Chapter 4766-2 Ambulances

4766-2-01 Definitions.

(A) "Board" means the Ohio medical transportation board as described in section 4766.02 of the Revised Code.

(B) "Headquarters" means the location which a licensee operates, designated by the licensee as the location where the records described in this chapter are maintained or readily available.

(C) "Medical Transportation Organization (MTO)" has the same meaning as emergency medical service organization as defined in division (H) of section 4766.01 of the Revised Code.

(D) "Operate" means to engage in conduct or activity in furtherance of the licensed activity at or from a physical location owned, leased or maintained by the licensee where employees report to work and vehicles or aircraft are stored. Operate also includes the act of receiving a person within Ohio for transportation to a location within Ohio.

(E) "Readily Available" means produced upon demand by the board.

(F) "Satellite Base" means a physical location other than headquarters from which a licensee operates.

(G) "Service Number" means the number assigned to the licensee by the Ohio medical transportation board for the purpose of identifying and validating the service or licensee.

(H) "Service Code" has the same meaning as service number.

(I) "Reinspection Fee" means a fee required to conduct an inspection as a result of the issuance of a notice of deficiency, also referred to as a notice of non-compliance with a provision of Chapter 4766. of the Revised Code or agency 4766. of the Administrative Code, by the board or its designee, to a licensee or license applicant, regarding a permitted ambulance/non-transport vehicle or an ambulance/non-transport vehicle for which a permit application is pending.

(J) "Temporary Vehicle" means an ambulance or non-transport vehicle issued a temporary permit used to replace a permitted ambulance or non-transport vehicle in accordance with rule 4766-2-12 of the Administrative Code that is out of service until the permitted ambulance or non-transport vehicle is returned to service not to exceed sixty days.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.01
Prior Effective Dates: 07/02/2009

4766-2-02 Application for initial or renewal licensure.

(A) A MTO applying for licensure shall file with the board an application on the form prescribed by the board,as published on the board's website at http://omtb.ohio.gov/Forms/Form1.pdf, dated April 16, 2012, in the English language, and shall submit the completed application to the board accompanied by the appropriate fee as defined in rule 4766-2-03 of the Administrative Code.

(B) In addition to the requirements set forth in section 4766.04 of the Revised Code, for each application the MTO applicant shall provide:

(1) The name, organizational structure, and address of applicant as follows:

(a) Name;

(b) Identification of organizational structure as a corporation (whether for profit or not-for-profit); limited liability company; partnership; limited liability partnership; government unit; or sole proprietor (individual human);

(c) All other names under which applicant plans to operate;

(d) Copies of all trade name registrations and fictitious name registrations for all other names under which applicant plans to operate on file with the Ohio secretary of state;

(e) Address of physical location of applicant's headquarters (no post office box);

(f) Mailing address of applicant;

(2) All medicare provider numbers, all medicaid provider numbers;

(3) Highest level of service to be provided, service areas including county and state;

(4) A list of the names of all officers, directors, and/or owners of the MTO;

(5) The name, address and physician license or certificate number of the medical director as and state of licensure;

(6) For each satellite base, the MTO shall provide the street address, city, county, state, and zip code;

(7) The name of the primary contact person, business or administrative office telephone number, and if applicable, office fax number and e-mail address;

(8) Year of manufacture, make, model, vehicle identification number, odometer reading, license plate number (renewal only) of each ambulance or non-transport vehicle to be permitted;

(9) A color photograph of the side of applicant's vehicle displaying color scheme, insignia, monogram, or other distinguishing characteristic. If multiple color schemes, insignias, monograms, or other distinguishing characteristics are used, a color photograph of each must accompany application. (Digital photographs are preferred);

(10) A current certificate of liability insurance in the name of the applicant listing Ohio medical transportation board as a certificate holder with a thirty day cancellation notice as specified in section 4766.06 of the Revised Code:

The actual name on the licensure application shall appear on the certificate of liability insurance;

(C) Each MTO shall pay the appropriate fees as specified in rule 4766-2-03 of the Administrative Code.

(D) If an application for licensure is incomplete, the board will notify the applicant that the application will not be processed until it is complete. Such notification will occur via certified mail one time for each submission.

(E) The certificate of licensure issued by the board shall indicate the highest level of service the MTO is authorized to provide.

(F) Licenses shall be issued to MTOs who meet the criteria to provide the following levels of service:

(1) Basic life support;

(2) Intermediate life support;

(3) Advanced life support.

(G) No applicant or licensee shall submit false statements in order to obtain a license or permit.

(H) A license is not transferable.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.03 , 4766.04 , 4766.07
Prior Effective Dates: 07/02/2009

4766-2-03 Fees.

