure
that an accurate and complete e-PCR is completed and submitted to the
OEMS within the required time frames, and use software approved by the
OEMS’ Director.
(3) Each provider service shall provide a copy of the
patient care report to the receiving facility as soon as reasonably
possible. In no instance should the delivery of the report exceed 24
hours.
(4) Records and data collected or otherwise captured by
the Board, its agents, or designees shall be deemed to be confidential
medical records and shall be released only in the following
circumstances:
(a) Upon a patient’s presentation of a duly signed
release.
39
(b) Records and data may be used by Department staff and
staff of other designated agencies in the performance of regulatory
duties and in the investigation of disciplinary matters provided
that individual patient records used in the course of public hearings
shall be handled in a manner reasonably calculated to protect the
privacy of individual patients.
(c) Records and data may be used by Department staff and
staff of other designated agencies in the performance of authorized
quality assurance and improvement activities.
(d) Existing records, data, and reports may be released in
any format in which they appear in the Department’s database in
response to a valid subpoena or order from a court of competent
jurisdiction.
(e) Data may be compiled into reports by an emergency
medical provider service from the respective emergency medical provider
service’s collected records.
(f) Aggregate patient care report data may be released to
the public in a format reasonably calculated to not disclose the
identity of individual patients or proprietary information such as the
volume of non-emergency calls undertaken by an individual provider
service or insurance and other reimbursement related-information
related to an individual provider service.
(g) Records and data shall be disclosed as required by
federal and state law.
(h) Any individual or entity designated by the OEMS as
having authority to collect or handle data that withholds or releases
data or information collected in a manner not pursuant to these rules
shall be subject to disciplinary action.
(5) Any individual or entity that is not compliant with
the disclosure aspects of this rule is subject to loss of licensure or
prosecution under these rules.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
O
ctober 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21,
2008.
Repeal and New Rule: Filed
March 16, 2017; effective April 30, 2017. Repeal and New Rule:
Filed February 20, 2019; effective April 6, 2019. Repeal and New Rule:
Filed April 7, 2020; effective June 14, 2020. Repeal and New Rule:
Filed February 17, 2022; effective April 14, 2022.
40
420-2-1-.22 Provider Service Record Keeping.
(1) Each emergency medical provider service shall be
responsible for supervising, preparing, filing, and maintaining records
and for submitting reports to the Board as requested. All records
shall be handled in a manner as to ensure reasonable safety from water
and fire damage and shall be safeguarded from unauthorized use. Any
records maintained by a provider service as required by these rules
shall be accessible to authorized representatives of the Board and
shall be retained for a period of at least 5 years except as otherwise
specified in these rules. Each provider service shall maintain the
following administrative records:
(a) A current license certificate issued by the OEMS which
is publicly displayed at the provider service’s location. Any provider
service changing ownership, ceasing operations, or surrendering its
license shall return its license certificate within
5 working days to the OEMS.
(b) A copy of past inspection reports.
(c) Personnel records for each employee that shall include
protocols and continuing education, a current approved CPR card, and a
copy of current license. If applicable, a copy of driver’s
certification requirements.
(2) Each provider service shall maintain written plans,
compliant with these rules and available for review by the OEMS, for
the proper handling, storage, and disposal of all bio-hazardous waste,
emergency medical dispatch, employee drug screening, mutual aid
agreements and for the proper use, handling, storage, and disposal of
all fluids and medications.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24,
1996. Amended: Filed March 20, 2001;
effective
April 24, 2001.
Repealed and New Rule: December 17,
2007;
effective January 21,
2008.
Repeal and New Rule: Filed March 16, 2017; effective April 30,
2017. Repeal and New Rule: Filed February 20, 2019; effective
April 6, 2019. Repeal and New Rule: Filed April 7, 2020; effective
June 14, 2020. Repeal and New Rule: Filed February 17, 2022; effective
April 14, 2022.
420-2-1-.23 Controlled Substance Plan.
(1) Each emergency medical provider service carrying
controlled substances shall submit a Controlled Substance Plan (CSP) to
the OEMS at the time of licensure and renewal. If a provider service
does not plan to carry controlled substances, this shall be noted in
the service’s I.V. Fluid and Drug Plan. Any modification to the plan
shall be submitted to the OEMS for approval.
41
(2) Each CSP shall include the following items: a method
of ownership, security, how initial stock is obtained, restocking
procedures, internal orientation for new employees, on-going internal
training for employees, drug testing for employees, quality assurance
and quality improvement program, tables to be used for accounting logs,
and original signatures from the service medical control physician, the
pharmacist from the medical direction hospital, and the Controlled
Substance Oversight Coordinator (CSOC).
(3) All controlled substances shall be secured behind no
less than two locks upon initial receipt. If a provider service stores
a controlled substance at a central location, it shall be placed in a
separate container with a lock, and inside a safe, cabinet, file
cabinet, or similar device, which is secured to the wall and floor of
the building. Controlled substances may be placed in a medication
container, but shall be placed in a separate, locked container.
Building or vehicle doors are not considered to be separate, locked
containers. The only time it is permissible for an employee to maintain
a personal key to a service provider's controlled substances containers
is if that key is for a container specifically for that individual.
Otherwise, controlled substance keys shall be exchanged at shift
change.
(4) Prior to obtaining any controlled substances, all
employees shall be given an in-service by the provider service's CSOC
on the protocols for handling/securing controlled substances based on
the CSP approved for the service by the OEMS.
(5) All ALS I and ALS I Critical Care emergency medical
provider services shall have the option to stock controlled substances.
(6) Each licensed provider service shall immediately
notify the OEMS upon identification of missing or suspected diversion
of a controlled substance.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1 et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21,
2008.
Repeal and New Rule: Filed
March 16, 2017; effective April 30, 2017. Repeal and New Rule: Filed
February 20, 2019; effective April 6, 2019. Repeal and New Rule:
Filed April 7, 2020; effective June 14, 2020. Repeal and New Rule:
Filed February 17, 2022; effective April 14, 2022.
420-2-1-.24 Patient Transfers.
