DEPARTMENT OF HEALTH AND HUMAN SERVICES

BUREAU OF EMS TRAUMA AND PREPAREDNESS

EMERGENCY MEDICAL SERVICES - LIFE SUPPORT AGENCIES AND

MEDICAL CONTROL

(By authority conferred on the director of the department of health and human

services by sections 2233, 20910, and 20975 of the public health code, 1978 PA 368,

MCL 333.2233, 333.20910, and 333.20975, and Executive Reorganization Order No.

2015-1, MCL 400.227)

PART 1. GENERAL PROVISIONS

R 325.22101 Definitions; A to D.

Rule 101. As used in these rules:

(a) "Accountable" means ensuring compliance on the part of each life support

agency or emergency medical services personnel in carrying out emergency medical

services based upon protocols established by the medical control authority and approved

by the department.

(b) “Air ambulance service” means providing at least advanced life support services

utilizing an air ambulance or ambulances that operate in conjunction with a base hospital

or hospitals. Air ambulance service may also include any of the following:

(i) Searches.

(ii) Emergency transportation of any of the following:

(A)

(B)

(C)

(D)

Drugs.

Organs.

Medical supplies.

Equipment.

(E) Personnel.

(c) “Back-up air ambulance” means an air ambulance that is used to provide air

ambulance services if the primary air ambulance is not available to provide air ambulance

services.

(d) "Board certified in emergency medicine" means current certification by the

American Board of Emergency Medicine, the American Board of Osteopathic

Emergency Medicine, or other organization approved by the department that meets the

standards of these organizations.

(e) "Code" means the public health code, 1978 PA 368, MCL 333.1101 to

333.25211.

(f) "Designated event” means a temporary event, such as an air show, of no more

than 7 days in duration that requires full-time, on-site availability of an air ambulance.

(g) Direct communication" means a communication methodology that ensures

medical control authority supervision of a life support agency when performing

emergency medical services through any of the following methods:

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(i) Direct interpersonal communications at the scene of the emergency.

(ii) Direct verbal communication by means of an approved two-way

telecommunications system operating within the medcom requirements.

(iii) Protocols adopted by the medical control authority and approved by the

department.

(iv) Other means approved by the department that are not in conflict with the

medcom requirements.

(h) "Disciplinary action" means an action taken by the department against a medical

control authority, a life support agency, or individual, or an action taken by a medical

control authority against a life support agency or individual for failure to comply with the

code, rules, or protocols approved by the department.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22102 Definitions; E to M.

Rule 102. As used in these rules:

(a) "Emergency medical services intercept" means an ambulance operation is

transporting an emergency patient from the scene of an emergency, and requests patient

care intervention from another transporting ambulance operation.

(b) "Emergency medical services telecommunications" means the reception and

transmission of voice or data, or both, information in the emergency medical services

system consistent with the medcom requirements prescribed by the department.

(c) “Field study status” means that process required under sections 20910 and

20956 of the code, MCL 333.20910 and 333.20956.

(d) "Fixed wing aircraft" means a non-rotary aircraft transport vehicle that is

primarily used or available to provide patient transportation between health facilities and

is capable of providing patient care according to orders issued by the patient's physician.

(e) "Ground ambulance" means a vehicle that complies with design and structural

specifications, as that term is defined in these rules, and is licensed as an ambulance to

provide transportation and basic life support, limited advanced life support, or advanced

life support.

(f) "Hold itself out" means the agency advertises, announces, or charges specifically

for providing emergency medical services, as that term is defined in the code.

(g) "License" means written authorization issued by the department to a life support

agency and its life support vehicles to provide emergency medical services, as that term

is defined in the code.

(h) "License expiration date" means the date of expiration indicated on the license

issued by the department.

(i) "Licensure action" means probation, suspension, limitation, or removal by the

department of a license for a life support agency or a life support vehicle for violations of

the code or these rules.

(j) “Life support agency” means an ambulance operation, non-transport pre-hospital

life support operation, air transport operation, or medical first response service.

(k) "Life support vehicle" means an ambulance, a non-transport, prehospital life

support vehicle, or a medical first response vehicle, as that term is defined in the code.

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(l) "Medcom requirements" means medical communication requirements for an

emergency medical services communication system.

(m) "Medical control" means supervising and coordinating emergency medical

services through a medical control authority, as prescribed, adopted, and enforced

through department-approved protocols, within an emergency medical services system.

(n) "Medical control authority" means an organization designated by the department

to provide medical control.

(o) "Medical control authority area" means the geographic area composed of a

county, group of counties, or parts of an individual county, as designated by the

department.

(p) "Medical control authority board" means a board appointed by the participating

organizations to carry out the responsibilities and functions of the medical control

authority.

(q) “Mutual aid” means a written agreement between 2 or more licensed life support

agencies for the provision of emergency medical services when an agency is unable to

respond to a request for emergency services, or an agreement according to the direction

of a medical control authority in accordance with department approved protocols.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22103 Definitions; P to S.

Rule 103. As used in these rules:

(a) "Physician" means a doctor of medicine or doctor of osteopathy who possesses a

valid license to practice medicine in this state.

(b) "Primary dispatch service area" means a service area.

(c) “Professional standards review organization” means a committee established by

a life support agency or a medical control authority for the purpose of improving the

quality of medical care.

(d) “Protocol” means a patient care standard, standing orders, policy, or procedure

for providing emergency medical services that is established by a medical control

authority and approved by the department under section 20919 of the code, MCL

333.20919.

(e) "Quality improvement program" means actions taken by a life support agency,

medical control authority, or jointly between a life support agency and medical control

authority with a goal of continuous improvement of emergency medical services in

accordance with section 20919 of the code, MCL 333.20919.

(f) “Regional trauma network” means an organized group comprised of the local

medical control authorities within a region, which integrates into existing regional

emergency preparedness, and is responsible for appointing a regional trauma advisory

council and creating a regional trauma plan.

(g) "Rotary aircraft" means a helicopter that is licensed under the code as an

ambulance.

(h) "Service area" means the geographic area in which a life support agency is

licensed to provide emergency medical services for responding to an emergency.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

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R 325.22104 Terms in code.

Rule 104. Terms defined in the code have the same meanings when used in

these rules.

History: 2004 AACS.

PART 2. LIFE SUPPORT AGENCIES-GENERAL

R 325.22111 Life support agencies; general provisions.

Rule 111. (1) A life support agency shall not operate unless it is licensed by the

department and operates under the direction of a medical control authority in accordance

with department-approved protocols. A life support agency shall not operate at a level

that exceeds its license or violates approved medical control authority protocols, unless

otherwise allowed by part 209 of the code, MCL 333.20901 to 333.20979.

(2) A life support agency license shall do both the following:

(a) Communicate approved protocols to appropriate emergency medical services

personnel.

(b) Provide emergency medical services in accordance with protocols established

by the medical control authority and approved by the department.

(3) A life support agency application shall not be approved by the department unless

signed by the medical director of each medical control authority responsible for the

service area of the life support agency in accordance with R 325.22205(2). The medical

director’s signature serves as confirmation that the medical control authority intends to

provide medical control to the life support agency.

(4) A life support agency, except an aircraft transport operation, shall provide at

least 1 life support vehicle for response to requests for emergency assistance on a 24-

hour-a-day, 7-day-a-week basis in accordance with its licensure level and medical control

authority protocols.

(5) All life support agencies shall have a mutual aid agreement with another life

support agency to ensure a response within the bounds of its service area.

(6) If no other life support agency is licensed in the medical control authority that

meets this criteria, a mutual aid agreement may be entered into with a life support agency

in an adjacent medical control authority. This does not preclude a life support agency

from entering into additional mutual aid agreements with other life support agencies that

are at a level of licensure that is less than their level of licensure.

(7) A life support agency shall notify the jurisdictional medical control authority of

any of the following:

(a) Any investigations, disciplinary actions, or exclusions against the life support

agency with the potential to impact service delivery.

(b) Action taken by an agency against emergency medical services personnel based

on a violation of section 20958 of the code, MCL 333.20958.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

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R 325.22112 Patient destination; transporting agencies.

Rule 112. (1) An ambulance operation, both ground and rotary, shall transport an

emergency patient only to an organized emergency department located in and operated by

1 of the following:

(a) A hospital licensed under part 215 of the code, MCL 333.21501 to 333.21571.

(b) A freestanding surgical outpatient facility licensed under part 208 of the code,

MCL 333.20801 to 333.20821, that operates a service for treating emergency patients 24-

hours-a-day, 7-days-a-week, and complies with medical control authority protocols.

(c) An off-campus emergency department of a hospital licensed under part 215 of

the code, MCL 333.21501 to 333.21571, if the off-campus emergency department is

available for treating emergency patients 24-hours-a-day, 7-days-a-week, complies with

medical control authority protocols, and has obtained provider-based status under 42 CFR

413.65.

(2) An ambulance operation may transport to an alternate destination requested by

the medical control authority and approved by the department under field study status.

History: 2004 AACS; 2014 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22113 Patient transfers; ground, rotary, aircraft transport.

Rule 113. (1) A person shall not transport a patient by stretcher, cot, litter, or

isolette unless it is done in a licensed ambulance or aircraft transport vehicle. The life

support agency transporting the patient shall require that any applicable department-

approved protocols of the medical control authority are followed in accordance with

section 20921(4) and (5) of the code, MCL 333.20921.

(2) An out-of-state service that is coming to this state to transfer a patient from a

Michigan facility to a facility in another state or country shall be licensed or certified

within its own jurisdiction.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22114 Professional standards review organization: data collection.

Rule 114. Each life support agency shall establish a professional standards review

organization for improving the quality of emergency medical services. As part of the

professional standards review organization, each life support agency shall collect data to

assess the need for and quality of emergency medical services. The data must be

submitted to the medical control authority as determined by department-approved

medical control authority protocol as required in R 325.22207.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22115 Use of descriptive words, phrases, symbols, advertising.

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Rule 115. A person shall not use words, phrases, signs, symbols, or insignia

that advertise or convey to the public that it provides emergency medical services or

that it provides emergency medical services at a particular level unless it is licensed

to do so.

History: 2004 AACS.

R 325.22116 Inability to provide service.

Rule 116. (1) If a life support agency cannot operate or staff at least 1 vehicle for

response to an emergency within its service area in accordance with the code, these rules,

or applicable protocols, then the life support agency shall do all the following:

(a) Immediately notify the department and medical control authority within its

service area if it cannot provide at least 1 life support vehicle available for response to

requests for emergency assistance on a 24-hour-a-day, 7-day-a-week basis in accordance

with medical control authority protocols. This rule excludes air ambulance services and

aircraft transport operations when the weather does not meet weather minimums outlined

by a national accrediting body for air ambulance services.

(b) Immediately notify the department of a change that would alter the information

contained on its application.

(c) Notify the dispatch center that regularly receives requests for its services, and

other public safety agencies if appropriate, that it is not available to respond. The

notification must advise the dispatch center of the period in which the agency will be out

of service and the name of the agency that will be covering its service area.

(d) Notify life support agencies providing mutual aid.

(2) The life support agency shall comply with R 325.22202(4).

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22117 Maintenance of medical records.

Rule 117. In accordance with section 20175(1) of the code, MCL 333.20175, a life

support agency shall maintain an accurate record of each case where care is rendered in a

format approved by the medical control authority. Medical records must be maintained

for a minimum of 7 years. However, records of minors must be maintained until they

reach 25 years of age.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22118 Removal of vehicle from service; licensure; interagency vehicle

transfer, lease, loan, from another life support agency.

Rule 118. (1) A life support agency shall notify the department if it permanently

removes a vehicle from service. If a vehicle is permanently removed from service, then

the agency shall contact the department, in writing, within 30 days after removal. The

notification must include the make, model, year, and vehicle identification number on an

application prescribed by the department. The agency shall remove all oscillating,

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rotating, or flashing lights, and words, phrases, signs, symbols, or insignia that advertise

or convey to the public that it provides emergency medical services before transfer or sale

of the vehicle.

