Chapter 4766-4 Mobile Intensive Care Units

4766-4-01 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) "Mobile Intensive Care Unit (MoICU)" has the same meaning as mobile intensive care unit as defined in division (O) of section 4766.01 of the Revised Code.

(E) "Neonate" means a newborn beginning at birth and lasting through the twenty-eighth day of life.

(F) "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.

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

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

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

(J) "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.

(K) "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 MoICU or a MoICU for which a permit application is pending.

(L) "Temporary Vehicle" means a MoICU issued a temporary permit used to replace a permitted MoICU in accordance with rule 4766-4-12 of the Administrative Code that is out of service until the permitted agency 4766 of the MoICU is returned to service not to exceed sixty days.

Effective: 04/16/2012
R.C. 119.032 review dates: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.01

4766-4-02 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 4766-4-03 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 to include 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 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 MoICU 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;

(a) 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 4766-4-03 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 that the MTO is authorized to provide.

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

(G) A license is not transferable.

Effective: 04/16/2012
R.C. 119.032 review dates: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.03 , 4766.04 , 4766.07

4766-4-03 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 MoICU(s) or non-transport vehicle of one hundred dollars annually;

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

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

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

Effective: 04/16/2012
R.C. 119.032 review dates: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.05

4766-4-04 Physical facilities.

(A) The board shall conduct initial and renewal inspections of all MTOs pursuant to Chapter 4766. of the Revised Code and rules 4766-4-04, 4766-4-05 , and 4766-4-06 of the Administrative Code to include the following:

(1) MTO service headquarters;

(2) MTO service satellite location(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 4766-4-10 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(s) 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 location(s);

(3) MoICU(s) and non-transport vehicle(s).

Effective: 04/16/2012
R.C. 119.032 review dates: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04

4766-4-05 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) Certification or license 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 45C.F.R. 164.512 ;

(6) Current maintenance records for vehicles as specified in rule 4766-4-09 of the Administrative Code;

(7) Current maintenance records for all equipment used for patient care as specified in rule 4766-4-09 of the Administrative Code;

(8) Dispatch log;

(9) Written plan for restocking of supplies or compliance with paragraph (C)(4) of rule 4766-4-04 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 4766-4-07 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 4766-4-04 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 or licensure 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: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.06

4766-4-06 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 MoICU(s) and non-transport vehicle(s) within the declared service area:

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

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

(B) All permitted MoICU(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;

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

(i) Location of call;

(ii) Nature of call;

(iii) Initial dispatch time;

(iv) Enroute time;

(v) On-scene time;

(vi) Departure from scene time;

(vii) 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: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07

4766-4-07 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: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07

4766-4-08 Vehicle inspections.

(A) The board shall inspect all MoICU(s) and non-transport vehicle(s) for roadworthiness and for appropriate equipment as prescribed in rule 4766-4-10 of the Administrative Code.

(B) In order to qualify for a MoICU permit, a MoICU shall contain the equipment set forth in paragraphs (A) to (H) of rule 4766-4-10 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, a MoICU 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 properly inflates/deflates.

(2) A MTO must demonstrate proof that the MoICU(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 MoICU.

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) 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.

(F) A permit is not transferable.

(G) 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, MoICU(s) and non-transport vehicle(s).

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

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

Effective: 04/16/2012
R.C. 119.032 review dates: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07

4766-4-09 Maintenance documentation.

(A) MoICU 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 MoICU(s) or non-transport vehicle(s)

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

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

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

(c) Reason permitted MoICU 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 permitted MoICU 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

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:

(1) Date of last bio-medical inspection;

(2) Date of service or repair;

(3) Description of service/repair performed;

(4) Name of person who performed inspection, service, or repair;

(5) Documentation, if any, of inspection, service, or repair performed.

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

(D) MoICU 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: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07

4766-4-10 Equipment requirements.

Disposable equipment is acceptable where applicable.

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

(A) Equipment for all MoICUs.

(1) Isolation equipment

(a) Four packaged kits or

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

(ii) Isolation gowns (four);

(iii) Isolation gloves (four);

(b) High particulate filter washes (HEPA filter or N95 mask)(four)-assorted sizes;

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

(d) Sharps container;

(e) Disinfectant/germicidal;

(f) Waterless hand cleaner.

