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The Oregon Administrative Rules contain OARs filed through May 15, 2017
 
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OREGON HEALTH AUTHORITY,
PUBLIC HEALTH DIVISION

 

DIVISION 250

AMBULANCE SERVICE LICENSING

333-250-0000 [Renumbered to 333-250-0200]

333-250-0010 [Renumbered to 333-250-0205]

333-250-0020 [Renumbered to 333-250-0210]

333-250-0030 [Renumbered to 333-250-0215]

333-250-0040 [Renumbered to 333-250-0250]

333-250-0041 [Renumbered to 333-250-0270]

333-250-0043 [Renumbered to 333-250-0280]

333-250-0046 [Renumbered to 333-250-0290]

333-250-0047 [Renumbered to 333-250-0300]

333-250-0050 [Renumbered to 333-250-0340]

333-250-0060 [Renumbered to 333-250-0370]

333-250-0070 [Renumbered to 333-250-0400]

333-250-0080 [Renumbered to 333-250-0240]

333-250-0200

Effective Date and Preemption

(1) No person shall operate an ambulance service unless issued an ambulance service license by the Oregon Health Authority, Public Health Division.

(2) These rules preempt any local ambulance ordinances and county ambulance service area plans that are in conflict. This rule does not prevent a city or county from establishing requirements more stringent than those set forth in these rules.

Stat. Auth.: ORS 682.017
Stats. Implemented: ORS 682.017 - 682.117 & 682.991
Hist.: HD 18-1994, f. 6-30-94, cert. ef. 7-1-94; OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; Renumbered from 333-250-0000, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0205

Definitions

(1) "Advertise" means to communicate information to the public, or to any person concerned, by any oral, written, or graphic means including, but not limited to, pamphlets, newspapers, television, billboards, radio, Internet and telephone directories.

(2) "Agent" has the same meaning given that term in OAR 847-035-0001.

(3) "Ambulance" or "Ambulance Vehicle" means any privately or publicly owned motor vehicle, aircraft, or watercraft that is regularly provided or offered to be provided for the emergency transportation of persons who are ill or injured or who have disabilities.

(4) "Ambulance Based Clinician":

(a) Means a registered nurse, physician, or physician assistant who:

(A) Has an active license in Oregon and is in good standing with the Oregon Board of Nursing or the Oregon Medical Board; and

(B) Staffs an ambulance for a licensed ambulance service.

(b) Includes an EMS medical director or agent that staffs an ambulance.

(5) "Ambulance Service" means a person, governmental unit, or other entity that operates ambulance(s) and that holds itself out as providing prehospital care or medical transportation to persons who are ill or injured or who have disabilities.

(6) "Ambulance Service Administrator" means an individual responsible for the professional, supervisory and administrative work in the operation of the ambulance service and its staff.

(7) "Ambulance Service Area (ASA)" means a geographic area served by one ground ambulance service provider, and may include all or portion of a county, or all or portions of two or more contiguous counties.

(8) "Ambulance Service License" means the documents issued by the Authority to the owner of an ambulance service when the service is found to be in compliance with ORS chapter 682; OAR chapter 333, division 255 and these rules.

(9) "Authority" means the Emergency Medical Services and Trauma Systems Program, within the Oregon Health Authority.

(10) "Business Day" means Monday through Friday when the Authority is open for business, excluding holidays.

(11) "Emergency Care" means the performance of acts or procedures under emergency conditions in the observation, care and counsel of persons who are ill or injured or who have disabilities; in the administration of care or medications as prescribed by a licensed physician, insofar as any of these acts is based upon knowledge and application of the principles of biological, physical and social science as required by a completed course utilizing an approved curriculum in prehospital emergency care. However, "emergency care" does not include acts of medical diagnosis or prescription of therapeutic or corrective measures.

(12) "EMS" means Emergency Medical Services.

(13) "EMS Medical Director" has the same meaning as "Supervising physician" in ORS 682.025.

(14) "Emergency Medical Services Provider (EMS provider)" has the meaning given that term in ORS 682.025.

(15) "Employee" means any full-time paid or part-time paid person acting within the scope of his or her duties and for or on behalf of an ambulance service.

(16) "Fraud or Deception" means the intentional misrepresentation or misstatement of a material fact, concealment of or failure to make known any material fact or any other means by which misinformation or false impression is knowingly given.

(17) "Non-emergency Care" means the performance of acts or procedures on a patient who is not expected to die, become permanently disabled or suffer permanent harm within the next 24-hours, including but not limited to observation, care and counsel of a patient and the administration of medications prescribed by a physician licensed under ORS chapter 677, insofar as any of those acts are based upon knowledge and application of the principles of biological, physical and social science and are performed in accordance with scope of practice rules adopted by the Oregon Medical Board in the course of providing prehospital care as defined in this rule.

(18) "Owner" means the person having all the incidents of ownership in an ambulance service or an ambulance or where the incidents of ownership are in different persons, the person, other than a security interest holder or lessor, entitled to the possession of an ambulance vehicle or operation of an ambulance service under a security agreement or a lease for a term of 10 or more successive days.

(19) "Paramedic" means a person who is licensed by the Authority as a Paramedic.

(20) "Patient" means a person who is ill or injured or who has a disability and who is transported in an ambulance.

(21) "Patient Care Report (PCR)" means an Authority-approved form or electronic field data format that is completed by an EMS provider or ambulance based clinician for all patients receiving prehospital assessment, care or transportation to a medical facility.

(22) "Person" has the meaning given that term in ORS 174.100.

(23) "Physician" means a person licensed under ORS chapter 677, actively registered and in good standing with the Oregon Medical Board as a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO).

(24) "Prehospital Care" means care rendered by EMS providers as an incident of the operation of an ambulance and care rendered by EMS providers as incidents of other public or private safety duties, and includes, but is not limited to "emergency care" as defined in this rule.

(25) "Procedure" means a written, dated and signed course of action to carry out a directive. A procedure must be able to answer the questions; who, what, why, when and where.

(26) "Qualified Driver" means someone who is not licensed by the Authority and who meets Authority requirements to operate a ground ambulance.

(27) "Volunteer" means a person who is not compensated for their time to staff an ambulance or EMS agency, but who may receive reimbursement for personal expenses incurred.

Stat. Auth.: ORS 682.017
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: HD 18-1994, f. 6-30-94, cert. ef. 7-1-94; OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 11-2010, f. 6-30-10, cert. ef. 7-1-10; PH 1-2013, f. & cert. ef. 1-25-13; Renumbered from 333-250-0010, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0210

Application for an Ambulance Service License

(1) Any person who furnishes, operates, conducts, maintains, advertises, engages in, proposes to engage in, or professes to engage in the provision of ambulance service must be licensed by the Authority and comply with ORS chapter 682; OAR chapter 333, division 255 and these rules before offering such service to the public.

(2) An applicant for an ambulance service license must:

(a) Possess at least one ambulance, facilities, equipment, and a communications system meeting the requirements of these rules and OAR chapter 333, division 255;

(b) Have adequate staffing that supports the type of service, local call volume and the needs of the area as approved by the Authority; and

(c) Comply with all applicable state and federal regulations if laboratory tests are conducted by the ambulance service.

