TRAINING AND CERTIFICATION OF FIRST RESPONDERS,
EMERGENCY RESCUE TECHNICIANS AND
EMERGENCY MEDICAL TECHNICIANS-AMBULANCE
CHAPTER 132
EMERGENCY MEDICAL SERVICES
[Joint Rules pursuant to 147A.4]
[Prior to 7/29/87, Health Department[470] Ch 132]
641—132.1(147A) Definitions. For the purpose of these rules, the following definitions shall apply:
“ACLS” or “advanced cardiac life support” means training and successful course completion in advanced cardiac life support according to American Heart Association standards.
“Air carrier” or “air taxi” means any privately or publicly owned fixed-wing aircraft which may be specifically designed, modified, constructed, equipped, staffed and used regularly to transport the sick, injured or otherwise incapacitated who are in need of out-of-hospital emergency medical care or whose condition requires treatment or continuous observation while being transported.
“Ambulance” means any privately or publicly owned rotorcraft or ground vehicle specifically designed, modified, constructed, equipped, staffed and used regularly to transport the sick, injured or otherwise incapacitated who are in need of out-of-hospital emergency medical care or whose condition requires treatment or continuous observation while being transported.
“Ambulance service” means any privately or publicly owned service program which utilizes ambulances in order to provide patient transportation and emergency medical care at the scene of an emergency or while en route to a hospital or during transfer from one medical care facility to another or to a private home. An ambulance service may use first response or rescue vehicles (nontransport) to supplement ambulance vehicles.
“Automated defibrillator” means any external automatic or semiautomatic device that determines whether defibrillation is required. Automated defibrillators must meet or exceed design and performance guidelines stipulated by the Association for the Advancement of Medical Instrumentation for automated external defibrillators, published in February 1986.
“Basic ambulance service” means an ambulance service that provides patient treatment at the basic care level.
“Basic care” means treatment interventions, appropriate to certification level, that provide minimum care to the patient including, but not limited to, CPR, bandaging, splinting, oxygen administration, spinal immobilization, oral airway insertion and suctioning, antishock garment, vital sign assessment and administration of over-the-counter drugs.
“Board” means the state board of medical examiners appointed pursuant to Iowa Code section 147.14, subsection 2.
“CEHs” means “continuing education hours” which are based upon a minimum of 50 minutes of training per hour.
“Continuing education” means training approved by the department which is obtained by a certified emergency medical care provider to maintain, improve, or expand relevant skills and knowledge and to satisfy renewal of certification requirements.
“Course completion date” means the date of the final classroom session of an emergency medical care provider course.
“Course coordinator” means an individual who has been assigned by the training program to coordinate the activities of an emergency medical care provider course.
“CPR” means training and successful course completion in cardiopulmonary resuscitation and obstructed airway procedures according to American Heart Association or American Red Cross standards. This includes one rescuer, two rescuer, and child/infant cardiopulmonary resuscitation and adult and child/infant obstructed airway procedures.
“Current course completion card” means written recognition given for training and successful course completion of CPR or ACLS with an expiration date or a recommended renewal date that exceeds the current date.
“Department” means the Iowa department of public health.
“Director” means the director of the Iowa department of public health.
“Emergency medical care” means such medical procedures as:
	1.	Administration of intravenous solutions.
	2.	Intubation.
	3.	Performance of cardiac defibrillation and synchronized cardioversion.
	4.	Administration of emergency drugs as provided by rule by the department.
	5.	Any other medical procedure approved by the department, by rule, as appropriate to be performed by emergency medical care providers who have been trained in that procedure.
“Emergency medical care personnel” or “provider” means any FR, FR-D, EMT-A, EMT-B, EMT-D, EMT-I, or EMT-P currently certified by the department.
“Emergency medical technician-ambulance” means an individual who has successfully completed, as a minimum, the 1984 United States Department of Transportation’s Emergency Medical Technician-Ambulance curriculum, passed the department’s approved written and practical examinations, and is currently certified by the department as an EMT-A.
“Emergency medical technician-basic” means an individual who has successfully completed, as a minimum, the 1994 United States Department of Transportation’s Emergency Medical Technician-Basic curriculum (excluding endotracheal intubation), passed the department’s approved written and practical examinations, and is currently certified by the department as an EMT-B.
“Emergency medical technician-defibrillation” means an individual who has successfully completed an approved program which specifically addresses manual or automated defibrillation, passed the department’s approved written and practical examinations, and is currently certified by the department as an EMT-D.
“Emergency medical technician-intermediate” means an individual who has successfully completed the United States Department of Transportation’s EMT-intermediate curriculum (excluding endotracheal intubation), passed the department’s approved written and practical examinations, and is currently certified by the department as an EMT-I.
“Emergency medical technician-paramedic” means an individual who has successfully completed the United States Department of Transportation’s EMT-paramedic curriculum, passed the department’s approved written and practical examinations, and is currently certified by the department as an EMT-P.
“Emergency medical transportation” means the transportation, by ambulance, of sick, injured or otherwise incapacitated persons who require emergency medical care.
“Emergency rescue technician” means an individual trained in various rescue techniques including, but not limited to, extrication from vehicles and agricultural rescue, and who has successfully completed a curriculum approved by the department in cooperation with the Iowa Fire Service Institute.
“EMS” means emergency medical services.
“EMS advisory council” means a council appointed by the director to advise the director and develop policy recommendations concerning regulation, administration, and coordination of emergency medical services in the state.
“EMS-I” means emergency medical services-instructor.
“EMS instructor” means an individual who has successfully completed an EMS Instructor curriculum, approved by the department, and is currently certified by the department as an EMS-I.
“EMT-A” means emergency medical technician-ambulance.
“EMT-B” means emergency medical technician-basic.
“EMT-D” means emergency medical technician-defibrillation.
“EMT-I” means emergency medical technician-intermediate.
“EMT-P” means emergency medical technician-paramedic.
“ERT” means emergency rescue technician.
“First responder” means an individual who has successfully completed the United States Department of Transportation’s First Responder curriculum, passed the department’s approved written and practical examinations, and is currently certified by the department as an FR.
“First responder-defibrillation” means an individual who has successfully completed an approved program which specifically addresses defibrillation, passed the department’s approved written and practical examinations, and is currently certified by the department as an FR-D.
“First response vehicle” means any privately or publicly owned vehicle which is used solely for the transportation of emergency medical care personnel and equipment to and from the scene of a medical or nonmedical emergency.
“FR” means first responder.
“FR-D” means first responder-defibrillation.
“Hospital” means any hospital licensed under the provisions of Iowa Code chapter 135B.
“Intermediate” means an emergency medical technician-intermediate.
“Medical direction” means direction, advice, or orders provided by a medical director, supervising physician, or physician designee (in accordance with written parameters and protocols) to emergency medical care personnel.
“Medical director” means any physician licensed under Iowa Code chapter 148, 150, or 150A who shall be responsible for overall medical direction of the service program and who holds a current course completion card in ACLS.
“Mutual aid” means an agreement, preferably in writing, between two or more services that addresses how and under what circumstances each service will respond to a request for assistance.
“Nonemergency transportation” means transportation that may be provided for those persons determined to need transportation only.
“Nontransport service” means any privately or publicly owned rescue or first response service program which does not provide patient transportation (except when no ambulance is available or in a disaster situation) and utilizes only rescue or first response vehicles to provide emergency medical care at the scene of an emergency.
“Off-line medical direction” means the monitoring of EMS providers through retroactive field assessments and treatment documentation review, critiques of selected cases with the EMS personnel, and statistical review of the system.
“On-line medical direction” means immediate medical advice via radio or phone communications between the EMS provider and the medical director, supervising physician or physician designee.
“Outreach course coordinator” means an individual who has been assigned by the training program to coordinate the activities of an emergency medical care provider course held outside the training program facilities.
“PA” means physician assistant.
“Paramedic” means an emergency medical technician-paramedic.
“Patient” means any individual who is sick, injured, or otherwise incapacitated.
“Physician” means any individual licensed under Iowa Code chapter 148, 150, or 150A.
“Physician assistant” means an individual licensed pursuant to Iowa Code chapter 148C.
“Physician designee” means any registered nurse licensed under Iowa Code chapter 152, or any physician assistant licensed under Iowa Code chapter 148C and approved by the board of physician assistant examiners, who holds a current course completion card in ACLS. The physician designee may act as an intermediary for a supervising physician in directing the actions of emergency medical care personnel in accordance with written policies and protocols.
“Preceptor” means an individual who has been assigned by the training program, clinical facility or service program to supervise students while the students are completing their clinical or field experience. A preceptor must be an emergency medical care provider certified at the level being supervised or higher, or must be licensed as a registered nurse, physician’s assistant or physician.
“Primary instructor” means an individual who is responsible for teaching the majority of an initial emergency medical care provider course.
“Primary response vehicle” means any ambulance, rescue vehicle or first response vehicle which is utilized by a service program and is normally dispatched as the initial vehicle to respond to an emergency call.
“Protocols” means written directions and guidelines established and approved by the service program’s medical director that address the procedures to be followed by emergency medical care providers in emergency and nonemergency situations.
“Registered nurse” means an individual licensed pursuant to Iowa Code chapter 152.
“Rescue vehicle” means any privately or publicly owned vehicle which is specifically designed, modified, constructed, equipped, staffed and used regularly for rescue or extrication purposes at the scene of a medical or nonmedical emergency.
“RN” means a registered nurse.
“Rotorcraft ambulance” means any privately or publicly owned rotorcraft specifically designed, modified, constructed, equipped, staffed and used regularly to transport the sick, injured or otherwise incapacitated who are in need of out-of-hospital emergency medical care or whose condition requires treatment or continuous observation while being transported.
“Secondary response vehicle” means any ambulance, rescue vehicle or first response vehicle which is utilized by a service program when dispatched for routine or convalescent transfers, when the service program’s primary response vehicle would have a longer response time, is already in service or is otherwise unavailable or when a mutual aid request requires a different type of response vehicle. Secondary response vehicles may be staffed and equipped at any level up to and including the service program’s level of authorization.
“Service program” or “service” means any 24-hour emergency medical care ambulance service or nontransport service that has received authorization by the department.
“Service program area” means the geographic area of responsibility served by any given ambulance or nontransport service program.
“Specialty certification” means a nonmedical certification in an area related to emergency medical care including, but not limited to, emergency rescue technician and emergency medical services-instructor.
“Student” means any individual enrolled in a training program and participating in the didactic, clinical, or field experience portions.
“Supervising physician” means any physician licensed under Iowa Code chapter 148, 150, or 150A who holds a current course completion card in ACLS. The supervising physician is responsible for medical direction of emergency medical care personnel when such personnel are providing emergency medical care.
“Training program” means an area community college, law enforcement academy or hospital approved by the department to conduct emergency medical care training.
“Training program director” means an appropriate health care professional (full-time educator or practitioner of emergency or critical care) assigned by the training program to direct the operation of the training program.
