98-22911 RESO
RESOLUTION NO.
98-22911
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF
THE CITY OF MIAMI BEACH, FLORIDA, APPROVING AN
AGREEMENT BETWEEN THE CITY OF MIAMI BEACH AND
HARRY HEINITSH, M.D., AS MEDICAL DIRECTOR FOR THE CITY
OF MIAMI BEACH EMERGENCY MEDICAL SERVICES (EMS),
FROM OCTOBER 1, 1998 TO SEPTEMBER 30, 1999, TO BE
A V AILABLE AT SUCH TIMES AS REQUIRED BY THE FIRE CHIEF
AND HIS COMMAND STAFF, FOR AN ANNUAL SALARY OF $64,090
AUTHORIZING THE MAYOR AND CITY CLERK TO EXECUTE
THE AGREEMENT.
WHEREAS, the City has contracted with Harry Heinitsh, M.D., to act as Medical Director for the
City's Emergency Medical Service from August 28, 1986, through September 30, 1999; and
WHEREAS, upon expiration of Dr. Heinitsh's latest Agreement, the City wishes to enter into a new
one (1) year Agreement for his services, from October 1, 1998 through September 30, 1999.
NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and the City Clerk are
hereby authorized to execute the attached Agreement between the City of Miami Beach and Harry Heinitsh,
M.D., as Medical Director for the City of Miami Beach Emergency Medical Services (EMS), from October
1,1998 to September 30,1999, to be available at such times as required by the Fire Chief and his command
staff, for an annual salary of $64,090.
PASSED AND ADOPTED THIS 23rd day of
September, 1998.
ATTEST:
~r Patdt>>-
CITY CLERK
~1/11
MAYOR
C:Rclcue\RCloCmj99.HH
APPROVED AS TO
FORM & LANGUAGE
& FOR EXECUTION
~~ 0)//7 //>r)
ify Attorney ~
CITY OF MIAMI BEACH
CITY HALL 1700 CONVENTION CENTER DRiVE MIAMI BEACH, FLORIDA 33139
'lttp:\\ci. miami-beach. fl.lJS
COMMISSION MEMORANDUM NO. l..,.-:<.., L q 8
TO:
Mayor Neisen O. Kasdin and
Members of the City Co mission
/
, ,
DATE: September 23, 1998
FROM:
Sergio Rodriguez
City Manager
SUBJECT:
A RESOL ION OF THE MAYOR AND CITY COMMISSION OF THE
CITY OF MIAMI BEACH, FLORIDA, APPROVING AN AGREEMENT
BETWEEN THE CITY OF MIAMI BEACH AND HARRY HEINITSH, M.D.
AS MEDICAL DIRECTOR FOR THE CITY OF MIAMI BEACH
ElVIERGENCY MEDICAL SERVICES (EMS), FROM OCTOBER 1, 1998 TO
SEPTEMBER 30, 1999, TO BE A V AILABLE AT SUCH TIMES AS
REQUIRED BY THE FIRE CHIEF AND HIS COMMAND STAFF, FOR AN
ANNUAL SALARY OF $64,090 AND AUTHORIZING THE MAYOR AND
CITY CLERK TO EXECUTE THE AGREEMENT.
ADMINISTRA TION RECOMMENDATION
Adopt the Resolution.
BACKGROUND
Upon the passing of City Physician, Dr. Leo Grossman, the City reviewed the qualifications of three
(3) Fire Rescue Doctors that it had under contract at that time, and selected Harry Heinitsh, M.D.
The City of Miami Beach entered into an Emergency Medical Service Director Agreement with Dr.
Harry Heinitsh, commencing August 28, 1986.
The Medical Director is required per Florida Statute 401.265 and 64E-2 (Attachment), as stated in
the "EMS Medical Director Agreement", Page 1, Item #2: "Services." Attached is the Department
of Health -EMS Program Letter acknowledging the Florida Statutes.
AGENDA ITEM~
DATE cr -;239 ~
As part of this Agreement, the Medical Director shall present himself and/or be available at such
times as required by the Fire Chief and his command staff, Dr. Heinitsh's average work schedule
is 40 hours per week. The current contract term is from 1 % 1/98 through 09/30/99 and allows for
a yearly extension if mutually agreed by both parties, The agreement may be terminated without
cause by either party upon furnishing a 60 day notice.
ANAL YSIS
In addition to being Medical Director, Dr. Heinitsh also serves as Quality Assurance Officer and
Infection Control Officer for the Fire Department at no extra cost to the City. Furthermore, he has
a Memorandum of Understanding for medical direction with our Beach Patrol and Medical
Dispatching at no extra cost to the City. A survey of neighboring EMS systems is attached, based
on which the Administration has determined that under the present contract, less is spent by the City
of Miami Beach for medical direction than any other system in the County.
The current salary of $64,090 has been in effect since FY 1997/98. The terms of the proposed
agreement remain the same as the current agreement.
SR~/mc
C~R~~~mm099Jrn
AAUachmenl
~'.'; ". '., '.'J.l'''''.
~'"J.t~~~~'6.""'''''-'''~IJ'''''J.'4''U~UJ.:.J~J...Ja.1At~'t(~ '...i..t.l'J",.,\...~~~:n:.........".....n'"--"''''''' .-,........ #O~__._., . ~ -. .-----
'f ~~~
~/G
, I l Effective 08/04/98
~ Emergency Medical Services q EABj<=JY
\'1
\\
'\
(c) Pediatric LV. arm board or splint appropriate for LV.
stabilization.
(d) Disposable endotracheal tubes; adult, child
and infant sizes. Those below 5.5 shall be uncuffed.
2.5 mm - 5.0 mm uncuffed; 5.5 mm -7.0 mm; 7.5 mm-
9.0mm.
(e) Endotracheal tube stylets pediatric and adult.
(f) Magill forceps, pediatric and adult sizes.
(g) Device for intratracheal meconium sucticlr1!ng in newborns.
(h) Tourniquets.
(i) t.V. cannulae 14 thru 24 gauge.
(j) Micro drip sets.
(k) Macro drip sets.
(I) t.V. pressure infuser.
(m) Needles 18 thru 25 gauge.
(n) Intraosseous needles 15 or 16 gauge and three way stop
cocks for use with intraosseous needles. As allowed by
medical director.
(0) Syringes, from 1 ml. to 20 ml.
(p) D.C. battery powered portable monitor defibrillator with
adult paddles (or hands-free pads) and pediatric paddles
(or pediatric paddle adapter) ECG printout and spare battery.
The unit shall be capable of delivering energy below 25 watts/sec.
(q) Monitoring electrodes for adults and pediatrics.
(r) Pacing electrodes, if monitor or defibrillator requires.
(s) Oro/Nasogastric tubes.
(t) Syringe appropriate for checking placement of
oro/nasogastric tube.
. (u) A method for rapidly determining blood glucose as approved
by the medical director.
(v) Pediatric length based measurement tape for equipment
selection and drug dosage.
(w) Approved sharps container per chapter 64E-16, F.A.C.
(x) Flexible suction catheters.
One.
Six total. (2 each size range).
One each. (, J
One each. '_0
'-1 C;)
One. (/) AJ
Three. (.-.,! i'1 nl
--0
Ten total. 1-- (')
-., f'"'."
, .
Three. :rJ \.D i'"n
=^
Three. (/') \) <
One. :::J:
0 m
Six total. '"T1 r-
..,., .. 0
Two each. U1
('")
,."
Eight total,
assorted sizes.
One.
Two sets each.
Two sets.
One each of each
size range, infant (8),
and pediatric (12, 14,
or 16).
One.
One.
One.
Assorted sizes, 1 each
of each size range: infant
(6-8 French), pediatric
(10-12 French), and adult
(14 French).
Specific Authority 381.0011, 395.405, 401.121,
401.35 FS. Law Implemented 381.0011,
381.025, 395.401, 395.4015, 395.402, 395.4025,
395.403, 395.404, 395.4045, 395.405, 401.23,
401.24, 401.25, 401.26, 401.27, 401.281,
401.30, 401.31, 401.321, 401.34, 401.35,
401.41,401.411,401.414,401.421 FS. History-
New 11-29-82, Amended 4-26-84, 3-11-85,
Formerly 100-66.50, Amended 4-12-88, 8-3-88.
8-7-89, 12-10-92, 11-30-93, 1-26-97. Formerly
100-66.050. Amended 08-04-98.
,-_.,' ,','-,"<
64E-2.004 Medical Direction.
.J ~t. "..
(1) Each ALS, BLS or air ambulance
provider shall maintain on file for inspection and
copying by the department its current contract
for a medical director by which it employs or
independently contracts with a physician
qualified pursuant to this section to be its
medical director.
(2) There is no standard format for a
medical director's contract, however, in drafting
such an instrument, the following provisions may
be addressed:
6
Emergency Medical Services .
Effectiv~ 08/04/98
(a) Name and relationship of the
contracting parties.
(b) A list of contracted services inclusive
of medical direction, administrative
responsibilities, professional membership, basic
and advanced life support review
responsibilities, and reporting requirements.
(c) Monetary consideration inclusive of
fees, expenses, reimbursement, fringe benefits,
clerical assistance and office space.
(d) Termination clause.
(e) Renewal clause.
(f) Provision for liability coverage.
(g) Effective dates of the contract.
(3) Qualifications:
(a) A medical director shall be a Florida
licensed M.D. or D.O.
(b) In addition to all other provisions
applicable to medical directors in this rule, an air
ambulance medical director shall be
knowledgeable of the aerDmedical requirements
of patients and shall evaluate each patient in
person or by written protocol prior to each
interfacility transfer flight for the purpose of
determining that the aircraft, flight and medical
crew, and equipment meet the patient's needs.
(c) A medical director shall be frDm a
broad-based medical specialty such as
emergency medicine, intemal medicine,
anesthesiolDgy, or other surgical specialty, with
demonstrated experience in prehospital care and
hold an ACLS certificate of successful course
completion or be board certified in emergency
medicine. Prehospital care experience shall be
documented by the provider.
(d) A medical director shall demonstrate
and have available for review by the department
documentation of active participation in a
regional or statewide physician group involved in
prehospital care.
(4) Duties and Responsibilities of the
Medical Director.
(a) Supervise and accept direct
responsibility for the medical performance of the
paramedics and EMTs working for emergency
medical services providers.
(b) Develop medically correct standing
orders or protocols which permit specified ALS
and BLS procedures when communication
cannot be established with a supervising
physician or when any delay in patient care
would potentially threaten the life or health of the
patient. . The medical director shall issue
standing orders and protocols to the prDvider to
ensure that the provider transports each of its
patients to facilities that offer a type and level of
care appropriate to the patient's medical
condition if available within the service region.
The medical director or his appointee shall
provide continuous 24-hour-per-day, 7 -day-per-
week medical direction which shall include in
addition to the development of protocols and
standing orders, direction to personnel of the
provider as to availability of medical director "off-
line" service to resolve problems, system
conflicts, and provide services in an emergency
as that term is defined by section 252.34(3), FS.
(c) Develop and implement a patient care
quality assurance system to assess the medical
performance of paramedics and EMTs. The
medical director shall audit the performance of
system personnel by use of a quality assurance
program to include but not limited to a prompt
review of run reports, direct observation, and
comparison of performance standards for drugs,
equipment, system prDtocols and procedures.
The medical director shall be responsible for
participating in quality assurance programs
developed by the department.
(d) With the exception of BLS medical
directors each ALS or air ambulance service
medical director shall possess proof of current
registration asa medical director, either
individually or through a hospital, with the U.S.
Department of Justice, DEA, to provide
controlled substances to an EMS provider. DEA
registration shall include each address at which
controlled substances are stored. Proof of such
registration shall be maintained on file with each
ALS or air ambulance provider and shall be
readily available for inspection.
(e) Ensure and certify that security
procedures of the EMS provider for medications,
fluids and controlled substances are in
compliance with chapters 499 and 893, FS., and
chapter 100-45, Florida Administrative Code.
(f) Create, authorize and ensure
adherence to, detailed written operating
procedures regarding all aspects of the handling
of medications, fluids and controlled substances
by the provider.
(g) Notify the department in writing when
the use of telemetry is not necessary.
(h) Notify the department in writing of each
substitution by the EMS provider of equipment or
medication.
(I) Assume direct responsibility for: the
use by an EMT of an automatic or semi-
automatic defibrillator; the performance of
esophageal intubation by an EMT; and on
routine interfacility transports, the monitoring and
maintenance of non-medicated I.V.s by an EMT.
The medical director shall ensure that the EMT
is trained to perform these procedures; shall
establish written protocols for the performance of
these procedures; and shall provide written
"
7
Emergency Medical Services
evidence to the department documenting 401.25, 401.26, 401.265, 401.27, 401.281,
compliance with provisions of this paragraph. 401.2915, 401.30, 401.34. 401.35, 401.41,
(j) Review, and if appropriate, approve a 401.411, 499.005 FS. History-New 8-7-89,
30-hour EMT refresher course for which the Amended 6-6-90, 12-10-92, 3-19-95, 1-26-97.
medical director is contracted. Formerly 100-66.0505. Amended 08-04-98.
(k) Ensure that all EMTs and paramedics
are trained in the use of the trauma scorecard
methodologies as provided in sections 64E-
2.017, F.A.C., for adult trauma patients and 64E-
2.0175, F.A.C., for pediatric trauma patients.
(I) Develop and revise when necessary
TIPs for submission to the department for
approval.
(m) Participate as a crew member on an
EMS vehicle for a minimum of 10 hours per year
and complete a minimum of 10 hours per year of
continuing medical education related to
prehospital care or teaching or a combination of
both.
(n) If he is a medical director of a training
program:
1. Be responsible for the instruction of the
Department of Transportation (DOT) approved
training prDgram for EMTs and paramedics.
2. Have substantial knowledge of the
qualifications, training, protocols, and quality
assurance programs for the training facility.
3. Maintain current instructDr level
training in advanced cardiac life support (ACLS)
or advanced trauma life support (ATLS),
maintain provider level training in basic trauma
life support (BTLS) or prehospital trauma life
support (PHTLS); or advanced pediatric life
support (APLS).
4. Act as a liaison between training
centers, local EMS providers and hospitals.
5. Participate in state and local quality
assurance and data collections programs.
6. The EMS training center shall by
contract, require such medical director to be
available 4 hours per month for classroom
teaching or review of student performance, be
available for 4 hours per month for EMS provider
field time, participate as a crew member on an
EMS vehicle for a minimum of 10 hours per year,
and complete a minimum of 10 hours per year of
continuing medical education related to
prehospital care or teaching or a combination of
both.
7. Participate in the recruitment,
selection, and orientation of instructors and
preceptors.
8. Participate in student selection, mid-
term evaluation and final practical examination of
students.
U~.........~..J.....A..l.a.1LI""4~,.Jl-,O~"'!""~"',(L~-" ".- '6....... .... .~._- --.---
Specific Authority 381.0011, 395.405, 401.35,
499.05 FS. Law Implemented 401.23, 401.24,
Effective 08/04/98
64E.2.005 Air Ambulances.
(1) Each applicant for an air ambulance
license shall pay the required fee as specified in
section 401.34(1 )0). FS., and submit an
application to the department on DOH Form
1575, October, 1996, Air Ambulance Service
License ApplicatiDn which is incorporated by
reference and available from the department.
The air ambulance license shall automatically
expire 2 years from the date of issuance.
(2) Security of medications, fluids and
controlled substances shall be maintained by
each air ambulance provider. Security
procedures shall be apprDved by the service's
medical director and be in compliance with
chapters 499 and 893, FS., and chapter 100-45,
Florida Administrative Code. Medication
inventory techniques and schedules shall be
maintained in compliance with chapters 499 and
893, FS., and Title 21, Code of Federal Register,
Food and Drugs, Part 1300 To End, Chapter II -
Drug Enforcement Administration, Department of
Justice.
(3) Each licensed air ambulance shall
have emergency protocols which address at
least, emergency procedures when the aircraft is
overdue, when radio communications cannot be
established, or when aircraft location cannot be
verified. Each licensed rotary wing air
ambulance shall document at least every 15
minutes of flight while en route to and from the
patient's location.
(4) Each provider shall maintain in each
paramedic's employment file documentation of
successful completion of an initial air crew
member (ACM) education program that was
conducted in accordance with the 1988 United
States (U.S.) Department of Transportation
(DOT) Air Medical Crew-Advanced National
Standard Curriculum (NSC), which is
incDrporated by reference and is available for
purchase from AAMS; 110 North Royal Street,
Suite 307, Alexandria, VA 22314; 703-836-
8732. Each provider shall ensure and shall
document in its employee records that each
EMT and paramedic which it employs holds a
current certification from the department.
(5) Each air ambulance provider shall
establish a safety committee. The committee
shall:
8
MEDICAL TELECOMMUNICATIONS AND TRANSPORTATION
Ch. 401
401.252 Interfacility transfer.-
(1) A licensed basic or advanced life support ambu-
lance service may conduct interfacility transfers in a per-
mitted ambulance, using a registered nurse in place of
an emergency medical technician or paramedic, if:
(a) The registered nurse holds a current certificate
of successful course completion in advanced cardiac
life support;
(b) The physician in charge has granted permission
for such a transfer, has designated the level of service
required for such transfer, and has deemed the patient
to be in such a condition appropriate to this type of
ambulance staffing; and
(c) The registered nurse operates within the scope
of chapter 464.
(2) A licensed basic or advanced life support service
may conduct interfacility transfers in a permitted ambu-
lance if the patient's treating physician certifies that the
transfer is medically appropriate and the physician pro-
vides reasonable transfer orders. If the emergency medi-
cal technician or paramedic believes the level of patient
care required during the transfer is beyond his capabil-
ity, the medical director, or his designee, must be con.
tacted for clearance prior to conducting the transfer. If
necessary, the medical director, or his designee, shall
attempt to contact the treating physician for consulta-
tion to determine the appropriateness of the transfer.
Hlslory.-ss. 7. 25, ell. 82-402: s. 13, ch. 83-196; ss. 6. 36. ch. 92-78.
401.26 Vehicle permits for basic life support and
advanced life support servlces.-
(1) Every licensee shall possess a valid permit for
each transport vehicle and advanced life support non-
transport vehicle in use. Applications for such permits
shall be made upon forms prescribed by the depart-
ment. The licensee shall provide documentation that
each vehicle for which a permit is sought meets the
appropriate requirements for a basic life support or
advanced life support service vehicle, whichever is
applicable, as specified by rule of the department.
(2) To receive a valid vehicle permit, the applicant
must submit a completed application form for each vehi-
cle for which a permit is desired. pay the appropriate
fees established as provided in s. 401.34, and provide
documentation that each vehicle meets the following
requirements as established by rule of the department;
the vehicle must:
(a) Be furnished with essential medical supplies and
equipment which is in good working order,
(b) Meet appropriate standards for design and con-
struction.
(c) Be equipped with an appropriate communication
system.
(d) Meet appropriate safety standards.
(e) -Meet sanitation and maintenance standards,
(f) Be insured for an appropriate sum against inju-
ries to or the death of any person arising out of an acci-
dent.
(3) The department may deny, suspend, or revoke
a permit if it determines that the vehicle or its equipment
fails to meet the requirements specified in this part or
in the rules of the department.
(4) A permit issued in accordance with this section
will expire automatically concurrent with the service
license.
(5) In order to renew a vehicle permit issued pursu-
ant to this part, the applicant must:
~ (a) Submit a renewal application. Such application
must be received by the department not more than 90
days or less than 30 days prior to the expiration of the
permit.
(b) Submit the appropriate fee or fees, established
as provided in s. 401.34.
(c) Provide documentation that current standards
for issuance of a permit are met. -
Hlstory.-s.6, ch. 73-128; I. 3, ell. 76-168; I. 250, ell. 77-147; s. 1, ell. 77-457;
1.19, ell. 76-95; so. 7, 10, ell. 79-280; so. 2, 3, ch. 81-318; 11.9.24,25, ch. 82'-402:
I, 13. ell. 83-196: s. 56, ch. 83-218: I. 8, ell. 84-317; s. 56, ell. 86-220: ss. 1~ 36,
ell. 92-78.
401.265 Medical dlrectors.-
(1) Each basic life support transportation service or
advanced life support service must employ or contract
with a medical director. The medical director must be a
licensed physician; a corporation, association, or part-
nership composed of physicians; or physicians
employed by any hospital that delivers in-hospital emer-
gency medical services and employs or contracts with
physicians specifically for that purpose. Such a hospital,
physician, corporation. association, or partnership must
designate one physician from that organization to be
medical director at any given time. The medical director
must supervise and assume direct responsibility for the
medical performance of the emergency medical techni-
cians and paramedics operating for that. emergency
medical services system. The medical director must per-
form duties including advising, consulting, training,
counseling, and overseeing of services, including appro-
priate quality assurance but not including administrative
and managerial functions,
(2) Each medical director shall establish a quality
assurance committee to provide for quality assurance
review of all emergency medical technicians and
paramedics operating under his supervision. If the medi-
cal director has reasonable belief that conduct by an
emergency medical technician or paramedic may con-
stitute one or more grounds for discipline as provided by
this part. he shall document facts and other information
related to the alleged violation. The medical director
shall report to the Department of Health and Rehabilita-
tive Services any emergency medical technician or
paramedic whom the medical director reasonably
believes to have acted in a manner which might consti-
tute grounds for disciplinary action. Such a report of
disciplinary concern must include a statement and docu-
mentation of the specific acts of the disciplinary con-
cern. Within 7 days after receipt of such a report, the
department shall provide the emergency medical tech-
nician or paramedic a copy of the report of the disciplin-
ary concern and documentation of the specific acts
related to the disciplinary concern. If the department
determines that the report is insufficient for disciplinary
action against the emergency medical technician or
paramedic pursuant to s. 401.411, the report shall be
expunged from the record of the emergency medical
technician or paramedic,
7
\
Ch.401
MEDICAL TELECOMMUNICATIONS AND TRANSPORTATION
(3) Any medical director who in good faith gives oral
or written instructions to certified emergency medical
services personnel for the provision of emergency care
shall be deemed to be providing emergency medical
care or treatment for the purposes of s, 768,13(2),
History.-ss. 6. 25. ch. 82-402: ss. 12. 13. ch. 83-196: s. 8. ch. 8Il-186; s. 15. ch.
89-275: s. 13. ch. 89-283: s. 70. ch. 89-374: ss. 8, 36. ch. 92-78.
401.27 Personnel; standards and certification.-
(1) Each permitted ambulance not specifically
exempted from this part, when transporting a person
who is sick, injured, wounded, incapacitated, or help-
less, must be occupied by at least two persons, one of
whom must be a certified emergency medical techni-
cian, certified paramedic, or licensed physician and one
of whom must be a driver who meets the requirements
for ambulance drivers. This subsection does not apply
to interfacility transfers governed by s, 401,252(1).
(2) The department shall establish by rule educa-
tional and training criteria and examinations for the certi-
fication and recertification of emergency medical techni-
cians and paramedics. Such rules must require, but
need not be limited to:
(a) For emergency medical technicians, proficiency
in techniques identified in s. 401.23(7) and in rules of the
department.
(b) For paramedics, proficiency in techniques identi-
fied in s, 401,23(1) and in rules of the department.
(3) Any person who desires to be certified or recerti-
fied as an emergency medical technician or paramedic
must apply to the department on forms provided by the
department. The department shall determine whether
the applicant meets the requirements specified in this
section and in rules of the department and shall issue
a certificate to any person who meets such require-
ments.
(4) An applicant for certification or recertification as
an emergency medical technician or paramedic must:
(a) Have completed an appropriate training course
as follows:
1. For an emergency medical technician, an emer-
gency medical technician training course equivalent to
the most recent emergency medical technician basic
training course of the United States Department of
Transportation as approved by the department;
2. For a paramedic, a paramedic training program
equivalent to the most recent paramedic course of the
United States Department of Transportation as
approved by the department;
(b) Certify under oath that he is not addicted to alco-
hol or any controlled substance;
(c) Certify under oath that he is free from any physi-
calor mental defect or disease that might impair his abil-
ity to perform his duties;
(d) Within 1 year after course completion have
passed an examination developed or required by the
department;
(e)1. For an emergency medical technician, hold
either a current American Heart Association cardiopul-
monary resuscitation course card or an American Red
Cross cardiopulmonary resuscitation course card;
2. For a paramedic, hold a certificate of successful
course completion in advanced cardiac life support from
the American Heart Association or its equivalent;
(f) Submit the certification fee and the nonrefund-
able examination fee prescribed in s. 401.34, which
examination fee will be required for each examination
administered to an applicant; and
(g) Submit a completed application to the depart-
ment, which application documents compliance with
paragraphs (a), (b), (c), (e), (t). (g), and, if applicable, (d).
The application must be submitted so as to be received
by the department at least 30 calendar days before the
next regularly scheduled examination for which the
applicant desires to be scheduled.
(5) The certification examination must be offered
monthly. The department shall issue an examination
admission notice to the applicant advising him of the
time and place of the examination for which he is sched- -
uled. Individuals achieving a passing score on the certifi-
cation examination may be issued a temporary certifi-
cate with their examination grade report. The depart-
ment must issue an original certification within 45 days
after the examination.
(6)(a) The department shall establish by rule a pro-
cedure for biennial renewal certification of emergency
medical technicians. Such rules must require a United
States Department of Transportation refresher training
program of at least 30 hOln as approved by the depart-
ment every 2 years. The refresher program may be
offered in multiple presentations spread over the 2-year
period. The rules must also provide that the refresher
course requirement may be satisfied by passing a chal-
lenge examination.
(b) The department shaD establish by rule a proce-
dure for biennial renewal certification of paramedics,
Such rules must require cancidales for renewal to have
taken at least 30 hours of continuing Eictucation units dur-
ing the 2-year period. The rules must provide that the
continuing education requirement may be satisfied by
passing a challenge examination.
(7) A physician, dentist, or registered nurse may be
certified as a parame<f1C if the physician, dentist, or reg-
istered nurse is certified in this state as an emergency
medical technician, has passed the required emergency
medical technician curricult.m. has successfully com-
pleted an advanced cardiac. lite support course, has
passed the examination for certification as a paramedic,
and has met other certificalion requirements specified
by rule of the department. A physician, dentist, or regis-
tered nurse so certified must be recertified under this
section.
(8) Each emergency medical technician certificate
and each paramedic certificale Will expire automatically
and may be renewed if the holder meets the qualifica-
tions for renewal as established by the department.
(9) The department may suspend or revoke a certifi.
cate at any time if it detemines that the holder does not
meet the applicable quaIificalions.
(10) The department may provide by rule for physi-
cally disabled persons to take and be provided with the
results of the written portion of the emergency medical
technician certification examination or paramedic certifi-
cation examination. However, such persons may not
receive any special assistance in completing the exami-
nation, An individual who achieves a passing grade on
the emergency medical technician certification examina-
8
EMS MEDICAL DIRECTOR AGREEMENT
THIS AGREEMENT made this 23rd day of September, 1998 by and between the CITY OF MIAMI
BEACH, a Florida Municipal Corporation having an address of 1700 Convention Center Drive, Miami Beach,
Florida 33139 (City), and HARRY HEINITSH, M.D., having an address of 6396 Manor Lane, Apartment
6, South Miami, Florida 33143 (Contractor).
WITNESSETH
WHEREAS, The City wishes to enter into an agreement for Medical Director of the City's Emergency
Medical Services (EMS) provided by the City's Fire Department (Agreement); and
WHEREAS, Contractor wishes to serve as the Medical Director for the City's EMS.
NOW THEREFORE, in consideration of the mutual covenants and other good
and valuable consideration the receipt and sufficiency of which is hereby acknowledged the parties agree
as follows:
1. Term. The term of the Agreement shall be for one (1) year, commencing on the 1 st of October
1998, and ending on the 30th Day of September 1999. The term may be extended by mutual agreement of
the parties hereto,
2. Services. Contractor agrees to direct and coordinate the delivery of the City's EMS system in
accordance with the State of Florida Department of Health; F.A.c. 64E-2.004 Medical Direction, F.S.
