Chapter 4766-5 Medical Transportation
(A) "Air Operator" means the federal aviation administration part 135 certificate holder.
(B) "Aircraft" means either or both of the following:
(1) Fixed wing air ambulance;
(2) Rotorcraft air ambulance.
(C) "AMSO" means air medical service organization as defined in division (B) of section 4766.01 of the Revised Code.
(D) "Board" means the Ohio medical transportation board as described in section 4766.02 of the Revised Code.
(E) "FAA" means the federal aviation administration.
(F) "FAR" means the federal air regulation.
(G) "FCC" means the federal communication commission.
(H) "Headquarters" means the location which a licensee operates, designated by the licensee as the location where the records described in this chapter are required to be maintained or readily available.
(I) "Health Care Profession" means the occupation of:
(1) Physician assistant;
(3) Registered nurse;
(4) Respiratory care professional;
(5) Emergency medical technician paramedic.
(J) "IFR" means flight under instrument flight rules.
(K) "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.
(L) "Part 135 Certificate" means a certificate issued to the air operator by the FAA setting forth the air operating requirements for commuter and on-demand air operations and rules governing persons on board such aircraft.
(M) "Pilot in Command (PIC)" means the pilot with the final authority and responsibility for operation and safety of the flight.
(N) "Primary Aircraft" means an aircraft permitted in accordance with section 4766.07 of the Revised Code.
(O) "Satellite Base" means a physical location other than headquarters from which a licensee operates.
(P) "Second in Command (SIC)" means a pilot who is designated to be second in command of an aircraft during flight time.
(Q) "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.
(R) "Service Code" has the same meaning as service number.
(S) "Temporary Aircraft" means an aircraft used to temporarily replace a primary aircraft that is out-of-service until the primary aircraft is returned to service.
(T) "Temporary Aircraft Permit" means a permit issued by the board to enable an AMSO to use a temporary aircraft to replace a specific primary aircraft that is out-of-service which expires on the same date as the permit issued to the specific primary aircraft.
(U) "VFR" means flight under visual flight rules.
An applicant shall complete the application in the English language.
(A) An AMSO applying for licensure shall file with the board an application on the form prescribed by the board and shall submit the completed application to the board accompanied by the appropriate fee as defined in rule 4766-5-03 of the Administrative Code.
(B) In addition to the requirements set forth in section 4766.04 of the Revised Code, for each application the AMSO applicant shall provide:
(1) The name of applicant to include:
(a) All names that applicant plans to operate under including but not limited to trade name(s), dba(s), registered with the Ohio secretary of state;
(b) Address of AMSO's headquarters;
(c) Mailing address of applicant;
(2) All medicare provider numbers, all medicaid providers numbers;
(3) Type of organization and geographical service areas including county and state;
(4) A list of the names and addresses of all officers, directors, and/or owners of the AMSO;
(5) The name, address and physician license number of Ohio program medical director as specified in rule 4765-1-01 of the Administrative Code;
(6) For each satellite base, the AMSO 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, aircraft hours on airframe, and tail number;
(9) A color photograph of the side of the aircraft 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 encouraged.);
(10) A current certificate of liability insurance listing OMTB 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;
(11) Type of entity, including but not limited to, corporation, partnership, and sole proprietorship as registered with the Ohio secretary of state.
(C) Each AMSO shall pay the appropriate fees as specified in rule 4766-5-03 of the Administrative Code.
(D) If an application for licensure is incomplete, the board will notify the AMSO 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 AMSO 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.
(A) An AMSO shall pay a license fee of one hundred dollars annually.
(B) An AMSO shall pay a permit fee of one hundred dollars annually for each aircraft that it seeks to have permitted.
(C) An AMSO shall pay an annual inspection fee of one hundred dollars per aircraft.
(D) An AMSO shall pay a one hundred dollar reinspection fee for every aircraft that requires reinspection as a result of a deficiency issued by the board.
(E) If the AMSO fails to make an aircraft available for inspection as previously established between the AMSO and the board, the inspection fee shall be one hundred dollars for every occasion the aircraft is not made available for inspection. The board may waive this inspection fee if the AMSO appeals to the board and provides sufficient proof that the aircraft was on a patient transport.