“Training program medical director” means any physician licensed under Iowa Code chapter 148, 150, or 150A who is responsible for directing an emergency medical care training program and who holds a current course completion card in ACLS.
641—132.2(147A) Authority of emergency medical care personnel.
	132.2(1) Emergency medical care personnel shall perform under the supervision of a physician in accordance with Iowa Code chapter 147A and these rules.
	132.2(2) An emergency medical care provider may:
	a. 	Render emergency and nonemergency medical care in those areas for which the emergency medical care provider is certified, as part of an authorized service program:
	(1)	At the scene of an emergency;
	(2)	During transportation to a hospital;
	(3)	While in the hospital emergency department;
	(4)	Until patient care is directly assumed by a physician or by authorized hospital personnel; and
	(5)	During transfer from one medical care facility to another or to a private home.
	b. 	Function in any hospital when:
	(1)	Enrolled as a student or participating as a preceptor in a training program approved by the department;
	(2)	Fulfilling continuing education requirements;
	(3)	Employed by or assigned to a hospital as a member of an authorized service program, by rendering lifesaving services in the facility in which employed or assigned pursuant to the emergency medical care provider’s certification and under direct supervision of a physician or registered nurse. An emergency medical care provider shall not routinely function without the direct supervision of a physician or registered nurse. However, when the physician or registered nurse cannot directly assume emergency care of the patient, the emergency medical care personnel may perform, without direct supervision, emergency medical care procedures for which certified, if the life of the patient is in immediate danger and such care is required to preserve the patient’s life;
	(4)	Employed by or assigned to a hospital as a member of an authorized service program to perform nonlifesaving procedures for which trained and designated in a written job description. Such procedures may be performed after the patient is observed by and when the emergency medical care provider is under the supervision of the physician or registered nurse and where the procedure may be immediately abandoned without risk to the patient.
	132.2(3) When emergency medical care personnel are functioning in a capacity identified in subrule 132.2(2), paragraph “a,” they may perform emergency and nonemergency medical care without contacting a supervising physician or physician designee if written protocols have been approved by the service program medical director which clearly identify when the protocols may be used in lieu of voice contact.
	132.2(4) Emergency medical care skills which may be performed if approved by the service program’s medical director include:
	a. 	At the FR and FR-D levels, skills identified in the United States D.O.T. FR curriculum, plus the following skills in which training can be documented:
	(1)	Automated defibrillation and external cardiac pacing (provided the pacing is part of an automated defibrillator device and requires no decision making by the FR and FR-D).
	(2)	Oral airway suctioning.
	(3)	Insertion of an oral or nasopharyngeal airway device.
	(4)	Oxygen administration.
	(5)	Endotracheal or esophageal intubation when using a blindly inserted, combined esophageal/endotracheal device approved by the department.
	(6)	Blood pressure.
	b. 	At the EMT-A, EMT-B and EMT-D levels, skills identified in the United States D.O.T. EMT-A and EMT-B curricula, plus the following additional skills in which training can be documented:
	(1)	Defibrillation and external cardiac pacing (provided the pacing is part of an automated defibrillator device and requires no decision making by the EMT-A, EMT-B and EMT-D).
	(2)	Monitoring and maintenance of nonmedicated intravenous solutions.
	(3)	All skills identified in 132.2(4)“a.”
	c. 	At the EMT-I level, skills identified in the United States D.O.T. EMT-I curriculum, plus the following additional skills in which training can be documented:
	(1)	Endotracheal intubation when using a blindly inserted, combined esophageal/endotracheal device.
	(2)	Gastric tube insertion.
	(3)	Defibrillation and external cardiac pacing (provided the pacing is part of an automated defibrillator device and requires no decision making by the EMT-I).
	(4)	All skills identified in 132.2(4)“b.”
	d. 	At the EMT-P level, skills identified in the United States D.O.T. EMT-P curriculum, plus the following additional skills in which training can be documented:
	(1)	Gastric tube insertion.
	(2)	Nasogastric tube insertion.
	(3)	Urinary catheterization.
	(4)	Intraosseous infusion.
	(5)	All skills identified in 132.2(4)“c.”
	132.2(5) The department may approve other emergency medical care skills on a limited pilot project basis. Requests for pilot projects shall be submitted in writing to the department.
	132.2(6) An emergency medical care provider who has knowledge of an emergency medical care provider, service program or training program that has violated Iowa Code chapter 147A or these rules shall report such information to the department.
641—132.3(147A) Emergency medical care providers—requirements for enrollment in training programs.
	132.3(1) To be enrolled in a training program, an applicant shall:
	a. 	Be at least 17 years of age at the time of enrollment.
	b. 	Have a high school diploma or its equivalent if enrolling in an EMT-I or EMT-P course.
	c. 	Be able to speak, write and read English.
	d. 	Hold a current course completion card in CPR if enrolling in an EMT-B, EMT-I, or EMT-P course.
	e. 	Be currently certified as an FR, if enrolling in an FR-D course.
	f. 	Be currently certified, as a minimum, as an EMT-A, if enrolling in an EMT-I or paramedic course.
	132.3(2) Audits.
	a. 	With training program approval, persons who are not enrolled in an emergency medical care provider course may audit those courses. They shall not be eligible to take the practical and written certification examinations.
	b. 	Students enrolled in an out-of-state training program may participate in clinical or field experience in Iowa provided:
	(1)	The out-of-state training program has been approved by that state to conduct emergency medical care training, and
	(2)	A written agreement exists between the out-of-state training program and the clinical or field experience provider.
641—132.4(147A) Emergency medical care providers—certification, renewal standards and procedures, and fees.
	132.4(1) Application and examination.
	a. 	Applicants shall complete an “EMS Student Registration” form at the beginning of the course. Courses which are completed within two weeks are exempt from this requirement. “EMS Student Registration” forms are provided by the department.
	b. 	“EMS Student Registration” forms shall be forwarded to the department by the training program no later than two weeks after the beginning of the course.
	c. 	Upon satisfactory completion of the course and all training program requirements, including successful completion of the state certifying practical examination, the student shall be recommended by the training program to take the state certification written examinations. Candidates for state certification are not eligible to continue functioning as a student in the clinical and field setting. State certification must be obtained to perform appropriate skills.
	d. 	The practical examination shall be administered by the training program using the standards and forms provided by the department. The training program shall notify the department at least two weeks prior to the administration of a practical examination.
	e. 	To be eligible to take the written examination, the student shall first pass the practical examination.
	f. 	The student shall submit an “EMS Certification Application” form. “EMS Certification Application” forms are provided by the department.
	g. 	When a student’s “EMS Student Registration” or “EMS Certification Application” is referred to the department for investigation, the student shall not be certified until approved by the department.
	h. 	The certifying written examinations shall be administered at times and places determined by the department.
	i. 	No oral certification examinations shall be permitted; however, candidates may be eligible for appropriate accommodations for the written examination. Contact the Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa, 50319-0075.
	j. 	Practical examination fees shall be determined by the training program.
	k. 	The fee for grading and processing each EMT-I and EMT-P written examination is $20 payable to the Iowa Department of Public Health.
	l. 	A student who fails the practical certification examination shall be required to repeat only those stations which were failed and shall have two additional opportunities to attain a passing score. The student may repeat the failed examination stations on the same day as determined by the training program. If a student fails the written examination, the practical examination remains valid for a 12-month period from the date it was successfully completed.
	m. 	A student who fails to attain the appropriate overall score on the written certification examination shall have two additional opportunities to complete the entire examination and attain a passing score. Required overall passing scores for the Iowa certification examinations are: FR, EMT-A, or EMT-B—70 percent; EMT-I and EMT-P—75 percent. Passing criteria for the National Registry of EMT’s written examinations is established by the National Registry.
	n. 	A student who fails to pass the written certification examination on the third attempt and who wishes to pursue certification must submit, at a minimum, written verification (card or certificate) of successful completion of an appropriate D.O.T refresher course or equivalent. Students failing the examination on six attempts must repeat the entire EMT training program to be eligible for certification.
	o. 	All examination attempts shall be completed within one year of the initial course completion date. If an individual is unable to complete the testing within the one year due to medical reasons, an extension may be granted upon submission of a signed statement from a physician and approval by the department.
	p. 	Examination scores shall be confidential except that they may be released to the training program which provided the training or released in a manner which does not permit the identification of an individual.
	q. 	To be eligible to take the practical examination, FR candidates shall have a current course completion card in CPR.
	r. 	Applicants for EMS-I certification shall:
	(1)	Be currently certified as an emergency medical care provider or currently licensed as a registered nurse, physician assistant or physician.
	(2)	Successfully complete an EMS-Instructor curriculum approved by the department.
	s. 	Applicants for ERT certification shall successfully complete an ERT curriculum approved by the department in cooperation with the Iowa Fire Service Institute.
	132.4(2) Multiple certificates and renewal.
	a. 	With the exception of specialty certifications, only one certificate issued by the department shall be considered active. That certificate shall be for the individual’s highest level of certification. Any lower levels of certification shall be considered inactive.
	b. 	A lower level certificate may be issued if the individual fails to renew the higher level of certification or voluntarily chooses to move from a higher level to a lower level. To be issued a certificate in these instances, an individual shall:
	(1)	Complete all applicable continuing education requirements for the lower level during the certification period and submit a written request for the lower level.
	(2)	Complete and submit to the department an “Application for Renewal of Certification” and the applicable fee.
	(3)	Complete the reinstatement process in 132.4(3) if renewal of the higher level is later requested.
	c. 	A denial, probation, suspension or revocation imposed upon an individual certificate holder by the department shall be considered applicable to all certificates issued to that individual by the department.
	132.4(3) Renewal of certification.
	a. 	A certificate shall be valid for two years from issuance unless specified otherwise on the certificate or unless sooner suspended or revoked.
	b. 	All continuing education requirements shall be completed during the certification period prior to the certificate’s expiration date. Failure to complete the continuing education requirements prior to the expiration date shall result in an expired certification.
	c. 	The “Application for Renewal of Certification” shall be submitted to the department within the 90 days prior to the expiration date. Failure to submit a renewal application to the department within the 90 days prior to the expiration date (based upon the postmark date) shall cause the current certification to expire. Emergency medical care providers shall not function on an expired certification.
An individual who completes the required continuing education during the certification period, but fails to submit the “Application for Renewal of Certification” within the 90 days prior to the expiration date, shall be required to submit a late fee of $30 (in addition to the renewal fee) to obtain renewal of certification.
	d. 	An individual who has not completed the required continuing education during the certification period and is seeking to reinstate an expired certificate shall:
	(1)	Complete continuing education courses equivalent to the renewal requirements for that particular level of certification within six years following the certificate’s expiration date. Refer to Table 1 for total number of hours required.
	(2)	Meet all applicable eligibility requirements.
	(3)	Submit an “EMS Reinstatement Application” and the applicable fees to the department.
	(4)	Pass the appropriate practical and written certification examinations.
