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This publication is printed on permanent, acid-free paper in compliance with G.S. 125-11.13 NORTH CAROLINA REGISTER VOLUME 23 ● ISSUE 04 ● Pages 285 - 377 August 15, 2008 I. IN ADDITION Notice of Rule Making Proceedings and Public Hearing – Building Code .... 285 – 286 II. PROPOSED RULES Agriculture, Department of Agriculture, Board of ...................................................................................... 287 – 288 Commerce, Department of Cemetery Commission.................................................................................... 288 – 289 Community Colleges, Department of Community Colleges, Board of....................................................................... 358 – 359 Environment and Natural Resources, Department of Wildlife Resources Commission..................................................................... 348 – 350 Health and Human Services, Department of Medical Care Commission.............................................................................. 289 – 346 Justice, Department of Private Protective Services Board................................................................... 346 – 348 Occupational Licensing Boards and Commissions Funeral Service, Board of ............................................................................... 350 – 357 Pharmacy, Board of.........................................................................................357 – 358 III. RULES REVIEW COMMISSION ................................................................. 360 – 373 IV. CONTESTED CASE DECISIONS Index to ALJ Decisions ...................................................................................... 374 – 377 PUBLISHED BY The Office of Administrative Hearings Rules Division 6714 Mail Service Center Raleigh, NC 27699-6714 Telephone (919) 733-2678 Fax (919) 733-3462 Julian Mann, III, Director Camille Winston, Deputy Director Molly Masich, Codifier of Rules Dana Vojtko, Publications Coordinator Julie Edwards, Editorial Assistant Felicia Williams, Editorial Assistant This publication is printed on permanent, acid-free paper in compliance with G.S. 125-11.13 Contact List for Rulemaking Questions or Concerns For questions or concerns regarding the Administrative Procedure Act or any of its components, consult with the agencies below. The bolded headings are typical issues which the given agency can address, but are not inclusive. Rule Notices, Filings, Register, Deadlines, Copies of Proposed Rules, etc. Office of Administrative Hearings Rules Division Capehart-Crocker House (919) 733-2678 424 North Blount Street (919) 733-3462 FAX Raleigh, North Carolina 27601-2817 contact: Molly Masich, Codifier of Rules molly.masich@ncmail.net (919) 733-3367 Dana Vojtko, Publications Coordinator dana.vojtko@ncmail.net (919) 733-2679 Julie Edwards, Editorial Assistant julie.edwards@ncmail.net (919) 733-2696 Felicia Williams, Editorial Assistant felicia.s.williams@ncmail.net (919) 733-3361 Rule Review and Legal Issues Rules Review Commission 1307 Glenwood Ave., Suite 159 (919) 733-2721 Raleigh, North Carolina 27605 (919) 733-9415 FAX contact: Joe DeLuca Jr., Commission Counsel joe.deluca@ncmail.net (919) 715-8655 Bobby Bryan, Commission Counsel bobby.bryan@ncmail.net (919) 733-0928 Fiscal Notes & Economic Analysis Office of State Budget and Management 116 West Jones Street (919) 807-4700 Raleigh, North Carolina 27603-8005 (919) 733-0640 FAX contact: William Crumbley, Economic Analyst william.crumbley@ncmail.net (919) 807-4740 Governor’s Review Reuben Young reuben.young@ncmail.net Legal Counsel to the Governor (919) 733-5811 116 West Jones Street(919) Raleigh, North Carolina 27603 Legislative Process Concerning Rule-making Joint Legislative Administrative Procedure Oversight Committee 545 Legislative Office Building 300 North Salisbury Street (919) 733-2578 Raleigh, North Carolina 27611 (919) 715-5460 FAX contact: Karen Cochrane-Brown, Staff Attorney karenc@ncleg.net Jeff Hudson, Staff Attorney jeffreyh@ncleg.net County and Municipality Government Questions or Notification NC Association of County Commissioners 215 North Dawson Street (919) 715-2893 Raleigh, North Carolina 27603 contact: Jim Blackburn jim.blackburn@ncacc.org Rebecca Troutman rebecca.troutman@ncacc.org NC League of Municipalities (919) 715-4000 215 North Dawson Street Raleigh, North Carolina 27603 contact: Anita Watkins awatkins@nclm.org This publication is printed on permanent, acid-free paper in compliance with G.S. 125-11.13 NORTH CAROLINA REGISTER Publication Schedule for January 2008 – December 2008 FILING DEADLINES NOTICE OF TEXT PERMANENT RULE TEMPORARY RULES Volume & issue number Issue date Last day for filing Earliest date for public hearing End of required comment period Deadline to submit to RRC for review at next meeting Earliest Eff. Date of Permanent Rule Delayed Eff. Date of Permanent Rule 31st legislative day of the session beginning: 270th day from publication in the Register 22:13 01/02/08 12/06/07 01/17/08 03/03/08 03/20/08 05/01/08 05/13/08 09/28/08 22:14 01/15/08 12/19/07 01/30/08 03/17/08 03/20/08 05/01/08 05/13/08 10/11/08 22:15 02/01/08 01/10/08 02/16/08 04/01/08 04/21/08 06/01/08 01/2009 10/28/08 22:16 02/15/08 01/25/08 03/01/08 04/15/08 04/21/08 06/01/08 01/2009 11/11/08 22:17 03/03/08 02/11/08 03/18/08 05/02/08 05/20/08 07/01/08 01/2009 11/28/08 22:18 03/17/08 02/25/08 04/01/08 05/16/08 05/20/08 07/01/08 01/2009 12/12/08 22:19 04/01/08 03/10/08 04/16/08 06/02/08 06/20/08 08/01/08 01/2009 12/27/08 22:20 04/15/08 03/25/08 04/30/08 06/16/08 06/20/08 08/01/08 01/2009 01/10/09 22:21 05/01/08 04/10/08 05/16/08 06/30/08 07/21/08 09/01/08 01/2009 01/26/09 22:22 05/15/08 04/24/08 05/30/08 07/14/08 07/21/08 09/01/08 01/2009 02/09/09 22:23 06/02/08 05/09/08 06/17/08 08/01/08 08/20/08 10/01/08 01/2009 02/27/09 22:24 06/16/08 05/23/08 07/01/08 08/15/08 08/20/08 10/01/08 01/2009 03/13/09 23:01 07/01/08 06/10/08 07/16/08 09/02/08 09/22/08 11/01/08 01/2009 03/28/09 23:02 07/15/08 06/23/08 07/30/08 09/15/08 09/22/08 11/01/08 01/2009 04/11/09 23:03 08/01/08 07/11/08 08/16/08 09/30/08 10/20/08 12/01/08 01/2009 04/28/09 23:04 08/15/08 07/25/08 08/30/08 10/14/08 10/20/08 12/01/08 01/2009 05/12/09 23:05 09/02/08 08/11/08 09/17/08 11/03/08 11/20/08 01/01/09 01/2009 05/30/09 23:06 09/15/08 08/22/08 09/30/08 11/14/08 11/20/08 01/01/09 01/2009 06/12/09 23:07 10/01/08 09/10/08 10/16/08 12/01/08 12/22/08 02/01/09 05/2010 06/28/09 23:08 10/15/08 09/24/08 10/30/08 12/15/08 12/22/08 02/01/09 05/2010 07/12/09 23:09 11/03/08 10/13/08 11/18/08 01/02/09 01/20/09 03/01/09 05/2010 07/31/09 23:10 11/17/08 10/24/08 12/02/08 01/16/09 01/20/09 03/01/09 05/2010 08/14/09 23:11 12/01/08 11/05/08 12/16/08 01/30/09 02/20/09 04/01/09 05/2010 08/28/09 23:12 12/15/08 11/20/08 12/30/08 02/13/09 02/20/09 04/01/09 05/2010 09/11/09 This publication is printed on permanent, acid-free paper in compliance with G.S. 125-11.13 EXPLANATION OF THE PUBLICATION SCHEDULE This Publication Schedule is prepared by the Office of Administrative Hearings as a public service and the computation of time periods are not to be deemed binding or controlling. Time is computed according to 26 NCAC 2C .0302 and the Rules of Civil Procedure, Rule 6. GENERAL The North Carolina Register shall be published twice a month and contains the following information submitted for publication by a state agency: (1) temporary rules; (2) notices of rule-making proceedings; (3) text of proposed rules; (4) text of permanent rules approved by the Rules Review Commission; (5) notices of receipt of a petition for municipal incorporation, as required by G.S. 120-165; (6) Executive Orders of the Governor; (7) final decision letters from the U.S. Attorney General concerning changes in laws affecting voting in a jurisdiction subject of Section 5 of the Voting Rights Act of 1965, as required by G.S. 120-30.9H; (8) orders of the Tax Review Board issued under G.S. 105-241.2; and (9) other information the Codifier of Rules determines to be helpful to the public. COMPUTING TIME: In computing time in the schedule, the day of publication of the North Carolina Register is not included. The last day of the period so computed is included, unless it is a Saturday, Sunday, or State holiday, in which event the period runs until the preceding day which is not a Saturday, Sunday, or State holiday. FILING DEADLINES ISSUE DATE: The Register is published on the first and fifteen of each month if the first or fifteenth of the month is not a Saturday, Sunday, or State holiday for employees mandated by the State Personnel Commission. If the first or fifteenth of any month is a Saturday, Sunday, or a holiday for State employees, the North Carolina Register issue for that day will be published on the day of that month after the first or fifteenth that is not a Saturday, Sunday, or holiday for State employees. LAST DAY FOR FILING: The last day for filing for any issue is 15 days before the issue date excluding Saturdays, Sundays, and holidays for State employees. NOTICE OF TEXT EARLIEST DATE FOR PUBLIC HEARING: The hearing date shall be at least 15 days after the date a notice of the hearing is published. END OF REQUIRED COMMENT PERIOD An agency shall accept comments on the text of a proposed rule for at least 60 days after the text is published or until the date of any public hearings held on the proposed rule, whichever is longer. DEADLINE TO SUBMIT TO THE RULES REVIEW COMMISSION: The Commission shall review a rule submitted to it on or before the twentieth of a month by the last day of the next month. FIRST LEGISLATIVE DAY OF THE NEXT REGULAR SESSION OF THE GENERAL ASSEMBLY: This date is the first legislative day of the next regular session of the General Assembly following approval of the rule by the Rules Review Commission. See G.S. 150B- 21.3, Effective date of rules. IN ADDITION 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 285 NOTICE OF RULE MAKING PROCEEDINGS AND PUBLIC HEARING NORTH CAROLINA BUILDING CODE COUNCIL Notice of Rule-making Proceedings is hereby given by NC Building Code Council in accordance with G.S. 150B-21.5(d). Citation to Existing Rule Affected by this Rule-Making: North Carolina Building, Fire, Plumbing and Residential Codes. Authority for Rule-making: G.S. 143-136; 143-138. Reason for Proposed Action: To incorporate changes in the NC State Building Codes as a result of rulemaking petitions filed with the NC Building Code Council and to incorporate changes proposed by the Council. Public Hearing: September 8, 2008, 1:00PM, Wake County Commons, 4011 Carya Drive, Raleigh, NC 27610 Comment Procedures: Written comments may be sent to Chris Noles, Secretary, NC Building Code Council, NC Department of Insurance, 322 Chapanoke Road, Suite 200, Raleigh, NC 27603. Comment period expires on October 14, 2008. Statement of Subject Matter: 1. Request by David E. Gall, Architect, P.A., to amend the Chapter 4 and Chapter 9 of the 2009 NC Building Code. The proposed amendment is as follows: 422.1. Existing A-2 and A-3 Occupancies shall be permitted to provide facilities for temporary overflow emergency shelters for the homeless provided that all of the following conditions are met and approved by the local code official and fire marshal: .1 The total number of homeless Occupants is limited to 20 individuals who are ambulatory. The homeless Occupants must be 18 years of age or older. .2 The building used for the temporary overflow emergency shelter must be of Type I, II, or III construction. .3 The temporary overflow emergency shelter must be staffed by a minimum of two individuals of 21 years of age or older trained in accordance with Chapter 4 of the NC Fire Code and at least one trained individual shall be awake to monitor the sleeping room and restrooms throughout the time the facility is occupied by the homeless. .4 Functioning smoke detection and a local fire alarm system per 907.2.8 shall be provided throughout the sleeping room and exit access corridors and stairs of the temporary overflow emergency shelter. .5 There shall be a minimum of two separate code compliant means of egress serving the temporary overflow emergency shelter. An evacuation route approved by the local code official and fire marshal shall be posted and be in compliance with Sections 404, 406, and 408 of the NC Fire Code. .6 There shall be no lockable doors between sleeping rooms and required exits. .7 The temporary overflow emergency shelter sleeping room and exit access corridors and stairs shall have night-lighting and emergency lighting with back-up power. .8 No fire protection sprinkler system is required per 903.2.7, Exception #2. .9 Heating, cooling, and ventilation must be provided by equipment installed and approved for such use. No space heaters are permitted. .10 There must be an adequate number of fire extinguishers to serve the temporary overflow emergency shelter as determined by the local fire marshal. Travel distance to an approved fire extinguisher shall not exceed 50 feet. Minimum rating of extinguishers shall be 3A40BC. .11 No smoking is permitted in the temporary overflow emergency shelter. .12 Building Owner must submit documentation illustrating that the fire alarm system is approved and that all emergency batteries have been tested and are operational. .13 Temporary overflow emergency shelters must be approved by the local code official for Occupancy by issuance of an approved Occupancy Permit. Drawings of the temporary overflow emergency shelter sealed by a NC licensed architect or engineer must be provided for local code official review and approval. .14 Compliance with NC Accessibility code for temporary overflow emergency shelters is not required provided that the local jurisdiction has other shelter facilities that are accessible by the disabled. .15 Occupancy of a temporary overflow emergency shelter shall be for a maximum of 150 calendar days within any 365 day time span. 903.2.7 Group R. An automatic sprinkler system installed in accordance with Section 903.3 shall be provided throughout all buildings with a Group R fire area. Exceptions: 1. An automatic sprinkler system is not required in Group R-3 and R-4 adult and child day care facilities. 2. an automatic sprinkler system is not required in Group R-1 for temporary overflow emergency shelters per 422.1. IN ADDITION 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 286 2. Request by Michael D. Crotts, City of Morganton, to amend the 2009 NC Building Code by adding a new Section 422. The proposed amendment is as follows: 422.1 Classification. Existing Church Buildings (places of worship) to be used as Temporary Homeless Shelters. R-1 use in an A-3 occupancy. 422.1.1 Fire Extinguishers shall be installed in accordance with the North Carolina Fire Prevention Code. 422.2 Non-sprinklered buildings to be occupied for Temporary Homeless Shelters must meet all the following: 1. Shelters would be limited to a maximum of 20 homeless persons. 2. The temporary shelters would be for adults only, no children under the age of 16 years. 3. The buildings would be a minimum of Type I, II, or III, construction. 4. The temporary shelters would have to be staffed by adults (21 years or older). 5. Each shelter would have a minimum of 2 staff persons 1 of which would be awake at all times the shelter is occupied to provide a fire watch. There would also be a posted evacuation route approved by the Fire Official. These facilities would be non-smoking. 6. Shelters would be required to acquire a building permit and be inspected by the Building and Fire Official for egress and safety. 7. Temporary shelters would be allowed only for 120 days after approval and be renewable no more than 2 concurrent permits in a calendar year. 422.3 No requirements currently exist in the North Carolina Accessibility Code for Emergency Shelters. The U.S. Department of Justice ADA Checklist for Emergency Shelters document may be used for Accessibility Guidelines. 3. Request by Michael D. Crotts, City of Morganton, to amend the 2009 Fire Code, Section 903.2. The proposed amendment is as follows: 903.2.7 Group R. An automatic sprinkler system installed in accordance with Section 903.3 shall be provided throughout all buildings with a Group R fire area. Exceptions: 1. An automatic sprinkler system is not required in Group R-3 and R-4 adult and child day care facilities. 2. Temporary Homeless Shelters. See Section 422 4. Request by Kirk Aten, with Mecklenburg County Code Enforcement, to amend the 2009 NC Building Code, Chapter 11, Accessibility. The proposed amendment is as follows: 1104.3.2 Press boxes: Press boxes in assembly areas shall be on an accessible route. Exceptions: 1. An accessible route shall not be required to press boxes in bleachers that have points of entry at only one level, provided that the aggregate area of all press boxes is 500 square feet (46 m2) maximum. 2. An accessible route shall not be required to free-standing press boxes that are elevated above grade 12 feet (3660 mm) minimum provided that the aggregate area of all press boxes is 500 square feet (46 m2) maximum. 5. Request by William Eubanks, New Hanover County Inspections, to amend the 2009 NC Plumbing Code, Section 305.6. The proposed amendment is as follows: 305.6 Freezing. The top of water pipes, installed below grade outside the building, shall be below the frost line or a minimum of 12 inches below finished grade whichever is greater. Water pipes installed in a wall exposed to the exterior shall be located on the heated side of the wall insulation. Water piping installed in an unconditioned attic or unconditioned utility room shall be insulated with an insulation having a minimum R factor of 6.5 determined at 75 degrees Fahrenheit in accordance with ASTM C-177. Exception: Water Piping installed in attics directly on top of ceiling joists and directly beneath the attic insulation does not need to be insulated with an insulation having a minimum R factor of 6.5. The piping must be covered with a tent of 4 mil. poly to prevent the building insulation from cutting off heat loss through the ceiling reaching the pipe. 6. Request by Jeff Griffin, Mecklenburg County Government, to amend the 2009 NC Residential Code. The proposed amendment is as follows: Complete revision on Appendix M Wood Decks. The proposed Appendix M text may be viewed at the following link: http://www.ncdoi.com/OSFM/Engineering/BCC/engineering_bcc_minutes.asp PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 287 Note from the Codifier: The notices published in this Section of the NC Register include the text of proposed rules. The agency must accept comments on the proposed rule(s) for at least 60 days from the publication date, or until the public hearing, or a later date if specified in the notice by the agency. If the agency adopts a rule that differs substantially from a prior published notice, the agency must publish the text of the proposed different rule and accept comment on the proposed different rule for 60 days. Statutory reference: G.S. 150B-21.2. TITLE 02 – DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES Notice is hereby given in accordance with G.S. 150B-21.2 that the North Carolina Board of Agriculture intends to amend the rule cited as 02 NCAC 48A .1703. Proposed Effective Date: December 1, 2008 Instructions on How to Demand a Public Hearing: (must be requested in writing within 15 days of notice): Any person may request a public hearing on the proposed rules by submitting a request in writing no later than August 30th, 2008, to David S. McLeod, Secretary, NC Board of Agriculture, 1001 Mail Service Center, Raleigh, NC 27699-1001. Reason for Proposed Action: The proposed amendments would add regulated areas for Beach Vitex and Bushkiller, two plants which have been proposed for addition to the list of noxious weeds under 02 NCAC 48A .1702. Procedure by which a person can object to the agency on a proposed rule: Any person may object to the proposed rules by submitting a written statement of objection(s) to David S. McLeod, Secretary, NC Board of Agriculture, 1001 Mail Service Center, Raleigh, NC 27699-1001. Comments may be submitted to: David S. McLeod, 1001 Mail Service Center, Raleigh, NC 27699-1001, phone (919) 733- 7125 extension 238, fax (919) 716-0090, email david.mcleod@ncmail.net Comment period ends: October 14, 2008 Procedure for Subjecting a Proposed Rule to Legislative Review: If an objection is not resolved prior to the adoption of the rule, a person may also submit written objections to the Rules Review Commission. If the Rules Review Commission receives written and signed objections in accordance with G.S. 150B-21.3(b2) from 10 or more persons clearly requesting review by the legislature and the Rules Review Commission approves the rule, the rule will become effective as provided in G.S. 150B-21.3(b1). The Commission will receive written objections until 5:00 p.m. on the day following the day the Commission approves the rule. The Commission will receive those objections by mail, delivery service, hand delivery, or facsimile transmission. If you have any further questions concerning the submission of objections to the Commission, please call a Commission staff attorney at 919-733-2721. Fiscal Impact: State Local Substantive (>$3,000,000) None CHAPTER 48 - PLANT INDUSTRY SUBCHAPTER 48A - PLANT PROTECTION SECTION .1700 - STATE NOXIOUS WEEDS 02 NCAC 48A .1703 REGULATED AREAS (a) Except as permitted in 02 NCAC 48A .1705 and .1706, the following is prohibited: (1) The movement of Beach Vitex (Vitex rotundifolia L.F.) or any regulated article infested with Beach Vitex from the following counties: Brunswick, Carteret, Currituck, Dare, Hyde, New Hanover, Onslow, Pender; (2) The movement of Bushkiller (Cayratia japonica Thunb.) or any regulated article infested with Bushkiller from the following counties: Davidson, Forsyth, Franklin, Mecklenburg; (1)(3) The movement of Canada Thistle [Cirsium arvense (L.) Scop.] or any regulated article infested with Canada Thistle from the following counties: Ashe, Avery, Haywood, Mitchell, Northampton, Yancey; (2)(4) The movement of Class A, B, or C noxious weeds or any regulated article infested with Class A, B, or C noxious weeds into North Carolina; (3)(5) The movement of a Class A noxious weed or any regulated article infested with any Class A noxious weed is prohibited within the state; (4)(6) The movement of Eurasian Watermilfoil (Myriophyllum spicatum L.) or any regulated article infested with Eurasian Watermilfoil from the following counties: Halifax, Northampton, Perquimans, Tyrrell, Warren; (5)(7) The movement of Florida Betony (Stachys floridana Shuttlew.) or any regulated article infested with Florida Betony from the following counties: Bladen, Brunswick, Cumberland, Forsyth, Hoke, New Hanover, Onslow, Wake; (6)(8) The movement of Musk Thistle (Carduus nutans L.) or any regulated article infested with Musk Thistle from the following PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 288 counties: Buncombe, Cleveland, Chatham, Gaston, Henderson, Lincoln, Madison, Randolph, Rowan, Rutherford; (7)(9) The movement of Plumeless Thistle (Carduus acanthoides L.) or any regulated article infested with Plumeless Thistle from the following counties: Haywood, Jackson, Madison, Watauga; (8)(10) The movement of Puncturevine (Tribulus terrestris L.) or any regulated article infested with Puncturevine from the following counties: Durham, New Hanover; (9)(11) The movement of any Lythrum species not native to North Carolina or any regulated article infested with any nonnative Lythrum species from the following counties: Forsyth, Watauga; (10)(12) The movement of Uruguay Waterprimrose [Ludwigia hexapetala (Hook & Arn.) Zardini, Gu & Raven] or any regulated article infested with Uruguay Waterprimrose from the following counties: Bladen, Brunswick, Columbus, Durham, Granville, Hyde, New Hanover, Orange, Rowan, Wake, Warren; (11)(13) The movement of Yellow Fieldcress [Rorippa sylvestris (L.) Bess.] or any regulated article infested with Yellow Fieldcress from the following county: Orange; (12)(14) The movement of Oriental Bittersweet (Celastrus orbiculatus Thunb.) or any regulated article infested with Oriental Bittersweet from the following counties: Alleghany, Ashe, Avery, Buncombe, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, Mitchell, Swain, Transylvania, Watauga, Wilkes, Yancey; (13)(15) The sale or distribution of any Class A or B noxious weed; (14)(16) The sale or distribution of any Class C noxious weed outside a regulated area. (b) Other regulated areas. The Commissioner may designate as a regulated area any state or portion of a state in which there is reasonable cause to believe that a noxious weed exists, and there is an immediate need to prevent its introduction, spread or dissemination in North Carolina. Authority G.S. 106-420; 106-421. TITLE 04 – DEPARTMENT OF COMMERCE Notice is hereby given in accordance with G.S. 150B-21.2 that the North Carolina Cemetery Commission intends to amend the rule cited as 04 NCAC 05D .0202. Proposed Effective Date: December 1, 2008 Instructions on How to Demand a Public Hearing: (must be requested in writing within 15 days of notice): Any person who demands a public hearing shall submit a letter of objection in writing by US Postal Service to Jimmy Miller, 1001 Navaho Drive, Suite 100, Raleigh, NC 27609. The letter of demand must be postmarked no later than August 30, 2008. Reason for Proposed Action: Regarding delivery of cemetery merchandise in storage at the cemetery, rule makes reference to a report by a "licensed public accountant", a term that is prohibited from use in North Carolina by N.C.G.S. 93-6. This amendment removes that reference, permitting a certified public accountant. Procedure by which a person can object to the agency on a proposed rule: Any person who objects to a proposed rule amendment shall either submit a letter of objection in writing to Jimmy Miller, 1001 Navaho Drive, Suite 100, Raleigh, NC 27609. Comments may be submitted to: Jimmy Miller, 1001 Navaho Drive, Suite 100, Raleigh, NC 27609, phone (919) 981-2536, fax (919) 981-2538, email jmiller@nccommerce.com Comment period ends: October 14, 2008 Procedure for Subjecting a Proposed Rule to Legislative Review: If an objection is not resolved prior to the adoption of the rule, a person may also submit written objections to the Rules Review Commission. If the Rules Review Commission receives written and signed objections in accordance with G.S. 150B-21.3(b2) from 10 or more persons clearly requesting review by the legislature and the Rules Review Commission approves the rule, the rule will become effective as provided in G.S. 150B-21.3(b1). The Commission will receive written objections until 5:00 p.m. on the day following the day the Commission approves the rule. The Commission will receive those objections by mail, delivery service, hand delivery, or facsimile transmission. If you have any further questions concerning the submission of objections to the Commission, please call a Commission staff attorney at 919-733-2721. Fiscal Impact: State Local Substantive (>$3,000,000) None CHAPTER 05 - CEMETERY COMMISSION SUBCHAPTER 05D - TRUST FUNDS SECTION .0200 - PRE-NEED CEMETERY MERCHANDISE: PRE-CONSTRUCTED MAUSOLEUMS AND BELOW GROUND CRYPTS TRUST FUNDS 04 NCAC 05D .0202 DELIVERY (a) Vaults and crypts shall not be considered delivered unless installed or stored on the cemetery premises or stored off PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 289 premises by a supplier. If vaults are not to be installed, the contract between cemetery and purchaser must so state in bold print that purchaser has accepted above ground delivery. If vault is to be installed, then the contract must be broken down into sales cost and installation cost. (b) Markers, bases and vases shall not be considered delivered unless installed or stored at the cemetery or if stored off premises by a supplier, there shall be no additional charge for delivery or freight, unless specified in bold print in the contract. If vaults, crypts or other merchandise are stored off premises the cemetery company must submit to the Cemetery Commission not less than annually a report by a certified public accountant of each item which has been purchased through a North Carolina cemetery company and which at the date of the report was then in storage and properly designated the property of the cemetery company's customer and not the property of the supplier. If vaults, crypts or other merchandise are stored at the cemetery the cemetery company must submit to the Cemetery Commission not less than annually a report by a certified or licensed public accountant of each item which has been purchased and which at the date of the report was then in storage and properly designated the property of the cemetery company's customer. (c) If opening and closing of crypts at the time of interment are not included in the cost of this merchandise, then it must be so stated in bold print on the contract between cemetery and purchaser. Authority G.S. 65-49. TITLE 10A – DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice is hereby given in accordance with G.S. 150B-21.2 that the Medical Care Commission intends to adopt the rules citied as 10A NCAC 13P .0305, .0511, amend the rules citied as 10A NCAC 13P .0101-.0102, .0201-.0202, .0204-.0210, .0212-.0215, .0301-.0302, .0401-.0406, .0408-.0409, .0501-.0502, .0504, .0507-.0510, .0601-.0603, .0701, .0901-.0905, .1101-.1103 and repeal the rules cited as 10A NCAC 13P .0103-.0107, .0109- .0124, .0303-.0304, .0801, .1001-.1002; 13Q .0101-.0103; 13R .0101, .0103-.0105, .0201-.0202, .0504-.0206, .0301. Proposed Effective Date: January 1, 2009 Public Hearing: Date: September 23, 2008 Time: 10:00 a.m. Location: Room 201 Council Building, Division of Health Service Regulation, Dorothea Dix Campus, 701 Barbour Drive, Raleigh, NC 27603. Reason for Proposed Action: The Emergency Medical Services and Trauma Rules, EMS Formula Grants, and Minimum Standards for Mobile Intensive Care Units Rules were reviewed by the agency and found to be in need of updating. The rules are being adopted, amended or repealed to conform to new General Statute mandates for criminal history background checks, differentiate between rotary wing and fixed wing aircraft, conform to current standards of the NC College of Emergency Physicians, reorganize the Subchapter for uniformity of rule subjects and/or add clarity to existing rule language. Procedure by which a person can object to the agency on a proposed rule: An individual may object to the agency on the proposed rules by submitting written comments on the proposed rules. They may also object by attending the public hearing and personally voice their objections during that time. Comments may be submitted to: Nadine Pfeiffer, Division of Health Service Regulation, 2701 Mail Service Center, Raleigh, NC 27699-2701, fax (919)733-2757, email DHSR.RulesCoordinator@ncmail.net Comment period ends: September 30, 2008 Procedure for Subjecting a Proposed Rule to Legislative Review: If an objection is not resolved prior to the adoption of the rule, a person may also submit written objections to the Rules Review Commission. If the Rules Review Commission receives written and signed objections in accordance with G.S. 150B-21.3(b2) from 10 or more persons clearly requesting review by the legislature and the Rules Review Commission approves the rule, the rule will become effective as provided in G.S. 150B-21.3(b1). The Commission will receive written objections until 5:00 p.m. on the day following the day the Commission approves the rule. The Commission will receive those objections by mail, delivery service, hand delivery, or facsimile transmission. If you have any further questions concerning the submission of objections to the Commission, please call a Commission staff attorney at 919-733-2721. Fiscal Impact: A copy of the fiscal note can be obtained from the agency. State Local Substantive (>$3,000,000) None CHAPTER 13 – NC MEDICAL CARE COMMISSION SUBCHAPTER 13P – EMERGENCY MEDICAL SERVICES AND TRAUMA RULES SECTION .0100 – DEFINITIONS 10A NCAC 13P .0101 ABBREVIATIONS As used in this Subchapter, the following abbreviations mean: (1) ACS: American College of Surgeons; (1)(2) AHA: American Heart Association; (3) ATLS: Advanced Trauma Life Support; (4) CA3: Clinical Anesthesiology Year 3; (5) CRNA: Certified Registered Nurse Anesthetist; (2)(6) CPR: Cardiopulmonary Resuscitation; (7) DOA: Dead on Arrival; (8) ED: Emergency Department; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 290 (3)(9) EMD: Emergency Medical Dispatcher; (4)(10) EMDPRS: Emergency Medical Dispatch Priority Reference System; (5)(11) EMS: Emergency Medical Services; (6)(12) EMS-NP: EMS Nurse Practitioner; (7)(13) EMS-PA: EMS Physician Assistant; (8)(14) EMT: Emergency Medical Technician; (9)(15) EMT-I: EMT-Intermediate; (10)(16) EMT-P: EMT-Paramedic; (17) ENT: Ear, Nose and Throat; (18) FAA: Federal Aviation Administration; (19) FAR: Federal Aviation Regulation; (20) FCC: Federal Communications Commission; (21) GSC: Glasgow Coma Scale; (22) ICD: International Classification of Diseases; (23) ISS: Injury Severity Score; (24) IV: Intravenous; (25) LPN: Licensed Practical Nurse; (11)(26) MICN: Mobile Intensive Care Nurse; (12)(27) MR: Medical Responder; (13)(28) NHTSA: National Highway Traffic Safety Administration; (14)(29) OEMS: Office of Emergency Medical Services; and (30) OMF: Oral maxillofacial; (31) OR: Operating Room; (32) PGY2: Post Graduate Year 2; (33) PGY4; Post Graduate Year 4; (34) PSAP: Public Safety Answering Point; (35) RAC: Regional Advisory Committee; (36) RFP: Request For Proposal; (37) RN: Registered Nurse; (38) SCTP: Specialty Care Transport Program; (39) SMARTT: State Medical Asset and Resource Tracking Tool; (40) STEMI: ST Elevation Myocardial Infarction; (41) TR: Trauma Registrar; (42) TNC: Trauma Nurse Coordinator; (43) TPM: Trauma Program Manager; and (15)(44) US DOT: United States Department of Transportation. Authority G.S. 143-508(b). 