401.265 Medical Directors, and other pertinent State, County and Local Laws. A copy of 64E-2.004 and F.S.
401.265 are attached hereto as Exhibit "A" and by reference made a part hereof. Contractor acknowledges
that he has read and is familiar with the foregoing codes and statues.
3. Payment. City agrees to pay Contractor compensation for the above services at an annual rate
of sixty four thousand ninety dollars ($64,090,00), payable in 26 equal bi-weekly amounts.
4. Medical Malpractice Insurance, City agrees to provide, on behalf of Contractor, medical
malpractice liability insurance for the period of time he acts as the City's Medical Director, Such insurance
shall cover Contractor only for the activities relating to Contractor's capacity as Medical Director and not to
any other activities of Contractor. City shall have the option to self insure Contractor's medical malpractice
liability, to the extent permitted by law, but only up to the limits of liability set forth in Section 768.28,
Florida Statutes.
5. No Partnership, Nothing herein contained shall create or be construed as creating a co-
partnership between the City and the Contractor or to constitute the Contractor as an agent of the City.
Contractor shall be deemed to be an independent contractor and not an agent or employee of the City; and
shall not attain any rights or benefits under the Civil Service or Pension Ordinance of the City; or any rights
generally afforded classified or unclassified employees. Furthermore, he shall not be entitled to Florida
Workman's Compensation benefits as an employee of the City or accumulation of sick or annual leave.
6. It is further agreed that this Agreement may be altered, extended and amended only upon the prior
written consent of both parties. Contractor shall not assign, transfer or subcontract his rights and obligations
under this Agreement.
7. The Contractor covenants that he presently has no interest and shall not acquire any interest, direct
nor indirectly, which should conflict in any manner or degree with the performance of the services to be
provided hereunder.
8. This Agreement may be terminated without cause for the convenience of either party at any time
upon furnishing sixty (60) days' written notice to the other party.
In the event of termination for convenience of either party, the Contractor shall be paid a sum equal
to all payments due to him up to the date of termination of this Agreement, provided Contractor is continuing
to provide all services pursuant to the Agreement up to the date of termination.
9. Contractor agrees to indemnify, defend and hold harmless, the City of Miami Beach and its
officers, employees and agents, from and against any and all actions, claims, liabilities, losses and expenses,
including, but not limited to, attorney's fees, for personal, economic or bodily injury, wrongful death, loss of
or damage to property, in law or in equity, which may arise or be alleged to have arisen from the negligent
acts or omission or other wrongful conduct of the Contractor in connection with the Contractor's performance
of services pursuant to this Agreement. The Contractor's obligation under this article shall not include the
obligation to indemnify the City of Miami Beach and its officers, employees and agents, from and against any
actions or claims which arise or are alleged to have arisen from negligent acts or omissions or other wrongful
conduct of the City and its officers, employees or agents. The parties each agree to give the other party
prompt notice of any claim coming to its knowledge that in any way directly or indirectly affects the other
party.
10. The City desires to enter into this Agreement only if in so doing the City can place a limit on
City's liability for any cause of action for money damages due to an alleged breach by the City of this
Agreement, so that its liability for any such breach never exceeds the sum of $5,000,00 Contractor hereby
expresses its willingness to enter into this Agreement with Contractor's recovery from the City for any
damage action for breach of contract to be limited to a maximum amount of $5,000.00. Accordingly, and
notwithstanding any other term or condition of this Agreement, Contractor hereby agrees that the City shall
not be liable to Contractor for damages in an amount in excess of $5,000,00 for any action or claim for breach
of contract arising out of the performance or non-performance of any obligations imposed upon the City by
this Agreement. Nothing contained in this subparagraph or elsewhere in this Agreement is in any way
intended to be a waiver of the limitation placed upon City's liability as set forth in Section 768.28, Florida
Statutes.
11. All notices under the term of this Agreement shall be sent to the following:
CONTRACTOR:
DR. HARRYHEINITSH
6396 MANOR LANE
APT. #6
SOUTH MIAMI, FL 33143
CITY
CITY OF MIAMI BEACH
1700 CONVENTION CENTER DRIVE
MIAMI BEACH, FL 33139
WITH COPIES TO:
OFFICE OF THE CITY ATTORNEY
CITY OF MIAMI BEACH
1700 CONVENTION CENTER DRIVE
MIAMI BEACH, FL 33139
t-\~~\-W)~I!.
12. This Agreement shall be enforceable in ~ County, Florida and iflegal action is necessary by
either party with respect to the enforcement of any and all terms or conditions herein, exclusive venue for the
t'\\~,. ~c;
enforcement of same shall lie In ~ County, Florida,
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their
appropriate officials, as of the date first entered above.
ATTEST
CITY OF MIAMI BEACH
~rf~
WL#!
CITY CLERK
MAYOR
WITNESS
CONTRACTOR
~~~~
L/ ~ H
Uw~flZF
~'\)
C:Rescue:ResoCmj99.llli
APPROVED AS TO
FORM & LANGUAGE
& FOR EXECUTION
C;/17/?f
Date
Miami Dade County
Coral Gables
Miami
Hialeah
MEDICAL DIRECTORS
COMPARATIVE SALARIES
$80,000.00 + $20,000 (fringe benefits)
Medical Director
$27,500
Assistant Medical Director
$40,000
Medical Director (part-time)
$95,000
$45,000
(part-time, 2 hours per week)
Emergency Medical Services Rules of the Department of Health
Chapter 64E-2, Florida Administrative Code (F.A.C.)
Emergency Medical Services
(To Be Submitted)
Lawton Chilc::s
Governor
hmc::s T. Howe!!. 0.-1.0. M.P.H.
Sc::.:rc::t:rry
Fl..ORlDA OE?ARTMENr OF \
BCRE.-\L" OF DIERGENCY MEDICAL SERVICES
July 27, 1998
TO:
See Distribution
SUBJECT:
Revisions to Chapter 64E-2, Fionda Ad~ode
DinoJ. Villani.~ .
Emergency Medical Service
FROM:
Attached is a copy of the revised rule, Chapter 64E-2. Florida Administrative Code, (F.AC.)
which becomes effective August 4, 1998.
A summary of these amendments include:
Equipment - The rule deletes outdated equipment and supplies and adds wording to represent
the consensus of those items necessary to facilitate patient care activities.
Staffing - The rule provides a provision which allows emergency medical technicians to provide
care to basic life support patients in advanced life support ambulances under certain
circumstances.
Neonatal - The rule deletes outdated equipment and adds wording to provide some latitude to
the transferring physician and neonatologist in staffing and equipping the ambulance or
neonatal vehicle.
EMT and Paramedic Applications - Amendments were made to reflect current statutory
requirements and other technical changes.
Paramedic Recertification - The rule was amended to allow the department to accept the
affirmation of the service medical director that the applicant had met the requirements for
recertification.
Voluntary Inactive Certification - This section establishes the training and educational
requirements for the activation of an EMT or paramedic certificate that has been on inactive
status.
Involuntary Inactive Certification - This section establishes the training and educational
requirements for the activation of an EMT or paramedic certificate that has reverted to
involuntary inactive status for a period of 180 days.
Variances - The rule was amended to repeal this section as it conflicted with recent variance
and waiver provisions now mandated by Chapter 120, F.S.
Eligibility Rosters - The rule was amended to delete the requirement for DH Form 480,
1
..
Phone (850) ~1-1911
FA.","{ (850) 488-2511 or 487 -2911
"'M"_n r''',~ " .\ ..,~,,_.:~ ~ 0..........,.... T..,""\h........-....... C"T ""''''',
HJQ'
Adult Trauma Scorecard Methodology - Revisions were made to improve the metr.odolcgy far
the systematic assessment of adult trauma patients.
Pediatric Trauma Scorecard Methodology - The rule establishes a methodology to be used by
the paramedic or EMT in assessing children who have suffered a traumatic event.
Trauma Standards Pamphlet - 150-9 - Amendments were made to correct previous errors that
caused substantial changes to pamphlet's content and meaning. Further changes include the
revised adult and new pediatric trauma scorecard methodology.
Grants - The rule was amended to create three distinct grant applications and manuals.
Please replace all previous versions of the rule with this version and make copies available to all
of your EMTs and paramedics.
We would like to thank the EMS community far your input and participation during this rule
promulgation effort. If you have any questions, please feel free to contact Pam Lesley at (850)
487-1618.
Attachment: Chapter 64E-2, F.A.C., Effective August 4, 1998
Distribution:
Licensed Providers
Training Centers
Trauma Centers
Medical Directors
President's of Constituency Organizations
EMS Advisory Council Members
')
N
Effective 08/04/98
EMERGENCY MEDICAL SERVICES
RULES
OF THE
DEPARTMENT OF HEALTH
CHAPTER 64E-2, FLORIDA ADMINISTRATIVE CODE (FAC.)
EMERGENCY MEDICAL SERVICES
64E-2.001 Definitions 64E-2.029 Application by Hospitals Denied
64E-2.002 Basic Ufe Support Service Ucense _ Approval
Ground 64E-2.030 Emergency Medical Ser/ices Grants
64E-2.003 Advanced Ufe Support Service Application Procedures
Ucense - Ground 64E-2.031 Prehospital Do Not Resuscitate Order
64E-2.004 Medical Direction (DNRO)
64E-2.00S Air Ambulances 64E-2.032 Certificate of Public Convenience and
64E.2.006 Neonatal fnteriaciIity Transfers Necessity
64E.2.007 Vehic1e Permits
64E-2.008 Emergency Medical Technician
64E-2.009 Paramedic
64E-2.0094 Voluntary Inactive Certification
64E.2.0095 Involuntary Inactive Certification
64E-2.010 Examinations
64E-2.011 EMS Training Programs
64E-2.012 Drivers
64E.2.013 Records and Reports
64E-2.015 Prehospital Requirements fer Trauma
Care
64E-2.016 Trauma Transport Protocols Approval
and Denial Process
64E-2.017 Adult Trauma Scorecard Methodology
64E-2.0175 Pediatric Trauma Scorecard
Methodology
64E-2.018 Trauma Registry
64E-2.019 Trauma Agency Formation
Requirements
64E-2.020 Trauma Agency Plan Approvaf and
Denial Process
64E.2.021 Trauma Agency Implementation and
Operation Requirements
64E-2.022 Apportionment of State-Approved
Trauma Centers (SATC) or State-
Approved Pediatric Trauma Referral
Centers (SAPTRC) within a Trauma
SelVice Area (TSA)
64E-Z.023 SA TC and SAPTRC Requirements
64E-2.024 Process for the Approval of SA TCs
and SAPTRCs
64E-2.025 E:ctension of Application Period
64E-2.026 Certificate of State-Approval
64E-2.027 Process fer Renewal of SA TCs and
SAPTRCs
64E-2.028 Site Visits and ApprovaJ
3
E:T1ergency Mecic::;l Ser/i C2S
~~2c~i'/e 08,'OJ.,'9S
E~~.2.(JOj Cerir.itions. In acciticn to the ceRnitiens
p~:'i:cec in S2C::C;~s 395..J.Ol, 401.~07, and 401.23,
F2.. ~'":e ~cile'.vins;.:erlniticns acciy tc ~r.ese rules:
(~) ;':::i2'/i2~ec Inj~r/ Sc:re (AIS-'=O) - me2r~S
a c::~se:.St.:s cer:'/ec. ar.2tcmlC3ily casec S:/S:2:71
~"":2:::2s3iRes :r:c:l/:cual ir:jcr:es by :cc:/ r2~:cn C~ a
,5..::c:"~: cr(:;~2: s2liehr/ sc:::le rc~~:~~ fr::r71 1 tc c.
T:~e j~e~~cc.::c:S~/ fer Cere!77'":ini~g ...l,iS-~O C.:ce :s
Fc:...:r:c: ir; ~~e .,~l:t:re'/fC.lec l~jc:""/ SC2ie 1 sse
r::21/is;cf":," 1Nr.;:::: is jr:c:r;:crar~ by i:rerer:c2 a~c: is
2'/2ii2:ie tTc~ ~~e ,..l.sscc:aricn fer ~~e ~.Cv2r:c3~e;::
cf )..c.;:C..-:-:ctj'ie i\lec:cine, 234.'] C es F:aines Fiver
,~C2:. Ces ;::2:nes, IL ceo 13 2t a c:s: cf S40.
("\ ;'CC::c2::cn me2ns a ccr.:cie:ec:
c~.ciI~:.:c~ ~(:.~, as s~e~:~ed by ~~e ce~2r..rj-:e::r,
tc~=~~e: \Nit.~ all c::c:Jme!itaticn reC:L;ire~ ty ~~ese
r~ies :r,;c ~"1e i=~uirac fee.
(3) Ec;r.:. r.:e2ns a tissue inj~rl rest.:it:r.c; ir:r-:-:
eX:2s3;ve e~;:cs:..1re to tJ'ie!'"T71ai, c:-:er7iicai, e!es:'~C3j
cr i;:.::cac:.:ve a~e~ts.
H C~ief - r.:ear.s the chief cf :."1e ce!:2r:i7':e",'S
El.;re2t..: cf ::;',lS,
(5) C.:r.:-:ilec: Subs~2nces means ~"1cse
cr":Gs !is:ec in '::-:a~:er 893, FS.
(6) Oe~2r:me!'1t means the Ficr.C2
Oe!:sr::::ent cf Heal:'1 (Of-i), Bureau cr :::r.er;er.c!
Mec:c::i Ser/ices. 2002-0 Olc St. ;',ugustine Read,
TaJIahassee, F:cr.ca 32301-4881.
(7) E:7ier;er.cj Medical Services Frevicer _
mear.s any e",:t'j !icer.sed in the State of Ficr.da tc
previte air, cr grcur.a ambulance, whet.'1er basic life
st.:;:ccr: (SLSj cr scvanced life sur::~cr. (ALS), ant
whet::er a r.cr1-!.ici':s;:cr..aticn or a trans;:cr.aticr.
ser/rce.
(3) G;as~cw Ccma Scale Sc:re - me2ns tlie
r.et..'rcic;:ca/ assessr.-:ent ee'lelapee by G. Teascaie
a~c :. Jen~it:; in "Assessment cf Cema anc
Im;:air~ Ccns,::cusr.ess: A ,=ractical Scale' L2ncet,
1974; 2: a 1-3~. which is inccrporcred by reference
and avaiiabie Ficm :."1e ceQar.rnent
(9) 1CO-=-C~f means t.'1e ~:nterr:aticr.a/
C:assfflc:;:::cn cf Cisease, 9t.1 Re'lision, c: in ic:;:J
i\lcCi::ca::cn", .l,larc~, 1989. U.S. Oecar:i7':enr ef
i-:e21~~ ;:r.c H:..;r.:an S~r/icss P'Jolic:atien No. (F:-:S)
8S-~ 2::C: an ir.,e!'7;at:cr.aily a=c:lied me~~ad by whic;;
c:se2ses cr ~~:~cs cf r.-:ec:ca/ o::r.dticns cr ir.juries
are c:::c:ec ~cr :'''':e ::..;r:cse cf su:tistic:;:j anaiyses.
(~C \ Ir.j~r/ S ,:'/,=r:ty Sc:::re (rSS) - means the
S~r.i c~ :'''':e sc:.:ar:s of ~'ie hic;hes~ AIS-SO c::ce ir.
~3C.~ c.f ~e j'-:r:e ,~cs: SC'lere!y injL;rec cccy re~:cr!s.
T:~e ,7:eu-:cc ~:... e:::..-:-::utinc; rss is feune in tlie
./~t:ie'lfa:=c ~~jc:""/ SC~le j SSG RS'Iis;cns. IW
(1 ~) Necr.aGi ,.l.7::::utancs - meails an ,.lLS
,ee!7:":::::2C ver::c;e wr:te:': is desiC;:iarec scleiy tc
ir.:er.'ce:::t'j ::C..~sccr.s cf necnares to a Le'/e! 11 cr
L~'Iei ill ,~~r.a:al ;r.:er:s;ve care unit.
(12) l'les~a!:=1 I i2t:S:C:-: - ;;:e2r:s ~"":e ~2:'"1S=c;-:
cr any l~ecr:2re ('eGt..:ir:~~ ::'7:.::;er:c,/ ~3~s{e; ;7::~ a
r.CSClt2! !ic2:.sec: unc:er C:-:2::2r 295 i=2., te 2 L::?'/e! II
cr Le\jei !i; ,~e'.:r:c:21 ir-:~e:.s;\'e C2te '...:r:t.
(. ~ \
,..;!
cays c~ !if2 2r-:C cr :eS3 ::~2;; 5 :,;.
Ne:nct2 .. r7:e2:~S 2.~ :~f2j"~: less ~~2:~ 23
(i .1) "::~e;2:~". "'2:::~:2s' cr "Cce:2::cr:"
rr:e2:~S ,:;::',ic:r::;. ci7e::r:s ~,: .:;":'/~c~. sciic:::~~. cr
cc'/e:::s:;~:; ,:r2;~cs;:it2j c:- ;i::2::=cc::i~1 I~'L.,S sefv:c2s c:'"
ELS ~!2:~S:Cr:2::C~ S2:/:C.=s as ~r:.~e: c:esc~:es in
S2C::Cr. :"':=>2.03:2. F..~.I:.
(~5' ,=eci2:~c Trcl.;"-:-:2 :=2::e~, - ,7.22n3 := :;-2C1r.:a
. , . , .,. . . .. . .
~2~:e::~ '.'I;~~ 2f12:C:i7!IC21 2:-:~ ~r:YS;C.21 '::-:2r;:c:e;;s~:cs
af a ;e:3c~ ; 5 ye:=rs cf c~~ c;- YC~r:S2:.
(~5i ,=~c'li3;cr.al S~:e-.~::~c'iec:
:-~C;:2:r:C
I icl1i7:2 ,~2fe!721 Cen~2; (S;'..=T:=:Ci me2f1S a
hcs~ita! ;:c2::sec u~ce: c~a~:e; 3S5. FS., whic.1
si...:cmits al; ac:iicaticn ir.c;catr.~ ~~2: ~~e hos=ital
meets t:-:= t:"aL:~a canc:; r~uire!7:e::ts pr:vicec in
C'HP 1':0-3 a~d [s a~~rcv~ :y u~e cep2ru-;je~t to
prcviee .cecia:.-:c t;--auma C::ia ser'liC2s until approval
er cenial 2S a S).?~C.
(17) i=,"c'/isicnai Sta:e-~pc:rcvec: Trauma Center
(S.-l.IC) - means a nescit2i licsnsee I.lr.cer c;;ap,er
395, FS.. ~,vhic:-: sL:cmits ar: a~piic~ticri incfcating t'"':a~
the hcs;:i:ai liieets u~e r=G~ireme~ts prcvicec fn DHP
150-9 ar.c is approved by ~'ie ce!:aru-r.ent to previce
trauma care ser/ices until a:;;:revai cr cenial as a
SATC.
(18) ~:..:n Re!:cr. - r.:eans ~'1e written recorc
c:esc:-:bee in sectien 64c-2.013, := AC.. anc in OOf-i
Pamphlet (OOHP) 150-1~, Oc:c::er, 93, Statewice
RL:n Reccr:ing System User Guice, which is
:nc:::;-;:erared by referer.ce and a'laiiaole tiom ~"1e
c:epar::ne::t
(19) T...'Cinir.~ ,O,"cgram - means an eCt,;c3ticr.al
insmutcn having cr.e ces;S:iated pr:sram diree:.:r,
one cesiG:12tee medc:al Cir;c:cr, ana single butget
entity; fc~ the pur,:oses of proviCinc; EMT cr
parcmed:c eCL!c3tfcn pregrams.
(20) I,cuma - me2ns a blum, pene:rating er
:~m inj~r/ caL!sec :'1 ex: e!'7': al fcrce er '/ieience.
(2 j) Tlcuma ;'ler: me2ns a nocrnc:aticn
initiared =y S',lS infcl7ilir.g a hesi=ital :''1at :.":ey are en
rcute \Nit~ a ,::;atfe~t i:":eer:~g ~"":e tcUl"'i:2 aie;: c:-fte::a.
(22) TiCt.:~a ;Ole:: Pa::=~t .. me:::f':S a ,:e:3G~
'.vhcse ,:r~ar/ ,:r:ysfc:aj ;~jr..;~1 is a =i~Ji:. ~e;;et.c::~s;
cr ::l.:~ irjL:i/, ar-:c: 'Nhc ri:ee:s CIie cr i7:cr:= cr u~e
ac:..:it tr'aL;:7:2 sc::r~~~rc c:-::a;:a in S2(:::cn e4E.2~O~7.
F ..J...C.. Ci ~~e .ses:aw-:c trc~rT;a sc::raC2rc c~tc~a in
sec::cn :~.=.2~O 17':, F A.C.
(23) T;"'2~ma Fatient - :7:e2ns any ;:erscn whe
has ir.c:.;r.ed a iChys;C3/ inj:.;;'".' cr 'Nc:..:r.c caused =y
~t.:r:;a ar~c w~a has a~S.3ec an emerge~~/
mec:c2/ ser'lices sysrem.
(2.!.) TlcL:~a i",e+;:s~1 .. (7;e3~S a s~at='Nfce
c~ta:asa ',vr';!C:-: fr-::e~rcr:s t7:e~:cal ar:c S:/S~~~
;1
Emergency Medical Services
Effective 08/04/98
information related to trauma patient diagnosis and
the provision of trauma care by prenospital, hospital,
SA TC, SAPTRC. providers and medical examiners.
(25) Trauma Transport Protocols (TIPs) _
means a document which describes the policies,
processes and procedures governing the dispatch of
vehicles, and the triage and transport of trauma
patients.
Specific Authority 381.0011(13),395.4025(13),
395.405, 401.121, 401.35 FS. Law Implemented
381.0011, 395.401, 395.4015, 395.402, 395.4025,
395.403, 395.404, 395.4045, 395.405, 401.121,
401.211, 401.23, 401,25, 401.35, 401.435 FS.
History-New 11-29-82. Amended 4-26-84, 3-11-85,
11-2-86, 4-12-88, 8-3-88, 8-7-89, 6-6-90, Formerly
100-66.485, Amended 12-10-92, 11-30-93, 10-2-94,
1-26-97. Formerly 100-66.0485. Amended 08-04-
98.
64E-2.002 Basic Life Support Service License _
Ground.
(1) To obtain a license or renewal each
applicant shall submit an application to the
department an DOH Farm 631, October, 1996,
Ground Ambulance Service Provider License
Application. Tnis farm is incorporated by reference
and is available from the department.
(2) The department shall issue a license to
any applicant who has met the requirements of
chapter 401, part III, the rules promulgated pursuant
thereto, and:
(a) Furnished evidence of insurance coverage
far claims arising out of injury or death of persons
and damage to the property of others resulting from
any cause for which the owner of said business or
service would be liable. Each motor vehicle shall be
insured for the sum of at leas. $100,000 for injuries
to or death of anyone person arising aut of anyone
accident; the sum of at least 5.300,000 for injuries to
or death of more t,an one person in anyone
accident; and, fer the sum af at leas. 550,000 for
damage to property arising from any ene accident.
Government operated service vehicies shall be
insured far the sum of at least 5100.000 fer any
claim or judgment and the sum of 5200,000 total for
all claims or judgments arising out of the same
occurrence. Every insurance policy or contract for
suc;, insurance shall provice fer the payment and
satisfaction of any financial judgment entered against
the operator and present insured, or any person
driving the insured vehide. All such insurance
policies shall provide for 30-day cancellation notice
to the department.
(b) Obtained a Certificate of Public
Convenience and Necessity (COPCN) consistent
with the requirements of section 64E-2.032, F A.C.
(3) Each BLS provider shail ensure and
document in its employee records that each of its
EMTs and paramedics held a current certification
from the department.
(4) Except as provided for in section 401.252,
FS., a BLS provider shail not transport a patient
receiving ALS care in a BLS permitted ambulance
from the emergency scene to a hospital or other
facility .
(5) Every provider, except those exempted in
section 64E-2.006(1 )(a), F AC., shail ensure that
eac.., EMS vehicle permitted by the department shall
be equipped and maintained as listed in Table III.
TABLE III
GROUND VEHICLE AND SERVICE STANDARDS
MEDICAL EQUIPMENT AND SUPPLJES
1. Bandaging, dressing, and taping
supplies:
a. Adhesive, silk, or plastic tape.
b. Sterile 4x4 inch gauze pads.
c. Triangular bandages.
d. Roller gauze.
e. ABO (minimum 5x9 inch) pads.
2. Bandage shears.
3. Patient restraints, wrist and ankle.
4. Blood pressure cuffs: infant. pediatric,
and adult
5. Stethoscopes: pediatric and adult
6. Blankets.
7. Sheets (not required for non-transport
vehide.)
Six rolls total.
Six packs of 10 pacs each, any size.
Six total.
Six total.
Six total.
One.
One set each.
One eac.,.
One eac.,.
Two.
Two.
c-
o
2
Emergency Medical Services
Effective 08/04/98
8, Pillows with waterproof covers
and pillow cases or disposable single use
pillows (not required for non-transport
vehicle),
9, Disposable blanket or patient rain
cover,
10. Long spine board and three straps
or equivalent.
11. Short spine board and two straps or
equivalent.
12. Adult and Pediatric cerlical
immobilization devices(C/D), approved by
the medical director of the serlice. This approval
must be in writing and made available by the provider
for the department to review.
13. Padding for lateral lower spine
immobilization of pediatric patients or
equivalent.
14. Portable oxygen tanks, "D" or "E"
cylinders, with one regulator and gauge.
Each tank must have a
minimum pressure of 1 000 psi.
15. Transparent oxygen masks; adult,
child and infant sizes, with tubing.
16. Sets of pediatric and adult nasal
cannulae with tubing.
17. Hand operated bag-valve mask
resuscitators, adult and pediatric
accumulator, including adult, child and
infant transparent masks capable of
use with supplemental oxygen.
18. Portable suction, electric or gas
powered, with wide bore tubing and tips
which meet the minimum standards as
published by the GSA in KKK-A 1822C
specifications.
19. Extremity immobilization devices.
20. Lower extremity traction splint.
21. Sterile obstetrical kit to include,
at minimum, bulb syringe, sterile scissors
or scalpel, and cord clamps or cord-ties.
22. Bum sheets.
23. Flashlight with batteries.
24. Occlusive dressings.
25. Oropharyngeal airways.
26. Installed oxygen with regulator
gauge and wrench, minimum .M" size cylinder
(minimum 500 PSI) with oxygen flowmeter
(not required for non-transport vehicles.)
(Other installed oxygen delivery systems, such as liquid
oxygen, as allowed by medical director. This
approval must be in writing and available to
the department for review).
27.Gloves - suitable to provide barrier
protection for biohazards..
Two.
One.
One.
One.
One each.
Two.
Two.
Two each.
Two.
One each.
One.
Six assorted sizes.
One.
One.
Two.
One.
Four.
Six assorted sizes.
One.
Sufficient quantity,
sizes and material for all crew
members.
6
3
Emergency Medical Services
Sufficient quantity
of each for all
crew members.
Six, assorted
pediatric and adult
sizes.
One each of each
size range:
infant (12, 14, 16,
18), pediatric (20,
22, 24) and adult
(26, 28, 30).
One each.
28. Face Masks -both surgical and
respiratory protective.
29. Rigid cervical cDllars as approved in
writing by the medical director and available
for review by the department.
30. Nasopharyngeal airways,
French or mm equivalents.
31. Approved biohazardous waste plastic
bag or impervious cDntainer per
chapter 64E-16, F.AC.
32. Safety goggles or equivalent
meeting AN.S.1. Z87.1 standard.
33. Bulb syringe separate from
obstetrical kit.
34. Thermal absorbent reflective blanket.
35. Multitrauma dressings.
Specific Authority 381.0011, 395.405, 401.121,
401.35 FS. Law Implemented 381.0011, 395.401,
395.4015, 395.402, 395.4025, 395.403, 395.404,
395.4045, 401.23, 401.24, 401.25, 401.252, 401.26,
401.27,401.281,401.30,401.31,401.321,401.34,
401.35, 401.41, 401.411, 401.414, 401.421 FS.
History-New 11-29-82, Amended 4-26-84, 3-11-85,
Formerfy 100-66.49, Amended 4-12-88, 8-3-88,12-
10-92, 10-2-94, 1-26-97. Formerly 100-66.049.