TABLE 1

 	REQUIRED CONTINUING EDUCATION
HOURS FOR REINSTATEMENT
(including required topics)	
CERTIFICATION EXPIRED FOR	FR-D
FR	EMT-D
EMT-A
EMT-B	EMT-I	EMT-P	
Less than 2 years	14	24	48	60	
2-4 years	28	48	96	120	
4-6 years	42	72	144	180	
	e. 	If certification has been expired for more than six years, the individual shall repeat the entire course, pass the practical and written certification examinations, meet all applicable eligibility requirements and submit the applicable fees and forms to again become certified.
	f. 	If an individual is unable to complete the required continuing education during the certification period due to an illness or injury, an extension of certification may be issued upon submission of a signed statement from a physician and approval by the department.
	132.4(4) Renewal standards. To be eligible for renewal, the certificate holder shall:
	a. 	Have signed and submitted an “Application for Renewal of Certification,” provided by the department, and the applicable fee within the 90 days prior to the certificate’s expiration date.
	b. 	Have a current CPR course completion card or a signed and dated statement from a recognized CPR instructor that documents current course completion in CPR.
	c. 	Have completed the continuing education requirements during the certification period including:
	(1)	FR, FR-D—14 hours of approved continuing education including at least 1 hour in each of the required topic areas listed in subparagraph (5).
	(2)	EMT-A, EMT-B, EMT-D—24 hours of approved continuing education including at least 1 hour in each of the required topic areas listed in subparagraph (5).
	(3)	EMT-I—48 hours of approved continuing education including at least 1 hour in each of the required topic areas listed in subparagraph (5).
	(4)	EMT-P—60 hours of approved continuing education including at least 1 hour in each of the required topic areas listed in subparagraph (5).
	(5)	Required topics for all levels include the following:
Infectious diseases
Abuse (child and dependent adult)
Trauma emergencies (should include skills practice)
Medical emergencies (should include skills practice)
	(6)	EMS-I—Attend at least one EMS-I workshop sponsored by the department.
	(7)	ERT—It is recommended that at least 1 hour in each of the following topic areas be completed:
Agricultural/industrial rescue
Rescue equipment/techniques
Special hazards
Vehicle rescue
	d. 	Notify the department of a change in address.
	e. 	Maintain a file containing documentation of continuing education hours accrued during each certification period and retain this file for four years from the end of each certification period.
A group of individual certificate holders will be audited for each certification period and will be required to submit verification of continuing education compliance within 45 days of the request. If audited, the following information must be provided: date of program, program sponsor number, title of program, number of hours approved, and appropriate supervisor signatures if clinical or practical evaluator hours are claimed. Certificate holders audited will be chosen in a random manner or at the discretion of the bureau of EMS. Falsifying reports or failure to comply with the audit request may result in formal disciplinary action.
	132.4(5) Continuing education approval. Continuing education hours (CEHs) may be issued for the following types of training during the certification period:
	a. 	Courses which are based upon the department’s curricula for EMS providers and other courses pertinent to emergency medical care. Approved self-study and video courses are permitted (4 hours maximum for FR and FR-D; 8 hours maximum for EMT-A, EMT-B and EMT-D; 16 hours maximum for EMT-I; 20 hours maximum for EMT-P).
	b. 	In-hospital clinical experience in areas relating to emergency medical care (4 hours maximum for FR and FR-D; 8 hours maximum for EMT-A, EMT-B and EMT-D; 16 hours maximum for EMT-I; 20 hours maximum for EMT-P).
	c. 	Disaster drills (4 hours maximum).
	d. 	Continuing education course instructors will be granted the appropriate number of CEHs for the courses taught.
	e. 	EMS course instructors will be granted the appropriate number of CEHs for the courses taught. When identical courses are taught, CEHs will be granted for the first course only.
	f. 	Practical certification examination evaluation (6 hours maximum).
	g. 	EMS course attendance (or audit) will qualify as continuing education based upon the number of hours attended (or audited).
	h. 	ACLS training and successful course completion (6 hours maximum).
	132.4(6) Out-of-state continuing education. Out-of-state continuing education courses will be accepted for CEHs if they meet the criteria in subrule 132.4(5) and have been approved for emergency medical care personnel in the state in which the courses were held. A copy of course completion certificates (or other verifying documentation) shall, upon request, be submitted to the department with the “Application for Renewal of Certification.”
	132.4(7) Nonapproval of CEHs. CEHs shall not be approved for:
	a. 	CPR course attendance, CPR course instruction or CPR instructor training.
	b. 	Courses or portions of courses which are beyond the scope of training and authority for emergency medical care personnel.
	132.4(8) Certification and renewal fees. The following fees shall be collected by the department and shall be nonrefundable:
	a. 	EMT-I and EMT-P written examination/certification fee—$20.
	b. 	FR-D and EMT-D certification fee—$10.
	c. 	Renewal of EMT-I and EMT-P certification(s) fee—$10.
	d. 	Endorsement certification fee—$30.
	e. 	Reinstatement fee—$30.
	f. 	Late fee—$30.
	132.4(9) Certification through endorsement. An individual currently certified by another state or by the National Registry of EMTs must also possess a current Iowa certificate to be considered certified in this state. The department shall contact the state of certification or the National Registry of EMTs to verify certification or registry and good standing. To receive Iowa certification, the individual shall:
	a. 	Complete and submit the “EMS Endorsement Application” available from the department.
	b. 	Provide verification of current certification in another state or with the National Registry of EMTs.
	c. 	Provide verification of current course completion in CPR. Applicants for paramedic endorsement shall also provide verification of current course completion in ACLS.
	d. 	Pass the appropriate Iowa practical and written certification examinations in accordance with subrule 132.4(1) within one year of the department’s approval of the endorsement candidate’s application. Current National Registry endorsement candidates are exempt from testing.
	e. 	Meet all other applicable eligibility requirements necessary for Iowa certification pursuant to these rules.
	f. 	Submit all applicable fees to the department.
	g. 	An individual certified through endorsement must satisfy the renewal and continuing education requirements set forth in subrule 132.4(4) to renew Iowa certification.
	132.4(10) Temporary certification through endorsement. Upon written request, the endorsement applicant may be issued temporary certification by the department. Justification for issuance of the temporary certification must accompany the request. Temporary certification shall not exceed six months.
641—132.5(147A) Training programs—standards, application, inspection and approval.
	132.5(1) Curricula.
	a. 	The training program shall use, as a minimum, the course curricula approved by the department and shall include, as a minimum, the following course components:
	(1)	Defibrillation course:
	1.	Four hours of classroom instruction for automated defibrillators.
	2.	Sixteen hours of classroom instruction for manual defibrillators.
	3.	Clinical experience as may be required by the training program.
	4.	Ambulance field experience as may be required by the training program.
	(2)	Emergency medical technician-intermediate (EMT-I) course:
	1.	Sixty hours of classroom instruction.
	2.	Fifty hours of clinical experience.
	3.	Fifty hours of ambulance/rescue field experience.
	(3)	Emergency medical technician-paramedic (EMT-P) course:
	1.	Three hundred hours of classroom instruction.
	2.	One hundred fifty hours of clinical experience.
	3.	One hundred fifty hours of ambulance/rescue field experience.
	(4)	First responder course:
	1.	Forty hours of classroom instruction.
	2.	Clinical experience as may be required by the training program.
	3.	Ambulance/rescue field experience as may be required by the training program.
	(5)	Emergency rescue technician course:
	1.	Forty hours of classroom instruction.
	2.	Clinical experience as may be required by the training program.
	3.	Ambulance/rescue field experience as may be required by the training program.
	(6)	Emergency medical technician-basic:
	1.	One hundred and ten hours of classroom instruction.
	2.	Eighteen hours of clinical time.
	3.	Ambulance/rescue field experience as may be required by the training program.
	b. 	The training program may waive portions of the required training by documenting equivalent training and what portions of the course have been waived for equivalency.
	c. 	Currently certified first responders who were certified before January 1, 1996, may perform the skills outlined in 132.2(4)“a,” upon successful completion of a transition course approved by the department. The transition course shall not exceed 14 hours.
	d. 	Individuals currently certified at the EMT-A or EMT-D level and who were certified prior to January 1, 1996, may perform the skills outlined in 132.2(4)“b,” upon successful completion of a transition course approved by the department. The transition course shall not exceed 24 hours.
	e. 	Individuals currently certified at the FR level and who were certified prior to January 1, 1996, may obtain EMT-B certification upon successful completion of a transition course approved by the department. Candidates shall successfully pass the EMT-B state certifying practical and written examinations. The transition course shall not exceed 70 hours.
	f. 	FR-D, EMT-D, and EMT-A courses shall not be initiated after July 1, 1996.
	132.5(2) Cardiac arrest tape review. Training programs may apply to the department for approval to provide cardiac arrest tape review if:
	a. 	A written agreement between the service program medical director and the training program exists to ensure responsibility for the review of cardiac arrest tapes and the maintenance of statistical information; and
	b. 	The training program has the necessary equipment and staff available to perform cardiac arrest tape review and to report statistical information; and
	c. 	The training program provides a written review of the cardiac arrest tape to the service program, the service program medical director and the department; and
	d. 	The training program submits to the department on a monthly basis a standardized data collection sheet for each cardiac arrest tape review. The standardized data collection sheets are available upon request from: Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075.
	132.5(3) Clinical or field experience resources. If clinical or field experience resources are located outside the framework of the training program, written agreements for such resources shall be obtained by the training program.
	132.5(4) Facilities.
	a. 	There shall be adequate classroom, laboratory, and practice space to conduct the training program. A library with reference materials on emergency and critical care shall also be available.
	b. 	Opportunities for the student to accomplish the appropriate skill competencies in the clinical environment shall be ensured. The following hospital units should be available for clinical experience for each training program as required in subrule 132.5(1):
	(1)	Emergency department;
	(2)	Intensive care unit or coronary care unit or both;
	(3)	Operating room and recovery room;
	(4)	Intravenous or phlebotomy team, or other method to obtain IV experience;
	(5)	Pediatric unit;
	(6)	Labor and delivery suite, and newborn nursery; and
	(7)	Psychiatric unit.
	c. 	Opportunities for the student to accomplish the appropriate skill competencies in the field environment shall be ensured. The training program shall use an appropriate emergency medical care service program to provide field experience as required in subrule 132.5(1).
	d. 	The training program shall have liability insurance and shall offer liability insurance to students while enrolled in a training program.
