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DELAWARE STATE FIRE PREVENTION REGULATIONS Part

VIEWS: 4 PAGES: 20

									                          DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                     Part X
                                           Ambulance Service Regulations

I.   PURPOSE                                                 telemetered electrocardiography, administration of
                                                             anti arrhythmic agents, intravenous therapy,
The purpose of this regulation is to ensure a                administration of specific medications, drugs and
consistent and coordinated high quality level of             solutions, use of adjunctive medical devices, trauma
ambulance service throughout the state, focusing on          care and other authorized techniques and procedures.
timeliness, quality of care and coordination of efforts.
                                                             ADVERTISING – Information communicated to the
II. APPLICATION                                              public, or to an individual concerned by any oral,
                                                             written, or graphic means including, but not limited
This regulation shall apply to any person, firm,             to, handbills, newspapers, television, billboards,
corporation or association either as owner, agent or         radio, and telephone directories.
otherwise providing either pre-hospital or inter
hospital ambulance service meeting the definitions of        AMBULANCE – Any publicly or privately owned
either “BLS Ambulance Service” or “Non-                      vehicle, as certified by the Delaware State Fire
Emergency Ambulance Service” within the State of             Prevention Commission, that is specifically designed,
Delaware. The following are exempted from this               constructed or modified and equipped, and intended
regulation:                                                  to be used for and is maintained or operated for the
                                                             transportation upon the streets and highways of this
a.    Privately owned vehicles not ordinarily used in        state for persons who are sick, injured, wounded or
      the business of transporting persons who are           otherwise incapacitated or helpless.
      sick, injured, wounded or otherwise
      incapacitated or helpless.                             AMBULANCE ATTENDANT – A person trained
b.    A vehicle rendering service as an ambulance            in emergency medical care procedures and currently
      in case of a major catastrophe or emergency            certified by the Delaware State Fire Prevention
      when the ambulances with permits and based             Commission as an EMT-B in accordance with
      in the locality of the catastrophe or emergency        standards prescribed by the Delaware State Fire
      are insufficient to render the services required.      Prevention Commission.         Ambulance Attendant
c.    Ambulances based outside the State rendering           remains in this document for the purpose of clarity
      service in case of a major catastrophe or              and is to be construed interchangeably with EMT-B.
      emergency when the ambulances with permits
      and based in the locality of the catastrophe or        AMBULANCE SERVICE DISTRICT – A
      emergency are insufficient to render the               geographical area with boundaries which are
      services required.                                     typically (but not always) aligned to fire service
d.    Ambulances owned and operated by an agency             districts within the state as identified and certified by
      of the United States Government.                       the Delaware State Fire Prevention Commission.
e.    Ambulances based outside the State engaged
      strictly in interstate transportation.                 BLS RUN REPORT – Standardized Patient Care
f.    A vehicle which is designed or modified and            Report provided by the State EMS office, paper or
      equipped for rescue operations to release              computerized.
      persons from entrapment and which is not
      routinely used for emergency medical care or           BASIC LIFE SUPPORT (BLS) – The level of
      transport of patients.                                 capability which provides EMT-B/Ambulance
                                                             Attendant emergency patient care designed to
III. DEFINITIONS                                             optimize the patient’s chances of surviving an
                                                             emergency situation.
For the purpose of this policy the following
definitions are used:                                        BLS AMBULANCE SERVICE – Ambulance
                                                             service which provides BLS level intervention both
ADVANCED LIFE SUPPORT (ALS) – The                            through the level of personnel and training provided.
advanced level of pre-hospital and inter hospital
emergency care that includes basic life support              BLS AMBULANCE SERVICE CONTRACT – A
functions including cardiopulmonary resuscitation,           written contract between either a Primary or
plus cardiac monitoring, cardiac defibrillation,             Secondary Ambulance Service Provider and an



42                                                  Part X                                  Date: 02/11/08
                         DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                   Part X
                                         Ambulance Service Regulations

individual, organization, company, site location or          2.     Systematized pre-arrival instruction; and
complex or other entity for BLS ambulance service.           3.     Protocols matching the dispatcher’s evaluation
                                                                    of injury or illness severity with vehicle
STATE BOARD OF MEDICAL PRACTICE                                     response mode and configuration.
(BOARD) – The Board of Medical Practice is
charged with protecting the consumers of the                 EMERGENCY MEDICAL SERVICES (EMS)
Delaware healthcare system through the proper                PROVIDER – Individual providers certified by the
licensing and regulation of physicians and other             Delaware State Fire Prevention Commission to
health care professionals.                                   perform pre hospital care. For the purposes of this
                                                             regulation   this    includes   EMT-B/Ambulance
CARDIOPULMONARY                 RESUSCITATION                Attendant and First Responders.
(CPR) – A combination of chest compressions and
rescue breathing used during cardiac and respiratory         EMERGENCY MEDICAL TECHNICIAN –
arrest to keep oxygenated blood flowing to the brain.        BASIC (EMT-B) – The individual as defined in
(AHA Manual)                                                 Title 16 of Delaware Code who provides patient care
                                                             on an ambulance and has completed the National
CERTIFICATION – An initial authorization by the              Department of Transportation curriculum and
Delaware State Fire Prevention Commission to                 initially certified as a National Registered and
practice the skills of an EMT-B/Ambulance                    Delaware Emergency Medical Technician-Basic and
Attendant or First Responder specifying that the             upon re-certification chooses to meet the State of
individual has successfully completed and passed the         Delaware requirements.
approved curriculum and evaluation process.
                                                             EMERGENCY – The BLS and ALS response to the
DELAWARE STATE FIRE PREVENTION                               needs of an individual for immediate medical care in
COMMISSION (DSFPC) – The State Governing                     order to prevent loss of life or aggravation or
Body mandated in Title 16, Delaware Code whom                physiological of psychological illness or injury.
Regulates the Basic Life Support System in
Delaware.                                                    FIRST RESPONDER – An individual who has to
                                                             take the First Responder Course that meets the DOT
DELAWARE REFRESHER COURSE – A course                         curriculum.
of instruction for re-certification required by the
Delaware State Fire Prevention Commission for                CENTER        FOR        MEDICARE/MEDICAID
EMT-B/Ambulance Attendants and First Responders              SERVICES (CMS) – The Federal Agency which
that meet the guidelines of the DOT Curriculum.              oversee Medicare Billing and Ambulance Standard.

DELAWARE STATE FIRE SCHOOL (DSFS) –                          HIPAA – Health Insurance               Portability   and
An agency of the Delaware State Fire Prevention              Accountability Act of 1996.
Commission which is designated as its duly
authorized representative to administer the provisions       HOSPITAL – An institution having an organized
of the Ambulance Service Regulations.                        medical staff which is primarily engaged in providing
                                                             to inpatients, by or under the supervision of
DELAWARE TRAINING STANDARD FOR                               physicians, diagnostic and therapeutic services or
DELAWARE                   EMT-B/AMBULANCE                   rehabilitation services for the care or rehabilitation of
ATTENDANTS & FIRST RESPONDERS – The                          injured, disabled, pregnant, diseased, sick or mentally
current of United States Department of                       ill persons. The term includes facilities for the
Transportation Curriculum.                                   diagnosis and treatment of disorders within the scope
                                                             of specific medical specialties, but not facilities
EMERGENCY MEDICAL DISPATCH SYSTEM                            caring exclusively for the mentally ill.
– Means an approved protocol system used by an
approved dispatch center to dispatch aid to medical          MEDICAL COMMAND FACILITY – The distinct
emergencies which must include:                              unit within a hospital which meets the operational,
                                                             staffing and equipment requirements established by
1.    Systematized caller interrogation questions            the Secretary, Delaware Health and Social Services