(2) A life support vehicle license is nontransferable. A life support agency may

temporarily use a state licensed life support vehicle of another licensed life support

agency through a loan. Vehicle loans may occur if mechanical problems prevent an

agency from deploying its existing vehicles. The life support agency acquiring the

vehicle shall do all the following:

(a) Notify the department of the loan within 3 business days on an application

prescribed by the department.

(b) Replace an existing licensed vehicle with the loaned vehicle at the agency. The

loaned vehicle must not increase the total number of vehicles the agency is licensed to

use.

(c) Use the loan for a maximum of 60 calendar days.

(d) Extend the loan 1 time for 60 additional calendar days if the agency notifies the

department on an application prescribed by the department.

(3) A life support agency that obtains a vehicle through a gift, lease, transfer, or

purchase from another life support agency shall comply with both of the following:

(a) Submit an application for the vehicle in accordance with R 325.22190.

(b) Comply with R 325.22181.

(4) A life support agency that gives, leases, transfers, or sells a vehicle to another

life support agency shall comply with subrule (1) of this rule.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22119 Operational routine vehicle and equipment inspection.

Rule 119. A life support agency shall have a written policy in place to ensure

vehicles and equipment are operational and provide documentation of not less than a

weekly inspection program for

all

vehicles, communications equipment, and

mechanical and electronic medical equipment.

History: 2004 AACS.

R 325.22120 Life support agencies licensed in other states or dominion of

Canada.

Rule 120. (1) A life support agency licensed in another state or the dominion of

Canada that responds to emergencies in this state shall be licensed by the department

unless specific intergovernmental agreements exist between the department, the dominion

of Canada, or the other state.

(2) A life support agency licensed in another state or in the dominion of Canada that

responds to emergencies is accountable to the medical control authority in whose

geographical boundaries initial patient contact is made.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

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R 325.22121 Inquiry into ability to pay.

Rule 121. Life support agencies shall not inquire about ability to pay or source of

payment before providing life support consistent with its license and approved medical

control authority protocols to each emergency patient.

History: 2004 AACS.

R 325.22122 Misleading information concerning emergency response.

Rule 122. A life support agency shall not knowingly provide a person with false or

misleading information concerning the time at which an emergency is initiated or the

location from which the response is being initiated. The department or medical control

authority may investigate any allegation of wrongdoing submitted under this rule. If a

violation of this rule occurs, the department or medical control authority may take any

corrective action authorized under the code and these rules.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22123 Spontaneous use of vehicle under exceptional circumstances;

written report.

Rule 123. (1) If an ambulance operation is unable to respond to an emergency

patient within a reasonable time, a vehicle may be used under exceptional circumstances,

as defined by department policy, to provide, without charge or fee and as a humane

service, transportation for the emergency patient.

(2) Emergency medical personnel who transport, or who make the decision to

transport, an emergency patient under subrule (1) of this rule shall file a written report

with the medical control authority describing the incident within 7 days.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22124 Enforcement.

Rule 124. (1) The department may take any action authorized by sections 20162,

20165, and 20168 of the code, MCL 333.20162, 333.20165, and 333.20168, or other

provisions of the code in response to a violation of the code or these rules. Enforcement

actions include any of the following:

(a) Denial, suspension, limitation, or revocation of a life support agency license.

(b) The issuance of a nonrenewable conditional license effective for not more than 1

year.

(c) The issuance of an administrative order to correct deficiencies and prescribing

the actions the department determines necessary to obtain compliance with the code or to

protect the public health, safety, and welfare.

(d) Imposition of an administrative fine.

(e) The issuance of an emergency order limiting, suspending, or revoking license.

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(2) A life support agency that is granted a 1-year nonrenewable conditional license

by the department shall comply with, at a minimum, all the following:

(a) Provide at least 1 vehicle for response to requests for emergency assistance on a

24-hour-a-day, 7-day-a-week basis in accordance with its licensure level.

(b) Submit a statement of the reasons for the life support agency's inability to

comply with the code for licensure.

(c) Develop a plan of action to meet all licensure requirements. The plan must be

submitted to the medical control authority and the department.

(d) Submit a monthly report to the medical control authority that outlines the

progress made on the plan.

(e) Report all out-of-service time to each involved medical control authority.

(3) A life support agency that is granted a 1-year nonrenewable conditional license

shall comply with all licensure fee requirements in the code.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22125

requirements.

Life support agency; licensure at higher level of care;

Rule 125. (1) A life support agency seeking licensure at a higher level qualifies for

that license only if the life support agency meets the following requirements:

(a) Under the code, a life support agency that is licensed to provide medical first

response life support may apply for licensure at the basic, limited advanced, or advanced

life support level. A life support agency that is licensed to provide basic life support may

apply for licensure at the limited advanced or advanced life support level. In the same

manner, a life support agency that is licensed to provide limited advanced life support

may apply for licensure at the advanced life support level.

(b) Each life support agency that meets the requirements of subdivision (a) of this

subrule shall apply for a higher level of licensure on applications provided by the

department and meet the requirements of the code and these rules. The application must

include the required fee and identification of level of life support of the operation.

(2) A life support agency that obtains licensure at a higher level shall provide that

level of care 24-hours-a-day, 7-days-a-week.

(3) If a life support agency applies to the department for licensure at a higher level

than that of its current level, the department shall conduct an inspection of the agency and

its vehicles. Verification of compliance with this subrule must be included with the

application for licensure for each ground ambulance or non-transport, prehospital life

support vehicle by both of the following methods:

(a) Provide, as part of the application, the name and address of the medical control

authority or authorities under which the life support agency is operating. The agency shall

complete an application for licensure, as prescribed by the department, for each medical

control authority under which it operates. The signature on the application of the

emergency medical services medical director, from each medical control authority, must

verify that the medical control authority agrees to provide medical control to the life

support agency.

(b) Attest, by signing the application, to all the following:

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(i) The radio communication system for each ambulance or non-transport,

prehospital life support vehicle complies with the medcom requirements.

(ii) Each vehicle meets minimum equipment requirements.

(iii) Minimum staff requirements are being met to operate at least 1 vehicle on a 24

hour-a-day, 7 day-a-week basis.

(iv) Each ground ambulance licensed by the department has a manufacturer

certificate of compliance.

(4) Verification of compliance with this subrule must be available to the department

upon request.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22126 Life support agency; medical control; disciplinary action.

Rule 126. (1) A medical control authority may exercise disciplinary action against a

life support agency or its emergency medical services personnel that may result in the life

support agency, or its personnel not being allowed to provide prehospital emergency care.

The basis for these actions must be for noncompliance with protocols established by the

medical control authority and approved by the department. Disciplinary action may

include the suspension, limitation, or removal of medical control for the life support

agency of a medical control authority providing medical control, from an individual

providing emergency medical services care, or any other action authorized by the code.

(2) If a suspension or removal of medical control for a life support agency or

individual occurs, the life support agency or individual shall not operate or practice in

that medical control authority region until medical control is restored by the medical

control authority.

(3) If a suspension or removal of medical control for a life support agency or

individual occurs, the life support agency or individual may appeal the decision to the

medical control authority. After appeals to the medical control authority have been

exhausted, the life support agency or individual may appeal the medical control

authority's decision to the statewide emergency medical services coordination committee.

An appeal to the emergency medical services coordination committee must be filed with

the department in writing not more than 30 calendar days following notification to the

agency or individual of the final determination of the medical control authority.

(4) The emergency medical services coordination committee shall review the appeal

of a life support agency or individual and make a recommendation to the department. The

department shall consider the emergency medical services coordination committee

recommendation and conduct its own review of the appeal. If the department determines

that licensure action is required, the department shall provide a hearing in accordance

with the code and chapter 4 of the administrative procedures act of 1969, 1969 PA 369,

MCL 24.271 to 24.288.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22127 Life support agency; life support vehicle; inspection; contractor

requirements.

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Rule 127. (1) The department shall, at least annually, inspect or provide for the

inspection of each life support agency. The department shall conduct random inspections

of life support vehicles during the agency licensure period.

(2) A life support agency that receives accreditation from the Commission on

Accreditation of Ambulance Services or another department-approved national

accrediting organization as having equivalent expertise and competency in the

accreditation of life support agencies, may not be subject to an agency inspection by the

department if the life support agency meets both of the following requirements:

(a) Submits verification of accreditation described in this rule.

(b) Maintains accreditation as described in this rule.

(3) Accreditation of a life support agency does not prevent the department from

conducting a life support agency inspection.

(4) Pursuant to section 20910(2)(b) of the code, MCL 333.20910, if emergency

medical services activities apply to contracts with agencies or individuals for purposes of

providing life support agency and life support vehicle inspections, the department shall

notify each life support agency and medical control authority of the existence of the

contracts, including the roles and responsibilities of those agencies or individuals having

been awarded contracts.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

PART 3. LIFE SUPPORT AGENCIES

R 325.22131 Life support agency; initial application.

Rule 131. A life support agency and its life support vehicles shall be licensed by the

department in accordance with sections 20920, 20926, 20931, and 20941 of the code,

MCL 333.20920, 333.20926, 333.20931, and 333.20941. The application for initial

licensure must include all the following:

(a) Be on an application provided by the department and include the required fees

and identification of level of life support of the agency.

(b) Specify each life support vehicle to be operated, the level of life support being

provided by that life support vehicle, and include a certificate of insurance covering each

life support vehicle as identified in this rule.

(c) Provide the name and address of each medical control authority under which the

life support agency is operating. The agency shall complete an application for licensure,

as prescribed by the department, for each medical control authority under which it

operates. A signature on the application by the emergency medical services medical

director, from each medical control authority, is proof that the medical control authority

agrees to provide medical control to the life support agency.

(d) Provide an attestation, as evidenced by signing the application, of all the

following:

(i) Radio communications for each life support vehicle comply with medcom

requirements.

(ii) Each vehicle meets minimum equipment requirements.

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(iii) Minimum staff requirements must be met to operate at least 1 vehicle on a 24

hour-a-day, 7 day-a-week basis, consistent with section 20921(3) and (4), 20927(3),

20932(2), or 20941(6) of the code, MCL 333.20921, 333.20927, 333.20932, and

333.20941, as appropriate.

(iv) A manufacturer certificate of compliance for each ground ambulance licensed

by the department.

(e) Include evidence that the operation possesses not less than $1,000,000.00

insurance coverage or is under a self-insurance program authorized under 1951 PA 35,

MCL 124.1 to 124.13 for property damage and personal injury, except for rotary winged

aircraft. An application for rotary winged aircraft must include evidence that the

operation possesses not less than $5,000,000.00 insurance coverage or is under a self-

insurance program authorized under 1951 PA 35, MCL 124.1 to 124.13, for property

damage and personal injury, except under section 20934(6) of the code, MCL 333.20934.

(f) Include full disclosure of the operation ownership, including all the following:

(i) Copies of documents relating to the official type of legal organization of the

operation, stating whether it is an individual proprietorship, partnership, corporation, or

subsidiary of another corporation or unit of government. These documents must be

maintained by the operation and made available to the department upon request.

(ii) Copies of registration of the operation with the secretary of state or other

designated official in each state that the agency is chartered, incorporated, or authorized

to do business. These documents must be maintained by the operation and made available

to the department upon request.

(iii) Disclose all legally responsible individuals, owners, or officers of the life

support agency when submitting an application, including any trade names under which

the organization operates. These must include, but are not limited to, the name or names

by which the life support agency is known to the public.

(iv) Disclose all parent organizations and any person, as that term is defined in

section 20908 of the code, MCL 333.20908, that have not less than a 10% interest in the

life support agency.

(g) Identify 1 individual who will serve as the agency licensure administrator for the

life support agency. The agency licensure administrator is the point of contact for

licensing and inspection activities.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22132 Life support agency; operating requirements.

Rule 132. In addition to requirements prescribed in the code and these rules, life

support agency shall do all the following:

(a) Establish and maintain a written procedure that explains the steps that will be

followed when a complaint is received by the agency. This procedure shall be maintained

by the agency and made available to the department upon request.

(b) Maintain evidence of participation in the county, local, or regional disaster plan.

Approved protocols may be used to meet this requirement. These documents must be

maintained by the operation and made available to the department upon request.

(c) Comply with medical record keeping requirements in accordance with R

325.22117.