(2) Airway equipment

(a) Complete set of oropharyngeal airway devices: adult, pediatric, and infant

(b) Complete set of nasopharyngeal airway devices: adult, pediatric, and infant

(c) Complete set of intubation equipment: adult, pediatric, and infant:

(i) Extra batteries and bulbs;

(ii) Syringes, assorted sizes;

(iii) Adult stylet;

(iv) Pediatric stylet;

(v) Infant stylet;

(vi) Adult magill forceps;

(vii) Pediatric magill forceps;

(viii) Booted hemostat or device appropriate clamp;

(ix) Adult endotracheal tube set, one each: cuffed 6.0, 7.0, 8.0

(x) Pediatric/infant endotracheal tube set, one each: cuffed or uncuffed 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5

(xi) Water soluble lubricant;

(xii) Laryngoscope handle;

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

(xiv) End-tidal CO2 detector or capnometer;

(d) Needle cricothyrotomy kit, per protocol;

(e) Ventilator circuits (two);

(f) Supraglottic airway devices in adult and pediatric sizes (e.g. LMA, Kin airway, combitube);

(g) Commercial endotracheal securing device.

(3) Definitive equipment

(a) Approved medications, per protocol;

(b) ECG monitor/defibrillator and appropriate pads, adult/pediatric:

(i) One set pediatric paddles/pads;

(c) ECG leads;

(d) External pacemaker and pads;

(e) Hemodynamic monitoring equipment;

(f) Pulse oximeter;

(g) Doppler and gel;

(h) I.V. pumps (two);

(i) Ventilator with minimum of PEEP;

(j) Generator and one hundred ten power source;

(k) Chest tube drainage system.

(4) Bleeding/burns equipment

(a) Adhesive dressing strips (ten);

(b) Gauze pads, (twenty) assorted sizes;

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

(d) Assorted standard gauze rolls (four);

(e) Universal trauma dressings, size ten inch by thirty-six inch (two);

(f) Sterile water and/or 0.9 per cent saline for irrigation (four).

(5) Suction equipment

(a) Wall mounted suction unit;

(b) Portable suction unit, battery operated;

(c) Hard tip suction (e.g., Yankauer) (two);

(d) Soft tip suction catheters set, adult & pediatric sizes;

(e) Suction tubing (two);

(f) Suction liner or equivalent;

(g) Sterile gloves (two pairs).

(6) Medical gas and equipment

(a) Main oxygen (M tank or greater);

(b) Wall mounted oxygen gauge 0-15 L/min. minimum;

(c) Medical grade compressed air with regulator;

(d) Portable oxygen unit -minimum "D" tanks (two);

(e) Portable variable flow regulator 0-15 L/min. minimum;

(f) Bag-valve-mask with reservoir one hundred per cent oxygen flow:

(i) Adult (two);

(ii) Pediatric (two);

(iii) Infant (two);

(g) Transparent oxygen masks, simple and non rebreather:

(i) Adult (two);

(ii) Pediatric (two);

(iii) Infant (two);

(h) Nasal cannulas:

(i) Adult (two);

(ii) Pediatric (two);

(iii) Infant (two);

(i) Oxygen connective tubing and appropriate adapters;

(j) Nebulizers and appropriate connecting tubing (two);

(k) Any compressed gasses must have shut off access from the patient care compartment.

(7) Adjunct equipment

(a) Trauma shears (one);

(b) Stethoscope;

(c) B/P cuffs:

(i) Infant;

(ii) Pediatric;

(iii) Adult;

(iv) Large adult;

(d) Thermometer;

(e) Penlight;

(f) Flashlight;

(g) Tongue blades (two);

(h) Patient cot with three straps/isolette with two straps appropriate for age/weight as defined by MTO's protocols;

(i) Eye shields or eye protector pads (two);

(j) Assorted tape (four);

(k) Exam gloves, one box each of small-medium-large or one box of uni-size;

(l) Emesis basins or equivalent (two);

(m) Obstetrical kit;

(n) Urinal or equivalent;

(o) Bed pan (one)(ten personal towelettes or equivalent);

(p) Two ABC fire extinguisher, five pound minimum, front and back;

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

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

(q) Nasogastric tubes, adult and pediatric sizes;

(r) Patient restraints (four);

(s) Hot and cold packs (two each);

(t) Pillows and cases (two);

(u) Sheets (two);

(v) Heavy blankets (two);

(w) Towels (two);

(x) Water soluble lubricant (one);

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

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

(8) Intravenous equipment

(a) Disinfecting preps (ten);

(b) Short arm boards (two);

(c) IV administration sets (four):

IV infusion pump tubing (four);

(d) IV catheters, assorted sizes;

(e) Intraosseous needles (two) and three-way stopcocks (two);

(f) Needles, assorted sizes;

(g) IV solutions (two), per protocol;

(h) Associated adjunct equipment:

(i) Invasive line set-up (two);

(ii) Pressure bags (two).