(A) Each MTO shall pay the following license fee annually:

Initial or renewal license fee of one hundred dollars.

(B) Each MTO shall pay a permit fee for each ambulance or non-transport vehicle of one hundred dollars annually.

(C) Each MTO that shows satisfactory evidence of compliance with section 4766.10 of the Revised Code shall be eligible for the fifty percent fee reduction only for the ambulance(s) or non-transport vehicle(s) operating within the municipality. The fifty percent reduction applies to license fees, permit fees, and renewal fees but does not apply to the inspection and reinspection fees.

(1) To be eligible for reduction, the MTO must show evidence of municipal license that meets or exceeds section 4766.10 of the Revised Code;

(2) Each MTO shall declare the number of ambulance(s) and non-transport vehicle(s) at each licensed location.

(D) Each MTO shall pay an inspection fee of one hundred dollars per ambulance or non-transport vehicle.

(E) Each MTO shall pay a one hundred dollar reinspection fee for every ambulance or non-transport vehicle that requires reinspection as a result of a deficiency issued by the Ohio medical transportation board.

(F) Each MTO shall pay a temporary permit fee of one hundred dollar fee for each temporary permit to be obtained.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.05
Prior Effective Dates: 07/02/2009

4766-2-04 Physical facilities.

(A) The board shall conduct initial and renewal inspections of all MTOs pursuant to Chapter 4766. of the Revised Code and rules 4766-2-04, 4766-2-05 , and 4766-2-06 of the Administrative Code to include the following:

(1) MTO service headquarters;

(2) MTO service satellite base(s).

(B) A MTO shall not commence operations from its headquarters or satellite(s) until the location is licensed as required by division (G) of section 4766.04 of the Revised Code.

(C) A MTO shall ensure compliance with the inspection requirements for physical facilities. The inspection requirements for physical facilities of a MTO are as follows:

(1) Board issued license shall be prominently displayed in conspicuous location at every licensed facility (renewal inspection only);

(2) Ohio state board of pharmacy license(s) shall be displayed;

(3) A written sanitation plan shall be on site;

(4) The physical facilities shall maintain all single use supplies and equipment as set forth in rule 4766-2-10 of the Administrative Code.

(5) The physical facilities shall be clean and free of debris;

(6) Crew quarters shall be clean.

(D) The board may conduct routine unannounced inspections at any location of licensed MTO at any time, including night or weekend inspections to determine compliance with Chapter 4766. of the Revised Code and agency 4766 of the Administrative Code to include, but not limited to, the following:

(1) MTO service headquarters;

(2) MTO service satellite base(s);

(3) Ambulance(s) and non-transport vehicles(s).

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04
Prior Effective Dates: 07/02/2009

4766-2-05 Transportation records.

(A) Each licensed MTO shall maintain or have readily available the following at its headquarters:

(1) Current copy of the organization's operating protocol(s) as filed with the Ohio state board of pharmacy;

(2) Verification of the following:

(a) Completion of emergency vehicle operator course for non-EMS certified personnel as described in rule 4766-2-13 of the Administrative Code;

(b) EMS certification of all personnel;

(3) A current certificate of liability insurance issued by an insurer licensed to do business in Ohio that includes a thirty day notice of cancellation to the board in compliance with the terms set forth in section 4766.06 of the Revised Code listing Ohio medical transportation board as a certificate holder ;

(4) Current copy of the MTO's written policy covering the use of warning devices;

(5) Records or other documents related to patient care or to emergency medical service personnel maintained by the licensed MTO which shall be made available for review by the board;

Such records or documents shall be made available in accordance with 45 C.F.R. 164.512 ;

(6) Current maintenance records for vehicles as specified in rule 4766-2-09 of the Administrative Code;

(7) Current maintenance records for all equipment used for patient care as specified in rule 4766-2-09 of the Administrative Code;

(8) Dispatch log;

(9) Written plan for restocking of supplies or compliance with paragraph (C)(4) of rule 4766-2-04 of the Administrative Code;

(10) Ohio state board of pharmacy license and addendum;

(11) DEA registration certificate (as applicable);

(12) Clinical laboratory improvement amendments (CLIA) waiver (as applicable);

(13) Current written plan for the handling and disposal of bio-medical infectious materials (OSHA rule 29 C.F.R. part 1910.1030 ).

(B) A licensee shall maintain or have readily available the following at each satellite base:

(1) Current copy of the organization's operating protocol(s) as filed with the Ohio state board of pharmacy;

(2) Documentation as required under rule 4766-2-07 of the Administrative Code;

(3) Current copy of the MTO's written policy covering the use of warning devices;

(4) Written plan for restocking of supplies or compliance with paragraph (C)(4) of rule 4766-2-04 of the Administrative Code;

(5) Ohio state board of pharmacy license(s) and addendum(s);

(6) Current written plan for the handling and disposal of bio-medical infectious materials (OSHA rule 29 C.F.R. part 1910.1030 ).

