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NORTH CAROLINA REGISTER VOLUME 12 • ISSUE 5 • Pages 334 - 442 eptember 2, 1997 SEP 1997 i '^vv*" i fl IN THIS ISSUE Revenue - Tax Review Board ' l Voting Rights Letters Environment, Health, and Natural Resources Human Resources Labor Nursing, Board of {t Psychology Board ' *' Public Education Speech and Language Pathologists & Audiologists Transportation Rules Review Commission ' Contested Case Decisions PUBLISHED BY The Office ofAdministrative Hearings Rules Division PO Drawer 27447 Raleigh, NC 27611-7447 Telephone (919) 733-2678 Fax (919) 733-3462 This publication is printed on permanent, acid-free paper in compliance with G.S. 125-1 1.13 Digitized by the Internet Archive in 2011 with funding from University of North Carolina at Chapel Hill http://www.archive.org/details/northcarolinareg125nort NORTH CAROLINA IN THIS ISSUE Volume 12, Issue 5 Pages 334 - 442 I. IN ADDITION Voting Rights Letters 334-335 Revenue Tax Review Board 336 n. RULE-MAKING PROCEEDINGS Environment, Health, and Natural Resources Wildlife Resources Commission 337 Human Resources Medical Assistance 337 Licensing Boards Nursing, Board of 338 Psychology Board 338 Transportation Highways, Division of 337 - 338 September 2, 1997 This issue contains documents officially filed through August 12, 1997. in. PROPOSED RULES Environment, Health, and Natural Resources Environmental Management Commission 414-418 Marine Fisheries Commission 418 - 426 Human Resources Medical Care Commission 339 - 354 Labor Occupational Safety & Health, Division of 354 - 414 Licensing Boards Speech and Language Pathologists and Audiologists, Board of Examiners 427 - 430 Office of Administrative Hearings Rules Division 424 North Blount Street (27601) PO Drawer 27447 Raleigh, NC 27611-7447 (919) 733-2678 FAX (919) 733-3462 Julian Mann III, Director James R. Scarcella Sr., Deputy Director Molly Masich, Director of APA Services Ruby Creech, Publications Coordinator Jean Shirley, Editorial Assistant Linda Richardson, Editorial Assistant IV. TEMPORARY RULES Environment, Health, and Natural Resources Marine Fisheries Commission 431 - 433 Public Education Elementary & Secondary Education 433 - 434 V. RULES REVIEW COMMISSION 435-437 VI. CONTESTED CASE DECISIONS Index to ALJ Decisions 438 - 441 VII. 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OJ X OJ ^ . f— a. < Z .S2 O _ c •= U (d X o 00 —(U Oc CO Q- 3 '5 Ou re T3 •5 ^ ? = gz p2 uU Of -J < 3 * e! s e [2 OJ •<: T3 O aj f*^ "3 — u CQ S om >, — c X _oj c/i 5 d —c Xu _^• •a OJ E o 5 '= c= y 00 2 •= •I 3 2 to h- •- o t; re a re o „ '^ 2 OJ c ^1 o CJ S^ '5b -^ OJ " C o re •o 3 re on O OJ Z 3 H _ 3 X OJ to X '^ >> re T3 X >> CJ re X :2 ^ o > >.•« QJ Cd D X ^ S |l > OJ CJ c u >. -— u- re a. -a >. OJ § -g 5 c^ 0. SOu U X — "O to C: 3 i> OJ o X CJ i2 S Z H .S £75 2 cl? IN ADDITION This Section contains public notices that are required to be published in the Register or have been approved by the Codifier of Rules for publication. IKP:DHH:ALP:tlb DJ 166-012-3 97-1496 U.S. Department of Justice Civil Rights Division Voting Section P.O. Box 66128 Washington. D. C. 20035-6128 July 25, 1997 Jesse L. Warren, Esq. City Attorney P.O. Box 3136 Greensboro, North Carolina 27402-3136 Dear Mr. Warren: This refers to four annexations (Ordinance Nos. 97-63, 97-65, 97-66 and 97-69) and their designation to districts of the City of Greensboro in Guilford County, North Carolina, submitted to the Attorney General pursuant to Section 5 of the Voting Rights Act, 42 U.S.C. 1973c. We received your submission on May 28, 1997. The Attorney General does not interpose any objection to the specified changes. However, we note that Section 5 expressly provides that the failure of the Attorney General to object does not bar subsequent litigation to enjoin the enforcement of the changes. See the Procedures for the Administration of Section 5 (28 C.F.R. 51.41). Please be advised that it is imnecessary to provide multiple copies of documents when making a Section 5 submission. Sincerely, Isabelle Katz Pinzler Acting Assistant Attorney General Civil Rights Division By: Elizabeth Johnson for Chief, Voting Section 12:5 NORTH CAROLINA REGISTER September 2, 1997 334 IN ADDITION U.S. Depanment of Justice Civil Rights Division IKP:DHH:NT:tlb Voting Section DJ 166-012-3 P.O. Box 66128 97-1494 Washington. D.C. 20035-6128 97-2027 July 28, 1997 David A. Holec, Esq. City Attorney P.O. Box 7207 Greenville, North Carolina 27835-7207 Dear Mr. Holec: This refers to ten annexations (Ordinance Nos. 97-25, 97-31, 97-33, 97-34, 97-45, and 97-52 through 97-56) and theii designation to districts of the City of Greenville in Pitt County, North Carolina, submitted to the Attorney General pursuant to Section 5 of the Voting Rights Act, 42 U.S.C. 1973c. We received your submissions on May 28 and July 14, 1997. The Attorney General does not interpose any objection to the specified changes. However, we note that Section 5 expressly provides that the failure of the Attorney General to object does not bar subsequent litigation to enjoin the enforcement of the changes. In addition, as authorized by Section 5, we reserve the right to reexamine these submissions if additional information that would otherwise require an objection comes to our attention during the remainder of the sixty-day review period. See the Procedures for the Administration of Section 5 (28 C.F.R. 51.41 and 51.43). Sincerely, Isabelle