Amended 08-04-98.
64E-2.003 Advanced Ufe Support Service
License - Ground.
(1) To obtain a license or renewal each
applicant for an ALS license shall submit to the
department DOH Form 631, October, 1996, Ground
Ambulance Service Provider License Application,
which is incorporated by reference and available
from the department
(2) The department shall issue a license to
any applicant who meets the requirements of
chapter 401, part III, FS., and sections 64E-
2.002(2)(a),(b), and 64E-2.032, F.AC.
(3) Each ALS provider shall ensure and
document in its employee records that each of its
EMTs or paramedics hold a current certification
from the department.
(4) Except as prDvided for in section 401.252,
FS., an ALS provider shall not transport a patient
receiving ALS care in a BLS permitted ambulance
from the emergency scene to a hospital or other
facility .
(5) Security of medications, fluids and
controlled substances shall be maintained by each
Effective 08/04/98
One per crew member.
One.
One.
Two.
ALS provider. Security procedures shall be
apprDved by the medical director and be in
compliance .with chapters 499 and 893, FS., and
chapter 100-45, Florida Administrative Code.
Medication inventory techniques and schedules
shall be maintained in compliance with chapters 499
and 893, FS., and Title 21, Code of Federal
Register, Food and Drugs, Part 1300 To End,
Chapter " - Drug Enforcement Administration,
Department of Justice.
(6) Each ALS provider shall staff each ALS
permitted vehicle in use with a minimum of two
individuals; one of whom shall be a paramedic or
licensed physician who shall attend the patient
throughout transport, the other shall be a
paramedic, EMT, or licensed physician who meets
the requirements of section 401.281, FS.
(7) Each ALS provider shall ensure that a
current copy of all standing orders authorized by the
medical director shall be available in each of the
provider's vehicles; for review by the department; to
each of the provider's paramedics; and supplied to
each physician designated by the medical directDr
to receive a copy.
(8) In addition to the equipment and supplies
listed in Table III, the medications and I.V. solutions
and equipment listed in Table V are required on
each ALS permitted vehicle, except those exempted
in section 64E-2.006(1 lea), F AC. Substitutions are
allowed with signed approval from the medical
director and written notification to the department.
(9) The medical director may authorize an
EMT instead of the paramedic or licensed physician
4
'7
Emergency Medical Services
Effective 08/04/98
to attend a BLS patient on an ALS permitted
ambulance under the following conditions:
(a) Tne medical director determines what
type of 8LS patient may be attended by an EMT
and develops standing orders for use by the EJ\IT
when attending the type of 8LS patients icentified.
Tne onscene paramedic shall condt.;ct the primary
patient assessment to determine if the patient's
condition meets the criteria in the standing orders
for BLS care. This survey shall be documented on
the run report and shall identify the paramedic who
conducted the survey.
(b) The run report for any patient care or
transport shall c!ear1y state whenever an EMT
attends the patient.
(c) The provider shall maintain and have
accessible fer revie....,. by the department
documentation of compliance with the above
requirements,
TABLE V
ALS EQUIPMENT AND MEDICATIONS
MEDICATION
WTNOL
QTY
1. Atropine Sulfate.
2. Dextrose, 50 percent.
3. Epinephrine HCL.
25 gm. per 50 ml.
1 :1,000 1 mgJml.
4. Epinephrine HCL.
5. Lidocaine HCL.
6. Lidocaine HCL.
1:10,000 1 mgJ10ce
100 mg. per 5 ml.
In any of the following combinations:
2 gm. vials or pre-mixed
syringes; or .
1 gm. vials or
pre-filled syringes; or
pre-mixed solutions of 4 mg.
per ml. in a 500 ml. bag.
1 mgJml. 2 mg. amp.
0.4 mg. spray pump.
7. Naloxone (Narcan).
8. Nitroglycerin.
9. Diazepam.
10. Inhalant beta adrenergic
agent with nebulizer
apparatus, as approved by the
medical director.
2 mg. Total.
Two.
Two 1 mgfml amps or
one multi dose vial.
Four.
Two.
4 gms. Total.
Two.
Four.
Two.
4 mg.
1 pump sprayer.
20 mg. total.
2 doses.
I.V. Solutions
Amount
Minimum
Minimum
Quantity
1. Lactated Ringers or
Normal Saline.
4,000 ml.
In any combination.
EQUIPMENT
QTY.
(a) Laryngosccpe handle with batteries.
(b) Laryngosccpe blades; adult, child and infants sizes.
8
5
One.
One eac.,.
Emergency Medical Services
Effective 08/04/98
(c) Pediatric LV. arm board or splint appropriate for I.V.
stabilization.
(d) Disposable endotracheal tubes; adult, child
and infant sizes. Those below 5.5 shall be uncuffed.
2.5 mm - 5.0 mm uncuffed; 5.5 mm - 7.0 mm; 7.5 mm -
9.0mm.
(e) Endotracheal tube stylets pediatric and adult.
(f) Magill forceps, pediatric and adult sizes.
(g) Device for intratracheal meconium suctioning in newborns.
(h) Tourniquets.
(i) LV. cannulae 14 thru 24 gauge.
Q) Micro drip sets.
(k) Macro drip sets.
(I) I.V. pressure infuser.
(m) Needles 18 thru 25 gauge.
(n) Intraosseous needles 15 or 16 gauge and three way stop
cocks for use with intraasseaus needles. As allowed by
medical director.
(0) Syringes, from 1 mL to 20 ml.
(p) D.C. battery powered portable monitor defibrillator with
adult paddles (or hands-free pads) and pediatric paddles
(or pediatric paddle adapter) ECG printout and spare battery.
The unit shall be capable of delivering energy below 25 watts/sec.
(q) Monitoring electrodes for adults and pediatrics.
(r) Pacing electrodes, if monitor or defibrillator requires.
(s) Oro/Nasogastric tubes.
(t) Syringe appropriate for checking placement of
oro/nasogastric tube.
'(u) A method for rapidly determining blood glucose as approved
by the medical director.
(v) Pediatric length based measurement tape for equipment
selection and drug dosage.
(w) Approved sharps container per chapter 64E-16, F AC.
(x) Flexible suction catheters.
One.
Six total. (2 each size range).
One each.
One each.
One.
Three.
Ten tDtal.
Three.
Three.
One.
Six total.
Two each.
Eight total,
assorted sizes.
One.
Two sets each.
Two sets.
One each of each
size range, infant (8),
and pediatric (12, 14,
or 16).
One.
One.
One.
Assorted sizes, 1 each
of each size range: infant
(6-8 French), pediatric
(10-12 French), and adult
(14 French).
Specific Authority 381.0011, 395.405, 401.121,
401.35 FS. Law Implemented 381.0011,
381.025,395.401,395.4015,395.402,395.4025,
395.403, 395.404, 395.4045, 395.405, 401.23,
401.24, 401.25, 401.26, 401.27, 401.281,
401.30, 401.31, 401.321, 401.34, 401.35,
401.41,401.411,401.414,401.421 FS. History-
New 11-29-82. Amended 4-26-84, 3-11-85,
Formerly 10D-66.50, Amended 4-12-88, 8-3-88,
8-7-89, 12-10-92. 11-30-93, 1-26-97. Formerly
100-66.050. Amended 08.Q4-98.
64E.2.004 Medical Direction.
(1) Each ALS, 8LS or air ambulance
provider shall maintain on tile for inspection and
copying by the department its current contract
for a medical director by which it employs or
independently contracts with a physician
qualified pursuant to this section to be its
medical director.
(2) There is no standard format for a
medical director's contract. however, in drafting
such an instrument. the following proviSions may
be addressed:
9
6
Emergency Medical Ser/ices
Effec~jve 08/04/98
(a) ,'Jame ar.c relatienship er the
c:r. :rac::r.~:Jai.ies.
(0) A lis: of ccr.trac:ed se~/ices inc:usive
or mecical eirec::en. administrative
res::onsici/ities, professicnal mer.-:bership, basic
2nc aC'lanc.ec life SL.:CCCi. re'liew
res:ensiciiit:es, anc recci.;ng recL.:iremen:s.
(e) I\knetarj c::;nsiceraticr. inc:usive of
rees. ex::::enses, reimbursement. fr:nge benefits,
c:er:cal assistar.ce and cffice s;Jace.
(e) Terminaticn c:ause.
(e) Renewal c:ause,
(0 ,C,-:'/isicn for !iaci/ity c::::ver2ge.
(S) ::.=rec:ive cates cf the ccn:rac:.
(3) Cualific2ticns:
(2) A mecica! eirec:or sh2i1 :e a F:crica
licensed ,\1.0. or 0.0.
(t:) In aeciticn to all ether provisicns
asslicable to ,'7iecical eirec:ers in this rule. an air
amcuiance mec:ical cirec:or sha!1 be
kncwledgeacle af the aeremediC.31 re'1uiremenrs
of patients and shall evaluate eac.1 patient in
person or by written protecol prior to each
imerfaciii~1 transrer flight fer the purpose of
c.et.er:7:ining that the aire:-aft, flight and medical
c:-.ew, and ec;uipment meet the patient's neecs.
(c) A mecical director shall be from a
i::rea'::::-based medical specialty sL;ch as
eme:-gency medicine, incemal mecicine.
anes~'1esioicgy, or other surgical specialty, with
demonstrated experience in prehospital care and
hold an ACLS certificate of suc::;essful course
ccmpietion or be board certified in eme:-gency
medicine. Frenospitai care experience shall be
documented by the provider.
(c) A medical director shall demonstrate
and have avaiiabie ror review by t1e department
cccumemation of active participatien in a
regicnal or statewide physician group involved in
prehcspital care.
(.!) Duties and Responsibilities of the
Medical Director.
(a) Super/ise and ac::;ept direct
respensibility fer the medicaf performance ef the
paraj'7,ecics and E\ITs werking fer emergency
medica! ser/ices providers.
(0) Develop medically correa: standing
creer:; or pretccols which permit specified ,olLS
anc B LS prcceeures when communicaticn
03nnot be established with a supervising
physician cr '.vhen any delay in patient C.3re
wcule ,:::ctentiaily ~1reaten the life or health cf :'1e
patient. Tr~e medical director shaH issue
stcnc:ng erGers and protecols to the provicer to
er:sur::! that the provider transports each er its
patier.:s to fadities that offer a type and leve! of
03re acprocr.ate to tne patient's mecical
~nc:Ucn if available within t!ie service regicn.
The mecic21 eirec:er cr his aepclr:tee shall
prcvice ccnrinL.:eus 2~-~ct.:r-per-cay. i-cay-per-
week mecic2i eirec::on whic,.... shall induce in
aedition to the eeve!o::menr cf i=retcccls and
staneing orcers, tirec:ic,1 :0 i=erscrnel of the
prcvicer as to a\/2ijabi1i~/ cf ~ec:cal c:rec:cr 'off-
line" ser'/ic2 tc resei'/e i=rcc!er.-:s, system
ccnt1ic:s, anc i=rc'liee ser/ices in an er.-:erc:enc'l
-s 'h_t .e,....., J's AOr~"e,.; bv s",.."c" "'::.., 1 '(3)- F- .
c:: Ule l. ilil 1..._.11, """" ~ ~.....~. II ~......;......,_ ,I .::J.
(e) De'/e!ep and ir.-:cler:ienr a patient care
c;uaiity assuranC2 syster:i :0 assess the medical
per.'er:71anC2 or i=aramec:cs anc E;\fls. Tile
mecical eirec:ci Sh211 aL:cit the per.'ermance ef
system persenne! ::y use of a c;u2iity assurance
prcgrar:1 to inC;L;ce but ne: limited to a prompt
re'/iew of n.:n re.certs, eirec: obse~/aticn, and
comparison of perfcrmar:ce S;2r:carcs rcr drugs.
equipment, system protecels and precedures.
Tne medica! director sha!1 ::e responsible fer
participating in quality assurai;ce prcgrams
developed by the department.
(d) With the exception of BLS medical
direc:ers each ALS or air ambu/2nce service
medical director shall possess preof of current
registration as a medical director, either
individually or through a hcspital, with the U.S.
Department af Justice. DE.<l., to provide
controlled substances to an EMS previder. DE..;
registration shall include each acdress at which
controlled substances are 5rcrec. Froof of such
registration shall be maintained on me with each
ALS or air ambulance provider and shall be
readily available fer inspection.
(e) Ensure and certify that security
procedures of the EMS prcvicer for medications,
fluids and controlled substances are in
compliance with chapters 499 and 893, FS., and
chapter 100.-45, Flcrida Ad:7:inistrative Cede.
(f) Create, authorize and ensure
adherence to, detailed written operating
procedures regarding all asoects of the handling
of medications, fluids and ccntrellec: subsrances
by the provider.
(g) Notify the department in wr.ting when
the use of telemetry is not necessarj.
(h) Notify the ceoartr.-:ent in writing of each
substitutien by the E;\IS provicer of ecuipment er
medication.
(i) Assume efrec: res::cns;:iiit,/ fer: the
use by an EMI of an automatic or semi-
automatic centriilarer; t.1e perfcr.71ar.ce of
esophageal intubation by an :::'11; and on
routine interfacilirj trans;:er:s. ~1e :7:cnitor:ng and
maintenance of non-mediC.3ted I.lf,s by an ::MT.
ine mecical direc:or snail ensure ~at the EMT
is trained to perfcr.71 these prccedL;res; shall
establish written protocols for tile cerfcr:i1ance of
these prccecures: ar.c shail provide written
10
7
Effective 08/04/98
Emergency Medical Services
evidence to the department documenting 401.25, 401.26, 401.265, 401.27, 401281,
compliance with provisions of this paragraph. 401.2915, 401.30, 401.34, 401.35, 401.41,
0) Review, and if appropriate, approve a 401.411, 499.005 FS. History-New 8-7-89,
30-hour EMT refresher course for which the Amended 6-6-90, 12-10-92, 3-19-95, 1-26-97.
medical director is contracted. Formerly 100-66.0505. Amended 08-04-98.
(k) Ensure that all EMTs and paramedics
are trained in the use of the trauma scorecard
methodologies as provided in sections 64E-
2.017, F.A.C., for adult trauma patients and 64E-
2.0175, F.A.C., for pediatric trauma patients.
(I) Develop and revise when necessary
TIPs for submission tD the department for
approval.
(m) Participate as a crew member on an
EMS vehicle for a minimum of 10 hours per year
and complete a minimum of 10 hours per year of
continuing medical education related to
prehospital care or teaching or a combination of
both.
(n) If he is a medical director of a training
program:
1. Be responsible for the instruction of the
Department of Transportation (DOT) approved
training program for EMTs and paramedics.
2. Have substantial knowledge of the
qualifications, training, protocols, and quality
assurance programs for the training facility.
3. Maintain current instructor level
training in advanced cardiac life support (ACLS)
or advanced trauma fife support (A TLS),
maintain provider level training in basic trauma
life support (BTLS) or prehospital trauma life
support (PHTLS); or advanced pediatric life
support (APLS).
4. Act as a liaison between training
centers, local EMS providers and hospitals.
5. Participate in state and focal quality
assurance and data collections programs.
6. The EMS training center shall by
contract, require such medical director to be
available 4 hours per month for classroom
teaching or review of student performance, be
available for 4 hours per month for EMS provider
field time, participate as a crew member on an
EMS vehicle for a minimum of 10 hours per year,
and complete a minimum of 10 hours per year of
continuing medical education related tD
prehospital care or teaching or a combination of
both.
7. Participate in the recruitment,
selection, and orientation of instructors and
preceptors.
8. Participate in student selection, mid-
term evaluation and final practical examination of
students.
Specific Authority 381.0011, 395.405, 401.35,
499.05 FS. Law Implemented 401.23, 401.24,
64E.2.005 Air Ambulances.
(1) Each applicant for an air ambulance
license shall pay the required fee as specified in
section 401.34(1 )0), FS., and submit an
application to the department on DOH Form
1575, October, 1996, Air Ambulance Service
License Application which is incorporated by
reference and available from the department.
The air ambulance license shall automatically
expire 2 years from the date of issuance.
(2) Security of medications, fluids and
controlled substances shall be maintained by
each air ambulance provider. Security
procedures shall be approved by the service's
medical director and be in compliance with
chapters 499 and 893, FS., and chapter 100-45,
Florida Administrative Code. Medication
inventory techniques and schedules shall be
maintained in compliance with chapters 499 and
893, FS., and Title 21, Code of Federal Register,
Food and Drugs, Part 1300 To End, Chapter II -
Drug Enforcement Administration, Department of
Justice.
(3) Each licensed air ambulance shall
have emergency protocols which address at
least, emergency procedures when the aircraft is
overdue, when radio communicatiDns cannot be
established, or when aircraft location cannot be
verified. Each licensed rotary wing air
ambulance shall document at least every 15
minutes of flight while en route to and from the
patient's location.
(4) Each prDvider shall maintain in each
paramedic's employment file documentation of
successful cDmpletion of an initial air crew
member (ACM) education program that was
conducted in accordance with the 1988 United
States (U.S.) Department of Transportation
(DOT) Air Medical Crew-Advanced National
Standard Curriculum (NSC), which is
incorporated by reference and is available for
purchase from AAMS; 110 North Royal Street,
Suite 307, Alexandria, VA 22314; 703-836-
8732. Each provider shall ensure and shall
document in its employee records that each
EMT and paramedic which it employs holds a
current certification from the department.
(5) Each air ambulance provider shall
establish a safety committee. The committee
shall:
:11
8
Emergency Medical Ser/ices
(a) c:nsist cf a merr.bers,'-:ip to incluce: (1) Neonates rec::..;:nng c~itical care
.. I ..... inter.'aciliry transe. crt to a Le'/e! II cr Le'le! III
one piiot, one night meC:C3 c~ew member, u;e
h 't I Neonatal Intensive Care Unit shall be
provicer'3 medical direc~er, one espl a
acminis:.-atcr if the provicer is a heseitai based transpor:ed in eit1er a necnatal ambulance cr a
prcgram, ar;d a representative ef a quaJit..' permitted ALS or ELS trar;sport ambulance cr
assurar:ce di'/isicn if one exists; airc~ar..
(a) A neonat21 amcu!2nce s,'-:ail meet the
(J) ce'/elcp safet,! prccect.:res fcr the ~
. rec:t.:iremerlts jistec in Tatie IX, sec~icns 6..lc-
2.006(1 )(c) anc (c) anc 6..lE-2.0C6(2) anc (3),
FAC" ar;c shall be exempt from meeting the
ecuicment and mec:ical sL.::::piies listed in sec:icn
6.iE~2.C02, Table III, FAC., and in sec~icn 6..iE-
2.003, Table If, F,A.C.
(b) When a ,cer.r:itec: SLS or ALS
ambulance is used to trans::::crt a neonate, the
sending neonatelegist cr physician and EMS
provider's medical cirec:cr s,1all er:SiJre that tlie
level of care, staffing, and ec:;uipment is
c:mmensurate to the neec::s of the neonate
being transpcrted.
(c) The neonatal ambulance as defined in
section 64E-2.001 (11), F AC., shall have
exterior wording or rr.arking which identifies that
the ambulance is eniy for neonatal transport.
Tne wording shall be such that the public cannot
mistake a neonatal vehicle as an ambulance for
general patient care.
(d) Any EMS provicer operating, a
permitted neonatal ambulance fer transporung
neonates to a Level II or Level III Neonatal
Intensive Care Unit shall contract with a
neonat%eist or have the hasoital's staff
neonatole9ist assigned as the provid'ers medical
director.
previce:;
(c) meet a, least <:;u2i":erly to re'/iew s2fet';
peiicies, prccect,;res, unusu2i cc;::..;rrer:ces.
safety issues, end aucit c:mpliance with safer;
poiicies ai":d prccecures;
(c) c8mmt,;nicate the results of the safer;
at,;cit to ail :::rccrar.1 :Jerscnne!; anc
(e) r~c:;:: minutes cf the meeting and
retain them cn me fer 2 years.
(5) ::2C;-' prenespital air a"'~-:bujar:ce
provicer s,'-:all staff the airc.-aft with a minimt,;m of
cne pers.::n who shall be a paramecic who
meets the c~iter;a in secticn 64E-2.005(..i), FAC.
Specific Authority 381.0011, 401.251, d01.35
FS. Law Implemented 381.0011, 381.0205,
395.405, 401',23, 401.24, 401,25, 401.251,
401.252, 401.26, 401.27, 401.30, 401,31,
401.321,401.34,401.35,401.41,401.411
401.414, 401.421 FS. Historj-l'Jew 11-29-82,
Amended 4-25--34, 3-11-85, Formerly 100-
66.51, .Aiilended 4-12-88,8-3-88,8-7-89, 12-10-
92, 11-30-93, 10-2-94, 1-25-97. Formerly 100-
66.051.
64E-2.006 Neonatallnterfacility Transfers.
Effective 08/04/93
TABLE IX
(Reference section 64E-2.006)
Necnatal Interfacifity Transfers
ITE~A
1. Direct tmc-way ccmmt.:r:icatiens wit.1 the designated
neonatologist or atenciing physician.
2. A sianeby cr bad<up pcwer sat.:rce c:,'1er than the
one cvn,ainec in :he isolerte,
3. A source of electrical ,cower sufficient te cperate
the isolerte and anc:i1arf e!ec:r.caily powered ec:uipment.
4. A transccr: :r:c:.;bator isoiette with portable power
suppiy, :cGabie oxygen tanks or liGuid oX'j!;en, and a
scurce of c;::rr:cressed air, inc:uc:ing apprcpriate valves,
meters, anci fittin!;s.
5. Pcr.able heart rate monitor 'Nit.~ visual or auc:ible
display ar.c aiar.il system.
a. Fcr.able :iccci pressure maniter with asscr:ment of
QTY.
One.
One.
One.
Or:e per ,:arient.
One each.
12
9
Effective 08/04/98
Emergency Medical Services
cuff sizes suitable for infants.
b. Battery powered mechanicall.V. pumps capable of
delivering as low as 1 ce. increments fDr I.V. fluids.
c. Battery or self-powered oxygen sensor and
transcutaneous Dxygen monitor or oxygen saturation mDnitor.
d. Oxygen delivery device and tubing capable of
administering high concentrations of oxygen.
e. Thermistor type temperature monitor.
f. Portable ventilator and self-inflating resuscitating
bag and clear mask premature, newborn and infant size
with sleeve and oxygen adapter for delivering high oxygen
content.
g. Laryngoscope handle, blades, bulbs and batteries,
endotracheal tubes.
Stylet.
Adapters.
Oral AilWays.
h. Suction equipment with low suction
capabilities of less than 80 mm of hg.
Two.
One.
One.
One.
One.
Miller 0 x Miller 1 and
2.0, 2.5, 3.5, 4.0. 2 each.
Two each.
Assortment of sizes.
Assortment of sizes.
One.
MEDICATION
OTY.
'NTNOL
1. Atropine Sulfate.
2. Aquamephyton.
3. Antibiotics, to be determined
by medical director.
4. Calcium Gluconate.
5. Digoxin pede
6. Anticonvulsant as required
by medical directDr.
7. Dextrose.
8. Dopamine or dobutamine.
9. Epinephrine.
10. Eye prophylaxis.
11. Furosemide (Lasix).
12. Heparin.
13. Udocaine.
14. Naloxone (Narcan).
15. Paralyzing agent
16. Phenobarbital.
17. Prostin VR
(available for transport)
18. Sodium Bicarbonate.
1 mg.l10 ml.
1 mgJO.5 ml.
One.
One.
Two.
10% - 10- ml.
0.1 mgJml.
One.
One.
50% 50 cc.
40 mgJ1 ml.
1:10,000
20 mgJ2 ml.
1 %/2 mg.
1.0 mgJml
.4 mgJml.
130 mgJml.
500 mcglml.
One.
One.
One.
One.
One.
One.
One.
One.
One.
One.
One.
One.
4.2% soln.
8.4% so/n.
One.
One.
19. Sedative as determine by the
medical director.
20. Volume expander.
21. Suction catheters Size 5.0, 6.5, 8, & 10.
22. Syringes sizes 1 ce. through 60 ce.
23. Medication access device.
24. Vascular aceess devices 23-27 gauge.
25. Sterile Gloves assorted sizes.
26. LV. fluid. 250 cc bags of
DSW and D10W
27. I.V. extension tubing.
28. Adhesive tape.
29. LV. tilters.
One.
One.
Two each.
Three each.
Two each.
Two each.
Sufficient quantity for all crew members.
One each.
Sufficient length to administer I.V.
Assorted sizes.
13 Two.
10
Emergency Medical Services
Two.
Two.
Ten.
One.
Five.
One.
Two.
One each.
One.
Twenty-five.
One each.
One.
One each.
30. Tongue blades.
31, UAC catheters.
32. 8etadine or alcohol swabs.
33. Chemstrips.
34. Lancets.
35, Neonatal stethoscope.
36, Blood culture bottles,
37. Scissors and hemostats.
38. Fiashlight.
39. 2 x 2 gauze pads,
40. No.5 & NO.8 French feeding tubes.
41. High intensity light capable of transillumination.
42. Approved biomedical waste plastic bag or impervious
container and used sharps container per chapter
64E-16, FAC.
43, Gloves - latex or other suitable materials.
44. Respiratory face masks.
45. Benzoin.
46, Special procedure trays with capability for
performing umbilical catheterization,
venous cutdown and thoracostomy.
47. Injectable non-preservative sterile water.
48. Injectable non-preservative normal saline.
49. 8ulb syringe.
50. Cord clamp.
51. Chest tube evacuation device.
52. Needle aspiration device or chest tubes.
size 3.5 & 5
(2) Each permitted ambulance or neonate
ambulance when transporting a neonate to a
Level II or Level III Neonatal Intensive Care Unit
shall be staffed with a minimum of two persons.
One person shall be a registered neonatal nurse,
the second person shall be either a neonatal
registered respiratory therapist (RT), or a
paramedic or a registered neonatal nurse. The
staffing for each neonate transport shall be
determined by the licensee's medical director in
conjunction with the attending physician and the
neonatologist. A physician can be substituted for
any team member.
(a) The provider shall assure the RN is
licensed in accordance with chapter 464, FS.;
have a minimum of 4,000 hours RN experience,
which includes 2,000 hours of Levell/or Level III
Neonatal Intensive Care Unit (NICU) nursing
experience; and have American Heart
Association (AHA) Neonatal Resuscitation
Program (NRP) Certification or an equivalent
certification and successfully complete a neonatal
transport stabilization program within 2 years
prior to application to neonatal transport,
approved in writing by a medical director; and.
accompany a minimum of six neonatal transports
prior to staffing a neonatal transport as the only
RN in attendance.
(b) The provider shall assure the RT is
registered by the National Soard of Respiratory
Care with a minimum of 2.000 hours of Level II or
Level III N1CU experience or be certified as a RT
Effective 08/04/98
Sufficient quantity for all crew members.
Sufficient quantity for all crew members.
Two.
One.
One.
One.
One.
One.
Appropriate sizes for neonate.
with a minimum of 3,000 hours of Level II or
Level III NICU experience; and have AHA NRP
Certification or an equivalent certification and
successfully complete a neonatal transport
stabilization program within 2 years prior to
application to neonatal transport, approved in
writing by a medical director; and, accompany a
minimum of six neonatal transports prior to
staffing a transport as the only RT in attendance.
(c) The provider shall assure the
paramedic is a Florida licensed paramedic with a
minimum of 2,000 hours of Level II or Level III
Neonatal Intensive Care unit experience; or be a
Florida paramedic with a minimum of 3,000 hours
experience; and have AHA NRP Certification or
an equivalent cer-ification and successfully
complete a neonatal transport stabilization
program within 2 years prior to application to
neonatal transport, approved in writing by a
medical director; and. accompany a minimum of
six neonatal transports prior to staffing a neonatal
transport.
(d) A neonatolegist or a licensee's medical
director may make medical staff substitutions
with individuals of comparable skills when the
condition of the neonate warrants such
substitution.
(3) Treatment protocols for the
management of the neonatal patient from the
responsible neonatologist shall accompany eac.1
neonatal transport.