	132.5(5) Staff.
	a. 	The training program medical director shall be a physician who holds a current course completion card in ACLS.
	b. 	A training program director shall be appointed who is an appropriate health care professional. This individual shall be a full-time educator or a practitioner in emergency or critical care. Current EMS instructor certification is also recommended, but not mandatory.
	c. 	Course coordinators, outreach course coordinators, and primary instructor(s) used by the training program shall be currently certified as EMS instructors.
	d. 	The instructional staff shall be comprised of physicians, nurses, pharmacists, emergency medical care personnel, or other health care professionals who have appropriate education and experience in emergency and critical care. Current EMS instructor certification is also recommended, but not mandatory.
	e. 	Preceptors shall be assigned in each of the clinical units in which emergency medical care students are obtaining clinical experience and field experience. The preceptors shall supervise student activities to ensure the quality and relevance of the experience. Student activity records shall be kept and reviewed by the immediate supervisor(s) and by the program director and course coordinator.
	f. 	If a training program’s medical director resigns, the training program director shall report this to the department and provide a curriculum vitae for the medical director’s replacement. A new course shall not be started until a qualified medical director has been appointed.
	g. 	The training program shall maintain records for each instructor used which include, as a minimum, the instructor’s qualifications.
	h. 	The training program is responsible for ensuring that each course instructor is experienced in the area being taught and adheres to the course curricula.
	i. 	The training program shall ensure that each practical examination evaluator and mock patient is familiar with the practical examination requirements and procedures. Practical examination evaluators shall attend a workshop sponsored by the department.
	132.5(6) Advisory committee. There shall be an advisory committee which includes training program representatives and other groups such as affiliated medical facilities, local medical establishments, and ambulance, rescue and first response service programs.
	132.5(7) Student records. The training program shall maintain an individual record for each student. Training program policy and department requirements will determine contents. These requirements may include:
	a. 	Application;
	b. 	Current certifications;
	c. 	Student record or transcript of hours and performance (including examinations) in classroom, clinical, and field experience settings.
	132.5(8) Selection of students. There may be a selection committee to select students using, as a minimum, the prerequisites outlined in subrule 132.3(1).
	132.5(9) Students.
	a. 	Students may perform any procedures and skills that certified emergency medical care personnel may perform, if they are under the direct supervision of a physician or physician designee, or under the remote supervision of a physician or physician designee, with direct field supervision by an appropriately certified emergency medical care provider.
	b. 	Students shall not be substituted for personnel of any affiliated medical facility or service program, but may be employed while enrolled in the training program.
	132.5(10) Financing and administration.
	a. 	There shall be sufficient funding available to the training program to ensure that each class started can be completed.
	b. 	Tuition charged to students shall be accurately stated.
	c. 	Advertising for training programs shall be appropriate.
	d. 	The training program shall provide to each student, within two weeks of the course starting date, a guide which outlines as a minimum:
	(1)	Course objectives.
	(2)	Minimum acceptable scores on interim testing.
	(3)	Attendance requirements.
	(4)	Disciplinary actions that may be invoked and the reasons for them.
	132.5(11) Training program application, inspection and approval.
	a. 	An applicant seeking initial or renewal training program approval shall use the “EMS Training Program Application” provided by the department. The application shall include, as a minimum:
	(1)	Appropriate officials of the applicant;
	(2)	Evidence of availability of clinical resources;
	(3)	Evidence of availability of physical facilities;
	(4)	Evidence of qualified faculty;
	(5)	Qualifications and major responsibilities of each faculty member;
	(6)	Policies used for selection, promotion, and graduation of trainees;
	(7)	Practices followed in safeguarding the health and well-being of trainees, and patients receiving emergency medical care within the scope of the training program; and
	(8)	Level(s) of EMS certification to be offered.
	b. 	New training programs shall submit a needs assessment which justifies the need for the training program.
	c. 	Applications shall be reviewed in accordance with the current “Essentials and Guidelines of an Accredited Educational Program for the Emergency Medical Technician-Paramedic,” published by the American Medical Association.
	d. 	An on-site inspection of the applicant’s facilities and clinical resources will be performed. The purpose of the inspection is to examine educational objectives, patient care practices, facilities and administrative practices, and to prepare a written report for review and action by the department.
	e. 	No person shall interfere with the inspection activities of the department or its agents. Interference with or failure to allow an inspection may be cause for disciplinary action regarding training program approval.
	f. 	Representatives of the applicant may be required by the department to meet with the department at the time the application and inspection report are discussed.
	g. 	A written report of department action accompanied by the department inspection reports shall be sent to the applicant.
	h. 	Training program approval shall not exceed five years.
	i. 	The training program shall notify the department, in writing, of any change in ownership or control within 30 days.
641—132.6(147A) Continuing education providers—approval, record keeping and inspection.
	132.6(1) Continuing education courses for emergency medical care personnel may be approved by the board, the department, training program or a national EMS continuing education accreditation entity.
	132.6(2) A training program may conduct continuing education courses (utilizing appropriate instructors) which are within the scope of training and authority for emergency medical care personnel.
	a. 	Each training program shall assign a sponsor number to each continuing education course using an assignment system approved by the department.
	b. 	Each training program shall maintain a student record that includes, as a minimum:
Name Address
Certification number Social security number
	c. 	Each training program shall submit to the department the “Approved EMS Continuing Education” form on a quarterly basis.
	132.6(3) Record keeping and record inspection.
	a. 	The department may request additional information or inspect the records of any continuing education provider currently approved or who is seeking approval to ensure compliance or to verify the validity of any training program application.
	b. 	No person shall interfere with the inspection activities of the department or its agents. Interference with or failure to allow an inspection may be cause for disciplinary action regarding training program approval.
641—132.7(147A) Service program—authorization and renewal procedures, inspections and transfer or assignment of certificates of authorization.
	132.7(1) General requirements for authorization and renewal of authorization.
	a. 	An ambulance or nontransport service in this state that desires to provide emergency medical care, in the out-of-hospital setting, shall apply to the department for authorization to establish a program utilizing certified emergency medical care providers for delivery of care at the scene of an emergency or nonemergency, during transportation to a hospital, during transfer from one medical care facility to another or to a private home, or while in the hospital emergency department and until care is directly assumed by a physician or by authorized hospital personnel. Application for authorization shall be made on forms provided by the department. Applicants shall complete and submit the forms to the department at least 30 days prior to the anticipated date of authorization.
	b. 	To renew service program authorization, the service program shall continue to meet the requirements of Iowa Code chapter 147A and these rules. The renewal application shall be completed and submitted to the department at least 30 days before the current authorization expires.
	c. 	Applications for authorization and renewal of authorization may be obtained upon request to: Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075.
	d. 	The department shall approve an application when the department is satisfied that the program proposed by the application will be operated in compliance with Iowa Code chapter 147A and these administrative rules.
	e. 	Service program authorization is valid for a period of three years from its effective date unless otherwise specified on the certificate of authorization or unless sooner suspended or revoked.
	f. 	Service programs shall be fully operational upon the effective date and at the level specified on the certificate of authorization and shall meet all applicable requirements of Iowa Code chapter 147A and these rules.
	g. 	The certificate of authorization shall be issued only to the service program based in the city named in the application and shall not be inclusive of any other base of operation when that base of operation is located in a different city. Any ambulance service or nontransport service that is based in and operates from more than one city shall apply for and, if approved, shall receive a separate authorization for each base of operation that desires to provide emergency medical care.
	h. 	Any service program owner in possession of a certificate of authorization as a result of transfer or assignment shall continue to meet all applicable requirements of Iowa Code chapter 147A and these rules. In addition, the new owner shall apply to the department for a new certificate of authorization within 30 days following the effective date of the transfer or assignment.
	i. 	Nontransporting service programs that only provide basic care need only complete the application process of these rules for authorization.
	132.7(2) Out-of-state service programs.
	a. 	Service programs located in other states which wish to provide emergency medical care in Iowa must meet all requirements of Iowa Code chapter 147A and these rules and must be authorized by the department except when:
	(1)	Transporting patients from locations within Iowa to destinations outside of Iowa;
	(2)	Transporting patients from locations outside of Iowa to destinations within Iowa;
	(3)	Transporting patients to or from locations outside of Iowa that requires travel through Iowa; or
	(4)	Responding to a request for mutual aid in this state.
	b. 	Reserved.
	132.7(3)  Rotorcraft ambulances and air taxis or air carriers.
	a. 	Rotorcraft ambulances shall meet all applicable requirements of Iowa Code chapter 147A and these rules except for subrule 132.7(2), paragraphs 132.8(1)“b” and “c,” and subrules 132.8(8) and 132.8(9).
	b. 	Air taxis or air carriers shall not be subject to the requirements of Iowa Code chapter 147A and these rules except when utilizing emergency medical care personnel to provide emergency medical care. In such instances, emergency medical care personnel shall be members of an authorized service program (assigned by that service program) and shall be provided with the appropriate equipment and medical direction deemed necessary by that service program’s medical director.
	132.7(4) Service program inspections.
	a. 	The department shall inspect each service program at least once every three years. The department without prior notification may make additional inspections at times, places and under such circumstances as it deems necessary to ensure compliance with Iowa Code chapter 147A and these rules.
	b. 	The department may request additional information from or may inspect the records of any service program which is currently authorized or which is seeking authorization to ensure continued compliance or to verify the validity of any information presented on the application for service program authorization.
	c. 	The department may inspect the patient care records of a service program to verify compliance with Iowa Code chapter 147A and these rules.
	d. 	No person shall interfere with the inspection activities of the department or its agents pursuant to Iowa Code section 135.36.
	e. 	Interference with or failure to allow an inspection by the department or its agents may be cause for disciplinary action in reference to service program authorization.
	132.7(5) Temporary service program authorization.
	a. 	A temporary service program authorization may be issued to services that wish to operate during special events that may need emergency medical care coverage at a level other than basic care. Temporary authorization is valid for a period of 30 days unless otherwise specified on the certificate of authorization or unless sooner suspended or revoked. Temporary authorization shall apply to those requirements and standards for which the department is responsible. Applicants shall complete and submit the necessary forms to the department at least 30 days prior to the anticipated date of need.
	b. 	The service shall meet applicable requirement of these rules, but may apply for a variance using the criteria outlined in rule 132.14(147A).
	c. 	The service shall submit a justification which demonstrates the need for the temporary service program authorization.
	d. 	The service shall submit a report, to the department, within 30 days after the expiration of the temporary authorization which includes as a minimum:
	(1)	Number of patients treated;
	(2)	Types of treatment rendered;
	(3)	Any operational or medical problems.
	132.7(6) Conditional service program authorization. Any service that is unable to meet the staffing requirement to receive full authorization that wishes to provide emergency medical care shall apply to the department. The service shall:
	a. 	Justify why the service is unable to meet the staffing requirements of subrule 132.8(1), paragraphs “a” and “b.”
	b. 	Rescinded IAB 2/3/93, effective 3/10/93.
	c. 	If approved, receive a conditional certificate of authorization from the department, but the service shall not advertise or otherwise imply or hold itself out to the public as a fully authorized service program.
	d. 	If approved, utilize emergency medical care providers as appropriate to their level of certification up to and including the level of conditional authorization.
	e. 	Meet all applicable requirements of these rules with the exception of subrule 132.8(1), paragraphs “a” and “b.”
	f. 	If an ambulance service, provide as a minimum, one EMT-B and one licensed driver, who holds a current course completion card in CPR, on each primary response vehicle call (see Table 2). The service shall document each driver’s training in emergency driving techniques and in the use of the service’s communications equipment.
	g. 	If a nontransporting service, have, as a minimum, a written mutual aid agreement with at least one ground ambulance service to ensure coverage when no certified personnel are available (see Table 3). Simultaneous dispatching may be used in lieu of a written mutual aid agreement.