(1) No person or facility of any type shall order,
arrange, or conduct a transfer of a patient in a recumbent position by
ground or air ambulance unless transport of the patient is done by an
42
emergency medical provider service licensed by the Board in an
ambulance permitted in accordance with the level of care (ALS or BLS)
the patient needs, or is likely to need, during transport. Each
ambulance transporting patients between facilities shall have, in
addition to a driver or pilot, at least one EMSP licensed at a level
which will allow the EMSP to provide the care the patient needs or is
likely to need. The provider service medical director is responsible
for assuring, in advance, that the ambulance and EMSP have the
capability to meet the patient's expected needs. The transferring
physician will ensure that the level of patient care, staffing, and
equipment during transport is appropriate to meet the current and
anticipated needs of the patient.
(2) The transferring hospital should provide a complete
medical record or patient chart to the receiving hospital. The
emergency medical provider service operator shall ensure that a
complete and accurate patient care report, as prescribed by the Board,
is submitted for each transfer.
(3) In addition to the fluids and medications which a
paramedic may administer to an emergency patient, they may administer,
perform, and maintain other types of I.V. fluids and medications during
the transfer of a stabilized patient on the signed, written order of
the transferring physician given to a paramedic in advance. The
following conditions apply:
(a) The patient shall be deemed by the transferring
physician to be appropriately stabilized to permit transport to another
healthcare facility by the mode of transport selected.
(b) The transferring physician shall have communicated to
a paramedic all necessary aspects of patient management and the
administration or maintenance of specified fluids, medications,
equipment, and procedures that would be administered or maintained
during transport.
(c) During transfers, a paramedic may be authorized to
administer or maintain infusion of the classification of fluids and
medications, perform procedures, or maintain equipment identified
herein only after successful completion of the continuing education
course of instruction approved by the State Board of Health entitled,
"Administration and Maintenance of Fluids, Medications, Procedures, and
Equipment during Inter-hospital Transfer of the Stabilized Patient,"
and have in his or her possession documented evidence issued by the
OEMS attesting to the completion of such training. In addition, the
service medical director, regional medical director, and SEMCC shall
approve, in writing, specific medications under each general
classification. This written approval shall be on file with the
transferring institution and the OEMS, and shall be renewed annually.
43
(d) The specific classifications of I.V. fluids and
medications which a paramedic is authorized to administer or maintain
are strictly limited to the following, or their generic equivalents,
for administration or maintenance only in the dosages, forms,
frequency, and amounts as ordered in writing, in advance, by the
transferring physician:
1. Vitamin, mineral, and electrolyte infusions.
2. Central nervous system and neuromuscular agents.
3. Anticonvulsants.
4. Antipsychotics, anxiolytics, antidepressants.
5. Anti-infective agents.
6. Antineoplastic agents.
7. Respiratory agents.
8. Cardiovascular agents.
9. Gastrointestinal agents.
10. Endocrine and ophthalmic agents.
11. Reproductive agents.
12. Circulatory support agents.
(e) Administration of thrombolytics by paramedics will be
administered by established Alabama EMS Patient Care Protocols.
(f) The specific invasive procedures and equipment which a
paramedic is authorized to administer or maintain during transfers are
strictly limited to the following as ordered in writing, in advance, by
the transferring physician:
1. Portable Ventilators.
2. Chest Tubes.
(g) A written order, signed by the transferring physician
containing the following elements of information, shall be completed
and delivered to the receiving hospital with the patient:
1. The patient's name and diagnosis.
2. The name and signature of the transferring physician.
44
3. The name of the transferring hospital.
4. The name of the paramedic accepting the patient for
transport.
5. The name of the receiving physician.
6. The name of the receiving hospital.
7. The date and time the patient was released by the
transferring physician.
8. The date and time the patient was accepted by the
receiving physician.
9. All fluids and medications administered or maintained
or both.
10. Specific medical orders and detailed prescriptions
clearly specifying dosages and frequency.
11. All required life support equipment the patient needs
or is likely to need.
12. Other remarks as appropriate related to patient
management.
13. Patient’s personal belongings should be signed off for
by the patient’s family when given details of the patient to the
receiving hospital. If no family is available, they should be signed
off for by the staff at the receiving hospital.
(h) All medications required by the transferring physician
to accompany the patient or medications which are already infusing
should be supplied by the transferring hospital. All medications
provided for use during the transfer together with all unused
medications, syringes, vials, or empty containers shall be accounted
for by the paramedic in the same manner in which the transferring
hospital would normally do so or require.
(i) Documentation shall account fully for all medications
administered or maintained during transfer.
(j) All medications authorized to be administered or
maintained during inter-hospital transfers shall be stored, managed,
and accounted for separately from those in the normal paramedic’s
medication container for pre-hospital emergency care.
(4) The requirements of this rule and other requirements
of these rules do not apply to vehicles operated by a hospital
exclusively for intra-hospital facility transfers. To qualify for this
45
exemption, a vehicle shall conform to all of the following
requirements:
(a) The vehicle shall be used exclusively for the
transport of patients from one facility in a licensed hospital to
another facility in the same licensed hospital. The vehicle shall not
be used to respond to emergencies, to transport emergency patients, or
to transport patients for any purpose other than intra-hospital
facility transfers.
(b) The hospital shall be licensed by the Board and
licensure records shall be on file with the Department’s Bureau of
Health Provider Standards.
(c) Each building from which patients are sent or by which
patients are received shall be operated by the licensed hospital, as
documented in the hospital's licensure records. Patients sent from a
facility operated by one licensed hospital to a facility operated by
another licensed hospital will be considered inter-facility and NOT
intra-facility transfers, regardless of whether the licensed facilities
are owned or operated by the same entity.
(d) All crew members on board the vehicle shall be
hospital employees.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: Filed September 1, 1982. Repealed and
Replaced:
Filed September 20, 1996; effective October 24, 1996.
Amended:
Filed March 20, 2001; effective April 24, 2001. Repealed
and
New
Rule: December 17, 2007; effective January 21,
2008.
Repealed and
New Rule: Filed April 20, 2011;
effective May 2
5,
2011.
Ed. Note: Rule .07 was renumbered .16 and original
Rule
420-2-1-.16 Responsibility For Patient was repealed as
per
certification filed April 20, 2011; effective May 25,
2011.
Repeal and New Rule: Filed March 16, 2017; effective April 30, 2017.
Repeal and New Rule: Filed February 20, 2019; effective April 6, 2019.
Repeal and New Rule: Filed April 7, 2020; effective June 14, 2020.
Repeal and New Rule: Filed February 17, 2022; effective April 14,
2022.
420-2-1-.25 Out-of-State Ambulance Contracts for Disaster
Assistance.