(A) An AMSO shall ensure compliance with the inspection requirements for physical facilities. The inspection requirments for physical facilities of an AMSO are as follows:
(1) The physical facilities shall be clean and free of debris;
(2) Board issued license(s) shall be prominently displayed in conspicuous location(s) at every licensed facility;
(3) Crew quarters shall be clean;
(4) The physical facilities shall be compliant with local building codes;
(5) The physical facilities shall be compliant with fire codes;
(6) Ohio state board of pharmacy license(s) shall be displayed;
(7) A written sanitation plan shall be on site;
(8) The physical facilities shall maintain all single use supplies and equipment as set forth in rule 4766-5-22 of the Administrative Code.
(B) The board may conduct announced and unannounced inspections at any location a licensed AMSO operates at any time, including nights or weekends to determine compliance with Chapter 4766. of the Revised Code and rules promulgated thereunder.
(C) Upon licensure, each AMSO shall prominently display its original certificate of licensure at its headquarters and satellite locations.
(D) An AMSO license is not transferable.
(A) All aircraft to be permitted shall be made available for inspection.
(B) Except as otherwise provided in this chapter, no AMSO shall operate an aircraft without obtaining a permit from the board. In addition to submitting the appropriate fee and application to obtain a permit, an aircraft must meet or comply with the following inspections requirements:
(1) A standardized insignia, monogram or other distinguishing characteristices of the AMSO shall be displayed on each rotorcraft air ambulance. If an AMSO is under contract which requires other signage, the AMSO's name and service code shall be permanently affixed with each letter being at a minimum of three inches in height on both sides of the air ambulance;
(2) FAA airworthiness certificate shall be readily available upon request by the board;
(3) Contain/possess all applicable equipment set for in rule 4766-5-22 of the Administrative Code.
(C) An AMSO shall ensure that all aircraft permits are displayed in a manner that complies with all applicable federal aviation regulations and in accordance with division (B)(3) of section 4766.07 of the Revised Code on each aircraft.
(1) A licensed AMSO shall maintain accurate records that contain the information set forth in paragraph (A)(3) of this rule concerning the transportation of each patient for a period of five years from the date of the transport;
(2) An AMSO shall make all records required to be maintained under this rule available to the board for review during an inspection in accordance with 45 C.F.R. 164.512 ;
(3) The information shall include:
(a) Patient name;
(d) Date of birth;
(f) Location of incident;
(g) Patient's chief complaint;
(h) Patient's history;
(i) List of patient's current medications, route, dosage, administration schedule;
(j) Patient's allergies and reaction;
(k) Vital signs as appropriate;
(l) Responsible guardian;
(m) Advanced directives, if available;
(n) Beginning location and final destination;
(o) Treatment rendered;
(p) Time interventions and treatments performed;
(q) Time call received, as applicable;
(r) Time dispatched, as applicable;
(s) Time enroute, as applicable;
(t) Estimated time of arrival (ETA);
(u) Time on-scene, as applicable;
(v) Time departed, as applicable;
(w) Time at receiving facility, as applicable;
(x) Time in-service, as applicable;
(y) Names and level of certification or licensure of medical personnel;
(z) Pilot(s) name(s);
(aa) Date of service;
(bb) Fuel on-board;
(cc) Number of souls on-board;
(dd) Estimated flight time, if applicable;
(4) An AMSO shall be responsible for ensuring that a copy of the medical record for each patient is provided to the receiving facility.
(B) An AMSO shall maintain at each location, as applicable, the following:
(1) Ohio state board of pharmacy licenses;
(2) DEA registration(s);
(3) Air operator part 135 certificate;
(4) Evidence of appropriate insurance as defined in section 4766.06 of the Revised Code;
(5) Verification of employee certfication and licenses;
(6) Statutorily required permits and licenses such as fuel permits, oil permits, hazardous waste;
(7) Original certificate of licensure issued by the board;
(8) Emergency contact list with telephone numbers;
(9) Copy of written sanitation plan as described in rule 4766-5-11 of the Administrative Code.