10A NCAC 13P .0102 DEFINITIONS As used in this Subchapter, "Air Medical Ambulance" means an aircraft specifically designed and equipped to transport patients by air. The patient care compartment of air medical ambulances shall be staffed by medical crew members approved for the mission by the medical director. The following definitions apply throughout this Subchapter: (1) "Advanced Trauma Life Support" means the course sponsored by the American College of Surgeons. (2) "Affiliated EMS Provider" means the firm, corporation, agency, organization, or association identified to a specific county EMS system as a condition for EMS Provider Licensing as required by Rule .0204(a)(1) of this Subchapter. (3) "Affiliated Hospital" means a non-Trauma Center hospital that is owned by the Trauma Center or there exists a contract or other agreement to allow for the acceptance or transfer of the Trauma Center's patient population to the non-Trauma Center hospital. (4) "Air Medical Ambulance" means an aircraft configured and medically equipped to transport patients by air. The patient care compartment of air medical ambulances shall be staffed by medical crew members approved for the mission by the medical director. (5) "Air Medical Program" means a SCTP or EMS System utilizing rotary-wing or fixed-wing aircraft configured and operated to transport patients. (6) "Assistant Medical Director" means a physician, EMS-PA, or EMS-NP who assists the medical director with the medical aspects of the management of an EMS System or EMS SCTP. (7) "Attending" means a physician who has completed medical or surgical residency and is either eligible to take boards in a specialty area or is boarded in a specialty. (8) "Board Certified, Board Certification, Board Eligible, Board Prepared, or Boarded" means approval by the American Board of Medical Specialties, the Advisory Board for Osteopathic Specialties, or the Royal College of Physicians and Surgeons of Canada unless a further sub-specialty such as the American Board of Surgery or Emergency Medicine is specified. (9) "Bypass" means the transport of an emergency medical services patient from the scene of an accident or medical emergency past an emergency medical services receiving facility for the purposes of accessing a facility with a higher level of care, or a hospital of its own volition reroutes a patient from the scene of an accident or medical emergency or referring hospital to a facility with a higher level of care. (10) "Contingencies" mean conditions placed on a trauma center's designation that, if unmet, can result in the loss or amendment of a hospital's designation. (11) "Convalescent Ambulance" means an ambulance used on a scheduled basis solely to transport patients having a known non-emergency medical condition. Convalescent ambulances shall not be used in place of any other category of ambulance defined in this Subchapter. (12) "Clinical Anesthesiology Year 3" means an anesthesiology resident having completed two PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 291 clinical years of general anesthesiology training. A pure laboratory year shall not constitute a clinical year. (13) "Deficiency" means the failure to meet essential criteria for a trauma center's designation as specified in Section .0900 of this Subchapter, that can serve as the basis for a focused review or denial of a trauma center designation. (14) "Department" means the North Carolina Department of Health and Human Services. (15) "Diversion" means the hospital is unable to accept a pediatric or adult patient due to a lack of staffing or resources. (16) "E-Code" means a numeric identifier that defines the cause of injury, taken from the ICD. (17) "Educational Medical Advisor" means the physician responsible for overseeing the medical aspects of approved EMS educational programs in continuing education, basic, and advanced EMS educational institutions. (18) "EMS Care" means all services provided within each EMS System that relate to the dispatch, response, treatment, and disposition of any patient that would require the submission of System Data to the OEMS. (19) "EMS Educational Institution" means any agency credentialed by the OEMS to offer EMS educational programs. (20) "EMS Nontransporting Vehicle" means a motor vehicle dedicated and equipped to move medical equipment and EMS personnel functioning within the scope of practice of EMT-I or EMT-P to the scene of a request for assistance. EMS nontransporting vehicles shall not be used for the transportation of patients on the streets, highways, waterways, or airways of the state. (21) "EMS Peer Review Committee" means a committee as defined in G.S. 131E-155(a)(6b). (22) "EMS Performance Improvement Toolkits" mean one or more reports generated from the state EMS data system analyzing the EMS service delivery, personnel performance, and patient care provided by an EMS system and its associated EMS agencies and personnel. Each EMS toolkit focuses on a topic of care such as trauma, cardiac arrest, EMS response times, stroke, STEMI (heart attack), and pediatric care. (23) "EMS Provider" means those entities defined in G.S. 131E-155 (13a) that hold a current license issued by the Department pursuant to G.S. 131E-155.1. (24) "EMS System" means a coordinated arrangement of local resources under the authority of the county government (including all agencies, personnel, equipment, and facilities) organized to respond to medical emergencies and integrated with other health care providers and networks including, but not limited to, public health, community health monitoring activities, and special needs populations. (25) "EMS System Peer Groups" are defined as: (a) Urban EMS System means greater than 200,000 population; (b) Suburban EMS System means from 75,001 to 200,000 population; (c) Rural EMS System means from 25,001 to 75,000 population; and (d) Wilderness EMS System means 25,000 population or less. (26) "Essential Criteria" means those items listed in Rules .0901, .0902, and .0903 of this Subchapter that are the minimum requirements for the respective level of trauma center designation (I, II, or III). (27) "Focused Review" means an evaluation by the OEMS of a trauma center's corrective actions to remove contingencies that are a result of deficiencies placed upon it following a renewal site visit. (28) "Ground Ambulance" means an ambulance used to transport patients with traumatic or medical conditions or patients for whom the need for emergency or non-emergency medical care is anticipated either at the patient location or during transport. (29) "Hospital" means a licensed facility as defined in G.S. 131E-176. (30) "Immediately Available" means the physical presence of the health professional or the hospital resource within the trauma center to evaluate and care for the trauma patient without delay. (31) "Inclusive Trauma System" means an organized, multi-disciplinary, evidence-based approach to provide quality care and to improve measurable outcomes for all defined injured patients. EMS, hospitals, other health systems and clinicians shall participate in a structured manner through leadership, advocacy, injury prevention, education, clinical care, performance improvement and research resulting in integrated trauma care. (32) "Infectious Disease Control Policy" means a documented policy describing how the EMS system will protect and prevent its patients and EMS professionals from exposure and illness associated with contagions and infectious disease. (33) "Lead RAC Agency" means the agency (comprised of one or more Level I or II trauma centers) that provides staff support and serves as the coordinating entity for trauma planning in a region. PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 292 (34) "Level I Trauma Center" means a hospital that has the capability of providing leadership, research, and total care for every aspect of injury from prevention to rehabilitation. (35) "Level II Trauma Center" means a hospital that provides trauma care regardless of the severity of the injury but may not be able to provide the same comprehensive care as a Level I trauma center and does not have trauma research as a primary objective. (36) "Level III Trauma Center" means a hospital that provides prompt assessment, resuscitation, emergency operations, and stabilization, and arranges for hospital transfer as needed to a Level I or II trauma center. (37) "Licensed Health Care Facility" means any health care facility or hospital licensed by the Department of Health and Human Services, Division of Health Service Regulation. (38) "Medical Crew Member" means EMS personnel or other health care professionals who are licensed or registered in North Carolina and are affiliated with a SCTP. (39) "Medical Director" means the physician responsible for the medical aspects of the management of an EMS System or SCTP. (40) "Medical Oversight" means the responsibility for the management and accountability of the medical care aspects of an EMS System or SCTP. Medical Oversight includes physician direction of the initial education and continuing education of EMS personnel or medical crew members; development and monitoring of both operational and treatment protocols; evaluation of the medical care rendered by EMS personnel or medical crew members; participation in system or program evaluation; and directing, by two-way voice communications, the medical care rendered by the EMS personnel or medical crew members. (41) "Mid-level Practitioner" means a nurse practitioner or physician assistant who routinely cares for trauma patients. (42) "Model EMS System" means an EMS System that is recognized and designated by the OEMS for meeting and mastering quality and performance indicator criteria as defined by the OEMS. (43) "Off-line Medical Control" means medical supervision provided through the EMS System Medical Director or SCTP Medical Director who is responsible for the day to day medical care provided by EMS personnel. This includes but is not limited to EMS personnel education, protocol development, quality management, peer review activities, and EMS administrative responsibilities related to assurance of quality medical care. (44) "Office of Emergency Medical Services" means a section of the Division of Health Service Regulation of the North Carolina Department of Health and Human Services located at 701 Barbour Drive, Raleigh, North Carolina 27603. (45) "On-line Medical Control" means the medical supervision or oversight provided to EMS personnel through direct communication in person, via radio, cellular phone, or other communication device during the time the patient is under the care of an EMS professional. The source of on-line medical control is typically a designated hospital's emergency department physician, EMS nurse practitioner, or EMS physician assistant. (46) "Operational Protocols" means the administrative policies and procedures of an EMS System that provide guidance for the day-to-day operation of the system. (47) "Participating Hospital" means a hospital that supplements care within a larger trauma system by the initial evaluation and assessment of injured patients for transfer to a designated trauma center if needed. (48) "Physician" means a medical or osteopathic doctor licensed by the North Carolina Medical Board to practice medicine in the state of North Carolina. (49) "Post Graduate Year Two" means any surgery resident having completed one clinical year of general surgical training. A pure laboratory year shall not constitute a clinical year. (50) "Post Graduate Year Four" means any surgery resident having completed three clinical years of general surgical training. A pure laboratory year shall not constitute a clinical year. (51) "Promptly Available" means the physical presence of health professionals in a location in the trauma center within a short period of time, that is defined by the trauma system (director) and continuously monitored by the performance improvement program. (52) "Regional Advisory Committee (RAC)" means a committee comprised of a lead RAC agency and a group representing trauma care providers and the community, for the purpose of regional trauma planning, establishing, and maintaining a coordinated trauma system. (53) "Request for Proposal (RFP)" means a state document that must be completed by each hospital seeking initial or renewal trauma center designation. (54) "State Medical Asset and Resource Tracking Tool (SMARTT)" means the Internet web-based program used by the OEMS both daily in its operations and during times of disaster to identify, record and monitor EMS, hospital, health care and sheltering resources statewide, PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 293 including but not limited to facilities, personnel, vehicles, equipment, pharmaceutical and supply caches. (55) "Specialty Care Transport Program" means a program designed and operated for the provision of specialized medical care and transportation of critically ill or injured patients between health care facilities and for patients who are discharged from a licensed health care facility to their residence that require specialized medical care during transport which exceeds the normal capability of the local EMS System. (56) "Specialty Care Transport Program Continuing Education Coordinator" means a Level I EMS Instructor within a SCTP who is responsible for the coordination of EMS continuing education programs for EMS personnel within the program. (57) "Stroke" means an acute cerebrovascular hemorrhage or occlusion resulting in a neurologic deficit. (58) "System Continuing Education Coordinator" means the Level I EMS Instructor designated by the local EMS System who is responsible for the coordination of EMS continuing education programs. (59) "System Data" means all information required for daily electronic submission to the OEMS by all EMS Systems using the EMS data set, data dictionary, and file format as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and additions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. (60) "Transfer Agreement" means a written agreement between two agencies specifying the appropriate transfer of patient populations delineating the conditions and methods of transfer. (61) "Trauma Center" means a hospital facility designated by the State of North Carolina and distinguished by its ability to immediately manage, on a 24-hour basis, the severely injured patient or those at risk for severe injury. (62) "Trauma Center Criteria" means essential criteria to define Level I, II, or III trauma centers. (63) "Trauma Center Designation" means a process of approval in which a hospital voluntarily seeks to have its trauma care capabilities and performance evaluated by experienced on-site reviewers. (64) "Trauma Diversion" means a trauma center of its own volition declines to accept an acutely injured pediatric or adult patient due to a lack of staffing and/or resources. (65) "Trauma Guidelines" mean standards for practice in a variety of situations within the trauma system. (66) "Trauma Minimum Data Set" means the basic data required of all hospitals for submission to the trauma statewide database. (67) "Trauma Patient" means any patient with an ICD-9-CM discharge diagnosis 800.00-959.9 excluding 905-909 (late effects of injury), 910.0-924 (blisters, contusions, abrasions, and insect bites), and 930-939 (foreign bodies). (68) "Trauma Program" means an administrative entity that includes the trauma service and coordinates other trauma related activities. It must also include, at a minimum, the trauma medical director, trauma program manager/trauma coordinator, and trauma registrar. This program's reporting structure shall give it the ability to interact with at least equal authority with other departments providing patient care. (69) "Trauma Protocols" mean standards for practice in a variety of situations within the trauma system. (70) "Trauma Registry" means a disease-specific data collection composed of a file of uniform data elements that describe the injury event, demographics, pre-hospital information, diagnosis, care, outcomes, and costs of treatment for injured patients collected and electronically submitted as defined by the OEMS. (71) "Trauma Service" means a clinical service established by the medical staff that has oversight of and responsibility for the care of the trauma patient. (72) "Trauma Team" means a group of health care professionals organized to provide coordinated and timely care to the trauma patient. (73) "Treatment Protocols" means a document approved by the medical directors of both the local EMS System or Specialty Care Transport Program and the OEMS specifying the diagnostic procedures, treatment procedures, medication administration, and patient-care-related policies that shall be completed by EMS personnel or medical crew members based upon the assessment of a patient. (74) "Triage" means the assessment and categorization of a patient to determine the level of EMS and healthcare facility based care required. (75) "Water Ambulance" means a watercraft specifically configured and medically equipped to transport patients. PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 294 Authority G.S. 131E-155(a)(6b); 131E-162; 143- 508(b),(d)(1),(d)(3),(d)(4),(d)(6),(d)(7),(d)(8),(d)(13); 143- 518(a)(5). 10A NCAC 13P .0103 AIR MEDICAL PROGRAM As used in this Subchapter, "Air Medical Program" means a Specialty Care Transport Program designed and operated for transportation of patients by either fixed or rotary wing aircraft. Authority G.S. 143-508(b); 143-508(d)(1). 10A NCAC 13P .0104 ASSISTANT MEDICAL DIRECTOR As used in this Subchapter, "Assistant Medical Director" means a physician, EMS-PA, or EMS-NP who assists the medical director with the medical aspects of the management of an EMS System or EMS Specialty Care Transport Program. Authority G.S. 143-508(b). 10A NCAC 13P .0105 CONVALESCENT AMBULANCE As used in this Subchapter, "Convalescent Ambulance" means an ambulance used on a scheduled basis solely to transport patients having a known non-emergency medical condition. Convalescent ambulances shall not be used in place of any other category of ambulance defined in this Subchapter. Authority G.S. 143-508(b); 143-508(d)(8). 10A NCAC 13P .0106 EDUCATIONAL MEDICAL ADVISOR As used in this Subchapter, "Educational Medical Advisor" means the physician responsible for overseeing the medical components of approved EMS educational programs in continuing education, basic, and advanced EMS educational institutions. Authority G.S. 143-508(b); 143-508(d)(3). 10A NCAC 13P .0107 EMS EDUCATIONAL INSTITUTION As used in this Subchapter, "EMS Educational Institution" means any agency credentialed by the OEMS to offer EMS educational programs. Authority G.S. 143-508(b); 143-508(d)(4). 10A NCAC 13P .0109 EMS NONTRANSPORTING VEHICLE As used in this Subchapter, "EMS Nontransporting Vehicle" means a motor vehicle dedicated and equipped to move medical equipment and EMS personnel functioning within the scope of practice of EMT-I or EMT-P to the scene of a request for assistance. EMS nontransporting vehicles shall not be used for the transportation of patients on the streets, highways, waterways, or airways of the state. Authority G.S. 143-508(b); 143-508(d)(8). 10A NCAC 13P .0110 EMS SYSTEM As used in this Subchapter, "EMS System" means a coordinated arrangement of resources (including personnel, equipment, and facilities) organized to respond to medical emergencies and integrated with other health care providers and networks including, but not limited to, public health, community health monitoring activities, and special needs populations. Authority G.S. 143-508(b). 10A NCAC 13P .0111 GROUND AMBULANCE As used in this Subchapter, "Ground Ambulance" means an ambulance used to transport patients with traumatic or medical conditions or patients for whom the need for emergency or non-emergency medical care is anticipated either at the patient location or during transport. Authority G.S. 143-508(b); 143-508(d)(8). 10A NCAC 13P .0112 MEDICAL CREW MEMBERS As used in this Subchapter, "Medical Crew Member" means EMS personnel or other health care professionals who are licensed or registered in North Carolina and are affiliated with a Specialty Care Transport Program. Authority G.S. 143-508(b); 143-508(d)(3). 10A NCAC 13P .0113 MEDICAL DIRECTOR As used in this Subchapter, "Medical Director" means the physician responsible for the medical aspects of the management of an EMS System or EMS Specialty Care Transport Program. Authority G.S. 143-508(b). 10A NCAC 13P .0114 MEDICAL OVERSIGHT As used in this Subchapter, "Medical Oversight" means the responsibility for the management and accountability of the medical care aspects of an EMS System or Specialty Care Transport Program. Medical Oversight includes physician direction of the initial education and continuing education of EMS personnel or medical crew members; development and monitoring of both operational and treatment protocols; evaluation of the medical care rendered by EMS personnel or medical crew members; participation in system or program evaluation; and directing, by two-way voice communications, the medical care rendered by the EMS personnel or medical crew members. Authority G.S. 143-508(b). 10A NCAC 13P .0115 MODEL EMS SYSTEM As used in this Subchapter, "Model EMS System" means an approved EMS System that chooses to meet the criteria for and receives this designation by the OEMS. Authority G.S. 143-508(b). PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 295 10A NCAC 13P .0116 OFFICE OF EMERGENCY MEDICAL SERVICES As used in this Subchapter, "Office of Emergency Medical Services (OEMS)" means a section of the Division of Health Service Regulation of the North Carolina Department of Health and Human Services located at 701 Barbour Drive, Raleigh, North Carolina 27603. Authority G.S. 143-508(b). 10A NCAC 13P .0117 OPERATIONAL PROTOCOLS As used in this Subchapter, "Operational Protocols" means the written administrative policies and procedures of an EMS System that provide guidance for the day-to-day operation of the system. Authority G.S. 143-508(b). 10A NCAC 13P .0118 PHYSICIAN As used in this Subchapter, "Physician" means a medical or osteopathic doctor licensed by the North Carolina Medical Board to practice medicine in the state of North Carolina. Authority G.S. 143-508(b). 10A NCAC 13P .0119 EMS PEER REVIEW COMMITTEE As used in this Subchapter, "EMS Peer Review Committee" means a committee as defined in G.S. 131E-155(a)(6b). Authority G.S. 131E-155(a)(6b); 143-508(b); 143-518(a)(5). 10A NCAC 13P .0120 SPECIALTY CARE TRANSPORT PROGRAM As used in this Subchapter, "Specialty Care Transport Program" means a program designed and operated for the provision of specialized medical care and transportation of critically ill or injured patients. Authority G.S. 143-508(b); 143-508(d)(1). 10A NCAC 13P .0121 SPECIALTY CARE TRANSPORT PROGRAM CONTINUING EDUCATION COORDINATOR As used in this Subchapter, "Specialty Care Transport Program Continuing Education Coordinator" means a Level I EMS Instructor within a specialty care transport program who is responsible for the coordination of EMS continuing education programs for EMS personnel within the program. Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(13). 10A NCAC 13P .0122 SYSTEM CONTINUING EDUCATION COORDINATOR As used in this Subchapter, "System Continuing Education Coordinator" means a Level I EMS Instructor within a Model EMS System who is responsible for the coordination of EMS continuing education programs. Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(13). 10A NCAC 13P .0123 TREATMENT PROTOCOLS As used in this Subchapter, "Treatment Protocols" means a written document approved by the medical directors of both the local EMS System or Specialty Care Transport Program and the OEMS specifying the diagnostic procedures, treatment procedures, medication administration, and patient-care-related policies that shall be completed by EMS personnel or medical crew members based upon the assessment of a patient. Authority G.S. 143-508(b); 143-508(d)(6); 143-508(d)(7). 