(C) Upon licensure, each licensed MTO shall prominently display the original certification of licensure at its headquarters and each satellite base.

(D) Patient records

(1) Each licensed MTO shall maintain accurate records concerning the transportation of each patient for a minimum of seven years.

(2) Each record shall include the following:

(a) Patient's name;

(b) Patient's sex;

(c) Patient's age;

(d) Patient's date of birth;

(e) Patient's address;

(f) Location address of incident or pickup;

(g) Patient's chief complaint;

(h) Patient's history including:

(i) Current medical condition;

(ii) List of current medications;

(iii) Allergies;

(iv) Vital signs and time assessed

(a) Blood pressure;

(b) Pulse;

(c) Respiration;

(i) Any responsible guardian;

(j) Advanced directives, if applicable;

(k) Final destination;

(l) Treatment rendered;

(m) The following times:

(i) Time call received;

(ii) Dispatch time;

(iii) Enroute time;

(iv) On-scene time;

(v) Departure from scene time;

(vi) Arrival at destination time;

(n) The names and level of certification for all medical personnel;

(o) The names of any non-EMS certified personnel, if applicable.

(3) A copy of the record for each patient shall be provided to the receiving facility, which includes all the information required no later than twenty-four hours from time of dispatch.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.06
Prior Effective Dates: 07/02/2009

4766-2-06 Communication requirements.

(A) All licensed MTO dispatch centers shall be equipped with a base station capable of two-way communications with associated mobile radios on an assigned frequency. Cellular telephone with active two-way radio communication capabilities is permissible. This channel will be used exclusively for dispatch. The base station shall demonstrate and maintain voice communications with the radios used in the permitted ambulance(s) and non-transport vehicle(s) within the declared service area.

(1) The base station shall be hard-wired;

(2) A hand held battery operated base station used as primary source of communication is prohibited.

(B) All permitted ambulance(s) and non-transport vehicle(s) shall be equipped with two-way communications which shall have the capability to communicate with the licensed MTO's dispatch center and with medical control in the licensed MTO's service area.

(1) Primary two-way communication devices shall maintain either a one hundred ten-volt or twelve-volt power source backup for each communication device;

(2) All MTOs shall maintain a detailed radio log that documents the following:

(a) Location of call;

(b) Nature of call;

(c) Initial dispatch time;

(d) Enroute time;

(e) On-scene time;

(f) Departure from scene time;

(g) Arrival at destination time.

(C) If a MTO contractually uses another communication center for dispatch purposes, the communication center shall provide written certification of compliance with Chapter 4766. of the Revised Code and agency 4766 of the Administrative Code as applicable.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07
Prior Effective Dates: 07/02/2009

4766-2-07 Health and safety requirements.

(A) Each licensed MTO shall comply with all occupational safety and health administration-bloodborne pathogens regulations as defined by 29 C.F.R. 1910.1030 .

(B) A licensed MTO shall ensure that sanitation procedures are provided to all personnel in a written document that conforms with current standards as set forth in occupational safety and health administration-bloodborne pathogens protocol.

(C) A licensed MTO shall maintain and follow a written sanitation plan that conforms with the latest bloodborne pathogen standards as written by the occupational safety and health administration. The following documentation shall be maintained for each vehicle:

(1) Sanitation schedule;

(2) Date the sanitation was completed;

(3) Documentation of who performed sanitation.

(D) All licensed MTOs shall establish a written policy governing the use of emergency lights and audible warning devices pursuant to section 4511.24 of the Revised Code which shall be made available for the board's inspection.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07
Prior Effective Dates: 07/02/2009

4766-2-08 Vehicle inspections.

(A) The board shall inspect all ambulance(s) and non-transport vehicle(s) for roadworthiness and for appropriate equipment as prescribed in rule 4766-2-10 of the Administrative Code.

(B) In order to qualify for an ambulance permit, an ambulance shall contain the equipment set forth in paragraph (A) to (H) of rule 4766-2-10 of the Administrative Code.

(C) In order to qualify for a non-transport vehicle permit, a non-transport vehicle shall contain the equipment set forth in paragraph (I) of rule 4766-2-10 of the Administrative Code.

