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) Drugs.  
(B) Organs.  
(C) Medical supplies.  
(D) 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 AACS.  
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.  
(l) "Medcom requirements" means medical communication requirements for an  
emergency medical services communication system.  
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(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 AACS.  
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 AACS.  
R 325.22104 Terms in code.  
Rule 104. Terms defined in the code have the same meanings when used in these rules.  
Page 3  
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 AACS.  
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:  
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(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 AACS.  
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 AACS.  
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 AACS.  
R 325.22115 Use of descriptive words, phrases, symbols, advertising.  
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.  
Page 5  
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 AACS.  
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 AACS.  
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, 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.  
Page 6  
(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 AACS.  
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 AACS.  
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  
Page 7  
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 AACS.  
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 AACS.  
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.  
(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.  
Page 8  
History: 2004 AACS; 2023 AACS.  
R 325.22125 Life support agency; licensure at higher level of care; requirements.  
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:  
(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 AACS.  
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  
Page 9  
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 AACS.  
R 325.22127 Life support agency; life support vehicle; inspection; contractor  
requirements.  
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,  
Page 10  
including the roles and responsibilities of those agencies or individuals having been  
awarded contracts.  
History: 2004 AACS; 2023 AACS.  
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.  
(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.  
Page 11  
(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 AACS.  
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.  
(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.  
Page 12  
(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 AACS.  
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.  
(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 AACS.  
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:  
Page 13  
(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 AACS.  
R 325.22135  
requirements.  
Rotary aircraft ambulance operations; additional licensure  
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.  
(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.  
Page 14  
(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 AACS.  
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 AACS.  
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.  
(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 AACS.  
R 325.22138 Life support agency; renewal.  
Page 15  
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 AACS.  
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:  
(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.  
Page 16  
(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 AACS.  
PART 4. NONTRANSPORT PREHOSPITAL LIFE SUPPORT OPERATIONS  
R 325.22141 Nontransport prehospital life support operation; initial application for  
licensure.  
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 of insurance covering each vehicle as identified in subrule  
(5) 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 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.  
Page 17  
(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 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.  
(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 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  
requirements.  
Nontransport prehospital life support operation; operating  
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.  
Page 18  
(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 improvement activities authorized under  
medical control authority protocols.  
(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.  
(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 a vehicle operation education and competency  
assessment.  
History: 2004 AACS.  
R 325.22143  
requirements.  
Nontransport prehospital life support operation; licensure  
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 minimum 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  
20927(3) of the code.  
(f) Ensure that patient care and safety equipment carried on a nontransport vehicle meet  
the minimum requirements prescribed by the department and approved medical control  
authority protocols.  
Page 19  
(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 level; additional licensure requirements.  
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:  
(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 support 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 nontransport prehospital life support operation to comply with section 20936 of  
the code.  
Page 20  
(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.  
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 rule, and make available to the  
department upon request.  
(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  
Page 21  
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.  
(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 aircraft transport vehicle complies with the  
code and applicable medical control authority protocols.  
(f) Require that an aircraft transport vehicle is not operated while 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 each medical control authority under  
which the agency operates.  
Page 22  
(j) Participate in data collection and quality improvement activities authorized under  
medical control authority protocols.  
(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 medical control authority,  
Page 23  
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.  
(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.  
Page 24  
(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 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.  
(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  
Page 25  
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 improvement activities authorized under  
medical control authority protocols.  
(i) Ensure that all vehicles meet state equipment requirements as established by the  
department and department-approved medical control authority protocols.  
(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 a vehicle operation education and competency  
assessment.  
History: 2004 AACS.  
Page 26  
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.  
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.  
Page 27  
(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 AACS.  
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.  
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 unit of 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 upgraded license shall be  
Page 28  
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 a life support level higher than basic life support.  
(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 care and radio equipment  
requirements for the level of upgrade requested.  
(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 the ambulance operation  
operates.  
(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, and exchange of pharmaceuticals.  
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).  
Page 29  
(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 2 years from date of issuance  
by the department.  
(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 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.  
Page 30  
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.  
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:  
Page 31  
(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.  
History: 2004 AACS; 2018 AACS; 2023 AACS.  
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 AACS.  
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 AACS.  
Page 32  
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 AACS.  
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.  
(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 AACS.  
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.  
Page 33  
(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 AACS.  
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.  
(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 AACS.  
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.  
Page 34  
(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 AACS.  
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.  
Page 35  
History: 2004 AACS; 2023 AACS.  
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.  
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 AACS.  
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 AACS.  
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.  
Page 36  
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.  
(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 AACS.  
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  
Page 37  
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.  
(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 AACS.  
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 AACS.  
Page 38  
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.  
History: 2004 AACS; 2023 AACS.  
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 AACS.  
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 AACS.  
R 325.22207 Medical control authority; protocol development; promulgation of  
protocols; emergency protocol.  
Page 39  
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.  
(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.  
Page 40  
(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.  
(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 AACS.  
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.  
Page 41  
(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.  
History: 2004 AACS; 2023 AACS.  
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 AACS.  
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.  
Page 42  
(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 AACS.  
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 AACS.  
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 AACS.  
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  
Page 43  
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.  
History: 2004 AACS; 2023 AACS.  
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  
Page 44  
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.  
(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.  
Page 45  
(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  
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 AACS.  
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 AACS.  
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  
Page 46  
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 AACS.  
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 AACS.  
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 AACS.  
Page 47  
;