(3) An application for a license to operate an ambulance service shall be submitted electronically in a manner prescribed by the Authority and shall include, but is not limited to, the following information:

(a) The name and address of the person or public entity owning the ambulance service;

(b) If other than the applicant's true name, the name under which the applicant is doing business;

(c) A corporation, limited partnership, or limited liability company shall attach to the application:

(A) A written statement from the Oregon Secretary of State's Corporation Division that the ambulance service is registered in accordance with the requirements of the Secretary of State's Corporation Division and that the ambulance service is in good standing, has filed required annual reports and has paid all registration fees;

(B) The name of the registered agent of the ambulance service that is on file with the Secretary of State's Corporation Division; and

(C) All trade names recorded with the Secretary of State's Corporation Division for the business entity, and if the business entity is a subsidiary, all trade names or names of all other subsidiaries recorded with the Secretary of State's Corporation Division.

(d) A public agency shall attach to the application documentation from an applicable local city or county agency authorizing operation as an ambulance service;

(e) Documentation clearly defining the organizational structure including responsibility, authority and chain of command for all necessary functions within the organization;

(f) The name of the principal contact person that the ambulance service wants contacted regarding official communications from the Authority, if different than the person identified in subsection (3)(a) of this rule;

(g) The mailing and actual street address of the principal place of business of the ambulance service and the actual street address of all fixed locations where an ambulance is parked when not in operation;

(h) Proof of financial responsibility as specified in ORS 682.105;

(i) Copies of all licenses issued by the Federal Communications Commission (FCC) for the operation of the ambulance service's communications equipment and radio configuration data as required by OAR 333-250-0290 or written authorization from a FCC license holder to use the license holder's frequencies;

(j) If laboratory tests are conducted that require a Clinical Laboratory Improvement Amendment (CLIA) Certificate or CLIA Certificate of Waiver, a copy of the certificate(s);

(k) A copy of the licensed ambulance service's Air Carrier Operating Certificate, if the service will be operating an air ambulance;

(l) Copies of all primary modes of advertising used by an ambulance service, including but not limited to, brochures and website addresses;

(m) A copy of the PCR;

(n) The name of the approved EMS medical director and any designated agent(s) meeting the requirements in OAR 333-250-0300;

(o) A roster of all EMS providers, ambulance based clinicians, and qualified drivers specifying who shall either operate an ambulance or attend to patients, or both, along with the following information for each employee and volunteer:

(A) The full legal name;

(B) The employment status as either full-time paid, part-time paid or volunteer;

(C) The level of professional license held; and

(D) License numbers, including EMS provider license numbers, driver and pilot license numbers for those persons operating the ambulance.

(p) A list of all ambulances to be operated by the ambulance service under the ambulance service license along with photos and the information required for an ambulance license pursuant to OAR chapter 333, division 255;

(q) A statement under the penalties of perjury that certifies the following:

(A) There has been no attempt to knowingly and willfully falsify, conceal, or omit a material fact, or make any false, fictitious, incomplete or fraudulent statements or representations, or make or use any false writing or document knowing the same to contain any false, fictitious, or fraudulent statement or entry for the purpose of obtaining or attempting to obtain an ambulance service license to operate in the State of Oregon. Where an applicant relies on documents submitted by employees, volunteers, ambulance based clinicians, agents or EMS medical directors, the applicant has made a reasonable effort to verify the validity of those documents;

(B) The applicant authorizes any persons or entities, including but not limited to hospitals, institutions, organizations, or governmental entities to release to the Authority any information, files, or records requested by the Authority in connection with the processing of an application; and

(C) Upon receiving an ambulance service license, the licensed ambulance service authorizes to release information by insurance companies, physicians, health care facilities (including but not limited to, hospitals, nursing homes, urgent care centers or primary care facilities) to the Authority relating to services provided by the ambulance service to those facilities or to patients being taken from or to those facilities.

(r) The completed application must contain the signature(s) of the person(s) having the lawful responsibility for the overall operation of an ambulance service or the authorized person empowered to sign on behalf of the ambulance service; and

(s) Such other information as the Authority may reasonably require.

(4) If the applicant's primary ambulance service business office is located in another state, the applicant must:

(a) Meet requirements listed in sections (1) through subsection (3)(s) of this rule; and

(b) Attach copies of current ambulance service and ambulance license(s) for that state to the application.

(5) The completed application to license an ambulance service must be accompanied by a nonrefundable licensing fee in accordance with ORS 682.047.

Stat. Auth.: ORS 682.017
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: HD 18-1994, f. 6-30-94, cert. ef. 7-1-94; OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 11-2010, f. 6-30-10, cert. ef. 7-1-10; PH 1-2013, f. & cert. ef. 1-25-13; Renumbered from 333-250-0020, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0215

Review of License Application

(1) In reviewing an application for a license to operate an ambulance service, the Authority shall:

(a) Verify compliance with ORS chapter 682; ORS 820.300 through ORS 820.380; OAR chapter 333, division 255; OAR 847-035-0020 through 0025 and these rules; and

(b) Conduct an on-site licensing survey in accordance with OAR 333-250-0370.

(2) In determining whether to license an ambulance service, the Authority shall consider the following factors:

(a) The use of proper medical and communication equipment;

(b) The level of care provided ranging from basic life support to advanced life support;

(c) The level of staffing to support the type of service, local call volume and the needs of the area;

(d) Whether there are adequately trained staff;

(e) The ability to safely operate the ambulance service; and

(f) Whether there is a documented need for the service supported by the county government.

Stat. Auth.: ORS 682.017
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: HD 18-1994, f. 6-30-94, cert. ef. 7-1-94; OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 1-2013, f. & cert. ef. 1-25-13; Renumbered from 333-250-0030, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0220

Approval of License Application

(1) The Authority shall notify an applicant in writing if a license application is approved and include instructions on how to access the license electronically.

(2) A license shall be conspicuously displayed in the main business office of the ambulance service, or as otherwise directed by the Authority.

(3) An ambulance service license shall be issued only to the owner of the ambulance service named in the application and shall not be transferable to any other person, governmental unit, or ambulance service.

(4) Except when specifically exempted by ORS 682.035, an out-of-state ambulance service that operates or advertises in Oregon must be licensed by the Authority. An out-of-state ambulance service is not required to obtain an ambulance service license and ambulance license for the following situations:

(a) Transporting a patient through the state;

(b) Delivering a patient to a medical facility or other location within the state, if the beginning of the transport originated outside of the state;

(c) Picking up a patient at a medical facility or airport within the state for the purpose of transporting the patient to a medical facility or other location outside of the state, unless prohibited by the county's Ambulance Service Area plan; or

(d) In the event of a man-made or natural disaster declared by federal, state or local officials and resulting in the need to utilize all available resources to provide patient care and transportation in the affected area.

(5) When an ambulance service is found to be in non-compliance with ORS chapter 682; ORS 820.300 through 820.380; OAR division 333, chapter 255; OAR 847-035-0020 through 0025 or these rules, the Authority may deny, suspend or revoke an ambulance service license or place an ambulance service on probation in accordance with OAR 333-250-0390 or 333-250-0400.

Stat. Auth.: ORS 682.017
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0225

Denial of License Application

If the Authority intends to deny a license application, it shall issue a Notice of Proposed Denial of License Application in accordance with ORS chapter 183.