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(d) Maintain written policies and procedures that address safety and accident

reduction and comply with all applicable state and federal health and safety laws as

prescribed on the department-approved agency inspection form. These procedures must

be maintained by the operation and be available to the department upon request.

(e) Require that each individual staffing a licensed life support agency complies with

the code and applicable medical control authority protocols.

(f) Require that a life support vehicle is not operated while transporting a patient

unless the ambulance is staffed in accordance with section 20921(3), (4), and (5) of the

code, MCL 333.20921.

(g) Require that a non-transport prehospital life support vehicle is not operated

unless it is staffed in accordance with sections 20927(3) and 20941(6) of the code, MCL

333.20927 and 333.20941.

(h) Require that an aircraft transport vehicle is not operated unless it is staffed in

accordance with section 20932(2) of the code, MCL 333.20932.

(i) Maintain evidence of an orientation process of emergency medical services

personnel that familiarizes them with the agency's policies and procedures and trains

them in the use and application of all the equipment carried in the licensed life support

vehicle. At a minimum, the orientation process must include an introduction to personnel

duties and responsibilities, in addition to medical control authority protocols.

(j) Maintain access to the current version of all applicable protocols for each medical

control authority under which the agency operates.

(k) Complete and submit patient care records according to department-approved

medical control authority protocols.

(l) Participate in data collection and quality improvement activities authorized under

medical control authority protocols.

(m) Ensure that each licensed life support vehicle meets all applicable vehicle

standards and state minimum equipment requirements prescribed by the department and

department-approved medical control authority protocols.

(n) Require compliance with medcom requirements.

(o) Not knowingly respond to, or advertise its services for, prehospital emergency

patients from outside its service area except for mutual aide requests.

(p) Require that each individual operating a licensed ground life support vehicle

during an emergency response or patient transport has completed a department-approved

vehicle operation education and competency assessment.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22133 Life support agency; licensure requirements.

Rule 133. A life support agency shall comply with all the following:

(a) Ensure compliance with the code and these rules.

(b) Advise the department immediately of any changes that would alter the

information contained on its licensure application, including any of the following:

(i) Change of ownership.

(ii) Change of facility name.

(iii) Change in vehicle status.

(iv) Change in agency licensure administrator contact information.

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(v) Circumstances that preclude the life support agency from complying with

staffing or minimum equipment requirements.

(vi) Change in communication ability to comply with medcom requirements.

(vii) Change in service area.

(c) A life support agency shall require that an individual whose license is at least

equal to the level of vehicle license is in the patient compartment when transporting an

emergency patient, or consistent with department-approved medical control authority

protocols.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22134 Additional licensure requirements for life support agencies

approved to administer medications.

Rule 134. In addition to meeting the other licensure requirements of the code and

these

rules, a life support agency approved to administer medications by their local medical

control authority shall do both of the following:

(a) Comply with the procedures of drug acquisition, storage, security, dispensing,

and accountability in accordance with department-approved medical control authority

protocols and federal and state law.

(b) If licensed at the limited advanced or advanced life support level, comply with

the acquisition, storage, security, dispensing, and accountability procedures for

intravenous solutions, tubing, and related apparatus in accordance with department-

approved medical control authority protocols and in compliance with the federal and state

law.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22135 Rotary aircraft ambulance operations; additional licensure

requirements.

Rule 135. (1) In addition to meeting other licensure requirements of the code and

these rules, an ambulance operation providing rotary aircraft transport shall do all the

following:

(a) Meet all equipment requirements of the Federal Aviation Administration for the

specific type of aircraft and flying conditions under which the aircraft will operate as

specified by the air taxi certificate of operation of the aircraft transport provider.

(b) Maintain accurate medical flight records concerning the transportation of each

emergency patient in intrastate flights or interstate flights originating in this state. The

records must be available to the department and the medical control authority of the

originating scene, when requested.

(c) Meet department licensure requirements and follow department-approved

medical control authority protocols when providing on-scene emergency care.

(d) Meet department licensure requirements when providing interfacility transfers.

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(e) Provide verification of Medicaid participation. A new provider not currently

enrolled in Medicaid shall certify that proof of Medicaid participation is provided to the

department within 6 months after the new provider begins offering services.

(2) An ambulance operation licensed in this state that provides rotary aircraft

services or fixed wing ambulance service shall be accredited by a department-approved

national accrediting organization within 2 years after beginning operation. During the

provisional period between licensing and accreditation, the air ambulance operation must

provide all the following:

(a) Written policies and procedures specifying the levels of patient care to be

provided. The level of patient care provided must be commensurate with the education

and experience of the staff and the capabilities of the base hospitals.

(b) Written patient care protocols including provisions for continuity of care.

(c) Written policies and procedures that define the roles and responsibilities of

all staff members.

(d) Written policies and procedures addressing the appropriate use of air

ambulance’services in accordance with section 20932a of the code, MCL 333.20932a.

(e) A written communicable disease and infection control program.

(f) A written plan for dealing with situations involving hazardous materials.

(g) A planned and structured program for initial and continuing education and

training,

including didactic, clinical, and in-flight, for all scheduled staff members

appropriate for the respective duties and responsibilities.

(h) Written policies and procedures addressing the integration of the air

ambulance service with public safety agencies governing the base hospitals including, but

not limited to, the federal aviation administration, medical control authorities, life support

vehicles and disaster planning.

(i) A quality management program.

(j) A clinical database for utilization review and professional standards review

organization.

(k) Procedures to screen patients to ensure appropriate utilization of the air

ambulance service.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22136 Life support agency; issuance of license.

Rule 136. Receipt of the completed application by the department serves as

attestation by the life support agency that the agency and life support vehicles being

licensed comply with the minimum standards required by the department. Upon approval

of the application, the department shall issue a license to the life support agency.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22137 Ambulance operation; false advertising; conflict of interest.

Rule 137. An ambulance operation may not do any of the following:

(a) Induce or seek to induce any person engaging an ambulance to patronize a long-

term care facility, mortuary, or hospital.

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(b) Advertise, or allow advertising of, within or on the premises of the ambulance

operation or within or on an ambulance, the name or the services of an attorney, accident

investigator, nurse, physician, long-term care facility, mortuary, or hospital. If 1 of those

persons or facilities owns or operates an ambulance operation, then the person or facility

may use its business name in the name of the ambulance operation and may display the

name of the ambulance operation within or on the premises of the ambulance operation or

within or on an ambulance.

(c) Advertise or disseminate information for the purpose of obtaining contracts

under a name other than the name of the person holding an ambulance operation license,

the trade, or assumed name of the ambulance operation.

(d) Use the terms "ambulance" or "ambulance operation" or a similar term to

describe or refer to the person unless the department licenses the person under section

20920 of the code, MCL 333.20920.

(e) Advertise or disseminate information leading the public to believe that the person

provides an ambulance operation, unless that person does in fact provide that service and

is licensed by the department.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22138 Life support agency; renewal.

Rule 138. (1) A life support agency shall complete an application for renewal and

return the completed application to the department before the date of license expiration.

Failure to receive a notice for renewal from the department does not relieve the licensee

of the responsibility to apply for renewal.

(2) The license of a life support agency and its life support vehicles expire on the

same date.

(3) An application for licensure renewal received by the department after the license

expiration date, but within 60 calendar days after the expiration date requires the life

support agency to comply with section 20936 of the code, MCL 333.20936.

(4) A life support agency may provide emergency medical services during the 60

days following its license expiration date, whether or not the department has received an

application for renewal.

(5) An application for licensure renewal not received by the department within 60

calendar days after the license expires must be considered revoked.

(6) Reinstatement of the life support agency and life support vehicle licenses require

completion of a new application for licensure, including all fees prescribed in section

20936 (1) and (2) of the code, MCL 333.20936.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22139 Aircraft transport operations; additional licensure requirements.

Rule 139. (1) In addition to meeting other licensure requirements of the code and

these rules, an aircraft transport operation shall do all the following:

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(a) Meet all equipment requirements of the Federal Aviation Administration for the

specific type of aircraft and flying conditions under which the aircraft will operate, as

specified by the air taxi certificate of operation of the aircraft transport provider.

(b) Maintain accurate medical flight records concerning the transportation of each

emergency patient in intrastate flights or interstate flights originating in this state. The

records must be available to the department and the medical control authority of the

originating scene, when requested.

(c) Meet department licensure requirements when providing interfacility transfers.

(d) Provide verification of Medicaid participation. A new provider not currently

enrolled in Medicaid shall certify that proof of Medicaid participation is provided to the

department within 6 months after the new provider begins offering services.

(2) An aircraft transport operation licensed in this state shall be accredited by a

department-approved national accrediting organization within 2 years of beginning

operation. During the provisional period between licensing and accreditation, the aircraft

transport operation shall provide all the following:

(a) Written policies and procedures specifying the levels of patient care to be

provided. The level of patient care provided must be commensurate with the education

and experience of the staff and the capabilities of the base hospitals.

(b) Written patient care protocols including provisions for continuity of care.

(c) Written policies and procedures that define the roles and responsibilities of all

staff members.

(d) Written policies and procedures addressing the appropriate use of aircraft

transport in accordance with section 20932a of the code, MCL 333.20932a.

(e) A written communicable disease and infection control program.

(f) A written plan for dealing with situations involving hazardous materials.

(g) A planned and structured program for initial and continuing education and

training, including didactic, clinical, and in-flight, for all scheduled staff members

appropriate for the respective duties and responsibilities.

(h) Written policies and procedures addressing the integration of the air ambulance

service with public safety agencies governing the base hospitals including, but not limited

to, the Federal Aviation Administration, medical control authorities, life support vehicles

and disaster planning.

(i) A quality management program.

(j) A clinical data base for utilization review and professional standards review

organization.

(k) Procedures to screen patients to ensure appropriate utilization of the aircraft

transport operation.

(3) An air ambulance service may operate a back-up air ambulance if the primary air

ambulance or ambulances are not available or for a designated event with prior

notification and approval from the local medical control authority.

(4) A back-up air ambulance must not be operated at the same time as the primary

aircraft for the provision of air ambulance services except for a designated event or

disaster.

History: 2023 MR 10, Eff. May 26, 2023.

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PART 4. NONTRANSPORT PREHOSPITAL LIFE SUPPORT

OPERATIONS

R 325.22141 Nontransport prehospital

application for licensure.

life

support operation; initial

Rule 141. A nontransport prehospital life support operation and its vehicles

shall be licensed by the department in accordance with section 20926 of the code.

Application for initial licensure shall include all of the following:

(a) Be on forms provided by the department and include the required fees and

identification of level of life support of the operation.

(b) Specify each vehicle to be operated, the level of life support being provided

by that vehicle, and include a certificate

identified in subrule (5) of this rule.

of

insurance covering each vehicle as

(c) Provide as part of the application, the name and address of each medical

control authority under which the life support agency is operating. The agency

shall complete an application for licensure, as prescribed by the department, for each

medical control authority in which it operates.Signature on the application of the

emergency medical services medical director, from each medical control authority,

shall be proof that the medical control authority agrees to provide medical control to

the life support agency.

(d) Attest, as evidenced by signing the application, to all of the following:

(i) Radio communications for each vehicle are in compliance with the medcom

requirements.

(ii) Each vehicle meets minimum equipment requirements.

(iii) Minimum staff requirements will be met in order to operate at least 1 vehicle

on a 24 hour-a-day, 7 day-a-week basis, consistent with section 20927

(3) of the code.

(iv) Verification of compliance with subrules (3) and (4) of this rule, shall be

available to the department upon request.

(e) Include evidence that the operation

$1,000,000.00 insurance coverage or is under

possesses

self-insurance program authorized

not

less than

a

under 1951 PA 35, MCL 124.1 et seq. for property damage and personal injury.

(f) Include full disclosure of the operation ownership, including all of the

following:

(i) Copies of documents relating to the official type of legal organization of

the operation, stating whether it is

an

individual proprietorship, partnership,

corporation, or subsidiary of any other corporation or unit of government. These

documents shall be maintained by the operation and shall be available to the department

upon request.

(ii) Copies of official registration of the entity with the secretary of state or other

designated official in each state in which the agency is chartered, incorporated, or

authorized to do business. These documents shall be maintained by the operation and

shall be available to the department upon request.

