641—132.8 (147A) Service program levels of care and staffing standards.
	 132.8(1) A service program seeking ambulance authorization shall:
	  a.   	 Apply for authorization at one of the following levels:
	 (1) 	 EMT-B.
	 (2) 	 EMT-I.
	 (3) 	 EMT-P.
	 (4) 	 PS.
	  b.   	 Maintain an adequate number of ambulances and personnel to provide 24-hour-per-day, 7-day-per-week coverage. Ambulances shall comply with paragraph 132.8(1)“d.” The number of ambulances 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.
	  c.   	 Provide as a minimum, on each ambulance call, the following staff:
	 (1) 	 One currently certified EMT-B.
	 (2) 	 One currently licensed driver. The service shall document each driver’s training in CPR (AED training not required), in emergency driving techniques and in the use of the service’s communications equipment.
	  d.   	 Submit an EMS contingency plan that will be put into operation when coverage pursuant to the 24/7 rule in paragraph 132.8(1)“b” is not possible due to unforeseen circumstances.
	  e.   	 Report frequency of use of the contingency plan to the department upon request.
	  f.   	 Seek approval from the department to provide nontransport coverage in addition to or in lieu of ambulance authorization.
	  g.   	 Advertise or otherwise imply or hold itself out to the public as an authorized ambulance service only to the level of care maintained 24 hours per day, seven days a week.
	  h.   	 Apply to the department to receive approval to provide critical care transportation based upon appropriately trained staff and approved equipment.
	  i.   	 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.
	 132.8(2) A service program seeking nontransport authorization shall:
	  a.   	 Apply for authorization at one of the following levels:
	 (1) 	 Basic care.
	 (2) 	 First responder.
	 (3) 	 EMT-B.
	 (4) 	 EMT-I.
	 (5) 	 EMT-P.
	 (6) 	 PS.
	  b.   	 For staffing purposes provide, as a minimum, a transport agreement.
	  c.   	 Advertise or otherwise hold itself out to the public as an authorized nontransport service program only to the level of care maintained 24 hours per day, seven days a week.
	  d.   	 Not be prohibited from transporting patients in an emergency situation when lack of transporting resources would cause an unnecessary delay in patient care.
	 132.8(3) Service program operational requirements. Ambulance and nontransport service programs shall:
	  a.   	 Complete and maintain a patient care report concerning the care provided to each patient. Ambulance services shall provide, at a minimum, a PCR verbal report upon delivery of a patient to a receiving facility and shall provide a complete PCR within 24 hours to the receiving facility.
	  b.   	 Utilize department protocols as the standard of care. The service program medical director may make changes to the department protocols provided the changes are within the EMS provider’s scope of practice and within acceptable medical practice. A copy of the changes shall be filed with the department.
	  c.   	 Ensure that personnel duties are consistent with the 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 EMS provider credentials including, but not limited to:
	 (1) 	 Current provider level certification.
	 (2) 	 Current course completions/certifications/endorsements as may be required by the medical director.
	 (3) 	 PA and RN exception forms for appropriate personnel and verification that PA and RN personnel have completed the appropriate EMS level continuing education.
	  e.   	 If requested by the department, notify the department in writing of any changes in personnel rosters.
	  f.   	 Have a medical director and 24-hour-per-day, 7-day-per-week on-line medical direction available.
	  g.   	 Ensure 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 service director or ownership or control or of any reduction or discontinuance of operations.
	  i.   	 Select a new or temporary medical director if for any reason the current medical director cannot or no longer wishes to serve in that capacity. Selection shall be made before the current medical director relinquishes the duties and responsibilities of that position.
	  j.   	 Within seven days of any change of medical director, 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.   	 Not prevent a registered nurse or physician assistant from supplementing the staffing of an authorized service program provided equivalent training is documented pursuant to Iowa Code sections 147A.12 and 147A.13.
	  l.   	 Not be authorized to utilize a manual defibrillator (except paramedic, paramedic specialist).
	  m.   	 Implement a continuous quality improvement program that provides a policy to include as a minimum:
	 (1) 	 Medical audits.
	 (2) 	 Skills competency.
	 (3) 	 Follow-up (loop closure/resolution).
	  n.   	 Require physician assistants and registered nurses providing care pursuant to Iowa Code sections 147A.12 and 147A.13 to meet CEH requirements approved by the medical director.
	  o.   	 Document an equipment maintenance program to ensure proper working condition and appropriate quantities.