Stat. Auth.: ORS 682.017
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0230

Expiration and Renewal of License

(1) Each license to operate an ambulance service:

(a) Shall be valid until June 30 of each year, unless sooner revoked or suspended. The initial licensing period may not exceed 15 months; and

(b) Shall expire on June 30 of the following year, if a license is applied for and issued between April 1 and June 30.

(2) If a license renewal is desired, the licensed ambulance service shall make application and pay the appropriate fee at least 30 days prior to the expiration date in a manner prescribed by the Authority.

Stat. Auth.: ORS 682.017
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0235

Return of License

If an ambulance service license is suspended, revoked, or expires, the license certificate and any applicable license decals shall be returned to the Authority by registered mail immediately.

Stat. Auth.: ORS 682.017
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0240

Surrender of License

(1) An ambulance service license is non-transferable.

(2) When an owner sells or closes the ambulance service, the owner must:

(a) Provide a minimum 30-days written notice of the intent to cease operation to the Authority;

(b) Provide the required notice as prescribed in the county ASA plan to the county health department and the ASA authority in which the ambulance service operates; and

(c) Take such other actions as may be determined to be necessary by the Authority or the county health department, or the ASA authority to assure the smooth transition to a new ambulance service provider, including but not limited to permitting the continued operation of the existing provider for more than the required period of legal notice or making equipment and supplies available to an interim ambulance service provider.

(3) Within 10 days of final closing of the ambulance service sale, the owner must return the ambulance service license to the Authority.

(4) An owner may not terminate the ambulance service business or otherwise cease operations in violation of any provisions, rules or ordinances established under the provision of ORS chapter 682.

Stat. Auth.: ORS 682.017
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: HD 18-1994, f. 6-30-94, cert. ef. 7-1-94; OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 1-2013, f. & cert. ef. 1-25-13; Renumbered from 333-250-0080, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0250

Operational Requirements

(1) A licensed ambulance service may only utilize an ambulance for the provision of providing ambulance services that has been issued a license by the Authority, and that complies with all of the requirements of these rules, ORS chapter 682, ORS 820.300 through 820.380, OAR division 333, chapter 255, and other applicable federal, state and local laws and regulations governing the operation of a licensed ambulance service.

(2) A licensed ambulance service must:

(a) Document the organizational structure of the agency including identifying lines of responsibility and authority;

(b) Notify the Authority, upon making initial application or within 14-days of the date of registration, of any new "trading as", "division of", or "doing business as" names utilized by the licensed ambulance service;

(c) Transport only patients for which it has the resources to provide appropriate medical care and transportation unless in transfers between medical facilities, the sending or receiving facility has provided medically appropriate life support measures, personnel, and equipment to sustain the patient during the transfer; and

(d) Document any mutual aid agreements with other licensed ambulance service organizations that are necessary to respond in emergency situations.

(3) A licensed ambulance service may advertise only when the ambulance service and ambulance meets the requirements of ORS chapter 682 and these rules.

(a) If a licensed ambulance service does not provide the level of service advertised, the ambulance service license may be suspended or revoked, or a renewal application denied in accordance with OAR 333-250-0390 or 333-250-0400 for failure to comply.

(b) No licensed ambulance service shall advertise or promote the use of any telephone number other than "9-1-1" for emergency ambulance service.

(c) A licensed ambulance service which offers non-emergency service may advertise its non-emergency or business telephone number for other than emergency use, provided that in any print, audio or video advertising the phrase "FOR EMERGENCIES — CALL 9-1-1" is provided. When using the phrase "FOR EMERGENCIES — CALL 9-1-1" in print, it must be in bold-faced type at least one and one-half times the font size in which the non-emergency or business telephone number is displayed.

(d) Contents of ambulance service advertising must include:

(A) The legal name of the ambulance service indicated on the license issued by the Authority;

(B) If advertising 24-hours-a-day operation, the licensed ambulance service must provide uninterrupted service 24-hours-a-day, 7 days-a-week, 365 days-a-year; and

(C) If the licensed ambulance service provides service for only a portion of a 24-hour day or week, any advertising must specify the hours and days of operation.

(e) The licensed ambulance service must maintain copies of all print, audio, video, and all other types of advertisements for one year after use and distribution have ceased, and must make those copies available to the Authority upon request.

(f) Novelty or promotional items which are not distributed to the general public do not meet the definition of advertisement.

(4) A licensed ambulance service shall require each person staffing an ambulance or providing prehospital emergency or non-emergency care to display his or her level of licensure on the outermost garment of his or her usual work uniform at all times while staffing an ambulance or rendering patient care, and shall make reasonable efforts to display this information under other circumstances.

(5) If a licensed ambulance service accepts students for Paramedic internships from an accredited teaching institution, the licensed ambulance service must:

(a) Have a signed and dated contract with each teaching institution providing internship students; and

(b) Use qualified preceptors, as defined by OAR 333-265-0000, who will be assigned to supervise, document and evaluate the Paramedic interns.

(6) Any EMS related continuing education offered by the licensed ambulance service or designee must be documented in accordance with OAR 333-265-0140 sections (3) and (4) and provided to the employee or volunteer.

(7) All records relating to an ambulance service's operations must be retained by the licensee or the licensee's successors or assignees for not less than seven years from the date of implementation, purchase, dispatch, creation or longer if so required by law or regulation. The record keeping mechanism may be in any permanent form including paper or on magnetic media provided that the information can be made readily available for inspection by the Authority.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991, 820.330
Hist.: HD 18-1994, f. 6-30-94, cert. ef. 7-1-94; OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 11-2010, f. 6-30-10, cert. ef. 7-1-10; PH 1-2013, f. & cert. ef. 1-25-13; PH 14-2016, f. & cert. ef. 4-28-16; Renumbered from 333-250-0040, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0255

Facility

(1) A building used by the licensed ambulance service shall be kept clean, in good repair and free from fire and safety hazards.

(2) A licensed ambulance service must provide:

(a) A facility or area for sleeping or resting for an employee or volunteer working a 24-hour shift;

(b) Adequate toilet, hand-washing and shower facilities with hot and cold running water, antiseptic soap and clean towels for hand and body drying. If the licensed ambulance service does not have shower facilities, the licensed ambulance service must have a signed agreement or contract with a medical facility or other entity to make available shower facilities to ambulance personnel for the purpose of showering after coming in contact with medical or other biohazardous waste;

(c) Clean and soiled linen receptacles in separate areas in accordance with the Oregon Occupational Safety and Health Division and other rules governing the handling of special medical wastes;

(d) Designated secure storage for all medications which are deteriorated, outdated, misbranded, adulterated or otherwise unfit for use;

(e) Designated storage for malfunctioning patient care equipment clearly marked "out-of-service" until the equipment has been repaired or replaced; and

(f) Secure storage for patient care equipment, supplies and medications, or alternatively, a signed agreement with a medical facility that the medical facility will provide the patient care equipment, supplies, and medications.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.99
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0265

Policies and Procedures

(1) The licensed ambulance service must have written policies and procedures to carry out daily ambulance service operations including, but not limited to:

(a) Work practice controls for bloodborne pathogens in compliance with OAR chapter 437, division 2, subdivision Z;

(b) Storage and security of medications including controlled substances if authorized by the EMS medical director that meet the requirements of the Oregon Board of Pharmacy in OAR chapter 855 and the US Drug Enforcement Administration found in 21 CFR 1301.75(b);