(iii) Disclose all legally responsible individuals, owners, or

officers of the

operation at the time of license application, including any trade names under which

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the organization operates. These shall include, but not limited to the name or names

under which the operation is known to the public.

(iv) Disclose all parent organizations and any person as defined in the code,

that have at least a 10% interest in the applicant operation.

(g) Identify 1 individual who will serve as the primary contact person for the

operation.

History: 2004 AACS.

R 325.22142 Nontransport

operating requirements.

prehospital

life

support

operation;

Rule 142. In addition to requirements prescribed in the code and these rules, a

nontransport prehospital life support operation shall do all of the following:

(a) Establish and maintain a written procedure that explains the steps that will be

followed when a complaint is received by the operation. This procedure shall be

maintained by the operation and shall be available to the department upon request.

(b) Maintain evidence of participation in the county,

local,

or regional

disaster plan and response. Approved protocols may be used to satisfy this

requirement. These documents shall be maintained by the operation and shall be

available to the department upon request.

(c) Comply with medical record keeping requirements in accordance with R

325.22117.

(d) Maintain written policies and procedures that address safety and accident

reduction and comply with all applicable state and federal health and safety laws as

prescribed on the department-approved agency inspection form. These procedures

shall be maintained by the operation and shall be available to the department upon

request.

(e) Require that each individual staffing a nontransport prehospital life support

vehicle complies with the code and applicable medical control authority protocols.

(f) Require that a nontransport prehospital life support vehicle is not operated

unless it is staffed in accordance with section 20927(3) of the code.

(g) Maintain evidence of an orientation process for emergency medical

services personnel to familiarize them with the agency's policies and procedures

and are trained in the use and application of

all the equipment carried in the

nontransport prehospital life support vehicle.At a minimum, this shall include an

introduction to the duties to be performed as well as medical control authority

protocols.

(h) Maintain a copy of all applicable protocols for each medical control

authority under which the agency operates.

(i) Participate in data collection and quality

authorized under medical control authority protocols.

improvement activities

(j) Ensure that vehicles licensed by the operation

meet all vehicle

standards, and meet state equipment requirements prescribed by the department and

department-approved medical control authority protocols.

(k) Require compliance with medcom requirements.

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(l) Not knowingly respond to or advertise its services for prehospital

emergency patients from outside its service area as defined in these rules, except for

mutual aid requests.

(m) Require that an individual operating a licensed life support vehicle during

an emergency response has completed

competency assessment.

a

vehicle operation education and

History: 2004 AACS.

R 325.22143 Nontransport

licensure requirements.

prehospital

life

support

operation;

Rule 143. A nontransport prehospital life support operation shall comply with

all of the following:

(a) Provide not less than 1 staffed nontransport prehospital life support vehicle

as defined in section 20921(3) of the code, at the agency licensure level, available for

response to requests for emergency assistance 24-hours-a-day, 7-days-a-week.

(b) Respond or ensure a response is provided to each request for emergency

assistance from within its service area.

(c) Ensure compliance with the code and these rules.

(d) Immediately advise the department of any changes that would alter the

information contained on its licensure application, including any of the following:

(i) Change of ownership.

(ii) Change of facility name.

(iii) Change in vehicle status.

(iv) Circumstances which preclude the nontransport prehospital life support

operation from complying with subrule (1) of this rule or

requirements.

minimum equipment

(v) Change in ability to comply with medcom requirements.

(vi) Change in service area.

(e) Ensure compliance with the minimum staffing requirements prescribed in

section 20927(3) of the code.

(f) Ensure that patient care and safety equipment carried on a nontransport

vehicle meet the minimum requirements prescribed

approved medical control authority protocols.

by

the department and

(g) Ensure that each vehicle is equipped with

a

communications system

consistent with the medcom requirements developed by the department.

History: 2004 AACS.

R 325.22144 Nontransport prehospital life support operations operating at

limited advanced or advanced life support

requirements.

level;

additional licensure

Rule 144. In addition to meeting the other licensure requirements of the code

and these rules, a nontransport prehospital life support agency at the limited advanced or

advanced life support level shall do all of the following:

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(a) Comply with the procedures of drug acquisition, storage, security,

dispensing, and accountability in accordance with the criteria established by the

medical control authority, in compliance with federal and state law, and approved by

the department and R 325.22207(1)(k) and

325.22207(3).

(b) Comply with the acquisition, storage, security,

dispensing and

accountability procedures of intravenous solutions, tubing and related apparatus in

accordance with medical control authority protocols and in compliance with the

federal and state law.

(c) Ensure storage areas are locked and secured as required by federal and state law.

History: 2004 AACS.

R 325.22145 Nontransport prehospital life support operation; issuance of

nontransport prehospital life support license.

Rule 145. Receipt of the completed application by the department serves as

attestation that the operation and vehicles being licensed comply with the minimum

standards required by the department. Upon approval of the application, the

department shall issue a license to the nontransport prehospital life support operation.

The license shall identify each vehicle being licensed. The license may be renewed on

an annual basis.

History: 2004 AACS.

R 325.22146 Nontransport prehospital life support operation; relicensure.

Rule 146. (1) A nontransport prehospital life

support

operation shall

complete an application for relicensure and return the completed application to the

department before the date of license expiration. Failure to receive a notice for

relicensure from the department does not relieve the licensee of the responsibility to

apply for relicensure.

(2) The license of a nontransport prehospital life

vehicles shall expire on the same date.

support

operation and its

(3) An application for licensure renewal received by the department after the

license expiration date, but within 60 calendar days after the expiration date of the

license, shall require the nontransport prehospital life support operation to comply with

section 20936 of the code.

(4) A nontransport prehospital life support operation may provide emergency

medical services during the 60 days following its license expiration date, whether

or not the department has received an application.

(5) An application for licensure renewal not received by the department

within 60 calendar days following the date of license expiration shall be considered

revoked, effective on the sixty-first day.

(6) Reinstatement of the nontransport prehospital life support operation and

vehicle licenses shall require completion of a new application for licensure, including

all fees prescribed in section 20936 (1) and (2) of the code.

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History: 2004 AACS.

PART 5. AIRCRAFT TRANSPORT OPERATIONS

R 325.22151 Aircraft transport operation; fixed wing; initial application for

licensure.

Rule 151. An aircraft transport operation and its vehicles shall be licensed by

the department in accordance with section 20931 of the code. Application for initial

licensure shall do all of the following:

(a) Be on forms provided by the department and include the required fees and

identification of level of life support of the operation.

(b) Specify each aircraft transport vehicle to be operated, the level of life support

being provided by the vehicle, and include a certificate of insurance covering each

vehicle as prescribed in subrule (6) of this rule.

(c) Provide as part of the application, the name and address of each medical

control authority under which the life support agency is operating. The agency shall

complete an application for licensure, as prescribed by the department, for each

medical control authority in which it

operates. Signature on the application of the emergency medical services medical

director, from each medical control authority, shall be proof that the medical control

authority is in agrees to provide medical control to the life support agency.

(d) Attest, as evidenced by signing the application, to all of the following:

(i) Radio communications for each aircraft transport vehicle are in

compliance with the medcom requirements.

(ii) Each vehicle meets minimum equipment requirements.

(iii) Minimum staff requirements will be met to operate each vehicle

consistent with section 20932(2) of the code.

(e) Verify compliance with subrules (3) and (4) of this

available to the department upon request.

rule,

and make

(f) Include evidence that the operation

possesses

not

less than

$10,000,000.00 insurance coverage or is under a self-insurance program authorized

under 1951 PA 35, MCL 124.1 et seq., for property damage and personal injury.

(g) Include full disclosure of the operation ownership, including all of the

following:

(i) Documents relating to the official type of legal

organization

of the

operation, stating whether it is an individual proprietorship, partnership,

corporation, or subsidiary of any other corporation or unit of government. These

documents shall be maintained by the operation and shall be available to the department

upon request.

(ii) Official registration of the entity with the secretary of state or other

designated official in each state in which the agency is chartered, incorporated, or

authorized to do business. These documents shall be maintained by the operation and

shall be available to the department upon request.

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(iii) Disclosure of all legally responsible individuals, owners, or officers of the

aircraft transport operation at the time of license application, including any trade

name under which the organization operates. These shall include, but not limited to, the

name or names under which the aircraft transport operation is known to the public.

(iv) Disclosure of all parent organizations and any person as defined in the code

that have at least a10% interest in the applicant operation.

(h) Identify 1 individual who will serve as the primary contact person for the

operation.

History: 2004 AACS.

R 325.22152 Aircraft transport operation; operating requirements.

Rule 152. In addition to requirements prescribed in the code and these rules,

an aircraft transport operation shall do all of the following:

(a) Establish and maintain a written procedure that explains the steps that will be

followed when a complaint is received by the operation. This procedure shall be

maintained by the operation and shall be available to the department upon request.

(b) Maintain evidence which may show participation in the county, local, or

regional disaster plan and response. Approved protocols may be used to satisfy this

requirement. These documents shall be maintained by the operation and shall be

available to the department upon request.

(c) Comply with medical record keeping requirements in accordance with R

325.22117.

(d) Maintain written policies and procedures to address safety and accident

reduction and comply with all applicable state and federal health and safety laws as

prescribed on the department-approved agency inspection form. These procedures shall

be maintained by the operation and shall be available to the department upon request.

(e) Require that each individual staffing an

complies with the code and applicable medical control authority protocols.

(f) Require that an aircraft transport vehicle is not operated while

aircraft

transport vehicle

transporting a patient unless the ambulance is staffed in accordance with section

20932(2) of the code.

(g) Ensure compliance with additional staffing requirements established by local

medical control authority, and approved by the department, or as needed, and for life

support during that transportation according to the written orders of the patient's

physician.

(h) Maintain evidence of an orientation process for emergency medical services

personnel to familiarize them with the agency's policies and procedures and are

trained in the use and application of all the equipment carried in the vehicle. At a

minimum, the evidence shall include an introduction to the duties to be performed

as well as medical control authority protocols.

(i) Maintain a copy of all applicable protocols for

authority under which the agency operates.

each

medical control

(j) Participate in data collection and quality improvement activities authorized

under medical control authority protocols.

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(k) Ensure that aircraft transport vehicles licensed by the operation meet all

applicable vehicle standards, state equipment requirements as established by the

department and department-approved medical control authority protocols.

(l) Require compliance with medcom requirements.

History: 2004 AACS.

R 325.22153 Aircraft transport operation; licensure requirements.

Rule 153. An aircraft transport operation shall comply with section 20932 of

the code and all of the following:

(a) Provide an aircraft transport vehicle for patient transportation between health

facilities, as needed, and for life support during that transportation according to the

written orders of the patient's physician.

(b) Operate in accordance with the code, rules, and orders

established by the

patient's physician. The operation shall not provide life support at a level that exceeds

its license, department approved medical control authority protocols, or violates those

orders established by the patient's physician.

(c) Ensure compliance with the R 325.22111(1)(4)(5) and 325.22113.

(d) Immediately advise the department of any changes that would

alter the

information contained on its licensure application, including any of the following:

(i) Change of ownership.

(ii) Change of facility name.

(iii) Change in vehicle status.

(iv) Circumstances which preclude the operation from providing patient

transportation between health facilities, as needed, or for not being capable of meeting

minimum staffing or equipment requirements.

(v) Change in ability to comply with medcom requirements.

(vi) Change in service area.

(e) While transporting a patient, ensure that the aircraft transport operation

complies with the minimum staffing and equipment requirements prescribed in

section 20932(2) of the code.

(f)

Ensure that an aircraft transport vehicle is equipped with

a

communications system consistent with the medcom requirements developed by the

department.

History: 2004 AACS.

R 325.22154 Aircraft transport operations operating at limited advanced life

support or advanced life support levels; additional licensure requirements.

Rule 154. In addition to meeting licensure requirements of the code and these

rules, an aircraft transport operation licensed at the limited advanced or advanced life

support level shall do all of the following:

(a) Comply with the procedures of drug acquisition, storage, security,

dispensing, and accountability in accordance with the criteria established by the

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medical control authority, federal and state law, and approved by the department and

R 325.22207(1)(k) and 325.22207(3).