	 132.8(4) Equipment and vehicle standards. The following standards shall apply:
	  a.   	 Ambulances placed into service after July 1, 2002, shall meet, as a minimum, the National Truck and Equipment Association’s Ambulance Manufacture Division (AMD) performance specifications.
	  b.   	 All EMS 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 and available certified EMS personnel and as established in the service program’s approved protocols.
	  c.   	 Pharmaceutical drugs and over-the-counter drugs may be carried and administered upon completion of training and pursuant to the service program’s established protocols approved by the medical director.
	  d.   	 All drugs shall be maintained in accordance with the rules of the state board of pharmacy examiners.
	  e.   	 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.
	  f.   	 Each ambulance service program shall maintain a telecommunications system between the emergency medical care provider and the source of the service program’s 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.
	  g.   	 All telecommunications shall be conducted in an appropriate manner and on a frequency approved by the Federal Communications Commission and the department.
	 132.8(5) Preventative maintenance. Each ambulance service program shall document a preventative maintenance program to make certain that:
	  a.   	 Vehicles are fully equipped and maintained in a safe operating condition. In addition:
	 (1) 	 All ground ambulances shall be housed in a garage or other facility that prevents engine, equipment and supply freeze-up 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 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.   	 Soiled supplies shall be appropriately disposed of according to current biohazard practices.
	 132.8(6) Service program—incident and accident reports.
	  a.   	 Incidents of fire or other destructive or damaging occurrences or theft of a service program ambulance, equipment, or drugs shall be reported to the department within 48 hours 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) Adoption by reference. The Iowa EMS Patient Registry Data Dictionary (January 2004) is adopted and incorporated by reference for inclusion criteria and reportable patient data. For any differences which may occur between the adopted reference and this chapter, the administrative rules shall prevail.
	  a.   	 The Iowa EMS Patient Registry Data Dictionary (January 2004) is available through the Iowa Department of Public Health, Bureau of Emergency Medical Services, Lucas State Office Building, Des Moines, Iowa 50319-0075, or the EMS bureau Web site (www.idph.state.ia.us/ems).
	  b.   	 The department shall prepare compilations for release or dissemination on all reportable patient data entered into the EMS service program registry during the reporting period. The compilations shall include, but not be limited to, trends and patient care outcomes for local, regional, and statewide evaluations. The compilations shall be made available to all service programs submitting reportable patient data to the registry.
	  c.   	 Access and release of reportable patient data and information.
	 (1) 	 The data collected by and furnished to the department pursuant to this subrule are confidential records of the condition, diagnosis, care, or treatment of patients or former patients, including outpatients, pursuant to Iowa Code section 22.7. The compilations prepared for release or dissemination from the data collected are not confidential under Iowa Code section 22.7, subsection 2. However, information which individually identifies patients shall not be disclosed, and state and federal law regarding patient confidentiality shall apply.
	 (2) 	 The department may approve requests for reportable patient data for special studies and analysis provided the request has been reviewed and approved by the deputy director of the department with respect to the scientific merit and confidentiality safeguards, and the department has given administrative approval for the proposal. The confidentiality of patients and the EMS service program shall be protected.
	 (3) 	 The department may require entities requesting the data to pay any or all of the reasonable costs associated with furnishing the reportable patient data.
	  d.   	 To the extent possible, activities under this subrule shall be coordinated with other health data collection methods.
	  e.   	 Quality assurance.
	 (1) 	 For the purpose of ensuring the completeness and quality of reportable patient data, the department or authorized representative may examine all or part of the patient care report as necessary to verify or clarify all reportable patient data submitted by a service program.
	 (2) 	 Review of a patient care report by the department shall be scheduled in advance with the service program and completed in a timely manner.
	  f.   	 The director, pursuant to Iowa Code section 147A.4, may grant a variance from the requirements of these rules for any service program, provided that the variance is related to undue hardships in complying with this chapter.
	 132.8(8) 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 these 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 these reports.
	 132.8(9) Implementation. The director may grant exceptions and variances from the requirements of this chapter for any ambulance or nontransport service. Exceptions or variations shall be reasonably related to undue hardships which existing services experience in complying with this chapter. Services requesting exceptions and variances shall be subject to other applicable rules adopted pursuant to Iowa Code chapter 147A. Nothing in this chapter shall be construed to require any nontransport service to provide a level of care beyond minimum basic care standards.