(D) In order to receive a permit, an ambulance or non-transport vehicle shall meet the requirements set forth as follows:

(1) Roadworthiness requirements:

(a) High and low beam headlights shall be operational;

(b) Clearance lights, marker lights and reflectors shall be operational (if applicable);

(c) High beam indicator light (on dashboard) shall be operational;

(d) Dashboard lights and interior lights shall be operational;

(e) Left and right tail lights shall be operational;

(f) Left and right front turn signals shall be operational;

(g) Left and right rear turn signals shall be operational;

(h) Left and right brake lights shall be operational;

(i) License plate light shall be operational;

(j) Back up light(s) shall be operational;

(k) Audible back up alarms shall be operational;

(l) Tread depth on each tire shall be minimum of one sixteenth inch;

(m) Tread or sidewall of tires shall be free of major deformities;

(n) Rims/wheels shall be free of significant damage;

(o) Each tire shall have full range-of-motion without rubbing chassis or body;

(p) Brake pedal travel shall not exceed:

(i) Two thirds travel in vehicles with non-assisted brakes;

(ii) Four fifths travel in vehicles with power assisted brakes;

(q) Emergency/parking brake shall be operational;

(r) Windshield shall be without breach, unobstructed;

(s) Windshield wipers and washer shall be operational;

(t) Windows shall be without breach and consistent with original equipment manufacturer specifications;

(u) Exhaust system shall be properly secured and without breach;

(v) Steering shaft shall be secure with no more than one quarter turn play;

(w) Power steering shall operate properly;

(x) Rear view mirrors and side view mirrors shall be installed in accordance with the original equipment manufacturer specifications and shall be without any breach;

(y) Horn shall be operable and audible;

(z) Heater, defroster, and air conditioner shall be properly installed and operational;

(aa) Each seat shall be securely fastened to the floor;

(bb) Floor of vehicle shall be intact and free of holes;

(cc) Interior of vehicle shall be free of broken tubing, protruding metal, protruding plastic, debris, and trash;

(dd) Safety belts for driver and passengers shall be operational and free of visible damage;

(ee) Vehicle body and frame shall have structural integrity without breach;

(ff) Each shock/spring shall be mounted and intact;

(gg) Fuel tank shall be free of leaks and securely mounted;

(hh) License plates shall be properly mounted on front and rear of vehicle (if required by state law);

(ii) Emergency lighting shall be operational;

(jj) Siren shall be operable and audible.

(kk) Air ride suspension system shall properly inflate/deflate.

(2) A MTO must demonstrate proof that the ambulance(s) complies with all specifications set forth in the current national standard in effect at the date of manufacturing of the ambulance(s) by one of the following:

(a) Placard/sticker;

(b) Certificate issued by the manufacturer;

(c) Signed affidavit by the manufacturer certifying compliance with national standards in effect at time the vehicle was manufactured.

(3) The name of the MTO shall be permanently affixed with each letter being a minimum of three inches in height on both sides and each letter being a minimum of one and one half inches in height on the rear of the ambulance or non-transport vehicle.

(a) If a MTO is under contract which requires other signage, the MTO's name and service code shall be permanently affixed with each letter being at a minimum of three inches in height on both sides and one and one half inches in height on the rear of vehicle.

(4) All board identified deficiencies must be corrected. The vehicle shall be placed out-of-service until it passes reinspection by the board.

(E) Vehicles not titled as ambulances are not eligible for permits as ambulances, but may be issued permits as "non-transport vehicles" pursuant to section 4766.07 of the Revised Code, provided they fall within the definition of such vehicles in division (Q) of section 4766.01 of the Revised Code.

(F) Upon issuance of a vehicle permit, each licensed MTO shall apply the decal on the outside of the right rear window in accordance with division (B)(2) of section 4766.07 of the Revised Code on each ambulance and non-transport vehicle.

The permit must be unobstructed at all times.

(G) A permit is not transferable.

(H) The board may conduct routine unannounced inspections at any location of licensed MTO at any time, including night or weekend inspections to determine compliance with Chapter 4766. of the Revised Code and agency 4766 of the Administrative Code to include, but not limited to, ambulance(s) and non-transport vehicle(s).

(I) A permitted ambulance or non-transport vehicle shall maintain compliance with roadworthy requirements set forth in this rule at any time it is used as an ambulance or non-transport vehicle.

(J) Each permitted vehicle shall be free from dirt, stains, impurities and/or foreign matter in driver's compartment and ambulance patient care compartments.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07
Prior Effective Dates: 07/02/2009

4766-2-09 Maintenance documentation.

(A) Ambulances and non-transport vehicles

(1) All licensed MTOs shall ensure performance and maintain documentation of all periodical maintenance and repairs on each permitted vehicle to include:

(a) Date of service or repair;

(b) Description of service/repair performed;

(c) Name of person who performed service/repair.