Katz Pinzler Acting Assistant Attorney General Civil Rights Division By: Elizabeth Johnson for Chief, Voting Section 335 NORTH CAROLINA REGISTER September 2, 1997 12:5 IN ADDITION STATE OF NORTH CAROLINA COUNTY OF WAKE IN THE MATTER OF: The Denial of Sales and Use Tax Claims for Refund for the period of January 10, 1990 through August 21, 1992, by the Secretary of Revenue against Inacom Business Centers, Inc. BEFORE THE TAX REVIEW BOARD ADMINISTRATIVE DECISION NUMBER: 334 THIS MATTER was heard before the Tax Review Board (hereinafter "Board") on Tuesday, April 22, 1997, in the office of the State Treasurer in the City of Raleigh, Wake County, North Carolina. It involved a Petition for administrative review filed by Inacom Business Centers, Inc. (hereinafter "Taxpayer") from the Final Decision of Michael A. Hannah, Assistant Secretary for Legal and Administrative Services for the Department of Revenue (hereinafter "Assistant Secretary") entered on August 23, 1996, denying Taxpayer's request for refund of sales taxes collected upon the sales of computer software for the period of January 10, 1990 through August 21, 1992. Chairman Harlan E. Boyles, State Treasurer presided over the hearing with ex officio member, Jo Anne Sanford, Chairman, Utilities Commission and duly appointed member, Noel L. Allen, attorney at law. Gerald Johnson, Wilma Ross and Dell Evans appeared at the hearing on behalf of the Taxpayer; George W. Boylan, Special Deputy Attorney General, appeared on behalf of the Department of Revenue. Pursuant to G.S. §1 05-24 1.2(bl), the Tax Review Board conducted the hearing upon review of the petition, the final decision, the record, the brief and documents filed in this matter. The scope of administrative review for petitions filed with the Tax Review Board is governed by G.S. §1 05-24 1.2(b2). After conducting a hearing, G.S. §1 05-24 1.2(b2) states in pertinent part that: (b2)... "the Board shall confirm, modify, reverse, reduce, or increase the assessment or decision of the Secretary." AND IT APPEARING TO THE BOARD: after review of the petition, the final decision, the record, the brief and documents filed in this matter, and upon carefully considering the arguments presented that the findings of fact made by the Assistant Secretary were fully supported by competent evidence in the record, that the conclusions of law made by the Assistant Secretary were fully supported by the findings of fact, and that the decision by the Assistant Secretary was fully supported by the conclusions of law; IT IS THEREFORE ORDERED that the Final Decision of the Assistant Secretary is CONFIRMED in every respect. Entered this the 6th day of August, 1997. TAX REVIEW BOARD /s/Harlan E. Boyles, Chairman State Treasurer /s/Jo Aime Sanford Chairman, Utilities Commission /s/Noel L. Allen, member a2:5 NORTH CAROLINA REGISTER September 2, 1997 336 RULE-MAKING PROCEEDINGS A Nonce ofRule-making Proceedings is a staiement ofsubject matter of the agency 's proposed rule making. The agency must publish a notice of the subject matter for public comment at least 60 days prior to publishing the proposed text of a rule. Publication of a temporary rule ser\'es as a Notice of Rule-making Proceedings and can be found in the Register under the section heading of Temporary Rules. A Rule-making Agenda published by an agency senses as Rule-making Proceedings and can be found in the Register under the section heading of Rule-making Agendas. Statutory reference: G.S. 150B-2L2. TITLE 10 - DEPARTMENT OF HUMAN RESOURCES CHAPTER 26 - MEDICAL ASSISTANCE ^^otice of Rule-making Proceedings is hereby given by the DHR - Division of Medical Assistance in accordance wth G.S. 150B-21.2. The agency shall subsequently publish in the Register the text of the rule(s) it proposes to adopt as a result of this notice of rule-making proceedings and any comments received on this notice. Citation to Existing Rules Affected by this Rule-Making: 15A NCAC 1OF. 0330 and .0339 - Other rules may be proposed in the course of the rule-making process. Authority for the rule-making: G.S. 75A-3; 75A-15 Statement of the Subject Matter: 15A NCAC lOF .0330 - Amendment to modify' provisions for placement and maintenance of markers. 15.A NCAC lOF .0339 - Amend no wake zone at Lake Viev, Pointe in McDowell Countw Citation to Existing Rules Affected by this Rule-Making: 10 NCAC 26K .0006 - Other rules may be proposed in the course of the rule-making process. Authority for the rule-making: 42 C.F.R. 447.15 G.S. 108A-25(b): 108A-54; Statement of the Subject Matter: Lists conditions for which providers can bill Medicaid recipients. Clarifies patient liability for the cost of care, when managed care patient knowingly seeks out-of-network care. Reason for Proposed Action: Providers have expressed confusion about the apparem conflict in 10 NCAC 26M .0203 and 10 NCAC 26K .0006 regarding patient liability for the cost of care. Comment Procedures: Written comments concerning this rule-making action must be submitted by November 3, 1997, to Portia W. Rochelle, Rule-making Coordinator, Division of Medical Assistance, 1995 Umstead Drive, Raleigh, NC 27603. TITLE ISA - DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES CH.APTER 10 - WILDLIFE RESOLUCES •ANT) W ATER SAFETY SL^CHAPTER lOF - NIOTORBOATS AND WATER SAFETY A Jotice of Rule-making Proceedings is hereby given by the 1 y North Carolina Wildlife Resources Commission in