Date: 02/11/08                                      Part X                                                        43
                         DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                    Part X
                                          Ambulance Service Regulations

for providing medical control to the providers of           NON-EMERGENCY AMBULANCE SERVICE –
advanced life support services. Any hospital that           Ambulance service which provides routine transport
operates an emergency medical facility and desires to       of persons who are sick, convalescent, incapacitated
be designated as a medical command facility shall           and non-ambulatory but do not ordinarily require
maintain and staff such facility on its premises and at     emergency medical treatment while in transit.
its own expense with exception of base station
communication devices which shall be an authorized          OFFICE        OF    EMERGENCY            MEDICAL
shared expense pursuant to the provisions of Title 16,      SERVICES (OEMS) – The State Agency Mandated
Chapter 98.                                                 in Title 16 that serves as the designated
                                                            representative of the NREMT; provides medical
MEDICAL CONTROL – shall mean directions and                 advise and direction; regulates the statewide
advice normally provided from a centrally designated        automatic external defibrillator program; and
medical facility operating under medical supervision,       coordinates data collection activities for the EMS
supplying professional support through radio or             system.
telephonic communication.
                                                            PATIENT – An individual who is sick, injured,
MEDICAL CONTROL PHYSICIAN – Any                             wounded or otherwise incapacitated or helpless
physician board-certified or board-prepared in              and/or seeks immediate medical attention.
emergency medicine, or a physician certified on
advanced trauma life support (ATLS) and advanced            PRE-HOSPITAL CARE – Any emergency medical
cardiac life support (ACLS) who is credentialed by          service, including advanced life support, rendered by
the hospital within which a medical command facility        an emergency medical unit before and during
is located, and who is authorized by the medical            transportation to a hospital or other facility.
command facility to give medical commands via
radio or other telecommunication devices to a               PRIMARY AMBULANCE SERVICE – BLS
paramedic.     When a medical control physician             Ambulance Service provided by the Primary
establishes contact with a paramedic, and provides          Ambulance Service Provider certified by the
medical control instructions that exceed or otherwise       Delaware State Fire Prevention Commission within a
modify the standing orders of the statewide standard        specific ambulance service district.
treatment protocol, the paramedic shall, solely for the
purpose of compliance with the Medical Practices            PRIMARY             AMBULANCE              SERVICE
Act, be considered to be operating under the license        PROVIDER – An organization or company which
of said medical control physician.                          has been designated by the Delaware State Fire
                                                            Prevention Commission as having primary
NATIONAL             DEPARTMENT            OF               responsibility for providing BLS ambulance service
TRANSPORTATION (DOT) – EMERGENCY                            within a specific ambulance service district.
MEDICAL TECHNICIAN CURRICULUM - A
curriculum developed and adopted by the Federal             PROTOCOLS – shall mean written and uniform
Government as a recommended guide for people                treatment and care plans for emergency and critical
providing emergency care in the field.                      patient statewide that constitutes the standing order of
                                                            basic life support provider. The treatment protocols
NATIONAL REGISTRY OF EMERGENCY                              shall be prepared by the Board of Medical Practice as
MEDICAL TECHNICIANS (NREMT) - The                           defined by House Bill 332 of the 140th General
nationally recognized organization for the testing and      Assembly.
registering of persons who have completed DOT,
EMT-Basic and First Responder Courses.                      QUALITY ASSURANCE - is the retrospective
                                                            review or inspection of services or processes that is
NATIONAL        REGISTERED        EMERGENCY                 intended to identify problems.
MEDICAL TECHNICIAN – BASIC (NREMT-B)
- a person who completed the DOT curriculum and             QUALITY IMPROVEMENT - is the continuous
passed the National Registry of Emergency Medical           study and improvement of a process, system or
Technicians Examination.                                    organization




44                                                 Part X                                 Date: 02/11/08
                        DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                  Part X
                                        Ambulance Service Regulations

RECERTIFICATION TRAINING – A defined                      B.   The issuance of a permit hereunder shall not be
curriculum that once completed allows the individual           construed so as to authorize any person, firm,
to continue practicing as an EMT-B/Ambulance                   corporation or association to provide ambulance
Attendant or First Responder for a specific period of          services or to operate any ambulance without
time as determined by the Delaware State Fire                  compliance with all ordinances and regulations
Prevention Commission.                                         enacted or promulgated by any state, county or
                                                               municipal government concerning ambulances.
RESPONSE TIME – The time the ambulance is
notified by dispatch until the ambulance arrives on       C.   Prior to issuing an original or renewal permit,
scene.                                                         the Delaware State Fire Prevention Commission
                                                               shall determine that all requirements of this
RESPONSIBLE CHARGE – The individual who is                     regulation are fully met. Additionally, the
identified as having both the responsibility and               Delaware State Fire Prevention Commission
authority to ensure full and complete compliance               has the authority to ensure continued
with all requirements of this regulation.                      compliance with these regulations through the
                                                               periodic review of records and operations.
SECONDARY AMBULANCE SERVICE –
Ambulance Service provided under contract to              D.   Only companies holding a current, valid BLS
specific locations within a primary ambulance service          Ambulance Service Provider Permit shall be
district by a BLS Ambulance Service Provider other             authorized to respond and provide BLS
than the primary provider.                                     Ambulance Service within the state.

SECONDARY           AMBULANCE       SERVICE               E.   A Primary or Secondary Ambulance Service
PROVIDER – An organization or company which                    Provider may not discontinue BLS ambulance
provides supplemental BLS ambulance service                    service until a replacement provider has been
anywhere in the state and always under specific                selected and can assume service with no
contractual agreements.                                        reduction in service.

SEMI           AUTOMATIC             EXTERNAL             V. BLS AMBULANCE SERVICE DISTRICTS
DEFIBRILLATION (AED) – An external
computerized defibrillator designed for use in            A.    The Delaware State Fire Prevention
unresponsive victims with no breathing or signs of              Commission shall have the authority to
circulation (AHA Manual).                                       establish Ambulance Service Districts as per
                                                                Title 16 Delaware Code, Section 6717(a).
BASIC  LIFE   SERVICE                        (BLS)
AMBULANCE SERVICE                                         B.    The role of Primary Ambulance Service
                                                                Provider shall be assigned to those fire
IV. BLS AMBULANCE SERVICE PERMITS                               departments providing BLS Ambulance
                                                                Service at the time this regulation was initially
A.   Any person, firm, corporation or association               adopted in 1997. The ambulance service
     either as owner, agent or otherwise who furnish,           district for these providers shall correspond to
     conduct, maintain, advertise or otherwise                  their established fire districts as certified by
     engage in or profess to be engaged in the                  the Delaware State Fire Prevention
     business or service of providing BLS                       Commission.
     Ambulance Service upon the streets or
     highways of this state shall hold a valid permit     C.    In those areas in which fire departments were
     as either a Primary or Secondary Ambulance                 not providing BLS Ambulance Service at the
     Service Provider issued by the Delaware State              time this regulation was officially adopted in
     Fire Prevention Commission. Application for                1997, the organization who was providing
     this permit shall be upon forms provided by the            BLS Ambulance Service shall be designated as
     Delaware State Fire Prevention Commission.                 the Primary Ambulance Service Provider. The
                                                                ambulance service district for these providers
                                                                shall correspond to their current boundaries.