10A NCAC 13P .0124 WATER AMBULANCE As used in this Subchapter, "Water Ambulance" means a watercraft specifically designed and equipped to transport patients. Authority G.S. 143-508(b); 143-508(d)(8). SECTION .0200 – EMS SYSTEMS 10A NCAC 13P .0201 EMS SYSTEM REQUIREMENTS (a) County governments shall establish EMS Systems. Each EMS System shall have: (1) a defined geographical service area for the EMS System. The minimum service area for an EMS System shall be one county. There may be multiple EMS Provider service areas within the service area of an EMS System. The highest level of care offered within any EMS Provider service area must be available to the citizens within that service area 24 hours per day; (2) a defined scope of practice for all EMS personnel, functioning in the EMS System, within the parameters set forth by the North Carolina Medical Board pursuant to G.S. 143- 514; (3) a written plan written policies and procedures describing the dispatch and coordination dispatch, coordination and oversight of all responders that provide EMS care care, specialty patient care skills and procedures as defined in Rule .0301(a)(4) of this Subchapter, and ambulance transport within the system; (4) at least one licensed EMS provider. For those systems with providers operating within the EMD, EMT-I, or EMT-P scope of practice, there shall be a plan for medical oversight required by Section .0400 of this Subchapter; Provider; (5) an identified number a listing of permitted ambulances to provide coverage to the service area 24 hours per day; (6) personnel credentialed to perform within the scope of practice of the system and to staff the ambulance vehicles as required by G.S. 131E- 158. There shall be a written plan for the use PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 296 of credentialed EMS personnel for all practice settings used within the system; (7) a mechanism to collect and electronically submit to the OEMS data that uses the EMS data set and data dictionary as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and additions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. EMS Systems shall comply with this requirement by July 1, 2004; documented policies and procedures specific to the utilization of the EMS System's EMS Care data for the daily and on-going management of all EMS System resources; (8) a written infection control policy Infectious Disease Control Policy as defined in Rule .0102(31) of this Subchapter and documented procedures which are approved by the EMS System medical director that addresses address the cleansing and disinfecting of vehicles and equipment that are used to treat or transport patients; (9) a written plan to provide orientation to personnel on EMS operations and related issues for hospitals routinely receiving patients from the EMS System; (10)(9) a listing of facilities that will provide online medical direction for systems with providers operating within the EMT, EMT-I, or EMT-P scope of practice. To provide online medical direction, the facility shall have: (A) availability of a physician, MICN, EMS-NP, or EMS-PA to provide online medical direction to EMS personnel during all hours of operation of the facility; (B) a written plan to provide physician backup to the MICN, EMS-NP, or EMS-PA providing online medical direction to EMS personnel; (C) a mechanism for persons providing online medical direction to provide feedback to the EMS Peer Review Committee; and (D) a written plan to provide orientation and education regarding treatment protocols for those individuals providing online medical direction; all EMS Providers operating within the EMS System; (11) a written plan to ensure that each facility that routinely receives patients and also offers clinical education for EMS personnel provides orientation and education to all preceptors regarding requirements of the EMS System; (12) a written plan for providing emergency vehicle operation education for system personnel who operate emergency vehicles; (13)(10) an EMS communication system that provides for: (A) public access using the emergency telephone number 9-1-1 within the public dial telephone network as the primary method for the public to request emergency assistance. This number shall be connected to the emergency communications center or Public Safety Answering Point (PSAP) PSAP with immediate assistance available such that no caller will be instructed to hang up the telephone and dial another telephone number. A person calling for emergency assistance shall never not be required to speak with more than two persons to request emergency medical assistance; (B) an emergency communications system operated by public safety telecommunicators with training in the management of calls for medical assistance available 24 hours per day; (C) dispatch of the most appropriate emergency medical response unit or units to any caller's request for assistance. The dispatch of all response vehicles shall be in accordance with an official written documented EMS System plan for the management and deployment of response vehicles including requests for mutual aid; and (D) two-way radio voice communications from within the defined service area to the emergency communications center or PSAP and to facilities where patients are routinely transported. The emergency communications system shall maintain all required Federal Communications Commission (FCC) FCC radio licenses or authorizations required; authorizations; (14)(11) a written plan written policies and procedures for addressing the use of Specialty Care Transport Programs SCTP and Air Medical Programs within the system; (15)(12) a written continuing education plan program for all credentialed EMS personnel personnel, under the direction of a System Continuing Education Coordinator, developed and modified based on feedback from system EMS PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 297 Care data, review, and evaluation of patient outcomes and quality management peer reviews, that follows the guidelines of the: (A) "US DOT NHTSA First Responder Refresher: National Standard Curriculum" for MR personnel; (B) US DOT NHTSA EMT-Basic Refresher: National Standard Curriculum" for EMT personnel; (C) "EMT-P and EMT-I Continuing Education National Guidelines" for EMT-I and EMT-P personnel; and (D) "US DOT NHTSA Emergency Medical Dispatcher: National Standard Curriculum" for EMD personnel. These documents are incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and additions. These documents are available from NHTSA, 400 7th Street, SW, Washington, D.C. 20590, at no cost; and (16) a written plan addressing the orientation of MICN, EMS-NP, or EMS-PA used in the system. The orientation program shall include the following: (A) a discussion of all EMS System treatment protocols and procedures; (B) an explanation of the specific scope of practice for credentialed EMS personnel, as authorized by the approved EMS System treatment protocols as required by Rule .0405 of this Chapter; (C) a discussion of all practice settings within the EMS System and how scope of practice may vary in each setting; (D) a mechanism to assess the student's ability to effectively use EMS System communications equipment including hospital and prehospital devices, EMS communication protocols, and communications contingency plans as related to on-line medical direction; and (E) the successful completion of a scope of practice evaluation administered under the direction of the medical director. (13) written policies and procedures to address management of the EMS System that includes: (A) triage and transport of all acutely ill and injured patients with time-dependent or other specialized care issues including but not limited to trauma, stroke, STEMI, burn, and pediatric patients that may require the by-pass of other licensed health care facilities and which are based upon the expanded clinical capabilities of the selected healthcare facilities; (B) triage and transport of patients to facilities outside of the system; (C) arrangements for transporting patients to appropriate facilities when diversion or bypass plans are activated; (D) reporting, monitoring, and establishing standards for system response times using data provided by the OEMS; (E) weekly updating of the SMARTT EMS Provider information; (F) a disaster plan; and (G) a mass-gathering plan. (14) affiliation with the trauma RAC as required by Rule .1101(b) of this Subchapter; and (15) medical oversight as required by Section .0400 of this Subchapter. (b) An application to establish an EMS System shall be submitted by the county to the OEMS for review. When the system is comprised of more than one county, only one application shall be submitted. The proposal shall demonstrate that the system meets the requirements in Paragraph (a) of this Rule. System approval shall be granted for a period of six years. Systems shall apply to OEMS for reapproval. Authority G.S. 131E-155(1),(6),(8),(9),(15); 143- 508(b),(d)(1),(d)(2),(d)(3),(d)(5),(d)(8),(d)(9),(d)(10),(d)(13); 143-509(1),(3),(4),(5); 143-517; 143-518; SECTION .0200 – EMS SYSTEMS 10A NCAC 13P .0202 MODEL EMS SYSTEMS (a) Some EMS Systems may choose to move beyond the minimum requirements in Rule .0201 of this Section and receive designation from the OEMS as a Model EMS System. To receive this designation, an EMS System shall document that, in addition to the system requirements in Rule .0201 of this Section, the following criteria have been met: The OEMS shall accept applications from July 1 through July 31 of each year from EMS Systems that desire to seek designation as a Model EMS System. EMS System performance measurement shall be based on the results, and a designation of Model EMS System will be given by the OEMS to those EMS systems, which meet or exceed the following seven performance indicators as described: (1) a uniform level of care throughout the system available 24 hours per day; Six EMS Performance Improvement Toolkits as defined in Rule .0102(22) of this Subchapter as follows: (A) EMS System Response Toolkit; (B) EMS Acute Trauma Care Toolkit; (C) EMS Cardiac Arrest Care Toolkit; (D) EMS Acute Cardiac Care (STEMI) Toolkit; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 298 (E) EMS Acute Stroke Care Toolkit; (F) EMS Acute Pediatric Care Toolkit; and (2) EMD performance data. (2) a plan for medical oversight that meets the requirements found in Section .0400 of this Subchapter. Specifically, Model EMS Systems shall meet the additional requirements for medical director and written treatment protocols as defined in Rules .0401(1)(b) and .0405(a)(2) of this Subchapter; (3) a mechanism to collect and electronically submit to the OEMS data that use the EMS data set and data dictionary as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and additions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; (4) a written plan to address management of the EMS System to include: (A) triage of patients to appropriate facilities; (B) transport of patients to facilities outside of the system; (C) arrangements for transporting patients to appropriate facilities when diversion or bypass plans are activated; (D) a mechanism for reporting, monitoring, and establishing standards for system response times; (E) a disaster plan; and (F) a mass-gathering plan; (5) a written continuing education plan for EMS personnel, under the direction of the System Continuing Education Coordinator, developed and modified based on feedback from system data, review, and evaluation of patient outcomes and quality management reviews; (6) a written plan to assure participation in clinical and field internship educational components for all EMS personnel; (7) operational protocols for the management of equipment, supplies and medications. These protocols shall include a methodology: (A) to assure that each vehicle contains the required equipment and supplies on each response; (B) for cleaning and maintaining the equipment and vehicles; and (C) to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications; (8) a written plan for the systematic and periodic inspection, repair and maintenance of all vehicles used in the system; (9) a written plan addressing the role of the EMS System in the areas of public education, injury prevention, and community health; (10) affiliation with at least one trauma Regional Advisory Committee; and (11) a system-wide communication system that meets the requirements of Paragraph (a)(13) of Rule .0201 of this Section, and in addition: (A) operates an EMD program; and (B) has an operational E-911 system. (b) EMS Systems holding current accreditation by a national accreditation agency may use this as documentation of completion of the equivalent requirements outlined in this Rule. The date range of the data analyzed within the EMS performance indicators is the first six months of the calendar year. (c) To receive Model EMS System designation, the EMS System must be performing in the top 20 percent of their EMS peer group as defined in Rule .0102(23) of this Subchapter in at least four of the seven EMS performance improvement indicators. (c)(d) The county EMS System shall submit an application for designation as a Model EMS System to the OEMS for review. When the system is comprised of more than one county, only one application shall be submitted. The application shall demonstrate that the system meets the standards found in Paragraph (a) of this Rule. Designation as a Model EMS System shall be awarded for a period of to coincide with the expiration date of the current system approval, not to exceed six years. Systems shall apply to OEMS for model system redesignation. Authority G.S. 143-508(b); 143- 508(d)(1),(d)(3),(d)(5),(d)(8),(d)(9),(d)(10),(d)(13); 143- 509(1),(3),(4),(5). 10A NCAC 13P .0204 EMS PROVIDER LICENSE REQUIREMENTS (a) Any firm, corporation, agency, organization or association that provides emergency medical services as its primary responsibility shall be licensed as an EMS Provider by meeting and continuously maintaining the following criteria: (1) Be affiliated with an each EMS System; System where there is to be a physical base of operation or where the EMS Provider will provide point-to-point patient transport within the system; (2) Present an application for a permit for any ambulance that will be in service as required by G.S. 131E-156; (3) Submit a written plan detailing how the EMS Provider will furnish credentialed personnel; (4) Where there is a are franchise ordinance ordinances pursuant to G.S. 153A-250 in effect that covers cover the proposed service PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 299 area, be areas of each EMS system of operation, show the affiliation with each EMS System, as required by Subparagraph (a)(1) of this Rule, by being granted a current franchise to operate operate, or present written documentation of impending receipt of a franchise franchise, from the county; and each county. In counties where there is no franchise ordinance in effect, present a signature from each EMS System representative authorizing the EMS Provider to affiliate as required by Subparagraph (a)(1) of this Rule; (5) Present a written plan and method for recording Provide systematic, periodic inspection, repair, cleaning, and routine maintenance of all EMS responding vehicles. vehicles and maintain records available for inspection by the OEMS which verify compliance with this Rule; (6) Collect and within 24 hours electronically submit to the OEMS EMS Care data that uses the EMS data set and data dictionary as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B- 21.6, including subsequent amendments and additions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. (7) Develop and implement documented operational protocols for the management of equipment, supplies and medications and maintain records available for inspection by the OEMS which verify compliance with this Subparagraph. These protocols shall include a methodology: (A) to assure that each vehicle contains the required equipment and supplies on each response; (B) for cleaning and maintaining the equipment and vehicles; and (C) to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications. (b) In addition to the general requirements detailed in Paragraph (a) of this Rule, if providing fixed-wing air medical services, affiliation with a hospital is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. (c) In addition to the general requirements detailed in Paragraph (a) of this Rule, if providing rotary-wing air medical services, affiliation with a Level I or Level II Trauma Center designated by the OEMS is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. Due to the geographical barriers unique to the County of Dare, the Medical Care Commission exempts the Dare County EMS System from this Paragraph. (b)(d) An EMS Provider may renew its license by presenting documentation to the OEMS that the Provider meets the criteria found in Paragraph (a) Paragraphs (a) through (c) of this Rule. Authority G.S. 131E-155.1(c), 143-508(d)(1),(d)(5). 10A NCAC 13P .0205 EMS PROVIDER LICENSE CONDITIONS (a) Applications for an EMS Provider License must be received by the OEMS at least 30 days prior to the date that the EMS Provider proposes to initiate service. Applications for renewal of an EMS Provider License must be received by the OEMS at least 30 days prior to the expiration date of the current license. (b) Only one license shall be issued to each EMS Provider. The Department shall issue a license to the EMS Provider following verification of compliance with applicable laws and rules. (c) EMS Provider Licenses shall not be transferred. (d) The license shall be posted in a prominent location accessible to public view at the primary business location of the EMS Provider. (e) EMS Provider Licenses may not be issued by the Department to any firm, corporation, agency, organization or association that does not provide emergency medical services as part of its operation to the citizens of North Carolina. Authority G.S. 131E-155.1(c). 10A NCAC 13P .0206 TERM OF EMS PROVIDER LICENSE (a) EMS Provider Licenses shall remain in effect for six years unless any of the following occurs: (1) the Department imposes an administrative sanction which specifies license expiration; (2) the EMS provider Provider closes or goes out of business; (3) the EMS provider Provider changes name or ownership; or (4) substantial failure to continue to comply with Rule .0204 of this Section. (b) When the name or ownership of the EMS provider Provider changes, an EMS Provider License application shall be submitted to the OEMS at least 30 days prior to the effective date of the change. (c) For EMS providers maintaining affiliation with a Model EMS System, licenses may be renewed without requirement for submission of an application. Authority G.S. 131E-155.1(c). 10A NCAC 13P .0207 GROUND AMBULANCE: VEHICLE AND EQUIPMENT REQUIREMENTS (a) To be permitted as a Ground Ambulance, a vehicle shall have: (1) a patient compartment that meets the following interior dimensions: (A) the length, measured on the floor from the back of the driver's PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 300 compartment, driver's seat or partition to the inside edge of the rear loading doors, shall be is at least 102 inches; and (B) the height shall be is at least 48 inches over the patient area, measured from the approximate center of the floor, exclusive of cabinets or equipment; (2) patient care equipment and supplies as defined in the treatment protocols for the system. Vehicles used by EMS providers that are not required to have treatment protocols shall have patient care equipment and supplies as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and secured in the vehicle; (3) other equipment to include: that includes: (A) one fire extinguisher mounted in a quick release bracket that shall either be is either a dry chemical or all-purpose type and have has a pressure gauge; and (B) the availability of one pediatric restraint device to safely transport pediatric patients and children under 20 40 pounds in the patient compartment of the ambulance; (4) the name of the ambulance provider EMS Provider permanently displayed on each side of the vehicle; (5) reflective tape affixed to the vehicle such that there is reflectivity on all sides of the vehicle; (6) emergency warning lights and audible warning devices mounted on the vehicle as required by G.S. 20-125 in addition to those required by Federal Motor Vehicle Safety Standards. All warning devices shall function properly; (7) no structural or functional defects that may adversely affect the patient, the EMS personnel, or the safe operation of the vehicle; (8) an operational two-way radio that shall: that: (A) be is mounted to the ambulance and installed for safe operation and controlled by the ambulance driver; (B) have has sufficient range, radio frequencies, and capabilities to establish and maintain two-way voice radio communication from within the defined service area of the EMS System to the emergency communications center or public safety answering point (PSAP) PSAP designated to direct or dispatch the deployment of the ambulance; (C) be is capable of establishing two-way voice radio communication from within the defined service area to the emergency department of the hospital(s) where patients are routinely transported and to facilities that provide on-line medical direction to EMS personnel; (D) be is equipped with a radio control device mounted in the patient compartment capable of operation by the patient attendant to receive on-line medical direction; and (E) be is licensed or authorized by the Federal Communications Commission (FCC). FCC. (9) permanently installed heating and air conditioning systems; and (10) a copy of the EMS System patient care treatment protocols. (b) Ground ambulances shall not use a radiotelephone device such as a cellular telephone as the only source of two-way radio voice communication. (c) Other communication Communication instruments or devices such as data radio, facsimile, computer, or telemetry radio shall be in addition to the mission dedicated dispatch radio and shall function independently from the mission dedicated radio. Authority G.S. 131E-157(a); 143-508(d)(8). 10A NCAC 13P .0208 CONVALESCENT AMBULANCE: VEHICLE AND EQUIPMENT REQUIREMENTS (a) To be permitted as a Convalescent Ambulance, a vehicle shall have: (1) a patient compartment that meets the following interior dimensions: (A) the length, measured on the floor from the back of the driver's compartment, driver's seat or partition to the inside edge of the rear loading doors, shall be is at least 102 inches; and (B) the height shall be is at least 48 inches over the patient area, measured from the approximate center of the floor, exclusive of cabinets or equipment; (2) patient care equipment and supplies as defined in the treatment protocols for the system. Vehicles used by EMS providers that are not required to have treatment protocols shall have patient care equipment and supplies as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 301 and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and secured in the vehicle; (3) other equipment to include: that includes: (A) one fire extinguisher mounted in a quick release bracket that shall either be is either a dry chemical or all-purpose type and have has a pressure gauge; and (B) the availability of one pediatric restraint device to safely transport pediatric patients and children under 20 40 pounds in the patient compartment of the ambulance. ambulance; (4) permanently installed heating and air conditioning systems; and (5) a copy of the EMS System patient care treatment protocols. (b) Convalescent Ambulances shall: (1) not be equipped, permanently or temporarily, with any emergency warning devices, audible or visual, other than those required by Federal Motor Vehicle Safety Standards; (2) have the name of the ambulance provider EMS Provider permanently displayed on each side of the vehicle; (3) not have emergency medical symbols, such as the Star of Life, block design cross, or any other medical markings, symbols, or emblems, including the word "EMERGENCY," on the vehicle; (4) have the words "CONVALESCENT AMBULANCE" lettered on both sides and on the rear of the vehicle body; and (5) have reflective tape affixed to the vehicle such that there is reflectivity on all sides of the vehicle. (c) A two-way radio or radiotelephone device such as a cellular telephone shall be available to summon emergency assistance for a vehicle permitted as a convalescent ambulance. (d) The convalescent ambulance shall not have structural or functional defects that may adversely affect the patient, the EMS personnel, or the safe operation of the vehicle. Authority G.S. 131E-157(a); 143-508(d)(8). 10A NCAC 13P .0209 AIR MEDICAL AMBULANCE: VEHICLE AND EQUIPMENT REQUIREMENTS To be permitted as an Air Medical Ambulance, an aircraft shall meet the following requirements: (1) Configuration of the aircraft interior shall patient care compartment does not compromise the ability to provide appropriate care or prevent providers from performing in-flight emergency patient care procedures if necessary. as approved by the program medical director. (2) The aircraft shall have has on board patient care equipment and supplies as defined in the treatment protocols for the program. Air Medical Ambulances used by EMS providers that are not required to have treatment protocols shall have patient care equipment and supplies as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and secured in the vehicle. aircraft. (3) There shall be is installed in the aircraft an internal voice communication system to allow for communication between the medical crew and flight crew. (4) Due to the different configurations and space limitations of air medical ambulances, the The medical director shall designate designates the combination of medical equipment specified in Item (2) of this Rule that is carried on a mission based on anticipated patient care needs. (5) Air Medical Ambulances shall have the The name of the organization EMS Provider is permanently displayed on each side of the aircraft. (6) Air Medical Ambulances shall be The aircraft is equipped with a two-way voice radio licensed by the Federal Communications Commission FCC capable of operation on any frequency required to allow communications with public safety agencies such as fire departments, police departments, ambulance and rescue units, hospitals, and local government agencies within the defined service area. (7) All rotary wing aircraft permitted as an air medical ambulance shall have the following flight equipment operational in the aircraft: In addition to equipment required by applicable air worthiness certificates and Federal Aviation Regulations (FAA Part 91 or 135), any rotary-wing aircraft permitted has the following functioning equipment to help ensure the safety of crew members and ground personnel, patient comfort, and medical care: (a) two 360-channel VHF aircraft frequency tranceivers; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 302 (b) one VHF omnidirectional ranging (VOR) receiver; (c) attitude indicators; (d) one transponder with 4097 code, Mode C with altitude encoding; (e) turn and slip indicator in the absence of three attitude indicators; (f) current FAA approved navigational aids and charts for the area of operations; (g) radar altimeter; (h)(a) Satellite Global Navigational System; Global Positioning System; (i) Emergency Locator Transmitter (ELT); (j)(b) a remote control external search light; an external search light that can be operated from inside the aircraft; (k)(c) a light which illuminates the tail rotor; a light that illuminates the tail rotor in nighttime conditions; (l) a fire extinguisher; and (m)(d) survival gear appropriate for the service area and the number of occupants. aircraft occupants; (e) permanently installed heating and air conditioning systems; and (f) the ability to carry at least a 220 pound patient load and transport at least 60 nautical miles or nearest level one Trauma Center non-stop without refueling. (8) Any fixed wing aircraft issued a permit to operate as an air medical ambulance shall have a current "Instrument Flight Rules" certification. (9)(8) The availability of one pediatric restraint device to safely transport pediatric patients and children under 20 40 pounds in the patient compartment of the air medical ambulance. (10)(9) The Air Medical Ambulance shall not have aircraft has no structural or functional defects that may adversely affect the patient, or the EMS personnel, or the safe operation of the aircraft. personnel. Authority G.S. 131E-157(a); 143-508(d)(8). 10A NCAC 13P .0210 WATER AMBULANCE: WATERCRAFT AND EQUIPMENT REQUIREMENTS To be permitted as a Water Ambulance, a watercraft shall meet the following requirements: (1) The watercraft shall have a patient care area that: (a) provides access to the head, torso, and lower extremities of the patient while providing sufficient working space to render patient care; (b) is covered to protect the patient and EMS personnel from the elements; and (c) has an opening of sufficient size to permit the safe loading and unloading of a person occupying a litter. (2) The watercraft shall have on board patient care equipment and supplies as defined in the treatment protocols for the system. Water ambulances used by EMS providers that are not required to have treatment protocols shall have patient care equipment and supplies as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B- 21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and secured in the vehicle. (3) Water ambulances shall have the name of the ambulance provider EMS Provider permanently displayed on each side of the watercraft. (4) Water ambulances shall have a 360-degree beacon warning light in addition to warning devices required in Chapter 75A, Article 1, of the North Carolina General Statutes. (5) Water ambulances shall be equipped with: (a) two floatable rigid long backboards with proper accessories for securing infant, pediatric, and adult patients and stabilization of the head and neck; (b) one floatable litter with patient restraining straps and capable of being secured to the watercraft; (c) one fire extinguisher mounted in a quick release bracket that shall either be is either a dry chemical or all-purpose type and have has a pressure gauge; (d) lighted compass; (e) radio navigational aids such as ADF (automatic directional finder), Satellite Global Navigational System, navigational radar, or other comparable radio equipment suited for water navigation; (f) marine radio; and (g) the availability of one pediatric restraint device to safely transport pediatric patients under 20 40 pounds in the patient compartment of the ambulance; (6) The water ambulance shall not have structural or functional defects that may adversely affect PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 303 the patient, the EMS personnel, or the safe operation of the watercraft. (7) Water ambulances shall have a copy of the EMS System patient care treatment protocols. Authority G.S. 131E-157(a); 143-508(d)(8). 