accordance with G.S. 150B-21.2. The agency shall subsequently publish in the Register the text of the rule(s) it proposes to adopt as a result of this notice of rule-making proceedings and any comments received on this notice. Reason for Proposed Action: congested area. To regulate boat speed in Comment Procedures: The record will be open for receipt oj written comments from September 2, 1997 through November 2, 1997. Such written comments nrnst be delivered or mailed to the North Carolina Wildlife Resources Commission, 512 N. Salisbury Street, Raleigh, NC 27604-1188. TITLE 19A - DEPARTMENT OF TRANSPORTATION CHAPTER 2 - DIVISION OF HIGHWAYS SUBCHAPTER 2E - MISCELLANEOUS OPERATIONS \ Jotice of Rule-making Proceedings is hereby given by the 1 V North Carolina Department of Transportation - Division oj Highways in accordance with G.S. 150B-21.2. The agency shall subsequently publish in the Register the text of the rule(s) it proposes to adopt as a result of this notice of rule-making proceedings and any comments received on this notice. Citation to Existing Rules Affected by this Rule-Making 19A NCAC2E .0218 - .0222 - Other rules may be proposed in the course of the rule-making process. Authority for the rule-making: G.S. 136-13; 136-137; 136- 89.56: 143B-348; 143B-350(f); 23 C.F.R. 750 Subpart A; 23 U.S.C 131(f) Statement of the Subject Matter: Rules set out parameters and conditions for the Logo Signing Program. Reason for Proposed Action: Rules are proposed for atyiendmem to clarify existing language for legal interpretation 337 NORTH CAROLINA REGISTER September 2, 1997 12:5 change criteria for participation in program, and set standardized fees for program signs. Comment Procedures: Any interested person may submit written comments on the proposed rules by mailing the comments to Emily Lee, Department of Transportation, P.O. Box 25201, Raleigh, NC 27611, within 30 days after the proposed rules are published. RULE-MAKING PROCEEDINGS TITLE 21 - OCCUPATIONAL LICENSING BOARDS CHAPTER 36 - BOARD OF NURSING SECTION .0200 - LICENSURE "KTotice of Rule-making Proceedings is hereby given by the 1 yNorth Carolina Board of Nursing in accordance with G.S. I50B-2I.2. The agency shall subsequently publish in the Register the text of the rule(s) it proposes to adopt as a result of this notice of rule-making proceedings and any comments received on this notice. Citation to Existing Rules Affected by this Rule-Making: 21 NCAC 36 .0227 - Other rules may be proposed in the course of the rule-making process. Authority for the rule-making: G.S. 90-6; 90-18(14); 90- 18.2; 90-171.20(4); 90-171.20(7); 90-171. 23(b); 90-171.36; 90-171.37; 90-171.42 Statement of the Subject Matter: Describes the nurse practitioner qualifications for approval to practice and the practice requirements. The physician supen'ision Paragraph (h) to be changed will allow more flexibility. Reason for Proposed Action: The Board of Nursing and the N. C. Medical Board are recommending that a change be made in the current rule to allow more flexibility in how physician supervision of the nurse practitioner's performance of medical acts is implemented and validated. Comment Procedures: Comments regarding this action should be directed to Jean H. Stanley. APA Coordinator, North Carolina Board of Nursing, P.O. Box 2129, Raleigh, NC 27602-2129. Comments must be received in the Board of Nursing office by 4:30 p.m. on November 3, 1997. CHAPTER 54 - NORTH CAROLINA PSYCHOLOGY BOARD A Totice of Rule-making Proceedings is hereby given by the 1 y North Carolina Psychology Board in accordance with G.S. 150B-21.2. The agency shall subsequently publish in the Register the text of the rule(s) it proposes to adopt as a result of this notice of rule-making proceedings and any comments received on this notice. Citation to Existing Rules Affected by this Rule-Making: 21 NCAC 54 .1611 - .1613, .2006. .2010, .2104, .2301 - .2314, .2401 - .2402, .2501 - .2505, .2601 - .2602, .2704 - .2706 - Other rules may be proposed in the course of the rule-making process. Authority for the rule-making: G.S. 90-270. 4(d)(e); 90- 270.5(e); 90-270.9; 90-270. 13(c); 90-270. 14(a)(2); 90- 270.15(a)(3); 90-270. 15 (a) (22); 90-270. 20(b) (c)(d); 90-270.21; 150B-3; 150B-4; 150B-20; 150B-21.2; 150B-38; 150B-39; 150B-40 Statement of the Subject Matter: Ancillary Services; Administrative Hearing Procedures; Rule-making Proceedings; Rule-making Hearings; Declaratory Rulings; Continuing Education; Psychological Associate Activities Requiring Supervision; Health Services Provider Certification; Practice by Other Professionals; Practice and Supervision of Students, Interns, Fellows, and Trainees; Responding to Board Inquiries Reason for Proposed Action: To more clearly and accurately set the procedures for conducting administrative and rule-making hearings, andfor issuing declaratory rulings; to define ancillary services; to set continuing education requirements; to clarify activities for which Psychological Associates require supervision; to define academic requirements for health services provider certification; to clarify exemption from the Psychology Practice Actfor qualified members of other professional groups, and for students, interns, fellows, or other trainees; to clarify licensees ' responsibility to respond to Board inquiries. Comment Procedures: Comments shall be submitted in writing to Martha Storie. Executive Director, North Carolina Psychology