11
11
Effective 08/04/98
Emergency Medical Services
Specific Authority 381.0011, 383.19, 395.405, Specific Authority 381.0011, 401.35 FS. Law
401.251 (6), 401,35 FS. Law Implemented Implemented 381.001, 381.0205, 401.23, 401.24,
381.001, 383.15, 395.405, 401.24, 401.25, 401.25,401.251,401.26,401.27,401.30,401.31,
401.251, 401.252, 401.26, 401.265, 401.27, 401.34,401.35,401.41,401.411,401.414 FS.
401.30, 401.31, 401.35, 401.41, 401.411, History-New 11-29-82, Amended 4-26-84,3-11-
401.414, 401.421 FS. History-New 11-30-93, 85, Formerly 100-66.53, Amended 4-12-88, 12-
Amended 1-26-97. Formerly 100-66.0525, 10-92,11-30-93,1-26-97. Formerly 100-66.053
Amended 08-04-98.
64E.2.007 Vehicle Permits.
(1) Each application for a ground vehicle
permit shall be on DOH Form 1510, October,
1996, Application for Vehicle Permit(s). Each
application for an aircraft: permit shall be on DOH
Form 1576, October, 1996, Application for Air
Ambulance Permit. These forms are
incorporated by reference and available from the
department. All applications shall be
accompanied by the required fee as specified in
section 401.34(1 )(c),(k), FS.
(2) When it is necessary for a permitted
vehicle to be out of service for routine
maintenance or repairs, a substitute vehicle
meeting the same transport capabilities and
equipment specifications as the out-of-service
vehicle may be used for a period of time not to
exceed 30 days. If the substitute vehicle needs to
be in service for longer than 30 days, the agency
must seek written approval from the department.
An unpermitted vehicle cannot be placed into
service, nor can a BLS vehicle be used at the
ALS level, unless it is replacing a vehicle that has
been temporarily taken out of service for
maintenance. When such a substitution is made,
the following information shall be maintained by
the provider and shall be accessible to the
department
(a) Identification of permitted vehicle taken
out of service.
(b) Identification of substitute vehicle.
(c) The date on which the substitute
vehicle was placed into service and the date on
which it was removed from service and the date
on which the permitted vehicle was returned to
service.
(3) All transport vehicles permitted to
licensed services must meet the vehicle design
specifications, except for color schemes and
insignias, as listed in United States General
Services Administration (GSA)-KKK-1822,
Federal Specifications fDr Ambulances as
mandated by section 401.35(1 )(d), FS.,
applicable to the year of the manufacture of the
vehicle.
64E-2.008 Emergency Medical Technician.
(1) Qualifications and Procedures for
Certification in addition to those contained in
section 401.27, FS. - To be qualified for EMT
certification, an individual must:
(a) successfully complete an initial EMT
education program that was conducted in
accordance with the 1994 U.S. DOT EMT-8asic
(EMT-B) NSC, which is incorporated by reference
and is available for purchase from the
Government Printing Office by telephoning 202-
512-1800, or
(b) currently hold a valid EMT certification
from the National Registry of Emergency Medical
Technicians or be currently certified in another
state or U.S. territory and have the certifying
authority submit to the department OH Form
1164, January 1998, Statement of Good Standing
which is incorporated by reference and available
from the department and
(c) apply for Florida EMT certification on
OH Form 1583, Jan. 98, Emergency Medical
Services Profile Data Form, EMT/Paramedic
Certification Application, which is incorporated by
reference and available from the department.
(2) Recertification - To be eligible for
recertification as. an EMT an individual shall
submit OH Form 622, EffeC+.ive Oct. 96, Revised
June 98, Application for Recertification, which is
incorporated by reference and available from the
department; and within 2 years prior to the
expiration date of his EMT certification:
(a) complete 30 hours of EMT refresher
training which shall be based on the 1994 U.S.
DOT EMT-B NSC, as approved by the
department and complete 2 hours of human
immunodeficiency virus and acquired immune
deficiency syndrome (HIV AIDS) training, in
accDrdance with sectiDn 381.0034, FS.; the
department shall accept the affirmation of the
medical directDr as proof of compliance; or,
(b) in one attempt, successfully challenge
and pass the EMT certification examination,
based on the 1994 U.S. DOT EMT-Basic NSC,
prior to the expiration date of his current EMT
cartification and complete 2 hours of human
immunodeficiency virus and acquired immune
:1.5
12
Emergency Medical Services
Effective 08/0.!i98
cericier.c'f S'fncrc~e (HIV Ale,S) training, in
acccrC2nce with secticn 331.0034, FS. If a
candic2te faiis the examin2tion he or she is
ineligible for recer:if:cation anc must complere
initi2i cer:if:c:::t:cn reC1uiremer.ts cr section 6~c-
2.008(1), FA-C.
(c) Pr:cr to taking tr:e examination, a
cancicate 5,'-:all sc.::.-:-:it OH FOrTT1 1 :23, Jan. ::2,
E:i1er~er.c! I\fecical Ser/ices Prcrile Data FOrTT1,
E;',ITiParamec:c Ce::iflcation Apciication, to t.~e
ceQar-mer.t so as to be receiveG by L~e
cepar:mer.t r.o later ~han 30 calencar e2Ys r;r:cr
to the cate or tr:e certificaticn examination fcr
which the aooiicam cesires to be sCheculec, and
P2Y the reGl.;irec fees.
(3) in the ever.t an aoplicant cr certif;ec
E;'vIT chan~es tj~e i":-:aiiing accress he or she has
r;roviced the cepar::-:-:ent, the applicant or cer-iRed
E~,lT Sh2/1 r.crirj'the eepartmer:t within 10 C2YS of
the change.
Specific Au:hcrity 381,0011, 381.0034, 381.0035,
401.27, 401.35 FS. Law Impiemented 381.001,
401.23,401.27,401.34,401.41,401.35,401.411,
401.414 FS, History-New 11-29-82, Amenced 4-
26-84, 3-1/-85, Fer.Tierly 100-B6.56, Amenced
11-2-86, 4-12-.38, 8-3-88, 12-10-92, 11-30-93,
12-10-95, 1-25-97. Fomerly 100-66.056.
Amended 08-04-98.
64E.2.009 Paramedic.
(1) Qualificaticns anc Procedures for
Certification in acdition to those conrainec in
section 401.27, FS. - To be qualified fcr
paramedic cer-ification, an incividual must:
(a) successfully camplete an initial
paramecic education program that was
conducted in ac::orcar.ce with the 1985 U.S. DOT
Paramecic NSC, which is incorporated by
reference anc is available for purc;,ase from the
Government Proming Office by telephoning 202-
512~1800, Or
(b) cur.emly hclc a valid parameCic
certificaticn from the Naticnal Registry ef
E:'T1ergenc/, Medical Technicians or be currer.t1y
certified in anether state Cr U.S. territcrj 2nc
have the certifying aL:tJ-:ority submit to L'-:e
ceparment Of-: Fcr.Ti 116~, Januarj 19S8,
Statement or Gecd Standng, wr:ic~ is
incorporatec by reference in secticn 6~E-2.0C8,
FAC., and
(c) acciy fcr Ficr;ca paramecic cer:ificaticn
on OH FCr:71 1523, Jan. 98, E:nergenCI tvleciC3J
Ser/ic:=s P~cr:le Cara i='Or.i1, E~ITiParamecic
Certification At:c1icaticn whic" is ine::r;:cratec by
reference in sec~:cn 64E-2,OC8, FAC.
(2) Recer:if:cation ~ To t:e e!igible rcr
recer-iRcaticn as a paramedic an ineivicual Sh2/1
submit oH FCr:71 622, E~ective Cct. ::6. Re'/isec
June sa. .A;:ciicatien fcr Recer:iReaticn anc within
2 years prior to the e:qira:icn cate cr his
certir:catien:
(a,'/ ':;0 ",e' 'r':: or' "
ccmpiele - I, <... ~ paramec:c
refresher tra:nir.g anc c::mplete 2 heurs of HIV
,~.IOS trair.ir.g in acccrCar.ce wit:-: section
381,003~, FS; the cep2r.,l1er.r s,'iail accest the
aFRr:71at:cn cr L~e mecicai cirector 2S prccf or
compliance: or,
(a) in cne attempt, successfully c,12ilen~e
ar.c pass the para~edic certification examinaticn
i=ricr to the expiraricn care or his or her current
i=arameCic certification and ec~plete 2 hours of
HIV AiDS trainins in accorear.ce with section
381.0034, FS. If the caneicate fails the
examination, he cr she is ineligible for
recertification anc shall complete initial
certification requirements of section 64E-
2.009(1), F.A.C.
(c) Prior to taking L'-:e paramecic
examination, a can create shall submit OH Form
1583, Jan. 98, Profile Data Form,
EMT/Paramedic Certification Application, to the
deparment so as to be received no later than 30
calendar days prior to the certification
examination date for which the applicant desires
to be scheduled and pay the required fee.
(3) In the event an applicant or cerJfied
paramedic changes the mailing address he or
she has provfdec the department, the applicant
or certified paramecic shall notify the department
within 10 days or the change.
Specific Authority 38 j .0011, 381.0034, 381.0035,
401.27,401.35 FS. 13w Implemented 381.001,
401.23,401.27,401.34,401.35,401.41,401.411,
401.414 FS. History-New 11-29-82, .Amended 4-
25-84, 3-11-85, FOr.Tieriy 100-B6.57, Amended
4-12-88, 8-3-,38, 12-10-92, 11-30-93, 12-10-95,
1-26-97. Formerly 100-66.057, Amenced 08-04-
98.
64E-2.0094 Voluntary Inactive Car-.:ification.
A.J1 E~IT or p2ramedic who is c:..;r.ently cer:ifiec
can place their cer:iRcate en inacti'/e status by
sending a written reGt..:est to L1e departrnent and
r;aying a fee of $50. AI1Y EMT or paramedic
whose cer:ificate has been placed on inactiveFstatus shall not functicn as an EMT or paramedic
until such time as he or she has completed the
16
13
Emergency Medical Services
Effective 08/04/98
following requirements for reactivating the
certificate:
(1) A certificate holder whose certificate
has been on inactive status for 12 months or less
can activate his or her certificate by submitting a
written request to the department for activation
and receiving written approval. Pay a late
renewal fee of $50.
(a) For an EMT, send verification of having
a current American Heart Association Basic Life
Support Course or an American Red Cross
Professional Rescuer CPR course completion
certificate and meet the continuing education
requirements identified in section 64E-
2.008(2)(a), F.A.C.
(b) For a paramedic. send verification of a
current American Heart Association Advanced
Cardiac Life Support (ACLS) course completion
certificate and meet the continuing education
requirements identified in section 64E-
2.009(2)(a), FAC.
(2) An EMT whose certificate has been on
inactive status for more than 1 year can activate
his or her certificate by completing the following:
(a) 30 hours of EMT refresher training
which shall be based on the 1994 U.S. DOT EMT
NSC and 2 hours of human immunodeficiency
virus and acquired immune deficiency syndrome
(HIV AIDS) training. The training:
1. Shall have been completed after the
EMT certificate was placed on inactive status and
have been completed no more than 2 years prior
to the date of receipt of the request for retum to
active status; and.
2. Shall have been completed at a
department approved EMT training program or
have been approved by the medical director of a
licensed EMS provider.
(b) Hold either a current American Heart
Association Basic Ufe Support Cardiopulmonary
Resuscitation course card or an American Red
Cross Cardiopulmonary Resuscitation course
card.
(c) Complete a field intemship. The
internship shall be completed under the auspices
of an EMS training program or a licensed
ambulance service's medical director. Upon
completion of the field internship, the certificate
holder must provide the department with a signed
statement from the medical director attesting that
the certificate holder completed a field internship
program in which he or she demonstrated the
ability to assume patient care responsibilities.
(d) Pass the EMT certification examination.
Should the applicant fail the examination, he or
she must meet requirements for initial
certification.
(e) After completion of the above
requirements. submit to the department:
1. DH Form 622, Effective Oct. 96,
Revised June 98, Application for Recertification
which is incorporated in section 64E-2.008,
FAC.
2. DH Form 1583, Jan. 1998, Emergency
Medical Services Profile Data Form.
EMT/Paramedic Certification Application which is
incorporated by reference in section 64E-2.008,
FAC.
3. Late renewal fee of S 100 and the
examination fee required by section 401.34, FS.
(4) A paramedic whose certificate has
been on inactive status for more than 1 year can
activate his or her certificate by completing the
following:
(a) 30 hours of paramedic refresher
training which shall be based on the 1985 U.S.
DOT-Paramedic NSC and 2 hours of human
immunodeficiency virus and acquired immune
deficiency syndrome (HIV AIDS) training. The
training:
1. Shall have been completed after the
paramedic certificate was placed on inactive
status and have been completed no more than 2
years prior to the date of receipt of the request for
return to active status; and,
2. Shall have been completed at a
department apprDved paramedic training
program or have been apprDved by the medical
director of a licensed EMS provider.
(b) Hold a current American Heart
Association Advanced Cardiac Life Support
course card; or equivalent.
(c) Complete a field internship. The
intemship shall be completed under the auspices
of an EMS training program or a licensed
ambulance service's medical director. Upon
completion of the field intemship, the certificate
holder must provide the department with a signed
statement from the medical director attesting that
the certificate holder completed a field internship
program in which he or she demonstrated the
ability to assume patient care responsibilities.
(d) Pass the paramedic certification
examination. Should the applicant fail the
examination, he or she must meet the
requirements for initial certification.
(e) After completion of the above
requirements. submit tD the department:
1. DH Form 622. Effective Oct. 96.
Revised June 98. Application for Recertification.
1''''
. /
14
Emergency Medical Services
Effective 08/04/98
2. Of; :=cr;-;; 1583, "':2;'. 1998. Emer~er.cf
l\lecic3/ Se:'/ices Frc::ie Data Form,
E:\ITiFararr.ec:c Ce::ificatic:-: ;'pelicatien.
3. Late renewal fee of $100 anc the
eX2mination fee as re~t..:ire::: by sec:icn 401.34,
F3.
Spec:f:c A,ut~crjty ..101.27, ~Oi .35 F3. L3VI
Implementec ~C1.2:, J.01.3~. 401.35 :=3. New
08-0.1-98.
64E-2.0095 Involuntary Inactive
Certification.
(1) An =\11 cr ;::ar2rr.ec;c cer-ii':cate t.'iat is
net renewed at the e;;d or :,'":e 2-year certifiC3tien
period shall at..::oma:ically re'/ert to an inactive
status fer a period er 180 ca~/s.
(2) Sueh ce::ii':cates may be reactivatec if
me applicant submits tr:e rece::ii':cation fee
required by section 401.3.1, F8., and a late
renewal fee of $25 and the fellowing items to the
cepartment:
() OH F -?? E"".' 0" 1 cc-
a orm 0__, :7eCdve c.. ~~o,
Revised June 9S, Appiication for Recertification
which is incor;;erated by reference in section
64E-2.COS, F AC.
(b) Verification of having met one of the
recertifiC3tion re~uirements ccntained in section
64E-2.00S(2) or 64E-2.00S(2), FAC. The
requirements for recertification shall be
completed wit1in the 180-day inactive certification
period.
(3 j An application Fer recertification
received by the depar-ment more than 180 days
after the expiratien date of the certificate shall be
denied. Such certificate holcer is ineligible for
recertification and must meet the re~uirements
for initial certification.
Specific ,A,uthority 401.27, 401.35 F3. Law
Implemented 401.27, 401.34, d01.35 F3. New
08-04-98.
54E-2.010 Examinations.
(1) Grade Notification - If 2 C3nC!Cate fails
1.1e s~ate cer:ificaticn examinatien, he or she wiil
be notiried by t.'-:e cepartment cf the requiremer.ts
fer regrace, re'/iew, and 2::::eal rights and
prccecures.
(2) =-'(2mina:icn Regraces If the
candieate c:esires a regrading of his or her state
examinaticn, he or she must submit a written
request to the deoartmer:r for a rescore within 30
cays of the cate :neicated on the Failure netice.
(3) EX3mination Review.
(a) I ne cancidare shail notify the
ceparu"Tlent. in writing, that he or she desires an
examination re'/iew wit'lin 30 cays cf the cate
indicated en the failure ,;otice and induce the
required re'/iew fee or $30 payable to me
cepar:;7ler;tls OffiC2 af El\1S.
(tJ) E3cn cancicate who has taken the
examinatien shail have the rig:!t te review the
examination beokiet and answer sheet.
(..i) Passing Grace - Individuals 2chie'ling
the fellcwing graces on the state ~rtificatien
examination shail pass:
(a) E;\II, 70 .-=:ercent or higher,
(b) Paramecic, 80 percent or higher.
(5) To be reschecuJed for the state
certificatien examination, an applicmt shall
submit OH Form 1583, Jan. 98, Emergency
rvledical Services Frorile Date Form,
E\1T/Faramedic Certificaticn A.pplicatien which is
inccrporared by reference in section 64E-2.008,
FAC, ine application shall be submitted so as
to be received by the deparu"Tlent no later than 30
calendar days prier to the cate of t'1e sc.1edufed
examination.
(6) Persons with cccumented learning
disabilities in the areas of reading decocing or
reading comprehension er same form of
c:ocumented disabiiity or c::lgnitive precessing
ceficit specifically in the reading area which
'.vould negatively impact on the candidate's
performance on the written examination may be
eligible for special accommodations with the
written certification examination. ine person
requesting the ac::::;mmcdation must provide
cccumentation of the diagnosis before any
cecision shall be made by the deparment
regarcing the rec;uest for special ac::::;mmodation.
(a) Documentation of a specific learning
disability shall include one of the follewing:
1. Diagnosis of a leaming c:isabiiity in the
area of reading deccding or reading
comprehension based uccn the results of
standardized psycho-€ducaticnai assessment
induding an aopropriate star:dardized measure of
intelligence and an appropriate star.cardized
measure of achie'/ement in reacing cer...cding or
reacing comprehe~sien. T'NO recognized
ins:rt.:r.-:ents ac::eptatie to the ceoar.ment which
-=:rcvide the disabilit'j c:iagr:csis anc which are
s:andarcized fer adults are:
a. Wechsler Acult InteHiger:ce SC3/e-
Revised.
b. Woccc::e!~-Johnson
=~uc3tional Satter/-Revised:
A.chievement.
Psyche-
Tes-...s of
18
15
Emergency Medical Services
Effective 08/04/98
2. School or work records which
demonstrate that special education services or
accommodations were provided due to a leaming
disability in the area of reading decoding or
reading comprehension. Documentation of the
leaming disability shall be required.
(b) Individuals who qualify for special
accommodation on the written examination due
tD a documented leaming disability as described
above shall be permitted to take the standard
format of the examination, but shall receive an
additional hour in which to complete the
examination.
(c) Other types of accommodations to
meet the needs of applicant's documented
disabilities may be granted with appropriate
documentation of disability as determined by the
department.
Specific Authority 381.0011, 401.27, 401.35 FS.
Law Implemented 381.001, 40.1.27, 401.35 FS.
History-New 4-26-84, Amended 3-11-85,
Formerly 100-66.575, Amended 4-12-88, 12-10-
92, 12-10-95, 1-26-97. Formerly 100-66.0575.
Amended 08-04-98.
64E.2.011 EMS Training Programs.
(1) Training Program Approval Application
Process.
(a) To be approved as an EMS training
program, an entity must provide proof that the
sponsoring institution is in compliance with all
applicable statutes and rules of the State of
Rorida, Department of Education, including any
required licenses, and
1. Submit a completed DOH Form 1698,
October, 96, Application for Approval of an EMS
Training Program, which is incorporated by
reference and available from the department.
2. Submit a copy of an affiliation
agreement with a hospital, which holds a current
and active State of Rorida license and has an
emergency department staffed by at least one
physician and at least one registered nurse.
3. Submit a copy of an affiliation
agreement with an EMS prDvider, which holds a
current and active State of Florida license and
which agrees to provide the field experience
phase of the EMS training program.
4. Submit documentation verifying the
following faculty, minimum qualifications, and
requirements:
a. A medical director, who is a physician
holding a C"..Jrrent and active State of Rorida
license. The medical director shall also meet the
qualifications set forth in section 64E-2.004,
F A.C. The medical direc::r shall cer"Jfy that the
paramedic student has successfully completed
the didactic and clinical phases of a training
program and is competent in all ALS skills. The
medical director shall approve paramedic
preceptors far the field imernship portion of the
paramedic training program. Tnere shall be a
written contract between the training program
and the medical director which outlines the
program responsibilities of u'1e medical directDr.
b. A program director, who shall be
responsible for the operation, organization.
periodic review, administration, development, and
approval of the program.
c. Submit documentation verifying that the
curriculum:
(I) Meets the course guides and
instructor's lesson plans included in the 1994
Emergency Medical Tec.'1nician-Basic NSC (for
EMT prDgrams) and tl1e 1985 Emergency
Medical Technician-Paramedic NSC (for
paramedic programs).
(II) Includes 2 hours of instruction on the
trauma scorecard methocologies as required in
sections 54E-2.017, F AC., for assessment of
adult trauma patients and section 64E-2.0175,
F A.C., for assessment of pediatric trauma
patients, and run report documentation as
required in section 64E-2.013, FAC.
(III) Includes 4 hours of instruction on the
Florida HIV AIDS training as required by chapter
381, FS., and the rules promulgated thereto.
d. Submit documentation evidencing
sufficient medical and educational equipment to
meet the EMS training program needs.
(b) Within 30 days of receipt of the
application and required documentation, the
Department shall notify tl1e applicant of any
deficiencies. The applicant shall have 50 days
frDm the notice from the department tD correct
the deficiencies to the satisfaction of the
department. Should the deficiencies not be
corrected, the application for approval shall be
denied.
(2) Training Program Approval Site Visit
Process.
(a) If the application for approval is
accepted, the department shall schedule a site
visit to the applicant's institution within 30 days
after notifying the institution that the application
was accepted. During the site visit the
department shall determine the applicant's
compliance with the applicable standards for an
EMS training program as fcifows:
19
.~
16
Emergency Medical Services
Effective 08/04/93
1. E!\IT prcgrams shall be a minimum of
110 hcurs in length, with not less than 20 hcurs
of supervisee clinical ex;:erience to indude not
less than 10 hcurs in a hcspit;::1 emergency
depar:ment. The program shall consist of a
didactic cOo.1poner<r and a skills practiCe
component. with the skills laboratorj student to
instructor ratio nct exceeding eight to one. Tile
program shall provide fielc ex::er.ence aboan: a
permitted EMS vehicle with a preceptor which
inc;udes par:ic/patlen in not less than 5
emergency calls resulting in patient transport.
2. Paramedic programs shall be a'lai/aole
only to a student who helds a c:..Jrrent and valid
certif:ca:ion as a Fiorida E:\fT cr who becomes
Fiorida certif:ed as an EMT proor to the
cGmpleticn of ph2se one of the paramedic
program. The program shall be a minimum of
700 hours in length and consist of didactic and
skills practice components, with the skiils
laboratcr; student to instruc:or ratio not
exceeding six to one, The program shaH provide
field intemship experience aboard a permitted
EMS vehicle with an ALS provider.
(b) Within 30 days of completing the site
visit, the department shall notify the sponsoring
institution's chief administrative officer and
appliC<!nt's program director of the approval or
denial of the program. If approved, the applicant
shall be issued a 2 year certificate of approval as
an EMi training program or a paramedic training
program. If the program is not approved, the
deparment's notifiC<!tion shall include: a
statement of the program's areas of strength, a
statement of areas needing improvement, and
suggested means of improvement
(3) Process for Training Programs Denied
Approval.
(a) Correct the deficiencies noticed in the
deparunent's response to the application and
report from the site visit; or,
(b) Petition the action pursuant to chapter
120. FS.
(4) Requirements for Approved Training
Programs.
(a) All aporoved EMS training programs
must main rain acc:..;rate records and reports
including student applications. records of
attendance, rec:Jrds of participation in hospital
clinic and field training, medical records, course
objectives and outlines, class schedules, learning
objec:ives, lesson plans, number of appliC<!nts,
number of stt.:dents accepted, admission
requirements, cescription of the qualifications,
duties anc res;:cnsitilities of faculty members
and corres;:ondence. Such records and reports
shall be made available to the def:crtment on
request
(b) Notify the deparment, in writing, of any
changes in the faculty status wit.~in 30 days of
such change,
(c) Require EMT and paramecic students
to pass a comprehensive final wr:tten and
practical examination which shall indude a
representative sample of those sk.iIIs cescribed in
the U.S. DOT E:\IT-8asic or E~IT-?2ramedic,
NSC.
(d) Provide, within 14 days of course
completion, a certificare of completion to program
graduates as verification of successful
completion of an EMT or paramedic course.
Specific AtJthority 401.35 FS. Law Imciemented
401.24,401,27,401.34, .101,35, 401.411 FS.
Histor;-New 12-10-92. Formerly 100-66.058.
Amended 11-30-93, 3-19-9S, 12-10-95, 1-26-97.
Formerly 100-66.0586. Amended 08-04-98.
64E-2.012 Drivers.
(1) Each ALS and BLS prOVlcer shall
ensure that each driver who operates a permitted
vehicle meets the qualifications as listed in
section 401.281, FS.
(2) Each BLS and ALS provider shall
document that each driver has completed at least
a 16-hour course of instruction on driving an
authorized emergency vehicle, as defined by
section 316.003(1), FS., which includes, at a
minimum, classroom and behind-the-wheel
training as outlined below:
(a) Didactic.
1. Legal aspects of authorized emergency
vehicle operators.
2. Selecting routes and reporting
emergency operation.
3. Tne practice of defensive driving.
4. Accident avoidance.
5. Principles of vehide control.
6. Routine safety checks of vehic!e,
(b) Practical.
1. Braking and contrel braking.
2. Backing; road position. render
judgement and steering technique.
3. Slalom; steering technique and chassis
set.
4. Steering technique during a skid; a skid
pad is optional.
S. Tum-around-steering technique; fender
judgement, road position, controlled braking,
controlled aC:Je!eration, understeer, o'lersteer
and chassis set.
20
17
Emergency Medical Services
Effective 08/04/98
Specific Authority 401.35 FS. Law Implemented
401.27, 401.281, 401.35, 401.411 FS. Histcrj-
New 11-29-82, Amended 4-26-84, 3-11-85,
Formerly 100-66.59. Amended 4-12-88, 12-10-
92. Formerly 100-66.059.
64E.2.013 Records and Reports.
(1) Each provider shall be responsible for
supervising, preparing, filing and maintaining
records and for submitting reports to the
department as requested. All records shall be
handfed in such a manner as to ensure
reasonable safety from water and fire damage
and to be safeguarded from unauthorized use.
Any records maintained by the provider as
required by these rules shall be accessible to
authorized representatives of the department and
shall be retained for a period of at least 5 years
except as otherwise specified in this rule. Each
provider shall maintain the following
administrative records:
(a) Current service license issued by the
department which shall be publicly displayed in
the prDvider's main office.
(b) Vehicle registration, copy of past
department inspection reports, proof of current
vehicle permit, and proof of current insurance
coverage.
(c) Personnel records for each employee,
to include date of employment, training records,
employee application, copy of current certification
card, and confirmation that each driver is in
compliance with section 401.281, FS.
(d) Copy of up-to-date department
approved TIPs.
(2) Each EMS provider shall ensure that an
accurate and complete run report was prepared
for each instance in which a patient was
assessed, medical care was rendered, a patient
was transported, patient was pronounced dead at
the scene, patient was transferred to another
licensed service, patient was transferred from
one medical facility to another and for instances
when the person or persons fDr whom EMS was
dispatched refused treatment, transport or both.
(3) Eac.'1 provider shall document on DOH
Form 1894 or 1895, October 93, Florida EMS
Report each instance as described in section
64E-2.013(2), F.A.C. Instructions far completing
run reports are published in DOHP 150-14,
October 93. DOHP 150-14, October 93, provides
direction in the completion of prehospital,
abbreviated and interfacility run reports.
(4) An accurate and complete run report,
as required in sections 64E-2.013(2) and (3),
F AC., shall be provided to the receiving facility.