Date: 02/11/08                                   Part X                                                      45
                         DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                   Part X
                                         Ambulance Service Regulations

VI. PRIMARY AND SECONDARY BLS
   AMBULANCE SERVICE PROVIDERS                                 1.   The owner or registered agent must apply to
                                                                    the Delaware State Fire Prevention
A. BLS Ambulance Service may be provided by                         Commission upon forms provided and
   Primary Ambulance Service Providers within                       according to procedures established by the
   their ambulance service district or in the course                Delaware        State     Fire    Prevention
   of providing mutual aid within other ambulance                   Commission.
   service districts provided:                                 2.   The Primary or Secondary Ambulance
                                                                    Service Provider shall either be based in
     1.   They have a current permit                                Delaware or maintain an office in Delaware
     2.   They are assigned by the Delaware State                   with a full time individual domiciled at that
          Fire Prevention Commission as a Primary                   office who is in “Responsible Charge”.
          Ambulance Service Provider                           3.   All requirements set forth in this regulation
                                                                    must be met before issuance of permit.
B. The Delaware State Fire Prevention Commission               4.   The Primary or Secondary Ambulance
   shall be authorized to select a new Primary                      Provider must provide proof of liability
   Ambulance Service Provider at such time that:                    insurance in the amount of $1 Million
                                                                    blanket liability coverage.
     1. The current Primary Ambulance Service                  5.   The Primary or Secondary Ambulance
        Provider chooses to discontinue service                     Provider must provide proof of automobile
     2. Failure to meet one or more elements of these               liability insurance in the amount of $1
        regulations creates a threat to public safety               Million individual, $3 Million aggregate per
                                                                    occurrence.
C. Any organization desiring to assume the role of
   Primary Ambulance Service Provider will be              B. Permits shall be valid for a period of one year
   required to apply to the Delaware State Fire               from the permits effective date. Effective date
   Prevention Commission showing adequate cause               runs for a calendar year.
   in the interest of public safety to justify the
   change.                                                 C. The Delaware State Fire Prevention Commission
                                                              may issue temporary permits when determined to
D. BLS Ambulance Service may be provided by                   be in the interest of public safety per Title 16.
   Secondary Ambulance Service Providers only to
   those with whom they have a contract for such           D. On an on-going basis throughout the term of the
   service provided they:                                     permit, the owner or individual in “responsible
                                                              charge” shall be available upon reasonable
     1.   Have a current permit.                              notification for the purpose of providing
     2.   Have a written contract to provide BLS              documentation on any provisions of this
          Ambulance Service to that specific location         regulation and permitting physical inspection of
          or site.                                            all facilities and vehicles.
     3.   Provide the names, locations and conditions
          of all Secondary Ambulance Service               E. No ambulance service provider shall advertise or
          contracts to the Delaware State Fire                represent that it provides any ambulance service
          Prevention Commission within 20 days of             other than authorized to provide under this
          contract finalization.                              regulation.

VII. BLS AMBULANCE SERVICE PROVIDER                        F. All individuals or ambulance service providers
     PERMIT REQUIREMENTS                                      shall be required to participate in the Delaware
                                                              State Fire Prevention Commission approved
BLS ADMINISTRATIVE REQUIREMENTS                               ambulance data collection system which
                                                              includes:
A. Procedures for securing a BLS ambulance
   service primary or secondary ambulance service              1.    A BLS run report will be completed on all
   permit include:                                                   dispatched responses.



46                                               Part X                                 Date: 02/11/08
                          DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                     Part X
                                           Ambulance Service Regulations

     2.    EMT-B/Ambulance Attendant’s must                        Every ambulance shall be equipped with
           complete,      without     exception,    a              equipment and supplies as specified by the
           written/computer report on each patient                 Delaware State Fire Prevention Commission
           contact. Reports must be completed in a                 and      updated      annually    following
           timely fashion.                                         recommendations from the Delaware State Fire
     3.    When available, the report will be entered              School Director with concurrence from the
           electronically and forwarded to the state               Delaware State Fire Prevention Commission’s
           EMS office.                                             Medical Director.
     4.    Failure to comply with data submission
           will result in loss of ambulance provider         C.   Staffing Requirements
           license or EMT-B/Ambulance Attendant
           Certification.                                              1.      Minimum acceptable crew staffing
     5.    Submit any other data to the designated                             when transporting a patient shall consist
           agencies as required by the Delaware State                          of a driver and one EMT-B/Ambulance
           Fire Prevention Commission.                                         Attendant.
                                                                       2.      A minimum of one EMT-B/Ambulance
G. The ambulance company shall provide on an                                   Attendant shall always be in the patient
   annual basis a financial statement to the                                   compartment when a patient is present.
   Delaware State Fire Prevention Commission.                          3.      BLS ambulance drivers are required to
   The Delaware State Fire Prevention Commission                               have completed the “Emergency
   has the option to withhold funding as per HB                                Vehicle Operators” course conducted
   332 for failing to report the financial statement.                          by the Delaware State Fire School or an
                                                                               equivalent program approved by the
BLS OPERATIONAL REQUIREMENTS                                                   Delaware State Fire Prevention
                                                                               Commission.
A. Vehicle Standards
                                                             D.   Quality Assurance
     1.   All ambulances shall be registered and
          licensed in the State of Delaware by the                 1.       Each Primary and Secondary Ambulance
          Delaware Motor Vehicle Department.                                Service Provider shall be responsible for
                                                                            monitoring quality assurance in the form of
              EXCEPTIONS:                                                   patient care and both mobilization and
                                                                            response times. The method in which this
              a.   Those vehicles to which the                              is accomplished is the authority and
                   international    registration plan                       responsibility of the Primary or Secondary
                   applies                                                  Ambulance Service Provider per the
              b.   Those vehicles properly registered                       Quality Assurance and Improvement
                   in some other state.                                     Program established by the Delaware State
                                                                            Fire Prevention Commission in conjunction
     2.   Vehicles shall have clearly visible letters on                    with the Office of Emergency Medical
          both sides and the rear identifying the name                      Services and adopted by the Delaware State
          of the organization or corporation or the                         Fire Prevention Commission.
          vehicle’s specific identifier as specified
          under permit documentation. The letters            E. Communications Requirements
          shall be at least three inches in height.
                                                                  1.    Dispatch Centers
     3.   Vehicle patient compartment shall conform
          with the criteria within the GSA Federal                      a.     Dispatch centers for both Primary and
          Specifications for ambulances (KKK-                                  Secondary      Ambulance      Service
          1822C).                                                              Providers shall meet the criteria
                                                                               established by the Delaware State Fire
B.   Equipment Standards                                                       Prevention Commission.



Date: 02/11/08                                      Part X                                                          47
                          DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                     Part X
                                           Ambulance Service Regulations

          b.   Secondary ambulance service providers         J.   Health Insurance Portability and Accountability
               dispatch centers shall be responsible for          Act of 1996 (HIPAA)
               following call taking protocols as
               established by the Delaware State Fire             All ambulance service providers will comply
               Prevention Commission.              Calls          with the HIPAA of 1996.
               determined to be ALS in nature shall be
               transferred to the appropriate public         VIII. COMPLIANCE
               safety answering point (PSAP) within
               30 seconds of taking the call utilizing a     A. The owner or registered agent of every
               dedicated phone line to that PSAP.               ambulance service provider shall provide
          c.   Calls determined to be BLS in nature             ambulance service in accordance with the
               shall not be required to be forwarded to         requirements set forth in this regulation and the
               the PSAP.                                        contractual agreements established as either a
          d.   Dispatch centers shall follow an                 primary or secondary Ambulance Service
               Emergency Medical Dispatch System                Provider and filed with the Delaware State Fire
               approved by the Delaware State Fire              Prevention Commission in accordance with the
               Prevention Commission.                           provisions set forth in these regulations. Failure
                                                                to provide this service shall be grounds for
     2.   Ambulances                                            suspension or revocation of permit.
          a. All Ambulances shall be equipped with
             reliable communications systems which           B. Grievances - All grievances relative to
             permit direct communications with their            ambulance service shall follow procedures
             dispatch center and all medical                    established within the Delaware State Fire
             command facilities with which the                  Prevention Regulations, Part IX “Fire Service
             ambulance will or may operate.                     Standards”.