(9) Additional necessary equipment specific to neonatal MoICUs

(a) Infant head hoods (two)

(b) Infant transport isolette readily available

(c) Infant laryngoscope straight blade size double zero

(d) Neonatal blood pressure cuffs sizes one, two, three, and four

(e) Neonatal nasogastric tubes, assorted sizes

(f) Neonatal chest tubes assorted sizes

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

(1) A working two-way communication system pursuant to rule 4766-4-06 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 (A)(4) of rule 4766-4-08 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).

(C) A permitted MoICU shall be equipped with (have on board) all of the equipment set forth in paragraphs (A)(1) to (A)(8) of this rule at any time it is used a MoICU.

(1) For neonatal transports, in addition to the equipment set forth in paragraphs (A)(1) to (A)(8) of this rule, the MoICU shall contain the equipment set forth in paragraph (A)(9) of this rule.

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

Effective: 04/16/2012
R.C. 119.032 review dates: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.03 , 4766.04 , 4766.07

4766-4-11 Use of lights and other warning devices.

(A) Permitted MoICU(s) and non-transport vehicle(s) are considered public safety vehicles pursuant to division (E)(1) of section 4511.01 of the Revised Code.

(B) Permitted MoICU(s) and non-transport vehicle(s), when responding to emergency calls, may use emergency lights and audible warning devices pursuant to section 4511.24 of the Revised Code.

Effective: 04/16/2012
R.C. 119.032 review dates: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.07 , 4511.24

4766-4-12 Temporary and disaster operations.

(A) In the event of a disaster situation when permitted MoICU(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) A MoICU 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 MoICU or non-transport vehicle is used to replace a permitted MoICU 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 MoICU or non-transport vehicle;

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

(3) Vehicle identification number of the non-permitted MoICU or non-transport vehicle;

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

(5) Brief description of reason the permitted MoICU or non-transport vehicle was taken out of service.

(C) The licensed MTO shall ensure that the one hundred dollar fee prescribed in paragraph (E) of rule 4766-4-03 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 MoICU 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 MoICU or non-transport vehicle is returned to service.

Effective: 04/16/2012
R.C. 119.032 review dates: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.09

4766-4-13 Staffing compliance.

(A) MoICU transport team shall consist of three personnel: a driver operator and two other healthcare personnel as described herein;

(1) Driver operator means:

(a) A person who has successfully completed and passed an emergency vehicle operator course that meets requirements of national highway and traffic safety administration; or

(b) A person who is certified as an Ohio emergency medical technician.

(2) Healthcare personnel means one each of the following:

(a) A registered nurse whose training meets or exceeds the training required for a paramedic; and

(b) A physician or another person designated by a physician, who holds a valid license or certificate to practice in a health care profession.

Effective: 04/16/2012
R.C. 119.032 review dates: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.03 , 4766.04

4766-4-14 Regulations for out of state providers.

The exemption from licensure in division (B) of section 4766.09 of the Revised Code exempts out of state providers receiving a patient in Ohio for transport to a location not within Ohio or when transporting a patient received in another state. An out of state provider that receives a patient in Ohio for transportation to a location in Ohio shall be licensed and is subject to Chapter 4766. of the Revised Code and rules under this chapter and to all applicable fines and sanctions for any violation thereof.

Effective: 04/16/2012
R.C. 119.032 review dates: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.13

4766-4-15 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 MoICU 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 MTO licensed at the MoICU 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: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07

4766-4-16 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;

(f) Physical inspection;

(g) Photographs;

(h) Audio recording;

(i) Physician and/or coroner findings;

(j) Written and/or verbal complaints;

(k) 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: 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.08 , 4766.11

4766-4-17 [Rescinded]Changes to be reported to the board.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2011
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07
Prior Effective Dates: 04/18/2005

4766-4-18 [Rescinded]Investigation of alleged violations.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2011
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.08 , 4766.11
Prior Effective Dates: 04/18/2005

4766-4-19 [Rescinded]Grounds for suspension, revocation, or denial of license or permit.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2011
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.05 , 4766.06 , 4766.07 , 4766.08 , 4766.13 , 4766.99
Prior Effective Dates: 04/18/2005

4766-4-20 [Rescinded]Summary suspension.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2011
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.11
Prior Effective Dates: 04/18/2005

4766-4-21 [Rescinded]Equipment for adult MoICU.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2011
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07
Prior Effective Dates: 04/18/2005

4766-4-22 [Rescinded]Equipment for pediatric MoICU.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2011
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07
Prior Effective Dates: 04/18/2005

4766-4-23 [Rescinded]Equipment for neonatal MoICU.

Effective: 04/16/2012
R.C. 119.032 review dates: 12/22/2011
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04 , 4766.07
Prior Effective Dates: 04/18/2005