(A) All licensed AMSO communication centers shall be equipped with a base station capable of two-way communications with associated radios on an assigned frequency. This channel will be used exclusively for dispatch and tactical communications and shall be independent of any involvement in the Ohio emergency radio network. The communication center shall demonstrate and maintain a voice communications linkage with the radios used in the permitted aircraft within the declared service area. All licensed AMSOs shall be responsible for and ensure compliance with the following requirements:
(1) The base station must be hard-wired;
(2) A hand held battery operated base station used as primary source of communication is prohibited;
(3) The base station must be manned during all phases of aircraft operations;
(4) All in-coming and out-going telephone and radio transmissions regarding medical transports shall be recorded on a system with time recording and playback capabilities. Recordings must be kept for at least thirty days from the day of recording and be made available to the board upon request.
(5) An emergency plan for communications during power outages and in disaster situations shall be established;
(6) Service area maps and/or navigational charts or mapping software shall be readily available.
(B) All permitted aircraft shall be equipped with two-way communications capable of communication with the licensed AMSO's communication center, air traffic control, and medical control:
(1) The pilot shall be able to control and override radio transmissions from the cockpit in the event of an emergency situation;
(2) Medical team members shall be able to communicate with each other during flight. Rotorcraft air ambulance medical personnel must wear headsets and/or helmets with communications capabilities during medical transport;
(3) If cellular telephones or other such communications are used on board the aircraft, they are to be used in accordance with FCC regulations (Code of Regulations 47, Parts 20-39, Section 22.925 ; October 1, 1996);
(a) Cellular telephones must be shut off whenever the aircraft leaves the ground;
(b) A notice shall be posted in the aircraft indicating cellular telephone use while airborne is prohibited.
(C) All licensed AMSOs shall maintain a detailed radio log that documents the following:
(1) Time call received;
(2) Location of call, requesting agency;
(3) Nature of call;
(4) Initial dispatch time;
(5) Time enroute, as applicable;
(6) Time on-scene, as applicable;
(7) Departure from scene time;
(8) Arrival at destination time;
(9) Souls on-board.
(D) Radio equipment used in permitted aircraft shall meet the requirements specified in paragraph 90.203 of the federal communications commission and all federal aviation administration rules and regulations.
(A) An AMSO shall comply with all occupational safety and health administration, bloodborne pathogens regulations pertaining to the sanitation and maintenance of licensed bases and aircraft in accordance with 29 C.F.R. 1910.1030 .
(B) An AMSO shall create and utilize a written sanitation plan describing its sanitation procedures that conforms to the current standards of the occupational safety and health administration regarding bloodborne pathogens and other communicable diseases for each of its bases and aircraft.
(C) An AMSO shall provide a copy of its santitation plan to all of its personnel in a written document that conforms to the current standards as set forth in the occupational safety and health administration bloodborne pathogens protocol.
(A) An AMSO shall ensure that all permitted aircraft shall be in compliance at all times with FAA regulations pertaining to safety and maintenance with operating specifications of the part 135 certificate holder under which the AMSO operates.
(B) Bio-medical equipment
An AMSO shall maintain documentation of all periodical maintenance and repairs of bio-medical equipment as required by the manufacturer and/or food and drug administration for a period of two years from date of repair or maintenance including but not limited to the following:
(1) Date of last bio-medical inspection;
(2) Date of service or repair;
(3) Description of service or repair performed;
(4) Documentation of who performed inspection, service, or repair.
All AMSOs must comply with the staffing requirements under section 4766.17 of the Revised Code.
(A) No AMSO shall operate an aircraft without a permit issued in accordance with section 4766.07 of the Revised Code, a temporary permit issued in accordance with this section, or in the event of a disaster situation.