The EMS provider may provide to the receiving
facility an abbreviated run report in lieu of the
complete run repert required in sections 64E.
2.013(2) and (3), FAC. If the EMS provider
elects to provide the abbreviated run report
before departure, the hospital copy of the run
report shall be signed with an original signature of
the lead crew member. DOH? 150-14. October
93, identifies the minimum data elements
necessary far an abbreviated run report.
(5) If an EMS provider elects to provide the
receiving facility with an abbreviated run report at
the time responsibility of the patient is transferred
to the receiving facility, the EMS provider shall
have the complete and accurate r..m report, as
required in sections 64E-2.013(2) and (3), FAC.,
available within 24 hours of the time the vehicle
was originally dispatched in response to the
request far emergency medical assistance.
(6) Non-transporting vehicle personnel
shall provide information pertinent to the patient's
identification, patient assessment and care
provided tD the patient to the transporting vehicle
personnel at the time the responsibility of the
patient is transferred to the transporting service.
The nDn-transporting EMS provider shall have
the complete and aCC'.Jrate run report, as required
in sections 64E-2.013(2) and (3), FA.C., within
24 hours of the time the vehicle was originally
dispatched in response to the request far
emergency medical assistance.
(7) Each EMS provider shall maintain the
second copy of DOH Form 1894 or 1895,
October 93, Florida EMS Report far a period of at
least 5 years. This copy is considered to be the
copy of record, shall contain an original signature
by the lead crew member and is certifiable as a
true copy.
(8) Each licensed EMS provider is
responsible for quality review for completeness
and accuracy of their own run reports. Each
quarter, the Office of EMS will notify licensed
providers by exception reports of incompleteness
or inaccuracy of submitted run reports. It is the
provider's responsibifity to prospectively correct
procedure and performance sa that the types of
errors identified in the department's exception
report do not reoccur. Tne exception reports will
be reviewed by the Office of EMS staff in
conjunction with routine inspections and serve as
the basis far a determination of reporting
deficiencies which will require corrective action.
(9) Any EMS provider who desires to
provide run report data in a manner ather than
prescribed in this section shall submit a variance
to collect and provide the data by an alternative
method to the Office of EMS. Any variance
21
18
Emergency Medical Services
Effective 03/04/98
rec;uest shail t:e in accarc:ance with the inte~t of
this secticn,
(10) Mec:c2t:cn errcrs and reactions e:1
rcute shall :e rec:crted to the physician "VI~O
crcerec: the iiiec:;cation, ti;e receiving ;:nysic:an,
and the ,~.LS ii:ec:;cal direc:ci
(1 i) E3C~ ,8r-:vic:e: s,~2il 17i2ini:2in 2 ',vr;~2;!
pl2n, a'/2i/2c:e rCi ,-e'/iew :y Lle c:ecar:iiie~c. rei
L'le piccer h2nc::ng, stcrage, anc: diseos2! or
bicha::arccus wastes in 2cc:::rcance with cha:rer
64E:-16. F.A.C.
(12) E2c,l prc'/ider s,'iail retum his lice:1se to
the cep2r:ment w't.'iin 15 calenC2r cays af:2r a
cha:1ge of r:al"7ie cr ownership of the ser/ice er
uocn permanent!:/ ceasing to provice service.
(13) Eac,n air amcc/anee prcvicer s,~all
maintain ccc:.;;:-:entation cesc;-icing the se;'lice
rencered to L'ie ,:arient anc cost as part ef L"le
patient's rec::::rd in acccrdance with sec:;cn
401.251 (4)(c), FS.
(14) Each E~.IS provic:er shall have a
cis aster plan which integrates into both the lecal
and regional c:isaster plans.
(15) A fixed wing air ambulance previter
shall have an air medica! crew me~cer
c:occrr.enr the cabin altituce hourly, I ne c2cin
pressure shail be cocumenred on the patient
record.
Specific Authority 381.0011, 395.405, 401.30,
401.35 FS. Law lrr.piemented 381.001, 381.0205,
395A01-395A05, 401.23, 401.25, 401.27,
401.30,401.35, 401Al1 FS.1-iistor;-New 11-29-
82, Amended 4-25-34, 3-11-85, Formerly 100-
66.60, .Amended 11-2-86,4-12-,38,8-3-88, 12-10-
92, 11-30-93, 12-10-95, 1-25-97. Fermeny 100-
66.060.
64E-2.015 Prehospital Requirements for
Trauma Care.
(1) Each E~IS provlcer shall ensure mat
upon am'/al at the Ie cation of an incident, an E~,1T
or paramedic snall assess the conditien of eae:1
adult trauma patient using the acuJt traur.:a
scorec.ard r.:e:~ccciegy to cetermine t:':e
transcor. destira::on, as previc:ec in section 6.!E:-
2.017, F "~..C., anc: tJ'ie transcort des:inaticn of
each peciau:c p::ent by using tr.e pedia::-:c
tcuiiia sccree<;rd ,'i1e:hccelogy inciuc:ed In
secticn 6.!::-2.0175, .=.A.C.
(2) Each ::;\IS provice!" shail transcor" or
ceuse to :::e rrans::::er:ed, ever; traur.:a alert
,catlent te a S":'.TC or SA?TRC neares: to L'ie
Iccetion of u":e incicent, unless the distanc~ is nct
relevant to the !en~;th of tirr.e far transport cue to
~"':e use ef an air ar.:::ulan~, Peciau:c tiaL:r.:a
ale" patients Sh2il be tralnseer.ec to the neares:
SA'=T~C or SATe with S,.l,:JT~C services e'/en if
a SA Ie without SA?T~C se;,/'ces is nearer to
L'ie iccation er ti"e :ncicer::, except as pro'liced in
ceca:-:t71e~,-2cei:::'/ed T1?s. If a SA TC er
S':',=T:=-C :cr.her :r:r.: t~e !cca:ien of the incice:"'.t
r.2S .3 sc:ec:3j resccrce(s) :j~2t tr:e ~e2rest SATe
cr .5,':',,=7::::C tees I"":C: hal/e. SL:C~ 2S :,urn center,
'Nhic.~ is neecec: fer the i~r71eci2te c:nciticn of
the t;ac~a a!er::::a:ie:1t. the E:\IS provider ma'l
'---<:-er. ,('\ ""0 C:' -("' cr c:' ~--("' h . 'h-.
ll.:::: ,...~ ~~.... U~...... _,-. I V ......r.,-- I I\V laVIng lj ICl
see.:::::! ~eSCL.!rcc::s) e\/en if ~he SATe or SA.FTRe
is r:c: nearest to :.":e inc:cent. These exceotions
to t,-a::seorring to :he nearest SA IC or SAPTRC.
cr e[,":er exce::tiCi,s the E.\fS previcer wishes to
rec~est, shail ce accressed in the E:MS
r::rov:cer's T1?s '.';;"::ch shail be sub~itted to L"1e
decar:mer:: fer accrcva!, in accordance with
secticn 395.4045. FS. anc: sec:ion 6J.E-2.0 16,
F.A.C.
(3) A tra!..:rr:a alert patient may be
trans:::crted to a r.csQital other than a SA TC or
SA,=I~C only if the hospital is c:oser to the
scene ~f the inc:cer:r, and the patient's immediate
c::::ncit:cn is such that the patient's life will be
encangered if care is delayed by praceecing
cirec:!y to the SA IC or SAFTRC, If an EMS
prc'lic:er intencs to transport trauma alert patients
to hcsQitals other than SA TCs or SAPTRCs
under any ct"1er circumstances, those
circumstances r.:t.:st be described in and
autlcr.zed by the E:MS provider's department-
approved TIPs, as required in this section.
(2) An EMS provicer must transport a
trauma alert patient ta a SA TC or SAPTRC,
except as may be prcvidec in the EMS provider's
cepar,,'i1ent-aoprO'lec TIPS, For situations far
whic.., the EMS provider intends ta transport a
trauma alert patien: to a hospital other than SA TC
or SA?iRC, as incicated in the provider's
department-ap:::ro'led TIPs, tle EMS provider
shall ensure befcrehand that the hos;:ital meets
L"':e foilowing criteria:
1. Is staffec 2.:i-hccrs-per-cay with a
physician anc OLler ;:ersennel who are quaiified
in emer;enc:; air.'l2;/ rr.ana~ement, ventiiatcr;
SL;C~Or:, and centr::i cf life tr.reare!1ing c:r::ulatcrj
::iCeJer:-:S 'Nhich s~cn ;~c:uce :~t net be fimitec to
:::/acemen: ef enccu2c~e2/ tt.:t::es: es:at::iisilment
cr CSr-:::i2j ~nt;"a'lenc~s ;ir:es; 2~C insertfcn or chest
tcces:
2. f-ias ec:t.:icr-:ent and staff in-;'ics;:ital and
a'/2ii2cie to ccncL.:c: ones: anc cer/ical saine x-
jays;
3. ~as iat:era:cr/ facilities ecuicr.:ent and
staff in-,'ics.::it21 arc available toanaiyze and
re~cr: :at:cratcr:1 res;..:i:s;
-.,r,
t4.-.....
.0
I~
Emergency Medical Services
Effective 08/04/98
4. Has equipment and staff on call and
available tD initiate derinitive care required by a
trauma alert patient within 30 minutes of the
patient's arrival at the hospital, or can initiate
procedures within 30 minutes of the patients
arrival to transfer the trauma alert patient to a
SA TC or SAPTRC; and
5. Has a written transfer agreement with
at least one SA TC or SAPTRC. Tne transfer
agreement shall provide specific procedures to
ensure the timely transfer of the trauma alert
patient to the SA TC or SAPTRC.
(b) Any exceptions to this requirement
shall be induded in the EMS provider's TTPs and
be approved by the depar'unent.
(c) Prior to submitting an application for an
ALS. BLS or air ambulance license, or to renew
such a license, each EMS provider shall request
in writing, from the chief executive officer of each
hospital (excluding SA TCs and SAPTRCs) to
which the EMS provider intends to transport
trauma alert patient's, written documentation that
verifies that the hospital meets the requirements
provided in paragraph (3)(a) of this section.
When submitting TTPs for department apprDval,
EMS providers shall include copies of each letter
sent to the chief executive officer of such
hospital as well as the response, if any, from the
chief executive officer indicating whether the
hospital complies with paragraph (3)(a) of this
section.
(d) A trauma agency that has developed
uniform TTPs may request written documentation
from the hospitals in lieu of each EMS provider, in
accordance with the requirements of this section.
(e) If an EMS prDvider does not receive a
response from a hospital, or if the hospital
indicates that it is not in compliance with the
criteria in paragraph (3)(a) of this section, the
EMS provider shall not deliver a trauma alert
patient to that hospital. Any exception must also
be included in the EMS providers department-
approved TTPs.
(f) If a hospital's compliance with the
criteria in paragraph (3)(a) of this section
c.'1anges during the EMS provider's biennial
licensure period, the EMS provider shall submit,
within 30 days of becoming cognizant of the
c.'1ange, revised TTPs to the department for
approval, in accordance with section 64E-Z.016,
FA.C.
(g) If a hospital to which an EMS provider
transports trauma alert patients. as provided in
the EMS provider's or trauma agency
department-approved TTPs. becomes a SA TC or
SAPTRC, including those granted provisional
status by the department. the EMS prDvider shall
begin immediately transporting trauma alert
patients to that SA TC or SAPTRC. Tne EMS
provider shall revise and submit TIPs to the
department for approval wit~in 30 days of the
hospital becoming a SA TC or SAPTRC. Within
30 days of an EMS provider or a trauma agency
receiving notification that a SA TC or SAPTRC
intends to discontinue as a SA TC or SAPTRC,
the EMS provider or trauma a~ency shall submit
revised TTPs to the depami1ent fcr approval, in
accordance with section 64E-2.016, F AC.
(4) Each EMS provicer shall ensure that
the applicable elements of the trauma information
section of the run report are completed and the
form is delivered with the trauma patient to a
SA TC, SAPTRC. or hospital as required in
section 64E-Z.013, FAC. ALS non-transporting
vehicle personnel shail provide to the
transporting vehicle personnel complete
information about the patient's identity, the initial
patient assessment and care provided prior tD
arrival of the transporting vehicle personnel. at
the time that responsibility for the patient is
transferred. The transporting vehide personnel
shall deliver the run report with t'1e trauma patient
to the SA TC, SAPTRC, or hospital as required by
section 64E-2.013, FAC., and DOHP 150-14,
October 93.
(5) Tne EMS provider responsible for the
patient shall ensure that a prehospitaJ trauma
alert is issued upon determining that a trauma
patient meets the requirements of sections 64E-
2.017, and 64E-2.0175, F AC. The words
"trauma alert" shall be used when notifying the
SA TC, or SAPTRC, or hospital that EMS is en
route with a trauma alert patient The EMS
provider issuing the trauma alert shall also
provide the SA TC, or SAPTRC. or hospital with
information from the patient assessment and
trauma infDrmation sections of the run report
(6) As rapidly as pOSSible after receipt of a
request for emergency inter-hospital transfer of a
trauma patient. each EMS provider shall
dispatch, or cause tD be dispatched, an EMS
vehicle or air ambulance.
(7) Each EMS provider shall have
department-apprDved lIPs whic.., include at a
minimum:
(a) Dispatch procedures whic.., indude:
1. A description of information tD be
solicited from the individual requesting
emergency medical assistance in order to
determine the number of patients, lecation of the
incident, and extent and severity of reported
injuries;
2. A description of the method used to
ensure that the EMS vehice most readily
available is identified and dispatc.1ed to the
location of the incident; and
.23
20
Emer~ericy I\tedical Serlices
Effective 08/0~/93
"'\ A cesc~ct:cn cf the pracess used to
re~~est assistarce frcr.1 emer;;er.cj res::;cnse
ase~cies.
(b) F;e~cscital prccedures which inc:cce:
1. F;cc2ccre whic~ pro'lices Ulat uecn
a[7j'/ai at the !ccation of the incice::r, E:~.lls ar.c
;::2ra~ecics assess the ccr,citien of eaeh tr2L:ma
,carie"t to cete:.;:ine the transper: destir,atien, in
accc;-cance wit'1 sections 64:::-2.017, anc 5.!:::.
2.0175, F_~..C.;
2. A cesc;-:ption cf the methoc:clcc;ies
L.:sec: to assess the cenditien ef and to measure
L~e se'/erity cf irjL.:rj ef eae,'1 adult traum2 ::;alier:t
in acc::r:ar:ce with sec:icn 6.!E:-2.017, r...l..C"
anc cf each pediatrie tr2L.:ma pacie~t in
acec;cance wiL'l seden 64::::-2.0175, F.AC" to
det9:.;:ine their :rar~spcr: destinatien,
3, P;ccecL.:re to be foilowed by EMls anc
paramedics fer cer.1pietien cf me run repor: with
tra!.1ma infer.7:aticn and the deli'ler; of the fcrm
with t.';e tra!.1ma patient to a SA TC, SA.PI~C, ar
hescitat;
.:1 Criteria used to determine when
trans::;crt assistance shalf be requested anc the
process used fer ootaining sueh assistance. T;le
c;-;teria shail incit..;ce and differentiate be~Neen air
and ~;ound ambulance services; and
w. Prccacures for issuing a prehcspita/
trauma aiert.
(c) Transc::ert destination c~teria whic..,
induce:
1. Tne c;-fteria anc precess used to
dete:.;:i~e t'le trans pert destination of trauma
aler. patients; and
2. A list of situations, if any, in which it
may be in the best medical interest ef the trauma
alert patient to be transpeiied to a destinatien
otr.er than a SATC or S~PTRC, in accorcance
with tile re~uirements of this sec:ion.
Justir.cation to st..;pport eac.., situaticn shall be
inc!uded,
(c) Tne procedures for an emergencj inter-
hospital transfer of a trauma patient.
(e) Written documentation that the TT?s
submitted by t,e ,ilLS, 8LS or air amcL.:lance
provicer have beer. aporoved by t,';e previcers
medic:::i cirec:cr.
(0 A. list ef SA ICS, SAPTRCs, ard
hcscica!s to Wr.IC~ t'le EMS pro'lider inrends to
transcor: traL.:ma aier: .::atients.
(g) Wr;cten cec:..u1;en,aticn that ail
hesolt.::!s. SA ,C5 and SAPT~Cs to wnlC:: the
:::;\IS .:rcvicer rOL.:tine!y trans::er.s have been
pro'/:ced a c::cy cf the c;-iter:a whic.., the E~.tS
.c::rcvicer will fcilow to ceter.nine traL.:ma transpcr:
destinatiens.
(8) AI1Y ~~.1S ;:lrovider iecatee in a traL.:ma
ser/ica area 'Nit., a de;Jar:ment-accrc'Ied locai er
21
re~jenal traema ager.~1 s"'~all submit a c::py of
prcposed or re'lised Ti?s to ~'-:e agencj any time
the E\IS provide; su:mits an initial or renewai
license apciic3tien, cr re'/ised Ti?s, to the
ce~aru-r:enL The E;\fS ,:rcvic:er shail ensure that
the ager.~;'s ceoy ef ~'-:e .crccesec cr re'/isec
T'T'=s is recei'lec: en cr :efcre the cate that the
ir:"ial or re:1ewai licer:se, or re'/isee Ti?s, are
dee to the deaaru"7':er:t
(9) A has:ital licensee in ar:omer state
lNr-::ch meets the c:-fter:a ,:ravfcec in section 64E-
2.'J15(3)(c), rAC., r.::::j te ice~:ifiec in the TT?s
as a hcs:ital tc 'Nnic" t'le =:'.IS ~rovider may
trar.s:crt a traur.ia ale:: pa,ie~t, in ac::::rcance
wiL, the rec:uire.'i:ents in sec:icn 64E-2.015,
FAC,
(10) A hospital in ancther state which has
received aaprc'Ial frem ~e apprepriate
gavemmer:tai ase~~1 in L';at s:a:e to operate as a
!r3ema cente; may be idencifiee in TT?s as an
aepraved trauma center.
Specifie Authority 395..i05, ~01.35 FS. Law
Implemented 395.~01-395A03, 395.404-395.405,
~01.30, 401.35 FS. Histcr;-New 8-3-88,
,Amended 12-10-92, 11-30-93. For.nerly 100-
66.100. Amended 08-001-98.
64E-2.016 Trauma Transport Protocols
Approval and Denial Procass.
(1) Ti7s shall be approved by the EMS
provider's medical director prier to submission to
me eepar.ment fer appro'/aL
(2) Re'/isiens to TT:=s ct..;ring the licensure
period:
(a) Re'/isi.or.s must be submitted to the
de;Jarirnent, and to L'ie trat..;ma agencj if one
exists, fer appreval at least 60 cays prior to Lr,e
proposed implementaticn cate. Other sec:ions
t.lo;at mane ate eanier submissien under special
circ:Jmstancas shall take precedence over mis 60
cay requirement. T;"1e deparment shall, within 30
cays of receipt, review L';e E:\;IS pro'lic:er's
propcsed TT?s to cete:.71ir.e c::mpliance with
sectien 6.1:=.2.015, r _.;,C. T;le eeparment wiil
aisc consider the iecomr.:er:da:ions ef the lecal
cr re-;:enal tlacma ag9~C"j, if c:-:e exist.:;, before
ad'lising t'ie E~.lS pr::'/icer of any errcrs or
emissions. If tlo;ere are any er.-ers or emissiens,
b~e ce:Ja~ent s,'":a!! recees;: correctiens cr
aeditienal infc~atien from Llo;e =~.IS pravider.
(b) Tne EMS provide: sMail submit the
re:::uested c::rrec:;or~s er adCiticnaf infer.nation
wit'lin 15 days or receipt of tr.e ~etice ef err::rs cr
emissiens.
(c) The cesar::;;er.t shail teem the TT?s
c::mplete usen recaict cf t'le c:::l7ec::cns cr
:::' ]
Emergency Medical Services
Effective 08/04/98
ac:ditionaf informaticn, or upon expiration of the
15-day time period, whichever occurs first.
(d) The department shail review the EMS
provider's prcposed TT?s to determine
compliance with sec::on 64E-2.015, F .A.C., and
will consider the recommendation of the local or
regional trauma ager.cy, within 15 days of receipt
of the corrections or additional information, or
within 15 days of the TIPs being deemed
complete as originally submitted.
(e) The EMS provider may implement
proposed changes to TTPs and submit a request
for department apprcval within 30 days after a
change is implemented if a delay in approval
would have an adverse impact on the deliver; of
patient care. Changes in TIPs submitted to the
department after implementation by the EMS
provider will be reviewed by the department in
accordance with paragraphs (2)(a)-(d) of this
..
seCdon.
(3) When submitting TIPs for department
approval, each EMS provider, or trauma agency
that has developed uniform TIPs, shall include a
copy of the letters sent to the hospital's chief
executive officers as well as documentation
received in response from the hospital's chief
executive officers indicating whether the hospital
complies with 64E-2.015(3)(c), FAC.
(4) The department shall issue a fetter of
approval to the EMS provider upon determination
that the TIPs are in compliance with section
64E-2.015, F.AC.
(5) The department shall issue a letter of
denial to the EMS provider upon determination
that the TIPs are not in compliance with section
64E-2.015, F.AC. The letter shall specify the
deficiencies in the protocols and shall include
notification of any right to a section 120.57, FS.,
hearing.
SpeCific Authority 395.405, 401.35 FS. Law
Implemented 395.4045, 395.4045, 401.40, 40135
FS. History-New 8-3-88, Amended 12-10-92.
Formerly 100-66.101.
64E.2.017 Adult Trauma Scorecard
Methodology.
(1) Each EMS provider shall ensure that
upon arrival at the location of an incident., an !::VfT
or paramedic shall:
(a) Assess the condition of each adult
trauma patient using the adult trauma scorecard
methodology, as provided in this section tD
determine whether the patient should be a
trauma alert.
(b) In assessing the condition of each adult
trauma patient. the EMT or paramedic shall
evaluate the patient's status for each of the
following components: airway, circ:.Jiation, best
motor response (a component of the Glasgow
Coma Scale which is defined and incorporated by
reference in section 64E-2.001(8), F.A.C,),
cutaneous. longbone frac:ure, patient's age, and
mechanism of injury. Tne patient's age and
mechanism of injury shall only be assessment
factors when used in conjunction with
assessment criteria included in (3) of this section.
(2) The EMT or paramedic shall assess all
adult trauma patients using the following criteria
in the order presented and if anyone of the
following conditions are identified, the patient
shall be considered a trauma alert patient:
a. AirNay: The patient receives active
ailWay assistance beyond the administration of
oxygen.
b. Circulation: The patient lacks a radial
pulse with a sustained heart rate greater than
120 beats per minute or has a blood pressure of
less than 90 mmHg.
c. Best Motor Response (BMR): Tne
patient exhibits a score of four or less on the
motor assessment component of the Glasgow
Coma Scale, or exhibits the presence of paralysis
or there is the suspicion of a spinal cord injury or
the loss of sensation.
d. Cutaneous: Tne patient has 2nd or 3rd
degree bums tD 15 percent or more of the total
body surface area. or amputation proximal to the
wrist or ankle, or any penetrating injury to the
head, neck, or torso (excluding superficial
wounds where the depth of the wound can be
determined).
~. Longbone Fracture: The patient
reveals signs or' symptoms of two or more
longbone fracture sites (humerus, radius, ulna.
femur, tibia or fibula).
(3) Should the patient not be identified as a
trauma alert using the criteria listed in (2) of this
section, the trauma patient shall be further
assessed using the criteria in (3) of this section
and shall be considered a trauma alert patient
when a condition is identified from any two of the
seven components induded in this section.
a. AilWay: Tne patient has a respiratory
rate Df 30 or greater.
b. Circulation: The patient has a
sustained heart rate of 120 beats per minute or
greater.
c. BMR: Tne patient has a 8MR of 5 on
the motor component of the Glasgow Coma
Scale.
d. Cutaneous: Tne patient has a soft
tissue loss from either a major degloving injury,
," r-
,<- ~)
22
Emergency Medical Ser/ices
E:72c:ive 08/0~/98
cr a major nap avulsicn greater than 5 inches, cr
has sustained a gun sriot wcund tc the
ex:remities of the body.
e, Longbcne Fracture: !',e patient
re'/eals signs or sjmptoms cf a single long:cne
frac:ure resultir.g from a meter vehic:e ccllisien or
a Fall From an e!e'/atien ef 10 Feet er greater.
I. Age: The patie:.t is 55 years of age or
clcer.
g. Mec;-'2r.ism of Ir.jur;: The patient has
been ejec:ed frem a mater vehic:e (excluding any
metereycle, meped, all terrain vehic!e, bicycle er
tlie oeen becy of a pick-uo trt.;ck), or the criver of
the mecor vehic:e has imcac:ed with the sreering
wnee! causing sreering whee! ceformity.
(..1) If the parient is noc icenriTiec as a
trauma alert patient after e'/aluating the palient
using the c:-iteria in (2) anc (3) of this section, the
trauma patient wiil be e'/aluated using all
elements of the Glasgow Coma Scale. If tlie
patient's score is 12 or less, the patient shall be
consicered a trauma alert patient (exc!ucing
patients whose normal Glasgow Cema Scale
Sccre is 12 or less, as established by the
patient's medical history or preexisting medical
conditien when known).
(5) Where additional local trauma alert
c:-iteria has been approved by the mecica/
direc~cr of the EMS ser/ics and presented as
part of t.,e state IT? approval process, the use of
local trauma alert criteria 2S the basis for calling a
trauma alert shall be doc:..!mented as required in
section 64E-2.013, F.A..C. Local trauma
assessment c:-iteria can oniy be applied after the
patient has been assessee as provided in (2), (3),
and (4) of this seo:ion.
(6) In the event that none of the conditiens
are identified using the criteria in (2), (3), (4), or
(5) of this section in the assessment of the adult
trauma patient, the EMT or paramedic can cail a
trauma alert if, in his or her jucgment, the
patient's condition warrants such action. Where
EMT or paramedic judgment is used as the basis
for caIling a trauma alert, it shall be coc:..!mented
as required in sec~ion 64E-2.013, FAC.
(7) Tne results of me patient assessment
s,':all be recorced and re:lor:ed in aOCCrC2r1Ce
wit'1 tIle recuiremenrs e~ sectien 6.1E-2.013.
F.A.C.
(8) This r'..~le sh21l :::ec::me effec:i'le 15
menths fr::m the effec:ive ca:e ef the ot'-:er n..:ies
in this c:-:a:: ter,
Specific Authedy 395.405. 401.35 FS. Law
Impleme~ted 395..101, 395,.1015, 395...102.
395.4025, 395..1045, 395.405, 401.30, 401.35
FS. ~is:crf-!'Je\N 3-3-23. ;',~er.ced ~2-10-92. 11-
30-93. Fcrmer~y 100-66.1 02. '~J~er.ded 08-04-
98.
64E.2.01 is Fediatric Trauma Scorecard
Methodology.
(1) =2C;-' E\IS ;:rcvicer shail ensure that
ucen 2r.-ival at ~'-:e leC2t:cn of ar: incicer:t, tlie
EMI or ,cararT~edie s~ail assess t';e pec:iatric
tr2uma ;:2tier.t by e'/alu2tir.S the ;:a:;ent's status
for each cf the fcilowing CCiT1;:cr.en:s: Air.vay.
CCr1SC;eL;Sness, C;rc:..!la:;en, Fract:Jre. Cutaneous
and the ;:ediatric .catient's size when used in
ccnjur.ctien with L';e other ccm;:enents in (3) ef
this secticn, Tr~e assess~ent of L'ie pediatric
patient L:s;ng the weiSht end 1eng:.'1 parameter
and the eU,er Comcenents cf this se:::ion shall be
rerefled to as the Pec:iat:-:c Trauma Sccrecard
Methecclcgy. In assessins the peeiatric patient,
tlie c:-iteria for each of t'ie ccmponer.ts in (2) and
(3) of this section shall be t.:sed to ce,ermine the
transoort cestinatien fer peciat;";c trauma
patients.