641—132.8(147A) Service program—operational requirements, record keeping, equipment and supply standards.
	132.8(1) Service programs shall:
	a. 	Maintain an adequate number of primary response vehicles and personnel to provide 24-hour-per-day, 7-day-per-week service at their authorized level. The adequate number of primary response vehicles and personnel to be maintained shall be determined by the department, and shall be based upon, but not limited to, the following:
	(1)	Number of calls;
	(2)	Service area and population; and
	(3)	Availability of other services in the area.
	b. 	Provide on each primary response vehicle call, as appropriate to the service program’s level of authorization, the following :
	(1)	Fully authorized basic care and EMT-B ground ambulance service programs shall provide, as a minimum, one EMT-B and a licensed driver (see Table 2). The service shall document each driver’s training in emergency driving techniques and in the use of the service’s communications equipment. Fully authorized EMT-I ambulance services shall provide, as a minimum, one EMT-I and one EMT-B. Fully authorized EMT-P ambulance services shall provide, as a minimum, one EMT-P and one EMT-B (see Table 2).
	(2)	Fully authorized nontransporting service programs shall provide, as a minimum, one appropriately certified emergency medical care provider at the level of service authorization (see Table 3).
	(3)	Nontransporting service programs that may also want to transport patients shall:
	1.	Apply to the department for authorization to transport patients on an occasional basis.
	2.	Use a vehicle that complies with subrule 132.8(4).
	3.	Provide staffing in accordance with 132.7(6)“f.”

TABLE 2: AMBULANCE SERVICE STAFFING	
Level of Authorization	
 	Basic Care	EMT-B	EMT-I	EMT-P	
Full authorization
Minimum staffing	1-EMT-B
1-Licensed Driver	1-EMT-B
1-Licensed Driver	1-EMT-I
1-EMT-B	1-EMT-P
1-EMT-B	
Conditional
Authorization
Minimum staffing	Not Applicable	Not Applicable	1-EMT-B
1-Licensed Driver	1-EMT-B
1-Licensed Driver	

TABLE 3: NONTRANSPORTING SERVICE STAFFING	
Level of Authorization	
 	Basic Care	First Responder	emt-b	emt-i	emt-p	
Full
Authorization
Minimum
Staffing	Not Applicable	1-fr	1-emt-b	1-emt-i	1-emt-p	
Conditional
authorization
Minimum
staffing	Not Applicable	Mutual aid
agreement with
a transporting
service	Mutual aid
agreement with
a transporting
service	Mutual aid
agreement with
a transporting
service	Mutual aid
agreement with
a transporting
service	
	(4)	Nothing in these rules shall prevent a nontransporting service program from transporting patients in an emergency situation when lack of transporting resources would cause an unnecessary delay in patient care.
	(5)	Unless otherwise established by protocol approved by the medical director, the emergency medical care provider with the highest level of certification (on the transporting service) shall attend the patient.
	c. 	Ensure that personnel duties are consistent with their level of certification and the service program’s level of authorization.
	d. 	Maintain current personnel rosters and personnel files. The files shall include the names and addresses of all personnel and documentation that verifies the following qualifications:
	(1)	Current provider level certification.
	(2)	Current course completion card in CPR.
	(3)	If a paramedic, and working for an EMT-P service, current course completion card in ACLS.
	(4)	Other current certifications/endorsements as may be required by the medical director.
	(5)	Documentation of emergency driving and use of the service’s communications equipment.
	e. 	If requested by the department, notify the department in writing of any changes in their personnel rosters.
	f. 	Have a medical director and on-line medical direction available on a 24-hour-per-day, 7-day-per-week basis.
	g. 	Utilize a dispatching and scheduling system which ensures that the appropriate service program personnel respond as required in this rule, and that they respond in a reasonable amount of time.
	h. 	Notify the department in writing within seven days of any change in ownership or control or of any reduction or discontinuance of operations.
	i. 	Select a new or temporary medical director if for any reason the incumbent medical director cannot or no longer wishes to serve in that capacity. Selection shall be made before the incumbent relinquishes the duties and responsibilities of that position.
	j. 	Within seven days of any change in medical directors, notify the department in writing of the selection of the new or temporary medical director who must have indicated in writing a willingness to serve in that capacity.
	k. 	Rescinded IAB 2/2/94, effective 3/9/94.
	l. 	Secondary response vehicles are not required to meet the vehicle standards, staffing and equipment requirements of primary response vehicles. When emergency medical care is to be provided, however, appropriate staff, equipment and supplies shall also be provided to ensure continuity of care. If an appropriate emergency medical care provider is not available to staff and to provide emergency medical care on a secondary response vehicle, a registered nurse, physician or physician’s assistant may provide that care pursuant to their license.
	m. 	Nothing in these rules shall prevent a registered nurse, physician or physician’s assistant from supplementing the staff of a primary or secondary response vehicle.
	n. 	Nothing in these rules shall prevent an authorized ambulance service program from utilizing a rescue or first response vehicle as a secondary response vehicle.
	o. 	The service program shall maintain a skills maintenance log (or a similar form or system containing comparable data) available upon request from: Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075. The medical director shall designate, in writing, the minimum number and type of monthly or quarterly mandatory skills to be performed. Individuals who are certified as an FR, FR-D, EMT-B, EMT-D or EMT-I shall complete defibrillation practice sessions (monthly for individuals who utilize manual defibrillators and quarterly for individuals who utilize automated defibrillators).
	p. 	No initial authorization shall be issued to EMT-D, EMT-B or EMT-I services wishing to utilize a manual defibrillator. This provision does not apply to EMT-D or EMT-I services authorized prior to January 1, 1990.
	q. 	Provide appropriate patient care skills by level of authorization (see Tables 4 and 5).

TABLE 4: AMBULANCE LEVEL SKILLS	
BASIC LEVEL	EMT-B LEVEL	EMT-I LEVEL	EMT-P LEVEL	
CPR, oxygen,
bandaging, splinting,
traction splint, vital sign
assessment, antishock
garment, spinal
immobilization, oral
airway insertion and
suctioning	Skills identified in
132.2(4)“b” including
defibrillation
esophageal/tracheal/
double-lumen airway
IV maintenance*
patient-assisted meds
*optional	Skills identified in 132.2(4)“c”
including:
IV initiation
EOA
EGTA	Skills identified in
132.2(4)“d” including:
Pharmacologic agents
endotracheal intubation	

TABLE 5: NONTRANSPORT LEVEL SKILLS	
FR BASIC	FR	EMT-B	EMT-I	EMT-P	
CPR
oxygen
bandaging
splinting	Skills identified
in 132.2(4)“a”
including:
AED
esophageal
airway	Skills identified in
132.2(4)“b”
including:
defibrillation
esophageal airway
Pt. assisted meds	Skills identified
in 132.2(4)“c”
including:
IV initiation
EOA
EGTA	Skills identified
in 132.2(4)“d”
including:
Pharmacologic agents
endotracheal
intubation	
	132.8(2) Each service program shall complete and maintain accurate records concerning the emergency care provided to each patient. An oral or written report should be given to the receiving hospital to ensure continuity of patient care. The data entered thereon shall be provided, upon request of the department, to the department for statistical and other study purposes, or for verification of compliance with Iowa Code chapter 147A and these rules.
In addition, FR, FR-D, EMT-D, EMT-B and EMT-I service programs shall:
	1.	Use the defibrillation protocol approved by the department.
	2.	Make simultaneous voice/ECG recordings on each call where cardiopulmonary resuscitation is performed. These recordings shall commence upon arrival at the patient’s side and shall not be terminated until patient care is assumed by higher level personnel with appropriate training and equipment.
	3.	Submit a copy of the patient care report and the original voice/ECG recording to the approved training program designated by the medical director within 48 hours of the cardiac arrest.
	132.8(3) The patient care report is a confidential document and shall be exempt from disclosure pursuant to Iowa Code subsection 22.7(2) and shall not be accessible to the general public. Information contained in those reports, however, may be utilized by any of the indicated distribution recipients and may appear in any document or public health record in a manner which prevents the identification of any patient or person named in those reports.
	132.8(4) Required equipment and vehicle standards.
	a. 	Ground ambulance service programs shall, as a minimum, use primary response vehicles that meet the Iowa ambulance standards listed in subrule 132.8(8). These vehicles shall be equipped, as a minimum, with the Iowa essential EMS equipment listed in subrule 132.8(10). In addition to the Iowa EMS essential equipment listed in subrule 132.8(10), ambulance services shall carry equipment and supplies in quantities as determined by the medical director, and appropriate to the service program’s level of care as established in the service program’s approved protocols.
	b. 	Rotorcraft ambulances shall be equipped, as a minimum, with the Iowa essential EMS equipment (excluding lower extremity traction splints and long spine boards) listed in subrule 132.8(10).
	c. 	Rescinded IAB 2/2/94, effective 3/9/94.
	d. 	Nontransport service programs shall be equipped, as a minimum, with the Iowa essential EMS equipment listed in subrule 132.8(10). In addition to the Iowa essential EMS equipment listed in subrule 132.8(10), nontransport service programs shall carry equipment and supplies in quantities as determined by the medical director, and appropriate to the service program’s level of care as established in the service program’s approved protocols.
	e. 	Primary and secondary response ambulances shall be maintained in a safe operating condition or shall be removed from service.
	f.  to i.  Rescinded IAB 2/2/94, effective 3/9/94.
	j. 	Over-the-counter drugs may be administered by FR, FR-D, EMT-A, EMT-D, EMT-B, EMT-I or EMT-P service programs upon completion of training and establishment of a written protocol approved by the medical director.
	k. 	All drugs shall be maintained in accordance with the rules of the state board of pharmacy examiners. The rules are available upon request to: Iowa State Board of Pharmacy Examiners, Executive Hills West, Des Moines, Iowa 50319.
	l. 	Accountability for drug exchange, distribution, storage, ownership, and security shall be subject to applicable state and federal requirements. The method of accountability shall be described in the written pharmacy agreement. A copy of the written pharmacy agreement shall be submitted to the department.
	m. 	Ambulance service programs shall maintain a telecommunications system between the emergency medical care provider and the source of their medical direction and other appropriate entities. Nontransport service programs shall maintain a telecommunications system between the emergency medical care provider and the responding ambulance service and other appropriate entities.
	n. 	All communications equipment shall be capable of transmitting and receiving clear and understandable voice communications to and from the service program’s communications base and all points within the service program’s primary service area.
	o. 	All communications shall be conducted in an appropriate manner and on a frequency approved by the Federal Communications Commission and the department.