An emergency medical provider service (ground or air) shall
contact the OEMS prior to deploying or sending any Alabama permitted
ambulances to another state(s) to fulfill obligations of a state,
federal, or private contract or agreement for a disaster.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
46
History: Filed February 20, 2019; effective April 6, 2019. Repeal and
New Rule: Filed April 7, 2020; effective June 14, 2020. Repeal and
New Rule: Filed February 17, 2022; effective April 14, 2022.
420-2-1-.26 Exemptions.
(1) These rules shall not apply to the transport
ambulance services referred to in §22-18-2, Code of Ala. 1975, and
listed below, except when the services listed in (a) or (e) are
offering or proposing to offer ALS services, as defined in these
rules, to the public. All transport ambulance services offering or
proposing to offer ALS services to the public shall become licensed
as emergency medical provider service operators under these rules.
(a) Volunteer rescue squads that are members of the
Alabama Association of Rescue Squads, Inc., that are not offering
ALS services and that are not voluntarily licensed as a BLS transport
service.
(b) Ambulances operated by a federal agency of the
United States.
(c) Out of state services and Alabama licensed
ambulances (ground or air) that are rendering assistance in the case
of a major catastrophe, emergency, or natural disaster in which the
active licensed EMS personnel and emergency medical provider
services of Alabama are determined insufficient. All out of state
services and Alabama licensed services shall notify the OEMS of
their deployment to and departure from an
emergency area. The OEMS
may grant temporary approval for such
ambulances and services until
the incident can be managed by local Alabama licensed personnel and
services.
(d) Out of state ambulances that either pick up
patients in Alabama and transport to facilities outside Alabama or
pick up patients outside Alabama and deliver to facilities in
Alabama.
(e) BLS ambulances operated by a private business or
industry exclusively as a free service to employees of such
business or industry.
(f) Specialty care ambulances that are utilized for
interfacility transfers only and that are verified and approved by
the OEMS prior to operation.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: Filed September 1, 1982. Amended: Filed May
24,
1984. Emergency Rule filed August 22, 1990; September 19,
1990.
Amended: Filed September 19, 1990; November 19,
1990.
Emergency
R ule filed December 19, 1990; April 19,
1991.
Amended: Filed
47
March 20, 1992. Amended: Filed July 21,
1993;
effective August 25,
1993. Repealed and Replaced:
Filed
September 20, 1996; effective
October 24, 1996. Amended: F
iled
March 20, 2001; effective
April 24, 2001. Repealed and
New
Rule: December 17, 2007; effective
January 21, 2008.
Repealed
and New Rule: Filed April 20, 2011;
effective May 25,
2011.
Repeal and New Rule: Filed March 16, 2017;
effective April 30, 2017. Repeal and New Rule: Filed February 20,
2019; effective April 6, 2019. Repeal and New Rule: Filed April 7,
2020; effective June 14, 2020. Repeal and New Rule: Filed
February 17, 2022; effective April 14, 2022.
420-2-1-.27 Variances.
The State Health Officer may approve a variance to any provision
of these rules, except for any provision that restates a statutory
requirement or that defines any term, in accordance with Rule 420-1-2-
.09, Ala. Admin. Code.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21, 2008. Repealed and New Rule:
Filed
April 20, 2011; effective May 25,
2011.
Ed. Note: Rule 420-2-1-.17 was repealed as per
certification
Filed March 20, 2001; effective April 24, 2001. As a result
of
this, Rule 420-2-1-.28 was renumbered to 420-2-1-.27.
Rule
420-2-1-.27 was renumbered 420-2-1-.26 as per
certification
filed
December 17, 2007; effective January 21, 2008. Rule
was
.26 and
renumbered to .04 as per certification
filed
April 20, 2011;
effective May 25,
2011.
Repeal and New Rule: Filed March 16,
2017; effective April 30, 2017. Repeal and New Rule: Filed
Filed February 20, 2019; effective April 6, 2019. Repeal and New
Rule: Filed April 7, 2020; effective June 14, 2020. Repeal and New
Rule: Filed February 17, 2022; effective April 14, 2022.
420-2-1-.28 Compliance and Enforcement for Licensed Provider
Services.
(1) The OEMS shall have the right to inspect all
licensed emergency medical provider service premises, facilities,
vehicles, and aircraft at any time. A representative of the OEMS
shall properly identify himself or herself prior
to inspection.
(2) The provider service and vehicle/aircraft
inspection standards are available from the OEMS and are
posted at http://www.alabamapublichealth.gov/ems.
(3) The inspection frequency shall be determined by the
OEMS. Nothing in this rule precludes the OEMS from issuing an
48
immediate Notice of Intent to Suspend/Revoke order or issuing an
emergency order to immediately cease operation or cease using a
particular vehicle or aircraft, if necessary, in order to protect
public health.
(4) A routine inspection shall be conducted:
(a) Prior to licensure, the OEMS will inspect the proposed
emergency medical provider service’s premises, facilities, and
vehicles or aircraft to determine compliance with the requirements of
these rules.
(b) Each provider service’s premises, facilities, and
permitted vehicles or aircraft will be inspected minimally every
2 years. The OEMS may alter the frequency and the number of
vehicles inspected for providers that maintain a national
accreditation.
(c) A licensed provider service shall not operate a
vehicle or aircraft until the OEMS has inspected the vehicle and
issued a current permit decal. If an immediate inspection cannot
be performed, the OEMS may issue temporary approval to allow a
vehicle or aircraft to be placed in service if the vehicle meets
all other requirements of these rules. All pertinent information
regarding the vehicle or aircraft in question shall be documented
and provided to the OEMS prior to temporary approval.
(d) A provider service’s license may be suspended or
revoked if the provider service’s facilities do not provide
reasonably safe conditions for the provider service’s personnel.
(e) A deficiency noted during an inspection shall be
corrected and the correction reported in writing within 10 working
days of the inspection. A failure to comply may result in the
suspension or revocation of the provider service’s license.
(f) A vehicle or aircraft may be temporarily or
permanently removed from operation if it fails to meet minimum
requirements for its safe operation, if it poses a threat to the
public or staff, if it does not carry the appropriate equipment, or
if it does not have adequate staffing.
(5) A copy of the inspection report shall be furnished
to the emergency medical provider service with the OEMS retaining
possession of the original. The inspection report shall designate
the compliance status of the facility, vehicle, or aircraft.