(2) !',e E~lT or paramedic shail assess all
pediatric t-auma patients using the following
criteria anc if any ef the feilewing conditions are
identified, the patient shall be considered a
pediatric trauma alert patient:
a. AirNay: In order to maintain optimal
ventilation, the patient is intubated, or the
patient's breathing is assisted t,rough such
measures as mant.:al jaw thrust, single or multiple
suetioning or through the use of other adjuncts to
assist ventilatory efforts.
b. Consciousness: Tne patient exhibits
an altered mental status that induces:
drowsiness, lethargy, the inabiiit'j to follow
commancs, t.:nres;::onsiveness to voice, totally
unresponsive, or is in a cema or t'1ere is the
presence of paralysis; or the suspicien of a spinal
cord injurj; or loss of sensation.
c. CirC:.Jlaticn: The patiem has a faint or
nenpalpabie radial cr femoral pulse or ~'1e patient
has a systelic bleec press:.:re of less than 50
mii:Hg.
C. ,=;actL:re: ~lere is evidence or an coen
leng cene (ht..:mer.1s. raclus, ulna. fer.:t..:r, tibia er
fibuia) fiac:~r= cr the:= are ,~t..:ltfpie ~c:ure sites
or mt..:lti.:::ie c:isleeatiens (except fer isciated wrist
or ankle :Tac::..;res cr cislccar:cns).
e. C;,;tanect.:s: The ;Jatient has a major
soft tissc;e cisruptfcn, inc:uc:ing majer degloving
injurj. er major f1ae avt.:lsiens or 2nd or 3rd
degree ::t..:r.:s to 10 ,ceree::t er r.:cre cf the t;::ta/
boey sc;rface area, sr ar.:;:utarion ;:rexfmal to the
r~r-
"'- '-~
23
Emergency Medical Services
Effective 08/04/98
wrist or ankle, or any penetrating injury to the
head, neck or torso (excluding superficial wounds
where the depth of the wound can be
determined).
(3) In aedition to the criteria listed in (2) of
this section, a trauma alert shall be called when a
condition is identified from any two of the
components induded in (3) of this section.
a. Consciousness: The patient exhibits
symptoms of amnesia, or there is loss of
consciousness.
b. Circulation: The carotid or femoral
pulse is palpable, but the radial or pedal pulses
are not palpable or the systolic blcod pressure is
less than 90 mmHg.
c. Fracture: Tne patient reveals signs or
symptoms of a single closed long bone fracture.
Long bone fractures do not indude isolated wrist
or ankle fractures.
d. Size: Pediatric trauma patients
weighing 11 kilograms or less, or the body length
is equivalent to this weight on a pediatric length
and weight emergency tape (the equivalent of 33
inches in measurement or less).
(4) In the event that none of the criteria in
(2) or (3) of this section are identified in the
assessment of the pediatric patient, the EMT or
paramedic can call a "Trauma Alert" if, in his or
her judgment, the trauma patient's condition
warrants such action. Where EMT or paramedic
judgment is used as the basis for calling a trauma
alert, it shall be documented as required in
section 64E-2.013, FAC.
Specific Authority 395.405, 401.35 FS. Law
Implemented 395.401, 395.4015, 395.402,
395.4025, 395.4045, 395.405, 401.30, 401.35
FS. History-New 08-04-98.
64E-2.018 Trauma Registry.
(1) The department shall operate and
maintain a statewide trauma registry for the
purpose of evaluating the operation of trauma
systems and assessing the quality of trauma care
prDvided by each EMS provider, SA TC,
SAPTRC, and hospital. The deparJT1ent may, by
contract, or agreement allow a trauma agency or
other entity to collect or receive and review
trauma registry data. Such a contract or
agreement shaff be entered into only when the
department determines that the trauma agency or
entity has the capability of collecting and
transferring data to the department. or otherwise
using this data fur department approved
evaluation purposes.
(2) Each EMS previder, SA TC, SAPTRC,
and hospital shail collect trauma regis:ry data and
provide such data to the department, or to the
trauma agency or entity with which the
department has an agreement or contracts, as
follows:
(a) Each E~IS provider shall comply with
trauma registry repor:ing requirements by
completing the run report induding applicable
elements of the trauma information section of
DOH Form 1894, Octcber 93, or Form 1895,
October 93, Florida EMS Report as required in
section 64E-2.013, and DOHP 150-14, October
93.
(b) Each SATC, SAPTRe, or hospital shall:
1. Complete the patient information,
emergency depar:ment, and discharge
information sections of DOH Form 1728, October
93. which is incorporated by reference and
available from the department, when the trauma
patient is delivered to the faciiity by an EMS
provider or arrives by any other means and is
admitted, dies in the emergency department, or is
transferred to another licensed aC'Jte care facility.
Instructions for completing and submitting DOH
Form 1728, October 93, are published in DOHP
150-13, October 93, Rorida Trauma Registry
Guidebook, which is incorporated by reference
and available from the department
2. Submit DOH Form 1728, October 93, to
the department on a monthly basis, no later than
the 15th of the month following the month the
trauma patient was discharged from acute care
or died in the facility.
3. Maintain a completed copy of each
DOH Form 1728, October 93, for a period of at
least 5 years. Copies of these completed forms
shall be made . available for review by the
department upon request.
(3) A transferring SA TC, SAPTRC, or
hospital shall ensure that DOH Form 1728,
October 93, is provided to the EMS personnel
conducting an emergency inter-hospital transfer.
The EMS personnel shall deliver the form with
the trauma patient to the receiving SA TC,
SAPTRC or hospital.
(4) Arly SATC, SAPTRC, hospital or
trauma agency which desires to provide trauma
registry data in any manner other than prescribed
in this section may submit a request to provide
the data by an alternative method. Any request
shall be in accordanca with the intent of sections
64E-2.015 and .018, FAC.
Specific Authority 395.405, 401.35 FS. Law
Implemented 395.3025(4)(f), 395.401, 395.4015,
395.402, 395.4025, 395.404, 395.4045, 395.405,
401.30, 401.35 FS. History-New 8-3-88,
f" ~~
r<_ ..
24
Emergency Medical Ser/ices
effective 08iO~/93
ArT~er.c:ed ~::-~C-:;2, 1 ~-:C-93. For;-neriy 1CD-
66,013.
64~.2.019 Trauma
Requiremer.ts.
Agency
Formaticn
(~) Te :criil a traema a<;e:;cy. a cce~t'/ cr
ccen::es (if regicna!), cr 2:; entity with 'Nr:ic~ tr.e
cCL;nr; cr cct..:r:ties ccntr3C: fer the per;:cse cr
trauriia ser::C8 aCii1inistraticn shall:
(a) C:tain fermal aeihoriiy to create t.~e
2<;e;:Cf frCrii t,~e ccenty ccmmission or eac;-, cr
L"1e cCt..;nt:es in which the a<;er.c,! plans to
c~er3te.
(~) ESt3:lish inter:ecai a,;reeriients
betweer: CCL:r.r; gcveriiments if the prcccsed
2.<;e;:c:1 s;"'lail provice service to mcre L'lar. one
coenrj.
(c) HoIc a peblic hearin<; and give
ace~uate ndce of the hear:ng to the public in :'1e
coun'Y or c:::unries in which the prc~osed trauma
agency shall cperate. Acec;uate notiC8 shall
consist cf pL:ciiShing the notice, at least 30 cays
prior to the public hearing, in at least one
newspa;:er of general cirC:..ilation in each affected
coenty. If a newspaper is not published in a
county in which a prcposec trauma agency shaH
operate, 2.cec;uate notice may be given by
peblishing the notice in at least one newspaper of
general circulation in acjoining affectec counties.
(d) Deve!op and submit an original and four
copies of the trauma agency pian to the
deparu"i1ent for review and approval.
(2) The trauma agency plan shall contain
the following information in the follewing arder:
(a) Table of Contents;
(b) Pcpt..:iation and Geographic Area to be
Served.
1. Desc:-ibe the pooulatian and definec
geograchic area ta be served by the trauma
agency;
2. Induce a map showing the defined
geogi2chic area of the proposed trauma agency,
each major geographical barrier, all medical
facilities, alf prenospital ground and air facilities,
and all ather significant fac:ors that ar.ec: the
determination of the gecgraohic area bouncaries:
and
3. Cesc~ce the histCr:C3J patient neVI,
~atient refe:.al, ar.c transfer ;::attems usee: to
cerine ~';e ~eograpr.jc areas of the prcposed
trauriia a<;en C:/.
(c) Cr;;a~i::3tfcnal Stn..:c:ure:
1. Pro'/ice a cetaiied desc:ipticn of the
manager:al ar.c: adminis..ati'le struc:t..:re or the
proposed agenc/;
2. fnc:t.:c:e a table or organizaticn, the
names of the boarc of cirectcrs and each
rr:emter's amiiacien, anc icent:~/ the inci'/icuals
who will acminlster c:- CCer3!e :he tr2L;ma
agency, if known;
3. Provic:e the names, jcb cesc:-icrions
anc: res;:ensl::Jilities of e~;cials wr.o shall be
cirectly responsible for :'-3L:ma ager.c,! perscnnel,
anc the names, jec cescr:pticns and
rescolisibilities cf ir.civic:..:ais whe shail be
resccr;sible for m2na<;:ng ar;C ecerating the
tr2ema agency en a cad:,: basis; ar.c
4. Desc:-ibe in ce:ail the specif:c actherit'j
that trauma agency ;:e:scnne! snail h2'/e in
c:irectir;g the aceration ef .:rer:OSCit2i 2r~d hos:::it21
entities within the pL:rvie'.'l ef t~e traL:ma agency,
if approved, be it a single cr riiL:lti--:::L:nt'j traL:ir1a
a~enc:/.
(d) Tracma System S~"'~c:L:re:
1, Describe the cceraticn2J i't.;nctior;s of
the system; the c:::mpar.er.ts of the system; the
integration of the c-:riipcr:ems and cperatien2/
functions; anc the Ccori::r:at:en anc inte<;raticn of
the activities and resper.sibilities of SATes,
SAPTRCs, hospitals, ar:c prehaspital E~.IS
provicers; and
2. Include a list cf all par.ici:::ating and
nen-participating trauma care resct..:rcas within
the defined gecgr2phical area cf the propesed
trauma 2gency and dac:.1mentation s~cwing that
these entities have been given the opportunity to
participate in the system. TraL:ma care resources
shall include, but are not limited to, hospitals,
SA rcs, SAPTRCs, prehospitaJ providers, training
centers, and planning entities; anc
3. Induce the propcsec trauma agency's
recommendation and justification for the number
and location of SA TCs and SAPTRCs re~uirec to
serve its defined geographical area.
(e) Objectives, Prc:::osed Actions, and
Implementation Schecule. Provide a desc:ipticn
of the objectives of the plan, a cetailec list of t'le
proposed actions necessarJ ta aocomclish each
objective, and a timetable for the implementation
of the objec:ives ,md acticn. The timetable shall
icentify the Scheduling cf t.~e annual audit and
evaluation, incluc:ing the completion date 2nd
submission date to t'1e cepar:ment.
(f) Desc:ibe thecrccosed source or
income 2nd antic:cated e:censes by ca:egcrj fcr
the proposed tra~riia a<;er.c~:;
(g) Describe the .cr::cosec traL:ma
ac;enc:;'s fiscal imcac: cn :,":e t:-aL:ma sys:em
wnic~ inc:cces a c:esc:-:c::en of 2ny ;r.c:-easec
ccsts related to provicing :r2C:...T:a care,
(h) Transpar.ation S:/s:em Design:
1. Describe the E~,IS crcunc, w2ter, 2nd
air transcartation system c:e;ign or L'le tracma
system; and
~'S
25
Emergency Medical Services
Effective 08/04/98
2. Include trauma patient flow patterns,
emergency inter-hcsoital transfer agreements,
and the number, type, and level of service of
prehospital EMS providers within the trauma
system.
(i) TIPs:
1. Provide confirmation that existing
depar"Ji'lent-approvec TTPs for each EMS
provider, within the cefined geographical area of
the proposed trauma agency, are accurate and
shalf be adopted by t..'ie proposed trauma agency,
pending department aoproval of the plan;
2. A proposed trauma agency may
develop uniform TT?s for department approval
that shalf be adhered to by all EMS providers that
serve the geographic area of the proposed
trauma agency. If uniform TTPs are submitted to
the department for approval, the TIPs shall
include the name of each EMS prDvider that shall
operate according to the uniform TIPs, and proof
of consultation with each EMS provider's medical
director. TIPs developed arid submitted by a
proposed trauma agency shall be processed in
accordance with section 64E-2.016, F.A.C.; and
3. The proposed trauma agency shall
provide a copy of any county ordinance
governing the transport of trauma patients within
the defined geographic area of the proposed
trauma agency.
Q) Medical Control and Accountability.
Identify and describe the qualifications,
responsibilities and authority of individuals and
institutions providing off-line (system) medical
direction and on-line (direct) medical control of all
hospitals and prehospital EMS prDviders
operating under the purview of the trauma
agency .
(k) Emergency Medical Communications:
1. Describe the EMS communication
system within the proposed trauma agency's
trauma service area; and
2. Describe the proposed trauma
agency's compliance with the State of Florida
Communications Plan, requirements for normal
operating conditions, mass casualty and disaster
situations in which commercial power, telephone
lines or telephone services are not available,
including outages of base stations controlled by
leased telephone lines. The specific areas to be
addressed are:
a. Statewide medical coordination (SMC);
b. Local medical coordination (LMC);
c. Vehicle dispatch and response (VDR);
d. Medical resource coordination;
e. Local scene coordinatiDn;
f. Medical alert paging;
g. Communications coverage;
h. LMC and VCR c..,annels;
i. SMC channel;
j. Cellular phone use if appliC3ble; and
k. Locations and types of communications
equipment within the proposed trauma agenc,/s
geographical area.
(I) Data Collection. Desc:-it:e the trauma
data management system developed for the
purpose of documenting and evaluating the
trauma systems operation.
(m) Trauma System Evaluation. Describe
the methodology by which the proposed trauma
agency shall evaluate the trauma system.
(n) Mass Casualty and Disaster Plan
Coordination. Desc.~be the proposed trauma
agency's coordination of the prehospital and
hospital component's mass casualty and disaster
plan for the defined geographic area it
represents.
(0) Public Information and Education.
Describe the proposed trauma agency's
programs designed to increase public awareness
of the trauma system and public education
programs designed tD prevent, reduce the
incidence of, and care for traumatic injuries within
the defined geographic area it represents.
(p) Attachments. Include the following:
1. A copy of each contract and agreement
entered into by the proposed trauma agency,
pending department approval of the proposed
trauma agency, for the benefit and operation of
the trauma system; and
2. A copy of the public hearing notice and
minutes of the hearing.
Specific Authority 395.405, 401.35 FS. Law
Implemented 395.401, 395.4015, 395.402,
395.4025, 395.40.5, 401.35 FS. History-New 8-3-
88, Amended 12-10-92. Formerly 100-66.104.
64E-2.020 Trauma Agency Plan Approval and
Denial Precess.
(1) The department shall, within 30 days of
receipt, review the propDsed trauma agency's
trauma system plan and notify the proposed
trauma agency that the plan is complete. or that
there are omissions. If there are omissions, the
department shall request the required additional
information to be submitted by the proposed
trauma agency.
(2) The proposed trauma agency shall
submit the requested additional information to the
department within 30 days of receipt of the notice
of omissions.
(3) The department shall deem the plan
complete upon receipt of the additional
information or the expiration of the 30-day time
period, whichever occurs first.
~'K)
26
Emergency Medical Services
Effective 03/04/93
(~) The c8:::ar.0.ent s.:ail re'/ie'.'l the .i:lan to
ceter.T1ine c::::mpiiar.c8 with chaeters 395 ar.c
~OI, FS., anc c:-:apters 100-23 anc 6.ii::.2.
FAC., within 60 cays of receipt of the accitier.at
inrcr.71a:ien er er the plan being ceeG-:ec
c:::r.-:clere,
(5) Tne ce~2;-::71ent shall iss~e a le~2r cf
accrclfal to the ~.cccsec traL1ma age:.c:/ L:ccn
ceter.T1inaton that the pian is in cCri1piiar.ce wi:h
chaeters 395 and .iO ~, F3., and chapers 10C-25
and S.ii::-2, FAC,
(6) Tile Cecai~'71ent shail issL:e a letter cr
Geniai to the ;:;rcpesed a\;enci' t..:::cr.
ceter.T1ir.at:en that t:-:e plan is net in ccr.-:::/iar.ce
with cha:Jters 395 anc 401, FS., anc chae:ers
100-23 and 6J.i::-2, F.,A,.C. Tne letter s.'1ail
scec:~/ t."1e cef:cie:.c:es in the plan ar.c inc::..:ce
net/Rcalicn or any right to a hearing pursi.1ar.t to
sectien 120.5/, FS.
Spec:Rc Authcrity 395.405, 401,35 FS. Law
Imple:.:ented 395,401, 395.4015, 395,.102,
95.4025, 395.405,.101.35 FS. Histarj-New 8-3-
88, .AJrlenced 12-10-92. Formerly 100-66.106.
64E..IJ21 Trauma Agency Implementation and
Operation Requirements.
(1) To imple:.:ent a trauma system, a
depa~Ji1ent-approvec trauma agency shall:
(a) Implement the trauma system in
ac::crcance with its department-approved
planned timetable for implementation.
(b) Submit proposed changes to the
deparu"7ient-approved plan to the deparrrnent fer
approval, as proviced in section 64E-2.020,
FAC. Tne trauma agency may, at its own risk,
institute proposed c:;anges to the plan and
submit a request for department approval within
30 days after a change is instituted if a delay in
approval would have an adverse impact on the
c:..:rrent le'/e! or care. Tne trauma agencis
request shall explain how the delay in approval
wouid have adversely affected the current leve! or
care. E:::c."i request shall decument that affec:ad
trauma care resources within the denned
geographical area of the agency c::ncur wiL.,
these prcccsed changes.
(2) ::3ch tral.:ma agency shall ccer::::te ~":e
trauma system in acc:::rdance with L~e
decar-w-:-:er1c-appr::vee .:Jian, anc shall:
(a) Coneuct re'/ie'NS of SA TC ane
SA?TRC a::::plications :Tcm any hospital wit'1in the
cenned gecgraohic area er the traur.-:a agenc~(.
SL10mission ef an SA TC er an S,..\?TRC
appiicatien to the trauma agenC'j by a hos:it21
seeking apcroval shail :e in acccrdanC8 with t.'1e
time frar.-:es desc~ted in section 64E-2.02d(1)(c),
'30
F,AC. Reselts cf the :'-:::'..;r.-:2 ager.c,/s re'/iew
shall :::e si.1:mitted :0 the ce:Jar.r.-:ent ;-:c later than
.A.pril 7 or e3ch year, in creer :c t:e cc:-:siCeree by
the cecar.rr.ent.
(b) CcnCL1C: re'/jews cf Cicccsec er revised
TIPs submittec :::y e2C1 :::.\~S .:rcvice: withir. the
cefjr.ec gecg.2ph:c are::: cf tre tiaur.-:a ager.c:/.
Res~!~s af each re\lie\~v 5;-:211 be swc~it:ec to the
cepar.rr.er.t within 15 ca:/s cr receiot er the
prar:;csed cr re'/ised TT:=s, in erc:er to be
c::::nsieerec: by the cepar_"'i:er.:.
(c) Ccneuc: anr.ual pe:.'armance
e'/a/ualiens er the trauma SiSter:-: anc submit L"1e
results to the Ceoar..--:-:er.t fer apcroval, as
pralfieec in secticn 6.i:::-2.02Q, F..';.C. The
evaluatien reper: shall :e si.1t:~it:ec within 60
cays after cemolerien cr L":e e'/aJua:;cn. This
evaluation shall inc:L1de 2t leas: the fcllowing:
1, Results of ri1cnitcring each E:vIS
proviter, SA TC, S;'.?TRC anc hcspit;::l within the
derinee geographic area ef the tiauma agency for
compiianc8 with trauma s.:erecard methodelogy
reGuirements as pravidec in sections 64E::-2.017,
and 64E-2.0175, FAC.
2. Results of ri1cnitcring each EMS
provide:, SATC, SAPTRC and hospital within the
cefined geographic area cr the trauma agency far
compliance with 1T? reGuirements as provided in
section 64E-2.015, FAC.
(3) Each trauma agency shall have
personnel or arrange fer ri1anagement service
personnel with clear authcrity and responsibility
to operate the trauma agency. Tne
administrative function of the trauma agenC'f shall
not be carried aut or per.'er.nec under the direct
super/ision of any individual who acministers or
operates any health care entity in the trauma
system, whether a single or ri1uitk:::unty system.
(4) Tne deparu-nent shail withdraw trauma
agency approval at any time if the trauma agency
fails to effectively meet the needs or the persons
served by the trauma ager.C"j or if the cepar:ment
determines that implementatien is inconsistent
with the de;:artment-approvec trauma agenC'j
plan, c~apters 395 and 40~, FS, or rules of the
deparul1ent.
Specific Autherity 395.~C5. ~01,35 F3. Law
I,"'i:piemented 395.~0I, 395.~015, 395.402.
395.4025, 395.405, ~01.35 ~3. :-:is:cry-New 12-
10-92. Fcrme:iy 100-66.1 CC5. A.-:-:eneec 08-0J..-
98.
64E-2.022 Appor.ionment of State-Approved
Trauma Centers (SA TC) or State-Approved
Pediatric Trauma Referral Centers (SAPTRC)
within a Trauma Ser/ica Area (TS~).
27
Emergency Medical Services
Effective 08/04/98
(1 ) The number and composition of TSAs
shall be in accordance with section 395.402, FS.
(2) The number of SATCs or SAPTRCs in
each TSA shall be in accordance with the
minimum number set forth in the table below
which is replicated from table 3.3 in "A Report
and Proposal for Funding State-Sponsored
Trauma Centers," February 1990, except as
prDvided in this section. Each trauma service
area shall have at least one Level I or Level II
SA TC position.
(3) The number of SATC or SAPTRC
positions for each TSA is as follows:
TSA
Counties
SA TC or SAPTRC
1 Escambia; Okaloosa; Santa Rosa; Walton 2
2 Bay; Gulf; Holmes;Washington 1
3 Calhoun; Franklin; Gadsden; Jackson; Jefferson; Leon; Liberty; Madison; Taylor;
Wakulla 1
4 AJachua; Bradford; Columbia; Dixie;Gilchrist; Hamilton; Lafayette;
Levy; Putnam; Suwannee; Union 2
5 Baker; Clay; Duval; Nassau; St. Johns 2
6 Citrus; Hemando; Marion 1
7 Flagler; Volusia 2
8 Lake; Orange; Osceola; Seminole; Sumter 3
9 Pasco; Pinellas 3
10 Hillsborough 2
11 Hardee; Highlands; Polk 3
12 Brevard; Indian River 2
13 DeSoto; Manatee; SarasDta 3
14 Martin; Okeechobee; St. Lucie 1
15 Charlotte; Glades; Hendry; Lee 2
16 Palm Beach 2
17 Collier 1
18 BrDward 4
19 Dade; Monroe 6
TOTAl 43
(4) Any TSA which did not have a hospital
approved by the department as a PrDvisional
SATC or Provisional SAPTRC by May 1, 1991,
will have its assigned number of positions
reduced by one on that date. TSAs that have
only one available position are not affected. The
additional position(s) will be reserved and
assigned at the discretion of the department.
Due to an error in addition, the single trauma
center not designated by the table contained in
-A Report and PrDposal for Funding State-
Sponsored Trauma Centers", February 90, shall
be assigned at the discretion of the department.
Specific Authority 395.405 FS. Law Implemented
395.401, 395.4015, 395.402, 395.405 FS.
History-New 12-10-92. Formerly 100-66.1075.
64E-2.023 . SA TC and SAPTRC Requirements.
(1) The standards for Level I and Level"
SA TCs, and SAPTRCs, are pUblished in DH
Pamphlet (DHP) 150-9, March 98, State-
Approved Trauma Center and State-Approved
Pediatric Trauma Referral Center Approval
Standards, which is incorporated by reference
and available from the department.
(2) To be a Levell SATC, a hospital shall
be a state licensed general hospital and shall:
(a) Meet and maintain after receiving
provisional status and during the 7 year state-
approval periDd the standards for a Level I SA TC
and the standards for a SAPTRC as provided in
DHP 150-9; .
(b) Meet the site visit requirements
described in section 64E-2.028, F AC.;
(c) Meet and maintain after receiving
provisional status and during the 7 year state-
approval period the requirements provided in
section 64E-2.018, F.A.C., regarding the
collecting and reporting of trauma registry data;
and
(d) Maintain and update at feast annually
an in-hospital copy of the application that was
approved by the department as described in
section 64E-2.024, F.A.C., so that the application
reflects current and accurate information.
Documentation used by the SA TC or SAPTRC
to update the application, but maintained
eslewhere between annual application updates
shall be immediately available for department
31
28
Emergency Medical Services
E~ec:ive 08/04/93
re'llew at any t:r~e. I ne aopliC2tien shall be
ma'ntainec ar:d uccatec after receiving
prcvisicral status and cunng the 7 year state-
a~:roval periee, and organized in the same
~2nr:er as was re~uirec at the ti~e ef
aCClic3ticn.
(3) To be a Le'/e! II SA TC, a hospital shall:
(a) ~,feet ai~C l7iaintain af:er receiving
prc'/isicnal status ar:d curing the 7 year state-
accroval periec the star:carcs for a Le'/e! /I
SA -;-C as ,cro'/icec in Dr.? 150-9, 1I.larch 98;
(::) Meet tr~e site visit rec;uirel7ients
cescr:bec ;n section c':~.2.023, F _j.,.C.;
(c) Meet anc l7iaintain after receiving
pro'lisionai status ane during the 7 year state
accroval ,ceriec t.~e rec;uirements provieec in
sec:icn E.:=:-2,018, FAC., regarding the
cei/ecting anc repor::ir:g of trauma registrj data;
ar.c
(c) ~Iaintain ar:d upcate at least annually
an ir:-hoseitaJ cepy of the application that was
approved by the department as described in
section E4E-2.02.:, F.AC" so t."at the application
renects c:.JITent and accurate information. Tne
application shall be maintained and updated
after receivir:g previsional status and during the
7 year state-approval period, and organized in
the same manner as was required at the time ef
appiication.
(4) To be a S;';::TRC, a hospital shaH:
(a) Meet and maintain atter receiving
previsional status and curing the 7 year state-
approval period the standards for a SAPTRC as
provided in OHP 150-9, March 98;
(b) Meet the site visit requirements
desc~bed in sec:ion 64E-2.028, FAC.;
(c) Meet and maintain arter receiving
provisional status and during the 7 year state-
approval period t'1e requirements provided in
section 641:-2.018, FAC., regarding the
col/ecting and re;Jorting of trauma registry data;
and
(d) Maintain and update at least annuaHy
an in-hospital copy of the application that was
approved by the cepartiient as desc~bed in
secticn 64E-2.024, FAC., so that the acolication
retlec>..s c:...:r.ent and a cc:...: rate infcm,atien.
Dec:"':l7ientatien used by tne SA TC and SAPT2C
to Ijpcate the ap::iica,ion, but maintained
elsewhere between annual aoolicatien uocates
shaH be iITiITiediate!y availabie for department
review at any ti~e. Tne application shail be
maintained and uodated atter receiving
provisienal status ane curing the 7 year state-
approval per:cd, and ors;anized in the same
manner as was rec;:...:ired at the time ef
appliC2tion.
(5) T;~e s:.::ncarcs pL.;:iishec in Or.P 150-
9, March 98, are s:...:bjec: ~o re'/isien at any time
through rule premulgation, ;'J~Y hoseit.::1 t.'1at has
been granted Provisior:al SA TC or Provisional
S;.,pTRC status cr has bee;, s;rantec a 7 year
Cer:ificate or S~ate Apcraval as a SA TC er
SAPT::\C s,~all comply with ail re'/isicns to the
star:carc:s pd:lis,":ed in Or..:l 1 50-9, be~jnning en
the cate the ame;.ced rule ceccmeseFective.
Specific t-.utherity 395."!'C5 1"",::,. L3w
Imclel7iented 395.401, 395."!'015, 395.402.
395.-1025. 395."!'CJ, 395.4C"!'5. 395."!'05 F3.