10A NCAC 13P .0212 TERM OF AMBULANCE PERMIT (a) Ambulance Permits shall remain in effect for two years unless any of the following occurs: (1) The Department imposes an administrative sanction which specifies permit expiration; (2) The EMS provider Provider closes or goes out of business; (3) The EMS provider Provider changes name or ownership; or (4) Substantial failure Failure to comply with the applicable Paragraphs of Rules .0207, .0208, .0209, or .0210 of this Section. (b) Ambulance Permits shall be renewed without OEMS inspection for those ambulances currently operated within a Model EMS System. Authority G.S. 131E-157(a); 143-508(d)(8). 10A NCAC 13P .0213 EMS NONTRANSPORTING VEHICLE REQUIREMENTS (a) To be permitted as an EMS Nontransporting Vehicle, a vehicle shall: (1) have patient care equipment and supplies as defined in the treatment protocols for the system. The equipment and supplies shall be clean, in working order, and secured in the vehicle. (2) have the name of the organization EMS Provider permanently displayed on each side of the vehicle. (3) have reflective tape affixed to the vehicle such that there is reflectivity on all sides of the vehicle. (4) have emergency warning lights and audible warning devices mounted on the vehicle as required by G.S. 20-125 in addition to those required by Federal Motor Vehicle Safety Standards. All warning devices shall function properly. (5) not have structural or functional defects that may adversely affect the EMS personnel or the safe operation of the vehicle. (6) have one fire extinguisher that shall be is a dry chemical or all-purpose type with a pressure gauge, mounted in a quick-release bracket. (7) have an operational two-way radio that shall: that: (A) be is mounted to the EMS Nontransporting Vehicle and installed for safe operation and controlled by the driver; (B) have has sufficient range, radio frequencies, and capabilities to establish and maintain two-way voice radio communication from within the defined service area of the EMS System to the emergency communications center or public safety answering point (PSAP) PSAP designated to direct or dispatch the deployment of the ambulance; (C) be is capable of establishing two-way voice radio communication from within the defined service area to facilities that provide on-line medical direction to EMS personnel; and (D) be is licensed or authorized by the Federal Communications Commission (FCC). FCC. (8) not use a radiotelephone device such as a cellular telephone as the only source of two-way radio voice communication. (9) have a copy of the local EMS System patient care treatment protocols. (b) Other communication Communication instruments or devices such as data radio, facsimile, computer, or telemetry radio shall be in addition to the mission dedicated dispatch radio and shall function independently from the mission-dedicated radio. Authority G.S. 143-508(d)(8). 10A NCAC 13P .0214 EMS NONTRANSPORTING VEHICLE PERMIT CONDITIONS (a) An EMS provider Provider shall apply to the OEMS for an EMS Nontransporting Vehicle Permit prior to placing such a vehicle in service. (b) The Department shall issue a permit for a vehicle following verification of compliance with applicable laws and rules. (c) Only one EMS Nontransporting Vehicle Permit shall be issued for each vehicle. (d) EMS Nontransporting Vehicle Permits shall not be transferred. (e) The EMS Nontransporting Vehicle Permit shall be posted as designated by the OEMS inspector. (f) Vehicles that are not owned or leased by the EMS Provider are ineligible for permitting. Authority G.S. 143-508(d)(8). 10A NCAC 13P .0215 TERM OF EMS NONTRANSPORTING VEHICLE PERMIT (a) EMS Nontransporting Vehicle Permits shall remain in effect for two years in an EMS System or four years in a Model EMS System, years, unless any of the following occurs: (1) The Department imposes an administrative sanction that specifies permit expiration; (2) The EMS provider Provider closes or goes out of business; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 304 (3) The EMS provider Provider changes name or ownership; or (4) Substantial failure Failure to comply with Rule .0213 of this Section. (b) EMS Nontransporting Vehicle Permits shall be renewed without OEMS inspection for those vehicles currently operated within a Model EMS System. Authority G.S. 143-508(d)(8). SECTION .0300 – SPECIALTY CARE TRANSPORT PROGRAMS 10A NCAC 13P .0301 SPECIALTY CARE TRANSPORT PROGRAM CRITERIA (a) Programs EMS Providers seeking designation to provide specialty care transports shall submit an application for program approval to the OEMS at least 60 days prior to field implementation. The application shall document that the program has: (1) a defined service area; area that identifies the specific transferring and receiving facilities in which the program is intended to service; (2) a written policies and procedures implemented for medical oversight plan meeting the requirements of Section .0400; (3) service continuously available on a 24 hour per day basis; (4) the capability to provide the following patient care skills and procedures: (A) advanced airway techniques including rapid sequence induction, cricothyrotomy, and ventilator management, including continuous monitoring of the patient's oxygenation; (B) insertion of femoral lines; (C) maintaining invasive monitoring medical devices to include such as central venous pressure lines, arterial and venous catheters, arterial lines, intra-ventricular catheters, and epidural catheters; and (D) interpreting 12-lead electrocardiograms; (5) a written continuing education plan program for EMS personnel, under the direction of the Specialty Care Transport Program Continuing Education Coordinator, developed and modified based on feedback from program data, review and evaluation of patient outcomes, and quality management reviews. review that follows the guidelines of the: (A) "US DOT NHTSA EMT-Basic Refresher: National Standard Curriculum" for EMT personnel; and (B) "EMT-P and EMT-I Continuing Education National Guidelines" for EMT-I and EMT-P personnel. These documents are incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and additions. These documents are available from NHTSA, 400 7th Street, SW, Washington, D.C. 20590, at no cost; (6) a mechanism to collect and electronically submit to the OEMS data that uses the EMS data set and data dictionary as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. EMS Specialty Care Transport Programs shall comply with this requirement by July 1, 2004. a communication system that will provide two-way voice communications for transmission of patient information to medical crew members anywhere in the service area of the program. The SCTP medical director shall verify that the communications system is satisfactory for on-line medical direction; (7) medical crew members that have all completed training regarding: (A) operation of the EMS communications system used in the program; and (B) the medical and safety equipment specific to the vehicles used in the program. This training shall be conducted every six months; (8) written operational protocols for the management of equipment, supplies and medications. These protocols include: (A) a listing of all standard medical equipment, supplies, and medications for all vehicles used in the program based on the treatment protocols and approved by the medical director; (B) a methodology to assure that each vehicle contains the required equipment, supplies and medications on each response; and (9) written policies and procedures specifying how EMS Systems will dispatch and utilize the ambulances operated by the program. (b) Applications for specialty care transport program approval shall document that the applicant meets the requirements for the specific program type or types applied for as specified in Rules .0302, .0303 or .0304 of this Section. When transporting patients, staffing for the vehicle used in the SCTP shall be approved by the SCTP medical director as medical crew members, using any of the following appropriate for the condition of the patient: (1) EMT-Paramedic; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 305 (2) nurse practitioner; (3) physician; (4) physician assistant; (5) registered nurse; and (6) respiratory therapist. (c) EMS Providers whose primary dedicated service is the provision of the patient care skills and procedures as detailed in Subparagraph (a)(4) of this Rule are exempt from the staffing requirements defined in G.S. 131E-158(a). (c)(d) Specialty care transport program Care Transport Program approval shall be are valid for a period to coincide with the EMS Provider License, not to exceed six years. Programs shall apply to the OEMS for reapproval. Authority G.S. 131E-158; 143-508(d)(1),(d)(8),(d)(9); 143- 508(d)(13). 10A NCAC 13P .0302 AIR MEDICAL SPECIALTY CARE TRANSPORT PROGRAM CRITERIA FOR LICENSED EMS PROVIDERS USING ROTARY-WING AIRCRAFT (a) In addition to the general requirements of Specialty Care Transport Programs in Rule .0301 of this Section, Air Medical Programs using rotary-wing aircraft shall document that the program has: (1) Medical crew members that have all completed training regarding: (A) Altitude physiology; (B) The operation of the EMS communications system used in the program; (C) In-flight emergencies specific to the aircraft used in the program; and (D) Aircraft safety. This training shall be conducted every six months. (2) A Certificate of Need has been obtained from the Department when applicable; applicable as required by law; (3) A written plan Written policies and procedures for transporting patients to appropriate facilities when diversion or bypass plans are activated; (4) A written plan for providing emergency vehicle operation education for program personnel who operate ground emergency vehicles; and (5)(4) A written Written policies and procedures specifying how EMS Systems will request ground support ambulances dispatch and utilize aircraft operated by the program. program; (5) Written triage protocols for trauma, stroke, STEMI, burn, and pediatric patients reviewed and approved by the OEMS medical director; (6) Written policies and procedures specifying how EMS Systems will receive the Specialty Care Transport Services offered under the program when the aircraft are unavailable for service; (7) Pilot-In-Command (PIC) that: (A) Maintain instrument currency in accordance with FAR 61,57; (B) Hold at least a commercial rotor-craft instrument rating; (C) Have not less than 2,500 hours total rotor-wing flight time; and (8) A copy of the Specialty Care Transport Program patient care treatment protocols. (b) Air Medical Programs based outside of North Carolina that provide specialty care transports may be granted approval by the OEMS to operate in North Carolina by submitting an application for program approval. The application shall document that the program meets all criteria specified in Rules .0204 and .0301 of this Subchapter and Paragraph (a) of this Rule. All patient response, re-positioning and mission flight legs must be conducted under FAA part 135 regulations. Authority G.S. 143-508(d)(1),(d)(3),(d)(13). 10A NCAC 13P .0303 GROUND SPECIALTY CARE TRANSPORT PROGRAMS (a) When transporting patients that have a medical need for one or more of the skills or procedures as defined for specialty care transport programs in .0301(a)(4) of this Section, staffing for the vehicle used in the ground specialty care transport program shall be at a level to ensure the capability to provide in the patient compartment, when the patient condition requires, two of the following personnel approved by the medical director as medical crew members: (1) EMT-Paramedic; (2) nurse practitioner; (3) physician (4) physician assistant; (5) registered nurse; and (6) respiratory therapist. (b) When transporting patients that do not require specialty care transport skills or procedures, staffing for the vehicles used in the ground specialty care transport program shall be at a level to ensure compliance with G.S. 131E-158(a). (c) In addition to the requirements of specialty care transport programs in Rule .0301 of this Section, ground programs providing specialty care transports shall document that the program has: (1) a communication system that will provide two-way voice communications to medical crew members anywhere in the service area of the program. The medical director shall verify that the communications system is satisfactory for on-line medical direction; (2) medical crew members that have all completed training regarding: (A) operation of the EMS communications system used in the program; and (B) the medical and safety equipment specific to the vehicles used in the program. This training shall be conducted every six months; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 306 (3) operational protocols for the management of equipment, supplies and medications. These protocols shall include: (A) a standard equipment and supply listing for all ambulance vehicles used in the program. This listing shall meet or exceed the requirements for each category of ambulance used in the program as found in Rules .0207, .0208, .0209, and .0210 of this Subchapter; (B) a standard listing of medications for all ambulance and EMS nontransporting vehicles used in the system. This listing shall be based on the local treatment protocols and be approved by the medical director; (C) a methodology to assure that each vehicle contains the required equipment and supplies on each response; (D) a methodology for cleaning and maintaining the equipment and vehicles; and (E) a methodology for assuring that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer’s specifications; (4) a written plan for providing emergency vehicle operation education for program personnel who operate emergency vehicles; and (5) a written plan specifying how EMS Systems will request ambulances operated by the program. (d) Ground Specialty Care Transport programs based outside of North Carolina may be granted approval by the OEMS to operate in North Carolina by submitting an application for program approval. The application shall document that the program meets all criteria specified in Rules .0204 and .0301 of this Subchapter and Paragraphs (a) and (b) of this Rule. Authority G.S. 143-508(d)(1),(d)(8),(d)(9). 10A NCAC 13P .0304 HOSPITAL-AFFILIATED GROUND SPECIALTY CARE TRANSPORT PROGRAMS USED FOR INPATIENT TRANSPORTS (a) Patients transported by Hospital-affiliated Ground Specialty Care Transport Program shall: (1) Have a medical need for one or more of the skills or procedures as defined for Specialty Care Transport Programs as defined in .0301(a)(4); or (2) Be a patient of the hospital administering the program, or be scheduled for admission to or discharged from the hospital administering the program; (b) In addition to the general requirements of Specialty Care Transport Programs in Rule .0301 of this section, hospital-affiliated ground programs providing specialty care transports shall document that the program has: (1) A communication system that will provide, at a minimum, two-way voice communications to medical crew members anywhere in the service area of the program. The medical director shall verify that the communications system is satisfactory for on-line medical direction. (2) Medical crew members that have all completed training regarding: (A) Operation of the EMS communications system used in the program; and (B) The medical and safety equipment specific to the vehicles used in the program. This training shall be conducted every six months. (3) Staffing at a level to ensure the capability to provide in the patient compartment, when the patient's condition requires, two of the following personnel approved by the medical director as medical crew members: (A) EMT-Paramedic; (B) Nurse practitioner; (C) Physician; (D) Physician assistant; (E) Registered nurse; or (F) Respiratory therapist. (4) Operational protocols for the management of equipment, supplies, and medications. These protocols shall include: (A) A standard equipment and supply listing for all ambulance vehicles used in the program. This listing shall meet or exceed the requirements for each category of ambulance used in the program as found in Rules .0207, .0208, .0209, and .0210 of this Subchapter; (B) A standard listing of medications for all ambulance and EMS nontransporting vehicles used in the program. This listing shall be based on the local treatment protocols and be approved by the medical director; (C) A methodology to assure that each vehicle contains the required equipment and supplies on each response (D) A methodology for cleaning and maintaining the equipment and vehicles; and (E) A methodology for assuring that supplies and medications are not used beyond the expiration date and stored in a temperature-controlled PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 307 atmosphere according to manufacturer's specifications. (5) A written plan for providing emergency vehicle operation education for program personnel who operate emergency vehicles. (6) A written plan specifying how EMS systems will request ambulances operated by the program. (c) Hospital-Affiliated Ground Specialty Care Transport Programs based outside of North Carolina may be granted approval by the OEMS to operate in North Carolina by submitting an application for program approval. The application shall document that the program meets all criteria specified in Rules .0204 and .0301 of this Subchapter and Paragraphs (a) and (b) of this Rule. Authority G.S. 143-508(d)(1),(d)(8),(d)(9). 10A NCAC 13P .0305 AIR MEDICAL SPECIALTY CARE TRANSPORT PROGRAM CRITERIA FOR LICENSED EMS PROVIDERS USING FIXED-WING AIRCRAFT (a) In addition to the general requirements of Specialty Care Transport Programs in Rule .0301 of this Section, Air Medical Programs using fixed-wing aircraft shall document that: (1) Medical crew members have all completed training regarding: (A) Altitude physiology; (B) The operation of the EMS communications system used in the program; (C) In-flight emergencies specific to the aircraft used in the program; and (D) Aircraft safety. This training shall be conducted every six months. (2) All aircraft are operated by a two-pilot crew. Pilot-In-Command (PIC) shall be type rated in licensed aircraft and Airline Transport Pilot (ATP) certified. If the aircraft is over 12,500 pounds, both PIC and Second-In Command shall be type-rated. (3) A Certificate of Need has been obtained from the Department when applicable as required by law; (4) Written policies and procedures specifying how ground ambulance services are utilized by the program for patient delivery and receipt on each end of the transport; and (5) There is a copy of the Specialty Care Treatment Program patient care protocols. (b) All patient, re-positioning, and mission flight legs must be conducted under FAA part 135 regulations. Authority G.S. 143-508(d)(1),(d)(3). SECTION .0400 - MEDICAL OVERSIGHT 10A NCAC 13P .0401 COMPONENTS OF MEDICAL OVERSIGHT FOR EMS SYSTEMS Each EMS System operating within the scope of practice for EMD, EMT-I, or EMT-P or seeking designation as a Model EMS System shall have the following components in place to assure medical oversight of the system: (1) a medical director for adult and pediatric patients appointed, either directly or by documented delegation, by the county responsible for establishing the EMS System. Systems may elect to appoint one or more assistant medical directors. (a) For EMS Systems, the medical director and assistant medical directors shall meet the criteria as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; and (b) For Model EMS Systems, the medical director and assistant medical directors shall also meet the additional criteria for medical directors of Model EMS Systems as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; (2) written treatment protocols for adult and pediatric patients for use by EMS personnel; (3) for systems providing EMD service, an EMDPRS approved by the medical director; (4) an EMS Peer Review Committee; and (5) written procedures for use by EMS personnel to obtain on-line medical direction. On-line medical direction shall: (a) be restricted to medical orders that fall within the scope of practice of the EMS personnel and within the scope of approved system treatment protocols; (b) be provided only by a physician, MICN, EMS-NP, or EMS-PA. Only physicians may deviate from written treatment protocols; and PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 308 (c) be provided by a system of two-way voice communication that can be maintained throughout the treatment and disposition of the patient. Authority G.S. 143-508(b); 143-509(12). 10A NCAC 13P .0402 COMPONENTS OF MEDICAL OVERSIGHT FOR SPECIALTY CARE TRANSPORT PROGRAMS Each Specialty Care Transport Program shall have the following components in place to assure Medical Oversight of the system: (1) a medical director. The administration of the Specialty Care Transport Program SCTP shall appoint a medical director following the criteria for medical directors of Specialty Care Transport Programs as defined by the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The program administration may elect to appoint one or more assistant medical directors; (2) treatment protocols for adult and pediatric patients for use by medical crew members; (3) an EMS Peer Review Committee; and (4) a written protocol for use by medical crew members to obtain on-line medical direction. On-line medical direction shall: (a) be restricted to medical orders that fall within the scope of practice of the medical crew members and within the scope of approved program treatment protocols; (b) be provided only by a physician, MICN, EMS-NP, or EMS-PA. Only physicians may deviate from written treatment protocols; and (c) be provided by a system of two-way voice communication that can be maintained throughout the treatment and disposition of the patient. Authority G.S. 143-508(b); 143-509(12). 10A NCAC 13P .0403 RESPONSIBILITIES OF THE MEDICAL DIRECTOR FOR EMS SYSTEMS (a) The Medical Director for an EMS System shall be is responsible for the following: (1) ensure ensuring that medical control is available 24 hours a day; (2) the establishment, approval and annual updating of adult and pediatric treatment protocols; (3) EMD programs, the establishment, approval, and annual updating of the EMDPRS; (4) medical supervision of the selection, system orientation, continuing education and performance of all EMS personnel; (5) medical supervision of a scope of practice performance evaluation for all EMS personnel in the system based on the treatment protocols for the system; (6) the medical review of the care provided to patients; (7) providing guidance regarding decisions about the equipment, medical supplies, and medications that will be carried on all ambulances or and EMS nontransporting vehicles within the scope of practice of EMT-I or EMT-P; and operating within the system; (8) keeping the care provided up to date with current medical practice. practice; and (9) developing and implementing an orientation plan for all hospitals within the EMS system that use MICN, EMS-NP, or EMS-PA personnel to provide on-line medical direction to EMS personnel, which includes at a minimum: (A) a discussion of all EMS System treatment protocols and procedures; (B) an explanation of the specific scope of practice for credentialed EMS personnel, as authorized by the approved EMS System treatment protocols as required by Rule .0405 of this Section; (C) a discussion of all practice settings within the EMS System and how scope of practice may vary in each setting; (D) a mechanism to assess the ability to effectively use EMS System communications equipment including hospital and prehospital devices, EMS communication protocols, and communications contingency plans as related to on-line medical direction; and (E) the successful completion of a scope of practice performance evaluation which verifies competency in Parts (A) through (D) of this Subparagraph and which is administered under the direction of the medical director. (b) Any tasks related to Paragraph (a) of this Rule may be are completed, through written delegation, by assisting physicians, physician assistants, nurse practitioners, registered nurses, EMD's, or EMT-P's. (c) The Medical Director may suspend temporarily, pending due process review, any EMS personnel from further participation in the EMS System when it is determined the activities or medical care rendered by such personnel may be detrimental to the care PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 309 of the patient, constitute unprofessional behavior, conduct, or result in non-compliance with credentialing requirements. Authority G.S. 143-508(b), 143-508(d)(3),(d)(7); 143-509(12). 10A NCAC 13P .0404 RESPONSIBILITIES OF THE MEDICAL DIRECTOR FOR SPECIALTY CARE TRANSPORT PROGRAMS (a) The medical director for a Specialty Care Transport Program shall be responsible for the following: (1) The establishment, approval, and periodic updating of adult and pediatric treatment protocols; (2) Medical supervision of the selection, program orientation, continuing education, and performance of medical crew members; (3) Medical supervision of a scope of practice performance evaluation for all medical crew members in the program based on the treatment protocols for the program; (4) The medical review of the care provided to patients; (5) Keeping the care provided up to date with current medical practice; and (6) In air medical programs, determination and specification of the medical equipment required in Item (2) of Rule .0209 of this Subchapter that is carried on a mission based on anticipated patient care needs. (b) Any tasks related to Paragraph (a) of this Rule may be completed, through clearly established written delegation, by assisting physicians, physician assistants, nurse practitioners, registered nurses, or medical crew members. (c) The medical director shall have the authority to may suspend temporarily, pending due process review, any medical crew members from further participation in the Specialty Care Transport Program when it is determined the activities or medical care rendered by such personnel may be detrimental to the care of the patient, constitute unprofessional behavior, conduct, or result in non-compliance with credentialing requirements. Authority G.S. 143-508(b); 143-509(12). 10A NCAC 13P .0405 REQUIREMENTS FOR ADULT AND PEDIATRIC TREATMENT PROTOCOLS FOR EMS SYSTEMS (a) Written Treatment Protocols: Protocols used in EMS Systems shall: (1) Used in EMS Systems shall meet Be adopted in their original form from the standard adult and pediatric treatment protocols as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; and (2) Used in Model EMS Systems shall also meet the standard treatment protocols for Model EMS Systems as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; and (3)(2) Shall not Not contain medical procedures, medications, or intravenous fluids that exceed the scope of practice defined by the North Carolina Medical Board pursuant to G.S. 143- 514 for the level of care offered in the EMS System and any other applicable health care licensing board. (b) Treatment Individual adult and pediatric treatment protocols developed may be modified locally by EMS Systems if there is a change in a specific protocol which will optimize care within the local community which adds additional medications or medical procedures, or rearranges the order of care provided in the protocol contained within the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection" shall meet the requirements of as described in Paragraph (a) of this Rule, shall be reviewed annually and any change in the treatment protocols shall be submitted to the OEMS Medical Director for review and approval at least 30 days prior to the implementation of the change. Rule. Additional written Treatment Protocols may be developed by any EMS System in addition to the required protocols contained within the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection" as required by the EMS System. All North Carolina College of Emergency Physicians Policies and Procedures must be included and may be modified at the local level. All EMS System Treatment Protocols which have been added or changed by the EMS System shall be submitted to the OEMS Medical Director for review and approval at least 30 days prior to the implementation of the change. Authority G.S. 143-508(b); 143-509(12). 10A NCAC 13P .0406 REQUIREMENTS FOR ADULT AND PEDIATRIC TREATMENT PROTOCOLS FOR SPECIALTY CARE TRANSPORT PROGRAMS (a) Treatment Adult and pediatric treatment protocols used by medical crew members within a Specialty Care Transport Program shall: (1) be approved by the OEMS Medical Director and incorporate all skills, medications, equipment, and supplies for Specialty Care Transport Programs as defined by the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 310 accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; and (2) not contain medical procedures, medications, or intravenous fluids that exceed the scope of practice of the medical crew members. (b) Treatment All adult and pediatric treatment protocols shall be reviewed annually, and any change in the treatment protocols shall be submitted to the OEMS Medical Director for review and approval at least 30 days prior to the implementation of the change. Authority G.S. 143-508(b); 143-509(12). 10A NCAC 13P .0408 EMS PEER REVIEW COMMITTEE FOR EMS SYSTEMS (a) The EMS Peer Review Committee for an EMS System shall: (1) be composed of membership as defined in G.S. 131E-155(6b). (2) appoint a physician as chairperson; (3) meet at least quarterly; (4) analyze use, at a minimum, information gained from the analysis of system data submitted to the O
Object Description
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Title | North Carolina register |
Date | 2008-08-15 |
Description | Volume 23, Issue 4, (August 15, 2008) |
Digital Characteristics-A | 793 KB; 97 p. |
Digital Format |
application/pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_borndigital\images_master\ |