(6) All ALS licensed emergency medical provider
services shall:
49
(a) Ensure that all fluids and medications are properly
stored, secured, and inventoried no less than every 30 days by
authorized licensed personnel.
(b) Ensure that all outdated, misbranded, adulterated,
or deteriorated fluids and medications are removed immediately by
the delegated responsible party.
(c) Inventory all fluids and medications by an approved
method which documents their sale or disposal; approved methods can
include a contract with a reverse distributor company or return to
the origin of purchase.
(d) Notify the service medical director of all
medication activities.
(e) Ensure that log records of all fluids and medication
purchases, usage, wastage, and returns are documented and filed. Log
records shall include dates, times, vehicle/aircraft number,
medication or fluid name, quantity, and personnel’s name.
(f) Document all usage of fluids and medication on
the Alabama OEMS patient care reports.
(g) Allow OEMS to examine all records pertaining to the
usage, supply, and re-supply of fluids and medications at any time.
(h) Provide notification and written documentation
within 3 working days to the OEMS regarding any perceived protocol
or rule violations.
(i) Upon determining intent to sell or cease operations,
provide written documentation to the OEMS 5 working days prior to
closing. The original copy of the provider service license and ALS
authorization shall also be returned to the OEMS within 5 working
days of closing.
(7) Personnel found to be working with an expired
license are in violation of these rules and the OEMS may report
those individuals and the service to third-party reimbursement
agencies and the local District Attorney, when applicable.
(8) All personnel are required to maintain confidentiality
of all patient records and information.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed April 20, 2011;
effective
May 25,
2011.
Repeal and New Rule: Filed March 16, 2017; effective April 30, 2017.
Repeal and New Rule: Filed February 20, 2019; effective April 6,
2019. Repeal and New Rule: Filed April 7, 2020; effective
50
June 14, 2020. Repeal and New Rule: Filed February 17, 2022;
effective April 14, 2022.
420-2-1-.29 Standards of Conduct.
(1) A licensed EMSP shall perform his or her job duties
and responsibilities in a manner that reflects the highest ethical and
professional standards of conduct. Actions that are in violation of
the standard of conduct will be considered misconduct and are subject
to immediate disciplinary action, up to and including license
revocation.
(2) Misconduct is defined as:
(a) Making a false, fraudulent, or forged statement or
document, including but not limited to, a report of continuing
education requirements, a run report, a patient care record, EMSP
student record, clinical rotation record, intent to train form, self-
study document, fluid and drug application, physician medication order
form, or any other document that is material to the duties and
qualifications of the EMSP or those of a student in an EMSP training
program and which is fraudulent or knowingly false in any respect; or,
performing any dishonest act in connection with any official documents
required by the Board or an emergency medical services education
program.
(b) Being convicted of a felony or a crime involving moral
turpitude.
(c) Being currently charged with any crime that may
jeopardize public safety.
(d) Disregarding an appropriate order by a physician
concerning emergency treatment or transportation without
justification.
(e) While on duty at the scene of an accident or illness,
refusing to administer emergency care when appropriate.
(f) After initiating care of a sick or injured patient,
discontinuing care or abandoning the patient without the patient's
consent or without transferring patient care to an appropriate medical
personnel.
(g) By act or omission and without mitigating
circumstance, contributing to or furthering the injury or illness of a
patient under his or her care.
(h) Being careless, reckless, or irresponsible in the
operation of an emergency vehicle.
51
(i) Exceeding his or her scope of practice.
(j) Providing care to a patient under his or her care
which falls short of the standard of care which ordinarily would be
expected to be provided by similarly situated EMSP, thereby
jeopardizing the life, health, or safety of a patient.
(k) Observing substandard care by another EMSP without
documenting the event and notifying the appropriate authority.
(l) Providing services while his or her license is
suspended, revoked, or lapsed for failure to renew.
(m) Failing to complete remedial training or other courses
of action as directed by the Board as a result of an investigation.
(n) Having been charged with the physical or sexual abuse
of an individual.
(o) Being convicted of committing fraud in the performance
of his or her duties.
(p) Not cooperating with, or providing false information
to the Board and/or its representatives during the course of any
investigation or inspection.
(q) Providing services while under the influence of
alcohol or drugs.
(r) Taking action that would jeopardize the health and
safety of a patient including, but not limited to, the abandonment or
mistreatment of a patient.
(s) Violating the confidentiality of any patient records
or information.
(t) Performing any act requiring licensure or
certification under state EMS statutes or these rules without
possession of the requisite licensure or certification.
(u) Violating the provisions of Chapter 22-18 of the Code
of Alabama, 1975, or the rules of the Board.
(v) Disregarding a duty to act.
(w) Executing a dereliction of duty.
(x) Posing a danger to public health or safety.
52
(y) Diversion of, or tampering with, a medication or
controlled substance with or without a criminal charge for such
actions.
(z) The use of any tobacco products, including
cigarettes, e-cigarettes, vapes of any type, and smokeless tobacco,
or under the influence of alcohol or drugs while operating or riding
in an ambulance or while providing patient care.
(3) Any adverse action related to licensed personnel shall
be reported by the OEMS, as required, to the National Practitioner Data
Bank, in accordance with federal law, as well as the National Registry
of Emergency Medical Technicians.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: Filed February 20, 2019; effective April 6, 2019.
Repeal and New Rule: Filed April 7, 2020; effective June 14, 2020.
Repeal and New Rule: Filed February 17, 2022; effective April 14,
2022.
420-2-1-.30 Impaired EMSP.
(1) When the OEMS receives evidence of the possible
impairment of a licensed EMSP, it will initiate an investigation. The
OEMS will consider the facts and circumstances of each case, and may
recommend disciplinary action, or may offer entry into a drug, alcohol,
or psychiatric rehabilitation program approved by the OEMS.
(2) An individual may be offered entry into a drug,
alcohol, or psychiatric rehabilitation program if they meet the
following criteria:
(a) The individual has not been found guilty of any crime
related to drug or alcohol abuse associated with the incident. Guilty
means the individual was found guilty following a trial, or entered a
plea of guilty or no contest accompanied by a court’s finding of guilt.
(b) The appropriate medical authority has determined that
the individual does not present a danger to him or herself, to those
around them, or to patients.
(c) The individual has not previously been entered into an
approved drug, alcohol, or psychiatric rehabilitation program by the
OEMS.
(d) The individual consents to suspend his or her license
during the evaluation process and subsequent treatment, if recommended.