(B) An AMSO may obtain a temporary permit by submitting an executed temporary aircraft permit affidavit on a form prescribed by the board. The temporary aircraft permit affidavit shall include assertions that the AMSO shall:
(1) Use the temporary permit for the sole purpose of temporarily replacing the specific primary aircraft that is out-of-service;
(2) Clearly and conspicuously display the temporary permit on any temporary aircraft used by the AMSO;
(3) Immediately remove the temporary permit from the temporary aircraft upon the return to service of the primary aircraft;
(4) Ensure that any temporary aircraft used by the AMSO will be equipped in accordance with the requirements of rule 4766-5-22 of the Administrative Code.
(5) Not use the temporary permit for any purpose when the primary aircraft is in service.
(C) The AMSO shall complete and maintain a log for the temporary permit at any time the temporary permit is used by or removed from a temporary aircraft.
(D) The board shall create a temporary aircraft permit which shall contain a log form to be completed by the AMSO at any time the temporary permit is used by or removed from a temporary aircraft.
(E) An AMSO shall ensure that:
(1) A temporary permit is used only to replace the specific primary aircraft that is out-of-service;
(2) The temporary permit is conspicuously displayed on the temporary aircraft used by the AMSO;
(3) Upon return to service of any primary aircraft, the temporary permit used on a temporary aircraft must be removed immediately;
(4) Any temporary permit not in use shall be stored and made readily available to the board upon request;
(5) The log form on the temporary permit is completed at any time the temporary permit is used by or removed from a temporary aircraft;
(6) No temporary permit shall be used when the specific primary aircraft is in service.
(A) A licensed AMSO shall give written notification to the board within ten business days of any additions, deletions or changes in:
(1) Treatment or transport protocols;
(2) Executive officers, board members, or owners;
(3) FCC license modifications;
(4) Medical director;
(5) Purchase or acquisition of a licensed organization.
(B) Within ten days of the date a permitted aircraft is permanently withdrawn from service, a licensed AMSO shall return to the board a completed deletion form prescribed by the board and the permit decal that was required to be displayed on the aircraft.
(C) If an AMSO operates or plans to operate in move than one location under the same or different identities, the AMSO shall apply for on a form prescribed by the board and meet all requirements for licensure or renewal of a license, other than payment of a license fee or renewal fee, for operating at each separate location.
(D) Within ten days of the date a licensed AMSO ceases to operate a satellite location, it shall return to the board the certificate of licensure.
(E) Within ten days of the date a licensed AMSO ceases to operate, it shall return to the board all aircraft permits and certificates of licensure.
(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:
(d) Health care professionals;
(e) Public safety personnel;
(f) General public;
(2) Record review:
(a) Transportation documentation;
(b) Incident report;
(c) Crash and/or injury report;
(d) First report of injury;
(e) Employee records;
(3) Physical inspection;
(5) Audio recording;
(6) Physician and/or coroner findings;
(7) Written and/or verbal complaints;
(8) Factual evidence;
(9) Any other item(s) deemed appropriate for specific investigations.
(C) The board may issue a violation notification during any inspection or investigation.
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 organization to correct violation(s) cited by the inspectors of the board or provide sufficient documentation that the organization is correcting said violation(s) within seventy-two hours of the date of the notification.
(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) Incompetence, negligence, or misconduct in operating the licensed organization or in providing emergency medical care to patients.
(F) Failure to have all equipment required in rule 4766-5-22 of the Administrative Code, appropriate to the level of licensure on each in-service aircraft at all times.
(G) Failure to staff each aircraft with a sufficient number of certified or licensed personnel as defined in rule 4766-5-13 of the Administrative Code.
(H) Failure of the licensed organization to notify the board of a change of ownership within ten business days of purchase or acquisition.
(I) Abuse or abandonment of a patient.
(J) Unauthorized disclosure of medical or other confidential information.
(K) Willful preparation or filing of false reports or records, or the inducement of another to do so.
(L) Alteration or inappropriate destruction of medical records.
(M) Discrimination in the rendering of medical services because of patient's race, sex, creed, national origin, sexual preference, age, handicap, medical problem or financial inability to pay.
(N) Misuse or misappropriation of drugs or medication.
(O) Action by the licensed organization 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 organization.
(P) Continued pattern of violations.
The board may, at its discretion, summarily suspend a license under the authority of section 4766.11 of the Revised Code.
Air ambulances shall carry all equipment and supplies listed herein.