F. SAED Requirements                                         C. Penalties - Following review of a valid
                                                                complaint or upon failure to comply with any
     Upon placing an SAED on any ambulance, the                 provision of this regulation, the Delaware State
     ambulance service provider will comply with the            Fire    Prevention    Commission,      following
     Delaware     Early    Defibrillation  Program              procedures established within the Delaware State
     Administrative Policies as established by the              Fire Prevention Regulations, shall have the
     Office of Emergency Medical Services.                      authority to issue corrective orders, suspend or
                                                                revoke the provider’s permit.
G. Infection Control
                                                             D. Whenever there is reason to believe that any
     All ambulance service providers will comply                provisions of this regulation have been violated,
     with the infection control requirements in                 the ambulance service provider shall be
     Chapter 12A, Title 16 of the Delaware code.                immediately notified. Violations shall require
                                                                correction within five (5) working days of receipt
H. Medical Control                                              of notice with the exception of those violations
                                                                which represent an imminent danger to the
     Ambulance service providers shall be required to           public.
     follow all orders issued.
                                                             E. For those violations representing an imminent
I.   Center for Medicare Medicaid Services (CMS)                danger to the public, the Delaware State Fire
                                                                Prevention Commission shall issue and deliver
     All ambulance services providers will comply               an order to cease and desist any further
     with the Final Rule in the Federal Register                ambulance service until such time as the
     (64F.R3637) revising the Medicare policies for             violation has been verified as being corrected
     ambulance services adopted February 24, 1999.              and corrective measures accepted by the
                                                                Delaware State Fire Prevention Commission.




48                                                  Part X                                Date: 02/11/08
                         DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                    Part X
                                          Ambulance Service Regulations

F. The continued violation of any element of this           EMS systems that are served by the State Of
   regulation or failure or refusal to comply with          Delaware.
   any order to correct a violation or failure to obey
   a cease and desist order by any ambulance                C. DEFINITIONS
   service provider shall be cause for revocation or                 Quality Assurance is the retrospective
   suspension of permit by the Delaware State Fire          review or inspection of services or processes that is
   Prevention Commission after determination that           intended to identify problems.
   the provider is guilty of such violation.                         Quality Improvement is the continuous study
                                                            and improvement of a process, system or
G. In addition to (F), it shall be cause for revocation     organization
   or suspension of a permit after determining the
   ambulance service provider:                              D. OBJECTIVES
                                                                   1. Conduct medical incident reviews (QA)
     (a)   Has practiced any fraud, misrepresentation,             2. Collect patient care statistics to evaluate
           or deceit in obtaining or renewing a permit                system effectiveness and identify trends
     (b)   Is guilty of gross negligence, incompetence                (QI)
           or misconduct in providing services                     3. Provide constructive feedback on
     (c)   Is guilty of a violation of the codes and                  quality improvement to all EMS
           regulations adopted by the Delaware State                  professionals within the State Of
           Fire Prevention Commission                                 Delaware
     (d)   Has been found guilty of an unfair or                   4. To coordinate the findings of quality
           deceptive trade practice                                   assurance activities with the content of
     (e)   Has violated any contractual agreement                     EMS continuing education programs
           related to providing ambulance service                  5. To provide assistance to EMS providers
                                                                      with local agency QA/QI programs.
H. Upon issuance of an order, the ambulance
   service provider accused may request a review of         E. EMS AGENCIES QUALITY ASSURANCE &
   the order by the Delaware State Fire Prevention          IMPROVEMENT REQUIRMENTS
   Commission. All hearings shall be conducted in                  1. EMS agencies should appoint a Quality
   conformity with procedures established by the                      Assurance Manager
   Delaware State Fire Prevention Commission.                      2. The Quality Assurance Manager is
                                                                      charged with the responsibility of
I.   Any person aggrieved by a violation or order                     assuring that reasonable standards of
     may file an appeal to the Delaware State Fire                    care and professionalism are met within
     Prevention Commission pursuant to Delaware                       their respective EMS agency.
     Code, Title 16, Chapter 66, Section 6608.                     3. The Quality Assurance Manager should
                                                                      attend a Quality Management Training
                                                                      Program.
IX. STATEWIDE BASIC LIFE                   SUPPORT                 4. The Quality Assurance Manager shall
QUALITYASSURANCE/QUALITY                                              implement a Quality Assurance and
IMPROVEMENT                                                           Improvement Program within their
                                                                      agency, department.
A. The Delaware State Fire Prevention Commission                   5. The Quality Assurance Manager shall
   hereby establishes a Statewide Basic Life Support                  perform monthly reviews of their data
   (BLS)     Quality    Assurance     and    Quality                  collection and conduct formal reviews
   Improvement Committee hereinafter referred to as                   with their personnel.
   the Committee.                                                  6. The Quality Assurance Manager will
                                                                      work closely with the Statewide QA/QI
B. PURPOSE                                                            Committee on EMS policies,
        The Quality Assurance/Quality                                 guidelines, protocols and system
Improvement (QA/QI), under direction of the State                     performance.
Medical Director is responsible for assuring and
improving the quality of Basic Life Support within


Date: 02/11/08                                     Part X                                                    49
                        DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                  Part X
                                        Ambulance Service Regulations

        7.   The Quality Assurance manager will                               system effectiveness and identify
             consult with their County and State                              trends in patient care.
             EMS Medical Director.                                            Establish clinical benchmarks to
        8.   The Quality Assurance manager will                               measure the State’s BLS system.
             consult with the Delaware State Fire
             School Director or their designee.              H. MEDICAL INCIDENT REVIEW AND
                                                             ANALYSIS
F. STATEWIDE QA/QI IMPROVEMENT                                   1. The QA/QI process evaluates all aspects of
COMMITTEE                                                           patient care and EMS performance in the
          The statewide BLS QA/QI committee shall                   BLS system. The committee will
be comprised of one BLS representative from each                    concentrate on the following areas:
county (appointed by the County Fireman’s                                a. Time Elements
Association), The BLS Medical Advisor, The State                              Hour of day
Medical Director, one representative from the State                           Day of week
Fire Prevention Commission who shall chair the                                Response times (dispatched-arrival)
committee, one representative from the Delaware                               Scene time (arrival-left scene)
State Fire School, one representative from the Office                         Transport time (left scene-at
of EMS, one representative from the Delaware                                  hospital)
Volunteer Fireman’s Association, a dispatch center                       b. Patient Assessment
representative and a State Patient Care Report                                Chief complaint
Representative. The goal of this committee is to make                         Mechanism of injury
sure BLS is meeting all State standards and is                                History
providing the best patient care to the citizens and                           Vital Signs
visitors of Delaware.                                                         Physical Examination
                                                                         c. Patient Treatment
G. COMMITTEE RESPONSIBILITIES                                                 Treatment protocol followed
            Responsible to assure reasonable                                  Appropriate protocol followed
            standards of care and                                             If no, was deviation justified
            professionalism are met within the                                Patient response to treatment
            State Of Delaware’s BLS system.                                   adequately documented
            Participate in Patient Care Report                           d. Refused transport
            review audits, data collection, and                               Disposition appropriate
            evaluation of system performance.                                 Appropriate releases signed
            Maintain strict confidentiality of                           e. Documentation
            patient information, personnel and                                Overall documentation adequate
            Q/A topics.                                                  f. System issues
            Each committee member MUST                                        Recourses (equipment and
            sign a confidentiality statement to                               personnel)
            be provided by the Office of                                      Priority Medical Dispatch
            Emergency Medical Services.                                       Hospital Diversion
            Make sure information                                             Scratch Rate
            disseminated is protected from                                    ALS cancellations
            discovery of protected healthcare                                 Air medical utilization
            information.                                                      Funding
            Make recommendations for                                     g. Outcomes
            changes to policies, guidelines and                  2. Quarterly reports will be developed through
            protocols.                                              the state’s patient care reporting system. A
            Attend a quarterly meeting to                           percentage of the patient care reports will be
            discuss QA/QI issues.                                   reviewed using a designated and approved
            Design and implement QI projects                        auditing tool.
            that are practical and able to collect               3. The QA/QI committee shall review these
            patient care statistics to evaluate                     reports during the quarterly meeting.