Full Text | This publication is printed on permanent, acid-free paper in compliance with G.S. 125-11.13 NORTH CAROLINA REGISTER VOLUME 23 ● ISSUE 04 ● Pages 285 - 377 August 15, 2008 I. IN ADDITION Notice of Rule Making Proceedings and Public Hearing – Building Code .... 285 – 286 II. PROPOSED RULES Agriculture, Department of Agriculture, Board of ...................................................................................... 287 – 288 Commerce, Department of Cemetery Commission.................................................................................... 288 – 289 Community Colleges, Department of Community Colleges, Board of....................................................................... 358 – 359 Environment and Natural Resources, Department of Wildlife Resources Commission..................................................................... 348 – 350 Health and Human Services, Department of Medical Care Commission.............................................................................. 289 – 346 Justice, Department of Private Protective Services Board................................................................... 346 – 348 Occupational Licensing Boards and Commissions Funeral Service, Board of ............................................................................... 350 – 357 Pharmacy, Board of.........................................................................................357 – 358 III. RULES REVIEW COMMISSION ................................................................. 360 – 373 IV. CONTESTED CASE DECISIONS Index to ALJ Decisions ...................................................................................... 374 – 377 PUBLISHED BY The Office of Administrative Hearings Rules Division 6714 Mail Service Center Raleigh, NC 27699-6714 Telephone (919) 733-2678 Fax (919) 733-3462 Julian Mann, III, Director Camille Winston, Deputy Director Molly Masich, Codifier of Rules Dana Vojtko, Publications Coordinator Julie Edwards, Editorial Assistant Felicia Williams, Editorial Assistant This publication is printed on permanent, acid-free paper in compliance with G.S. 125-11.13 Contact List for Rulemaking Questions or Concerns For questions or concerns regarding the Administrative Procedure Act or any of its components, consult with the agencies below. The bolded headings are typical issues which the given agency can address, but are not inclusive. Rule Notices, Filings, Register, Deadlines, Copies of Proposed Rules, etc. Office of Administrative Hearings Rules Division Capehart-Crocker House (919) 733-2678 424 North Blount Street (919) 733-3462 FAX Raleigh, North Carolina 27601-2817 contact: Molly Masich, Codifier of Rules molly.masich@ncmail.net (919) 733-3367 Dana Vojtko, Publications Coordinator dana.vojtko@ncmail.net (919) 733-2679 Julie Edwards, Editorial Assistant julie.edwards@ncmail.net (919) 733-2696 Felicia Williams, Editorial Assistant felicia.s.williams@ncmail.net (919) 733-3361 Rule Review and Legal Issues Rules Review Commission 1307 Glenwood Ave., Suite 159 (919) 733-2721 Raleigh, North Carolina 27605 (919) 733-9415 FAX contact: Joe DeLuca Jr., Commission Counsel joe.deluca@ncmail.net (919) 715-8655 Bobby Bryan, Commission Counsel bobby.bryan@ncmail.net (919) 733-0928 Fiscal Notes & Economic Analysis Office of State Budget and Management 116 West Jones Street (919) 807-4700 Raleigh, North Carolina 27603-8005 (919) 733-0640 FAX contact: William Crumbley, Economic Analyst william.crumbley@ncmail.net (919) 807-4740 Governor’s Review Reuben Young reuben.young@ncmail.net Legal Counsel to the Governor (919) 733-5811 116 West Jones Street(919) Raleigh, North Carolina 27603 Legislative Process Concerning Rule-making Joint Legislative Administrative Procedure Oversight Committee 545 Legislative Office Building 300 North Salisbury Street (919) 733-2578 Raleigh, North Carolina 27611 (919) 715-5460 FAX contact: Karen Cochrane-Brown, Staff Attorney karenc@ncleg.net Jeff Hudson, Staff Attorney jeffreyh@ncleg.net County and Municipality Government Questions or Notification NC Association of County Commissioners 215 North Dawson Street (919) 715-2893 Raleigh, North Carolina 27603 contact: Jim Blackburn jim.blackburn@ncacc.org Rebecca Troutman rebecca.troutman@ncacc.org NC League of Municipalities (919) 715-4000 215 North Dawson Street Raleigh, North Carolina 27603 contact: Anita Watkins awatkins@nclm.org This publication is printed on permanent, acid-free paper in compliance with G.S. 125-11.13 NORTH CAROLINA REGISTER Publication Schedule for January 2008 – December 2008 FILING DEADLINES NOTICE OF TEXT PERMANENT RULE TEMPORARY RULES Volume & issue number Issue date Last day for filing Earliest date for public hearing End of required comment period Deadline to submit to RRC for review at next meeting Earliest Eff. Date of Permanent Rule Delayed Eff. Date of Permanent Rule 31st legislative day of the session beginning: 270th day from publication in the Register 22:13 01/02/08 12/06/07 01/17/08 03/03/08 03/20/08 05/01/08 05/13/08 09/28/08 22:14 01/15/08 12/19/07 01/30/08 03/17/08 03/20/08 05/01/08 05/13/08 10/11/08 22:15 02/01/08 01/10/08 02/16/08 04/01/08 04/21/08 06/01/08 01/2009 10/28/08 22:16 02/15/08 01/25/08 03/01/08 04/15/08 04/21/08 06/01/08 01/2009 11/11/08 22:17 03/03/08 02/11/08 03/18/08 05/02/08 05/20/08 07/01/08 01/2009 11/28/08 22:18 03/17/08 02/25/08 04/01/08 05/16/08 05/20/08 07/01/08 01/2009 12/12/08 22:19 04/01/08 03/10/08 04/16/08 06/02/08 06/20/08 08/01/08 01/2009 12/27/08 22:20 04/15/08 03/25/08 04/30/08 06/16/08 06/20/08 08/01/08 01/2009 01/10/09 22:21 05/01/08 04/10/08 05/16/08 06/30/08 07/21/08 09/01/08 01/2009 01/26/09 22:22 05/15/08 04/24/08 05/30/08 07/14/08 07/21/08 09/01/08 01/2009 02/09/09 22:23 06/02/08 05/09/08 06/17/08 08/01/08 08/20/08 10/01/08 01/2009 02/27/09 22:24 06/16/08 05/23/08 07/01/08 08/15/08 08/20/08 10/01/08 01/2009 03/13/09 23:01 07/01/08 06/10/08 07/16/08 09/02/08 09/22/08 11/01/08 01/2009 03/28/09 23:02 07/15/08 06/23/08 07/30/08 09/15/08 09/22/08 11/01/08 01/2009 04/11/09 23:03 08/01/08 07/11/08 08/16/08 09/30/08 10/20/08 12/01/08 01/2009 04/28/09 23:04 08/15/08 07/25/08 08/30/08 10/14/08 10/20/08 12/01/08 01/2009 05/12/09 23:05 09/02/08 08/11/08 09/17/08 11/03/08 11/20/08 01/01/09 01/2009 05/30/09 23:06 09/15/08 08/22/08 09/30/08 11/14/08 11/20/08 01/01/09 01/2009 06/12/09 23:07 10/01/08 09/10/08 10/16/08 12/01/08 12/22/08 02/01/09 05/2010 06/28/09 23:08 10/15/08 09/24/08 10/30/08 12/15/08 12/22/08 02/01/09 05/2010 07/12/09 23:09 11/03/08 10/13/08 11/18/08 01/02/09 01/20/09 03/01/09 05/2010 07/31/09 23:10 11/17/08 10/24/08 12/02/08 01/16/09 01/20/09 03/01/09 05/2010 08/14/09 23:11 12/01/08 11/05/08 12/16/08 01/30/09 02/20/09 04/01/09 05/2010 08/28/09 23:12 12/15/08 11/20/08 12/30/08 02/13/09 02/20/09 04/01/09 05/2010 09/11/09 This publication is printed on permanent, acid-free paper in compliance with G.S. 125-11.13 EXPLANATION OF THE PUBLICATION SCHEDULE This Publication Schedule is prepared by the Office of Administrative Hearings as a public service and the computation of time periods are not to be deemed binding or controlling. Time is computed according to 26 NCAC 2C .0302 and the Rules of Civil Procedure, Rule 6. GENERAL The North Carolina Register shall be published twice a month and contains the following information submitted for publication by a state agency: (1) temporary rules; (2) notices of rule-making proceedings; (3) text of proposed rules; (4) text of permanent rules approved by the Rules Review Commission; (5) notices of receipt of a petition for municipal incorporation, as required by G.S. 120-165; (6) Executive Orders of the Governor; (7) final decision letters from the U.S. Attorney General concerning changes in laws affecting voting in a jurisdiction subject of Section 5 of the Voting Rights Act of 1965, as required by G.S. 120-30.9H; (8) orders of the Tax Review Board issued under G.S. 105-241.2; and (9) other information the Codifier of Rules determines to be helpful to the public. COMPUTING TIME: In computing time in the schedule, the day of publication of the North Carolina Register is not included. The last day of the period so computed is included, unless it is a Saturday, Sunday, or State holiday, in which event the period runs until the preceding day which is not a Saturday, Sunday, or State holiday. FILING DEADLINES ISSUE DATE: The Register is published on the first and fifteen of each month if the first or fifteenth of the month is not a Saturday, Sunday, or State holiday for employees mandated by the State Personnel Commission. If the first or fifteenth of any month is a Saturday, Sunday, or a holiday for State employees, the North Carolina Register issue for that day will be published on the day of that month after the first or fifteenth that is not a Saturday, Sunday, or holiday for State employees. LAST DAY FOR FILING: The last day for filing for any issue is 15 days before the issue date excluding Saturdays, Sundays, and holidays for State employees. NOTICE OF TEXT EARLIEST DATE FOR PUBLIC HEARING: The hearing date shall be at least 15 days after the date a notice of the hearing is published. END OF REQUIRED COMMENT PERIOD An agency shall accept comments on the text of a proposed rule for at least 60 days after the text is published or until the date of any public hearings held on the proposed rule, whichever is longer. DEADLINE TO SUBMIT TO THE RULES REVIEW COMMISSION: The Commission shall review a rule submitted to it on or before the twentieth of a month by the last day of the next month. FIRST LEGISLATIVE DAY OF THE NEXT REGULAR SESSION OF THE GENERAL ASSEMBLY: This date is the first legislative day of the next regular session of the General Assembly following approval of the rule by the Rules Review Commission. See G.S. 150B- 21.3, Effective date of rules. IN ADDITION 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 285 NOTICE OF RULE MAKING PROCEEDINGS AND PUBLIC HEARING NORTH CAROLINA BUILDING CODE COUNCIL Notice of Rule-making Proceedings is hereby given by NC Building Code Council in accordance with G.S. 150B-21.5(d). Citation to Existing Rule Affected by this Rule-Making: North Carolina Building, Fire, Plumbing and Residential Codes. Authority for Rule-making: G.S. 143-136; 143-138. Reason for Proposed Action: To incorporate changes in the NC State Building Codes as a result of rulemaking petitions filed with the NC Building Code Council and to incorporate changes proposed by the Council. Public Hearing: September 8, 2008, 1:00PM, Wake County Commons, 4011 Carya Drive, Raleigh, NC 27610 Comment Procedures: Written comments may be sent to Chris Noles, Secretary, NC Building Code Council, NC Department of Insurance, 322 Chapanoke Road, Suite 200, Raleigh, NC 27603. Comment period expires on October 14, 2008. Statement of Subject Matter: 1. Request by David E. Gall, Architect, P.A., to amend the Chapter 4 and Chapter 9 of the 2009 NC Building Code. The proposed amendment is as follows: 422.1. Existing A-2 and A-3 Occupancies shall be permitted to provide facilities for temporary overflow emergency shelters for the homeless provided that all of the following conditions are met and approved by the local code official and fire marshal: .1 The total number of homeless Occupants is limited to 20 individuals who are ambulatory. The homeless Occupants must be 18 years of age or older. .2 The building used for the temporary overflow emergency shelter must be of Type I, II, or III construction. .3 The temporary overflow emergency shelter must be staffed by a minimum of two individuals of 21 years of age or older trained in accordance with Chapter 4 of the NC Fire Code and at least one trained individual shall be awake to monitor the sleeping room and restrooms throughout the time the facility is occupied by the homeless. .4 Functioning smoke detection and a local fire alarm system per 907.2.8 shall be provided throughout the sleeping room and exit access corridors and stairs of the temporary overflow emergency shelter. .5 There shall be a minimum of two separate code compliant means of egress serving the temporary overflow emergency shelter. An evacuation route approved by the local code official and fire marshal shall be posted and be in compliance with Sections 404, 406, and 408 of the NC Fire Code. .6 There shall be no lockable doors between sleeping rooms and required exits. .7 The temporary overflow emergency shelter sleeping room and exit access corridors and stairs shall have night-lighting and emergency lighting with back-up power. .8 No fire protection sprinkler system is required per 903.2.7, Exception #2. .9 Heating, cooling, and ventilation must be provided by equipment installed and approved for such use. No space heaters are permitted. .10 There must be an adequate number of fire extinguishers to serve the temporary overflow emergency shelter as determined by the local fire marshal. Travel distance to an approved fire extinguisher shall not exceed 50 feet. Minimum rating of extinguishers shall be 3A40BC. .11 No smoking is permitted in the temporary overflow emergency shelter. .12 Building Owner must submit documentation illustrating that the fire alarm system is approved and that all emergency batteries have been tested and are operational. .13 Temporary overflow emergency shelters must be approved by the local code official for Occupancy by issuance of an approved Occupancy Permit. Drawings of the temporary overflow emergency shelter sealed by a NC licensed architect or engineer must be provided for local code official review and approval. .14 Compliance with NC Accessibility code for temporary overflow emergency shelters is not required provided that the local jurisdiction has other shelter facilities that are accessible by the disabled. .15 Occupancy of a temporary overflow emergency shelter shall be for a maximum of 150 calendar days within any 365 day time span. 903.2.7 Group R. An automatic sprinkler system installed in accordance with Section 903.3 shall be provided throughout all buildings with a Group R fire area. Exceptions: 1. An automatic sprinkler system is not required in Group R-3 and R-4 adult and child day care facilities. 2. an automatic sprinkler system is not required in Group R-1 for temporary overflow emergency shelters per 422.1. IN ADDITION 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 286 2. Request by Michael D. Crotts, City of Morganton, to amend the 2009 NC Building Code by adding a new Section 422. The proposed amendment is as follows: 422.1 Classification. Existing Church Buildings (places of worship) to be used as Temporary Homeless Shelters. R-1 use in an A-3 occupancy. 422.1.1 Fire Extinguishers shall be installed in accordance with the North Carolina Fire Prevention Code. 422.2 Non-sprinklered buildings to be occupied for Temporary Homeless Shelters must meet all the following: 1. Shelters would be limited to a maximum of 20 homeless persons. 2. The temporary shelters would be for adults only, no children under the age of 16 years. 3. The buildings would be a minimum of Type I, II, or III, construction. 4. The temporary shelters would have to be staffed by adults (21 years or older). 5. Each shelter would have a minimum of 2 staff persons 1 of which would be awake at all times the shelter is occupied to provide a fire watch. There would also be a posted evacuation route approved by the Fire Official. These facilities would be non-smoking. 6. Shelters would be required to acquire a building permit and be inspected by the Building and Fire Official for egress and safety. 7. Temporary shelters would be allowed only for 120 days after approval and be renewable no more than 2 concurrent permits in a calendar year. 422.3 No requirements currently exist in the North Carolina Accessibility Code for Emergency Shelters. The U.S. Department of Justice ADA Checklist for Emergency Shelters document may be used for Accessibility Guidelines. 3. Request by Michael D. Crotts, City of Morganton, to amend the 2009 Fire Code, Section 903.2. The proposed amendment is as follows: 903.2.7 Group R. An automatic sprinkler system installed in accordance with Section 903.3 shall be provided throughout all buildings with a Group R fire area. Exceptions: 1. An automatic sprinkler system is not required in Group R-3 and R-4 adult and child day care facilities. 2. Temporary Homeless Shelters. See Section 422 4. Request by Kirk Aten, with Mecklenburg County Code Enforcement, to amend the 2009 NC Building Code, Chapter 11, Accessibility. The proposed amendment is as follows: 1104.3.2 Press boxes: Press boxes in assembly areas shall be on an accessible route. Exceptions: 1. An accessible route shall not be required to press boxes in bleachers that have points of entry at only one level, provided that the aggregate area of all press boxes is 500 square feet (46 m2) maximum. 2. An accessible route shall not be required to free-standing press boxes that are elevated above grade 12 feet (3660 mm) minimum provided that the aggregate area of all press boxes is 500 square feet (46 m2) maximum. 5. Request by William Eubanks, New Hanover County Inspections, to amend the 2009 NC Plumbing Code, Section 305.6. The proposed amendment is as follows: 305.6 Freezing. The top of water pipes, installed below grade outside the building, shall be below the frost line or a minimum of 12 inches below finished grade whichever is greater. Water pipes installed in a wall exposed to the exterior shall be located on the heated side of the wall insulation. Water piping installed in an unconditioned attic or unconditioned utility room shall be insulated with an insulation having a minimum R factor of 6.5 determined at 75 degrees Fahrenheit in accordance with ASTM C-177. Exception: Water Piping installed in attics directly on top of ceiling joists and directly beneath the attic insulation does not need to be insulated with an insulation having a minimum R factor of 6.5. The piping must be covered with a tent of 4 mil. poly to prevent the building insulation from cutting off heat loss through the ceiling reaching the pipe. 6. Request by Jeff Griffin, Mecklenburg County Government, to amend the 2009 NC Residential Code. The proposed amendment is as follows: Complete revision on Appendix M Wood Decks. The proposed Appendix M text may be viewed at the following link: http://www.ncdoi.com/OSFM/Engineering/BCC/engineering_bcc_minutes.asp PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 287 Note from the Codifier: The notices published in this Section of the NC Register include the text of proposed rules. The agency must accept comments on the proposed rule(s) for at least 60 days from the publication date, or until the public hearing, or a later date if specified in the notice by the agency. If the agency adopts a rule that differs substantially from a prior published notice, the agency must publish the text of the proposed different rule and accept comment on the proposed different rule for 60 days. Statutory reference: G.S. 150B-21.2. TITLE 02 – DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES Notice is hereby given in accordance with G.S. 150B-21.2 that the North Carolina Board of Agriculture intends to amend the rule cited as 02 NCAC 48A .1703. Proposed Effective Date: December 1, 2008 Instructions on How to Demand a Public Hearing: (must be requested in writing within 15 days of notice): Any person may request a public hearing on the proposed rules by submitting a request in writing no later than August 30th, 2008, to David S. McLeod, Secretary, NC Board of Agriculture, 1001 Mail Service Center, Raleigh, NC 27699-1001. Reason for Proposed Action: The proposed amendments would add regulated areas for Beach Vitex and Bushkiller, two plants which have been proposed for addition to the list of noxious weeds under 02 NCAC 48A .1702. Procedure by which a person can object to the agency on a proposed rule: Any person may object to the proposed rules by submitting a written statement of objection(s) to David S. McLeod, Secretary, NC Board of Agriculture, 1001 Mail Service Center, Raleigh, NC 27699-1001. Comments may be submitted to: David S. McLeod, 1001 Mail Service Center, Raleigh, NC 27699-1001, phone (919) 733- 7125 extension 238, fax (919) 716-0090, email david.mcleod@ncmail.net Comment period ends: October 14, 2008 Procedure for Subjecting a Proposed Rule to Legislative Review: If an objection is not resolved prior to the adoption of the rule, a person may also submit written objections to the Rules Review Commission. If the Rules Review Commission receives written and signed objections in accordance with G.S. 150B-21.3(b2) from 10 or more persons clearly requesting review by the legislature and the Rules Review Commission approves the rule, the rule will become effective as provided in G.S. 150B-21.3(b1). The Commission will receive written objections until 5:00 p.m. on the day following the day the Commission approves the rule. The Commission will receive those objections by mail, delivery service, hand delivery, or facsimile transmission. If you have any further questions concerning the submission of objections to the Commission, please call a Commission staff attorney at 919-733-2721. Fiscal Impact: State Local Substantive (>$3,000,000) None CHAPTER 48 - PLANT INDUSTRY SUBCHAPTER 48A - PLANT PROTECTION SECTION .1700 - STATE NOXIOUS WEEDS 02 NCAC 48A .1703 REGULATED AREAS (a) Except as permitted in 02 NCAC 48A .1705 and .1706, the following is prohibited: (1) The movement of Beach Vitex (Vitex rotundifolia L.F.) or any regulated article infested with Beach Vitex from the following counties: Brunswick, Carteret, Currituck, Dare, Hyde, New Hanover, Onslow, Pender; (2) The movement of Bushkiller (Cayratia japonica Thunb.) or any regulated article infested with Bushkiller from the following counties: Davidson, Forsyth, Franklin, Mecklenburg; (1)(3) The movement of Canada Thistle [Cirsium arvense (L.) Scop.] or any regulated article infested with Canada Thistle from the following counties: Ashe, Avery, Haywood, Mitchell, Northampton, Yancey; (2)(4) The movement of Class A, B, or C noxious weeds or any regulated article infested with Class A, B, or C noxious weeds into North Carolina; (3)(5) The movement of a Class A noxious weed or any regulated article infested with any Class A noxious weed is prohibited within the state; (4)(6) The movement of Eurasian Watermilfoil (Myriophyllum spicatum L.) or any regulated article infested with Eurasian Watermilfoil from the following counties: Halifax, Northampton, Perquimans, Tyrrell, Warren; (5)(7) The movement of Florida Betony (Stachys floridana Shuttlew.) or any regulated article infested with Florida Betony from the following counties: Bladen, Brunswick, Cumberland, Forsyth, Hoke, New Hanover, Onslow, Wake; (6)(8) The movement of Musk Thistle (Carduus nutans L.) or any regulated article infested with Musk Thistle from the following PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 288 counties: Buncombe, Cleveland, Chatham, Gaston, Henderson, Lincoln, Madison, Randolph, Rowan, Rutherford; (7)(9) The movement of Plumeless Thistle (Carduus acanthoides L.) or any regulated article infested with Plumeless Thistle from the following counties: Haywood, Jackson, Madison, Watauga; (8)(10) The movement of Puncturevine (Tribulus terrestris L.) or any regulated article infested with Puncturevine from the following counties: Durham, New Hanover; (9)(11) The movement of any Lythrum species not native to North Carolina or any regulated article infested with any nonnative Lythrum species from the following counties: Forsyth, Watauga; (10)(12) The movement of Uruguay Waterprimrose [Ludwigia hexapetala (Hook & Arn.) Zardini, Gu & Raven] or any regulated article infested with Uruguay Waterprimrose from the following counties: Bladen, Brunswick, Columbus, Durham, Granville, Hyde, New Hanover, Orange, Rowan, Wake, Warren; (11)(13) The movement of Yellow Fieldcress [Rorippa sylvestris (L.) Bess.] or any regulated article infested with Yellow Fieldcress from the following county: Orange; (12)(14) The movement of Oriental Bittersweet (Celastrus orbiculatus Thunb.) or any regulated article infested with Oriental Bittersweet from the following counties: Alleghany, Ashe, Avery, Buncombe, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, Mitchell, Swain, Transylvania, Watauga, Wilkes, Yancey; (13)(15) The sale or distribution of any Class A or B noxious weed; (14)(16) The sale or distribution of any Class C noxious weed outside a regulated area. (b) Other regulated areas. The Commissioner may designate as a regulated area any state or portion of a state in which there is reasonable cause to believe that a noxious weed exists, and there is an immediate need to prevent its introduction, spread or dissemination in North Carolina. Authority G.S. 106-420; 106-421. TITLE 04 – DEPARTMENT OF COMMERCE Notice is hereby given in accordance with G.S. 150B-21.2 that the North Carolina Cemetery Commission intends to amend the rule cited as 04 NCAC 05D .0202. Proposed Effective Date: December 1, 2008 Instructions on How to Demand a Public Hearing: (must be requested in writing within 15 days of notice): Any person who demands a public hearing shall submit a letter of objection in writing by US Postal Service to Jimmy Miller, 1001 Navaho Drive, Suite 100, Raleigh, NC 27609. The letter of demand must be postmarked no later than August 30, 2008. Reason for Proposed Action: Regarding delivery of cemetery merchandise in storage at the cemetery, rule makes reference to a report by a "licensed public accountant", a term that is prohibited from use in North Carolina by N.C.G.S. 93-6. This amendment removes that reference, permitting a certified public accountant. Procedure by which a person can object to the agency on a proposed rule: Any person who objects to a proposed rule amendment shall either submit a letter of objection in writing to Jimmy Miller, 1001 Navaho Drive, Suite 100, Raleigh, NC 27609. Comments may be submitted to: Jimmy Miller, 1001 Navaho Drive, Suite 100, Raleigh, NC 27609, phone (919) 981-2536, fax (919) 981-2538, email jmiller@nccommerce.com Comment period ends: October 14, 2008 Procedure for Subjecting a Proposed Rule to Legislative Review: If an objection is not resolved prior to the adoption of the rule, a person may also submit written objections to the Rules Review Commission. If the Rules Review Commission receives written and signed objections in accordance with G.S. 150B-21.3(b2) from 10 or more persons clearly requesting review by the legislature and the Rules Review Commission approves the rule, the rule will become effective as provided in G.S. 150B-21.3(b1). The Commission will receive written objections until 5:00 p.m. on the day following the day the Commission approves the rule. The Commission will receive those objections by mail, delivery service, hand delivery, or facsimile transmission. If you have any further questions concerning the submission of objections to the Commission, please call a Commission staff attorney at 919-733-2721. Fiscal Impact: State Local Substantive (>$3,000,000) None CHAPTER 05 - CEMETERY COMMISSION SUBCHAPTER 05D - TRUST FUNDS SECTION .0200 - PRE-NEED CEMETERY MERCHANDISE: PRE-CONSTRUCTED MAUSOLEUMS AND BELOW GROUND CRYPTS TRUST FUNDS 04 NCAC 05D .0202 DELIVERY (a) Vaults and crypts shall not be considered delivered unless installed or stored on the cemetery premises or stored off PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 289 premises by a supplier. If vaults are not to be installed, the contract between cemetery and purchaser must so state in bold print that purchaser has accepted above ground delivery. If vault is to be installed, then the contract must be broken down into sales cost and installation cost. (b) Markers, bases and vases shall not be considered delivered unless installed or stored at the cemetery or if stored off premises by a supplier, there shall be no additional charge for delivery or freight, unless specified in bold print in the contract. If vaults, crypts or other merchandise are stored off premises the cemetery company must submit to the Cemetery Commission not less than annually a report by a certified public accountant of each item which has been purchased through a North Carolina cemetery company and which at the date of the report was then in storage and properly designated the property of the cemetery company's customer and not the property of the supplier. If vaults, crypts or other merchandise are stored at the cemetery the cemetery company must submit to the Cemetery Commission not less than annually a report by a certified or licensed public accountant of each item which has been purchased and which at the date of the report was then in storage and properly designated the property of the cemetery company's customer. (c) If opening and closing of crypts at the time of interment are not included in the cost of this merchandise, then it must be so stated in bold print on the contract between cemetery and purchaser. Authority G.S. 65-49. TITLE 10A – DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice is hereby given in accordance with G.S. 150B-21.2 that the Medical Care Commission intends to adopt the rules citied as 10A NCAC 13P .0305, .0511, amend the rules citied as 10A NCAC 13P .0101-.0102, .0201-.0202, .0204-.0210, .0212-.0215, .0301-.0302, .0401-.0406, .0408-.0409, .0501-.0502, .0504, .0507-.0510, .0601-.0603, .0701, .0901-.0905, .1101-.1103 and repeal the rules cited as 10A NCAC 13P .0103-.0107, .0109- .0124, .0303-.0304, .0801, .1001-.1002; 13Q .0101-.0103; 13R .0101, .0103-.0105, .0201-.0202, .0504-.0206, .0301. Proposed Effective Date: January 1, 2009 Public Hearing: Date: September 23, 2008 Time: 10:00 a.m. Location: Room 201 Council Building, Division of Health Service Regulation, Dorothea Dix Campus, 701 Barbour Drive, Raleigh, NC 27603. Reason for Proposed Action: The Emergency Medical Services and Trauma Rules, EMS Formula Grants, and Minimum Standards for Mobile Intensive Care Units Rules were reviewed by the agency and found to be in need of updating. The rules are being adopted, amended or repealed to conform to new General Statute mandates for criminal history background checks, differentiate between rotary wing and fixed wing aircraft, conform to current standards of the NC College of Emergency Physicians, reorganize the Subchapter for uniformity of rule subjects and/or add clarity to existing rule language. Procedure by which a person can object to the agency on a proposed rule: An individual may object to the agency on the proposed rules by submitting written comments on the proposed rules. They may also object by attending the public hearing and personally voice their objections during that time. Comments may be submitted to: Nadine Pfeiffer, Division of Health Service Regulation, 2701 Mail Service Center, Raleigh, NC 27699-2701, fax (919)733-2757, email DHSR.RulesCoordinator@ncmail.net Comment period ends: September 30, 2008 Procedure for Subjecting a Proposed Rule to Legislative Review: If an objection is not resolved prior to the adoption of the rule, a person may also submit written objections to the Rules Review Commission. If the Rules Review Commission receives written and signed objections in accordance with G.S. 150B-21.3(b2) from 10 or more persons clearly requesting review by the legislature and the Rules Review Commission approves the rule, the rule will become effective as provided in G.S. 150B-21.3(b1). The Commission will receive written objections until 5:00 p.m. on the day following the day the Commission approves the rule. The Commission will receive those objections by mail, delivery service, hand delivery, or facsimile transmission. If you have any further questions concerning the submission of objections to the Commission, please call a Commission staff attorney at 919-733-2721. Fiscal Impact: A copy of the fiscal note can be obtained from the agency. State Local Substantive (>$3,000,000) None CHAPTER 13 – NC MEDICAL CARE COMMISSION SUBCHAPTER 13P – EMERGENCY MEDICAL SERVICES AND TRAUMA RULES SECTION .0100 – DEFINITIONS 10A NCAC 13P .0101 ABBREVIATIONS As used in this Subchapter, the following abbreviations mean: (1) ACS: American College of Surgeons; (1)(2) AHA: American Heart Association; (3) ATLS: Advanced Trauma Life Support; (4) CA3: Clinical Anesthesiology Year 3; (5) CRNA: Certified Registered Nurse Anesthetist; (2)(6) CPR: Cardiopulmonary Resuscitation; (7) DOA: Dead on Arrival; (8) ED: Emergency Department; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 290 (3)(9) EMD: Emergency Medical Dispatcher; (4)(10) EMDPRS: Emergency Medical Dispatch Priority Reference System; (5)(11) EMS: Emergency Medical Services; (6)(12) EMS-NP: EMS Nurse Practitioner; (7)(13) EMS-PA: EMS Physician Assistant; (8)(14) EMT: Emergency Medical Technician; (9)(15) EMT-I: EMT-Intermediate; (10)(16) EMT-P: EMT-Paramedic; (17) ENT: Ear, Nose and Throat; (18) FAA: Federal Aviation Administration; (19) FAR: Federal Aviation Regulation; (20) FCC: Federal Communications Commission; (21) GSC: Glasgow Coma Scale; (22) ICD: International Classification of Diseases; (23) ISS: Injury Severity Score; (24) IV: Intravenous; (25) LPN: Licensed Practical Nurse; (11)(26) MICN: Mobile Intensive Care Nurse; (12)(27) MR: Medical Responder; (13)(28) NHTSA: National Highway Traffic Safety Administration; (14)(29) OEMS: Office of Emergency Medical Services; and (30) OMF: Oral maxillofacial; (31) OR: Operating Room; (32) PGY2: Post Graduate Year 2; (33) PGY4; Post Graduate Year 4; (34) PSAP: Public Safety Answering Point; (35) RAC: Regional Advisory Committee; (36) RFP: Request For Proposal; (37) RN: Registered Nurse; (38) SCTP: Specialty Care Transport Program; (39) SMARTT: State Medical Asset and Resource Tracking Tool; (40) STEMI: ST Elevation Myocardial Infarction; (41) TR: Trauma Registrar; (42) TNC: Trauma Nurse Coordinator; (43) TPM: Trauma Program Manager; and (15)(44) US DOT: United States Department of Transportation. Authority G.S. 143-508(b). 