(b) Comply with the acquisition, storage, security,

dispensing and

accountability procedures of intravenous solutions, tubing, and related apparatus in

accordance with medical control authority protocols and federal and state law.

(c) Ensure storage areas are locked and secured as required by federal and state

law.

History: 2004 AACS.

R 325.22155 Aircraft transport operation; issuance of license.

Rule 155. (1) Receipt of the completed application by the department serves as

attestation to the department that the operation and aircraft transport vehicles being

licensed are in compliance with the minimum standards required by the department.

Upon approval of the application, the department shall issue a license to the aircraft

transport operation. The license shall include the vehicles being licensed. The license

may be renewed on an annual basis.

(2) An aircraft transport operation providing fixed wing transport shall comply

with R 325.22151 and shall do both of the following:

(a) The aircraft transport vehicle and equipment shall be in compliance with

current federal aviation administration regulations for the specific type of aircraft and

flying conditions under which the aircraft will operate, as specified by the air taxi

certificate of operation of the aircraft transport provider.

(b) Maintain accurate medical flight records concerning the transportation of

an emergency patient in intrastate flights or interstate flights originating in this

state. The records shall be available to the department and the medical control

authority of the originating scene, when requested.

History: 2004 AACS.

R 325.22156 Aircraft transport operation; relicensure.

Rule 156. (1) An aircraft transport operation shall complete an application

for relicensure and return the completed application to the department before the date

of license expiration. Failure to receive a notice for relicensure from the department

does not relieve the licensee of the responsibility to apply for relicensure.

(2) The license of an aircraft transport operation and its vehicles shall expire on

the same date.

(3) An application for licensure renewal received by the department after the

license expiration date, but within 60 calendar days after the expiration date of the

license, shall require the aircraft transport operation to comply with section 20936 of

the code.

(4) An aircraft transport operation may provide emergency medical services

during the 60 days following its license expiration date, whether or not the department

has received an application.

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(5) An application for licensure renewal not received by the department

within 60 calendar days following the date of license expiration shall be considered

revoked, effective on the sixty-first day.

(6) Reinstatement of the aircraft transport operation and vehicle licenses shall

require completion of a new application for licensure, including all fees prescribed

in section 20936(1) and (2) of the code.

History: 2004 AACS.

PART 6. MEDICAL FIRST RESPONSE SERVICES

R 325.22161 Medical first response service; initial application.

Rule 161. A medical first response service and its vehicles shall be licensed by

the department in accordance with section 20941 of the code and its application for

initial licensure shall comply with all of the following:

(a) Be on forms provided by the department.

(b) Specify each medical first response vehicle to be operated and include a

certificate of insurance for each vehicle as identified in subdivision (f) of this rule.

Each vehicle licensed shall meet minimum equipment and staffing requirements.

(c) Provide as part of the application, the name and address of each medical

control authority under which the life support agency is operating. The agency

shall complete an application for licensure, as prescribed by the department, for each

medical control authority in

which it operates. Signature on the application of the emergency medical

services medical director, from each medical control authority, shall be proof that

the medical control authority agrees to provide medical control to the life support

agency.

(d) Attest, as evidenced by signing the application, to all of the following:

(i) Radio communications for each vehicle is in compliance with the medcom

requirements.

(ii) Each vehicle meets minimum equipment requirements.

(iii) Minimum staff requirements will be met to operate each vehicle on a 24 hour-

a-day, 7 day-a-week basis, consistent with section section 20906(10) of the code.

(e) Verification of compliance with subdivisions (c) and (d) of this rule, shall be

available to the department upon request.

(f) Include evidence that the service possesses not less than $1,000,000.00

insurance coverage or is under a self-insurance program authorized under 1951 PA

35, MCL 124.1 et seq., for property damage and personal injury.

(g) Include full disclosure of the agency ownership, including all

following:

(i) Documents relating to the official type of legal

operation, stating whether it is an individual

of the

organization

of the

proprietorship, partnership,

corporation, or subsidiary of any other corporation or unit of government. These

documents shall be maintained by the operation and shall be available to the department

upon request.

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(ii) Official registration of the entity with the secretary of state or other

designated official in each state in which the agency is chartered, incorporated, or

authorized to do business. These documents shall be maintained by the operation and

shall be available to the department upon request.

(iii) Disclosure of all legally responsible individuals, owners, or officers of the

service at the time of license application, including any trade names under which the

organization operates. These shall include, but not limited to, the name or names that the

medical first response service is known to the public.

(iv) Disclose all parent organizations and persons as defined in the code, that

have at least a 10% interest in the applicant operation.

(h) Staff each vehicle with at least 1 medical first responder.

(i) Identify 1 individual who will serve as the primary contact person for the

service.

History: 2004 AACS.

R 325.22162 Medical first response services; operating requirements.

Rule 162. In addition to requirements prescribed in the code and these rules, a

medical first response service shall do all of the following:

(a) Establish and maintain a written procedure that explains the steps that will be

followed when a complaint is received by the operation. This procedure shall be

maintained by the operation and shall be available to the department upon request.

(b) Maintain evidence of participation in the county,

local,

or regional

disaster plan and response. Approved protocols may satisfy this requirement. These

documents shall be maintained by the service and shall be available to the department

upon request.

(c) Comply with medical record keeping requirements in accordance with R

325.22117.

(d) Maintain written policies and procedures that address safety and accident

reduction and comply with all applicable state and federal health and safety laws as

prescribed on the department-approved agency inspection form. These procedures

shall be maintained by the service and shall be available to the department upon

request.

(e) Require that each individual staffing a medical first response vehicle is in

compliance with the code and applicable medical control authority protocols.

(f) Maintain evidence of an orientation process for emergency medical

services personnel that familiarizes them with the agency's policies and procedures

and trains in the use and application of all equipment carried in the vehicle. At a

minimum, this evidence must include a proper introduction to the duties to be

performed as well as medical control authority protocols.

(g) Maintain a copy of all applicable protocols for each medical control

authority under which the agency operates.

(h) Participate in data collection and quality

authorized under medical control authority protocols.

improvement activities

(i) Ensure that all vehicles meet state equipment requirements as established

by the department and department-approved medical control authority protocols.

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(j) Require compliance with medcom requirements.

(k) Not knowingly respond to or advertise its services for prehospital

emergency patients from outside its service area as defined in these rules, except for

mutual aid requests.

(l) Require that each individual operating a licensed life support vehicle during

an emergency response has completed

competency assessment.

a

vehicle operation education and

History: 2004 AACS.

R 325.22163 Medical first response service; licensure requirements.

Rule 163. A medical first response service shall comply with section 20941 of

the code and do all of the following:

(a) Provide, at a minimum, 1 staffed vehicle available for response to requests

for emergency assistance, 24-hours-a-day, 7-days-a-week.

(b) Respond or ensure a response is provided to each request for emergency

assistance originating from within the bounds of its service area.

(c) Ensure compliance with the code and these rules.

(d) Immediately advise the department of any changes

that

alters the

information contained on its licensure application, including all of the following:

(i) Change of ownership.

(ii) Change of facility name.

(iii) Change in vehicle status.

(iv) Circumstances which preclude the medical first response service from

complying with subdivision (a) of this rule or equipment requirements.

(v) Change in ability to comply with medcom requirements.

(vi) Change in service area.

(e) Ensure compliance with the minimum staffing requirements prescribed in

section 20906(10) of the code.

(f) Ensure that patient care and safety equipment carried on a medical first

response vehicle meets the minimum requirements prescribed by the department.

(g) Ensure that each vehicle is equipped with

a

communications system

consistent with the medcom requirements developed by the department.

History: 2004 AACS.

R 325.22164 Medical first response service; issuance of license.

Rule 164. Receipt of the completed application by the department serves as

attestation by the service that the service and vehicles being licensed are in compliance

with the minimum standards required by the department. Upon approval of the

application, the department shall issue a license to the medical first response service.

The license shall include the vehicles being licensed. The license may be renewed on an

annual basis.

History: 2004 AACS.

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R 325.22165 Medical first response service; law enforcement; fire suppression

agency.

Rule 165. (1) A medical first response service means a person licensed by the

department to respond under medical control to an emergency scene with a medical first

responder and equipment required by the department before the arrival of the ambulance.

This includes a fire suppression agency only if it is dispatched for medical first response

life support.

(2) A fire suppression agency shall be licensed as a life support agency, in

accordance with R 325.22131, and provide life support as described in the code and these

rules if it is dispatched to provide any care a medical first responder is qualified to

provide under section 20906(8) of the code, MCL 333.20906.

(3) A law enforcement agency shall be licensed as a life support agency, in

accordance with R 325.22131, and provide life support as described in the code and these

rules if both of the following conditions are met:

(a) Holds itself out as a medical first response service.

(b) Is dispatched to provide medical first response life support.

(4) A law enforcement agency holds itself out as a medical first response service if it

advertises or announces that it will provide patient care that may include any care a

medical first responder is qualified to provide under section 20906(8) of the code, MCL

333.20906, or charges for those services.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22166 Medical first response service and vehicles; relicensure.

Rule 166. (1) A medical first response service shall complete an application

for relicensure and shall return the completed application to the department before the

date of license expiration.

Failure to receive a notice for relicensure from the

department does not relieve the licensee of the responsibility to apply for relicensure.

(2) The license of a medical first response service and its vehicles shall expire

on the same date.

(3) An application for licensure renewal received by the department after the

license expiration date, but within 60 calendar days after the expiration date of the

license, shall require the medical first response service to comply with section 20936

of the code.

(4) A medical first response service may provide emergency medical services

during the 60 days following its license expiration date, whether or not the department

has received an application.

(5) An application for licensure renewal not received by the department

within 60 calendar days following the date of license expiration shall be considered

revoked, effective on the sixty-first day.

(6) Reinstatement of the medical first response service and vehicle licenses shall

require completion of a new application for licensure.

History: 2004 AACS.

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PART 7. AMBULANCE OPERATION UPGRADE LICENSE

R 325.22171 Ambulance operation upgrade license; application process.

Rule 171. An ambulance operation described in sections 20920 (7) to (12) of the

code that applies for an ambulance operation upgrade license shall do all of the

following:

(a) Have been a licensed ambulance operation at the transporting basic life

support or transporting limited advanced life support on or before July 22, 1997.

(b) Have been owned, operated, or under contract to a local

government and providing first line emergency medical response to that local unit of

government on or before July 22, 1997. Emergency services provided under an

unit of

upgraded license shall be provided only to the local unit of government and only in

response to a 9-1-1 call or other call for emergency transport within jurisdiction of local

unit of government.

(c) A transporting basic ambulance operation shall staff and equip 1 or more

ambulances for the transport of emergency patients at

than basic life support.

a

life support level higher

(d) A transporting limited advanced ambulance operation shall staff and equip

1 or more ambulances for the transport of emergency patients at the advanced life

support level.

(e) Make application for licensure to the department on forms prescribed by the

department. Included with the application shall be the required $100.00 fee and

identification of the current level of life support of the operation and the higher level

of life support being sought. The application shall include verification of all of the

following:

(i) The ambulance operation was licensed on, or before, July 22, 1997.

(ii) The ambulance operation was licensed, at

a

minimum,

as

a basic

transporting ambulance operation on, or before, July 22, 1997.

(iii) The ambulance operation is owned, operated by, or under contract with a

local unit of government.

(iv) Services described in the application shall be provided only to the local unit

of government and only in response to 9-1-1 calls or

other calls for emergency

transport within the jurisdiction of the local unit of government.

(v) The ambulance operation complies with all patient

equipment requirements for the level of upgrade requested.

care

and radio

(vi) The ambulance operation provides a description of the staffing for each

vehicle under the upgrade provision.

(vii) The ambulance operation provides a 2-year plan of action to upgrade, on

a full-time basis, to the higher level. A letter of commitment by the local unit of

government supporting this plan of action shall be part of the plan.

(viii) The ambulance operation provides patient care protocols and a formal

recommendation from the medical control authority under which

operation operates.

the ambulance

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(ix) Quality monitoring procedures and use and protection of equipment

protocols have been developed and approved by the medical control authority. Use and

protection equipment protocols shall describe procedures the operation will use to

limit access to the limited advanced or advanced, or both, equipment and supplies when

not operating at the higher level.