(c) Identification, storage and security of all medications, fluids and controlled substances that are deteriorated, outdated, misbranded, adulterated or otherwise unfit for use that are readily identified as defective and stored in a separate location from usable products. Security procedures must be the same as for usable supplies;

(d) Destruction of outdated medications including controlled substances if authorized by the EMS medical director that meet the requirements of the Oregon Board of Pharmacy in OAR chapter 855 and the US Drug Enforcement Administration found in 21 CFR 1307.21;

(e) Identification and storage of malfunctioning patient care equipment clearly marked "out-of-service" to assure that defective equipment will not be used, if applicable;

(f) Employee, volunteer or ambulance based clinician notification requirements to the licensed ambulance service when an employee, volunteer or ambulance based clinician is impaired by excessive fatigue, illness, injury or other factors that may reasonably be anticipated to constitute a threat to the health and safety of patients or the public;

(g) Reporting of suspected child abuse as required in ORS 419B.005 through 419B.050;

(h) Reporting of suspected elder abuse as required in ORS 124.050 through 124.095;

(i) Patient rights in accordance with OAR 333-250-0330;

(j) Providing secure transport for patients in custody in accordance with OAR 309-033-0435, if the licensed ambulance service has been authorized to perform this service;

(k) Operation of an ambulance for both emergency and non-emergency situations;

(l) Vehicle cleanliness standards including frequency of cleaning and cleaning required after each patient transport;

(m) Removal of an ambulance from service when the mechanical condition of an ambulance is sufficiently unreliable so as to endanger or potentially endanger the health, safety, or welfare of a patient or crew member;

(n) Managing a mechanical breakdown including repairing or replacing a damaged tire or wheel when the ambulance is in operation;

(o) Actions necessary when an ambulance is involved in an accident, including the submission of a legible copy of the Department of Motor Vehicles Accident Report to the Authority within 10 business days of the accident;

(p) Release of continuing education records completed by an EMS provider or employee through the licensed ambulance service in a verifiable format to a requesting party within five business days of the request; and

(q) Release and destruction of patient care reports (PCRs) in accordance with OAR 333-250-0310;

(2) The licensed ambulance service must have a process in place to assure that employees, volunteers, ambulanced based clinicians, agents and EMS medical directors:

(a) Have access to current policies and procedures;

(b) Have access to state, federal and local rules and regulations governing the operation of a licensed ambulance service; and

(c) Are informed of changes to policies or procedures.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0270

Personnel

(1) The licensed ambulance service must ensure that the service, employees, volunteers, ambulance based clinicians, agents and EMS medical directors comply with all of the requirements of these rules, ORS chapter 682, ORS 820.300 through 820.380, OAR division 333, chapter 255, and other applicable federal, state and local laws and regulations governing the operation of a licensed ambulance service.

(2) Prior to an employee, volunteer, or ambulance based clinician being allowed to staff an ambulance, the licensed ambulance service shall:

(a) Provide and require that each employee, volunteer, and ambulance based clinician complete an initial orientation program that includes but is not limited to:

(A) Ambulance service standing orders;

(B) Ambulance service policies and procedures;

(C) Driving and operating requirements for ambulance vehicles; and

(D) Operations of equipment.

(b) Ensure that each employee, volunteer, and ambulance based clinician has successfully completed the following training:

(A) Bloodborne pathogen and infectious disease training that meets or exceeds standards found in OAR chapter 437, division 2, subdivision Z;

(B) Hazardous materials awareness training that meets or exceeds standards found in OAR chapter 437, division 2, subdivision H;

(C) Emergency vehicle operator’s course of instruction prior to independently operating an ambulance. The course must meet or be equivalent to the National Safety Council for Emergency Vehicle Operators Course (EVOC 3) or National Fire Protection Agency (NFPA) Fire and Emergency Service Vehicle Operations Training standards;

(D) Air medical crew training in accordance with chapter 333, division 255 when operating an air ambulance; and

(E) Proper operation of all ambulances and equipment that he or she is authorized to use, and is physically capable, and has the ability to lift and move patients, and assist in extrication of patients when necessary, if authorized to do so.

(3) In addition to the initial orientation program described in subsection (2)(a) of this rule, a licensed ambulance service shall ensure and document in the personnel file that all EMS providers and ambulance based clinicians receive training on:

(a) The proper use of any new equipment, procedure or medication prior to being placed into operation on an ambulance; and

(b) Secure transportation of patients in custody in accordance with OAR 309-033-0437, if the licensed ambulance service has been authorized to perform this service.

(4) If a licensed ambulance service contracts with or employs an ambulance based clinician for the purpose of providing advanced level care, the licensed ambulance service shall ensure that the ambulance based clinician meets all of the applicable training requirements in sections (2) and (3) of this rule and have documentation that the clinician has completed the following:

(a) A current AHA, Advanced Cardiac Life Support course or equivalent and a current AHA, Pediatric Advanced Life Support course or equivalent; and either

(b) A current Prehospital Trauma Life Support course;

(c) A current Basic Trauma Life Support course;

(d) A current Trauma Emergency Assessment Management (TEAM) course; or

(e) A Trauma Nurse Core Course (TNCC).

(5) The TEAM and TNCC courses referenced in section (4) of this rule must include a supplemental prehospital rapid extrication training session.

(6) In order to operate a ground ambulance, the licensed ambulance service must:

(a) Ensure the licensed ambulance service and its employees, volunteers or ambulance based clinicians:

(A) Comply with all applicable Oregon Motor Vehicle Code statutes relating to motor vehicle and emergency vehicle operations, ORS 820.300 through 820.380 and ORS chapter 445;

(B) Complete an emergency ground ambulance operator's training in accordance with subsection (2)(b) of this rule; and

(C) Comply with all applicable policies and procedures.

(b) Ensure the driver of a ground ambulance is a licensed EMS provider in accordance with OAR chapter 333, division 265 and has a valid driver’s license or if the driver is not a licensed EMS provider, ensure that the driver:

(A) Has a valid driver’s license;

(B) Has a current Basic Life Support (BLS) Provider card or proof of course completion that meets or exceeds the 2015 American Heart Association (AHA) Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) guidelines;

(C) Has completed the following training:

(i) Emergency ground ambulance operator's training in accordance with subsection (2)(b) of this rule;

(ii) Bloodborne pathogen and infectious disease training that meets or exceeds standards found in OAR chapter 437, division 2, subdivision Z; and

(iii) Hazardous materials awareness training that meets or exceeds the Oregon Occupational Safety and Health Division standards found in OAR chapter 437, division 2, subdivision H;

(D) Signs a statement that he or she is:

(i) Not addicted to alcohol or controlled substances and is free from any physical or mental condition that might impair his or her ability to operate or staff an ambulance; and

(ii) Physically capable of assisting in the extrication, lifting and moving of a patient at the direction of an EMS provider; and

(E) Had a criminal background check conducted by the licensed ambulance service that determined the driver was suitable to operate a ground ambulance; or

(F) Has been certified by the Department of Public and Safety Standards and Training within the last 365 days.