10A NCAC 13P .0102 DEFINITIONS As used in this Subchapter, "Air Medical Ambulance" means an aircraft specifically designed and equipped to transport patients by air. The patient care compartment of air medical ambulances shall be staffed by medical crew members approved for the mission by the medical director. The following definitions apply throughout this Subchapter: (1) "Advanced Trauma Life Support" means the course sponsored by the American College of Surgeons. (2) "Affiliated EMS Provider" means the firm, corporation, agency, organization, or association identified to a specific county EMS system as a condition for EMS Provider Licensing as required by Rule .0204(a)(1) of this Subchapter. (3) "Affiliated Hospital" means a non-Trauma Center hospital that is owned by the Trauma Center or there exists a contract or other agreement to allow for the acceptance or transfer of the Trauma Center's patient population to the non-Trauma Center hospital. (4) "Air Medical Ambulance" means an aircraft configured and medically equipped to transport patients by air. The patient care compartment of air medical ambulances shall be staffed by medical crew members approved for the mission by the medical director. (5) "Air Medical Program" means a SCTP or EMS System utilizing rotary-wing or fixed-wing aircraft configured and operated to transport patients. (6) "Assistant Medical Director" means a physician, EMS-PA, or EMS-NP who assists the medical director with the medical aspects of the management of an EMS System or EMS SCTP. (7) "Attending" means a physician who has completed medical or surgical residency and is either eligible to take boards in a specialty area or is boarded in a specialty. (8) "Board Certified, Board Certification, Board Eligible, Board Prepared, or Boarded" means approval by the American Board of Medical Specialties, the Advisory Board for Osteopathic Specialties, or the Royal College of Physicians and Surgeons of Canada unless a further sub-specialty such as the American Board of Surgery or Emergency Medicine is specified. (9) "Bypass" means the transport of an emergency medical services patient from the scene of an accident or medical emergency past an emergency medical services receiving facility for the purposes of accessing a facility with a higher level of care, or a hospital of its own volition reroutes a patient from the scene of an accident or medical emergency or referring hospital to a facility with a higher level of care. (10) "Contingencies" mean conditions placed on a trauma center's designation that, if unmet, can result in the loss or amendment of a hospital's designation. (11) "Convalescent Ambulance" means an ambulance used on a scheduled basis solely to transport patients having a known non-emergency medical condition. Convalescent ambulances shall not be used in place of any other category of ambulance defined in this Subchapter. (12) "Clinical Anesthesiology Year 3" means an anesthesiology resident having completed two PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 291 clinical years of general anesthesiology training. A pure laboratory year shall not constitute a clinical year. (13) "Deficiency" means the failure to meet essential criteria for a trauma center's designation as specified in Section .0900 of this Subchapter, that can serve as the basis for a focused review or denial of a trauma center designation. (14) "Department" means the North Carolina Department of Health and Human Services. (15) "Diversion" means the hospital is unable to accept a pediatric or adult patient due to a lack of staffing or resources. (16) "E-Code" means a numeric identifier that defines the cause of injury, taken from the ICD. (17) "Educational Medical Advisor" means the physician responsible for overseeing the medical aspects of approved EMS educational programs in continuing education, basic, and advanced EMS educational institutions. (18) "EMS Care" means all services provided within each EMS System that relate to the dispatch, response, treatment, and disposition of any patient that would require the submission of System Data to the OEMS. (19) "EMS Educational Institution" means any agency credentialed by the OEMS to offer EMS educational programs. (20) "EMS Nontransporting Vehicle" means a motor vehicle dedicated and equipped to move medical equipment and EMS personnel functioning within the scope of practice of EMT-I or EMT-P to the scene of a request for assistance. EMS nontransporting vehicles shall not be used for the transportation of patients on the streets, highways, waterways, or airways of the state. (21) "EMS Peer Review Committee" means a committee as defined in G.S. 131E-155(a)(6b). (22) "EMS Performance Improvement Toolkits" mean one or more reports generated from the state EMS data system analyzing the EMS service delivery, personnel performance, and patient care provided by an EMS system and its associated EMS agencies and personnel. Each EMS toolkit focuses on a topic of care such as trauma, cardiac arrest, EMS response times, stroke, STEMI (heart attack), and pediatric care. (23) "EMS Provider" means those entities defined in G.S. 131E-155 (13a) that hold a current license issued by the Department pursuant to G.S. 131E-155.1. (24) "EMS System" means a coordinated arrangement of local resources under the authority of the county government (including all agencies, personnel, equipment, and facilities) organized to respond to medical emergencies and integrated with other health care providers and networks including, but not limited to, public health, community health monitoring activities, and special needs populations. (25) "EMS System Peer Groups" are defined as: (a) Urban EMS System means greater than 200,000 population; (b) Suburban EMS System means from 75,001 to 200,000 population; (c) Rural EMS System means from 25,001 to 75,000 population; and (d) Wilderness EMS System means 25,000 population or less. (26) "Essential Criteria" means those items listed in Rules .0901, .0902, and .0903 of this Subchapter that are the minimum requirements for the respective level of trauma center designation (I, II, or III). (27) "Focused Review" means an evaluation by the OEMS of a trauma center's corrective actions to remove contingencies that are a result of deficiencies placed upon it following a renewal site visit. (28) "Ground Ambulance" means an ambulance used to transport patients with traumatic or medical conditions or patients for whom the need for emergency or non-emergency medical care is anticipated either at the patient location or during transport. (29) "Hospital" means a licensed facility as defined in G.S. 131E-176. (30) "Immediately Available" means the physical presence of the health professional or the hospital resource within the trauma center to evaluate and care for the trauma patient without delay. (31) "Inclusive Trauma System" means an organized, multi-disciplinary, evidence-based approach to provide quality care and to improve measurable outcomes for all defined injured patients. EMS, hospitals, other health systems and clinicians shall participate in a structured manner through leadership, advocacy, injury prevention, education, clinical care, performance improvement and research resulting in integrated trauma care. (32) "Infectious Disease Control Policy" means a documented policy describing how the EMS system will protect and prevent its patients and EMS professionals from exposure and illness associated with contagions and infectious disease. (33) "Lead RAC Agency" means the agency (comprised of one or more Level I or II trauma centers) that provides staff support and serves as the coordinating entity for trauma planning in a region. PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 292 (34) "Level I Trauma Center" means a hospital that has the capability of providing leadership, research, and total care for every aspect of injury from prevention to rehabilitation. (35) "Level II Trauma Center" means a hospital that provides trauma care regardless of the severity of the injury but may not be able to provide the same comprehensive care as a Level I trauma center and does not have trauma research as a primary objective. (36) "Level III Trauma Center" means a hospital that provides prompt assessment, resuscitation, emergency operations, and stabilization, and arranges for hospital transfer as needed to a Level I or II trauma center. (37) "Licensed Health Care Facility" means any health care facility or hospital licensed by the Department of Health and Human Services, Division of Health Service Regulation. (38) "Medical Crew Member" means EMS personnel or other health care professionals who are licensed or registered in North Carolina and are affiliated with a SCTP. (39) "Medical Director" means the physician responsible for the medical aspects of the management of an EMS System or SCTP. (40) "Medical Oversight" means the responsibility for the management and accountability of the medical care aspects of an EMS System or SCTP. Medical Oversight includes physician direction of the initial education and continuing education of EMS personnel or medical crew members; development and monitoring of both operational and treatment protocols; evaluation of the medical care rendered by EMS personnel or medical crew members; participation in system or program evaluation; and directing, by two-way voice communications, the medical care rendered by the EMS personnel or medical crew members. (41) "Mid-level Practitioner" means a nurse practitioner or physician assistant who routinely cares for trauma patients. (42) "Model EMS System" means an EMS System that is recognized and designated by the OEMS for meeting and mastering quality and performance indicator criteria as defined by the OEMS. (43) "Off-line Medical Control" means medical supervision provided through the EMS System Medical Director or SCTP Medical Director who is responsible for the day to day medical care provided by EMS personnel. This includes but is not limited to EMS personnel education, protocol development, quality management, peer review activities, and EMS administrative responsibilities related to assurance of quality medical care. (44) "Office of Emergency Medical Services" means a section of the Division of Health Service Regulation of the North Carolina Department of Health and Human Services located at 701 Barbour Drive, Raleigh, North Carolina 27603. (45) "On-line Medical Control" means the medical supervision or oversight provided to EMS personnel through direct communication in person, via radio, cellular phone, or other communication device during the time the patient is under the care of an EMS professional. The source of on-line medical control is typically a designated hospital's emergency department physician, EMS nurse practitioner, or EMS physician assistant. (46) "Operational Protocols" means the administrative policies and procedures of an EMS System that provide guidance for the day-to-day operation of the system. (47) "Participating Hospital" means a hospital that supplements care within a larger trauma system by the initial evaluation and assessment of injured patients for transfer to a designated trauma center if needed. (48) "Physician" means a medical or osteopathic doctor licensed by the North Carolina Medical Board to practice medicine in the state of North Carolina. (49) "Post Graduate Year Two" means any surgery resident having completed one clinical year of general surgical training. A pure laboratory year shall not constitute a clinical year. (50) "Post Graduate Year Four" means any surgery resident having completed three clinical years of general surgical training. A pure laboratory year shall not constitute a clinical year. (51) "Promptly Available" means the physical presence of health professionals in a location in the trauma center within a short period of time, that is defined by the trauma system (director) and continuously monitored by the performance improvement program. (52) "Regional Advisory Committee (RAC)" means a committee comprised of a lead RAC agency and a group representing trauma care providers and the community, for the purpose of regional trauma planning, establishing, and maintaining a coordinated trauma system. (53) "Request for Proposal (RFP)" means a state document that must be completed by each hospital seeking initial or renewal trauma center designation. (54) "State Medical Asset and Resource Tracking Tool (SMARTT)" means the Internet web-based program used by the OEMS both daily in its operations and during times of disaster to identify, record and monitor EMS, hospital, health care and sheltering resources statewide, PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 293 including but not limited to facilities, personnel, vehicles, equipment, pharmaceutical and supply caches. (55) "Specialty Care Transport Program" means a program designed and operated for the provision of specialized medical care and transportation of critically ill or injured patients between health care facilities and for patients who are discharged from a licensed health care facility to their residence that require specialized medical care during transport which exceeds the normal capability of the local EMS System. (56) "Specialty Care Transport Program Continuing Education Coordinator" means a Level I EMS Instructor within a SCTP who is responsible for the coordination of EMS continuing education programs for EMS personnel within the program. (57) "Stroke" means an acute cerebrovascular hemorrhage or occlusion resulting in a neurologic deficit. (58) "System Continuing Education Coordinator" means the Level I EMS Instructor designated by the local EMS System who is responsible for the coordination of EMS continuing education programs. (59) "System Data" means all information required for daily electronic submission to the OEMS by all EMS Systems using the EMS data set, data dictionary, and file format as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and additions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. (60) "Transfer Agreement" means a written agreement between two agencies specifying the appropriate transfer of patient populations delineating the conditions and methods of transfer. (61) "Trauma Center" means a hospital facility designated by the State of North Carolina and distinguished by its ability to immediately manage, on a 24-hour basis, the severely injured patient or those at risk for severe injury. (62) "Trauma Center Criteria" means essential criteria to define Level I, II, or III trauma centers. (63) "Trauma Center Designation" means a process of approval in which a hospital voluntarily seeks to have its trauma care capabilities and performance evaluated by experienced on-site reviewers. (64) "Trauma Diversion" means a trauma center of its own volition declines to accept an acutely injured pediatric or adult patient due to a lack of staffing and/or resources. (65) "Trauma Guidelines" mean standards for practice in a variety of situations within the trauma system. (66) "Trauma Minimum Data Set" means the basic data required of all hospitals for submission to the trauma statewide database. (67) "Trauma Patient" means any patient with an ICD-9-CM discharge diagnosis 800.00-959.9 excluding 905-909 (late effects of injury), 910.0-924 (blisters, contusions, abrasions, and insect bites), and 930-939 (foreign bodies). (68) "Trauma Program" means an administrative entity that includes the trauma service and coordinates other trauma related activities. It must also include, at a minimum, the trauma medical director, trauma program manager/trauma coordinator, and trauma registrar. This program's reporting structure shall give it the ability to interact with at least equal authority with other departments providing patient care. (69) "Trauma Protocols" mean standards for practice in a variety of situations within the trauma system. (70) "Trauma Registry" means a disease-specific data collection composed of a file of uniform data elements that describe the injury event, demographics, pre-hospital information, diagnosis, care, outcomes, and costs of treatment for injured patients collected and electronically submitted as defined by the OEMS. (71) "Trauma Service" means a clinical service established by the medical staff that has oversight of and responsibility for the care of the trauma patient. (72) "Trauma Team" means a group of health care professionals organized to provide coordinated and timely care to the trauma patient. (73) "Treatment Protocols" means a document approved by the medical directors of both the local EMS System or Specialty Care Transport Program and the OEMS specifying the diagnostic procedures, treatment procedures, medication administration, and patient-care-related policies that shall be completed by EMS personnel or medical crew members based upon the assessment of a patient. (74) "Triage" means the assessment and categorization of a patient to determine the level of EMS and healthcare facility based care required. (75) "Water Ambulance" means a watercraft specifically configured and medically equipped to transport patients. PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 294 Authority G.S. 131E-155(a)(6b); 131E-162; 143- 508(b),(d)(1),(d)(3),(d)(4),(d)(6),(d)(7),(d)(8),(d)(13); 143- 518(a)(5). 10A NCAC 13P .0103 AIR MEDICAL PROGRAM As used in this Subchapter, "Air Medical Program" means a Specialty Care Transport Program designed and operated for transportation of patients by either fixed or rotary wing aircraft. Authority G.S. 143-508(b); 143-508(d)(1). 10A NCAC 13P .0104 ASSISTANT MEDICAL DIRECTOR As used in this Subchapter, "Assistant Medical Director" means a physician, EMS-PA, or EMS-NP who assists the medical director with the medical aspects of the management of an EMS System or EMS Specialty Care Transport Program. Authority G.S. 143-508(b). 10A NCAC 13P .0105 CONVALESCENT AMBULANCE As used in this Subchapter, "Convalescent Ambulance" means an ambulance used on a scheduled basis solely to transport patients having a known non-emergency medical condition. Convalescent ambulances shall not be used in place of any other category of ambulance defined in this Subchapter. Authority G.S. 143-508(b); 143-508(d)(8). 10A NCAC 13P .0106 EDUCATIONAL MEDICAL ADVISOR As used in this Subchapter, "Educational Medical Advisor" means the physician responsible for overseeing the medical components of approved EMS educational programs in continuing education, basic, and advanced EMS educational institutions. Authority G.S. 143-508(b); 143-508(d)(3). 10A NCAC 13P .0107 EMS EDUCATIONAL INSTITUTION As used in this Subchapter, "EMS Educational Institution" means any agency credentialed by the OEMS to offer EMS educational programs. Authority G.S. 143-508(b); 143-508(d)(4). 10A NCAC 13P .0109 EMS NONTRANSPORTING VEHICLE As used in this Subchapter, "EMS Nontransporting Vehicle" means a motor vehicle dedicated and equipped to move medical equipment and EMS personnel functioning within the scope of practice of EMT-I or EMT-P to the scene of a request for assistance. EMS nontransporting vehicles shall not be used for the transportation of patients on the streets, highways, waterways, or airways of the state. Authority G.S. 143-508(b); 143-508(d)(8). 10A NCAC 13P .0110 EMS SYSTEM As used in this Subchapter, "EMS System" means a coordinated arrangement of resources (including personnel, equipment, and facilities) organized to respond to medical emergencies and integrated with other health care providers and networks including, but not limited to, public health, community health monitoring activities, and special needs populations. Authority G.S. 143-508(b). 10A NCAC 13P .0111 GROUND AMBULANCE As used in this Subchapter, "Ground Ambulance" means an ambulance used to transport patients with traumatic or medical conditions or patients for whom the need for emergency or non-emergency medical care is anticipated either at the patient location or during transport. Authority G.S. 143-508(b); 143-508(d)(8). 10A NCAC 13P .0112 MEDICAL CREW MEMBERS As used in this Subchapter, "Medical Crew Member" means EMS personnel or other health care professionals who are licensed or registered in North Carolina and are affiliated with a Specialty Care Transport Program. Authority G.S. 143-508(b); 143-508(d)(3). 10A NCAC 13P .0113 MEDICAL DIRECTOR As used in this Subchapter, "Medical Director" means the physician responsible for the medical aspects of the management of an EMS System or EMS Specialty Care Transport Program. Authority G.S. 143-508(b). 10A NCAC 13P .0114 MEDICAL OVERSIGHT As used in this Subchapter, "Medical Oversight" means the responsibility for the management and accountability of the medical care aspects of an EMS System or Specialty Care Transport Program. Medical Oversight includes physician direction of the initial education and continuing education of EMS personnel or medical crew members; development and monitoring of both operational and treatment protocols; evaluation of the medical care rendered by EMS personnel or medical crew members; participation in system or program evaluation; and directing, by two-way voice communications, the medical care rendered by the EMS personnel or medical crew members. Authority G.S. 143-508(b). 10A NCAC 13P .0115 MODEL EMS SYSTEM As used in this Subchapter, "Model EMS System" means an approved EMS System that chooses to meet the criteria for and receives this designation by the OEMS. Authority G.S. 143-508(b). PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 295 10A NCAC 13P .0116 OFFICE OF EMERGENCY MEDICAL SERVICES As used in this Subchapter, "Office of Emergency Medical Services (OEMS)" means a section of the Division of Health Service Regulation of the North Carolina Department of Health and Human Services located at 701 Barbour Drive, Raleigh, North Carolina 27603. Authority G.S. 143-508(b). 10A NCAC 13P .0117 OPERATIONAL PROTOCOLS As used in this Subchapter, "Operational Protocols" means the written administrative policies and procedures of an EMS System that provide guidance for the day-to-day operation of the system. Authority G.S. 143-508(b). 10A NCAC 13P .0118 PHYSICIAN As used in this Subchapter, "Physician" means a medical or osteopathic doctor licensed by the North Carolina Medical Board to practice medicine in the state of North Carolina. Authority G.S. 143-508(b). 10A NCAC 13P .0119 EMS PEER REVIEW COMMITTEE As used in this Subchapter, "EMS Peer Review Committee" means a committee as defined in G.S. 131E-155(a)(6b). Authority G.S. 131E-155(a)(6b); 143-508(b); 143-518(a)(5). 10A NCAC 13P .0120 SPECIALTY CARE TRANSPORT PROGRAM As used in this Subchapter, "Specialty Care Transport Program" means a program designed and operated for the provision of specialized medical care and transportation of critically ill or injured patients. Authority G.S. 143-508(b); 143-508(d)(1). 10A NCAC 13P .0121 SPECIALTY CARE TRANSPORT PROGRAM CONTINUING EDUCATION COORDINATOR As used in this Subchapter, "Specialty Care Transport Program Continuing Education Coordinator" means a Level I EMS Instructor within a specialty care transport program who is responsible for the coordination of EMS continuing education programs for EMS personnel within the program. Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(13). 10A NCAC 13P .0122 SYSTEM CONTINUING EDUCATION COORDINATOR As used in this Subchapter, "System Continuing Education Coordinator" means a Level I EMS Instructor within a Model EMS System who is responsible for the coordination of EMS continuing education programs. Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(13). 10A NCAC 13P .0123 TREATMENT PROTOCOLS As used in this Subchapter, "Treatment Protocols" means a written document approved by the medical directors of both the local EMS System or Specialty Care Transport Program and the OEMS specifying the diagnostic procedures, treatment procedures, medication administration, and patient-care-related policies that shall be completed by EMS personnel or medical crew members based upon the assessment of a patient. Authority G.S. 143-508(b); 143-508(d)(6); 143-508(d)(7). 