50                                                  Part X                                Date: 02/11/08
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                                           Ambulance Service Regulations

     4.     The primary goal is to identify and address      B.    The issuance of a permit hereunder shall not
            any problem or improvement areas and                   be construed so as to authorize any person,
            recommend potential solutions:                         firm, corporation or association to provide
                          Knowledge or skill issues                ambulance services or to operate any
                          Documentation issue                      ambulance without compliance with all
                          Resource issue                           ordinances and regulations enacted or
                          Protocol issue                           promulgated by any state, county or municipal
                          Communication issue                      government concerning ambulances.
                          Statewide system issue
                          Conduct issue                      C.    Prior to issuing an original or renewal permit,
     5.     The QA/QI committee shall provide                      the Delaware State Fire Prevention
            constructive feedback and recommendations              Commission shall determine that all
            to improve the State’s BLS system.                     requirements of this regulation are fully met.
                          Recommend changes to policy,             Additionally, the Delaware State Fire
                          procedures, or protocols                 Prevention Commission has the authority to
                          Recommend changes in                     ensure continued compliance with these
                          operational procedures or                regulations through the periodic review of
                          equipment                                records and operations.
                          Recommend training
     6.     All committee recommendations will be            D.    Only companies holding a current, valid non-
            forwarded to the appropriate agency(s) for             emergency ambulance service provider permit
            consideration.                                         shall be authorized to respond and provide
                                                                   non-emergency ambulance service within the
I.        GRIEVANCE PROCEDURE                                      state.

          In the event that the Committee has problems       XI. NON-EMERGENCYAMBULANCE
          with the Provider, or the Provider has                 SERVICE    PROVIDER    PERMIT
          problems with the Committee, either may                REQUIREMENTS
          forward the problem to the Delaware State
          Fire Prevention Commission through the             ADMINISTRATIVE REQUIREMENTS
          normal Grievance Procedures, previously
          adopted by the Delaware State Fire Prevention      A.   Procedures for securing a non-emergency
          Commission.                                             ambulance service permit include:

NON-EMERGENCY                       AMBULANCE                     1.   The owner or registered agent must apply
                                                                       to the Delaware State Fire Prevention
SERVICE                                                                Commission upon forms provided and
                                                                       according to procedures established by the
X. NON-EMERGENCY                       AMBULANCE                       Delaware      State    Fire     Prevention
   SERVICE PERMITS                                                     Commission.
A.        Any person, firm, corporation or association            2.   The non-emergency ambulance service
          either as owner, agent or otherwise who                      provider shall either be based in Delaware
          furnish, conduct, maintain, advertise or                     or maintain an office in Delaware with a
          otherwise engage in or profess to be engaged                 full time individual domiciled at that office
          in the business or service of providing non-                 who is in “Responsible Charge”.
          emergency ambulance service upon the streets
          or highways of this state shall hold a valid            3.   All requirements set forth in this regulation
          permit issued by the Delaware State Fire                     must be met before issuance of permit.
          Prevention Commission. Application for this
          permit shall be upon forms provided by the              4.   The non-emergency ambulance service
          Delaware State Fire Prevention Commission.                   provider must provide proof of liability



Date: 02/11/08                                     Part X                                                       51
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                                                      Part X
                                            Ambulance Service Regulations

            insurance in the amount of $1 Million                 3.   Vehicle patient compartment shall conform
            blanket liability coverage.                                with the criteria within the GSA Federal
                                                                       Specifications for ambulances (KKK-A-
      5.    The non-emergency ambulance service                        1822C).
            provider must provide proof of automobile
            liability insurance in the amount of $1           B. Equipment Standards
            Million individual, $3 Million aggregate
            per occurrence.                                       Every ambulance shall be equipped with
                                                                  equipment and supplies as specified by the
B.    Permits shall be valid for a period of one year             Delaware State Fire Prevention Commission and
      from the permits effective date.                            updated annually considering recommendations
                                                                  from the Delaware State Fire School Director
C.    The Delaware         State    Fire    Prevention            with concurrence from the Delaware State Fire
      Commission may issue temporary permits when                 Prevention Commission’s Medical Director.
      determined to be in the interest of public safety
      per Title 16.                                           C. Staffing Requirements

D.    On an on-going basis throughout the term of the             1.    Minimum acceptable crew staffing when
      permit, the owner or individual in “responsible                   transporting a patient shall consist of a
      charge” shall be available upon reasonable                        driver and one EMT-B/Ambulance
      notification for the purpose of providing                         Attendant.
      documentation on any provisions of this                     2.    A minimum of one EMT-B/Ambulance
      regulation and permitting physical inspection of                  Attendant shall always be in the patient
      all facilities and vehicles.                                      compartment when a patient is present.

E.    No ambulance service provider shall advertise           D. Communications Requirements Ambulances
      or represent that it provides any ambulance
      service other than authorized to provide under              1.    All Ambulances shall be equipped with a
      this regulation.                                                  reliable communications systems which
                                                                        permit direct communications with all
OPERATIONAL REQUIREMENTS                                                medical command facilities with which the
                                                                        ambulance will or may operate.
A. Vehicle Standards
                                                              E. SAED Requirements
     1.    All ambulances shall be registered and
           licensed in the State of Delaware by the               Upon placing an SAED on any ambulance, the
           Delaware Division of Motor Vehicle                     ambulance service provider will comply with the
           Department.                                            Delaware     Early    Defibrillation  Program
                                                                  Administrative Policies as established by the
           EXCEPTIONS:                                            Office of Emergency Medical Services

            a.   Those vehicles to which the                  F. Infection Control
                 international registration plan applies.
            b.   Those vehicles properly registered in            All ambulance service providers will comply
                 some other state.                                with the infection control requirements in
                                                                  Chapter 12A, Title 16 of the Delaware code.
     2.    Vehicles shall have clearly visible letters on
           both sides and the rear identifying the name       G. Center for Medicare Medicaid Services (CMS)
           of the organization or corporation or the
           vehicle’s specific identifier as specified             All ambulance services providers will comply
           under permit documentation. The letters                with the Final Rule in the Federal Register
           shall be at least three inches in height.              (64F.R3637) revising the Medicare policies for
                                                                  ambulance services adopted February 24, 1999.