Board, 895 State Farm Road, Suite 102, Boone, NC 28607. n:5 NORTH CAROLINA REGISTER September 2, 1997 338 PROPOSED RULES Diis Section contains the text ofproposed rules. At least 60 days prior to the publication of text, the agency published a Notice of Rule-making Proceedings. The agency must accept comments on the proposed rule for at least 30 days from the publication date, or until the public hearing, or a later date if specified in the notice by the agency. The required comment period is 60 days for a rule that has a substantial economic impact of at least five million dollars ($5,000,000). Statutory reference: G.S. 150B-21.2. TITLE 10 - DEPARTMENT OF HUMAN RESOURCES Notice is hereby given in accordance with G.S. 150B-21.2 that the North Carolina Medical Care Commission intends to amend 10 NCAC 3D .0801-. 0803. .0901. .0904. .0913, .0915-. 0916, .0925. .1001-. 1004. .1103, .1202-. 1206. .1301- .1302. .1401. .1403. and repeal rules cited as 10 NCAC 3D .0806. .0902. .0905. .0907-.0909. .0911, .0917-.0924, .0926. Notice of Rule-making Proceedings was published in the Register on March 3. 1997. Proposed Effective Date: August 1. 1998 A Public Hearing will be conducted at 9:30 a.m. on December 12, 1997 at the Weil-Spring Retirement Community Inc, Auditorium, 4100 Well Spring Drive, Greensboro, NC 27410. Reason for Proposed Action: Chapter 131E, Article 7 authorizes the Medical Care Commission to establish rules for ambulance services including vehicles and personnel. This is the first comprehensive review of these rules since 1989. These ainendmerus are necessary to update the rules to reflect current emergency medical practice. Comment Procedures: Persons who wish to make written or verbal comment regarding these proposed amendments should contact: Mr. Ed Seagroves. Disaster & Special Projects Coordinator. NC Office of Emergency Medical Services, PO Box 29530, Raleigh, North Carolina 27626-0530, Tele: (919) 733-2285, Fax: (919) 733-7021. Verbal and written comments will be received through the date of the public hearing. Persons are encouraged to submit written comments by September 2. 1997 to allow adequate time for review and consideration by the Commission. Fiscal Note: These Rules do affect the e.xpenditures or revenues of state and local government funds. These Rules do not have a substantial economic impact of at least five million dollars ($5,000,000) in a 12-month period. CHAPTER 3 - FACILITY SERVICES SUBCHAPTER 3D - RULES AND REGULATIONS GOVERNING AMBULANCE SERVICE .0801 SECTION .0800 - DEFINITIONS AMBULANCE AND BASIC LIFE SUPPORT (BLS) PROFESSIONAL (a) Definitions used in this Subchapter will be in accordance with those found in G.S. 131E-155. incorporated by rcfercBce according to G.S. 1 500- 14(c) and as follow. (b) An ambulance must have a permit issued by the Department of Human Resources, Division of Facility Services, Office of Emergency Medical Services in one of the following categories: (1) "Category I Ambulance" means an emergency ambulance used to transport patients with emergency traumatic or medical conditions or patients for which the need for emergency medical care is anticipated either at the scene of the emergency or enroute to a medical facility. Category I ambulances may be used to transport all tyf)es of patients. (2) "Category II Ambulance" means an ambulance used solely to transport sick or infirm patients, having a known, non-emergency medical condition, on scheduled basis between facilities or between residence and a facility. Category II ambulances must not be used to transport patients defined under any other category of ambulance. (3) "Category III Ambulance" means an emergency ambulance specifically designed and equipped to transfer critically ill patients from one medical facility to another or as ground support to a permitted air ambulance program. The patient care compartment of Category III ambulances must be staffed by appropriately certified or licensed personnel approved for the mission by the program medical director. Category III ambulances must be utilized as part of an organized critical care transport program and may not be used in place of any other category of ambulance defined in this Subchapter. (4) "Category IV Ambulance" means an ambulance specifically designed and equipped to transport patients by air. The patient care compartment of Category IV ambulances must be staffed by appropriately certified or licensed personnel approved for the mission by the program medical director. Category IV ambulances must be operated as either: (A) Part of an approved mobile intensive care program and must comply with the criteria as outlined in 21 NCAC 32H; or (B) Part of an air ambulance program which complies with 21 NCAC 32H .1004. (5) "Category V Ambulance" means a watercraft specifically designed and equipped to routinely transport patients. 339 NORTH CAROLINA REGISTER September 2, 1997 12:5 PROPOSED RULES (c) The term "field technician" "Basic Life Support (BLS) rnfessional" means a certified ambulance attendant or mergency medical technician. \uthority G.S. 131E-157(a); 131E- 159(b). 9802 CERTIFIED EMT INSTRUCTOR The term "qualified "certified Emergency Medical Technician EMT) instructor" means a person who instructs or coordinates mergency medical services (EMS) training educational rograms and continuing education programs who meets the riteria defined in Rule . 1202 of this Subchapter. [uthority G.S. 131E-159(b). 