(3) An individual who meets the above criteria may regain
his or her license if they successfully complete the rehabilitation
program, and agree to the following conditions:
53
(a) Waiver of confidentiality so that the OEMS may access
the individual’s patient records in the inpatient and/or aftercare
program.
(b) Submission of all follow-up treatment reports and drug
screening tests to the OEMS for review (submission shall be made by the
entity conducting the treatment or drug screening).
(c) Participation in random drug or alcohol screenings, or
psychiatric examinations as required by the OEMS or by the entity
providing outpatient care.
(4) An individual is in violation of this rule, and
subject to immediate disciplinary action if any of the following occur:
(a) The individual does not comply with the OEMS and the
approved program’s recommendations.
(b) The individual does not complete inpatient and/or
outpatient care.
(c) The individual tests positive for drugs or alcohol
prior to completing the treatment program.
(d) The individual tests positive on a random drug screen.
(e) The individual is deemed to present a danger to him or
herself, to those around them, or to patients.
(5) An emergency medical provider service shall
immediately report to the OEMS, in writing, any EMSP who refuses, or
tests positive on, any drug screening, including pre-employment
screenings.
(6) Emergency medical provider services shall provide
immediate notification to the OEMS and written documentation about any
EMSP that is or appears to be impaired. Written documentation shall
include the employee’s name, level of licensure, license number,
relevant facts, and drug screening and blood alcohol content results.
(7) An individual who meets the definition of an impaired
EMSP or self admits to a drug, alcohol, or psychiatric facility shall
provide immediate notification of his or her condition to the OEMS.
(8) An individual who is in violation of this rule and
consents to surrender his or her license to avoid adverse licensure
action may reapply for licensure no less than 2 years after the
surrender was approved and accepted by the Board and only after
completing an evaluation and subsequent treatment, if recommended, at
an approved drug, alcohol, or psychiatric rehabilitation program. The
54
individual must show sobriety during the program, and a letter of
advocacy for relicensure must be sent from the facility to the OEMS.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed April 20, 2011;
effective
May 25,
2011.
Repeal and New Rule: Filed March 16, 2017; effective April 30, 2017.
Repeal and New Rule: Filed February 20, 2019; effective April 6, 2019
Repeal and New Rule: Filed April 7, 2020; effective June 14, 2020.
Repeal and New Rule: Filed February 17, 2022; effective April 14,
2022.
420-2-1-.31 Complaint/Disciplinary Procedures.
(1) The Board may investigate any complaint at the
discretion of the State EMS Director, State EMS Medical Director, or
their authorized representative.
(2) If the Board receives a verbal complaint of any matter
relating to the regulation of provider services, EMSP, EMS education
programs, or students, the complainant is deemed to have filed an
informal complaint. Should the Board determine that a complaint is
valid, the complaint then becomes formal and may warrant action
pursuant to this chapter. The provider services, EMSP, EMS education
programs, or students shall comply with any request for records from
the OEMS within 3 business days from the date of request.
(3) If the Board receives a written and signed statement
of any matter relating to the regulation of provider services, EMSP,
EMS education programs, or students, the complainant is deemed to have
filed a formal complaint. Within 10 days of receipt of the complaint, a
designated representative of the Board shall inform the provider
services, EMSP, EMS education programs, or students that a formal
complaint has been filed. The personnel or organization shall be
informed of the nature of the allegations made and the potential rule
violation. The provider services, EMSP, EMS education programs, or
students shall comply with any request for records from the OEMS within
3 business days from the date of request.
(4) After the Board investigates a formal complaint, the
Board shall render a written decision to all parties involved of its
findings.
(5) The Board may issue a request for an interview with
the provider services, EMSP, EMS education programs, or students if
evidence indicates that grounds for action exist. The request shall
state the date and time for the interview.
(6) If the Board determines that evidence warrants action
or if the provider services, EMSP, EMS education programs, or students
refuse to attend the interview, the OEMS Director shall institute
55
formal proceedings and hold a hearing pursuant to §22-18-6, Code of
Ala. 1975.
(7) If the Board determines disciplinary action is
appropriate, the Board may take action up to and including license
revocation.
(8) Complaints against EMSP, applicants, or students, may
be submitted if they:
(a) Do not meet or no longer meet the qualifications for
licensure.
(b) Are guilty of misconduct as defined by these rules or
have otherwise committed a serious and material violation of these
rules.
(9) Hearings to suspend or revoke a license shall be
governed by the Board’s Rules for Hearing of Contested Cases, Chapter
420-1-3, Ala. Admin. Code.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed September 20, 1996;
effective
October 24, 1996. Amended: Filed March 20, 2001;
effective
April 24, 2001. Repealed and New Rule: December 17,
2007;
effective January 21, 2008. Repealed and New Rule:
Filed
April 20, 2011; effective May 25,
2011.
Ed. Note: Rule 420-2-1-.17 was repealed as per certification Filed
March 20, 2001; effective April 24, 2001. As a result of this, Rule
420-2-1-.27 was renumbered to 420-2-1-.26. Rule 420-2-1-.26 was
renumbered to 420-2-1-.25 as per certification filed December 17, 2007;
effective January 21, 2008. Rule
.25
was renumbered to .30 as per
certification filed April 20,
2011;
effective May 25,
2011.
Repeal and New Rule: Filed March 16, 2017; effective April 30, 2017.
Repeal and New Rule: Filed February 20, 2019; effective April 6,
2019. Repeal and New Rule: Filed April 7, 2020; effective June 14,
2020. Repeal and New Rule: Filed February 17, 2022; effective
April 14, 2022.
420-2-1-.32 Education Standards and Procedures.
(1) Education Program Specifics
(a) Any institution desiring approval as an education
program for Level 3 or Level 2 shall be an institution approved by
the Alabama Community College System (ACCS), or the ADPH OEMS. Any
institution desiring approval as an education program for Level 1
shall be an institution approved by the OEMS and shall be accredited
by the CoAEMSP.
(b) Any institution desiring approval as an EMS education
56
program must reserve one seat on its Advisory Board for the Director
of the OEMS or his designee. The OEMS shall be notified within a
reasonable timeframe of any Advisory Board meetings.
(c) Education programs shall be committed to equal
opportunity in employment and education and shall not discriminate on
the basis of sex, race, age, religion, or against qualified disabled
persons.