	132.8(5) Each service program shall establish periodic maintenance and checklist procedures to ensure that:
	a. 	Vehicles are fully equipped and maintained in a safe operating condition. In addition:
	(1)	All primary response vehicles (ground only) shall be housed in a garage or other facility that prevents engine, equipment and supply freezeup and windshield icing. An unobstructed exit to the street shall also be maintained;
	(2)	The garage or other facility shall be adequately heated or each primary response vehicle shall have permanently installed auxiliary heating units to sufficiently heat the engine and patient compartment; and
	(3)	The garage or other facility shall be maintained in a clean, safe condition free of debris or other hazards.
	b. 	The exterior and interior of the vehicles are kept clean. The interior and equipment shall be cleaned after each use as necessary. When a patient with a communicable disease has been transported or treated, the interior and any equipment or nondisposable supplies coming in contact with the patient shall be thoroughly disinfected.
	c. 	All equipment stored in a patient compartment is secured so that, in the event of a sudden stop or movement of the vehicle, the patient and service program personnel are not injured by moving equipment.
	d. 	All airway, electrical and mechanical equipment is kept clean and in proper operating condition.
	e. 	Compartments provided within the vehicles and the medical and other supplies stored therein are kept in a clean and sanitary condition.
	f. 	All linens, airway and oxygen equipment or any other supplies or equipment coming in direct patient contact is of a single-use disposable type or cleaned, laundered or disinfected prior to reuse.
	g. 	Freshly laundered blankets and linen, or disposable linens are used on cots and pillows, and are changed after each use.
	h. 	Proper storage is provided for clean linen.
	i. 	A closed container is provided for soiled supplies.
	132.8(6) Service program—incident and accident reports.
	a. 	Incidents of fire or other destructive or damaging occurrences affecting the service program or theft of a service program vehicle, equipment, or drugs shall be reported to the department within seven days following the occurrence of the incident.
	b. 	A copy of the motor vehicle accident report required under Iowa Code subsection 321.266(2), relating to the reporting of an accident resulting in personal injury, death or property damage, shall be submitted to the department within seven days following an accident involving a service program vehicle.
	132.8(7) Mutual aid agreements.
	a. 	The department may require a service program to have a written mutual aid agreement in place with at least one neighboring transport service for backup purposes in the event the service program’s vehicle is not available in its primary service area. The agreements shall specify the duties and responsibilities of the agreeing parties, and a copy of the written agreement shall be submitted to the department.
	b. 	Nontransport services (operating in conjunction with basic care transport services) shall provide assurances that the ambulance service will have adequate equipment and trained staff to ensure continuity of care. This shall include, if necessary, ensuring that an emergency medical care provider is present with the patient while en route to a hospital.
	132.8(8) Iowa ambulance standards.
	a. 	The vehicle shall be capable of a sustained speed of not less than 55 mph over dry, hard-surfaced, level roads and shall be capable of providing a stable ride during all weather conditions.
	b. 	The vehicle shall be capable of being driven for at least 150 miles before refueling.
	c. 	The electrical system shall be equipped to include, but shall not be limited to:
	(1)	Dual 12-volt batteries with equal ampere rating;
	(2)	A 130-ampere alternator system;
	(3)	Starting, lighting, ignition, visual and audible warning systems and an ampere meter or voltmeter.
	(4)	Owner-specified electronics equipment.
	(5)	Devices that include master consoles located in the cab and patient compartments; and
	(6)	Other owner-specified accessory wiring.
	d. 	All wiring devices, switches, outlets, etc., (except circuit breakers) shall be rated to carry at least 100 percent of the maximum ampere load for which the circuit is protected. All electrical wiring connectors and controls shall be easily identifiable and readily accessible for checking and servicing without having to move equipment or supplies from their usual location within the vehicle.
	e. 	The electrical generating system shall be reliable at outside temperatures ranging from minus 30 degrees Fahrenheit to plus 120 degrees Fahrenheit to permit prompt starting of all systems on board the vehicle while driving to the scene, while idling at the scene for variable periods of time, and while driving from the scene to the hospital with all systems at maximum capacity. The alternator shall be capable of producing a minimum of 130 amperes at 50 percent of the engine’s rated net horsepower RPM rating. An alternator producing more than 130 amperes at 50 percent of the furnished engine’s rated net horsepower RPM rating shall be used when the ampere load of all electrical equipment and accessories requires it. An auxiliary throttle shall be included to control the RPMs of an idling engine.
	f. 	A dual 12-volt battery system with a labeled “battery selector device” shall be furnished. The batteries shall not be rated less than 375 cold cranking amperes at zero degrees Fahrenheit with 115 minutes reserve capacity.
	g. 	The engine cooling system shall be a closed, air free liquid state type with an overflow recovery tank and a coolant compensating system. The cooling system shall maintain the engine at safe operating temperatures at all drivable altitudes and grades that may be encountered during vehicle use.
	h. 	All normal vehicle controls, switches and instruments shall be clearly identified, within normal reach of the driver and visible by day or night.
	i. 	The specified patient compartment controls, switches, and instruments shall be panel mounted and located within normal reach of a seated attendant facing the rear of the patient compartment forward of the primary patient’s head. All patient compartment controls shall be clearly identified and visible by day or night.
	j. 	There shall be emergency lights that provide 360 degrees of visibility and a siren capable of producing at least 100 decibels at 10 feet. A public address system shall be included.
	k. 	There shall be an exterior light over the rear loading door which shall be activated automatically when the door is opened and by a manual switch inside the vehicle. There shall be at least one clear white floodlight on each side of the vehicle.
	l. 	There shall be two mounted spotlights or one hand-held spotlight.
	m. 	The patient compartment size (including interior cabinet space) shall be a minimum of:
	(1)	Head room, 60 inches;
	(2)	Length, 116 inches; and
	(3)	Width, 60 inches.
	n. 	There shall be an in-line oxygen system that includes, as a minimum, an oxygen cylinder with a storage capacity of at least 2000 liters located in a compartment which is vented to the outside. The pressure gauge, regulator and control valve shall be readily accessible. In addition, there shall be at least one oxygen outlet accessible to the head of the patient stretcher.
	o. 	An engine vacuum with a reservoir or electrically powered suction aspirator system with an air flow of at least 30 liters per minute and a vacuum of at least 300 millimeters of mercury shall be securely mounted yet readily accessible. The unit shall be equipped with large bore, nonkinking suction tubing and semirigid, oropharyngeal suction tips (nonmetallic) and shall be located in the patient compartment.
	p. 	All vehicles shall be equipped with a complete climate control system(s) to supply and maintain clean air conditions with a comfortable level of inside temperature in both driver and patient compartments. The various systems for heating, ventilation, and air conditioning may be a separate or a combination system which shall permit independent control of the environment within each compartment.
	q. 	An inflated spare tire and wheel assembly, identical to those on the vehicle, together with the necessary tools for tire changing may be carried, and if carried, preferably located outside the patient compartment.
	r. 	All external storage compartments shall be readily accessible and weatherproofed.
	s. 	The type I modular unit, the type II van unit, and the type III integral cab-modular unit shall be of prime commercial quality metal or other material with strength at least equivalent to all-steel. Wood shall not be used for structural framing. The exterior of the body shall have a smooth finish, except for rub rails, and shall include provisions for doors and windows as specified. The ambulance body as a unit shall be designed and built to provide impact and penetration resistance, and shall be of sufficient strength to support the entire weight of the fully loaded vehicle on its top or side if overturned, without crushing, separation of joints, or permanently deforming roof bow or reinforcements, body posts, doors, strainers, stringers, floor, inner linings, outer panels and other reinforcements.
	t. 	Crash-stable quick-release devices (i.e., seat belts, fasteners, etc.) shall be available for the following:
	(1)	One driver and one passenger in the front seat(s);
	(2)	One attendant at the head of the primary patient stretcher;
	(3)	Two patients on stretchers, one patient on the primary stretcher and one on a backup stretcher (i.e., stair chair, hanging stretcher, etc.); and
	(4)	Additional equipment and supplies as appropriate for the level of service (medical care) provided.
	u. 	There shall be adequate space to mount radios and allow easy access for maintenance. The radio system shall allow for radio communications to all appropriate entities from the driver’s compartment as well as the patient’s compartment.
	v. 	Safety equipment shall include, but need not be limited to, flares (or the equivalent) and a readily accessible 5-pound ABC fire extinguisher.
	132.8(9) Iowa rescue and first response vehicle standards. Rescinded IAB 2/2/94, effective 3/9/94.
	132.8(10) Iowa essential EMS equipment for ambulance and nontransport services.
	a. 	Portable suction apparatus with wide-bore tubing and rigid pharyngeal suction tip.
	b. 	Hand-operated bag-valve-mask unit with adult, child and infant size masks or separate units for each size (an oxygen demand valve may be used in lieu of the adult size unit).
	c. 	Oropharyngeal airways in adult, child and infant sizes.
	d. 	Portable oxygen equipment with pressure and liter flow gauges.
	e. 	Oxygen nasal cannulas.
	f. 	Oxygen masks in adult, child and infant sizes (including a partial or nonrebreather adult size mask).
	g. 	Bite stick.
	h. 	Pocket mask or equivalent.
	i. 	Large and small sterile dressings.
	j. 	Soft roller bandages.
	k. 	Tape of various sizes.
	l. 	Clean burn sheets (need not be sterile).
	m. 	Occlusive dressing (occlusive gauze, plastic wrap or defibrillator pads).
	n. 	Lower extremity traction splint (optional for EMT-A, EMT-D, EMT-B, EMT-I, and EMT-P nontransport services).
	o. 	Extremity immobilizing device (board, ladder or formable splint).
	p. 	Short spine board (or equivalent extrication device) and long spine board (optional for EMT-A, EMT-D, EMT-B, EMT-I, and EMT-P nontransport services).
	q. 	Triangular bandages or slings.
	r. 	Shears and scissors.
	s. 	Sterile obstetrical kit.
	t. 	Aluminum foil or silver swaddler (or equivalent) to maintain infant body temperature.
	u. 	Stethoscope and blood pressure cuff (adult size required with pediatric size recommended).
	v. 	Penlight or equivalent and flashlight.
	w. 	Rigid extrication collars (Philadelphia, stiff-neck or equivalent) in at least three basic sizes.
	x. 	Defibrillator (required, except for basic level services).
	1.	Automated, portable, battery-operated with voice/ECG recorder. (FR-D).
	2.	Manual or automated, portable, battery-operated with voice/ECG recorder. (EMT-D, EMT-B, EMT-I, EMT-P).
	3.	Voice/ECG recorder is optional for EMT-P.
	y. 	Esophageal/tracheal double-lumen airway device (required, except for basic level services).