Disposable equipment is acceptable where applicable.
All equipment and supplies shall have current expiration dates where applicable.
(A) Isolation equipment:
(1) Four packaged kits or
(a) Isolation goggles and masks or mask/shield combination (four);
(b) Isolation gowns (four);
(c) Isolation gloves(four);
(2) High particulate filter washes (HEPA filter or N95 mask (four))-assorted sizes;
(3) Containers (bags) for infectious medical waste (four);
(4) Sharps container;
(6) Waterless hand cleaner.
(B) Airway equipment
(1) Complete set of oropharyngeal airway devices: adult, pediatric, and infant;
(2) Complete set of nasopharyngeal airway devices: adult, pediatric, and infant;
(3) Complete set of intubation equipment-adult, pediatric, and infant:
(a) Extra batteries and bulbs;
(b) Syringes, assorted sizes;
(c) Adult stylet;
(d) Pediatric stylet; (e) Infant stylet;
(f) Adult magill forceps;
(g) Pediatric magill forceps;
(h) Booted hemostat or device appropriate clamp;
(i) Adult endotracheal tube set, one each: cuffed 6.0, 7.0, 8.0;
(j) Pediatric/infant endotracheal tube set, one each: cuffed or uncuffed 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5;
(k) Water soluble lubricant;
(l) Laryngoscope handle;
(m) Laryngoscope blades, curved and straight, sizes 0-1-2-3;
(n) End-tidal CO2 detector or capnometer;
(4) Advanced airway procedure kit, as applicable.
(C) Definitive equipment
(1) Approved medications;
(2) ECG monitor/defibrillator and appropriate pads:
(3) External pacemaker and pads;
(4) Pulse oximeter:
(5) Doppler and gel;
(6) Inverter for a one hundred ten volt power source;
(7) Spare batteries as appropriate for powered medical devices;
(D) Bleeding/burns equipment
(1) Gauze pads;
(2) Sterile sponge pads;
(3) Universal trauma dressings.
(E) Suction equipment
(1) Wall mounted suction unit;
(2) Portable suction unit powered or hand operated;
(3) Hard tip suction;
(4) Soft tip suction catheters set:
(a) Adult sizes;
(b) Pediatric sizes;
(5) Suction tubing;
(6) Suction bags (package) or equivalent;
(7) 5, 6, 7 French suction catheter;
(8) Sterile gloves.
(F) Oxygen equipment
(1) Main oxygen (M tank or greater);
(2) Wall mounted oxygen gauge 0-15 L/min. minimum;
(3) Compressed air as appropriate;
(4) Portable oxygen unit-minimum "D" tanks;
(5) Portable variable flow regulator 0-15 L/min. minimum;
(6) Bag-valve-mask with reservoir one hundred per cent oxygen flow:
(7) Transparent oxygen masks, simple and non rebreather:
(8) Nasal cannulas:
(9) Oxygen connective tubing and appropriate adapters;
(10) Oxygen humidifier/nebulizer and appropriate connecting tubing;
(11) Infant bag valve mask;
(12) Infant oxygen mask.
(G) Adjunct equipment
(1) Trauma shears;
(3) B/P cuffs:
(d) Large adult;
(6) Tongue depressors;
(7) Patient cot with three straps;
(8) Patient hearing protection, rotorcraft air ambulance only;
(9) Assorted tape;
(10) Exam gloves;
(11) Obstetrical kit;
(12) Nasogastric tubes:
(a) Adult sizes;
(b) Pediatric sizes;
(13) Patient restraints;
(14) Hats for neonates;
(15) Chemical warming mattress if no isolette;
(16) Pediatric restraining system.
(H) Intravenous equipment
(1) Alcohol or betadine preps;
(2) IV administration sets:
IV infusion pump tubing;
(3) IV catheters and butterfly needles, assorted sizes 24-14;
(4) Intraosseous needles;
(5) Needles, assorted sizes;
(6) IV solutions, per protocol;
(7) Associated adjunct equipment:
(a) Invasive line set-up;
(b) Pressure bags;
(c) Survival kit.