(c) Have a certified copy of the qualified driver’s driving record completed through the Oregon Department of Motor Vehicles, Automated Reporting System (ARS) Program or equivalent. If the driver has an out-of-state driver’s license, the licensed ambulance service must obtain an equivalent certified copy driving record from that state, if available and if not available, conduct an annual driving record check. The latest copy must be kept in the driver’s personnel file.

(7) A licensed ambulance service may not permit an employee, volunteer or ambulance based clinician to operate an ambulance, equipment, or have contact with a patient if the employee, volunteer or ambulance based clinician:

(a) Is taking any medication that could impair safe operation and handling of the ambulance, equipment, or patient; or

(b) Has consumed any alcoholic beverages within the last eight hours.

(8) In order to provide air ambulance service, the licensed ambulance service must ensure that the licensed ambulance service, employee, volunteer or ambulance based clinician:

(a) Comply with the Federal Aviation Regulation (FAR), 14 CFR Part 135; and

(b) Successfully complete the 2004 Association of Air Medical Services (AAMS) Guidelines or equivalent. There must also be an annual review of the Air Medical Crew course material, the length of which must be established by the EMS medical director.

(9) Prior to independently staffing an ambulance, an employee, volunteer or ambulance based clinician must begin the Hepatitis-B immunization series or have a signed statement of declination.

(10) The licensed ambulance service must submit a completed reportable action form to the Authority, within the times specified, for any of the following actions:

(a) Hiring a new employee or volunteer, within 14 business days;

(b) Terminating or suspending an employee or volunteer for cause, within 14 business days; and

(c) Disciplinary action taken by the licensed ambulance service or the EMS medical director for unprofessional conduct as defined in OAR 333-265-0000, within 14 business days.

(11) A licensed ambulance service must not schedule or allow an employee, volunteer or ambulance based clinician to serve on an ambulance who is impaired by excessive fatigue, illness, injury or other factors that may reasonably be anticipated to constitute a threat to the health and safety of patients or the public.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 11-2010, f. 6-30-10, cert. ef. 7-1-10; PH 1-2013, f. & cert. ef. 1-25-13; PH 14-2016, f. & cert. ef. 4-28-16; Renumbered from 333-250-0041, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0280

Personnel File Documentation

The licensed ambulance service must maintain a complete and current personnel file for each employee, volunteer, ambulance based clinician, agent and EMS medical director including but not limited to, the following information:

(1) Full name;

(2) Current home mailing address;

(3) Affiliation status, listed as either an employee full-time paid, employee part-time paid, contractor or volunteer;

(4) Verifiable written documentation that the employee, volunteer or ambulance based clinician has completed required training including when and where training was obtained;

(5) Copies of:

(a) Reportable action forms as required under OAR 333-250-0270(10);

(b) Applicable professional certificates or licenses;

(c) A current driver's license;

(d) A current pilot’s license if the employee or volunteer operates an air ambulance;

(e) A certified driving record in accordance with OAR 333-250-0270(6)(c);

(f) A current BLS Provider card or proof of course completion that meets or exceeds the 2015 American Heart Association (AHA) ECC and CPR guidelines or equivalent;

(g) Training records that identify completion of an initial orientation program and training requirements specified in these rules;

(h) Health records documenting:

(A) Initial tuberculosis (TB) screening and any subsequent screenings in accordance with the Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings, 2005, published in the Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention (CDC), December 30, 2005, and incorporated by reference; and

(B) Hepatitis-B immunizations or a signed statement of declination; and

(i) Qualified driver statement in accordance with OAR 333-250-0270(6)(b)(D).

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 11-2010, f. 6-30-10, cert. ef. 7-1-10; PH 1-2013, f. & cert. ef. 1-25-13; Renumbered from 333-250-0043, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0290

Communications and Dispatch

(1) The licensed ambulance service is responsible for:

(a) Having a valid license from the Federal Communications Commission (FCC) to operate an EMS radio on assigned frequencies, or proper authorization from another agency holding a valid FCC license to operate on designated radio frequencies;

(b) Having 24-hour-a-day telephone answering, or 24-hour-a-day telephone and text-to-9-1-1 answering, and dispatching capabilities or having a signed agreement or contract with a recognized primary or secondary Public Safety Answering Point (PSAP), that will provide telephone answering, or telephone and text-to-9-1-1 answering, and emergency dispatching services;

(c) Providing a reliable means of alerting and communicating with an ambulance crew before, during and after an ambulance call;

(d) Immediately routing all emergency calls received from the public on any of the licensed ambulance service's 10-digit telephone number or if received by text to the primary PSAP. When a licensed ambulance service receives a request for an emergency ambulance and the licensed ambulance service is a recognized secondary PSAP, the licensed ambulance service shall dispatch the ambulance and notify the primary PSAP for coordination of other emergency responder agencies;

(e) Ensuring that any request for an ambulance received on the licensed ambulance service's 10-digit telephone number or if received by text is answered or responded to by a live person or that there is an answering machine referring the caller to the appropriate emergency telephone number; and

(f) Maintaining ambulance dispatch records as prescribed in ORS 820.330 and 820.340. The records must be kept by the licensed ambulance service or the licensed ambulance service must have a signed agreement with the PSAP, service or agency that provides telephone answering, or telephone and text-to-9-1-1 answering, and dispatching services that they will maintain and make available copies of the official dispatch records for a minimum of seven years.

(2) When the licensed ambulance service employs dispatchers for the purpose of answering the telephone or responding to text-to-9-1-1, taking information regarding the need for an ambulance and dispatching the ambulance, the dispatcher must have written documentation of completing:

(a) The Department of Public Safety Standards and Training's Emergency Medical Dispatcher's Course or equivalent; and

(b) Four hours of annual refresher training for dispatchers that meets the standards set forth by the Department of Public Safety Standards and Training.

(3) An air ambulance must meet Federal Aviation Regulation (FAR), 14 CFR Part 135 of the Operating requirements; Commuter and on demand operations and rules governing persons on board such aircraft.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 11-2010, f. 6-30-10, cert. ef. 7-1-10; Renumbered from 333-250-0046, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0300

EMS Medical Direction

(1) A licensed ambulance service must have an EMS medical director responsible for the duties described in OAR 847-035-0025(1) except:

(a) When the licensed ambulance service operates in non-contiguous counties, then the licensed ambulance service may have one EMS medical director in each non-contiguous county of operation; or

(b) Where a county or regional EMS system prescribes that multiple agencies within a county or region must have a governmentally appointed EMS medical director, that agency may have a different EMS medical director in contiguous counties. In this event, the signed agreement or contract may be between the EMS medical director and the county or regional EMS system.

(2) The EMS medical director may delegate the duties described in OAR 847-035-0025(2) to one or more agents as defined in OAR 333-250-0205.

(3) A licensed ambulance service must ensure that an EMS medical director:

(a) Meets the requirements and duties as prescribed in OAR 847-035-0020 through 847-035-0030;

(b) Has a written set of treatment protocols for each level of service offered by the licensed ambulance service; and

(c) Has a signed and dated agreement or contract with the licensed ambulance service.

(4) When an EMS medical director authorizes the administration of controlled substances, the EMS medical director must have on file with the licensed ambulance service:

(a) A US Drug Enforcement Administration License listing the name of the licensed ambulance service and address where the controlled substances are stored when not on an ambulance; and

(b) A signed and dated policy describing the type and amount of controlled substances stored on each ambulance and how controlled substances will be stored, accessed, recorded, administered, destroyed and secured. It is the responsibility of the EMS medical director to ensure that the procedure meets the minimum US Drug Enforcement Administration requirements found in 21 CFR 1301.75(b).