(f) Provide additional information as prescribed by the department to process the

application.

History: 2004 AACS.

R 325.22172 Ambulance operation upgrade license; limited advanced life

support; advanced life support; security, control,

pharmaceuticals.

and

exchange of

Rule 172. An ambulance operation upgrade licensed at the limited advanced

or advanced life support level shall do all of the following:

(a) Comply with the procedures of drug acquisition, storage, security,

dispensing, and accountability in accordance with the criteria established by the

medical control authority, in compliance with federal and state law and approved by

the department and R 325.22207(1)(k) and 325.22207(3).

(b) Comply with the acquisition, storage, security,

dispensing and

accountability procedures for intravenous solutions, tubing, and related apparatus in

accordance with medical control authority protocols and federal and state law.

(c) Ensure storage areas are locked and secured as required by federal and state

law.

History: 2004 AACS.

R 325.22173 Ambulance operation upgrade license; review process and

licensure.

Rule 173. An application submitted under R 325.22171 shall be reviewed by the

emergency medical services coordination committee.

The emergency medical

services coordination committee shall make a recommendation to the department if an

ambulance operation upgrade license should be granted to the applicant.

(a) If the emergency medical services coordination committee recommend a

license upgrade, then the department shall conduct a communication and equipment

inspection at the upgrade level before issuing a license

(b) If the emergency medical services coordination

committee

does not

recommend a license upgrade, then the department shall send a communication to

the ambulance operation upgrade applicant identifying concerns and advising the

operation of non-approval of licensure.

(c) A license issued under R 325.22173(1) shall be valid for

of issuance by the department.

2

years from date

(d) The medical control authority under which the ambulance operation

operates shall submit to the emergency medical services coordination committee an

annual written progress report on the ambulance operation upgrade plan of

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action. The progress report shall include, but is not limited to, information on

training, equipment, and personnel. The report shall demonstrate progress being

made by the ambulance operation to achieve licensure and the higher level and

comply with the 24-hour-a-day, 7-day-a-week requirements of the code.

History: 2004 AACS.

R 325.22174 Ambulance operation upgrade license; renewal process.

Rule 174. An ambulance operation upgrade license is renewable for 1

additional 2-year period provided the following requirements are met:

(a) The medical control authority has complied with R 325.22173(4).

(b) The ambulance operation has renewed and is currently licensed at the basic

transporting life support or limited advanced transporting life support level.

(c) The ambulance operation meets the renewal upgrade licensure

application requirements prescribed by the department, including the $100.00 fee.

(d) The ambulance operation submits, with the renewal upgrade licensure

application, a progress report on the initial plan of action.

(e) Provides a description of the staffing for each vehicle under the upgrade

license.

(f) Provides an updated 2-year plan of action to upgrade, on a full-time

basis, to the higher level. A letter of commitment by the local unit of government

supporting this plan of action shall be part of the plan.

History: 2004 AACS.

R 325.22175 Ambulance operation upgrade license; revocation or denial of

renewal.

Rule 175. The department may revoke or fail to renew an ambulance

operation upgrade license for a violation of the code or rules or for failure to comply with

the plan of action filed with the department. The ambulance operation's regular license

is not affected if the ambulance operation upgrade license is revoked or not renewed.

History: 2004 AACS.

R 325.22176 Ambulance operation upgrade license; nonrenewal.

Rule 176. An ambulance operation upgrade license that is not renewed or failure

of the operation to achieve the higher level after the second 2-year period shall not

provide life support at the higher level effective the day after the ambulance operation

upgrade license expiration date.

History: 2004 AACS.

R 325.22177 Ambulance operation upgrade license; advertisement.

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Rule 177. (1) An ambulance operation licensed under R 325.22173(1) shall

not advertise or hold itself out as a full-time transporting limited-advanced or

transporting advanced life support service unless the ambulance operation actually

provides those services on a 24-hour-a-day, 7-days-a-week basis.

(2) An ambulance operation licensed under this rule that is providing

services at the limited advanced or advanced life support level on a 24-hour-a-

day, 7-day-a-week basis and is advertising

these services, shall not qualify for

licensure under this rule. The ambulance operation shall make application to the

department to upgrade its regular ambulance operation license to the level of licensure

being provided.

History: 2004 AACS.

PART 8. LIFE SUPPORT VEHICLES

R 325.22181 Ground ambulance; requirements.

Rule 181. (1) An ambulance operation shall maintain the manufacturer's certificate

of compliance on file at the time of application to the department for licensure of each

ground ambulance. The certificate of compliance must be executed by the final

manufacturer of each ground ambulance and be on a form prescribed by the department.

(2) The manufacturer of a ground ambulance executing a certificate of compliance

shall comply with the ambulance structural and mechanical specifications with 1 of the

following standards that was in effect at the time of manufacture:

(a) Federal KKK-A-1822 standards, excluding the paint scheme.

(b) The Commission on Accreditation of Ambulance Services (CAAS) Ground

Vehicle Standard for Ambulances (GVSA) in its entirety.

(c) The National Fire Protection Association (NFPA) 1917 Standard for

Automotive Ambulances in its entirety.

(3) The manufacturer shall maintain test data demonstrating compliance.

(4) Once licensed for service, an ambulance must not be required to meet later

modified state vehicle standards during its use by the ambulance operation that obtained

the license.

(5) A ground ambulance referred to in subrule (2) of this rule must not be modified

to alter its original design upon which the certificate of compliance was based unless a

new certificate is issued verifying that the modifications have not altered the integrity of

the vehicle.

(6) The patient compartment of a ground ambulance that has met applicable

standards at the time of manufacture may be remounted on to a different chassis. The

remounter may be a member of 1 or more of the following: Ford Qualified Vehicle

Modifier, Mercedes Benz Sprinter Preferred Upfitter, Ram Q Pro Programs, or the

National Truck Equipment Association Member Verification Program.

(7) A new manufacturer’s certificate of compliance must be issued that identifies the

new vehicle identification number and demonstrates compliance with either KKK,

GVSA, or NFPA standards in accordance with subrule (2) of this rule.

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History: 2004 AACS; 2018 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22182 Non-qualifying vehicles for licensure.

Rule 182. (1) A ground ambulance that was originally manufactured before January

1, 1982, may not qualify for licensure by the department and must not be sold or donated

in this state for use as a ground ambulance. This subrule does not apply to a ground

ambulance that is currently licensed by the department and has been in continuous

service before January 1, 1982.

(2) A ground ambulance manufactured after January 1, 1982, whose age from the

date of manufacture exceeds 2 years, must have a safety inspection by a certified

mechanic being sold to provide ground ambulance services. The inspection must be

documented on a form developed by the department and include a notarized statement by

the previous owner attesting that the ground ambulance has not been involved in a

vehicular accident altering its safety. The documents required by this subrule must be

submitted to the department by the purchaser as part of the application for licensure by

the new owner.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22183 Life support vehicle sanitation.

Rule 183. A life support agency shall require that equipment, linen, and supplies be

cleaned or exchanged following each patient care use.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22184 Life support vehicles; displaying of name.

Rule 184. (1) A life support agency name shall be prominently displayed on the left

and right side of all licensed life support vehicles.

(2) If the life support agency is operated by or advertised with a name different than

the life support agency name, then the name may be displayed on the left and right side of

the life support vehicle below the name of the life support agency. The advertised name

shall be smaller than the life support agency name.

(3) A life support agency that identifies a level of licensure in its name or brand that

is higher than the level of life support provided by a specific licensed vehicle, shall

prominently display the actual level of licensure of the vehicle on the sides of the vehicle.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22185 Life support vehicles; equipment requirements.

Rule 185. (1) A ground ambulance, rotary ambulance, and aircraft transport

vehicle shall be equipped with equipment and patient care supplies as prescribed by

the department including temperature control in the patient compartment. The agency

shall require that equipment is available and in working order on each vehicle.

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(2) A nontransport and medical first response vehicle shall be equipped with

patient care equipment and patient care supplies as prescribed by the department. The

agency shall require that equipment is available and in working order on each vehicle.

(3)

Each life support vehicle shall be equipped with communication

capability in accordance with the medcom requirements.

History: 2004 AACS.

R 325.22186 Life support vehicles; patient care and safety equipment; review.

Rule 186. The department shall, with the advice of the emergency medical services

coordination committee, annually review and modify, as necessary, the minimum

equipment standards for life support vehicles.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22187 Rotary ambulance; requirements.

Rule 187. A rotary ambulance must meet all the following standards:

(a) Be capable of on-scene response and transportation of emergency patients.

(b) Be staffed in accordance with section 20921(3), (4), and (5) of the code, MCL

333.20921.

(c) Allow for patient access and treatment to the patient by the rotary ambulance

personnel.

(d) Possess access that allows for safe loading and unloading of a patient without

excessive maneuvering of the patient.

(e) Be temperature controlled for the comfort of the patient.

(f) Have adequate lighting for patient care and observation.

(g) Be equipped with communication capability with hospitals, life support vehicles,

and medical control in accordance with the medcom requirements.

(h) Be capable of carrying a minimum of 1 patient in a horizontal position.

(i) Securely store equipment and make the equipment readily accessible.

(j) Operate under the medical control authority.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22188 Rotary ambulance sanitation.

Rule 188. A rotary ambulance operation shall require that any equipment,

linen, and supplies be cleaned or exchanged following each patient care use.

History: 2004 AACS.

R 325.22189 Aircraft transport vehicle; requirements.

Rule 189. An aircraft transport vehicle must comply with all the following:

(a) Be authorized as part of a licensed aircraft transport operation.

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(b) Be capable of carrying a minimum of 1 patient in a horizontal position.

(c) Provide a means of securing the litter while supporting a patient to the floor,

walls, seats, specific litter rack, or any combination thereof.

(d) Ensure that the patient compartment has adequate lighting available for patient

observation.

(e) Require that equipment is secured to the aircraft, readily accessible, and when

not in use, securely stored.

(f) Ensure that the interior of each vehicle affords an adequate patient care and

treatment area.

(g) Ensure that each vehicle is equipped with a cargo door or other entry that allows

for loading and unloading of the patient without excessive maneuvering of the patient.

(h) Ensure that the interior of each vehicle is equipped with temperature control for

the comfort of the patient.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22190 Life support vehicles; licensure and relicensure inspections; new

and replacement vehicles; licensure at higher level of care.

Rule 190. Life support vehicles must be inspected as follows:

(a) The department may conduct random renewal inspections of life support

vehicles, including medical first response vehicles. Inspections are unannounced unless

circumstances warrant notifying a life support agency in advance that an inspection of its

life support vehicles will be conducted. The department shall determine if prior

notification of an inspection is warranted. A vehicle license may be renewed without an

inspection.

(b) Submission of a licensure renewal application is considered an attestation by the

life support agency that the vehicle meets all licensure requirements.

(c) A life support agency that is adding a new or higher licensure level for a life

support vehicle shall submit an application, on forms provided by the department, and

include the required fee. New and higher level of care vehicles must be inspected before

being placed into service. Upon receipt of the application and required fee, the

department shall inspect new or upgrade vehicles within 15 days after receipt of the

application.

(d) A life support agency that is replacing a life support vehicle shall submit an

application, on forms provided by the department, and include the required fee. A

replacement vehicle means a life support agency has removed a vehicle from service and

has replaced the vehicle with another.

(e) Replacement vehicles may be placed into service upon submission of an

application and the required fee to the department. Upon receipt of the application and

required fee, the department shall inspect the replacement vehicle within 15 days after

receipt of the application.

(f) With written notification in a format specified by the department, a rotary

ambulance back-up vehicle may be put into service for 30 days before it must comply

with subdivisions (a) to (e) of this rule.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

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R 325.22191 Life support vehicles inspected; non-compliance; corrective

measures.

Rule 191. If the department determines that a life support vehicle does not comply

with the requirements of the code and these rules, then the following applies:

(a) If an agency has a vehicle determined to be noncompliant with minimum

equipment items as identified on the inspection form, the agency has 24 hours to bring

the vehicle into compliance and notify the department in writing of the corrections made.

