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;
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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
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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.
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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,
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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.
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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).
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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
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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
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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;
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(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
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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
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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
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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;
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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
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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;
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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;
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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;
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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
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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
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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