(2) Out of service permitted ambulance(s) or non-transport vehicle(s)

If a licensed MTO removes a permitted ambulance or non-transport vehicle from service it shall place an "out of service" sign in the permitted ambulance or non-transport vehicle to be visible through the windshield with the following information included on the front of the sign:

(a) Date permitted ambulance or non-transport vehicle was taken out of service;

(b) Odometer reading at time permitted ambulance or non-transport vehicle was taken out of service;

(c) Reason permitted ambulance or non-transport vehicle was taken out of service;

(d) Printed name and signature of person responsible for taking permitted vehicle out of service;

(e) The words "out of service" utilizing not less than three inch lettering.

(3) If a permitted ambulance or non-transport vehicle is at a repair/maintenance shop that is not owned or operated by the licensed MTO for maintenance purposes, no "out of service" sign is required.

(B) Bio-medical equipment

(1) All licensed MTOs shall ensure performance and maintain documentation of all periodical maintenance and repairs of bio-medical equipment as required by manufacturer and/or food and drug administration including but not limited to the following:

(a) Date of last bio-medical inspection;

(b) Date of service or repair;

(c) Description of service/repair performed;

(d) Name of who performed inspection, service, or repair.

(e) Documentation of inspection, service or repair performed.

(C) All licensed MTOs shall maintain documentation of all periodical maintenance of patient care equipment as required by the original equipment manufacturer.

(D) Ambulance and non-transport vehicle maintenance/repair records shall be kept for a period of twelve months after the vehicle is removed from inventory.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07
Prior Effective Dates: 07/02/2009

4766-2-10 Equipment requirements.

Disposable equipment is acceptable where applicable.

All equipment and supplies shall have current expiration dates where applicable.

(A) Oxygen equipment

(1) Permanently installed main oxygen system (current hydrostatic testing);

(2) Permanent variable flow regulator (0-15 LPM minimum)(one)

(3) Portable oxygen tanks secured in appropriate tank storage mechanism (minimum "D")(current hydrostatic testing)(two);

(4) Portable variable flow regulator (0-15 LPM minimum)(one)

(5) Bag mask resuscitator with reservoir capable of one hundred percent oxygen flow (self inflating);

(6) Transparent masks for bag mask resuscitator (one each)(adult-child-infant) or (adult, combination child/pediatric);

(7) Transparent oxygen masks (adult-two; pediatric two; infant two );

(8) Nasal cannulas (adult-child)(two each).

(B) Suction equipment

(1) Permanently installed suction unit;

(2) Portable suction unit (powered or hand operated);

(3) Rigid pharyngeal curved suction catheters with wide-bore tubing (two);

(4) Soft tip suction catheter (two sizes)(one between 6.0 French - 10 French) and (one between 12 French - 16 French);

(5) Sterile water and/or normal saline (four), minimum 1000 ML, excluding I.V. solution;

(6) Sterile gloves (two pair);

(7) Suction tubing (two);

(8) Suction bags (two extra disposable liners or containers).

(C) Airway equipment

(1) Complete set of oropharyngeal airway devices (infant through adult);

(2) Complete set of nasopharyngeal airway devices (infant through adult);

(3) Complete intubation kit, BLS per protocol only:

(a) Extra batteries and bulbs;

(b) Syringes (assorted sizes);

(c) Adult stylet;

(d) Pediatric stylet;

(e) Adult magill forceps;

(f) Pediatric magill forceps;

(g) Booted hemostat or device appropriate clamp;

(h) Adult endotracheal tube set ( one each cuffed 6.0 mm, 7.0 mm, 8.0 mm);

(i) Pediatric endotracheal tube set (one each cuffed or uncuffed 2.5 mm, 3.0 mm, 3.5 mm, 4.0 mm, 4.5 mm, 5.0 mm, 5.5 mm);

(j) Water soluble lubricant ;

(k) Laryngoscope handle;

(l) Laryngoscope blades (curved and straight, sizes 0, 1, 2, 3, 4);

(m) End-tidal CO2 detector or capnometer;

(n) Commercial endotracheal tube securing device;

(4) Cricothyrothomy kit/set, per protocol;

(5) Supraglottic airway devices in adult and pediatric sizes (e.g. LMA, King Airway, Combitube), per protocol.

(D) Bleeding control/burn equipment

(1) Adhesive dressing strips (ten);

(2) Sterile gauze pads (twenty) , assorted sizes;

(3) Surgi pads/sterile sponge pads (four);

(4) Assorted standard gauze rolls (four);

(5) Sterile universal trauma dressing (two);

(6) Sterile non-porous dressing (four);

(7) Assorted tapes (four).