10A NCAC 13P .0124 WATER AMBULANCE As used in this Subchapter, "Water Ambulance" means a watercraft specifically designed and equipped to transport patients. Authority G.S. 143-508(b); 143-508(d)(8). SECTION .0200 – EMS SYSTEMS 10A NCAC 13P .0201 EMS SYSTEM REQUIREMENTS (a) County governments shall establish EMS Systems. Each EMS System shall have: (1) a defined geographical service area for the EMS System. The minimum service area for an EMS System shall be one county. There may be multiple EMS Provider service areas within the service area of an EMS System. The highest level of care offered within any EMS Provider service area must be available to the citizens within that service area 24 hours per day; (2) a defined scope of practice for all EMS personnel, functioning in the EMS System, within the parameters set forth by the North Carolina Medical Board pursuant to G.S. 143- 514; (3) a written plan written policies and procedures describing the dispatch and coordination dispatch, coordination and oversight of all responders that provide EMS care care, specialty patient care skills and procedures as defined in Rule .0301(a)(4) of this Subchapter, and ambulance transport within the system; (4) at least one licensed EMS provider. For those systems with providers operating within the EMD, EMT-I, or EMT-P scope of practice, there shall be a plan for medical oversight required by Section .0400 of this Subchapter; Provider; (5) an identified number a listing of permitted ambulances to provide coverage to the service area 24 hours per day; (6) personnel credentialed to perform within the scope of practice of the system and to staff the ambulance vehicles as required by G.S. 131E- 158. There shall be a written plan for the use PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 296 of credentialed EMS personnel for all practice settings used within the system; (7) a mechanism to collect and electronically submit to the OEMS data that uses the EMS data set and data dictionary as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and additions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. EMS Systems shall comply with this requirement by July 1, 2004; documented policies and procedures specific to the utilization of the EMS System's EMS Care data for the daily and on-going management of all EMS System resources; (8) a written infection control policy Infectious Disease Control Policy as defined in Rule .0102(31) of this Subchapter and documented procedures which are approved by the EMS System medical director that addresses address the cleansing and disinfecting of vehicles and equipment that are used to treat or transport patients; (9) a written plan to provide orientation to personnel on EMS operations and related issues for hospitals routinely receiving patients from the EMS System; (10)(9) a listing of facilities that will provide online medical direction for systems with providers operating within the EMT, EMT-I, or EMT-P scope of practice. To provide online medical direction, the facility shall have: (A) availability of a physician, MICN, EMS-NP, or EMS-PA to provide online medical direction to EMS personnel during all hours of operation of the facility; (B) a written plan to provide physician backup to the MICN, EMS-NP, or EMS-PA providing online medical direction to EMS personnel; (C) a mechanism for persons providing online medical direction to provide feedback to the EMS Peer Review Committee; and (D) a written plan to provide orientation and education regarding treatment protocols for those individuals providing online medical direction; all EMS Providers operating within the EMS System; (11) a written plan to ensure that each facility that routinely receives patients and also offers clinical education for EMS personnel provides orientation and education to all preceptors regarding requirements of the EMS System; (12) a written plan for providing emergency vehicle operation education for system personnel who operate emergency vehicles; (13)(10) an EMS communication system that provides for: (A) public access using the emergency telephone number 9-1-1 within the public dial telephone network as the primary method for the public to request emergency assistance. This number shall be connected to the emergency communications center or Public Safety Answering Point (PSAP) PSAP with immediate assistance available such that no caller will be instructed to hang up the telephone and dial another telephone number. A person calling for emergency assistance shall never not be required to speak with more than two persons to request emergency medical assistance; (B) an emergency communications system operated by public safety telecommunicators with training in the management of calls for medical assistance available 24 hours per day; (C) dispatch of the most appropriate emergency medical response unit or units to any caller's request for assistance. The dispatch of all response vehicles shall be in accordance with an official written documented EMS System plan for the management and deployment of response vehicles including requests for mutual aid; and (D) two-way radio voice communications from within the defined service area to the emergency communications center or PSAP and to facilities where patients are routinely transported. The emergency communications system shall maintain all required Federal Communications Commission (FCC) FCC radio licenses or authorizations required; authorizations; (14)(11) a written plan written policies and procedures for addressing the use of Specialty Care Transport Programs SCTP and Air Medical Programs within the system; (15)(12) a written continuing education plan program for all credentialed EMS personnel personnel, under the direction of a System Continuing Education Coordinator, developed and modified based on feedback from system EMS PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 297 Care data, review, and evaluation of patient outcomes and quality management peer reviews, that follows the guidelines of the: (A) "US DOT NHTSA First Responder Refresher: National Standard Curriculum" for MR personnel; (B) US DOT NHTSA EMT-Basic Refresher: National Standard Curriculum" for EMT personnel; (C) "EMT-P and EMT-I Continuing Education National Guidelines" for EMT-I and EMT-P personnel; and (D) "US DOT NHTSA Emergency Medical Dispatcher: National Standard Curriculum" for EMD personnel. These documents are incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and additions. These documents are available from NHTSA, 400 7th Street, SW, Washington, D.C. 20590, at no cost; and (16) a written plan addressing the orientation of MICN, EMS-NP, or EMS-PA used in the system. The orientation program shall include the following: (A) a discussion of all EMS System treatment protocols and procedures; (B) an explanation of the specific scope of practice for credentialed EMS personnel, as authorized by the approved EMS System treatment protocols as required by Rule .0405 of this Chapter; (C) a discussion of all practice settings within the EMS System and how scope of practice may vary in each setting; (D) a mechanism to assess the student's ability to effectively use EMS System communications equipment including hospital and prehospital devices, EMS communication protocols, and communications contingency plans as related to on-line medical direction; and (E) the successful completion of a scope of practice evaluation administered under the direction of the medical director. (13) written policies and procedures to address management of the EMS System that includes: (A) triage and transport of all acutely ill and injured patients with time-dependent or other specialized care issues including but not limited to trauma, stroke, STEMI, burn, and pediatric patients that may require the by-pass of other licensed health care facilities and which are based upon the expanded clinical capabilities of the selected healthcare facilities; (B) triage and transport of patients to facilities outside of the system; (C) arrangements for transporting patients to appropriate facilities when diversion or bypass plans are activated; (D) reporting, monitoring, and establishing standards for system response times using data provided by the OEMS; (E) weekly updating of the SMARTT EMS Provider information; (F) a disaster plan; and (G) a mass-gathering plan. (14) affiliation with the trauma RAC as required by Rule .1101(b) of this Subchapter; and (15) medical oversight as required by Section .0400 of this Subchapter. (b) An application to establish an EMS System shall be submitted by the county to the OEMS for review. When the system is comprised of more than one county, only one application shall be submitted. The proposal shall demonstrate that the system meets the requirements in Paragraph (a) of this Rule. System approval shall be granted for a period of six years. Systems shall apply to OEMS for reapproval. Authority G.S. 131E-155(1),(6),(8),(9),(15); 143- 508(b),(d)(1),(d)(2),(d)(3),(d)(5),(d)(8),(d)(9),(d)(10),(d)(13); 143-509(1),(3),(4),(5); 143-517; 143-518; SECTION .0200 – EMS SYSTEMS 10A NCAC 13P .0202 MODEL EMS SYSTEMS (a) Some EMS Systems may choose to move beyond the minimum requirements in Rule .0201 of this Section and receive designation from the OEMS as a Model EMS System. To receive this designation, an EMS System shall document that, in addition to the system requirements in Rule .0201 of this Section, the following criteria have been met: The OEMS shall accept applications from July 1 through July 31 of each year from EMS Systems that desire to seek designation as a Model EMS System. EMS System performance measurement shall be based on the results, and a designation of Model EMS System will be given by the OEMS to those EMS systems, which meet or exceed the following seven performance indicators as described: (1) a uniform level of care throughout the system available 24 hours per day; Six EMS Performance Improvement Toolkits as defined in Rule .0102(22) of this Subchapter as follows: (A) EMS System Response Toolkit; (B) EMS Acute Trauma Care Toolkit; (C) EMS Cardiac Arrest Care Toolkit; (D) EMS Acute Cardiac Care (STEMI) Toolkit; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 298 (E) EMS Acute Stroke Care Toolkit; (F) EMS Acute Pediatric Care Toolkit; and (2) EMD performance data. (2) a plan for medical oversight that meets the requirements found in Section .0400 of this Subchapter. Specifically, Model EMS Systems shall meet the additional requirements for medical director and written treatment protocols as defined in Rules .0401(1)(b) and .0405(a)(2) of this Subchapter; (3) a mechanism to collect and electronically submit to the OEMS data that use the EMS data set and data dictionary as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and additions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; (4) a written plan to address management of the EMS System to include: (A) triage of patients to appropriate facilities; (B) transport of patients to facilities outside of the system; (C) arrangements for transporting patients to appropriate facilities when diversion or bypass plans are activated; (D) a mechanism for reporting, monitoring, and establishing standards for system response times; (E) a disaster plan; and (F) a mass-gathering plan; (5) a written continuing education plan for EMS personnel, under the direction of the System Continuing Education Coordinator, developed and modified based on feedback from system data, review, and evaluation of patient outcomes and quality management reviews; (6) a written plan to assure participation in clinical and field internship educational components for all EMS personnel; (7) operational protocols for the management of equipment, supplies and medications. These protocols shall include a methodology: (A) to assure that each vehicle contains the required equipment and supplies on each response; (B) for cleaning and maintaining the equipment and vehicles; and (C) to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications; (8) a written plan for the systematic and periodic inspection, repair and maintenance of all vehicles used in the system; (9) a written plan addressing the role of the EMS System in the areas of public education, injury prevention, and community health; (10) affiliation with at least one trauma Regional Advisory Committee; and (11) a system-wide communication system that meets the requirements of Paragraph (a)(13) of Rule .0201 of this Section, and in addition: (A) operates an EMD program; and (B) has an operational E-911 system. (b) EMS Systems holding current accreditation by a national accreditation agency may use this as documentation of completion of the equivalent requirements outlined in this Rule. The date range of the data analyzed within the EMS performance indicators is the first six months of the calendar year. (c) To receive Model EMS System designation, the EMS System must be performing in the top 20 percent of their EMS peer group as defined in Rule .0102(23) of this Subchapter in at least four of the seven EMS performance improvement indicators. (c)(d) The county EMS System shall submit an application for designation as a Model EMS System to the OEMS for review. When the system is comprised of more than one county, only one application shall be submitted. The application shall demonstrate that the system meets the standards found in Paragraph (a) of this Rule. Designation as a Model EMS System shall be awarded for a period of to coincide with the expiration date of the current system approval, not to exceed six years. Systems shall apply to OEMS for model system redesignation. Authority G.S. 143-508(b); 143- 508(d)(1),(d)(3),(d)(5),(d)(8),(d)(9),(d)(10),(d)(13); 143- 509(1),(3),(4),(5). 10A NCAC 13P .0204 EMS PROVIDER LICENSE REQUIREMENTS (a) Any firm, corporation, agency, organization or association that provides emergency medical services as its primary responsibility shall be licensed as an EMS Provider by meeting and continuously maintaining the following criteria: (1) Be affiliated with an each EMS System; System where there is to be a physical base of operation or where the EMS Provider will provide point-to-point patient transport within the system; (2) Present an application for a permit for any ambulance that will be in service as required by G.S. 131E-156; (3) Submit a written plan detailing how the EMS Provider will furnish credentialed personnel; (4) Where there is a are franchise ordinance ordinances pursuant to G.S. 153A-250 in effect that covers cover the proposed service PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 299 area, be areas of each EMS system of operation, show the affiliation with each EMS System, as required by Subparagraph (a)(1) of this Rule, by being granted a current franchise to operate operate, or present written documentation of impending receipt of a franchise franchise, from the county; and each county. In counties where there is no franchise ordinance in effect, present a signature from each EMS System representative authorizing the EMS Provider to affiliate as required by Subparagraph (a)(1) of this Rule; (5) Present a written plan and method for recording Provide systematic, periodic inspection, repair, cleaning, and routine maintenance of all EMS responding vehicles. vehicles and maintain records available for inspection by the OEMS which verify compliance with this Rule; (6) Collect and within 24 hours electronically submit to the OEMS EMS Care data that uses the EMS data set and data dictionary as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B- 21.6, including subsequent amendments and additions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. (7) Develop and implement documented operational protocols for the management of equipment, supplies and medications and maintain records available for inspection by the OEMS which verify compliance with this Subparagraph. These protocols shall include a methodology: (A) to assure that each vehicle contains the required equipment and supplies on each response; (B) for cleaning and maintaining the equipment and vehicles; and (C) to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications. (b) In addition to the general requirements detailed in Paragraph (a) of this Rule, if providing fixed-wing air medical services, affiliation with a hospital is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. (c) In addition to the general requirements detailed in Paragraph (a) of this Rule, if providing rotary-wing air medical services, affiliation with a Level I or Level II Trauma Center designated by the OEMS is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. Due to the geographical barriers unique to the County of Dare, the Medical Care Commission exempts the Dare County EMS System from this Paragraph. (b)(d) An EMS Provider may renew its license by presenting documentation to the OEMS that the Provider meets the criteria found in Paragraph (a) Paragraphs (a) through (c) of this Rule. Authority G.S. 131E-155.1(c), 143-508(d)(1),(d)(5). 10A NCAC 13P .0205 EMS PROVIDER LICENSE CONDITIONS (a) Applications for an EMS Provider License must be received by the OEMS at least 30 days prior to the date that the EMS Provider proposes to initiate service. Applications for renewal of an EMS Provider License must be received by the OEMS at least 30 days prior to the expiration date of the current license. (b) Only one license shall be issued to each EMS Provider. The Department shall issue a license to the EMS Provider following verification of compliance with applicable laws and rules. (c) EMS Provider Licenses shall not be transferred. (d) The license shall be posted in a prominent location accessible to public view at the primary business location of the EMS Provider. (e) EMS Provider Licenses may not be issued by the Department to any firm, corporation, agency, organization or association that does not provide emergency medical services as part of its operation to the citizens of North Carolina. Authority G.S. 131E-155.1(c). 10A NCAC 13P .0206 TERM OF EMS PROVIDER LICENSE (a) EMS Provider Licenses shall remain in effect for six years unless any of the following occurs: (1) the Department imposes an administrative sanction which specifies license expiration; (2) the EMS provider Provider closes or goes out of business; (3) the EMS provider Provider changes name or ownership; or (4) substantial failure to continue to comply with Rule .0204 of this Section. (b) When the name or ownership of the EMS provider Provider changes, an EMS Provider License application shall be submitted to the OEMS at least 30 days prior to the effective date of the change. (c) For EMS providers maintaining affiliation with a Model EMS System, licenses may be renewed without requirement for submission of an application. Authority G.S. 131E-155.1(c). 10A NCAC 13P .0207 GROUND AMBULANCE: VEHICLE AND EQUIPMENT REQUIREMENTS (a) To be permitted as a Ground Ambulance, a vehicle shall have: (1) a patient compartment that meets the following interior dimensions: (A) the length, measured on the floor from the back of the driver's PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 300 compartment, driver's seat or partition to the inside edge of the rear loading doors, shall be is at least 102 inches; and (B) the height shall be is at least 48 inches over the patient area, measured from the approximate center of the floor, exclusive of cabinets or equipment; (2) patient care equipment and supplies as defined in the treatment protocols for the system. Vehicles used by EMS providers that are not required to have treatment protocols shall have patient care equipment and supplies as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and secured in the vehicle; (3) other equipment to include: that includes: (A) one fire extinguisher mounted in a quick release bracket that shall either be is either a dry chemical or all-purpose type and have has a pressure gauge; and (B) the availability of one pediatric restraint device to safely transport pediatric patients and children under 20 40 pounds in the patient compartment of the ambulance; (4) the name of the ambulance provider EMS Provider permanently displayed on each side of the vehicle; (5) reflective tape affixed to the vehicle such that there is reflectivity on all sides of the vehicle; (6) emergency warning lights and audible warning devices mounted on the vehicle as required by G.S. 20-125 in addition to those required by Federal Motor Vehicle Safety Standards. All warning devices shall function properly; (7) no structural or functional defects that may adversely affect the patient, the EMS personnel, or the safe operation of the vehicle; (8) an operational two-way radio that shall: that: (A) be is mounted to the ambulance and installed for safe operation and controlled by the ambulance driver; (B) have has sufficient range, radio frequencies, and capabilities to establish and maintain two-way voice radio communication from within the defined service area of the EMS System to the emergency communications center or public safety answering point (PSAP) PSAP designated to direct or dispatch the deployment of the ambulance; (C) be is capable of establishing two-way voice radio communication from within the defined service area to the emergency department of the hospital(s) where patients are routinely transported and to facilities that provide on-line medical direction to EMS personnel; (D) be is equipped with a radio control device mounted in the patient compartment capable of operation by the patient attendant to receive on-line medical direction; and (E) be is licensed or authorized by the Federal Communications Commission (FCC). FCC. (9) permanently installed heating and air conditioning systems; and (10) a copy of the EMS System patient care treatment protocols. (b) Ground ambulances shall not use a radiotelephone device such as a cellular telephone as the only source of two-way radio voice communication. (c) Other communication Communication instruments or devices such as data radio, facsimile, computer, or telemetry radio shall be in addition to the mission dedicated dispatch radio and shall function independently from the mission dedicated radio. Authority G.S. 131E-157(a); 143-508(d)(8). 10A NCAC 13P .0208 CONVALESCENT AMBULANCE: VEHICLE AND EQUIPMENT REQUIREMENTS (a) To be permitted as a Convalescent Ambulance, a vehicle shall have: (1) a patient compartment that meets the following interior dimensions: (A) the length, measured on the floor from the back of the driver's compartment, driver's seat or partition to the inside edge of the rear loading doors, shall be is at least 102 inches; and (B) the height shall be is at least 48 inches over the patient area, measured from the approximate center of the floor, exclusive of cabinets or equipment; (2) patient care equipment and supplies as defined in the treatment protocols for the system. Vehicles used by EMS providers that are not required to have treatment protocols shall have patient care equipment and supplies as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 301 and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and secured in the vehicle; (3) other equipment to include: that includes: (A) one fire extinguisher mounted in a quick release bracket that shall either be is either a dry chemical or all-purpose type and have has a pressure gauge; and (B) the availability of one pediatric restraint device to safely transport pediatric patients and children under 20 40 pounds in the patient compartment of the ambulance. ambulance; (4) permanently installed heating and air conditioning systems; and (5) a copy of the EMS System patient care treatment protocols. (b) Convalescent Ambulances shall: (1) not be equipped, permanently or temporarily, with any emergency warning devices, audible or visual, other than those required by Federal Motor Vehicle Safety Standards; (2) have the name of the ambulance provider EMS Provider permanently displayed on each side of the vehicle; (3) not have emergency medical symbols, such as the Star of Life, block design cross, or any other medical markings, symbols, or emblems, including the word "EMERGENCY," on the vehicle; (4) have the words "CONVALESCENT AMBULANCE" lettered on both sides and on the rear of the vehicle body; and (5) have reflective tape affixed to the vehicle such that there is reflectivity on all sides of the vehicle. (c) A two-way radio or radiotelephone device such as a cellular telephone shall be available to summon emergency assistance for a vehicle permitted as a convalescent ambulance. (d) The convalescent ambulance shall not have structural or functional defects that may adversely affect the patient, the EMS personnel, or the safe operation of the vehicle. Authority G.S. 131E-157(a); 143-508(d)(8). 10A NCAC 13P .0209 AIR MEDICAL AMBULANCE: VEHICLE AND EQUIPMENT REQUIREMENTS To be permitted as an Air Medical Ambulance, an aircraft shall meet the following requirements: (1) Configuration of the aircraft interior shall patient care compartment does not compromise the ability to provide appropriate care or prevent providers from performing in-flight emergency patient care procedures if necessary. as approved by the program medical director. (2) The aircraft shall have has on board patient care equipment and supplies as defined in the treatment protocols for the program. Air Medical Ambulances used by EMS providers that are not required to have treatment protocols shall have patient care equipment and supplies as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and secured in the vehicle. aircraft. (3) There shall be is installed in the aircraft an internal voice communication system to allow for communication between the medical crew and flight crew. (4) Due to the different configurations and space limitations of air medical ambulances, the The medical director shall designate designates the combination of medical equipment specified in Item (2) of this Rule that is carried on a mission based on anticipated patient care needs. (5) Air Medical Ambulances shall have the The name of the organization EMS Provider is permanently displayed on each side of the aircraft. (6) Air Medical Ambulances shall be The aircraft is equipped with a two-way voice radio licensed by the Federal Communications Commission FCC capable of operation on any frequency required to allow communications with public safety agencies such as fire departments, police departments, ambulance and rescue units, hospitals, and local government agencies within the defined service area. (7) All rotary wing aircraft permitted as an air medical ambulance shall have the following flight equipment operational in the aircraft: In addition to equipment required by applicable air worthiness certificates and Federal Aviation Regulations (FAA Part 91 or 135), any rotary-wing aircraft permitted has the following functioning equipment to help ensure the safety of crew members and ground personnel, patient comfort, and medical care: (a) two 360-channel VHF aircraft frequency tranceivers; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 302 (b) one VHF omnidirectional ranging (VOR) receiver; (c) attitude indicators; (d) one transponder with 4097 code, Mode C with altitude encoding; (e) turn and slip indicator in the absence of three attitude indicators; (f) current FAA approved navigational aids and charts for the area of operations; (g) radar altimeter; (h)(a) Satellite Global Navigational System; Global Positioning System; (i) Emergency Locator Transmitter (ELT); (j)(b) a remote control external search light; an external search light that can be operated from inside the aircraft; (k)(c) a light which illuminates the tail rotor; a light that illuminates the tail rotor in nighttime conditions; (l) a fire extinguisher; and (m)(d) survival gear appropriate for the service area and the number of occupants. aircraft occupants; (e) permanently installed heating and air conditioning systems; and (f) the ability to carry at least a 220 pound patient load and transport at least 60 nautical miles or nearest level one Trauma Center non-stop without refueling. (8) Any fixed wing aircraft issued a permit to operate as an air medical ambulance shall have a current "Instrument Flight Rules" certification. (9)(8) The availability of one pediatric restraint device to safely transport pediatric patients and children under 20 40 pounds in the patient compartment of the air medical ambulance. (10)(9) The Air Medical Ambulance shall not have aircraft has no structural or functional defects that may adversely affect the patient, or the EMS personnel, or the safe operation of the aircraft. personnel. Authority G.S. 131E-157(a); 143-508(d)(8). 10A NCAC 13P .0210 WATER AMBULANCE: WATERCRAFT AND EQUIPMENT REQUIREMENTS To be permitted as a Water Ambulance, a watercraft shall meet the following requirements: (1) The watercraft shall have a patient care area that: (a) provides access to the head, torso, and lower extremities of the patient while providing sufficient working space to render patient care; (b) is covered to protect the patient and EMS personnel from the elements; and (c) has an opening of sufficient size to permit the safe loading and unloading of a person occupying a litter. (2) The watercraft shall have on board patient care equipment and supplies as defined in the treatment protocols for the system. Water ambulances used by EMS providers that are not required to have treatment protocols shall have patient care equipment and supplies as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B- 21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The equipment and supplies shall be clean, in working order, and secured in the vehicle. (3) Water ambulances shall have the name of the ambulance provider EMS Provider permanently displayed on each side of the watercraft. (4) Water ambulances shall have a 360-degree beacon warning light in addition to warning devices required in Chapter 75A, Article 1, of the North Carolina General Statutes. (5) Water ambulances shall be equipped with: (a) two floatable rigid long backboards with proper accessories for securing infant, pediatric, and adult patients and stabilization of the head and neck; (b) one floatable litter with patient restraining straps and capable of being secured to the watercraft; (c) one fire extinguisher mounted in a quick release bracket that shall either be is either a dry chemical or all-purpose type and have has a pressure gauge; (d) lighted compass; (e) radio navigational aids such as ADF (automatic directional finder), Satellite Global Navigational System, navigational radar, or other comparable radio equipment suited for water navigation; (f) marine radio; and (g) the availability of one pediatric restraint device to safely transport pediatric patients under 20 40 pounds in the patient compartment of the ambulance; (6) The water ambulance shall not have structural or functional defects that may adversely affect PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 303 the patient, the EMS personnel, or the safe operation of the watercraft. (7) Water ambulances shall have a copy of the EMS System patient care treatment protocols. Authority G.S. 131E-157(a); 143-508(d)(8). 