52                                                   Part X                               Date: 02/11/08
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H. Health Insurance Portability and Accountability        F. The continued violation of any element of this
   Act of 1996 (HIPAA)                                       regulation or failure or refusal to comply with
                                                             any order to correct a violation or failure to obey
    All ambulance service providers will comply              a cease and desist order by any ambulance
    with the HIPAA of 1996.                                  service provider shall be cause for revocation or
                                                             suspension of permit by the Delaware State Fire
XII. COMPLIANCE                                              Prevention Commission after determination that
                                                             the provider is guilty of such violation.
A. The owner or registered agent of every
   ambulance service provider shall provide               G. In addition to (F), it shall be cause for revocation
   ambulance service in accordance with the                  or suspension of a permit after determining the
   requirements set forth in this regulation and the         ambulance service provider:
   contractual agreements established as either a
   primary or secondary Ambulance Service                       (a)     Has        practiced      any       fraud,
   Provider and filed with the Delaware State Fire                      misrepresentation, or deceit in obtaining
   Prevention Commission in accordance with the                         or renewing a permit
   provisions set forth in these regulations. Failure           (b)     Is    guilty    of    gross    negligence,
   to provide this service shall be grounds for                         incompetence or misconduct in providing
   suspension or revocation of permit.                                  services
                                                                (c)     Is guilty of a violation of the codes and
B. Grievances - All grievances relative to                              regulations adopted by the Delaware State
   ambulance service shall follow procedures                            Fire Prevention Commission
   established within the Delaware State Fire                   (d)     Has been found guilty of an unfair or
   Prevention Regulations, Part IX “Fire Service                        deceptive trade practice
   Standards”.                                                  (e)     Has violated any contractual agreement
                                                                        related to providing ambulance service
C. Penalties - Following review of a valid
   complaint or upon failure to comply with any           H. Upon issuance of an order, the ambulance
   provision of this regulation, the Delaware State          service provider accused may request a review of
   Fire    Prevention    Commission,      following          the order by the Delaware State Fire Prevention
   procedures established within the Delaware State          Commission. All hearings shall be conducted in
   Fire Prevention Regulations, shall have the               conformity with procedures established by the
   authority to issue corrective orders, suspend or          Delaware State Fire Prevention Commission.
   revoke the provider’s permit.
                                                          I.   Any person aggrieved by a violation or order
D. Whenever there is reason to believe that any                may file an appeal to the Delaware State Fire
   provisions of this regulation have been violated,           Prevention Commission pursuant to Delaware
   the ambulance service provider shall be                     Code, Title 16, Chapter 66, Section 6608.
   immediately notified. Violations shall require
   correction within five (5) working days of receipt
   of notice with the exception of those violations       XIII. DISCONTINUATION OF SERVICE BY
   which represent an imminent danger to the                    AMBULANCE PROVIDERS
   public.
                                                          A.          STEP 1
E. For those violations representing an imminent
   danger to the public, the Delaware State Fire                      Any fire department and/or ambulance
   Prevention Commission shall issue and deliver                      company desiring to terminate ambulance
   an order to cease and desist any further                           service in the state of Delaware must notify
   ambulance service until such time as the                           the Delaware State Fire Prevention
   violation has been verified as being corrected                     Commission in writing 120 days before
   and corrective measures accepted by the                            terminating service.
   Delaware State Fire Prevention Commission.


Date: 02/11/08                                   Part X                                                       53
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                                               Part X
                                     Ambulance Service Regulations

B.   STEP 2                                            XIV.        TRAINING/CERTIFICATION

     Immediately upon notification of a fire                       All individuals who successfully complete
     department and/or ambulance company’s                         initial   EMT-B/Ambulance       Attendant
     desire to terminate service, the Chairman or                  training shall be eligible for and must
     the Vice Chairman of the Delaware State                       successfully pass the NREMT examination
     Fire Prevention Commission shall notify the                   to receive Delaware EMT-B/Ambulance
     president of the county firemen’s association                 Attendant certification.
     in which the fire department and/or
     ambulance company provides service to the         ELIGIBILITY FOR CERTIFICATION/EMT-
     residences and visitors of the state of           B/AMBULANCE ATTENDANT
     Delaware for that district.
                                                       A.     Apply to the Delaware State Fire Prevention
C.   STEP 3                                                   Commission on the approved application form
                                                              provided by the Delaware State Fire School.
     Immediately upon receiving notification of a
     fire    department      and/or    ambulance       B.     An individual may apply for and receive
     company’s desire to terminate service the                certification as an EMT-B/Ambulance
     county firemen’s association president shall             Attendant provided that
     appoint a committee. The committee shall
     include, but not be limited to: two members              1.     They are a member in good standing of a
     shall be the President’s of the County Fire                     Delaware Fire Department, an Ambulance
     Chief’s      and      County      Ambulance                     Organization, a Private Ambulance
     Associations or their designees. The County                     Provider or any other group, business or
     President shall have the right to appoint                       industry certified by the Delaware State
     other members to this committee, as he                          Fire Prevention Commission to provide
     and/or she may deem necessary.                                  ambulance service.

     1.   To communicate and offer assistance to              2.     They have obtained EMT-B, EMT-I or
          the terminating company in an effort to                    EMT-P registration from the NREMT.
          help them continue service.
                                                              3.     The Chief, CEO, or head of the respective
     2.   In the event that the county committee                     organization signs the application.
          is unable to get the company to continue
          service, they shall then contact the                4.     They are compliant with criminal history
          surrounding departments and ascertain                      background check legislation.
          and/or develop a plan for those
          departments to divide the district and              5.     Must be 18 years of age.
          continue service.
                                                              6.     Comply with the State of Delaware
     3.   In the event that steps one and two fail                   Immunization policy.
          the county committee may put forth any
          and all suggestions they deem viable in      CERTIFICATION
          order to provide ambulance service to
          the residences and visitors of the state     A.          Certification will be obtained by completing
          of Delaware for that district.                           a state approved EMT-B/Ambulance
                                                                   Attendant Course and passing the National
     4. The committee, through the County                          Registry of Emergency Medical Technicians
          Firemen’s Association President, shall                   Exam. Registration & Certification will be
          report to the Delaware State Fire                        issued for the time period to coincide with
          Prevention Commission within 60 days                     the NREMT registration cycle. This is
          with their recommendations and/or                        typically a two-year period. Individuals will
          findings.                                                be issued a Delaware EMT-B/Ambulance



54                                            Part X                                   Date: 02/11/08
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                                                        Part X
                                              Ambulance Service Regulations

           Attendant certification upon successful                    1.      Continuing education classes to achieve
           completion of the NREMT registration                               re-registration through the NREMT will
           process.                                                           be reviewed for approval by the Office
                                                                              of Emergency Medical Services in
B.         Individual who take EMT-B/Ambulance                                accordance with NREMT policy and
           Attendant class from approved provider                             procedures.
           other than the Delaware State Fire School
           are required to meet all Delaware State Fire         E.    Active duty military personnel not able to re-
           Prevention Commission requirements for                     certify due to deployment may request for an
           certification.                                             extension of certification until they are able to
                                                                      return and complete necessary requirements.
           1.    It is the responsibility of the individual           Upon return the individual shall have 90 days
                 applying for certification to provide                to complete re-certification requirements.
                 criminal history background check as
                 specified by Delaware State Fire               DECERTIFICATION
                 Prevention Commission.
           2.    It is the responsibility of the individual     A.    An EMT-B/Ambulance Attendant will lose
                 applying to provide all necessary                    their Delaware EMT-B/Ambulance Attendant
                 documentation for certification to                   Certification to provide patient care if:
                 include AED/CPR, protocol training
                 and NREMT-B card.                                    1.   They do not meet the re-certification
                                                                           requirements as defined by the Delaware
RECERTIFICATION AS DELAWARE EMT-                                           State Fire Prevention Commission.
B/AMBULANCE ATTENDANT
                                                                      2.   De-certification by the Delaware State
A.    Individuals will be re-certified for a two-year                      Fire Prevention Commission following
      period.                                                              procedures and in compliance with
                                                                           Delaware       State  Fire  Prevention
B.    The re-certification requirements for a                              Regulations, Part IX Fire Service
      Delaware EMT-B/Ambulance Attendant will                              Standards.
      be determined by the Delaware State Fire
      Prevention Commission, with                               B.    National Registry of Emergency Medical
      recommendations of their medical                                Technicians will revoke certification based
      advisor/director.                                               upon their national policy. If an individual has
                                                                      their certification revoked by the National
C.    Requirements for re-certification are:                          Registry of Emergency Medical Technicians
                                                                      the Delaware State Fire Prevention
      1.        Individuals must submit a request for re-             Commission may also decertify their Delaware
                certification to the Delaware State Fire              EMT-B/Ambulance Attendant Certification.
                School documenting completion of
                requirements.                                   C.    The individual is convicted of an offense as
                                                                      specified in 16 Del C. §6712(b) while
                a.   Requirements                                     currently certified and the procedures in Part
                     • Attend        a      prescribed                X, Section XV, Criminal History Background
                        DOT/EMT-B/Ambulance                           Check.
                        Attendant refresher
                     • Current CPR/AED certificate              REINSTATEMENT FOR DELAWARE EMT-
                                                                B/AMBULANCE ATTENDANT
D.    Re-registration as an NREMT-B:          The
      registration requirements for a National                  A.    Individual desiring to regain certification as a
      Registry of Emergency Medical Technician –                      Delaware EMT-B/Ambulance Attendant, after
      Basic will be determined by the National                        the expiration of their certification may do so
      Registry of Emergency Medical Technicians.                      provided the following conditions are met.