(d) Each education program shall provide all preceptors
and instructors with procedures to properly document clinical and
field evaluations and proper criteria for skills verification.
Preceptors and instructors shall be required to acknowledge receipt of
this material in writing, with the document being filed in the
education program’s permanent records.
(e) Each education program shall provide all students with
EMS education, information on rules, and policies on testing and
licensure requirements by the OEMS. Students shall be required to
acknowledge receipt of this material in writing, with the document
being filed in the student’s permanent records at the training
facility.
(f) Each education program shall report any evidence of
academic dishonesty, dismissal, or termination from an EMS education
program due to evidence of academic dishonesty or positive drug screen
results for any currently licensed EMSP in the program. Action may
also be taken against an associate or employee of an EMS education
program who knowingly neglects to notify the OEMS of such. Evidence of
academic dishonesty, dismissal, or termination from a program may
result in disciplinary action or license revocation by the OEMS. This
includes any EMSP, student, or associate or employee of an EMS
education program who knowingly participates in academic dishonesty.
(g) Applications for education program approval are
available on the OEMS website http://www.alabamapublichealth.gov/ems,
or upon request from the OEMS, and must be returned to the agency
after completion by the applicant. Upon review and approval of the
application by the OEMS it will, where appropriate, be forwarded to
the ACCS or the ACHE for any required co-approval. All EMS education
programs will be reaccredited on a 5-year cycle. If a program is
currently on a cycle with CoAEMSP, the Level 2 and Level 3 programs
will coincide with that assessment. Otherwise, it will begin with
either the year of their initial application or the year in which
their next Level 2 or Level 3 class begins.
(h) All EMS education programs shall utilize a program
medical director who is licensed by the Medical Licensure Commission
of Alabama, a local member of the medical community, and experienced
and knowledgeable of emergency care of the acutely ill and traumatized
patients. The program medical director must review and approve the
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educational content of the program curriculum and the quality of
medical instruction and supervision delivered by the faculty. The
medical director must routinely review students’ performance to assure
adequate progress toward completion of the program. The medical
director must attest that each graduating student has achieved the
desired level of competence prior to graduation.
(i) Any education program not accredited by OEMS must
notify the OEMS at least 90 days prior to the beginning of any initial
EMSP licensure level program.
(j) An approved Letter of Review from CoAEMSP must be
obtained by the sponsoring institution and must be submitted to the
OEMS at least 90 days prior to the beginning of an initial Level 1
course.
(2) Program Accreditation
(a) Every EMS education program is required to complete an
OEMS Credentialing Application contained in the OEMS Credentialing
Manual.
(b) Accreditation is a required process for the offering
of each level of EMS education.
1. The Level 2 and Level 3 accreditation is gained
through completion of a credentialing application. The application
must be submitted to and approved by the OEMS. Submission of the
application serves as an agreement to adhere to all procedures
outlined in these rules and the requirements within the OEMS
Credentialing Manual.
2. Level 1 accreditation is gained through completion and
submission of the education program application and attainment and
maintenance of accreditation through CoAEMSP. All CoAEMSP site visits
shall be attended by an OEMS staff representative. Pending site
visits shall be communicated to the OEMS by the EMSP program.
(c) No fees are required for the application or the
accreditation process.
(d) Each approved EMS program shall receive a letter and
certificate of accreditation from the OEMS. The certificate must be
displayed in a public area of the approved program.
(e) Accreditation for Level 2 and Level 3 will be granted
through the OEMS, through a credentialing process. This process will
include a review of the completed application, a site visit, and
compliance with other pertinent aspects of these rules and the OEMS
Credentialing Manual.
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(f) Level 1 accreditation will be granted by the CoAEMSP
and will be concurrently approved by the OEMS, upon submission of a
complete credentialing application and documented proof of a current
accreditation through the CoAEMSP prior to initiating a second class.
In the event that this accreditation is withdrawn or is not renewed
for any reason, the program must seek accreditation from the OEMS in
order to gain a Level 2 or Level 3 status.
(g) Accreditation status must be maintained by a training
program for its students to be eligible for the OEMS approved
licensure examination.
(h) Any student graduating from an unapproved and
unrecognized EMSP course will not be eligible for the OEMS’ licensure
examination.
(i) Accreditation may be granted for a maximum of 5 years.
The accredited program must apply for re-accreditation at least 12
months prior to expiration of accreditation.
(j) An accredited program may lose its accreditation if the
program remains inactive for a period of time exceeding 2 years. Such
a loss of accreditation would not prevent the program from making a
new application for accreditation.
(k) Education programs seeking accreditation from the OEMS
shall be responsible for all expenses incurred by site visit team
members. This includes, but is not limited to, transportation,
hotels, and meals.
(3) Course Offerings
(a) Institutions gaining accreditation may offer as many
concurrent on-campus programs as needed, within their level of
accreditation.
(b) Institutions may submit in writing a request to hold a
satellite course for Levels 1 and 2 EMS education. Dual enrollment
and Level 3 courses must be submitted to the OEMS as a notice in
writing. Any satellite EMS course must meet all of the requirements
of an on campus course. If the course is not within a reasonable
distance to be served by the host program, it must meet the
appropriate essential elements of an education program, including
having the required service agreements, medical director, qualified
instructors, equipment, internship affiliations, facilities, and any
other items necessary to offer an EMS course. All satellite courses
shall be reported to the OEMS prior to the beginning of the first
class session.
(c) All Level 1 satellite courses must meet the
requirements and have prior approval from the CoAEMSP.
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(4) Curriculum
(a) Each educational program shall use the curriculum
established by the National Emergency Medical Services Education
Standards and shall conform to other stipulations as set forth in
these rules.
(b) Each educational program shall add to its curriculum
any new drugs or procedures approved by the State Board of Health,
after notice is given by the OEMS to do so.
(c) Each education program is subject to announced or
unannounced visits by personnel of the OEMS to check adherence to
lesson plans, self-study documentation, and training objectives. If
the educational program is found to be out of compliance, it may be
placed on probationary accreditation status for a period of time, or
the OEMS may withdraw the education program’s accreditation if the
program is found to not be in compliance with these rules, or if
program does not maintain a 70 percent certification examination pass
rate over a 3-year rotating basis.
(d) Each education program shall submit all documentation
pertaining to course offerings and instructors as required by the
OEMS. Documentation shall include, but is not limited to self-study
documents, instructor data sheets, intent to train forms, and any
administrative updates or changes made by the education program.