10A NCAC 13P .0212 TERM OF AMBULANCE PERMIT (a) Ambulance Permits shall remain in effect for two years unless any of the following occurs: (1) The Department imposes an administrative sanction which specifies permit expiration; (2) The EMS provider Provider closes or goes out of business; (3) The EMS provider Provider changes name or ownership; or (4) Substantial failure Failure to comply with the applicable Paragraphs of Rules .0207, .0208, .0209, or .0210 of this Section. (b) Ambulance Permits shall be renewed without OEMS inspection for those ambulances currently operated within a Model EMS System. Authority G.S. 131E-157(a); 143-508(d)(8). 10A NCAC 13P .0213 EMS NONTRANSPORTING VEHICLE REQUIREMENTS (a) To be permitted as an EMS Nontransporting Vehicle, a vehicle shall: (1) have patient care equipment and supplies as defined in the treatment protocols for the system. The equipment and supplies shall be clean, in working order, and secured in the vehicle. (2) have the name of the organization EMS Provider permanently displayed on each side of the vehicle. (3) have reflective tape affixed to the vehicle such that there is reflectivity on all sides of the vehicle. (4) have emergency warning lights and audible warning devices mounted on the vehicle as required by G.S. 20-125 in addition to those required by Federal Motor Vehicle Safety Standards. All warning devices shall function properly. (5) not have structural or functional defects that may adversely affect the EMS personnel or the safe operation of the vehicle. (6) have one fire extinguisher that shall be is a dry chemical or all-purpose type with a pressure gauge, mounted in a quick-release bracket. (7) have an operational two-way radio that shall: that: (A) be is mounted to the EMS Nontransporting Vehicle and installed for safe operation and controlled by the driver; (B) have has sufficient range, radio frequencies, and capabilities to establish and maintain two-way voice radio communication from within the defined service area of the EMS System to the emergency communications center or public safety answering point (PSAP) PSAP designated to direct or dispatch the deployment of the ambulance; (C) be is capable of establishing two-way voice radio communication from within the defined service area to facilities that provide on-line medical direction to EMS personnel; and (D) be is licensed or authorized by the Federal Communications Commission (FCC). FCC. (8) not use a radiotelephone device such as a cellular telephone as the only source of two-way radio voice communication. (9) have a copy of the local EMS System patient care treatment protocols. (b) Other communication Communication instruments or devices such as data radio, facsimile, computer, or telemetry radio shall be in addition to the mission dedicated dispatch radio and shall function independently from the mission-dedicated radio. Authority G.S. 143-508(d)(8). 10A NCAC 13P .0214 EMS NONTRANSPORTING VEHICLE PERMIT CONDITIONS (a) An EMS provider Provider shall apply to the OEMS for an EMS Nontransporting Vehicle Permit prior to placing such a vehicle in service. (b) The Department shall issue a permit for a vehicle following verification of compliance with applicable laws and rules. (c) Only one EMS Nontransporting Vehicle Permit shall be issued for each vehicle. (d) EMS Nontransporting Vehicle Permits shall not be transferred. (e) The EMS Nontransporting Vehicle Permit shall be posted as designated by the OEMS inspector. (f) Vehicles that are not owned or leased by the EMS Provider are ineligible for permitting. Authority G.S. 143-508(d)(8). 10A NCAC 13P .0215 TERM OF EMS NONTRANSPORTING VEHICLE PERMIT (a) EMS Nontransporting Vehicle Permits shall remain in effect for two years in an EMS System or four years in a Model EMS System, years, unless any of the following occurs: (1) The Department imposes an administrative sanction that specifies permit expiration; (2) The EMS provider Provider closes or goes out of business; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 304 (3) The EMS provider Provider changes name or ownership; or (4) Substantial failure Failure to comply with Rule .0213 of this Section. (b) EMS Nontransporting Vehicle Permits shall be renewed without OEMS inspection for those vehicles currently operated within a Model EMS System. Authority G.S. 143-508(d)(8). SECTION .0300 – SPECIALTY CARE TRANSPORT PROGRAMS 10A NCAC 13P .0301 SPECIALTY CARE TRANSPORT PROGRAM CRITERIA (a) Programs EMS Providers seeking designation to provide specialty care transports shall submit an application for program approval to the OEMS at least 60 days prior to field implementation. The application shall document that the program has: (1) a defined service area; area that identifies the specific transferring and receiving facilities in which the program is intended to service; (2) a written policies and procedures implemented for medical oversight plan meeting the requirements of Section .0400; (3) service continuously available on a 24 hour per day basis; (4) the capability to provide the following patient care skills and procedures: (A) advanced airway techniques including rapid sequence induction, cricothyrotomy, and ventilator management, including continuous monitoring of the patient's oxygenation; (B) insertion of femoral lines; (C) maintaining invasive monitoring medical devices to include such as central venous pressure lines, arterial and venous catheters, arterial lines, intra-ventricular catheters, and epidural catheters; and (D) interpreting 12-lead electrocardiograms; (5) a written continuing education plan program for EMS personnel, under the direction of the Specialty Care Transport Program Continuing Education Coordinator, developed and modified based on feedback from program data, review and evaluation of patient outcomes, and quality management reviews. review that follows the guidelines of the: (A) "US DOT NHTSA EMT-Basic Refresher: National Standard Curriculum" for EMT personnel; and (B) "EMT-P and EMT-I Continuing Education National Guidelines" for EMT-I and EMT-P personnel. These documents are incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and additions. These documents are available from NHTSA, 400 7th Street, SW, Washington, D.C. 20590, at no cost; (6) a mechanism to collect and electronically submit to the OEMS data that uses the EMS data set and data dictionary as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. EMS Specialty Care Transport Programs shall comply with this requirement by July 1, 2004. a communication system that will provide two-way voice communications for transmission of patient information to medical crew members anywhere in the service area of the program. The SCTP medical director shall verify that the communications system is satisfactory for on-line medical direction; (7) medical crew members that have all completed training regarding: (A) operation of the EMS communications system used in the program; and (B) the medical and safety equipment specific to the vehicles used in the program. This training shall be conducted every six months; (8) written operational protocols for the management of equipment, supplies and medications. These protocols include: (A) a listing of all standard medical equipment, supplies, and medications for all vehicles used in the program based on the treatment protocols and approved by the medical director; (B) a methodology to assure that each vehicle contains the required equipment, supplies and medications on each response; and (9) written policies and procedures specifying how EMS Systems will dispatch and utilize the ambulances operated by the program. (b) Applications for specialty care transport program approval shall document that the applicant meets the requirements for the specific program type or types applied for as specified in Rules .0302, .0303 or .0304 of this Section. When transporting patients, staffing for the vehicle used in the SCTP shall be approved by the SCTP medical director as medical crew members, using any of the following appropriate for the condition of the patient: (1) EMT-Paramedic; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 305 (2) nurse practitioner; (3) physician; (4) physician assistant; (5) registered nurse; and (6) respiratory therapist. (c) EMS Providers whose primary dedicated service is the provision of the patient care skills and procedures as detailed in Subparagraph (a)(4) of this Rule are exempt from the staffing requirements defined in G.S. 131E-158(a). (c)(d) Specialty care transport program Care Transport Program approval shall be are valid for a period to coincide with the EMS Provider License, not to exceed six years. Programs shall apply to the OEMS for reapproval. Authority G.S. 131E-158; 143-508(d)(1),(d)(8),(d)(9); 143- 508(d)(13). 10A NCAC 13P .0302 AIR MEDICAL SPECIALTY CARE TRANSPORT PROGRAM CRITERIA FOR LICENSED EMS PROVIDERS USING ROTARY-WING AIRCRAFT (a) In addition to the general requirements of Specialty Care Transport Programs in Rule .0301 of this Section, Air Medical Programs using rotary-wing aircraft shall document that the program has: (1) Medical crew members that have all completed training regarding: (A) Altitude physiology; (B) The operation of the EMS communications system used in the program; (C) In-flight emergencies specific to the aircraft used in the program; and (D) Aircraft safety. This training shall be conducted every six months. (2) A Certificate of Need has been obtained from the Department when applicable; applicable as required by law; (3) A written plan Written policies and procedures for transporting patients to appropriate facilities when diversion or bypass plans are activated; (4) A written plan for providing emergency vehicle operation education for program personnel who operate ground emergency vehicles; and (5)(4) A written Written policies and procedures specifying how EMS Systems will request ground support ambulances dispatch and utilize aircraft operated by the program. program; (5) Written triage protocols for trauma, stroke, STEMI, burn, and pediatric patients reviewed and approved by the OEMS medical director; (6) Written policies and procedures specifying how EMS Systems will receive the Specialty Care Transport Services offered under the program when the aircraft are unavailable for service; (7) Pilot-In-Command (PIC) that: (A) Maintain instrument currency in accordance with FAR 61,57; (B) Hold at least a commercial rotor-craft instrument rating; (C) Have not less than 2,500 hours total rotor-wing flight time; and (8) A copy of the Specialty Care Transport Program patient care treatment protocols. (b) Air Medical Programs based outside of North Carolina that provide specialty care transports may be granted approval by the OEMS to operate in North Carolina by submitting an application for program approval. The application shall document that the program meets all criteria specified in Rules .0204 and .0301 of this Subchapter and Paragraph (a) of this Rule. All patient response, re-positioning and mission flight legs must be conducted under FAA part 135 regulations. Authority G.S. 143-508(d)(1),(d)(3),(d)(13). 10A NCAC 13P .0303 GROUND SPECIALTY CARE TRANSPORT PROGRAMS (a) When transporting patients that have a medical need for one or more of the skills or procedures as defined for specialty care transport programs in .0301(a)(4) of this Section, staffing for the vehicle used in the ground specialty care transport program shall be at a level to ensure the capability to provide in the patient compartment, when the patient condition requires, two of the following personnel approved by the medical director as medical crew members: (1) EMT-Paramedic; (2) nurse practitioner; (3) physician (4) physician assistant; (5) registered nurse; and (6) respiratory therapist. (b) When transporting patients that do not require specialty care transport skills or procedures, staffing for the vehicles used in the ground specialty care transport program shall be at a level to ensure compliance with G.S. 131E-158(a). (c) In addition to the requirements of specialty care transport programs in Rule .0301 of this Section, ground programs providing specialty care transports shall document that the program has: (1) a communication system that will provide two-way voice communications to medical crew members anywhere in the service area of the program. The medical director shall verify that the communications system is satisfactory for on-line medical direction; (2) medical crew members that have all completed training regarding: (A) operation of the EMS communications system used in the program; and (B) the medical and safety equipment specific to the vehicles used in the program. This training shall be conducted every six months; PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 306 (3) operational protocols for the management of equipment, supplies and medications. These protocols shall include: (A) a standard equipment and supply listing for all ambulance vehicles used in the program. This listing shall meet or exceed the requirements for each category of ambulance used in the program as found in Rules .0207, .0208, .0209, and .0210 of this Subchapter; (B) a standard listing of medications for all ambulance and EMS nontransporting vehicles used in the system. This listing shall be based on the local treatment protocols and be approved by the medical director; (C) a methodology to assure that each vehicle contains the required equipment and supplies on each response; (D) a methodology for cleaning and maintaining the equipment and vehicles; and (E) a methodology for assuring that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer’s specifications; (4) a written plan for providing emergency vehicle operation education for program personnel who operate emergency vehicles; and (5) a written plan specifying how EMS Systems will request ambulances operated by the program. (d) Ground Specialty Care Transport programs based outside of North Carolina may be granted approval by the OEMS to operate in North Carolina by submitting an application for program approval. The application shall document that the program meets all criteria specified in Rules .0204 and .0301 of this Subchapter and Paragraphs (a) and (b) of this Rule. Authority G.S. 143-508(d)(1),(d)(8),(d)(9). 10A NCAC 13P .0304 HOSPITAL-AFFILIATED GROUND SPECIALTY CARE TRANSPORT PROGRAMS USED FOR INPATIENT TRANSPORTS (a) Patients transported by Hospital-affiliated Ground Specialty Care Transport Program shall: (1) Have a medical need for one or more of the skills or procedures as defined for Specialty Care Transport Programs as defined in .0301(a)(4); or (2) Be a patient of the hospital administering the program, or be scheduled for admission to or discharged from the hospital administering the program; (b) In addition to the general requirements of Specialty Care Transport Programs in Rule .0301 of this section, hospital-affiliated ground programs providing specialty care transports shall document that the program has: (1) A communication system that will provide, at a minimum, two-way voice communications to medical crew members anywhere in the service area of the program. The medical director shall verify that the communications system is satisfactory for on-line medical direction. (2) Medical crew members that have all completed training regarding: (A) Operation of the EMS communications system used in the program; and (B) The medical and safety equipment specific to the vehicles used in the program. This training shall be conducted every six months. (3) Staffing at a level to ensure the capability to provide in the patient compartment, when the patient's condition requires, two of the following personnel approved by the medical director as medical crew members: (A) EMT-Paramedic; (B) Nurse practitioner; (C) Physician; (D) Physician assistant; (E) Registered nurse; or (F) Respiratory therapist. (4) Operational protocols for the management of equipment, supplies, and medications. These protocols shall include: (A) A standard equipment and supply listing for all ambulance vehicles used in the program. This listing shall meet or exceed the requirements for each category of ambulance used in the program as found in Rules .0207, .0208, .0209, and .0210 of this Subchapter; (B) A standard listing of medications for all ambulance and EMS nontransporting vehicles used in the program. This listing shall be based on the local treatment protocols and be approved by the medical director; (C) A methodology to assure that each vehicle contains the required equipment and supplies on each response (D) A methodology for cleaning and maintaining the equipment and vehicles; and (E) A methodology for assuring that supplies and medications are not used beyond the expiration date and stored in a temperature-controlled PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 307 atmosphere according to manufacturer's specifications. (5) A written plan for providing emergency vehicle operation education for program personnel who operate emergency vehicles. (6) A written plan specifying how EMS systems will request ambulances operated by the program. (c) Hospital-Affiliated Ground Specialty Care Transport Programs based outside of North Carolina may be granted approval by the OEMS to operate in North Carolina by submitting an application for program approval. The application shall document that the program meets all criteria specified in Rules .0204 and .0301 of this Subchapter and Paragraphs (a) and (b) of this Rule. Authority G.S. 143-508(d)(1),(d)(8),(d)(9). 10A NCAC 13P .0305 AIR MEDICAL SPECIALTY CARE TRANSPORT PROGRAM CRITERIA FOR LICENSED EMS PROVIDERS USING FIXED-WING AIRCRAFT (a) In addition to the general requirements of Specialty Care Transport Programs in Rule .0301 of this Section, Air Medical Programs using fixed-wing aircraft shall document that: (1) Medical crew members have all completed training regarding: (A) Altitude physiology; (B) The operation of the EMS communications system used in the program; (C) In-flight emergencies specific to the aircraft used in the program; and (D) Aircraft safety. This training shall be conducted every six months. (2) All aircraft are operated by a two-pilot crew. Pilot-In-Command (PIC) shall be type rated in licensed aircraft and Airline Transport Pilot (ATP) certified. If the aircraft is over 12,500 pounds, both PIC and Second-In Command shall be type-rated. (3) A Certificate of Need has been obtained from the Department when applicable as required by law; (4) Written policies and procedures specifying how ground ambulance services are utilized by the program for patient delivery and receipt on each end of the transport; and (5) There is a copy of the Specialty Care Treatment Program patient care protocols. (b) All patient, re-positioning, and mission flight legs must be conducted under FAA part 135 regulations. Authority G.S. 143-508(d)(1),(d)(3). SECTION .0400 - MEDICAL OVERSIGHT 10A NCAC 13P .0401 COMPONENTS OF MEDICAL OVERSIGHT FOR EMS SYSTEMS Each EMS System operating within the scope of practice for EMD, EMT-I, or EMT-P or seeking designation as a Model EMS System shall have the following components in place to assure medical oversight of the system: (1) a medical director for adult and pediatric patients appointed, either directly or by documented delegation, by the county responsible for establishing the EMS System. Systems may elect to appoint one or more assistant medical directors. (a) For EMS Systems, the medical director and assistant medical directors shall meet the criteria as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; and (b) For Model EMS Systems, the medical director and assistant medical directors shall also meet the additional criteria for medical directors of Model EMS Systems as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; (2) written treatment protocols for adult and pediatric patients for use by EMS personnel; (3) for systems providing EMD service, an EMDPRS approved by the medical director; (4) an EMS Peer Review Committee; and (5) written procedures for use by EMS personnel to obtain on-line medical direction. On-line medical direction shall: (a) be restricted to medical orders that fall within the scope of practice of the EMS personnel and within the scope of approved system treatment protocols; (b) be provided only by a physician, MICN, EMS-NP, or EMS-PA. Only physicians may deviate from written treatment protocols; and PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 308 (c) be provided by a system of two-way voice communication that can be maintained throughout the treatment and disposition of the patient. Authority G.S. 143-508(b); 143-509(12). 10A NCAC 13P .0402 COMPONENTS OF MEDICAL OVERSIGHT FOR SPECIALTY CARE TRANSPORT PROGRAMS Each Specialty Care Transport Program shall have the following components in place to assure Medical Oversight of the system: (1) a medical director. The administration of the Specialty Care Transport Program SCTP shall appoint a medical director following the criteria for medical directors of Specialty Care Transport Programs as defined by the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost. The program administration may elect to appoint one or more assistant medical directors; (2) treatment protocols for adult and pediatric patients for use by medical crew members; (3) an EMS Peer Review Committee; and (4) a written protocol for use by medical crew members to obtain on-line medical direction. On-line medical direction shall: (a) be restricted to medical orders that fall within the scope of practice of the medical crew members and within the scope of approved program treatment protocols; (b) be provided only by a physician, MICN, EMS-NP, or EMS-PA. Only physicians may deviate from written treatment protocols; and (c) be provided by a system of two-way voice communication that can be maintained throughout the treatment and disposition of the patient. Authority G.S. 143-508(b); 143-509(12). 10A NCAC 13P .0403 RESPONSIBILITIES OF THE MEDICAL DIRECTOR FOR EMS SYSTEMS (a) The Medical Director for an EMS System shall be is responsible for the following: (1) ensure ensuring that medical control is available 24 hours a day; (2) the establishment, approval and annual updating of adult and pediatric treatment protocols; (3) EMD programs, the establishment, approval, and annual updating of the EMDPRS; (4) medical supervision of the selection, system orientation, continuing education and performance of all EMS personnel; (5) medical supervision of a scope of practice performance evaluation for all EMS personnel in the system based on the treatment protocols for the system; (6) the medical review of the care provided to patients; (7) providing guidance regarding decisions about the equipment, medical supplies, and medications that will be carried on all ambulances or and EMS nontransporting vehicles within the scope of practice of EMT-I or EMT-P; and operating within the system; (8) keeping the care provided up to date with current medical practice. practice; and (9) developing and implementing an orientation plan for all hospitals within the EMS system that use MICN, EMS-NP, or EMS-PA personnel to provide on-line medical direction to EMS personnel, which includes at a minimum: (A) a discussion of all EMS System treatment protocols and procedures; (B) an explanation of the specific scope of practice for credentialed EMS personnel, as authorized by the approved EMS System treatment protocols as required by Rule .0405 of this Section; (C) a discussion of all practice settings within the EMS System and how scope of practice may vary in each setting; (D) a mechanism to assess the ability to effectively use EMS System communications equipment including hospital and prehospital devices, EMS communication protocols, and communications contingency plans as related to on-line medical direction; and (E) the successful completion of a scope of practice performance evaluation which verifies competency in Parts (A) through (D) of this Subparagraph and which is administered under the direction of the medical director. (b) Any tasks related to Paragraph (a) of this Rule may be are completed, through written delegation, by assisting physicians, physician assistants, nurse practitioners, registered nurses, EMD's, or EMT-P's. (c) The Medical Director may suspend temporarily, pending due process review, any EMS personnel from further participation in the EMS System when it is determined the activities or medical care rendered by such personnel may be detrimental to the care PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 309 of the patient, constitute unprofessional behavior, conduct, or result in non-compliance with credentialing requirements. Authority G.S. 143-508(b), 143-508(d)(3),(d)(7); 143-509(12). 10A NCAC 13P .0404 RESPONSIBILITIES OF THE MEDICAL DIRECTOR FOR SPECIALTY CARE TRANSPORT PROGRAMS (a) The medical director for a Specialty Care Transport Program shall be responsible for the following: (1) The establishment, approval, and periodic updating of adult and pediatric treatment protocols; (2) Medical supervision of the selection, program orientation, continuing education, and performance of medical crew members; (3) Medical supervision of a scope of practice performance evaluation for all medical crew members in the program based on the treatment protocols for the program; (4) The medical review of the care provided to patients; (5) Keeping the care provided up to date with current medical practice; and (6) In air medical programs, determination and specification of the medical equipment required in Item (2) of Rule .0209 of this Subchapter that is carried on a mission based on anticipated patient care needs. (b) Any tasks related to Paragraph (a) of this Rule may be completed, through clearly established written delegation, by assisting physicians, physician assistants, nurse practitioners, registered nurses, or medical crew members. (c) The medical director shall have the authority to may suspend temporarily, pending due process review, any medical crew members from further participation in the Specialty Care Transport Program when it is determined the activities or medical care rendered by such personnel may be detrimental to the care of the patient, constitute unprofessional behavior, conduct, or result in non-compliance with credentialing requirements. Authority G.S. 143-508(b); 143-509(12). 10A NCAC 13P .0405 REQUIREMENTS FOR ADULT AND PEDIATRIC TREATMENT PROTOCOLS FOR EMS SYSTEMS (a) Written Treatment Protocols: Protocols used in EMS Systems shall: (1) Used in EMS Systems shall meet Be adopted in their original form from the standard adult and pediatric treatment protocols as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; and (2) Used in Model EMS Systems shall also meet the standard treatment protocols for Model EMS Systems as defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; and (3)(2) Shall not Not contain medical procedures, medications, or intravenous fluids that exceed the scope of practice defined by the North Carolina Medical Board pursuant to G.S. 143- 514 for the level of care offered in the EMS System and any other applicable health care licensing board. (b) Treatment Individual adult and pediatric treatment protocols developed may be modified locally by EMS Systems if there is a change in a specific protocol which will optimize care within the local community which adds additional medications or medical procedures, or rearranges the order of care provided in the protocol contained within the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection" shall meet the requirements of as described in Paragraph (a) of this Rule, shall be reviewed annually and any change in the treatment protocols shall be submitted to the OEMS Medical Director for review and approval at least 30 days prior to the implementation of the change. Rule. Additional written Treatment Protocols may be developed by any EMS System in addition to the required protocols contained within the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection" as required by the EMS System. All North Carolina College of Emergency Physicians Policies and Procedures must be included and may be modified at the local level. All EMS System Treatment Protocols which have been added or changed by the EMS System shall be submitted to the OEMS Medical Director for review and approval at least 30 days prior to the implementation of the change. Authority G.S. 143-508(b); 143-509(12). 10A NCAC 13P .0406 REQUIREMENTS FOR ADULT AND PEDIATRIC TREATMENT PROTOCOLS FOR SPECIALTY CARE TRANSPORT PROGRAMS (a) Treatment Adult and pediatric treatment protocols used by medical crew members within a Specialty Care Transport Program shall: (1) be approved by the OEMS Medical Director and incorporate all skills, medications, equipment, and supplies for Specialty Care Transport Programs as defined by the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in PROPOSED RULES 23:04 NORTH CAROLINA REGISTER AUGUST 15, 2008 310 accordance with G.S. 150B-21.6, including subsequent amendments and editions. This document is available from the OEMS, 2707 Mail Service Center, Raleigh, North Carolina 27699-2707, at no cost; and (2) not contain medical procedures, medications, or intravenous fluids that exceed the scope of practice of the medical crew members. (b) Treatment All adult and pediatric treatment protocols shall be reviewed annually, and any change in the treatment protocols shall be submitted to the OEMS Medical Director for review and approval at least 30 days prior to the implementation of the change. Authority G.S. 143-508(b); 143-509(12). 10A NCAC 13P .0408 EMS PEER REVIEW COMMITTEE FOR EMS SYSTEMS (a) The EMS Peer Review Committee for an EMS System shall: (1) be composed of membership as defined in G.S. 131E-155(6b). (2) appoint a physician as chairperson; (3) meet at least quarterly; (4) analyze use, at a minimum, information gained from the analysis of system data submitted to the O |
OCLC number | 13686205 |