0803 APPROVED TEACHING INSTITUTION The term "approved teaching institution" means any agency nth a current memorandum of agreement contract with the )ffice of Emergency Medical Services to provide emergency nedical services training educational programs. Approved caching instimtions must meet the criteria found in Rule .1201 if this Subchapter. [uthority G.S. 131E- 159(b). 0806 MEDICAL CREW MEMBER The te rm "medical c rew member " means a physician. ntermediate, EMT-intermediatc. CMT-dcfibrillation technician ce rtification and who has completed additional training in Jtitudc—physiology. EMS—communications. in-flight mcrgencies, and airc raft and flight safety conducted under the lirect guidance of the medical director for the program in egistcred nurse. EMT-paramedic, EMT-advanced )r EMT who holds a current North Carolina license or yhich he functions. luthority G.S. 1 31E-l57(a). SECTION .0900 - VEfflCLES 0901 INTERIOR DIMENSIONS (a) Any vehicle issued a permit as a Category I Category L ategory IL or Category III ambulance must have the following ninimum patient compartment interior dimensions: (1) 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, must be at least im 102 inches. (2) The width of the compartment after cabinet and cot installation must provide at least 1 1 inches of clear aisle walkway between the primary cot and the squad bench, a second cot or curbside wall of the vehicle. (3) The height must be at least 52 48 inches over the patient area, measured from the approximate center of the floor, exclusive of cabinets or equipment. (b) Any vcliiclL issued a permit as a Category II ambulance to an ambulance provider must have the following minimum patient compartment inte rior dimensions : fij The length, measured on the floor from the back of the drive r 's compartment, drive r 's seat, or partition to the inside edge of the rear loading doors must be at least 102 inches. (2) — The width of the compartment afte r cabinet and cot installation must provide for at least 1 1 inches of clear aisle walkway between the cot and the squad bench, a second cot or the curbside wall of the vehicle. iSr) The height must be at least 48 inches over the patient area measured from the approximate center of the floor , exclusive of cabinets or equipment. (c) £b} Category IV ambulances must have: (1) A patient care area sufficiently isolated from the cockpit to minimize inflight distractions and interference while providing sufficient working space to render patient care; and (2) Door openings of sufficient size to permit the safe loading and unloading of a person occupying a litter. (d)£c} Category V ambulances must have a patient care area which: (1) Provides access to the head, torso, and lower extremities of the patient while providing sufficient working space to render patient care; (2) Is covered to protect the patient and the technician from the elements; and (3) Has an opening of sufficient size to permit the safe loading and unloading of a person occupying a litter. Authority G.S. 131E-157(a). .0902 INSPECTION CERTIFICATE Any vehicle issued a permit as a Category I. II. or III ambulance must have a current safety equipment inspection certificate issued by the North Carolina Division of Motor Vehicles. Authority G.S. 131E-157(a). .0904 VEHICLE BODY The ambulance vehicle body must be free from defects that could adversely affect the safe ope ration of the vehicle. The ambulance is not to have structural or functional defects which may adversely affect the patient, the technicians, and/or the safe operation of the vehicle. Authority G.S. 131E-157(a). .0905 OXYGEN CYLINDERS Oxygen cylinder s used in ambulance vehicles must bear static pressure date and must be replaced or refilled as soon as possible afte r use. Authority G.S. 131E-1 57(a). 2:5 NORTH CAROLINA REGISTER September 2, 1997 340 PROPOSED RULES .0907 DOORS All doors leading into passenger and patient compartment must open prope rly and close securely with all hardware working properly. Authority G.S. 131E-157(a). .0908 WINDOWS Windows and windshield must be clear and free of c racks. Authority G.S. 131E-157(a). .0909 REAR-VIEW MIRROR Rear-view mirror utilized in Category I, II, or III ambulances must be free of c racks and blemishes. Authority G.S. 131E-157(a). .0911 SPARE TIRE Ambulance vehicles issued permits as Category I, II. or III must carry a se rviceable spare tire and equipment to change a flat ti re or unserviceable tire. An acceptable alte rnative to this requirement is an immediately available se rvice vehicle or a plan for the immediate dispatch of anothe r ambulance. Authority G.S. 131E-157(a). .0913 PERMIT (a) The ambulance permit must include the following information: (1) vehicle identification number; permit number; ambulance provider identification number; identification of inspector; and expiration date. (b) No person shall display or cause to be displayed or permit to be displayed or to knowingly possess, transfer, remove, imitate, or reproduce an ambulance permit, except by direction of the Office of Emergency Medical Services. (c) An ambulance shall be permitted in only one category. (d) Any vehicle permitted as a Category I Ambulance must contain all equipment required in 10 NCAC 3D .1001(a), . 1002, . 1003(a), and .1103. .1103 of this Subchapter. (e) Any vehicle permitted as a Category I Ambulance which operates as a Mobile Intensive Care Unit as defined in 10 NCAC 3M .0102, .0103. 