(E) Isolation equipment

(1) Packaged kits (four) or

(a) Isolation goggles and masks or mask/shield combination (four);

(b) Isolation gowns (four);

(c) Isolation gloves (four);

(2) High particulate filter masks (HEPA filter or N95 mask)(four)-assorted sizes;

(3) Containers (bags) for infectious medical waste (four);

(4) Sharps container

(5) Disinfectant/germicidal;

(6) Waterless hand cleaner.

(F) Immobilization equipment

(1) Extremity immobilization devices (e.g. board, air, vacuum, ladder, or an equivalent);

(2) Traction splint (adult and child one each)(or one adjustable for adult and child);

(3) Backboard or equivalent (two);

(4) Backboard straps (three each) per board;

(5) Commercial cervical immobilization device (two)(adult);

(6) Rigid extrication collar [infant, child, adult (small-medium-large)];

(7) Stairchair and/or combination stairchair/folding cot (one).

(G) Adjunct equipment

(1) Trauma shears (one pair);

(2) Stethoscope (one);

(3) BP cuff ;

(a) Pediatric;

(b) Adult;

(c) Large adult;

(4) Non-mercury thermometer (oral or equivalent)(one);

(5) Penlight (one);

(6) Large flashlight (one);

(7) Tongue blades (two);

(8) Eye protector pads (two);

(9) Packaged obstetrical kit (one);

(10) Exam gloves (minimum two full boxes, various sizes);

(11) Patient cot (with three straps);

(12) Pillows and cases (two), sheets (two), heavy blankets (two), (bath blankets shall not be substituted for blankets);

(13) Towels (two);

(14) Emesis basins or equivalent (two);

(15) Urinal or equivalent (one);

(16) Bedpan (one), (ten personal towelettes or equivalent);

(17) ABC fire extinguishers (two)(five pound minimum each)(front and back):

(a) Shall meet mounting requirements of the current national standard;

(b) Shall meet OSHA requirements, 29 C.F.R. 1910.157 for annual maintenance check;

(18) Patient restraints(four);

(19) ANSI II high visibility vest for each crew member-compliant with 23 C.F.R. 634;

(20) Age/weight appropriate pediatric restraining device must be available and utilized per MTO's protocols.

(H) Onboard definitive care equipment

(1) BLS

(a) Approved medications as shown on Ohio state board of pharmacy license/addendum;

(b) Automated external defibrillator (adult and pediatric pads).

(2) Intermediate

(a) Approved medications as shown on Ohio state board of pharmacy license/addendum;

(b) Approved I.V. solutions as shown on Ohio state board of pharmacy license/addendum;

(c) Intravenous equipment

(i) Alcohol and povidone iodine preps (ten each);

(ii) Arm boards (one);

(iii) I.V. administration sets (four);

(iv) I.V. catheters (assorted sizes);

(v) Needles (assorted sizes);

(d) Automated external defibrillator (adult and pediatric pads).

(3) ALS

(a) Approved medications as shown on Ohio state board of pharmacy license/addendum;

(b) Approved I.V. solutions as shown on Ohio state board of pharmacy license/addendum;

(c) Intravenous equipment

(i) Alcohol and povidone iodine preps (ten each);

(ii) Arm boards (one);

(iii) I.V. administration sets (four);

(iv) I.V. catheters (assorted sizes);

(v) Intraosseous needles or kit, per protocol (two);

(vi) Needles (assorted sizes);

(vii) Cricothyroidotomy-needle or surgical, per protocol;

(d) Monitor/defibrillator (with EKG trace) external cardiac pacing capability:

(i) Defibrillator gel or pads;

(ii) Adult paddles/pads, if applicable;

(iii) EKG electrodes and cables;

(iv) External pacing pads;

(v) Pedi-paddles/pads.

(I) Minimum requirements for a non-transport vehicle are:

(1) A working two-way communication system pursuant to rule 4766-2-06 of the Administrative Code;

(2) The permanent display of the company logo, insignia, or name on both sides and rear of vehicle pursuant to paragraph (D)(3) of rule 4766-2-08 of the Administrative Code;

(3) Audible and visual warning devices in accordance with section 4511.24 of the Revised Code;

(4) A permanently mounted fire extinguisher (ABC-minimum five pounds)

(a) Shall meet mounting requirements of the current national standard;

(b) Shall meet OSHA requirements, 29 C.F.R. 1910.157 for annual maintenance check;

(5) First aid kit:

(a) Permanently installed and/or secured;

(b) Shall include:

(i) Adhesive stripes (ten);

(ii) Gauze wraps (two);

(iii) Four inch by four inch bandages (five);

(iv) CPR mask (one);

(v) Trauma shears (one pair);

(vi) Tape one half inch (one roll);

(vii) Antiseptic wipes (four).