(5) A licensed ambulance service shall ensure that:

(a) Controlled substances, when authorized by the EMS medical director, are stored, accessed, inventoried, administered, destroyed and secured in a manner consistent with the signed and dated procedure established by the EMS medical director. The procedure must be in accordance with the regulations promulgated by the US Drug Enforcement Administration (DEA) found in 21 CFR 1301.75(b).

(b) A copy of the EMS medical director's DEA license is maintained in a secure manner, inaccessible to the public, at each fixed ambulance location where controlled substances are stored other than in the ambulance.

(c) Pharmacological and medical supplies with expiration dates affixed thereon by the manufacturer or packager are removed from service no later than the expiration date. Expired pharmacological and medical supplies must be disposed of in accordance with applicable laws and regulations.

(d) Medications and equipment are stored in a manner that protects viability and proper operation; and

(e) Ambulances available for or subject to a call are maintained to allow immediate starting of the engine and to prevent medications and medical supplies from becoming environmentally degraded.

(6) A licensed ambulance service must notify the Authority in writing of:

(a) Any denial, suspension, or voluntary surrender of an EMS medical director's or agent's medical license or US Drug Enforcement Administration license within 72 hours; and

(b) Any change in the EMS medical director or agents, 21 days prior to the change.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 11-2010, f. 6-30-10, cert. ef. 7-1-10; PH 1-2013, f. & cert. ef. 1-25-13; Renumbered from 333-250-0047, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0310

Patient Care Report

(1) A licensed ambulance service must complete a PCR in each instance where an ambulance arrives on the scene and patient contact is initiated.

(2) A complete PCR must be prepared by ambulance personnel and delivered to appropriate hospital staff at the time patient care is transferred, unless the PCR is provided electronically under section (3) of this rule.

(3) If a PCR is provided via electronic format, the licensed ambulance service shall ensure that personnel relay pertinent patient care information to hospital staff prior to leaving the hospital. A completed electronic report must be submitted to the hospital at a location designated by the hospital within 12 hours of the patient being transported to the hospital.

(4) If the ambulance crew is unable to complete the PCR at the time patient care is transferred, the ambulance crew may depart after receiving verbal verification from an emergency department employee involved with providing patient care that sufficient patient information has been transferred to support safe and timely continuation of patient care.

(5) The physician caring for the patient may request additional information or a completed PCR can be faxed or electronically sent to the hospital.

(6) A licensed ambulance service must ensure that a PCR contains:

(a) Data points as defined in the National Highway Transportation Safety Administration dataset dictionary (NEMSIS), using a version determined by the Authority; and

(b) For any patient meeting the criteria for trauma patient as defined in OAR 333-200-0010:

(A) The trauma band number; and

(B) Triage criteria as defined in OAR chapter 333, division 200, Exhibit 2.

(7) Notwithstanding the requirements in this rule, a completed PCR is not required when:

(a) There is a disaster or a multiple patient incident consisting of more than five patients or the number of patients prescribed in the county's ASA plan, and which results in a single ambulance transporting two stretcher patients at the same time or when an ambulance is required to make more than one trip to and from the incident site.

(b) In the situation described in subsection (7)(a) of this rule, the following information is acceptable patient care documentation as allowed by the triage tag used by the licensed ambulance service:

(A) The trauma system identification bracelet number or other identifier if not a trauma;

(B) A record of the times and results of vital signs and list of injuries; and

(C) A record of the times and types of treatment given.

(8) Every reasonable attempt must be made by the ambulance personnel or ambulance based clinicians to complete an approved PCR for each patient at the conclusion of the incident. The following minimum information is required:

(a) The time the crew assumed care;

(b) The time the patient was dropped off at the hospital; and

(c) The triage tag number or other identifier.

(9) The licensed ambulance service is responsible for:

(a) Storing PCRs in a secure manner, with limited access to the PCRs by office and ambulance personnel;

(b) Organizing the PCRs in a manner that will allow an authorized ambulance service representative to locate a PCR within a reasonable amount of time, given a patient's name and the date and time of the ambulance call;

(c) Establishing a procedure for releasing a PCR to a medical facility receiving the patient, the patient, the patient's family, the patient's legal guardian, an insurance company, an attorney, a law enforcement officer, or a law enforcement agency;

(d) Protecting the confidentiality of patient information including during quality improvement sessions by limiting access to the PCR and having all persons having access to PCRs sign a confidentiality statement; and

(e) Establishing a procedure for the method and verification of the destruction of a PCR which includes at a minimum:

(A) A medical record or report about a patient may not be destroyed for 10 years after the record or report is made, or longer if so required by law or regulation unless the patient is notified; and

(B) In the case of a minor patient, a medical record or report may not be destroyed until the patient attains the age of majority plus three years or for 10 years after the record or report is made, whichever is later, unless the parent or guardian of the minor patient is notified.

(10) In accordance with paragraph (9)(e)(B), the notification of a minor patient or the parent or guardian of the minor patient of the potential destruction of a prehospital care report must:

(a) Be made by first class mail to the last known address of the patient;

(b) Include the date on which the record of the patient shall be destroyed; and

(c) Include a statement that the record or synopsis of the record, if wanted, must be retrieved at a designated location within 30 days of the proposed date of destruction.

(11) A PCR is considered protected health information and may only be used or disclosed in accordance with state and federal privacy regulations.

(12) A PCR must be made available for review and duplication when requested by the Authority as authorized by ORS 41.675 and 41.685.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0320

Quality Assessment and Performance Improvement

(1) The licensed ambulance service shall establish and maintain an effective quality assessment and performance improvement program that is approved by the EMS medical director and ambulance service administrator and may include:

(a) A method to monitor, evaluate and improve organizational efficiency and care delivery;

(b) A method to select and track performance improvement indicators which may include, but are not limited to:

(A) Accurate patient assessment;

(B) Medical intervention delivered in accordance with established protocols;

(C) Success of skills;

(D) Quality of clinical documentation; and

(E) Clinical outcome data;

(c) A process for investigating and addressing patient safety issues raised by means other than measured indicators; and

(d) A defined quarterly reporting process for performance improvement activities and issues including:

(A) Documenting and reporting individual issues and clinical indicator results; and

(B) Documenting and reporting aggregate data of clinical indicators and other activities to staff.

(2) To assist the licensed ambulance service and the EMS medical director in determining if appropriate and timely emergency medical care was rendered to a patient, the ambulance service designated official may request the following information from the receiving hospital as authorized by ORS 682.056:

(a) Patient admit status and unit admitted to;

(b) Any procedure listed in the National Highway Transportation Safety

Administration dataset dictionary (NEMSIS), using a version to be determined by the Authority, and performed on the patient within the first hour of being admitted;

(c) Any medication administered to the patient within the first hour of being admitted; and

(d) Trauma system entry by emergency department staff.

(3) Information provided under section (2) of this rule is considered confidential pursuant to

ORS 682.056. Any employee or volunteer participating in a quality improvement session must have a signed confidentiality statement in their personnel file.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0330

Patient Rights for Emergency Medical Care and Transportation

(1) An ambulance service licensed by the Authority shall maintain written policies and procedures regarding patient rights.