70*05; or .0107 must contain all equipment required in 10 NCAC 3M .0202, .0203, .0205, or .0207. (2) (3) (4) (5) NCAC 3M .0102. .0103. or .0107 must contain all equipment required in 10 NCAC 3M .0202. .0203. or .0207. (h) Each licensed ambulance provider planning to operate permitted ambulances at an ALS level must first meet the minimum permitting requirements for BLS operation for all ambulances to be ALS permitted. The licensed ambulance provider must provide for inspection the number of ALS equipment/supplies/medications packages in accordance with the approved protocols for that provider. The licensed ambulance provider can not unless under disaster circumstances operate more permined ambulances at an ALS level at any time than the approved number of ALS packages. Authority G.S. 1 3]E- 157(a). .0915 AMBULANCE LETTERING: MARKINGS: SYMBOLS AND EMBLEMS (a) Each ambulance must have the name of the ambulance provider permanently displayed on each side of the vehicle in lette r s at least th ree inches high, vehicle. (b) Category II ambulances must have the words "CONVALESCENT AMBULANCE" permanently lettered on both sides and on the rear of the vehicle body in at least five inch lette rs, body. (c) Category II ambulances may not use 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 or in any advertisement publication, or literature pertaining to Category II ambulance services. Authority G.S. 131E-1 57(a). .0916 GENERAL AMBULANCE REQUIREMENTS The interior of the ambulance and the equipment within the ambulance shall be free from dirt, contamination, or impurities and shall work properly. The exterior of the ambulance and tics the patient area of the ambulance, to include interior and equipment surfaces is to be maintained in a clean manner and to bg managed at all times in accordance with the locally approvec infection control policy. Provisions are to be available for the storage of both stocked medical supplies and bedding materials as well as for soiled supplies. The base station(s)'s storage facilities for items to be restocked on the ambulances are to be kept clean and organized so as to permit effective cleaning. Authority G.S. 131E-157(a). (0 Each CMS provider must ensure that, at a minimum, .0917 EQUIPMENT 60% of the vehicles permitted as Category I Ambulances and which may operate as a Mobile Intensive Care unit must contain all appropriate equipment and supplies specified in 10 NCAC 3M .0202 - .0207. Any vehicle permined as a Category V Ambulance must contain all equipment required in Rules . 1001(h) and . 1003(e) of this Subchapter. (g) Any vehicle permitted as a Category V Ambulance which operates as a Mobile Intensive Care Unit as defmed in 10 Equipment shall be of smooth construction for case oi cleaning. Authority G.S. 131E-157(a). .0918 LINEN (a) Freshly laundered linen or disposable linen shall be used I oisposapie on cots and pillows and linen shall be changed after each patient 341 NORTH CAROLINA REGISTER September 2, 1997 12:5 PROPOSED RULES , tiaiisported. (b) Clean linen storage shall be provided on each ambulance. uthority G.S. 131E-157(a). )919 MEDICAL SUPPLIES Closed conipartmcnts shall be provided within the ambulance K medical supplies. uthority G.S. 131E-157(a). )920 PILLOWS AND MATTRESSES Pillows and mattresses shall be kept clean and in good repair . uthority G.S. 131E-157(a). )921 SOILED SUPPLIES Closed containers shall be provided for soiled supplies. luthority G.S. 131E-157(a). 9922 SURFACES Exterior and interior surfaces of ambulance shall be cleaned ally. [uthority G.S. 131E-157(a). 9923 BLANKETS AND HAND TOWELS Blankets and hand towels used in any ambulance shall be lean. [uthority G.S. 131E-157(a). }924 IMPLEMENTS INSERTED IN NOSE OR MOUTH (a) Implements inserted into the patient's nose or mouth shall c single-se rvice, wrapped and properly stored and handled. (b) — When multi-use items are used, the local health care acilities or County Health Department shall be consulted for istructions in sanitation and handling of such items. [uthority G.S. 131E-157(a). 0925 INFECTIOUS DISEASE When an ambulance has been utilized to transport a patient nown to the licensed ambulance providers to have a ommunicable disease as defined in G.S. 130A- 133(1), it is the esponsibility of the licensed ambulance provider to ensure that le ambulance, including its equipment and supplies, is taken ut of service until appropriately cleansed and disinfected ccording to local infection control policy. [uthority G.S. 131E-157(a). 0926 STORAGE (a) All stUMgL spaces used for storage of linens, equipment. medical supplies and other supplies at base stations shall be kept clean. (b) The contents shall be arranged so as to pe rmit diorough cleaning. Authority G.S. 131E-157(a). SECTION .1000 - AMBULANCE EQUIPMENT . 