(J) A permitted ambulance shall be equipped with (have on-board) all of the equipment set forth in paragraphs (A) to (H) of this rule at any time it is used as an ambulance.

(K) A permitted non-transport vehicle shall be equipped with (have on-board) all of the equipment set forth in paragraph (I) of this rule at any time it is used as a non-transport vehicle.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07
Prior Effective Dates: 07/02/2009

4766-2-11 Use of lights and other warning devices.

(A) Permitted ambulance(s) and non-transport vehicles(s) bearing license plates issued under section 4503.49 of the Revised Code are considered public safety vehicles pursuant to division (E)(1) of section 4511.01 of the Revised Code.

(B) Permitted ambulance(s) and non-transport vehicle(s), when responding to emergency calls, may use emergency lights and audible warning devices pursuant to section 4511.041 of the Revised Code.

Effective: 09/26/2014
Five Year Review (FYR) Dates: 07/11/2014 and 12/22/2016
Promulgated Under: 119.03
Statutory Authority: R.C. 4766.03
Rule Amplifies: R.C. 4766.04 , 4511.041
Prior Effective Dates: 7/2/09

4766-2-12 Temporary and disaster operations.

(A) In the event of a disaster situation when permitted ambulance(s) based in the locality of the disaster situation are incapacitated or insufficient in number to render services needed, a licensed MTO may utilize whatever means necessary to transport and treat patients.

(B) An ambulance or non-transport vehicle that has not been issued a permit by the board may be issued a temporary permit, for a period not to exceed sixty days, if the ambulance or non-transport vehicle is used to replace a permitted ambulance or non-transport vehicle that has been temporarily taken out of service for repair or maintenance . In order to obtain a temporary permit, a MTO shall submit a written application to the board containing:

(1) Vehicle identification number of the permitted ambulance or non-transport vehicle;

(2) Date permitted ambulance or non-transport vehicle was placed out of service;

(3) Vehicle identification number of the ambulance or non-transport vehicle to receive a temporary permit;

(4) Date temporarily permitted ambulance or non-transport vehicle is to be placed in service;

(5) Reason the permitted ambulance or non-transport vehicle was taken out of service.

(C) The licensed MTO shall ensure that the one hundred dollar fee prescribed in paragraph (F) of rule 4766-2-03 of the Administrative Code shall be received by the board within seven days of issuance of a temporary permit.

(D) The MTO shall note the date of return to service of the permitted ambulance or non-transport vehicle on the temporary permit.

(E) The licensed MTO shall return the temporary permit to the board within two days after the permitted ambulance or non-transport vehicle is returned to service.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.07 , 4766.09
Prior Effective Dates: 07/02/2009

4766-2-13 Staffing compliance.

(A) Staffing compliance for a MTO licensed as basic life support, intermediate life support or advanced life support service shall be as follows:

(1) A licensed MTO that responds to a call for medical assistance or patient transport shall ensure that in responding to the call, a minimum of one permitted ambulance and two certified EMTs are dispatched and respond to the call.

(2) A licensed MTO that responds to a call for medical assistance or patient transport shall ensure that any patient transport is done by a permitted ambulance staffed with two certified EMTs on board.

(3) When an ambulance is so staffed as contained herein, the ambulance may be operated by a person who is not certified as an emergency medical technician-basic, emergency medical technician-intermediate, emergency medical technician-paramedic, but said operator shall receive certification in an emergency vehicle operator course prior to operating an ambulance.

(B) Any non-EMS certified personnel who will be driving the ambulance or non-transport vehicle shall complete an emergency vehicle operator course that meets current requirements of the national highway traffic safety administration.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04
Prior Effective Dates: 07/02/2009

4766-2-14 [Rescinded] Regulations for out of state providers.

Effective: 09/26/2014
Five Year Review (FYR) Dates: 07/11/2014
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07 , 4766.13
Prior Effective Dates: 7/2/09

4766-2-15 Changes to be reported to the board.

(A) Each licensed MTO shall give written notification to the board within ten business days of any additions, deletions or changes in:

(1) Executive officers or board members;

(2) Medical director;

(3) Ownership of a licensed MTO.

(B) Within ten days of the date a permitted ambulance or non-transport vehicle is permanently withdrawn from service, the licensed MTO shall return to the board a deletion form prescribed by the board, as published on the board's website at http://omtb.ohio.gov/Forms/Form12.pdf, dated April 16, 2012, and the decal from the right rear window.

(C) Within ten business days of the date a licensed MTO ceases to operate, it shall return to the board all vehicle decals and the certificate of licensure.