	132.8(11) Implementation. The director may grant exceptions and variances from the requirements of this chapter for any ambulance or nontransporting service. Exceptions or variations shall be reasonably related to undue hardships which existing services experience in complying with this chapter. No exception or variance may be granted unless the service has adopted a plan, approved by the department prior to July 1, 1996, to achieve compliance during a period not to exceed seven years. Services requesting exceptions and variances shall be subject to other applicable rules adopted pursuant to 147A. Nothing in this chapter shall be construed to require any ambulance or nontransporting service to provide a level of care beyond minimum basic care standards.
641—132.9(147A) Service program—off-line medical direction.
	132.9(1) The medical director shall be responsible for providing appropriate medical direction and overall supervision of the medical aspects of the service program and shall ensure that those duties and responsibilities are not relinquished before a new or temporary replacement is functioning in that capacity.
	132.9(2) The medical director’s duties include, but need not be limited to:
	a. 	Developing, approving and updating protocols to be used by service program personnel.
	b. 	Developing and maintaining liaisons between the service, other physicians, physician designees, and hospitals.
	c. 	Monitoring and evaluating the activities of the service program and individual personnel performance.
	d. 	Assessing the continuing education needs of the service and individual service program personnel and assisting them in obtaining the appropriate continuing education programs.
	e. 	Being available for individual evaluation and consultation to service program personnel.
	f. 	Performing or appointing a designee to complete the medical audits required in subrule 132.9(4).
	g. 	Ensuring maintenance of skills by service program personnel including:
	(1)	Documenting training on specific equipment used by the service program. Such training may be performed by an approved training program or other qualified individual approved by the medical director.
	(2)	Documenting the monthly or quarterly defibrillation practice sessions required in subrule 132.8(1), paragraph “o.”
	(3)	The medical director may remove an individual from service program participation and require remedial education including, but not limited to: classroom instruction, clinical experience and field experience.
	h. 	Informing the medical community of the emergency medical care being provided according to approved protocols in the service program area.
	i. 	Helping to resolve service operational problems.
	132.9(3) Supervising physicians and physician designees may assist the medical director by:
	a. 	Providing medical direction.
	b. 	Reviewing the emergency medical care provided.
	c. 	Reviewing and updating protocols.
	d. 	Providing and assessing continuing education needs for service program personnel.
	e. 	Helping to resolve operational problems.
	132.9(4) The medical director, supervising physicians, physician designees or other qualified designees shall randomly audit (at least quarterly) documentation of calls where emergency medical care was provided. The medical director shall randomly review audits performed by the supervising physician, physician designee or other designee. The audit shall be in writing and shall include, but need not be limited to:
	a. 	Reviewing the patient care provided by service program personnel and remedying any deficiencies or potential deficiencies that may be identified regarding medical knowledge or skill performance.
	b. 	Time spent at the scene.
	c. 	Tiered response.
	132.9(5) The medical director shall approve written protocols for each drug carried by the service program which describe when and how each drug may be administered.
	132.9(6) On-line medical direction when provided through a hospital.
	a. 	The medical director shall designate in writing at least one hospital which has established a written on-line medical direction agreement with the department. It shall be the medical director’s responsibility to notify the department in writing of changes regarding this designation.
	b. 	Hospitals signing an on-line medical direction agreement shall:
	(1)	Ensure that the supervising physicians or physician designees who are trained and hold a current course completion card in ACLS will be available to provide on-line medical direction via radio communications on a 24-hour-per-day basis.
	(2)	Identify the service programs for which on-line medical direction will be provided.
	(3)	Establish written protocols for use by supervising physicians and physician designees who provide on-line medical direction.
	(4)	Administer a quality assurance program to review orders given. The program shall include a mechanism for the hospital and service program medical directors to discuss and resolve any identified problems.
	c. 	A hospital which has a written medical direction agreement with the department may provide medical direction for any or all service program authorization levels and may also agree to provide backup on-line medical direction for any other service program when that service program is unable to contact its primary source of on-line medical direction.
	d. 	Only supervising physicians or physician designees shall provide on-line medical direction via radio communications. However, a physician, registered nurse or EMT (of equal or higher level) may relay orders to emergency medical care personnel, without modification, from a supervising physician or physician designee.
	e. 	On an annual basis, the hospital shall notify the department in writing of any changes in the supervising physicians and physicians providing on-line medical direction.
	f. 	Supervising physicians and physician designees shall be trained in the proper use of radio protocols and equipment.
	g. 	The department may verify a hospital’s communications system to ensure compliance with the on-line medical direction agreement.
	h. 	A supervising physician or physician designee who gives orders (directly or via communications equipment from some other point) to an emergency medical care provider is not subject to criminal liability by reason of having issued the orders and is not liable for civil damages for acts or omissions relating to the issuance of the orders unless the acts or omissions constitute recklessness.
	i. 	Nothing in these rules requires or obligates a hospital, supervising physician or physician designee to approve requests for orders received from emergency medical care personnel.
Note:  Hospitals in other states may participate provided the applicable requirements of this subrule are met.
641—132.10(147A) Complaints and investigations—denial, citation and warning, probation, suspension or revocation of service program authorization or renewal.
	132.10(1) All complaints regarding the operation of authorized emergency medical care service programs, or those purporting to be or operating as the same, shall be reported to the department. The address is: Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075.
	132.10(2) Complaints and the investigative process will be treated as confidential in accordance with Iowa Code chapter 22.
	132.10(3) Service program authorization may be denied, issued a citation and warning, placed on probation, suspended or revoked by the department in accordance with Iowa Code subsection 147A.5(3) for any of the following reasons:
	a. 	Failure or repeated failure of the applicant or alleged violator to meet the requirements or standards established pursuant to Iowa Code chapter 147A or the rules adopted pursuant to that chapter.
	b. 	Obtaining or attempting to obtain or renew or retain service program authorization by fraudulent means, misrepresentation or by submitting false information.
	c. 	Engaging in conduct detrimental to the well-being or safety of the patients receiving or who may be receiving emergency medical care.
	132.10(4) The department shall notify the applicant of the granting or denial of authorization or renewal, or shall notify the alleged violator of action to issue a citation and warning, place on probation or suspend or revoke authorization or renewal pursuant to Iowa Code sections 17A.12 and 17A.18. Notice of issuance of a denial, citation and warning, probation, suspension or revocation shall be served by restricted certified mail, return receipt requested, or by personal service.
	132.10(5) Any requests for appeal concerning the denial, citation and warning, probation, suspension or revocation of service program authorization or renewal shall be submitted by the aggrieved party in writing to the department by certified mail, return receipt requested, within 30 days of the receipt of the department’s notice. The address is: Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075. If such a request is made within the 30-day time period, the notice shall be deemed to be suspended. Prior to or at the hearing, the department may rescind the notice upon satisfaction that the reason for the denial, citation and warning, probation, suspension or revocation has been or will be removed. After the hearing, or upon default of the applicant or alleged violator, the administrative law judge shall affirm, modify or set aside the denial, citation and warning, probation, suspension or revocation. If no request for appeal is received within the 30-day time period, the department’s notice of denial, probation, suspension or revocation shall become the department’s final agency action.
	132.10(6) Upon receipt of an appeal that meets contested case status, the appeal shall be forwarded within five working days to the department of inspections and appeals pursuant to the rules adopted by that agency regarding the transmission of contested cases. The information upon which the adverse action is based and any additional information which may be provided by the aggrieved party shall also be provided to the department of inspections and appeals.
	132.10(7) The hearing shall be conducted according to the procedural rules of the department of inspections and appeals found in 481—Chapter 10.
	132.10(8) When the administrative law judge makes a proposed decision and order, it shall be served by restricted certified mail, return receipt requested, or delivered by personal service. That proposed decision and order then becomes the department’s final agency action without further proceedings ten days after it is received by the aggrieved party unless an appeal to the director is taken as provided in subrule 132.10(9).
	132.10(9) Any appeal to the director for review of the proposed decision and order of the administrative law judge shall be filed in writing and mailed to the director by certified mail, return receipt requested, or delivered by personal service within ten days after the receipt of the administrative law judge’s proposed decision and order by the aggrieved party. A copy of the appeal shall also be mailed to the administrative law judge. Any request for an appeal shall state the reason for appeal.
	132.10(10) Upon receipt of an appeal request, the administrative law judge shall prepare the record of the hearing for submission to the director. The record shall include the following:
	a. 	All pleadings, motions, and rules.
	b. 	All evidence received or considered and all other submissions by recording or transcript.
	c. 	A statement of all matters officially noticed.
	d. 	All questions and offers of proof, objections, and rulings thereon.
	e. 	All proposed findings and exceptions.
	f. 	The proposed decision and order of the administrative law judge.
	132.10(11) The decision and order of the director becomes the department’s final agency action upon receipt by the aggrieved party and shall be delivered by restricted certified mail, return receipt requested, or by personal service.
	132.10(12) It is not necessary to file an application for a rehearing to exhaust administrative remedies when appealing to the director or the district court as provided in Iowa Code section 17A.19. The aggrieved party to the final agency action of the department who has exhausted all administrative remedies may petition for judicial review of that action pursuant to Iowa Code chapter 17A.
	132.10(13) Any petition for judicial review of a decision and order shall be filed in the district court within 30 days after the decision and order becomes final. A copy of the notice of appeal shall be sent to the department by certified mail, return receipt requested, or by personal service. The address is: Bureau of Emergency Medical Services, Iowa Department of Public Health, Lucas State Office Building, Des Moines, Iowa 50319-0075.
	132.10(14) The party who appeals a final agency action to the district court shall pay the cost of the preparation of a transcript of the contested case hearing for the district court.
	132.10(15) Final decisions of the department relating to disciplinary proceedings may be transmitted to the appropriate professional associations, the news media or employer.
641—132.11(147A) Complaints and investigations—denial, citation and warning, probation, suspension, or revocation of emergency medical care personnel certificates or renewal.
	132.11(1) The department may deny an application for issuance or renewal of an emergency medical care provider certificate, including specialty certifications, or place on probation, or issue a citation and warning, suspend or revoke the certificate when it finds that the applicant or certificate holder has committed any of the following acts or offenses:
	a. 	Negligence in performing emergency medical care.
	b. 	Failure to follow the directions of supervising physicians or their designees.
	c. 	Rendering treatment not authorized under Iowa Code chapter 147A.
	d. 	Fraud in procuring certification or renewal.
	e. 	Professional incompetency.
	f. 	Knowingly making misleading, deceptive, untrue or fraudulent representations in the practice of a profession or engaging in unethical conduct or practice harmful or detrimental to the public. Proof of actual injury need not be established.
	g. 	Habitual intoxication or addiction to drugs.
	h. 	Falsification of medical records.
	i. 	Fraud in representation as to skill, ability or certification.
	j. 	Willful or repeated violations of Iowa Code chapter 147A or these rules.
	k. 	Violating a statute of this state, another state, or the United States, without regard to its designation as either a felony or misdemeanor, which relates to the provision of emergency medical care. A certified copy of the record of conviction or plea of guilty is conclusive evidence of the violation.
	l. 	Having certification to practice emergency medical care suspended or revoked, or having other disciplinary action taken by a licensing or certifying authority of another state, territory or country. A certified copy of the record or order of suspension, revocation or disciplinary action is conclusive or prima facie evidence.
	m. 	Practicing the profession while certification is suspended.
	n. 	Violating the terms of probation, settlement or a decision and order.
	o. 	Falsifying certification renewal reports or failure to comply with the renewal audit request.