~istcr!.i'Jew 8-3-23, AJlle;.cec: 12-10-9:2. 12-10-
95. Formerly 100-66.108, .AIi':e:.cec 08-04-98.
64E.2.024 Process for the Approval of
SA TCs and SAPTRCs.
(1) Eeginning Septe!T:ce: 1, 1990, and
annually there3fte:, the ceOertment shall
approve SA TCs and SA?T;:I,Cs in ac:crdance
with the schedule shown in Taele VII; (Unless
stated otherNise ail dates given by c31endar
month anci day refer to that cate each year.)
(a) The department shail accept a letter of
intent, DOH Form 1840, July 95, .State-
Approved Trauma Center Letter of Intent", which
is incorporated by reference and avaifabie from
the depar::ment, postmarked roo earlier than
September 1 and no later t.'1an midnight, October
1, from any aC:.Jte care general er pediatric
hospital. Tne lette: of intent is non-binding, but
preser/es t~e hospital's right to submit an
application by the required due date if an
available position, as proviced in section 64E-
2.022, FAC., exists in the hospital's TSA If the
hospital dces not submit an application by April 1
ef the following year, the hospital's letter of intent
is void;
(b) By October 15, the cepartment shall
send to those hospitals sub~jr.ing a letter of
intent an appiication paCkage which will include,
as a minimum, instructions for submitting
information to the cepartment fer selection as a
SATCorSAPTRC,OHP 150-9,Ma~h98,S~te-
Acproved TraL.;ma Center anc S tate-.~.e:JrO'led
Pediarric Trauma Refe:.ai Center Acproval
Standards, which is inccr;:crated ::y reference in
secticn 6.i=:-2.023, FAC., ar:c the re~:.;ested
acclicatien (s);
(0) Nc later t."1an t-cd 1 ef t.'1e calendar
year fellewing the submission of a letter of intent,
a hese/tal see,~ing appreval as a SA TC cr
SA.oTRC shail submit to t.~e ceoar:j7;ent an
crfgir:al and 3 cccies of t1":e ac:iicaticn OOH-H
Fer.r. 2032. July 95, A.ppliC2tic~ fer Level I State-
Approved TraL.:ma Center, or CC~-H Fcrm 2043,
3~
~c
.:;-
Emergency Medical Services
Effective 08/04/98
July 95, Application for level II State-Approved
Trauma Center, or DOH Form 1721, July 95,
Application for State-Approved Pediatric Trauma
Referral Center, which are incorporated by
reference and available from the department.
Each hospital in a TSA with' a department-
approved local or regional trauma agency shail, .
at the time a SA TC or SAPTRC application is
submitted to the department, submit a duplicate
of the application to the trauma agency for
review. Recommendations from the trauma
agency shall be submitted to the department no
later than April 7, as provided in section 64E-
2.021, FA.C.
(d) After considering the results of the
focal or regional trauma agency's
recommendations, the department shall, by April
15, conduct a provisional review to determine
completeness of the application and the
hospital's compliance with the critical standards
for prDvisional status.
1. The critical standards for provisional
review for level J and Level II SA TC applications
are specified in DHP 150-9, March 98, as
follows:
STANDARD
I. Commitment A, S & C 1, 3 & 4;
N. Surgical Specialties Availabilities: A(1)
a & b,(2)a, b, B(7);
V. Non-Surgical Specialties Availabilities:
A;
VI. Emergency Department; Division;
Service; Section: A, B(1 )f, (2)f, (3)a, b, c, & f, C
5,6 & 7;
VII. Operating Suite Special Requirement: A
1 & 3;
IX. Intensive Care Unit: A(1 )a, b, & c;
XIII. Radiological Capabilities: C; and
XVI. Quality Management A, 8, C, 0 & E.
2. The minimum standards for review for
Provisional SAPTRCs are the fDllowing portions
of DHP 150-9, March 98;
STANDARD
I. Type of Hospital;
II. Surgery Department; Division;
Services; Sections: A;
III. Surgical Specialties Availabilities: A 1,
2,3&4;
V. Non-Surgical Specialties Availabilities: 1,
8, & 13;
VI. Emergency Department (ED): A, S, 0, &
H;
A;
VII. Operating Suite Special Requirements:
1;
IX. Pediatric Intensive Care (P-ICU): A, C,
XVI. Quality Management: A, B, C, 0, & E;
(e) No later than April 15, each hospital
whose application the department finds to be
unacceptable or deficient during the
department's provisional review, will be notified
in writing of deficiencies and given the
opportunity to submit additional clarifying or
corrective information.
(f) The hospital shall submit the
requested information to the department by
close of business 5 working days after April 15.
Failure tD provide the requested information, or
failure to successfully address the deficiencies
identified by the department, shall result in the
denial of the hospital's application.
(g) The department shall send written
notification to each applicant on or before May 1:
1. The department shall notify each
hospital whose application it has found
acceptable upon completion of the provisional
review that the hospital shall operate as a
Provisional SA TC or Provisional SAPTRC
beginning May 1;
2. The department shall inform each
hospital whose prDvisional application it has
denied of the remaining deficiencies in the
application and shall inform the hospital that it
may submit a letter of intent at the beginning of
the next apprDval cycle.
(h) The department shall, between May 1
and June 30, complete an in-depth review of all
sections of the Provisional SATC's or Provisional
SAPTRC's application. The department shall
notify the hospital of any omissions, deficiencies,
or problems and request additional information to
be submitted by the hospital.
(i) To have additional information
considered during' the department's in-depth
review of the application, the Provisional SA TC
or PrDvisional SAPTRC shall submit the
requested additional information to the
department no later than September 1.
m By September 30, the department shall
determine whether the omissions, deficiencies,
or problems have been corrected. The
department shall notify each Provisional SA TC
or Provisional SAPTRC on or before October 1
of any omissions, deficiencies, or problems that
were not resolved by submission of the
requested additional information.
(k) Provisional SA TCs and Provisional
SAPTRCs are subject to a site visit from October
1 to May 30. Any Provisional SA TC or
Provisional SAPTRC that was notified by the
department on or before October 1 at the
concJusion of the in-depth review that omissions,
deficiencies, or problems were not resolved shall
be given 30 calendar days from the department's
3<")
, .
30
Emergency Medical Services
Effective 08/04/93
nctification fcllowing the c:::::mpletion cf the site
visit to proviee aeeitienal infer:-:1aticn, as
eisc:..Jssed in see:ien 6.1E-2.028, FAC.
(I) Tile cepar'.rnent shall teny L'1e
acplieation of any F;cvisicnal SA TC or
F;ovis:onal SAPT?C L'!a: has not eorreetec the
emissions, eefie:ene:es, er ,creb/ems noted rrof71
L'le in-cepth re'liew within 30 e3jenear cays from
L'le ee.car::-:1ent's notifc3ticn fc/lowin~ the
c~mple:ion of the site '/isit, as provieec in section
6..1E-2.028, FAC., regar:less of the fineings of
t.'1e eut-of-state re'/lew te2m regarcjn~ the
~L;alii'! ef trauma patient care and tra!.1ma patie:1t
management proviced by :he Provisienal SA TC
or Fmvisienal SAPTRC.
(171) 3y July 1, the decar,,'T1ent shall appro'le
cr deny SA TCs anc SAFTRCs based upen t.'1e
rec:::mmerications of the out-of-s,ate re'/lew
team, t.'1e result of the in-<:iepth re'/iew anc, if
necessary, upon applicaticn of the aceitienal
c:-iteria in section 64E-2.023(1 0), FAC.:
1, Tne deparment shall issue the
certificate of state-approval to the hospital upon
approval as a SA TC or SAPTRC;
2. Tne depar'ment shall issue a letter of
cenial to eaoh hospital not approved as a SA TC
cr SAFTRC, specifying the basis for denial and
informing the hospital of the next available
approval cycle, and the hospital's right to an
acminist:-ative hearing pursuant to sections
120.57 and 395.4025, FS.
(2) Each hospital denied provisional status
or not approved as a SA TC or SAPTRC, may,
within 30 days of receipt of the denial notice,
re~uest a hearing in whioh to contest the fincings
of the cepartment.
(3) Tne department may deny, suspend,
er revoke the approval of any Provisional SA TC,
Frovisional SAPTRC, SA TC, or SAFTRC which
misrepresents a material fact in its application for
trauma center approval, including the site survey
precess.
Specific Authority 395.405 FS. Law Implemented
395.031,395.401,395.4015,395.402,395.4025,
395.404, 395.4045, 395.405 FS. History-New 8-
3-88, .A~enc!ed 12-10-92, 12-10-95. Formerlv
100-66.109. .Amenced 08-04-98. .
6~C:.2.025 Extension of Application Period.
(1) Any hospital r.:ay re~uest that the
CeCaiU'T1ent grant UD to 18 menths accitienal
time to c:::mp/ete its acpiication to become a
SA TC er S;.,pTRC if the hoseital deterri1ines
prior to sucmitting an application that tr.e hospital
wnnot meet all of the c.-: tica I stan cares as
prcvicec in section 64E-2.024(1 )(d), F ..A.C, Tne
c:-itical standards proviced in sectien 64E-
2.024(1) (d), FAC., are the only standares for
which an extensicn shall be c:::nsidered. I,le
rec;uest for extensien mL;st also comply with L~e
rec;uiremerits proviced in this sec:ian.
(2) To be eonsicered fer an extension, a
hoscital must submit an aD plication in
ac::::rcanee with the rec;uirements in sectiori
6-+E-2.024, FAC., to~et;~er with a rec;uest far
extension. Tne re~uest far extension mL;st
e::ntain the following:
(a) the specific date the hcseital cesires to
have the eeparment begin the provisienal
re'/iew of the hospital's aeaiicatien;
(b) a refererioe to eac" standard, or
specific part of a standare, in OHP 150-9, i\lar::h
98, State-A.porovec: Trawna Center and State-
Appro'led PediatMc TraL;ma Referral Center
Approval Standards which is incorporated by
reference in section 64E-2.023, FAC., that the
hospital is unable to meet;
(c) for each s,ancard, or specific part of a
standard, that the hospital is unable to meet, a
detaifed and separate explanation as to why the
standard, or speciflc part of a standard, cannot
be met; and
(d) an action pian that desc:-ibes the major
activities planned to meet each stancard, or
specific part of a standard, and the completion
date for each activity.
(4) Tne depar'ment shall, by April 15,
conduct a review of the hospital's extension
request for completeness and to determine any
deficiencies.
(5) No later than .A.pril 15, hospitals with
extension requests found to be incomplete or
deficient will be notified in writing of the
deficiencies or incomplete sections, and shall be
given the opportunity to submit acditional
c:arifying or corrective information.
(6) Tne hospital shall submit the
requested information to the depar:ment no later
than 5 working days after receipt of the
department's notification. Failure to provide the
requested infcrmaticn or faiiure to adcress the
ceficienc:es or incompiete information identifiec
by tile department shall result in the denial of the
hospital's extension rec:uest.
(7) I ne deparu"'71em shail notif; t'1e
hosoital on or before May 1 of t.~e approval or
Cenial of the hospital's extension re-:::uest. ff the
ex,ension is grantee, the depar:ment shail
pr::'Iic!e written notification to the hospitai of the
beginning and ending dates of the extension.
(8) Tne depar,,'T1ent shall make a final
deterii1inaticn on whether to aocro'le or deny a
hosoital's extension rec;t..;est. 'cnly after tile
provisional review of all oUler SATe or SAPTRC
.., 1
.j-
31
Emergency Medical Services
Effective 08/04/98
applications in the hospital's TSA are ~mpleted,
and it has been detennined that the number of
SA TCs, SAFTRCs, Provisional SA TCs and
Provisional SAFTRCs in the hospital's TSA is
less than the allocated number of positions
available for that TSA
(9) If the hospital's request for extension is
denied, the hospital may, within 30 days of
receipt of the notification of denial, request a
hearing to contest the decision of the
department., in accordance with chapter 120.57,
FS.
(10) The hospital may modify any date for
completion of a major ac-jvity in the department-
approved action plan discussed in (d) of this
section without prior department approval.
When any date for completion of a major activity
is modIfied by the hospital, the hospital must
provide an updated action plan to the
department The hospital must complete all
major a~jvities within the extension period
granted by the department. The department will
net begin the provisional review of the hospital's
application fer approval as a SA TC or SAPTRC
at the end of the extension period, or earlier at
the request of the hospital, unless the hospital
can substantiate completion of all major activities
32
in the action plan. Toe department may conduct
a site visit to detennine the hospital's ~mpliance
with the approved action plan.
(11) The department shall begin a
provisional review of the hospital's SA TC or
SAPTRC application on the date the hospital
specified in the extension request., as approved
by the department. The hospital may request
that the department begin the provisional review
earlier than the date specified in the extension
request if the hospital completes all action steps
before the expiration of the approved extension
period. The department's provisional review of
the hospital's application shall be conducted in
accordance with the timeframes fer processing
the application provided in section 64E-2.024,
F AC., but will not coincide with the dates
provided in that section. .
(12) The hospital shall ensure that the
SA TC or SAPTRC application provided at the
time the hospital submitted the extension request
is current on the date the department begins the
provisional review.
(13) A hospital receiving an extension
greater than 12 months shall have its extension
tenninated if the number of SA TCs, SAPTRCs,
Provisional SA TCs or Provisional SAPTRCs'in
JS
----~--~~--~~----------------------
I ~ I I
--------~~~-~~~-~-----------____. .t
I ~ I ~ I
-----------~----------------------,
Ii [ ~ /
------~~~-~~-~-~~~~~-~~-~-~~=__~__I
I ~ I ~ I
-----~----~--~--~~----~-----~--~--I
I ~ I ~ /
--~-~=-~=~=~~~~=~~===~==~~~~=====~,
I ~ I ~ /
---------~~--=----~-~-~-~--~------,
I ~ I ~ I
---------------------~---~--------,
I ~ I ~ I
--------~-~~-~~~-~=-~~-=~~--~=-~=-,
I ~ I ~ /
---------~--------~--------=----~-,
I g I ~ /
---------------------~-_._--------,
I ~ I ~ /
----~--~~--~-~------~--~~~~~----~~,
I ~ I ~ /
---~--~~~---~-~~~--~---~~~~-~~~~--,
I ~! ~ I
----------~---~-------------------,
/ ~ I j /
~---~--------~------~-~-------*-~--,
~l!l--__________._!________________!
~~I~I :# - . I
~~--------~._---~~~~~~~----~-----~~~,
~.I.J/~f :#:# /
!:;:~ 21 ~ i
WW~----__________________~___________,
a:~I'ffil :#:# I
~.j~ ... ~ ~
~~----~-------~~--~-~------~-----~--,
.g:I~1 ~ I
~~----___a________________~_________,
~~/~I ~ I
~------------------~----~--~-=-~---,
~ I ~ I ~ /
~----------------------------------,
/g/ =-:# /
--_._-------------------------~~~-,
I ~ I ~ I
--~--~--~~~~-~---------~--~--~----,
I
I
~ ..
.. 1; ~ ~ .. .~ ~
~: I _i i j i ~ i J1;~ ~ =] ~ [I
~ ~ ~ j ~ - ~ ~ ~ ~ ~= ~ ;~.
~ i ~ i t j ~ 1 i i i li ~ !;~
~ j i : i i 1 i j~ i ai ~j g i~
j J 8 j ~ J l j ij j i~ ij i J>
i j t i ! i i ! 111." ~ 11 j~ < i~
~ ~ l l i ! ! 1 =~ ~ JI ~j ~ ~:
-------------------~---------------
36
'1'1
Effective 08/04/98
Emergency Medical Services
the hospital's TSA equals the number of
available positions allocated to the TSA,
resulting in the denial of its application and the
department will inform the applicant of its right to
a section 120.57, FS.. hearing regarding this
denial.
(14) The department shall complete an in-
depth review of the application of each hospital
that received an extension and became a
Provisional SA TC or Provisional SAPTRC within
90 days of the hospital receiving provisional
status according to the following schedule:
(a) The department shall review the
application and inform the Provisional SA TC or
Provisional SAPTRC of any omissions.
deficiencies. or problems within 30 days of the
date the department begins the in-<lepth review;
(b) The Provisional SA TC or Provisional
SAPTRC may provide additional infDrmation in
response to the department's notice of
omissions, deficiencies, or problems within 30
days of receipt of the department's notification.
If the Provisional SA TC or Provisional SAPTRC
does not provide additional information within 30
days. the department shall inform the Provisional
SA TC or Provisional SAPTRC of any omissions,
deficiencies, or problems that were not corrected
at the conclusion of the in-depth review.
(c) If the Provisional SATC or Provisional
SAPTRC submits additional information, the
department shall review the additional
information and inform the PrDvisional SA TC or
Provisional SAPTRC of any remaining
omissions. deficiencies, or problems that were
not corrected at the conclusion of the in-depth
review.
(15) A hospital approved by the department
as a Provisional SA TC or Provisional SAPTRC
fallowing an approved extension period, shall
receive a site visit during the next scheduled site
visit phase. The hospital shall operate as a
PrDvisional SA TC or Provisional SAPTRC no
less than 6 consecutive months prior to the site
visit.
Trauma Center Certificate of Approval. or DOH
Form 1721A, October 91, State-Approved
Pediatric Trauma Referral Center Certificate of
Approval, which are incorporated by reference
and available from the department. Tne
certificates shall include:
(a) The date effec:ive and the date of
termination;
(b) Tne hospital's name; and
(c) The approved trauma center level.
(2) Unless sooner suspended. revoked, or
terminated pursuant to section 395.0335 (8), FS.
the certificate shall expire 7 years after the date
of issuance.
Specific Authority 395.4025, 395.405 FS. Law
Implemented 395.401, 395.4015. 395.402,
395.4025, 395.404, 395.4045, 395.405 FS.
History-New 8-3-88, Amended 12-10-92.
Formerly 100-66.110.
64E.2.026
Certificate of State-Approval.
64E.2.D21 Process for Renewal of SATCs and
SAPTRCs
(1) At least 14 months prior to the
expiration of the SA TC or SAPTRC certification,
the department shall send, to each SA TC or
SAPTRC that is eligible to renew, a blank DH
Form 2032R, Dec. 97, State-Approved Trauma
Center Application to Renew, which is
incorporated by reference and available from the
department, in accordance with the provisions of
this section. Within 15 calendar days after
receipt, the SA TC or SAPTRC choosing to
renew its certification shall submit to the
department the completed DH Form 2032R,
Dec. 91.
(2) All rE!newing SA TCs or SAPTRCs shall
receive an on-site survey after the department's
receipt of the completed DH Form 2032R. Dec.
97. The department shall notify each SATC or
SAPTRC of the results of the site survey within
15 working days from completiDn of the site
survey. If the SATC or SAPTRC desires to
provide additional information regarding the
results of the site survey to the department to be
considered, the information must be provided in
writing and be received by the department within
30 calendar days of the hospital's receipt of the
department's notice. If the SA TC or SAPTRC
elects not tD respond to the department's notice
within 30 calendar days, the department shall
make the final determination of approval or
denial based solely on information collected
during the applicant's site survey.
(3) At least 45 days prior to the expiration
of the certification, the department shall
simultaneously notify each facility in writing of
Specific Authority 395.405 FS..Law Implemented
395.401, 395.4015, 395.402. 395.4025, 395.404,
395.4045, 395.405 FS. History-New 12-10-92,
12-10-95. Formerly 100-66.1095. Amended 08-
04-98.
(1) Each hospital approved as a SA TC or
SAPTRC shall be issued a DOH-H Form 2032A.
October 91, State-Approved Level I Trauma
Center Certificate of Approval. DOH-H Form
2043A. October 91. State-ApprDved Level "
,..,,~
.j ,
34
Ei.1er;;ency Mecical Ser/ices
c~ec:i'/e 03,'0.1/93
their 2::1:'/21 C~ '~e:.;2j to r2:.=',11 If 2::rvv~~:.
tliis ,"~~e\v2j C2:::f':C:Jt:CG shad :e ~cr.:: :er;cc cr 7'
ye2~~ t:.e~i~~i~.~ the cay 2t:er ::-:e c:..:r:-:?:::
C2~1~:C2::C~ e:(::r~s.
(~) A 3)",7: cr 3.':,=7:=\-: 'N~ic~ tees ~c~
C2s;r3 to :e ;"=-:::::r:'/e~
5:,~2il fCi!C'.V
CUrC8r:ieS, t:y r:='/ie\N:r~ tj"2C~2 patie~~ C.lar:3
and ty e'/2;L.;2[i~~ ~~e eff"ec::'/e!;ess cf tr~
tr2~r:ia ~'....:aj;~/ m2::2'~8rT;e~t ~rcgrar:1 ~~rcugh
re'/ie\vs cr tr2~~a C2se S~~r:J2r:es 2nd r;;;r:utes
cf tr3Ci7:a ':~2jir./ ,~3r~2<;=mer:( c::r.-::7":ite~
'hO
,j.--
~e9::r;:;s.
;-;ct:i:C2::cr ,:r::'/:s:cr~s cf se'::::r~ :S~..;.C:::-3;,.
lr::pl'2::-:er"e~
2g5..!C ~
~c~ ~0-;
.....-...... .-........-,
3S5.':~::
(b) ='/2:-...2:jc~S:~ t:-2~~2 .:2tie~t c:....= 2~c::
t;-3Ur:la :2::e:-: f7:2t2~e~e::t 'Niil 2;SO ce
c:~cuc:ec ~s;~~ ~r3~~2 ....G~;o~t Gata c....:;~,.....er1
~Cr:l the ::CS:::::I tr~l.:~2 r;~:~~~ and l,~e ~,;:~~;c;
1,-2L.:,rT12, K2';iS::-/ iT.:~ tr:e ti~e ~e ~..:spjt2.j
i=C2J'/ec ,:j:\i:S;c~2j :j2~r7":a C2fHer s:atus
~h:"':L1<:h L~e G2:~ cf :.~2 c~-,;r:::. r~'/;e"l 1...-::111'""""'-::
. -- ........... ~ , j. , __,-"111(...;
':2ne~~ C2:2 i""7':2Y .2isc 1:e c~ilec:2c l7CG the
e~ergerc~/...ce:2r:i7':er:: ~2:;ent leg, 2L.:C;: fiiter
lee, cr C'~2!1i:/ .~2r~2Ce:7ie~r c~rja""i:.. 1';"00. ,r-, ;~I I rtos
__. -- ." _ _, u.......... .. ............. .
j i~e p2~:e;.t :;:~L.:!2::Cr: ~C~ re'/:e'N Si~2iI be
seiec:ed en t;....e J2S:S cf Ir:iur/ Sel/entv Sc:res
(IS3). . T;-:e iS2 si':2i1 be tererminee: using
A..:cre'/12rec: IrjL:rj Sc::iin-; (AIS-90). If the
Frcvisicn2i SA 7C cr r:rovisicnai S;'PT;::;;C has
an in-hes:it21 :i"aL:ma regis:i""/ whiC:l C:::r.:cutes
the ISS using :1":e IriterT:aticn~1 C:assificaticn of
Disease, Stn Re'/isicr:, Clinical i\ofccmcaticri (ICD-
9-C~I), the ccr:::uter ,crcgrar-:-: shail centain AIS-
SO as a c:::~pcr.er,t of :he program.
(c) Parier: c,";a,-:3 to be reviewee: shall be
S"lo,..'o--' '~'/ .....0 ,..je"~~~ . t'
~.'-....."....~ v.. Ui..... '- .....C._illent rrem C3ses J"i:ee..lng
the c:-iteria listec in Stancard X'/1 C.2,a-e,
published in Dr.? 150-S, Maic:. 98. A minimum
of 75 cases sh2i1 be selectee: fer review in each
fadity. If U~e cases tctal less than 75, then all
cases are sL:bjec: to re'/iew.
(d) Patie:.t C:'2,,3 s.'-:ail be reviewed to
icentify fac:crs rela,ed to negative paUent
eutcome or ccr::pror-:-:ised p2tient C3re. I;'/hen
st.:ch fac:crs are icer,tf:ed, trat.:ma C3se re'/iews
by the meGical c:r:::c:cr of t.~e trat.:ma ser/ice or
t'le trauma nt.:rse cccrcin2tcr. as weil as minutes
af trauma cL:a!itv r:lanacement com~ittee
meetings, snail be re'/jewed to determine if
ccr.ec:ive ac::cr: was taken by the tr2!Jma
ser/ica anc accrccriate ,:eer review c::Jmmitees
within the feciiit-I.
(e) ?e'/ie~"i'2r3 s,~a!! s,:";:j' the tr2L:r.:2 :.ase
re'l!e'NS a~c :i2:"':r7i2 ~U2jj~y rr:ana~er7':ent
c~~rT:ittee ;~ee::~~ r:-:ir:t...:t=:s to e'/2iu2r= the
c'/eralf ef72c:;'l~;~S3 .:f ;'~e ~,'-::i;t'/ maI""2c=,-.c~t
.. ........__.... "I.... _.,......., .
:S,:ec:t:c ,~.L:j~CI;~,' 3S5,~C251 3S5.~85 ~3. ~3'N
2;S.~C...!.. 3S:~..!:~~.~. ~~.~.~:1~ ,=.::;. r-.::s.,-...., \1..... Q
......... -, - - ___ '4- _ I" ll.,..l.;'-! H:::;"l' '...;._
.;-,3~, ;'J""7"':e~c2C: ~=-~2-~2. i-::-S8. 1=8r:7:e:~'/
~ C C -.:S . ~ ~ ~. ,~JT: e;: C 2'':: .:3 - ~ :5 - ~ 3.
6~;::.2.023 Site V:sits anc:: A;:;:ro'/ai.
(~) =2S.'l :=~:\/:s;cn2! S,.; I'e 2~C
F;(;'/:S;Cr:21 S,:,-,r:7:=:C: sl~cll res~ive at: cn-si:2
e'/2il~2~icn tc :e~e~jr:e ~Nhethe; t~e hcs:itai is in
s~:~z2r-:~;2j c:~.cifcr~c2 'Nit1 st2r:c:aics pL.:bljsj~ec
in D~? 150-9, J',far:.~ 98, Sta:e-.~.==rcvec
Trar..:rr:a Ce::ter aile State-Ac.:rcvec Feciati:c
Tiaur::a Referial Ce::ter p..p~rcvel St2,-:c2rcs,
whic:, is inccr;::cre!ec :y referer,ce in sec:;cn
6..iE-2.023, F.A.C., 2nc to dete:.7:ine t1-:e ctJalit'1
cr t;-aui'7':a c"c~~r-'/;co'" ,....,/ '~e ....c~~;t.~l. . ,
"-,.....1"" '-'. __>.J.. Ul i, _~..::..
(2) T;-:e cr.-site e'/aluat;cn s,";2i1 be
c:::ncucted by a re'/iew team cf cut~f~sta,e
reviewers with :<:I.Gwlecge ef traur-:-:a patient
management as evicenced by eX::Jer:ence in
t.cu~a care at a tia!J~a center acqrovec by tJ':e
go'/er-:-:ing bccy of the state in whic:. t.'le'/ 2re
license~. '
(3) .All .=rovisicn21 SA TCs anc Provisicnai
SAPT;::;;Cs shail iec.eive a site '/isit be~.veen
Cc:ober 1 cf eecn yeer anc JL:ne i of the
fcilcwing ye2r,
(..i) The re'/jewe,s shall asseS3 eac;-:
aop/icant hcspital's compliance WI!;' the
s,anC2rcs pL:t:lishec in DHP 150-9, ,\olar:;; 98, bv
l7.eens cf direc: cbser/ation, review of cail
sc.";ecules, anc review ef patient c.":a"s.
;::;;2'/iewers aise shail 2ssess the ~L:2Jity cr
~L:;71~ ~""'.;~r'!" -....r~ -~d . .