(e) All education programs must ensure each graduate
completes the OEMS and Alabama EMS Systems presentation.
(5) Didactic/Internship Credit Hours
(a) Time frames designated herein are recognized as
minimum required hours. This in no way suggests that these times may
not be exceeded by an accredited education program. As new
requirements in EMS education are adopted, minimum required hours may
increase to ensure that students receive adequate instructional time.
All levels of EMS education must include current national curriculum,
and current Alabama EMS Protocol instruction for the respective level
of education.
(b) The minimum time frames for Level 3 course of
instruction are 140 hours for didactic and laboratory and 48 hours
for internship. Internship hours may be divided between emergency
room and prehospital experience on an ambulance.
(c) The minimum time frames for Level 2 course of
instruction are 180 hours for didactic and laboratory and 96 hours
for internship. Internship hours may be divided between hospital and
prehospital experience on an ambulance.
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(d) The minimum time frames for Level 1 course of
instruction are 300 hours for didactic and laboratory and 440 hours
for internship. Internship hours may be divided between hospital and
prehospital experience on an ambulance.
(6) Skills Requirements
(a) The instruments used to measure validity and
reliability of the internship experience should be standardized
documents reflecting the practical skills of the curriculum and be
approved by the accrediting agencies.
(b) The Level 3 student shall successfully perform patient
assessments and management.
(c) The Level 2 student shall successfully perform, at a
minimum:
1. Two documented BIAD insertions.
2. Ten successful IV procedures.
3. Ten blood procedures (drawing for lab).
4. Twenty BLS assessments.
5. Twenty ALS assessments.
6. Ten pediatric assessments.
(d) The Level 1 student shall successfully perform all
requirements for the CoAEMSP.
(7) Internship Requirements
(a) Licensed emergency medical provider services may enter
into an agreement with EMS educational institutions to provide field
internships for EMSP students.
(b) Licensed provider services shall ensure that all
designated preceptors are informed of educational requirements for the
EMSP student.
(c) Field internship experiences shall include supervised
instruction and practice of emergency medical skills and shall be
evaluated by the designated preceptors.
(d) Licensed provider services are responsible to ensure
that no EMSP student exceeds his or her current level of scope or
privilege unless supervised by a designated preceptor in a designated
field internship.
(8) EMS Student Requirements and Standards
(a) The Level 3 student shall:
61
1. Meet all institutional admission requirements.
2. Maintain a current Health Care Provider CPR
certification.
3. Meet the “Essential Functions” as set forth by the
OEMS and can be found on the Essential Job Function Analysis Form
located at https://www.alabamapublichealth.gov/ems/forms.html.
or attach documentation to the program application from those
essential functions of which the student is not in compliance (for
review by the institution’s ADA Coordinator).
4. Provide an acceptable physical examination by a
licensed physician, nurse practitioner, or physician assistant to
include written documentation (on a form provided by the program).
5. Possess verification on file with the educational
institution of the following:
(i) Professional liability insurance.
(ii) Current health, hospitalization, accident insurance,
or waiver of liability.
(b) The Level 2 student shall:
1. Complete all entry requirements for Level 3 students.
2. Possess a high school diploma or General Equivalency
Diploma (GED), or dual enrollment.
3. Possess a current Alabama EMT license, or have
successfully completed an EMT course approved by the State Board of
Health within the past 12 months (student must possess an Alabama EMT
license prior to entering the internship portion or exit the program
until the license is obtained).
(c) The Level 1 student shall:
1. Complete all entry requirements for Level 3 students.
2. Possess a current Alabama EMT or AEMT license, or have
successfully completed a Level 2 or Level 3 course approved by the
State Board of Health within the last 12 months (student must possess
an Alabama EMT or AEMT license prior to entering the internship
portion or exit the program).
(d) The Registered Nurse (RN) shall:
1. Complete all entry requirements for Level 3 students.
62
2. Possess an Associate’s Degree or higher in nursing
from a regionally accredited institution.
3. Possess a license as an unencumbered RN license in
Alabama or an RN license accepted through the Nursing Compact.
4. Possess a current NREMT or NRAEMT certification prior
to entering the internship portion or exit the program.
5. Successfully complete all Level 3 course work from an
accredited institution.
(e) All education programs must inform students of the
specific requirements for progression through each level of EMS
education. No student will be allowed to sit for the state approved
certification exam if the student attempts to circumvent the
matriculation requirements set by the education program in which they
are enrolled.
(f) All EMS students must maintain current professional
liability insurance while enrolled in an education program.
(g) All EMS students must maintain current health and
hospitalization insurance or have a waiver on file while enrolled in a
program.
(h) All EMS students must comply with all institution and
program rules, policies, and procedures.
(9) Instructor Requirements
(a) EMR Instructor
1. Course Instructor
(i) Current Alabama license as an EMT or above, or
currently licensed in Alabama as a physician.
(ii) High school diploma or GED.
(iii) Certification from an EMS instructor course approved
by the OEMS, i.e. Level 1 National Association of Emergency Medical
Services Educators (NAEMSE), Department of Transportation (DOT)
Instructor Course, Alabama Fire College Instructor Course, Department
of Defense (DoD) Instructor Course, AHA Core Instructor Course.
(iv) Minimum of 3 years of prehospital field
experience.
(v) Current CPR certification.
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(b) Level 1, 2, and 3 Instructor Positions
1. Internship Preceptor
(i) High school diploma or GED.
(ii) Current Alabama license at the level being supervised,
a current Alabama license as a Registered Nurse (RN), or a current
Alabama license as a physician.
(iii) Be familiar with prehospital patient care.
(iv) Supervise students in the internship and field setting
and accurately document their performance.
2. Level 2 and 3 Course Instructor
(i) High school diploma or GED.
(ii) Current Alabama license as the level being taught or
above, or currently licensed in Alabama as a physician.
(iii) Certification from an EMS instructor course approved
by the OEMS, i.e. Level 1 NAEMSE, DOT Instructor Course, Alabama Fire
College Instructor Course, DoD Instructor Course, AHA Core Instructor
Course.
(iv) Minimum of 3 years of prehospital field experience.
(v) Current CPR Instructor certification.
(vi) Supervised probationary teaching experience for one
entire course at the instruction level being taught.
(vii) Approved by the Program Director and Medical
Director.
3. Level 1 Course Instructor
(i) Must meet all requirements for Level 2 and 3 Course
Instructor.