1001 MEDICAL AND RELATED EQUIPMENT (a) Except as allowed by .0913(e) and tf) (hj of these Rules, category I ambulances for which permits are issued shall contain at least the following operational and functional equipment exclusive of personal equipment carried by emergency medical technicians and ambulance attendants: (1) One portable aspirator capable of a minimum vacuum of 300 millimeters of mercury and a minimum air flow rate of 16 liters per minute with rapid drawdown time. A minimum of three, single use, non-opaque, one piece, rigid suction instruments or appropriate replacement containers for manually operated devices and a suction rinsing water bottle must be supplied with this either unit; (2) One each portable squeeze bag ventilation unit (bag and mask) in adult and child adult, child, and infant sizes with transparent face mask capable of operation down to zero degrees fahrenheit and an attachment for oxygen hookup. A minimum of two one transparent, flexible, disposable oxygen supply tubes tube must be supplied with each unit; (3) Six nonmetallic, oropharyngeal airways sanitarily stored together in separate sizes ranging from 55 millimeters through 115 millimeters; (4) One bite stick cithe r commercially manufactured or made of three tongue blades taped together and padded ; <^(4) One portable oxygen imit consisting of the following components: 360 liter (D size) or larger oxygen cylinder; yoke regulator with cylinder contents gauge (2000 pounds per square inch) and gravity or non-gravity dependent flow gauge (0-12 liters per minute minimum); a minimum of three transparent, nasal cannulas in adult and child sizes; and a minimum of three each, adult and child, disposable, transparent, oxygen masks with delivery tubes and headband. A full spare cylinder (D size) or larger of oxygen for this unit shall be furnished and stored on the ambulance vehicle; oxygen tanks must show date of last static test; f6)(5} One Two small, one two medium, and one two large size adult extrication collar collars and one two pediatric size extrication collar ; collars; fB(6) One rigid short backboard. The minimum size must be 14 inches wide by 32 inches long. A stabilization device which is of the design to allow horizontal flexibility and vertical rigidity, equipped with chest 2:5 NORTH CAROLINA REGISTER September!, 1997 342 PROPOSED RULES i^m W(8} tWOD (20)08} t22)(2m e»>(21) f25)!22J (26)123} and leg straps and accessories for stabilization of the head and neck may be substituted for the rigid short backboard; ©ne Two rigid long backboard backboards a minimum of 16 inches wide by 72 inches long with two straps each for patient stabilization and other accessories for stabilization of the head and neck; Two sets of each rigid padded board splints in the following sizes; 3 inches wide by 15 inches long, 3 inches wide by 3 feet long, and 3 inches wide by 4- 1/2 feet long. Other splints, in kit form, of inflatable design or rigid laminated and high density polyurethane foam construction are acceptable. A kit must contain at least two full leg and two full arm splints; One child and one adult size lower extremity traction splint with appropriate attachments; Two sandbags constructed of a nonporous mate rial Minimum size must be 12 inches. A head for immobilization purposes. 2 inches by 4 inches by immobilizer may be substituted for sandbags ; Twelve 4 inch by 4 inch sterile gauze pads individually packaged; Six sterile 5 inch by 9 inch or larger absorbent dressings individually wrapped; Twelve rolls of roller gauze; Four rolls of adhesive tape; Four Two sterile nonadhering, nonporous dressings for an open chest wound. Minimum size shall be 3 inches by 8 inches; Six triangular bandages; Two pairs One pair of 5-1/2 inches bandage shears; Two sterile bum sheets, minimum size of 40 inches by 72 inches; A total of 2606 1000 cubic centimeters of sterile irrigating solution in plastic containers in addition to the fluids carried for intravenous use; One emesis basin; basin, or scalable emesis container; One obstetrical kit containing gloves, scissors or surgical blades, umbilical cord clamps or tapes, dressings, towels, perinatal pad, a bulb syringe, and a receiving blanket; Onc-poison antidote kit contammg syrup ot ipecac, activated charcoal and a means of administe ring the prope r dosage: One each small, regular and large size aneroid or electronic blood pressure cuff and adult and pediatric stethoscopes. One stethoscope with adult and pediatric attachments is acceptable; One sheet of rubbe r or heavy plastic, minimum size of 30 inches by 72 inches, or one body bag; One four wheeled, elevating cot with a minimum three inch thick mattress pad with a nonporous cover. The cot must be equipped with restraining straps (chest and thigh area) of at least two inches in width. (chest and thigh area). A crash stable fastener installed per the cot manufacturer's instructions and compatible with the model cot furnished must secure the specified cot to the floor or side wall; -(2?) One additional st retche r with patient restraining (26)124 (29)125} (36)126} (3+)t27} straps and capable of being secured inside the paticiii compartment; Two sets of clean cot linen constructed of washable or disposable material in addition to a set on the cot (a set equals two sheets and one pillowcase); Two pillows covered with a nonporous material; Two blankets constructed of washable material; and One child restraint device to safely transport pediatric patients in the patient compartment of the ambulance. (b) Category II ambulances for which permits are issuec shall contain at least the following operational and ftmctiona equipment exclusive of personal equipment carried by personnel: (1) One portable aspirator capable of a minimun vacuum of 300 millimeters of mercury and minimum air flow rate of 16 liters per minute wit! rapid drawdown time. A minimum of three, single use, non-opaque, one piece, rigid suction instrument" or appropriate replacement collection containers foi manually operated devices and a suction rinsinj