(2) A statement of patient rights shall be distributed to each employee or volunteer and made available in the business office and in each satellite location.

(3) The statement of patient rights shall include, but is not limited to, the following:

(a) Access to appropriate emergency medical care and transportation without regard to race, ethnicity, religion, age, gender, sexual orientation, or disability;

(b) EMS providers will be considerate and respectful to all patients regardless of status;

(c) Opportunity to refuse any medical care or transportation to a medical facility when informed about the care to be provided and the risks associated with refusing medical care or transportation;

(d) Transportation to a clinically appropriate medical facility of the patient's choice without questioning ability to pay. The agency may elect to transport to a closer, appropriate medical facility if a patient's facility of choice:

(A) Is unreasonable due to unsafe conditions; or

(B) Requires an ambulance to be taken out of service for an unreasonable amount of time;

(e) When appropriate, opportunity to request private transport, for example from a friend or family member;

(f) Patient's health information will be protected in accordance with state and federal privacy laws;

(g) Opportunity to receive, upon request, medical information relating to the care or transport provided by EMS providers;

(h) Opportunity to receive, upon request, a reasonable explanation of any charges for emergency medical care provided by EMS providers or for ambulance services; and

(i) Information on how and where to file a complaint about the services performed is posted and available.

(4) Notwithstanding subsection (3)(d) of this rule, a licensed ambulance service may transport a patient without consent if the patient is incapacitated or cannot make sound decisions based upon illness, injury or age.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.99
Hist.: PH 14-2016, f. & cert. ef. 4-28-16; Renumbered from 333-250-0085, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0340

Variance from Standards

(1) A licensed ambulance service may request a variance from the standards established in ORS 820.330 to 820.380, ORS chapter 682 and these rules when:

(a) The licensed ambulance service believes that compliance with a rule is inappropriate because of special circumstances which would render compliance unreasonable, burdensome, or impractical due to special conditions or causes, or because compliance would result in substantial curtailment of necessary ambulance service; and

(b) A city ordinance or county ASA plan exists, and the licensee has presented his or her request for a variance to the local city or county governing body and that body has given their approval for the proposed variance.

(2) A request for a variance must be submitted to the Authority in writing and include the following information:

(a) The specific rule for which a variance is requested:

(b) A description of the special circumstances relied upon to justify the variance;

(c) What alternatives were considered, if any and why alternatives (including compliance) were not selected;

(d) An explanation of why the proposed variance will not jeopardize patient health and safety;

(e) The proposed duration of the variance; and

(f) A detailed and realistic plan to resolve the need for a future variance.

(3) The request for a variance may be presented to the State Emergency Medical Service Committee at a regularly scheduled meeting. The EMS Director or EMS Deputy Director, after considering the Committee's recommendation, when requested, may grant a variance.

(a) A variance shall be granted for a period of time as prescribed by the Authority; and

(b) A subsequent variance may only be granted when the licensed ambulance service has demonstrated to the Authority, insofar as possible, adequate progress in resolving the need for the initial variance as described in the plan.

Stat. Auth.: ORS 682.017, 682.068 & 682.079
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: HD 18-1994, f. 6-30-94, cert. ef. 7-1-94; OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 1-2013, f. & cert. ef. 1-25-13 Renumbered from 333-250-0050, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0350

Complaints

(1) Any person may make a complaint verbally or in writing to the Authority regarding an allegation against a licensed ambulance service of a violation of any licensing law.

(2) The identity of a person making a complaint will be kept confidential as permitted by law.

(3) An investigation will be carried out as soon as practicable after the receipt of the complaint in accordance with OAR 333-250-0360.

(4) If the complaint involves an allegation of criminal conduct or an allegation that is within the jurisdiction of another local, state or federal agency, the Authority will refer the matter to that agency.

(5) The Authority does not have jurisdiction over and shall not take action on complaints that relate solely to rates charged to a patient by a licensed ambulance service.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0360

Investigations

(1) As soon as practicable after receiving a complaint, taking into consideration the nature of the complaint, Authority staff will begin an investigation.

(2) An ambulance service shall permit Authority staff access to the service agency during an investigation. For purposes of an investigation, giving advanced notice to the licensed ambulance service is not required.

(3) An investigation may include but is not limited to:

(a) Interviews of the complainant, patients of the ambulance service, patient family members, witnesses, ambulance service management and staff;

(b) On-site observations of staff performance and the physical environment of the ambulance service or ambulance; and

(c) Review of documents and records.

(4) The Authority may make photographic, video-graphic or audio recording documentation as part of an investigation of non-compliance with ORS chapter 682 and these rules.

(5) Information obtained by the Authority during an investigation of a complaint or reported violation under this rule is confidential and not subject to public disclosure under ORS 676.175. Upon the conclusion of the investigation, the Authority may publicly release a report of its findings but may not include information in the report that could be used to identify the complainant or any patient of the ambulance service. The Authority may use any information obtained during an investigation in an administrative or judicial proceeding concerning the licensing of an ambulance service, and may report information obtained during an investigation to a health professional regulatory board as defined in ORS 676.160 as that information pertains to a licensee of the board.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0370

Surveys

(1) In addition to any investigation conducted under OAR 333-250-0360, the Authority may conduct a survey for the purpose of evaluating the eligibility of an ambulance service or an ambulance to receive or retain a license and to ensure the health, safety, and welfare of the persons who utilize ambulances.

(2) An ambulance service that acquires and maintains current status with a nationally recognized EMS service accreditation program that meets or exceeds Oregon requirements may be exempted from the survey process. A copy of the survey report from the nationally recognized EMS service accreditation program must be filed with the Authority for approval.

(3) Routine surveys of an ambulance service or an ambulance shall be scheduled with the management of the ambulance service at least 72 hours in advance of the survey unless otherwise mutually agreed upon by the Authority and the ambulance service representative.

(4) In conducting a survey or interview, the Authority representative must:

(a) Identify him or herself by presenting the Authority identification to the owner, manager, or ranking employee or volunteer present at the site of a survey or interview;

(b) Inform the ambulance service representative of the purpose for the survey or interview; and

(c) Inform the ambulance service representative when the survey or interview has been completed and the preliminary results of the survey only.

(5) An ambulance service shall permit Authority staff access to the facility and ambulance vehicles during a survey.

(6) A survey may include but is not limited to:

(a) Interviews of patients, patient family members, ambulance management and staff;

(b) On-site observations of staff performance and the physical environment of the ambulance facility or ambulance; and

(c) Review of documents and records.

(7) An ambulance service shall make all requested documents and records available to the surveyor for review and copying.

(8) The Authority may accept local city or county governing body inspections that meet or exceed requirements outlined in ORS chapter 682, OAR chapter 333, division 255 and these rules in lieu of a survey by the Authority.

(9) Following the survey, Authority staff shall prepare and provide the ambulance service administrator or designee specific and timely written notice of the findings.

(10) If the findings result in a referral to another regulatory agency, Authority staff shall submit applicable information to that referral agency for its review and determination of appropriate action.

(11) If no deficiencies are found during a survey, the Authority shall issue written findings to the ambulance service administrator indicating that fact.