(D) Within ten business days of the date a licensed MTO ceases to operate a satellite base, it shall return to the board the certificate of licensure.

(E) A licensed MTO may apply at any time to be licensed at a higher level. The application shall be made on a form prescribed by the board, as published on the board's website at http://omtb.ohio.gov/Forms/Form11.pdf, dated April 16, 2012, and include the one hundred dollar license fee. The MTO shall also ensure compliance with rules 4766-2-04 and 4766-2-08 of the Administrative Code. A change in level of service does not change the expiration date of the license.

(F) A MTO licensed at the intermediate or advanced life support level may apply at any time to be licensed at a lower level. The application shall be made on a form prescribed by the board, as published on the board's website at http://omtb.ohio.gov/Forms/Form11.pdf, dated April 16, 2012, and include the one hundred dollar license fee. The MTO shall also ensure compliance with rules 4766-2-04 and 4766-2-08 of the Administrative Code A change in level of service does not change the expiration date of the license.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07
Prior Effective Dates: 07/02/2009

4766-2-16 Investigations of alleged offenses.

(A) The board may investigate alleged violations of Chapter 4766. of the Revised Code and the rules promulgated thereunder.

(B) Board investigations may include but not be limited to the following:

(1) Interviews of:

(a) Employer;

(b) Employees;

(c) Client;

(d) Health care workers;

(e) Public safety personnel;

(f) General public;

(2) Record review of:

(a) Transportation documentation;

(b) Incident report;

(c) Crash and/or injury report;

(d) First report of injury;

(e) Employee records;

(3) Physical inspection;

(4) Photographs;

(5) Audio recording;

(6) Physician and/or coroner findings;

(7) Written and/or verbal complaints;

(8) Any other item(s) deem appropriate for specific investigation.

(C) The board may issue a violation notification during any inspection or investigation.

(D) The board may, at its discretion, summarily suspend a license under the authority of section 4766.11 of the Revised Code.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.08 , 4766.11
Prior Effective Dates: 07/02/2009

4766-2-17 Grounds for suspension, revocation, or denial of license or permit.

The board may, in compliance with Chapter 119 . of the Revised Code, suspend, revoke, or refuse to issue a license or service permit for any of the following reasons:

(A) Any violation of Chapter 4766. of the Revised Code or the rules promulgated thereunder.

(B) Failure of the MTO to correct violation(s) cited by the inspectors of the board or provide sufficient documentation that MTO is correcting said violation(s) within seventy-two hours of the date of the notification(s).

(C) Making a false statement on the application for a license or permit.

(D) Fraud or deceit in obtaining or attempting to obtain a license or permit.

(E) Lending a license or permit or borrowing or using the license or permit of another, or knowingly aiding or abetting such improper use or transfer of a license or permit.

(F) Incompetence, negligence or misconduct in operating the licensed MTO or in providing emergency medical care to patients.

(G) Failure to have all equipment required in rule 4766-2-10 of the Administrative Code on each in-service ambulance or non-transport vehicle at all times.

(H) Failure to staff each ambulance or non-transport vehicle with appropriate certified, licensed, or emergency vehicle operator trained personnel as defined in rule 4766-2- 13 of the Administrative Code.

(I) Failure of the licensed MTO to notify the board of a change of ownership within three business days of purchase or acquisition.

(J) Abuse or abandonment of a patient.

(K) Unauthorized disclosure of medical or other confidential information.

(L) Willful preparation or filing of false reports or records or the inducement of another to do so.

(M) Alteration or inappropriate destruction of medical records.

(N) Discrimination in the rendering of emergency medical care because of patient's race, sex, creed, national origin, sexual preference, age, handicap, medical problem or financial inability to pay.

(O) Misuse or misappropriation of drugs or medication.

(P) Action by the licensed MTO that is reckless or negligent so as to endanger the health or safety of patients or members of the general public while in the course of business as a licensed MTO.

(Q) Continued pattern of violations.

Effective: 09/26/2014
Five Year Review (FYR) Dates: 07/11/2014 and 12/22/2016
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.05 , 4766.06 , 4766.07 , 4766.08 , 4766.13 and 4766.99
Prior Effective Dates: 7/2/09

4766-2-18 Investigations of alleged offenses.[Rescinded].

Rescinded eff 7-2-09

4766-2-19 Grounds for Suspension, Revocation, or Denial of License or Permit.[Rescinded].

Rescinded eff 7-2-09

4766-2-20 Summary Suspension.[Rescinded].

Rescinded eff 7-2-09

4766-2-21 Equipment Requirements.[Rescinded].

Rescinded eff 7-2-09