-- - .....c~......;J. ~ _ C1. ~ra~ma patle::t
~2nagement by re'/iewing f2ditv traur.:a
i7':cr:aiit'1 Cc~::: ';-." -::.\/i':"'4';~f""I ~c:""'i;~~~ '-;"'a' --to_ -ne' '-1\/
. ." ~-''''''.. '-- '-""'='~ ...........\....1 l~.;:,;::. \.oJ..
r='/~e\NIr:g tra!..:r7':2 ::252 SCf7'lr7':2r:es a~c i~ir:L.;:==s
cf ~-at..:~a c~2i:rl ;:-:2~2ge~e~r c2i."':mit2e
~ee~;r:~s pt..:rS~2~t :c ~t2~C2rc: ;( /: cr C :-:I~ 15C-
S, 1\12r:~ 93.
(5) 1='/21' .",,:Cl' ~: ......" C, '-ii"'/ 0: ""'-L:r--
_ " ' - ,....--.. , .......1 1..01,-" .....c:...... I ,Ie II,C
,-3:1e::r Care ar':c TI-2~r:2 ,=2:fe~: 1\1a~ace;:jer:r:
(3) T:~e :=';ie':'ers sh2!! j~c:~e the "'C:~2lity cr
~~~a pat:e;,~ CGre ar:c:: the Gcaii~1 of :j'a~~a
pane!ir l'7ia~a<;e~e~c in ezch P;"':'I15iori2/ SA TO::
anc r:rc'lisicnai S;'?T?C bv 2nai';-;~c O"C'"
:- ;i;.., '_ ~_, . J I .-.j'.... _~.I
IC.C'II~/.:) Y .::t..:~a .=2~:e::r ~re anc :rat..:f7'!2 ;:at:enr
~rc~rar-:-:.
(5) l.....e ;-=\/'='.'19:3 she:! I"c:e a ~:-:\lis;cr:21
S,~,;': 2f:C ="'~'1;~:-----:::!' ':-.: . =7'=r-, ' . ;.... -h ~_
. ' ,'-' '.....1.,,0. ,...-1 '-'~, I, \_ lvnlC: 1 ~ i:::::1 Ilcve
rs'/rel'vec: as ei:.~er aC':2s~2:!e, 2C~:t2:ie 'Nith
~:17~~::C~S. ,:r, 1":~2':.~.~::2:je. T~e rad'ng 5.-:2:1 be
C2sec en e3C~ .ac:Jlr./s st..:cstar::iai C=~:::rr2r:ce
with ~"e S:21~C2''''S ~. ....iisi""e'" in DHc' 1 =,'_C
,'.farch se. 2nc '~;c/;~ c~':;Cr.7.ar.c~' cf ~;c~~
P~~'lis;cn2i S:'-.-:-: cr I=;Q~/is;cnal S~.?I::::C in
prc'/ic:r:g 2c::e::,2:!e :r2L:i'7':2 :atienr care er.c
~)6
25
Effective 08/04/98
trauma patient management which
acceptable patient outcomes.
(7) The department shall evaluate the
results of the site visit review and the in-depth
application review of each Provisional SA TC and
Provisional SAPTRC between June 1 and July 1.
All applicant hospitals shall be notified
simultaneously of their approval or denial to
become a SA TC or SAPTRC on or before July 1.
The department's selection will be based on the
results of the site visit and the in-depth
application review. In those situations in which
there are more SA TCs or SAPTRCs, Provisienal
SA TCs or Provisional SAPTRCs than available
positions in the TSA, the criteria in paragraph
(10) of this section shall be applied fer final
selection.
(8) The department shall notify each
Provisional SA TC or Provisional SAPTRC of the
results of the site visit within 15 working days
from completion of the site visit. The department
shall inc!ude in the notice any problems that the
Provisional SA TC or Provisional SAPTRC was
informed of at the conclusion of the department's
in-depth application review. If the Provisional
SA TC or Provisional SAPTRC desires to provide
additional information regarding the results of the
site visit or in-depth application review to the
department to be considered during the final
evaluation between June 1 and July 1, the
information must be provided in writing and be
received by the department within 30 calendar
days of the hospital's receipt of the department's
notice. If the Provisional SA TC or Provisional
SAPTRC elects not to respond to the
department's notice within 30 calendar days, the
department shall make the final determination of
approval or denial based solely on information
collected during the applicant's site visit and in-
depth application review.
(9) Site Visits may be conducted at any
reasonable time at the discretion of the
department at any Provisional SA TC or
Provisional SAPTRC, or SA TC or SAPTRC by
the department staff or reviewers to:
(a) verify information prDvided pursuant to
section (8); and
(b) ensure each SA TC or SAPTRC
maintains substantial compliance with trauma
center standards, quality of trauma patient care,
and quality of trauma patient management.
(10) Section 395.4025(12), FS., makes
confidential and exempt from the provisions of
section 119.07(1). FS., not only patient care,
transport or treatment records and patient care
quality assurance proceedings, but also records
or reports made or obtained pursuant to sections
119.07(3)(v), 395.3025(4 )(f), 395.401, 395.4015,
Emergency Medical Services
resulted in 395.402, 395.4025, 395.403, 395.404, 395.4045
and 395.405, FS. The depar:ment identifies the
confidential and exempt records included within
the authority of these laws to be the following:
(a) patient care, transport or treatment
records;
(b) patient care quality assurance
proceedings, records, or repcf1s;
(c) any site survey instrument of the
department, its agents. or surveyors in any form;
(d) any site survey findings of the
department; and
(e) a hospital's response to the
department's site survey findings.
(11) If the number of Provisional SA TCs or
Provisional SAPTRCs found eligible for selection
by the department in a given TSA exceeds the
number permitted, as provided in section 64E-
2.022(3), F .A.C., the following criteria shall be
applied independently and consecutively to all
Provisional SA TCs or Provisional SAPTRCs in
the TSA until application of the criteria results in
the number of SA TCs or SAPTRCs authorized in
section 64E-2.022(3), F .A.C., for that TSA
When that occurs, the remaining criteria shall not
be considered. The criteria to be applied are as
fDlIows:
(a) A hospital recommended to be a SATC
or SAPTRC in the department-approved local or
regional trauma agency plan pursuant to section
64E-2.019(2)(d)3., FAC., shall be .given
approval preference over any hospital which was
not recommended.
(b) A hospital shall be given selection
preference based on the revel of service they
intend to provide aco:lrding to the following
sequence:
1. A Provisional level I SA TC will be
given preference over a Provisional level II
SA TC with SAPTRC, a Provisional Level "
SA TC, and a Provisional SAPTRC;
2. A Provisional Level II SA TC with
SAPTRC will be given preference over a
Previsional Level II SA TC and a Provisional
SAPTRC; and
3. A Provisional level II SA TC will be
given preference over a Provisional SAPTRC in
TSA having only one allocated trauma center
position, and in a TSA with more than one
allocated trauma center position if there already
exist an approved level I SA TC, Levell/SA TC
with SAPTRC, or a SAPTRC; cr if in the instant
selection process a Level I SA TC, Level II SA TC
with SAPTRC, or SAPTRC is to be selected.
(c) A11 applicant hospital in a geographic
location that is most conducive to access by the
greatest number of people to be served within a
TSA shall be given preference for sefec+jon.
;;9
36
E:r.ercer1C'/ Mecica/ Ser/ices
- -
:::=72c~i~/9 C2J'C~/S3
(C) .-\ r:cs::it.:;:i r::sreser.tir.::; :he t:es:
gecs;r3~h:c cis::-:bL.:t:cn 'Nith ~es:es~ tc ter72rr.,
pcpcJaticn se:/ec anc craiec:2C ser/~C2
r::cct.:latic~ in a ::;i'/en TS;' S,1211 :e ::;:'/'=~
~r:fer2~c2 ~cr seiec::crl.
(e:1 .~ ;;cs:rt2i '.'Ir:ie~, ac::::r::::n::; :c ~:~e I"7:CS:
r=C2~: c:,'"7"::ie:2 ye2r cf ;',~e;:c:/ fer :-:e21t.~ C2;""=
~,cr7":ir:jS~;-:=::CG ':3r2. S;~C\VS a hi~~e: le\/e! c~
c~~~it:T:~;,t c~ C2i2 to ~~e ser/!C2 2r22. 23
e'lice~C2~ jy ~~e r2:fc cr nC~-:Jayir~ tc ;:a:/!r:;
~arjer:t3. sj~ai1 :e ';;'ien ;:r2rer2::ce fc~ 2~Crt::'12L
(~2) 7:,e C2:2r::7:e,,[ s~ail infer:-:-: in 'Nr:::r.::;
e2c.~ ?:--c'iis;cr.cl S~,;C cr P;:'1js;c~2i S~,?I~C:
ceniec: 2c:r:'1a; as a SATe cr S':',,=T~C cf it.:
cs::cn.:r.i:'/ to rec;t.:es, a ;;e2r.r.g in whic~ ::
c::ntest u~e cer:i21 in cc::::rC3~C~ 'iv:~"; sec::c ,-:
CH Fer:!; ~ 7:57:=:, 1:::,eG~es~ fer j~=iI7:;:ur3eme;:t,
~!2n. 93. CH I=::-~ i iSiC. ReG~es~ fer C~a~~e,
Jar.. 98, Oi-i F::r:71 17'57\1, l\f2rCatcr/ Criter;2,
J2r.. 93. Oi-i ,=cr~ 1 iSiG. 1\la:c~rr.g Gr2rt3
E:'/2it.:2t:cr Wcr:~3i:ee:, Jar. sa.
(~\
.. I
-/
In cr: er tc 2~::i~/ ~cr a r~"':r21 ~r7":erger:c:/
120.5/, FS.
rTiec:c2! ser/;C2S ~r2::t. 2:Ci:C2:::S mL:st SL:criiit
Ci-i r8r:7: 19:::, J2r~. 92. ::.\IS ~:';r21 ,\farc,1irg
Gr3r1t ~~~Jic2:;cr; c::r-:t3i~ec in ~~e =;\fS R~r2j
1\latc:-:ir.g Gr2:-, ,cre::;r:::r.. ?pClic2tiCr. 1\lar.t.:2I,
J2rt.:arj 1 S93. I.,is fCi771 arc r.2r.ual are
ir:c8Qcr:=tec ::~/ ief~;:?;,c8 ~.-~d 2'/2da:;e FicrTi t~e
c:e::ar:~er:t. T-:e 1\:2ri~2i C~Gt;;:jr:s G~e FCllc'Ning
f:r77':S INhic:, 2i2 c!sc ir:c::r;:cr2t2s ':y refsrenc2
a~c a'l2il2ble :7::171 ~~e Cesart~e~l: CH rCrTT:
S,cec:nc ~,~~~Cr:~1 3S5.4C25, 3S5.4C5 1=3. L3\V
Ir:-:~ieme;:tec 395.~01, 395.~015, 3S5.~02.
3S5..!025, 3S5.~CJ.. 395...1C..15, 395.405 1"'::.
i-:istcrj-New 8-3-28, ?rr.encec 12-10-22, 10-2-
94, 12-10-95. F::m'ier.y 100-c6.112. ?Jiienc:e-:
03-04-98.
19=5. .>l.~;:iiczr:cr:, -.Jan. S3. OH r-:r771 iS25?,
R=~Lles~ fer r..C'/2r:C2 1=2Yi7':er:t, J2r:. sa, C'r:
FCriii 1S::5;., Assc;~2r;c2s, Jan. 98, OH FOriii
1757'1'/, RaGio =~L:i~f7~e~t \iVcr:<sl~ee:, Jan. 98,
CH FOIiTI 1925::, c.'(cenc:::..:re Re~cr:, Jan. 98,
DH FOIiTI 1925R, Rec;ues: fcr Reimbursement,
Jan. 98, OH FOriii 1925C, Re~uest fcr C:-Jange,
Jan. 98.
(3) In cr~er to 2~ply fer a ~t.:nry aW2rc
::;~ant, 2~Djic2ms mt.:s, st.:::mit OH FCriii 1684,
Jar.uarj 1998, =,'i1erser:cy Mecic:ai Services
Cct.:nrj Grant Appiicaticn c:Jntair.ed in the
Ficrida =MS Ceur.ry Gr2nt Progiam Manual,
Januarj 1998. Tnis feri'il and manual are
incorporated by reference and available from the
decartment. T;ie manual contains the following
fOriiis which are also ir.c:::r;:orated by reference
ar.d aV2i/able from the cepartment: OH Form
1684, Applicaticn, Jan. 98, OH Form 1767W,
R2dio E:t.:ipmer.t \Nor:~sheet, Jan., 98, DH FOriii
1634C, =;\lS CCt.:nty Grant Program Request fer
C;,ange, Jan: 93, Oi-i Fori'il 1684A, E:MS Cet.:nty
Grar.t Program ?c:ivi~/ Re;:cr:, Jan. 98.
642-2.029 Appiication by Hospital Denied
Approval. ;'.r.y ~oscital that was nct acer::ve:
as a S?.TC cr S;'?T;:;:C basec cn the aceiic.a:;cn
of c:'iteMa in sec:ion 64=-2.028, F AC., riiay
submit a c:::riipleted Letter of Intent COH FOr7i1
1340, Jt.:ly 95, posJi1ar:<ec no earlier th2n
Septerr.oer 1 ar.c no later than midnight Oc:cber
1 of the fcilcwir.g :tear,
Specific ?t.:t,~cr.ty 395,..l.025, 395.405 FS, La'N
Implemented 395.401, 395.4015, 395.402,
395.4025, 3S5.~C4, 395.4C45, 395.~05 ;=3.
~istorj-New 3-2-28, Amenced 12-10-92, 1 :2-~ 0-
95. Fcrmer:y 1CO-66.113.
64E-2.0JO Emergency Medical Ser/icas
Grants Application Procadures.
Spec:flc A.t.:thority .lO1.121 rS. Law Ir.;piementec
401.111, .l01.113. .l01.121 FS. Histcr,/-New 6-0-
SO, ?menced 12-10-92, 1-25-97. Fc~erly 100-
66.205. .~,1~e~c=c 08-C.l-';3.
(1) In creer to 2pely fer a r.;atchir.~
er:-:er;erC'j r.ec:C21 sel"'/ices Siam, acciic.ar.:.s
r.;us: st.:briiit 01-: ,=0r.71 1/67, Jan. 92, =:.IS
\12tC,":ir.S Gia~, ,..l.;::I:c:a[;Or. c.::r.:arr.ec in ~":e
=,'JIS ,\12:::r.:rg Grar.: ?rct;;rcm, ;'.cciic.aticr.
.\t2nU2/, Ja~t.:ar/ ~ 9Se. I illS ~el'771 anc: 1712r.t.:ai
2r~ ir:c~r;;crcre~ ,j:; r2!fe;=r:c~ ar;d a~/ai1at;ie frcr:"~
~~e c:e~2r:r:ent. T;--:e mar:t..:ai c~r:t2ins ~~=
fci/cwinc; ~CI7:"'.S wr::C:l are aise ;r.e::r;:cratec =:/
refer:!ics a~c: a'/aiiatie iT;:~ ~'e cep2r~~e::::
CH .=Cr:71 1737, rl:ciiC3ricn, Jan. 98, C'H F~~
1/57?, Recuest fer ?C'/ar.c~ ,=aYriient, Jan. 92,
OH rCf"i'i1 175//';, .~.sst..;ra~css, J2f1. 98. CH Fc~
176f1N, Recio =c:..:icli.ent 'Ncr:<sheet, J2n. S2,
Ci-i FCriii ~/37=. =-'(:encit:..:r~ Reccrt, Jan. 98,
64;:::-2.031 Prahospital 00 Not Resuscitate
Oreer (D,~~~O),
(1) Pr2r:cs::::2i C,'i;:;:C COf-! ,=-:;,"'7'7: 1395,
cfs:;-:;:~t:cr:. :esc:--:;:::ic~r ar:c: ~x=c:...:t:cr:
(a) L'r:ies3 en eX:~=::cn is previte': in ~"is
sec::cn. a .:r~~cs:itai Ct't~CI r;-:~s~ :e issL.:ec en
Oei-i F:17:"'. 129-:, e:tr:er ~r.e Cc:cber, 94, or
C'c::cer, 93 ~t:tic~, \rV~:ch is inc:rpcra:ec ;--:ere:n
by rerer2f;C2. ar:c ~efer;-~c :0 arterN2rcs as COH
F8riii i ass 2r:c 'Nh:c,~ is available fie.., ~'":e
Cepar:me~: cf ~e2i~h, 2~r::2u cr E~,1S, 2C02..j]
.1D
37
Effective 08/04/98
Emergency Medical Services
Old S1. Augustine Read, Tallahassee, Flcrida
32301-4881. A bracelet is not required;
however if requested, an EMS-ONRO bracalet
shail be distributed along with DOH Fel"i11 1896.
(b) DOH Ferm 1856, is printed en yellow
paper and has a rectangular shaped box
displayed ac:'oss the top. A stop sign has been
placad in the upper left hand comer of the box
opposite the werds ~OO NOT RESUSCITATe'.
The effective date is in the upper right hand
comer of the form. When DOH Fel"i11 1896 is
properly completed, it identifies the patient and
declares the patient's wishes that resuscitation
efforts not be initiated if the patient suffers
respiratory or cardiac arrest. DOH Form 1896
also includes a statement that the patient has a
terminal condition, as determined by an
attending physician, in consultation with a
second physician, beth of whom are Iicansed
under chapter 458 or chapter 459, FS., and
contains the attending physician!s directive not
to resuscitate. DOH Form 1896 furJ1er dire~.s
EMS personnel to provide the patient with
comfort care to alleviate pain and any other
medically indicated care, short of CPR.
(c) Execution by patient or patient's
representative:
1. If the patient is competent, DOH Form
1896, must be signed by the patient.
2. If the patient is no longer capable of
making decisions about his health care or giving
informed consent, the prehospital DNRO must
be signed by either the patienfs surrogate, if the
patient designated a health care surrogate while
still capable; by the patienfs guardian (Of the
person) if one has been court appointed; or by
proxy, as specified in chapter 765, part IV, FS.
Before signing DOH Form 1896, under this
section the patienfs health care surrogate,
guardian or proxy must be satisfied that:
a. the patient does not have a reasonable
probability of recovering competency so that this
decision could be made directly by the patient,
b. the patient would have made a similar
decision not to be resuscitated under the
circumstances.
c. The signature of the patient or patient's
representative as specified in this section must
be made in the presence of two subscribing
witnesses who also must sign DOH Form 1896.
(d) Tne DOH Form 1896, must also be
signed by the patient's attending phYSician
licansed under chapter 4Sa or c.'1apter 459, FS.
If the patient is incapable of making an informed
decision and consent about providing,
withholding or withdrawing a specific medical
treatment because the patient is unable to
understand the nature, ex:ent or probable
consequences of the proposed medical decision,
or is unable to make a raticnal evaiuation of the
risks and benerits of a/ter.;ative decisions, a
ccnsultation with a second ,:::hysician licensed
under chapter 453 or cha:::ier 459, FS., is
required under section 765.204, FS. Before
signing the prehospital DNRO DOH Form, the
attending physician must determine which of the
following criteria the patient ~eets:
1. Tne patient is incompetent or
incapacitated and can not make health care
decisions.
2. The patient is capable or competent to
make health care decisiens.
(e) Any person or entity recaiving DOH
Form 1896 is authorized to cupiicate it on yellow
paper provided that the centent of the form is
unaltered and is identical to DOH Form 1896.
(2) Any individual cartitied as an EMT or
paramedic pursuant to section 401.27, FS., and
these rules who is empleyed by or works
voluntarily fer a licensed E~IS provider shalf .
honor a prehospital DNRO when responding tD a
call for assistance provided that the EMT or
paramedic:
(a) is presented the original DOH Form
1896 executed as required by section 64E-
2.031(1), FA.C., or
(b) is presented either a copy of DOH Form
1896 executed as required by section 64E-
2.031 (1), F.A.C., or a DNRO document from a
facility licensed pursuant to chapters 393, 395,
or 400, FS., or from a licensed hospice facility
which also pr.ovides home health patient care.
Fer EMS personnel to honor a facility's DNRO
they shall determine that the facility's DNRO:
1. states that it is a DNRO and provides
instructions that the patient is not tD be
resuscitated in the event of cardiac or respiratory
arrest,
2. has an effective date, which predates
the date the assistance is requested,
3. includes the patient's full legal name
typed or printed,
4. is signed by the patient's attending
physician and inc:ude the physician's medical
license number, telephone number and date
completed,
5. is signed and d<Jted by the patient if
competent or if the patient is incompetent, by the
patient's health care surrogate or legal guardian,
jf one has been appointed, or proxy,
6. is signed and dated by at least two
witnesses.
~ .
'L;'.
38
Effective 08/04/93
Emergency Medical Services
(c) c::taJns the icentir; ef the patient with a
Of'iRO throt..:gh a ci";ver's license, ether phete
ic:entir:catien, or frem a witness in the presence
cf the patient. If a witness is usee to ic:e:-.tify the
patien:, this s,1ail be eecume:-.tec: in the rc;n
reper: ta inc:t..;ce: the full name er the witnes3.
accres3, teie:hene i~t..:mter ar.c reiatienship cf
emerger.c'j perscnne! .espenc ~e assist a patient
'Nho has a prehospital ONRCJ. If E~,lS Cispatc"
personnel have been inror.r:ed or the presenc2
of a prehespit31 CNRO tr:ey s.1all make that
infcr:T1aticn kilown to tr:e resconcing E:\IS
persenre!.
(6) A pre~cscit2! Dj"~RO ,~2:/ :;e re'lckec 3:
any time by the ;:atient or ees:~nated he2ith care
sc;r.cgate purs'-!ant to section 765.104, FS.
Uncer this statute tne p2::e"t can re'/oke 2
DI'JRC in writing by physic21 c3nce!lation cr
dest~ctien or the DNRO for.n or by or2ily
ex;:ressir:~ a c8nt:"2r/ inte~t. i.e., by reGt.1estir:~
that resuscitation meas'-!res ::e :nitiatee.
L"":e \Nit~es.3 :c the ~2t;ent.
(c) E:\!S personnei shall recuest to re'/ie'.l/
the fer:T1 fer any patient who is wearing ary
crace!et whic:": icentifies the patient anc inc:c3res
L~2t the ~2t;e~t has exes:Jted CC,H r8r7:l 18SS.
(3) ,J,i'ter resi:erd:nG to a C3!1 ~e pro'lice cae
rer a patient who has a C~J~O exec~tec in
c~nfer.nance with sections 64E.:-2.031 (1) o. (2),
F..A..C.. the ::\IS prc'/ice:- shail:
(a) c:cc:':r.1ent in the nar.ari'l2 pcrtien cf :he
rc;n reper:: the effective Cate of the CI'JRO;
infermatien percaining to a witness, if ene is usee
to es.atlish patient icentification; anc the na~e
ef the attending physician who signed L~e
DNRO, In ac:cition, tne narrative must ieentity
whe1.'1er the patient signed the CNRO or whether
the DNRO was signed by a heaith care
surrogate, guardian or proxy.
(b) not initiate CPR, but initiate cCr.1forting,
pain-re!ie'/ing and any other mec:ically incicated
care, shert of resuscitative measures.
(c) ensure that the original Or a copy of t'1e
prehospital DNRO, accompanies the live patient
each time 1.'1e'l transpcrt ilie patient. Upcn
arrival at the receiving facility, tne EMS previcer
shall relinquish the DNRO farm, alcng with the
patient to t'1e receiving facility. If the E~,IS
provider receives a request to transport tr:e
patient ta his heme or to some other facility fcr
furt'1er treatment, tne EMS provicer shaIl obtain
a copy of the DNRO form from the seneing
facility prier to the transport.
(d) dccument in the narrative portien ef t.'1e
patienfs EMS run report t'1e infor.71atian required
in section 64:=-2.031 (1 )(3)(a), F AC,. whene'/er
the DNRO patient dies at hCr.1e er cur:r.c
transi:ort. -
(.) l~ :::~'IS "'Qrs~r.nQi are "'r"s",....",..! ""tlh -n
.... j -'" :-..... \J I i_i fJ .... _. H...........,., Ie,
invalid prehesi:ital DNRO or in the absence cf a
prei"':osoit31 ON?O, E\fS perscnnei must initiate
C,=R and other s.ancarc life-saving tec~ni~:.Jes.
Mcreover, ::\lS metical cjrec~crs aie aurhorizet
te ceve!cD ;:rcreccis when net to resuscitate in
t.'1e acsence of a ONRO anc ~e ce:::ar::-::er:t
shall net ciscipiine an ::;\IT er .caramedic wt.a
ac-.s in accordance with these pretoccls.
(5) Each ::;\IS ProviCer shail have wrir:en
E~,lS anc CiSi:2tC,'1 prctccds trat provic:e a
s<ancarc:, s~2i~:-:r.orNard caurse af ac::cn whe:i
Soedic Authcrity 331.0011, .!01.~S(3) FS, Law
Implemented 381,02C5, 401 AS FS Histery-.'Jew
11-30-93. ,Amencec: 3-19-95, 1-25-97. Formerly
10D-co.325,
64E.2.032 Certificate of Public Convenienca
and Necessity.
(1) Each cDun~1 is emcewered pursuant te
secticn 401.25(2)(d) and (6), :=S., to issue a
COPCN ta an ambulance service which
proposes to operate within that ccunty.
(2) T:"1e deparu'i1ent shail license an
amtulance service, and that service may
operate in a county in this state, provided the
appliCGnt meets the ambulance service
requirements of chapter 401, part Ill, FS.. and
this rule chapter, and praviced furJ1er that the
ambulance service has first obtained a COPCN:
(a) From each COUnty in which the
ambulance service provides or proposes ta
previc:e preh,?spital ALS services or prehospitaI
6LS transportation services.
(b) From each county within which the
ambulance ser/ice prevides or proposes to
provice intracoumy, interfacilirj ALS ser/ices or
interfacilirj BLS transportation ser/ices.
(c) From each ceur':,,! where the
ambulance ser/ice provices er proposes to
provic:e interfadir; ALS ser/ices ar BLS
transportatien ser/!ces in whic" tne need rer
such ser/ice either or:ginates cr teri71inates, but
net f10m beth t,'-:e cCt..:nry whe~e the need for
st.:ch ser/ice er:ginates and ~e caunt'j where the
need fer such ser/ice ter.71ina:es unless the
caunr; by ordinance pursuant to seden
401,25(6), FS.. r.1andares a cepe:'J rer both.
(3) ,All licer:ses issued by t.'le ceaarment
to an ALS, ELS tr2nscort er air ambulance
service prcvicer shall be censistent with t.'1e
ser/ices auilierizec by the COFC:'J, if the
ceoar,,'i1ent reGuires a COPC~J pt..;rsuant to this
sect:cn.
4~
39
Effective 08/04/98
Emergency Medical Services
(a) The department shall restrict such
licenses based upon the COPCN to one or more
of the following categories:
1. Prehospital.
2. Interfacility.
3. Ground.
4. Air (rotary wing, fixed wing or both).
5. ALS non-transport.
6. ALS.
7. BLS transportation service.
(b) If the applicant is exempt from the
COPCN requirement the department shall issue
a license in one or more of the categories in
(3}(a) based upon this chapter, any information
available to the department, and the licensure
application and supporting documentation
submitted by the applicant
(4) Provisions of this section to the
contrary notwithstanding, the department shall
license an ambulance service which meets the
ambulance service requirements of chapter 401,
FS., part III, and chapter 64E-2,' F .A.C., in any
county where the ambulance service provides or
proposes to provide services for which a license
is required under chapter 401, FS., part III,
where the county does not require a COPCN for
such services.
(5) An ambulance service licensed by the
department is permitted to. provide services
under its license in a county without first having
obtained a COPCN from the governing body of
that county, if such service is provided pursuant
to and consistent with the terms of a mutual aid
agreement with that county, or as part of a
coordinated response to a disaster or a mass
casualty incident. Pursuant to section
401.23(16), FS., a mutual aid agreement must
be in writing, must be sanctioned by the
governing bodies of the affected counties, and
must at a minimum in dude:
(a) The conditions under which the
agreement shall be activated.
(b) The procedures and medical protocols
to be followed during activation.
(c) The conditions and process by which
the agreed upon services shall be terminated.
Specific Authority 401.35 FS. Law Implemented
401.23, 401.25, 401.251, 401252, 401.33,
401.35,401.411,401.414,401.421 FS. History-
New 10-2-94, Amended 1-26-97. Formerly 100-
66.335.
43
40