(12) If deficiencies are found, the Authority shall take informal or formal enforcement action in accordance with OAR 333-250-0390 or 333-250-0400.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: HD 18-1994, f. 6-30-94, cert. ef. 7-1-94; OHD 7-2001, f. & cert. ef. 4-24-01l: PH 2-2007, f. & cert. ef. 2-1-07; PH 11-2010, f. 6-30-10, cert. ef. 7-1-10; PH 1-2013, f. & cert. ef. 1-25-13 Renumbered from 333-250-0060, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0380

Violations

In addition to non-compliance with any rules or laws that governs an ambulance service or ambulance service vehicle, it is a violation to:

(1) Refuse to cooperate with an investigation or survey, including but not limited to failure to permit Authority staff access to the ambulance service, its documents or records;

(2) Fail to implement a corrective action plan;

(3) Refuse or fail to comply with an order issued by the Authority;

(4) Refuse or fail to pay a civil penalty;

(5) Be convicted of a crime, including Medicare or Medicaid fraud, relating adversely to the person’s capability of owning or operating an ambulance service;

(6) Make a material omission or misrepresentation of facts on an application for a license or variance, or in response to an inquiry or investigation. This includes fraud or deception in obtaining or attempting to obtain a license or variance or in any other transaction with the Authority;

(7) Loan, borrow, or use the license of another, or knowingly aid or abet the improper granting of a license;

(8) Deface, alter, remove or obliterate any portion of any official entry upon a license, licensing decal, or variance issued by the Authority;

(9) Refuse to respond to or render prehospital emergency care because of a patient's race, ethnicity, religion, age, gender, sexual orientation, disability, medical problem or financial inability to pay;

(10) Fail to promptly notify the Authority of a change of ownership;

(11) Fail to report to the Authority any matter required by ORS 682.220(4) and OAR 333-265-0080;

(12) Fail to protect health information from unlawful use or disclosure in accordance with state and federal privacy laws;

(13) Alter or inappropriately destroy medical records;

(14) Willfully prepare or file false reports or records, or induce another to do so;

(15) Engage in a pattern of any of the following:

(a) Incompetence, negligence or misconduct in operating the ambulance service or in providing emergency medical care and transportation to patients;

(b) Abuse or abandonment of patients;

(c) Failure to comply with the county ASA plan, area trauma plan, or other lawfully promulgated policies, plans, or procedures;

(d) Failure to meet response time standards as prescribed by the county ASA plan or if no ASA plan is in effect, the area trauma plan;

(e) Misuse or misappropriation of medications or medical materials; and

(f) Other conduct determined by the Authority to pose a significant threat to the health, safety and well-being of ambulance patients.

(16) Fail to return a license as provided in OAR 333-250-0235; or

(17) Operate without a license.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0390

Informal Enforcement

(1) If during an investigation or survey Authority staff document violations of ambulance service licensing rules or laws, the Authority may issue a statement of deficiencies that cites the law or rule alleged to have been violated and the facts supporting the allegation. The Authority may share the statement of deficiencies with the applicable EMS medical director, local government, or county ASA administrator.

(2) Upon receipt of a statement of deficiencies, an ambulance service shall be provided an opportunity to dispute the Authority’s survey findings but must still comply with sections (3) and (4) of this rule.

(a) If an ambulance service desires an informal conference to dispute the Authority’s survey findings, the ambulance service shall advise the Authority in writing within three business days after receipt of the statement of deficiencies. The written request must include a detailed explanation of why the agency believes the statement of deficiencies is incorrect.

(b) An ambulance service may not seek a delay of any enforcement action against it on the grounds the informal dispute resolution has not been completed.

(c) If an ambulance service is successful in demonstrating the deficiencies should not have been cited, the Authority shall reissue the statement of deficiencies, removing such deficiencies and rescinding or modifying any remedies issued for such deficiencies. The reissued statement of deficiencies shall state that it supersedes the previous statement of deficiencies and shall clearly identify the date of the superseded statement of deficiencies.

(3) Depending on the nature and severity of the deficiency, a signed corrective action plan must be mailed to the Authority within a minimum of 24 hours or maximum of 30 business days, as specified by the Authority, from the date the statement of deficiencies was received by the ambulance service. A signed corrective action plan will not be used by the Authority as an admission of the violations alleged in the statement of deficiencies.

(4) An ambulance service shall correct all deficiencies by the date identified by the Authority, unless an extension of time is requested from the licensed ambulance service. A request for such an extension shall be submitted in writing and must accompany the corrective action plan.

(5) The Authority shall determine if a written corrective action plan is acceptable. If the corrective action plan is not acceptable to the Authority, the Authority shall notify the ambulance service owner in writing:

(a) Identifying which provisions in the plan the Authority finds unacceptable;

(b) Citing the reasons the Authority finds the provisions unacceptable; and

(c) Requesting that the corrective action plan be modified and resubmitted no later than 14 business days from the date notification of non-compliance was received by the ambulance service owner.

(6) Failure to respond to the Authority or if the ambulance service does not come into compliance by the date specified by the Authority, the Authority may:

(a) Propose to deny, suspend, or revoke the agency license;

(b) Place the ambulance service on probation; or

(c) Impose civil penalties.

(7) The Authority shall confirm by survey or other appropriate means that all deficiencies have been corrected.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

333-250-0400

Formal Enforcement

(1) If during an investigation or survey, Authority staff document a substantial failure to comply with ambulance service licensing rules or laws, or if an agency fails to pay a civil penalty imposed under ORS 682.224 and these rules, the Authority may issue a Notice of Proposed Suspension or Notice of Proposed Revocation in accordance with ORS 183.411 through 183.470.

(2) If during an investigation or survey, Authority staff document that an ambulance manifests evidence of a mechanical or equipment deficiency, which poses a significant threat to the health or safety of patients or crew, the Authority shall immediately suspend that ambulance from operation. No ambulance that has been suspended from operation may be operated until the licensed ambulance service has certified and the Authority has confirmed that all of the violations have been corrected.

(3) In the event that a license is suspended or revoked, the licensee must cease ambulance service operations and no person except the Authority may permit or cause the service to continue.

(4) The Authority shall notify applicable local government, county ASA administrator, and the EMS medical director of the ambulance service of the suspension or revocation of an ambulance service license, or the placing of a service on probation.

(5) If a principal owner of an ambulance service has had its ambulance service license revoked, following the opportunity for a hearing as provided by ORS chapter 183, that person may not be eligible to apply for or hold an ambulance service license for a period of two years from the date of revocation as specified in ORS chapter 682.

Stat. Auth.: ORS 682.017 & 682.068
Stats. Implemented: ORS 682.017 - 682.117, 682.991
Hist.: HD 18-1994, f. 6-30-94, cert. ef. 7-1-94; OHD 7-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 11-2010, f. 6-30-10, cert. ef. 7-1-10; PH 1-2013, f. & cert. ef. 1-25-13; Renumbered from 333-250-0070, PH 7-2017, f. & cert. ef. 3-21-17

333-250-0410

Civil Penalties

A person that violates licensed ambulance service rules or laws, an administrative order, or settlement agreement is subject to the imposition of a civil penalty not to exceed $5,000 per violation.

Stat. Auth.: ORS 682.017
Stats. Implemented: ORS 682.224
Hist.: PH 7-2017, f. & cert. ef. 3-21-17

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