(ii) Instructor certifications appropriate for the
curriculum being taught, e.g. ACLS instructor certification.
(iii) Hold an Associate’s Degree or higher.
4. Field Preceptor
(i) High school diploma or GED.
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(ii) Current Alabama license at or above the level being
supervised.
(iii) Minimum of 2 years of experience.
(iv) Be familiar with prehospital patient care.
(v) Supervise students in the internship and field setting
and accurately document their performance.
5. Guest Lecturer
(i) High school diploma or GED.
(ii) Expert knowledge in the subject matter.
(iii) Program Director and Medical Director approval for the
topic to be presented.
6. Medical Director
(i) Licensed physician by the Medical Licensure Commission
of Alabama.
(ii) Experience and knowledge of emergency care of acutely
ill and traumatized patients.
(iii) Review and approve adherence to the program curriculum
and quality of medical instruction and supervision delivered by the
faculty.
(iv) Routinely review student performance to assure
adequate progress toward completion of the program.
(v) Knowledgeable in EMS education programs and
legislative issues regarding the EMS programs and prehospital
providers.
7. Practical Skills Preceptor
(i) High school diploma or GED.
(ii) Minimum of 3 years of prehospital care experience
as a licensed practitioner at the level being instructed.
(iii) Current CPR certification.
(iv) Program Director and Medical Director approval to
assist with practical skills instruction.
65
8. Program Director, Regional Director, or Designee
(i) Meet all Course Instructor requirements.
(ii) Hold a Bachelor’s Degree or higher.
(iii) Assume ultimate responsibility for the administration
of all phases of the program.
(iv) Collaborate with the Medical Director.
(v) Full time employee with the institution’s EMS program
or Regional EMS Office.
(10) EMS Essential Functions
(a) To ensure that properly qualified individuals enter
and participate in EMS education programs, the OEMS requires that each
educational program verify that each student meets the minimum
essential functions requirements outlined by the “Functional Job
Analysis” available at https://one.nhtsa.gov/people/injury/ems/EMT-
P/disk_1%5B1%5D/Intro-C.pdf in the National Highway Traffic and Safety
Administration, National Standard Curriculum.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: Filed February 20, 2019; effective April 6, 2019. Repeal and
New Rule: Filed April 7, 2020; effective June 14, 2020. Repeal and
New Rule: Filed February 17, 2022; effective April 14, 2022.
420-2-1-.33 Continuing Education.
(1) All continuing education submitted in support of
license renewal shall meet the requirements set forth by the OEMS and
the NREMT.
(2) The Alabama EMS Patient Care Protocols include all
adult and pediatric protocols and are available from the OEMS or can be
found posted at http://www.alabamapublichealth.gov/ems. It is the
emergency medical provider service’s responsibility to ensure that the
most current protocols are being utilized.
(3) All licensed provider services shall ensure that
protocol training is provided for all EMSP employed by their service.
Evaluation and training records shall be kept on file and shall be
available for review by the OEMS.
(4) The provider service’s medical director and management
staff are responsible for appointing an individual to be the provider
service’s protocol trainer and continuing education coordinator.
66
(5) All continuing education must be state approved,
Commission on Accreditation for Prehospital Continuing Education
(CAPCE) approved, or an approved nationally recognized course.
Continuing education coordinators or instructors shall provide all
students with a certificate of course completion that documents the
dates of the course, the instructor’s signature, the title of the
course, state approval number, the student’s full name, and EMSP
license number (if applicable).
(6) Falsification of continuing education documents is a
violation of state law. Any provider service, continuing education
coordinator, or EMSP found guilty of such activity will be subject to
disciplinary action.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: New Rule: Filed April 20, 2011;
effective
May 25,
2011.
Repeal and New Rule: Filed March 16, 2017; effective April 30, 2017.
Repeal and New Rule: Filed February 20, 2019; effective April 6, 2019.
Repeal and New Rule: Filed April 7, 2020; effective June 14, 2020.
Repeal and New Rule: Filed February 17, 2022; effective April 14,
2022.
420-2-1-.34 Tactical Paramedic.
(1) To obtain a Tactical endorsement, a paramedic must:
(a) Present a Board approved application and proof of the
IBSC Tactical Paramedic certification.
(b) Have 3 years licensed at the paramedic level.
(2) The Tactical endorsement shall be valid so long as the
paramedic maintains:
(a) Current licensure as a paramedic by the Board.
(b) Current Tactical Paramedic certification through the
IBSC.
(3) A paramedic with a Tactical endorsement shall be
authorized to perform the skills and procedures included in the
Tactical Paramedic Section of the Alabama EMS Patient Care Protocols
in addition to the standard Alabama EMS Patient Care Protocols.
(4) A licensed paramedic with a Tactical endorsement shall
be responsible for providing the OEMS with copies of his or her
current IBSC certification.
(5) A licensed paramedic with a Tactical endorsement shall
be responsible for obtaining Medical Direction in order to operate
under his or her license level.
67
(6) Provider services must keep all training documents on
file for auditing purposes and make available to the OEMS upon request.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: Repeal and New Rule: Filed April 7, 2020; effective June 14,
2020. Repeal and New Rule: Filed February 17, 2022; effective
April 14, 2022.
420-2-1-.35 Community Paramedicine.
(1) To obtain a Community Paramedic license, an actively
licensed paramedic must:
(a) Present a Board approved application and proof of the
IBSC Community Paramedic certification.
(b) Be licensed and have 2 years of experience working at
the paramedic level.
(c) Successfully complete a community paramedic training
program from an accredited college or university approved by the
board.
(2) The Community Paramedic license shall be valid so long
as the paramedic maintains:
(a) Current licensure as a paramedic by the Board.
(b) Current Community Paramedic certification through the
IBSC.
(3) A Community Paramedic shall be authorized to perform
the skills and procedures included in the Alabama EMS Patient Care
Protocols in addition to the orders received by the treating or
attending physician, within the scope of practice of a Community
Paramedic.
(4) A licensed Community Paramedic shall be responsible
for providing the OEMS with copies of his or her current IBSC
certification.
(5) Provider services must keep all training documents on
file for auditing purposes and make available to the OEMS upon request.
Authors: William Crawford, M.D., and Jamie Gray
Statutory Authority: Code of Ala. 1975, §22-18-1, et
seq.
History: Repeal and New Rule: Filed February 17, 2022; effective
April 14, 2022.