Date: 02/11/08                                         Part X                                                      55
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                                                   Part X
                                         Ambulance Service Regulations

       •      Their card has been expired 24 months              4.   CPR and AED as approved by the
              or less.                                                Delaware     State     Fire    Prevention
       •      They must attend an approved EMT-                       Commission.
              B/Ambulance Attendant refresher                    5.   Challenge practical exams as required.
              course.                                            6.   Successfully     completed      Delaware
       •      They must show proof of a current                       Protocol Examination.
              AED and CPR certification.                         7.   Provide mandated State & Federal
       •      They must take and pass the current                     background checks.
              Delaware Protocol examination. The                 8.   Applicants will be advised of the appeal
              protocol self study course available                    process of Part X, Section XV, Criminal
              from the Delaware State Fire School.                    History Background Check if reciprocity
       •      They must acquire a Delaware and                        is denied because of criminal history
              Federal Background Check at their                       background check.
              expense.
       •      They must submit all required                B. Applicant’s certified from other states without at
              paperwork and application for                   least a Nationally Registered EMT-B
              certification to the Delaware State Fire        certification must obtain National Registry prior
              School.                                         to applying for Delaware Certification.

B. Individuals whose card has expired 24 months or         C. The Delaware State Fire Prevention Commission
   more must take the entire EMT-B/Ambulance                  reserves the right to administer a written
   Attendant course and National Registry                     examination if deemed necessary.
   Examination.
                                                           XV. CRIMINAL          HISTORY       BACKGROUND
C. Individuals desiring to regain registration as an           CHECK
   NREMT-B must follow the policies of the
   National Registry Organization.                         I.    Authorized Governmental Designee for the
                                                                 Delaware State Fire Prevention Commission
TESTING PROCEDURES FOR NATIONAL
REGISTRY                                                         A.      The Delaware State Fire Prevention
                                                                         Commission authorizes the Director of
     Initial testing and re-testing for National                         the Delaware State Fire School to be its
Registered EMT-B will follow the guidelines set                          governmental designee to acquire and
forth by the National Registry of Emergency Medical                      review State and Federal criminal
Technicians.                                                             history background checks submitted by
                                                                         the State Bureau of Identification for an
RECIPROCITY                                                              applicant applying to become a
                                                                         Delaware             EMT-B/Ambulance
A. Emergency Medical Technicians, paramedics,                            Attendant and to interview the
   nurses, or physicians who enter Delaware with a                       applicant, if necessary.
   National Registry EMT-B, EMT-I or EMT-P
   certification will receive reciprocity as EMT-          II.   Evaluation Procedure for Criminal History
   B/Ambulance Attendant in the Delaware System                  Background Checks
   provided that.
                                                                 A.      The Director of the Delaware State Fire
      1.   They become a member of a certified                           School shall evaluate the criminal
           ambulance service provider in Delaware.                       history background checks using the
      2.   They submit the required application form                     criteria established in 16 Del. C. §
           to the Delaware State Fire School.                            6712(b).        All criminal history
      3.   They have a current National Registry                         background checks will be forwarded
           EMT-B, EMT-I or EMT-P certification.                          by the State Bureau of Identification to
                                                                         the Director of the Delaware State Fire
                                                                         School.



56                                                Part X                                 Date: 02/11/08
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                                                   Part X
                                         Ambulance Service Regulations

                                                                         2.    Notice of the hearing shall be
       B.    Should the Director of the Delaware                               given at least 20 days before the
             State Fire School as a result of the                              day of the hearing and comply
             criminal history background check find                            with the provisions of 29 Del. C. §
             cause to recommend to the Delaware                                10122.
             State Fire Prevention Commission that
             it deny the application of the person                       3.    The grievance hearing before the
             seeking certification as an EMT-                                  Delaware State Fire Prevention
             B/Ambulance Attendant, the Director                               Commission will be conducted in
             shall notify the Delaware State Fire                              accordance with the Delaware
             Prevention     Commission    of   this                            Administrative Procedures Act 29
             decision.                                                         Del. C. Ch 101.

       C.    The Director of the Delaware State Fire                     4.    The hearing will be closed to the
             School shall advise the applicant that                            public unless the applicant
             the application is denied and state the                           requests an open hearing. After
             reason therefore. The Director of the                             the hearing, the Delaware State
             Delaware State Fire School will also                              Fire Prevention Commission will
             advise the applicant of the right to                              inform the applicant of its
             review all information reviewed by the                            decision.
             Director and the right to appeal the
             decision by requesting a hearing before       IV.   Requirements for Certification
             the Delaware State Fire Prevention
             Commission.                                         A.      Persons seeking certification as an
                                                                         Ambulance           Attendant/Delaware
III.   Appeal Process for Denial of Certification or                     Emergency Medical Technician must be
       De-certification  because    of     Criminal                      eighteen (18) years of age at the time of
       Conviction                                                        application.

       A.    Any Delaware EMT-B/Ambulance                                1.   Individuals entering an EMT-
             Attendant applicant or certificate holder                        B/Ambulance Attendant course
             notified by the Delaware State Fire                              must be eighteen (18) years of age
             Prevention Commission and or the                                 at the start of the course.
             Delaware State Fire School that the
             Delaware State Fire Prevention                      B.      An individual applying for certification
             Commission intends to deny the                              must meet the requirement of Part X, of
             application or decertify the certificate                    the Delaware State Fire Prevention
             holder because of criminal history                          Regulations    “Ambulance       Service
             background check information may                            Regulations”.
             appeal the denial to the Delaware State
             Fire Prevention Commission.          The            C.      Persons seeking certification must meet
             process is:                                                 the criminal history background check
                                                                         as mandated in 16 Del C. § 6712(b),
             1.   Within 10 days after the postmark                      effective July 12, 2001 and follow the
                  on the notification of the intent to                   procedures outlined in this policy.
                  deny certification or decertify a
                  certificate holder, the applicant        V.    Administrative Policy Pertaining to Criminal
                  shall submit a written request for a            History Background Checks
                  hearing to the Delaware State Fire
                  Prevention Commission stating                  A.      Delaware State Fire School training
                  the reason(s) supporting the                           announcements for EMT-B/Ambulance
                  appeal.                                                Attendant courses will include the
                                                                         statement     “Criminal     History


Date: 02/11/08                                    Part X                                                      57
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                                                 Part X
                                       Ambulance Service Regulations