The vehicle may be returned to service before a reinspection with approval of the

department. A reinspection must occur within 15 days after notification by the life

support agency.

(b) If an agency fails to bring a vehicle into compliance within 24 hours, the agency

shall remove the vehicle from service until the life support agency submits a written

explanation of corrective action to the department and the department reinspects the

vehicle. A vehicle taken out of service shall not function as an ambulance or life support

vehicle until the vehicle passes the department reinspection.

(c) If a vehicle remains out of compliance for more than 15 calendar days from the

date of inspection, its license is automatically revoked. Reinstatement of the life support

vehicle license requires reapplication for licensure, payment of the licensure fee

prescribed in the code, and a reinspection of the vehicle.

(d)The department may immediately order a life support vehicle out of service if it

determines that the health and welfare of a patient may be in jeopardy due to

noncompliance with minimum equipment standards or defective and nonfunctional

critical minimum equipment. A notice of that action be immediately provided to the life

support agency by the department based upon the deficiencies found.

(e) A life support agency that takes corrective measures to bring a life support

vehicle into compliance during the time of a department inspection will not receive notice

of noncompliance. The inspection report must reflect that the corrective action and

compliance have been met.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

PART 9. COMMUNICATIONS REQUIREMENTS

R 325.22192 Communications requirements; life support agencies.

Rule 192. A life support agency providing emergency medical services shall use

applicable communication systems consistent with its level of licensure in compliance

with the code, these rules, and the medcom requirements as prescribed by the

department.

History: 2004 AACS.

R 325.22193 Medcom requirements.

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Rule 193. Medcom requirements must be reviewed annually and updated, if

necessary, with the advice and recommendations of the emergency medical services

coordination

committee.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22194 Illegal interception of radio communications.

Rule 194. A person that receives any radio communication not intended for the

general public may not use the contents of the communication for initiating an emergency

medical service response as described in section 20963(2) of the code, MCL 333.20963.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22195 Communications system application process; life support agencies;

medical control authorities.

Rule 195. (1)

A

life support agency shall comply with the ambulance-to-

hospital radio communications system consistent with the medcom requirements in the

medical control authorities in which they operate.

(2) A medical control authority shall comply with the ambulance-to-

hospital radio communications system approval process, as prescribed by the

medcom requirements, under any of the following conditions:

(a) A medical control authority upgrades to provide limited advanced or advanced

life support oversight.

(b) An existing medical control authority changes the infrastructure of its

communication system affecting ambulance-to-hospital communications.

(c) A change is made in an existing communications system that results in an

inability of an agency or hospital to communicate with each other.

History: 2004 AACS.

PART 10. MEDICAL CONTROL AUTHORITY

R 325.22201 Medical control authorities; designation.

Rule 201. (1) The department shall designate a medical control authority to provide

medical control for emergency medical services for a particular geographic area. The

medical control authority shall operate in accordance with the code.

(2) A medical control authority shall be administered by the following:

(a) Each hospital licensed under part 215 of the code, MCL 333.21501 to

333.21571, that operates a service for treating emergency patients 24-hours-a-day, 7-

days-a-week, may participate and serve on the medical control authority board in the

ongoing planning and development activities of the medical control authority designated

by the department.

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(b) Each freestanding surgical outpatient facility licensed under part 208 of the

code, MCL 333.20801 to 333.20821, that operates a service for treating emergency

patients 24-hours-a-day, 7-days-a-week and meets standards established by the medical

control authority may participate and serve on the medical control authority board in the

ongoing planning and development activities of the medical control authority designated

by the department. If a freestanding surgical outpatient facility participates in the medical

control authority as described in this rule, the facility shall meet all applicable standards

established by the medical control authority.

(3) Each hospital, off-campus emergency department with provider-based status, as

described in R 325.22112(1)(c), and freestanding surgical outpatient facility shall comply

with protocols for providing services to a patient before care of the patient is transferred

to hospital personnel.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22202 Medical control authorities; authority board; advisory body;

medical director; responsibilities; approval.

Rule 202. (1) A medical control authority shall be approved by the department, and

do all the following:

(a) Develop bylaws that define the medical control authority organizational

structure.

(b) Appoint a medical control authority board to administer the medical control

authority. The majority of the board shall be comprised, at a minimum, of members of the

hospitals and, when applicable, freestanding surgical outpatient facilities and off-campus

emergency department with provider-based status, as described in R 325.22112(1)(c).

The board may include other entities as determined by the medical control authority

bylaws.

(c) If the board also functions as the advisory body to the medical control authority

as described in this rule, then the board shall include a representative of each type of life

support agency and emergency medical services personnel functioning within the medical

control authority's region.

(d) Appoint an advisory body, as that term is defined in section 20918(2) and (4) of

the code, MCL 333.20918. The advisory body shall meet at least quarterly.

(e) Appoint a medical director, with the advice of the advisory body, in accordance

with section 20918(3) of the code, MCL 333.20918. The medical director is responsible

for medical control for the emergency medical services system served by the medical

control authority. The medical control authority, with the advice of the advisory body,

may appoint more than 1 physician to serve as medical director provided the individual

meets all applicable criteria, or is approved by the department.

(f) Appoint a professional standards review organization to monitor and improve

the quality of medical care.

(g) Hold each licensed life support agency and individual accountable to the

medical control authority in the provision of emergency medical services, as that term is

defined in department-approved protocols.

(h) Provide protocols for the practice of life support agencies and emergency

medical services personnel as prescribed or approved by the department.

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(i) Collect data as necessary to assess the quality and needs of emergency medical

services throughout its medical control authority area.

(2) Each participating and nonparticipating hospital, off-campus emergency

department with provider-based status, as described in R 325.22112(1)(c), and

freestanding surgical outpatient facility within a medical control authority region shall

follow all standards, policies, procedures, and protocols established by the medical

control authority as approved by the department.

(3) Each medical control authority shall submit to the department current protocols

for department review and approval. Department approval shall be on a 3-year cycle, or

as defined by the department.

(4) The medical control authority shall notify the department if a life support agency

is consistently unable to provide at least 1 life support vehicle 24-hours-a-day, 7-days-a-

week.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22203 Medical control authority; denial, revocation, or suspension of

designation.

Rule 203. (1) The department may deny, revoke, limit, or suspend designation of a

medical control authority upon finding that the medical control authority meets 1 or more

of the following:

(a) Is guilty of fraud or deceit in securing its medical control designation.

(b) Has failed to perform in accordance with the terms of its designation and its

department-approved protocols.

(c) Has not maintained minimum criteria for medical control authorities, as

established by the department.

(d) Has failed to develop protocols as identified in the code to protect the public

health.

(2) If the department denies, revokes, limits, or suspends a medical control authority

designation, then the department shall designate a medical control authority to serve that

medical control authority area.

(3) The department shall provide notice of intent to deny, revoke, limit, or suspend

medical control authority designation and provide for a hearing in accordance with the

code and the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to

24.328.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22204 Medical control authority; advisory body.

Rule 204. A medical control authority shall appoint an advisory body, as that term

is defined in section 20918(2) and (4) of the code, MCL 333.20918. The advisory body

shall, at a minimum, do all the following:

(a) Advise the medical control authority on the appointment of a medical director.

(b) Advise the medical control authority on the development of protocols.

(c) Meet at least quarterly.

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History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22205 Medical control authority; medical director; responsibilities.

Rule 205. (1) The medical director is an agent of the medical control authority and

is responsible for medical control for the emergency medical services system.

(2) The medical director shall ensure the provision of medical control. The medical

director's signature on a life support agency's application for licensure or relicensure

affirms that the medical control authority intends to provide medical control to the life

support agency. If the medical director refuses to sign the life support agency application

for licensure or relicensure, then the medical director shall notify the department in

writing, within 5 business days, providing justification for denial based on a department-

approved protocol. Refusal of a medical director to sign a life support agency application

will result in denial justification review by the department.

(3) The medical director shall do all the following:

(a) Participate every 2 years in 1 department-approved educational program relating

to medical control issues.

(b) Be responsible for the supervision, coordination, implementation, and

compliance with protocols of the medical control authority.

(c) Receive input from, and be responsive to, the advisory body.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22206 Medical control authority; region.

Rule 206. (1) Not more than 1 medical control authority may be approved in each

designated region.

(2) A medical control authority shall obtain approval from the department to change

or combine medical control authority areas, or to assume a temporary contractual

responsibility for a portion of another medical control authority's region.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22207 Medical control authority; protocol development; promulgation of

protocols; emergency protocol.

Rule 207. (1) Each medical control authority shall establish protocols, as that term

is defined in section 20919 of the code, MCL 333.20919, which must include, but are not

limited to all the following:

(a) The acts, tasks, or functions that may be performed by each level of emergency

medical services personnel licensed under this part. Emergency medical services

personnel shall not provide life support at a level that exceeds the life support agency

license and approved medical control authority protocols.

(b) Procedures to ensure that life support agencies are providing clinical

competency assessments to emergency medical services personnel before the individual

provides emergency medical services within the medical control authority area.

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(c) Medical protocols to require the appropriate dispatching of a life support agency

based upon medical need and the capability of the emergency medical services system.

(d) A do-not-resuscitate protocol consistent with section 20919(1)(c) of the code,

MCL 333.20919.

(e) A protocol consistent with part 56B of the code, MCL 333.5671 to 333.5685.

(f) Protocols defining the process, actions, and sanctions a medical control authority

may use in holding life support agency or personnel accountable. This must include

disciplinary action against a life support agency or emergency medical services

personnel.

(g) Protocols defining the process to immediately remove medical control if the

medical control authority determines that an immediate threat to the public health, safety,

or welfare exists. These protocols must specify that a medical control authority has 3

business days to hold a hearing and make a determination.

(h) Protocols establishing that if medical control has been removed or suspended

from a participant, that the participant shall not provide prehospital services in that until

medical control is reinstated. If medical control is removed or suspended from a

participant in the medical control authority, then the department and life support agency

shall be notified within 1 business day of the removal. Medical control shall inform the

department when medical control is reinstated.

(i) Protocols that ensure a quality improvement program as follows:

(i) The quality improvement program must include a requirement that each life

support agency collects and submits data to the medical control authority.

(ii) Data must be reviewed by the medical control authority professional standards

review organization.

(iii) Data must be protected in accordance with section 20919(1)(g) of the code,

MCL 333.20919.

(j) Protocols that ensure an appeals process of a medical control decision is in effect.

(k) Protocols that specify that if life support agencies transport prehospital patients

to hospitals outside of their originating medical control authority area, they will comply

with their own medical control authority protocols.

(2) Each medical control authority shall develop standards for the withdrawal or

restoration of a hospital or free-standing surgical outpatient facility, or off-campus

emergency department with provider-based status, as described in R 325.22112(1)(c), to

a medical control authority. The protocol must include a provision to notify the regional

trauma network of the withdrawal or restoration of a facility.

(3) Each medical control authority shall develop specific protocols applicable to the

acquisition, storage, and use of drugs, intravenous fluids, and medical devices. Protocols

must include all of the following:

(a) All drugs must be under the control of a pharmacist licensed in this state

affiliated with a participating medical control authority hospital, free-standing surgical

outpatient facility, or off-campus emergency department with provider-based status, as

described in R 325.22112(1)(c).

(b) The medical control authority participating pharmacy shall provide medication

and intravenous fluid exchange services in accordance with the protocols developed by

the individual medical control authority and approved by the medical control authority

medical control director and the department.

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(c) In the instance of a recall relating to medical control authority participating

pharmacy supplied medications or devices, the pharmacy shall notify the medical control

authorities.

(d) All medication storage containers must be numbered. Each medication storage

container must be inspected and inventoried by a medical control authority-approved

pharmacy at least annually.

(e) All medication storage containers must have at least the following information

affixed to the outside of the container:

(i) The name of the medical control approved pharmacy that most recently

restocked the container.

(ii) The date of the most recent restock.

(iii) The name and date of the medications with the earliest expiration dates.

(iv) Notation of the licensed pharmacy personnel who completed and sealed the

medication container.

(f) The medical control authority participating facility or agency in possession of

intravenous fluids, tubing, and supplies shall have a method for verifying and tracking

that the supplies are within their expiration date and do not have any active recall notices.