	132.11(2) If clinical issues are involved, the matter shall be referred to the board for completion of the investigation and the conduct of any disciplinary proceeding pursuant to Iowa Code chapter 17A. The findings of the board shall be the final decision for purposes of Iowa Code section 17A.15 and shall be enforced by the department.
641—132.12(147A) Complaints and investigations—denial, citation and warning, probation, suspension, or revocation of training program or continuing education provider approval or renewal. The department may deny an application for approval or renewal, or issue a citation and warning, or place on probation, or suspend or revoke the approval or renewal when it finds that the applicant has failed to meet the applicable provisions of these rules or has committed any of the following acts or offenses:
	1.	Fraud in procuring approval or renewal.
	2.	Falsification of training or continuing education records.
	3.	Suspension or revocation of approval to provide emergency medical care training or other disciplinary action taken pursuant to Iowa Code chapter 147A. A certified copy of the record or order of suspension, revocation or disciplinary action is conclusive or prima facie evidence.
641—132.13(147A) Complaints, investigations and appeals.
	132.13(1) All complaints regarding emergency medical care personnel, training programs or continuing education providers, or those purporting to be or operating as the same, shall be reported to the department. The address is: Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075.
	132.13(2) An emergency medical care provider who has knowledge of an emergency medical care provider or service program that has violated Iowa Code chapter 147A or 641—Chapter 132 shall report such information to the department.
	132.13(3) Complaint investigations may result in the department’s issuance of a notice of denial, citation and warning, probation, suspension or revocation.
	132.13(4) A determination of mental incompetence by a court of competent jurisdiction automatically suspends a certificate for the duration of the certificate unless the department orders otherwise.
	132.13(5) Notice of denial, issuance of a citation and warning, probation, suspension or revocation shall be effected in accordance with the requirements of Iowa Code section 17A.12. Notice to the alleged violator of denial, probation, suspension or revocation shall be served by certified mail, return receipt requested, or by personal service.
	132.13(6) Any request for a hearing concerning the denial, citation and warning, probation, suspension or revocation shall be submitted by the aggrieved party in writing to the department by certified mail, return receipt requested, within 20 days of the receipt of the department’s notice to take action. The address is: Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075. If the request is made within the 20-day time period, the notice to take action shall be deemed to be suspended pending the hearing. Prior to or at the hearing, the department may rescind the notice upon satisfaction that the reason for the denial, citation and warning, probation, suspension or revocation has been or will be removed. If no request for a hearing is received within the 20-day time period, the department’s notice of denial, citation and warning, probation, suspension or revocation shall become the department’s final agency action.
	132.13(7) Upon receipt of a request for hearing, the request shall be forwarded within five working days to the department of inspections and appeals pursuant to the rules adopted by that agency regarding the transmission of contested cases. The information upon which the adverse action is based and any additional information which may be provided by the aggrieved party shall also be provided to the department of inspections and appeals.
	132.13(8) The hearing shall be conducted according to the procedural rules of the department of inspections and appeals found in 481—Chapter 4.
	132.13(9) When the administrative law judge makes a proposed decision and order, it shall be served by certified mail, return receipt requested, or delivered by personal service. That proposed decision and order then becomes the department’s final agency action without further proceedings ten days after it is received by the aggrieved party unless an appeal to the director is taken as provided in subrule 132.13(11).
	132.13(10) Any appeal to the director for review of the proposed decision and order of the administrative law judge shall be filed in writing and mailed to the director by certified mail, return receipt requested, or delivered by personal service within ten days after the receipt of the administrative law judge’s proposed decision and order by the aggrieved party. A copy of the appeal shall also be mailed to the administrative law judge. Any request for an appeal shall state the reason for appeal.
	132.13(11) Upon receipt of an appeal request, the administrative law judge shall prepare the record of the hearing for submission to the director. The record shall include the following:
	a. 	All pleadings, motions, and rules.
	b. 	All evidence received or considered and all other submissions by recording or transcript.
	c. 	A statement of all matters officially noticed.
	d. 	All questions and offers of proof, objections and rulings on them.
	e. 	All proposed findings and exceptions.
	f. 	The proposed decision and order of the administrative law judge.
	132.13(12) The decision and order of the director becomes the department’s final agency action upon receipt by the aggrieved party and shall be delivered by certified mail, return receipt requested, or by personal service.
	132.13(13) It is not necessary to file an application for a rehearing to exhaust administrative remedies when appealing to the director or the district court as provided in Iowa Code section 17A.19. The aggrieved party to the final agency action of the department who has exhausted all administrative remedies may petition for judicial review of that action pursuant to Iowa Code chapter 17A.
	132.13(14) Any petition for judicial review of a decision and order shall be filed in the district court within 30 days after the decision and order becomes final. A copy of the notice of appeal shall be sent to the department by certified mail, return receipt requested, or by personal service. The address is: Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075.
	132.13(15) The party who appeals a final agency action to the district court shall pay the cost of the preparation of a transcript of the contested case hearing for the district court.
	132.13(16) Final decisions of the department relating to disciplinary proceedings may be transmitted to the appropriate professional associations, the news media or employer.
641—132.14(147A) Temporary variances.
	132.14(1) If during a period of authorization there is some occurrence that temporarily causes a service program to be in noncompliance with these rules, the department may grant a temporary variance. Temporary variances to these rules (not to exceed six months in length per any approved request) may be granted by the department to a currently authorized service program. Requests for temporary variances shall comply only to the service program requesting the variance and shall apply only to those requirements and standards for which the department is responsible.
	132.14(2) To request a variance, the service program shall:
	a. 	Notify the department verbally (as soon as possible) of the need to request a temporary variance.
	b. 	Cite the rule from which the variance is requested.
	c. 	State why compliance with the rule cannot be maintained.
	d. 	Explain the alternative arrangements that have been or will be made regarding the variance request.
	e. 	Estimate the period of time for which the variance will be needed.
	f. 	Submit to the department, within ten days after having given verbal notification to the department, a written explanation for the temporary variance request that addresses each of the above paragraphs. The address and telephone number are: Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075, (515)281-3741.
	132.14(3) Upon notification of a request for variance, the department shall take into consideration, but shall not be limited to:
	a. 	Examining the rule from which the temporary variance is requested to determine if the request is appropriate and reasonable.
	b. 	Evaluating the alternative arrangements that have been or will be made regarding the variance request.
	c. 	Examining the effect of the requested variance upon the level of care provided to the general populace served.
	d. 	Requesting additional information if necessary.
	132.14(4) Preliminary approval or denial shall be provided verbally within 24 hours. Final approval or denial shall be issued in writing within ten days after having received the written explanation for the temporary variance request and shall include the reason for approval or denial. If approval is granted, the effective date and the duration of the temporary variance shall be clearly stated.
	132.14(5) Rescinded, effective July 10, 1987.
	132.14(6) Any request for appeal concerning the denial of a request for temporary variance shall be in accordance with the procedures outlined in rule 132.10(147A).
	132.14(7) Rescinded IAB 2/3/93, effective 3/10/93.
641—132.15(147A) Transport options for fully authorized paramedic service programs.
	132.15(1) Upon responding to an emergency call, ambulance, or nontransport paramedic level services may make a determination at the scene as to whether emergency medical transportation or nonemergency transportation is needed. The determination shall be made by a paramedic and shall be based upon the nonemergency transportation protocol approved by the service program’s medical director. When applying this protocol, the following criteria, as a minimum, shall be used to determine the appropriate transport option:
	a. 	Primary assessment,
	b. 	Secondary assessment (including vital signs and history),
	c. 	Chief complaint,
	d. 	Name, address and age, and
	e. 	Nature of the call for assistance.
Emergency medical transportation shall be provided whenever any of the above criteria indicate that treatment should be initiated.
	132.15(2) If treatment is not indicated, the service program may make arrangements for nonemergency transportation. If arrangements are made, the service program shall remain at the scene until nonemergency transportation arrives. During the wait for nonemergency transportation, however, the ambulance or nontransport service may respond to an emergency.
These rules are intended to implement Iowa Code chapter 147A.
[Filed 5/11/79, Notice 4/4/79—published 5/30/79, effective 7/5/79]
[Filed emergency 3/27/81—published 4/15/81, effective 3/27/81]
[Filed without Notice 5/21/81—published 6/10/81, effective 7/15/81]
[Filed emergency 7/15/81—published 8/5/81, effective 7/15/81]
[Filed emergency 2/4/82—published 3/3/82, effective 3/1/82]
[Filed 10/27/82, Notice 9/1/82—published 11/24/82, effective 12/29/82]
[Filed emergency 12/16/82—published 1/5/83, effective 12/30/82]
[Filed emergency 9/20/83—published 10/12/83, effective 9/21/83]
[Filed 9/15/83, Notice 7/6/83—published 10/12/83, effective 11/16/83]
[Filed emergency 12/26/84—published 1/16/85, effective 12/31/84]
[Filed emergency after Notice 5/8/85, Notice 3/27/85—published 6/5/85, effective 5/17/85]
[Filed emergency 9/11/85—published 10/9/85, effective 9/11/85]
[Filed emergency 12/24/85—published 1/15/86, effective 12/31/85]
[Filed 5/30/86, Notice 3/26/86—published 6/18/86, effective 7/23/86]
[Filed emergency 7/1/86—published 7/16/86, effective 7/1/86]1
[Filed 8/28/86, Notice 4/9/86—published 9/24/86, effective 10/29/86]
[Filed emergency 9/19/86—published 10/8/86, effective 9/19/86]
[Filed emergency 7/10/87—published 7/29/87, effective 7/10/87]
[Filed 7/10/87, Notice 2/11/87—published 7/29/87, effective 9/2/87]
[Filed emergency 1/30/89—published 2/22/89, effective 1/31/89]
[Filed emergency 5/10/89—published 5/31/89, effective 5/12/89]
[Filed 9/14/89, Notice 6/28/89—published 10/4/89, effective 11/8/89]
[Filed 6/22/90, Notice 4/18/90—published 7/11/90, effective 8/15/90]
[Filed 3/13/92, Notice 12/11/91—published 4/1/92, effective 5/6/92]
[Filed 1/15/93, Notice 9/30/92—published 2/3/93, effective 3/10/93]
[Filed 1/14/94, Notice 10/13/93—published 2/2/94, effective 3/9/94]
[Filed 9/20/95, Notice 8/2/95—published 10/11/95, effective 11/15/95]
[Filed 7/10/96, Notice 6/5/96—published 7/31/96, effective 9/4/96]
[Filed 9/16/96, Notice 7/31/96—published 10/9/96, effective 11/13/96]
1	See IAB, Inspections and Appeals Department.