          Background checks will be required as
          per the regulations.                                  G.     Any student accepted into the course
                                                                       who does not complete the course will
     B.   All Chiefs of Departments, Presidents                        be required to reimburse the Delaware
          or Ambulance Captains of volunteer                           State Fire Prevention Commission the
          rescue or ambulance squads or                                cost of the criminal history background
          Operating        Officers   of    private                    check and course materials.
          corporations which have students pre-
          registered for the class will be sent a         VI.   Condition and Duration of Certification/De-
          notice to inform the student that a                   certification
          criminal history background checks will
          be required. It will be the responsibility            A.     The Delaware State Fire Prevention
          of       private       EMT-B/Ambulance                       Commission      shall    issue   initial
          Attendant training institution to make                       certification  as     an     Ambulance
          their students aware that a Criminal                         Attendant/Delaware           Emergency
          History Background Check is required                         Medical Technician – Basic as
          to become a State of Delaware EMT-                           prescribed in Part X, of the Delaware
          B/Ambulance Attendant and the                                State Fire Prevention Regulations
          Criminal History Background Check be                         provided that:
          available      in    order   to   receive
          certification.                                        B.     Procedure for De-certification       for
                                                                       Criminal Offense
     C.   Any student not pre-registered for the
          class will not be accepted as a walk-in.                     1.   The      Delaware    State    Fire
                                                                            Prevention Commission may
     D.   All EMT-B/Ambulance Attendant                                     decertify any currently certified
          students will sign a release provided by                          EMT-B/Ambulance         Attendant
          the State Bureau of Identification                                when it has reason to believe that
          authorizing the criminal history                                  the person has been convicted of a
          background check. Any student failing                             crime within the scope of §6712
          to sign the designated form will not be                           of Title 16.
          allowed to participate in the course.
                                                                       2.   Upon receiving a written notice
     E.   Students who are members of a private                             that    an     EMT-B/Ambulance
          ambulance service are required to pay                             Attendant was convicted of a
          the course tuition prior to the first night                       crime within the provisions of
          of class. The tuition is non-refundable                           §6712, Title 16 the Delaware State
          unless the student drops out prior to the                         Fire Prevention Commission shall:
          first night of class. The tuition includes
          the cost of the criminal history                                  a.    Immediately suspend the
          background check which will be paid to                                  individual’s     certification
          the State Bureau of Identification on the                               pending an investigation into
          student’s behalf by the Delaware State                                  the allegations.
          Fire School.                                                      b.    Notify the individual in
                                                                                  writing of the allegations
     F.   Any volunteer fire, rescue or ambulance                                 and suspensions and allow
          company registering a student who is                                    the certificate holder an
          denied certification pursuant to the                                    informal opportunity to
          provision of 16 Del. C. § 6712(b), shall                                contest the allegations of a
          be responsible to reimburse the                                         conviction.
          Delaware State Fire Prevention                                    c.    Require the individual to
          Commission for the cost of the criminal                                 obtain a current Criminal
          history background check.



58                                               Part X                                Date: 02/11/08
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                                                      Part X
                                            Ambulance Service Regulations

                           History background check at                            Commission will reimburse the
                           their expense.                                         individual or the individual’s
                                                                                  volunteer   fire,  rescue   or
                           1.   Criminal          History                         ambulance organization for the
                                Background          check                         cost of the criminal history
                                information will be sent                          background check.
                                to and reviewed by the
                                Director      of       the     D.   Reciprocity    for   University   of   Delaware
                                Delaware State Fire                 Students
                                School, who will make
                                determination if cause              1.      The Delaware State Fire Prevention
                                for       de-certification                  Commission will waive the criminal
                                exists. The Director of                     history background check requirements
                                the Delaware State Fire                     for all University of Delaware Students
                                School will notify the                      applying for certification as an
                                Delaware State Fire                         Ambulance            Attendant/Delaware
                                Prevention Commission                       Emergency Medical Technician.
                                of the findings.
                                                                             a.   The       University        Police
                      d.   Based on the information                               Department will provide the
                           provided by the Director of                            Director of the Delaware State
                           the Delaware State Fire                                Fire School with a written
                           School, the Delaware State                             document listing all eligible
                           Fire Prevention Commission                             students and a statement that they
                           will either inform the                                 have     passed     an    internal
                           certificate holder of the                              background check at least equal
                           intent to de-certify the                               to the requirement of 16 Del. C.
                           individual or lift the                                 § 6712.
                           individual’s suspension.
                                                               E.   Confidentiality  of    Criminal          History
            3.        The individuals may appeal the                Background Check Information
                      de-certification   using     the
                      procedure under Part X, Section               1.      Information obtained pursuant to the
                      XV, Criminal History Background                       criminal history background check is
                      Check, Appeal Process.                                confidential and except as provided in
                                                                            Section 4 below, shall not be released
      C.   Funding of Reciprocity Criminal History                          from the Delaware State Fire School
           Background Checks                                                under any circumstances to anyone.

           1.        All applicants will pay for the                2.      All criminal history background check
                     criminal history background check                      information that is reviewed by the
                     at the time of their request.                          Director of the Delaware State Fire
                                                                            School shall be retained in a locked file
                a.     It is the responsibility of the                      cabinet in the custody of the Director
                       private     providers,     private                   for a two (2) year period.
                       individuals     or     City     of
                       Wilmington to pay all costs –                3.      When a denial for certification is made,
                       they are not eligible for                            the Delaware State Fire Prevention
                       reimbursement.                                       Commission will be advised by the
                                                                            Director of the Delaware State Fire
                b.     Upon successful completion of                        School and the Background Check will
                       the reciprocity process the                          be secured for at least 60 days or until
                       Delaware State Fire Prevention                       the appeal process is completed.


Date: 02/11/08                                        Part X                                                     59
                         DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                   Part X
                                         Ambulance Service Regulations

                                                                 1.          May have their certification revoked by
            1.     At the expiration of 60 days, if an                       the Delaware State Fire Prevention
                   appeal has not been filed, the                            Commission in compliance with the
                   information is to be retained by                          Delaware State Fire Prevention
                   the Director of the Delaware                              Regulations Part IX “Fire Service
                   State Fire School secured file                            Standards”.
                   system.
                                                           E.    Expired First Responder Certifications
      4.    Per 16 Del. C. § 6712 the individual
            may meet with the Director of the                         1.     Individuals desiring certification as a
            Delaware State Fire School and after                             First Responder after the expiration date
            providing proof of identification                                of their certification may do so
            including a photo identification, review                         providing the following conditions are
            their information. Copies will not be                            met.
            provided to anyone.                                       2.     Card expired 24 months or less
                                                                      3.     Attend approved refresher course
XVI         FIRST RESPONDER                                           4.     Show proof of current AED/CPR
                                                                             Certification
First Responders do not meet the requirements of                      5.     Submit all required applications and
EMT-B/Ambulance Attendant and cannot transport a                             paperwork to Delaware State Fire
patient without a Delaware EMT-B/Ambulance                                   School
Attendant present and in the patient care                             6.     Individuals whose card has expired
compartment.                                                                 more than 24 months must attend a
                                                                             complete First Responder Training
A.    Eligibility for Delaware First Responder                               course.
      Certification                                                   7.     Individuals desiring to regain National
                                                                             Registry Registration must follow the
      1.   16 years of age                                                   policies of the National Registry.
      2.   Complete       Approved   DOT First
           Responder Curriculum                            F.    Testing procedures Delaware First Responder
      3.   National Registry First Responder
           Certification is optional                             1.        Initial testing and retesting for First
      4.   Submit required applications and                                Responders will follow the guidelines set
           paperwork to Delaware State Fire                                forth by Delaware State Fire School.
           School.
                                                           G.    Reciprocity
B.    Certification is valid for 2 years with a re-              1. First Responders from other state must
      certification date of September.                               submit a request
                                                                 2. Show proof of attending a DOT
C.    Re-certification                                               curriculum
                                                                 3. Obtain CPR/AED as approved by
      1.    Must re-certify as mandated by the                       Delaware     State  Fire   Prevention
            Delaware State Fire Prevention                           Commission
            Commission.                                          4. Challenge practical examinations as
                                                                     determined by the Delaware State Fire
            a.     DOT First Responder Refresher,                    School
                   AED and CPR.                                  5. Challenge the State First Responder
            b.     National    Registry    –    As                   Examination
                   determined by National Registry.

D.    De-certification




60                                                Part X                                     Date: 02/11/08
                       DELAWARE STATE FIRE PREVENTION REGULATIONS

                                                 Part X
                                       Ambulance Service Regulations


Note:

This single line indicates changes made to the Part
X, Ambulance Service Regulations of the
Delaware State Fire Prevention Regulations dated
June 11, 2004. These Regulations are effective
February 11, 2008.




Date: 02/11/08                                 Part X                  61

								
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