(g) The medication containers must be stored in a method that maintains the

stability, integrity, and effectiveness of the medication contained therein.

(4) Emergency protocols developed in accordance with section 20919(3)(e) of the

code, MCL 333.20919, must be submitted to the department, within 5 business days, for

review and must remain in effect for not more than 60 days unless approved by the

department.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22208 Medical control authority protocols; department review; approval;

adoption by medical control authority.

Rule 208. (1) A medical control authority shall circulate, not less than 60 days

before adoption, a draft of proposed protocols to all affected life support agencies within

the emergency medical services system under the medical control authority.

(2) A medical control authority shall submit a written draft of proposed protocols to

the department for review by the quality assurance task force no later than the tenth day

of any given month. A protocol received not later than the tenth day of a given month

must be reviewed that month. A protocol received after the tenth day of a given month

must be reviewed the next month following the date of receipt by the department.

(3) The department shall consider any written comments received from persons

within the medical control authority when reviewing a protocol.

(4) The department shall provide written recommendations to the medical control

authority within 60 days after receipt of a protocol in compliance with this rule, and

comments, suggested changes, deletions, denial, or approval on the proposed protocol.

Protocols resubmitted with changes or modifications by the medical control authority fall

under the 60-day response deadline as prescribed in this rule.

(5) Following department approval of a protocol, the medical control authority may

formally adopt the protocol.

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History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22209 Medical control authority; additional standards.

Rule 209. A medical control authority may adopt protocols that require additional

or more stringent standards for life support agencies, equipment, and personnel than those

already required by the department to enhance its system. If a life support agency or

emergency medical services personnel within the medical control authority disagree with

the proposed protocol, the medical control authority shall provide the department with the

medical and economic considerations such enhancements may have on the local

community. The quality assurance task force shall review and make recommendations to

the department before department approval.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22210 Medical control authority; life support agencies and personnel;

compliance with protocols.

Rule 210. (1) A medical control authority shall establish written protocols for the

process, actions, and sanctions a medical control authority may use in holding a life

support agency or personnel accountable. These protocols must include disciplinary

action against a life support agency or emergency medical services personnel to ensure

compliance with all protocols or to protect the public health, safety, or welfare.

(2) A medical control authority may exercise disciplinary action against a life

support agency and its emergency medical services personnel that may result in the life

support agency, or its personnel not being allowed to provide emergency medical

services. The basis for these actions must be for noncompliance with policies,

procedures, or protocols established by the medical control authority. The disciplinary

action may include the suspension, limitation, or removal of a life support agency or its

personnel to provide emergency medical services within the medical control authority

area.

(3) If disciplinary action against an agency or individual results in the suspension,

limitation, or removal of medical control, the medical control authority shall advise the

department, in writing, of the action within 1 business day.

(4) If a suspension or removal of medical control to a life support agency or

individual occurs by the medical control authority, the life support agency or individual

may not operate or practice in that medical control authority region until medical control

is restored by the medical control authority.

(5) If a suspension or removal of medical control to a life support agency or

individual occurs by the medical control authority, the life support agency or individual

shall not operate or practice in that medical control authority area until medical control is

restored by the medical control authority.

(6) In cases of malfeasance, misfeasance, or nonfeasance on the part of the medical

control authority, the department shall take action to preserve medical control in a

medical control authority region.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

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R 325.22211 Medical control authority; quality improvement.

Rule 211. (1) A medical control authority shall establish a quality improvement

protocol to ensure a quality improvement program is in place and functional.

(2) Data submitted by the life support agencies within the medical control authority

area must be reviewed by the medical control authority professional standards review

organization for the purpose of improving the quality of medical care within the medical

control authority area.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22212 Medical control authority; appeals.

Rule 212. (1) A medical control authority shall incorporate procedures for the

appeal of decisions made by the authority against a life support agency and emergency

medical services personnel. Once appeals to the medical control authority have been

exhausted, the decision made by the medical control authority may be appealed to the

statewide emergency medical services coordination committee. An appeal to the

emergency medical services coordination committee must be filed with the department in

writing not more than 30 calendar days following notification to the agency or individual

of the final determination of the medical control authority. The emergency medical

services coordination committee shall issue an opinion on whether the actions or

decisions of the medical control authority comply with the department-approved

protocols of the medical control authority and the code.

(2) If a decision of the medical control authority is appealed to the emergency

medical services coordination committee, the medical control authority shall document

their decision to the statewide emergency medical services coordination committee for

their review.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22213 Medical control authority; data collection; data confidentiality.

Rule 213. (1) A medical control authority shall collect data under the department-

approved quality improvement protocol from each life support agency within the medical

control authority area. Data collected must be reviewed by the medical control authority

professional standards review organization to improve the quality of medical care within

the medical control authority area and comply with section 20919(1)(g) of the code, MCL

333.20919. All data collected under section 20919(1)(g) of the code, MCL 333.20919,

are confidential, not public record, not discoverable, and shall not be used as evidence in

a civil action or administrative proceeding.

(2) A medical control authority shall submit data to the department as prescribed by

the department and approved by the emergency medical services coordination committee.

(3) Medical control authorities shall have access to quality data residing within the

Michigan Emergency Medical System Information System for incidents that occur within

the medical control authority’s geographic area.

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History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22214 Medical control authority; special studies.

Rule 214. (1) A medical control authority that intends to establish a protocol

involving skills, techniques, procedures, or equipment that is not included in this state's

approved curriculum, may need to establish the practice as a special study. Determination

that a proposed protocol is acceptable under current practice or requires a special study is

decided by the quality assurance task force. A protocol may be approved as a medical

control authority protocol under the following conditions:

(a) The medical control authority provides documentation that the skill, technique,

procedure, or equipment complies with 1 of the following:

(i) The practice is recognized by a national organization as acceptable.

(ii) The practice has existing precedent in Emergency Medical System outside of

this state.

(iii) There are published studies that support the safety and efficacy in its

application of the practice within the emergency setting.

(b) The medical authority provides the educational outline that will be implemented

to instruct the emergency medical services personnel in the new skill, technique,

procedure, or equipment, as well as the verification of competency that will be utilized.

(c) A letter of support, justifying the need for the practice, signed by the medical

director for the medical control authority participating in the practice implementation.

(d) The medical control authority submits protocols that will be used for the

practice.

(e) The quality assurance task force may require data submission to this state for

approval of the practice. If data is required for approval, the approval must be indicated

as approval of the practice as a special study.

(2) A medical control authority that intends to establish a protocol involving skills,

techniques, procedures, or equipment that is not included in this state’s approved

curriculum, and is not consistent with its level of licensure requires a special study and

must comply with all of the following:

(a) Provide any available studies or supporting documentation indicating the

practice has been studied. Published studies supporting the safety and efficacy of its

applications within the emergency setting must also be submitted.

(b) The medical control authority provides an educational outline that will be

implemented to instruct the emergency medical services personnel in the new skill,

technique, procedure, or equipment, as well as the verification of competency that will be

utilized and the plan for continued competency assurance, such as a continuing education

plan.

(c) Provide a letter of support, justifying the need for the practice, signed by the

medical director for the medical control authority participating in the special study.

(d) The medical control authority shall submit protocols that will be used for the

practice.

(e) Identify life support agencies involved in the special study, their licensure level,

the number of emergency medical services personnel to be trained, and their respective

licensure levels.

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(f) Submit a timeline indicating the proposed duration of the study.

(g) Describe the proposed data to be submitted to this state during the study.

Generally, data submission is required quarterly.

(h) If the medical control authority designs the study to develop or contribute to

generalizable knowledge, the medical control authority shall also submit documentation

of Institutional Review Board approval, exemption, or not regulated status for the study.

(3) A medical control authority that intends to establish a protocol involving skills,

techniques, procedures, or equipment that is not included in this state’s approved

curriculum and is not consistent with either the level of licensure or scope of practice,

involves human subject research under 45 CFR part 46, or intends to publish the human

subject research, shall require a special study if it complies with all of the following:

(a) Provide any available studies or supporting documentation indicating the

practice has been studied. Published studies supporting the safety or efficacy of its

application within the emergency setting must also be submitted.

(b) Submit initial and refresher education requirements and provide an educational

outline to be implemented to instruct the emergency medical services personnel in the

new skill, technique, procedure, or equipment, as well as verification of competency that

will be utilized. Refresher education requirements must include frequency and content of

refresher to maintain proficiency in skill, technique, procedure, or equipment.

(c) Identify life support agencies involved, their licensure level, the number of

emergency medical services personnel to be trained, and their respective licensure levels.

(d) If providing mutual aid outside its medical control authority region, the medical

control authority shall have a written agreement with another medical control authority to

continue to utilize its protocols.

(e) Identify the quality review process that will be implemented.

(f) Submit protocols that will be included in the special study.

(g) Identify data parameters to be collected and the quality review process that will

be implemented. The medical control authority shall submit quarterly reports, and upon

completion of the study, submit a final report to the department.

(h) Obtain and submit an institutional review board approval or an institutional

review board official exemption. If the medical control authority used a randomized

study, include the consent form, method of institutional review board approval, and

institutional review board approval letter.

(4) A special study may be terminated by the department, with the advice of the

quality assurance task force, for any of the following reasons:

(a) The special study jeopardizes the health, safety, or welfare of the citizens of this

state.

(b) There is evidence of failure to follow study parameters.

(c) There is evidence of failure to submit reports.

(d) The medical control authority or medical director requests termination.

(e) There is not sufficient data to support continuation.

(5) A special study may be considered complete when outcomes have been met, the

timeline has been completed, or the study has been terminated by the department with the

advice of the quality assurance task force. A final report must be submitted to the

department by the medical control authority when the study is complete, unless the study

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is terminated by the department. The medical control authority may request any of the

following for the protocol being studied:

(a) That it become a standard protocol for the requesting medical control authority.

(b) That it become a standard protocol for this state.

(c) That it be extended.

(d) That it be terminated.

(6) Disposition of the protocol is determined by the quality assurance task force.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22215 Medical control authority; communication requirements.

Rule 215. (1) A medical control authority shall comply with the ambulance-to-

hospital radio communications system approval process, as prescribed by the medcom

requirements.

(2) Each medical control authority shall designate an individual or organization to be

responsible for maintaining records of the telecommunications activities in support of

medical control. The records must be in the form of electronic recordings and maintained

for 60 days.

(3) The department may add additional frequencies or other methods of

communications to the medcom requirements. The department, before implementation,

shall approve new requirements and technologies for ambulance-to-hospital

communication.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22216 Medical control authority; interface with public safety agencies;

authority for management of patient.

Rule 216. A medical control authority shall establish protocols that do all the

following:

(a) Clarify that the authority for the management of a patient in an emergency is

vested in the licensed health professional or licensed emergency medical services

personnel at the scene of the emergency who has the most training specific to the

provision of emergency medical care.

(b) Identify that when a life support agency is present at the scene of an emergency,

authority for the management of an emergency patient in an emergency is vested in the

physician responsible for medical control, until that physician relinquishes management

of the patient to a licensed physician at the scene of an emergency.

(c) Specify that the appropriate public safety agency shall manage the scene of an

emergency.

(d) Specify that if an emergency is declared, the declaration that an emergency no

longer exists may be made only by an individual licensed under the code or a health

professional licensed under the code who has training specific to the provision of

emergency medical services in accordance with department-approved protocols.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

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R 325.22217 Medical control authority; interfacility transfers.

Rule 217. (1) A medical control authority may adopt a protocol that governs the

transport of a patient from 1 health facility to another. If a medical control authority has

not established department-approved protocols for the interfacility transport of a patient,

then patient care must be determined according to written orders of the transferring

physician within the scope of practice of the emergency medical services personnel.

(2) A life support agency is accountable to a medical control authority in which it

has been approved to operate.

History: 2004 AACS; 2023 MR 10, Eff. May 26, 2023.

R 325.22218 Medical control authority; stretcher transport of nonemergency

patients.

Rule 218. With department approval, a medical control authority may implement a

protocol that governs the treatment and stretcher transport of nonemergency patients.

History: 2023 MR 10, Eff. May 26, 2023.

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