water bottle must be supplied with this either unit; One each portable squeeze bag ventilation imit (ba] and mask) in adult and child adult, child, and infan (2) (3) (4) (5)14} sizes with transparent face mask capable of operatioi down to zero degrees fahrenheit and an attachmen for oxygen hookup. A minimum of two om transparent, flexible, disposable oxygen supply ttibej mbe must be supplied with each imit; Six nonmetallic, oropharyngeal airways sanitaril) stored together in separate sizes ranging from 5! millimeters through 1 15 millimeters; One bite stick eithe r commercially manufactured oi (6)15} (^16} (8)17} made of three tongue blades taped together an( padded: One portable oxygen unit consisting of the followin| components: 360 liter (D size) or larger oxygei cylinder; yoke regulator with cylinder contents gaug< (2000 poimds per square inch) and gravity non-gravity dependent flow gauge (0-12 liters pei minute); a minimum of three transparent, nasa canniJas in adult and child sizes; and a minimum o three each, adult and child, disposable, transparent oxygen masks with delivery tubes and headband, full spare cylinder (D size) or larger of oxygen fo: this imit shall be furnished and stored on thf ambulance vehicle; oxygen tanks must show date o last static test; Twelve four Six 4 inch by ferar 4 inch sterile gauzf pads individually packaged; Six Three sterile five 5 inch by nine 9 inch absorben dressings individually wrapped; Six rolls of roller gauze; 343 NORTH CAROLINA REGISTER September 2, 1997 12:1 PROPOSED RULES tTtJT mm WIO) 'nim ^(16) {¥^ Two rolls of adhesive tape; Three triangular bandages; Two pairs One pair of five and one-half inches bandage shears; One emesis basin; basin, or sealable emesis container; One each small, regular and large size aneroid or electronic blood pressure cuff and adult and pediatric stethoscopes. One stethoscope with adult and pediatric attachments is acceptable; One four wheeled, elevating cot widi a minimum three inch thick manress pad with a nonporous cover. The cot must be equipped with restraining straps (chest and thigh area) of at least two inches in width. (chest and thigh area). A crash stable fastener installed per the cot manufacturer's instructions and compatible with the model cot furnished must secure the specified cot to the floor or side wall; Two sets of clean cot linen constructed of washable or disposable material in addition to a set on the cot (a set equals two sheets and one pillowcase); Two pillows covered with a nonporous material; Two blankets constructed of washable material; and A firm board of minimum size 14 inches by 32 inches to support the back during manual heart compressions; and compressions. One—ehrW — rest raint device—to — safely—transport pediatric patients in the patient compartment of the ambulance. (c) Category III ambulances for which permits are issued lust have the following operational and functional medical quipment immediately available to be plac ed loaded within ive minutes on the vehicle: (1) One portable aspirator capable of a minimum vacuum of 300 millimeters of mercury and a minimum air flow rate of 16 liters per minute with rapid drawdown time. A minimum of three, single use, non-opaque, one piece, rigid suction instruments or appropriate collection containers for manuallv operated devices and a suction rinsing water bottle must be supplied with this either unit; (2) One each portable squeeze bag ventilation unit (bag and mask) in adult and child adult, child, and infant sizes with transparent face mask capable of operation down to zero degrees fahrenheit and an attachment for oxygen hookup. A minimum of two one transparent, flexible, disposable oxygen supply tttbes mbe must be supplied with each unit; (3) Six nonmetallic, oropharyngeal airways sanitarily stored together in separate sizes ranging from 55 millimeters through 115 millimeters; W One bite stick cithe r commercially manufactured or made of three tongue blades taped together and padded; (5){4} One portable oxygen unit consisting of the following components: 360 liter (D size) or larger oxygen (6)15} mm f9)£81 / 1 r\\ fi^(lO) t«)Lm t+6) t+^a6i e-BH?) (22)081 cylinder; yoke regulator with cylinder contents gauge (2000 pounds per square inch) and gravity or non-gravity dependent flow gauge (0-12 liters per minute); a minimum of three transparent, nasal cannulas in adult and child sizes; and a minimum of three each, adult and child, disposable, transparent, oxygen masks with delivery tubes and headband. A full spare cylinder (D size) or larger of oxygen for this unit shall be furnished and stored on the ambulance vehicle; oxygen tanks must show date of last static test; Twelve fbor 4 inch by foor 4 inch sterile gauze pads individually packaged; Six sterile frre 5 inch by nine 9 inch absorbent dressings individually wrapped; Six rolls of roller gauze; Two rolls of adhesive tape; Three t riangular bandages; Two pairs One pair of five and one-half inches bandage shears; One emesis basin ; basin, or sealable emesis container: Two ste rile bum sheets, minimum size of 40 inches by 72 inches; A total of 2986 1000 cubic centimeters of sterile irrigating solution in plastic containers in addition to the fluids carried for intravenous use; One obstetrical kit containing gloves, scissors or surgical blades, umbilical cord clamps or tapes, dressings, towels, perinatal pad, a bulb syringe, and a receiving blanket; Gne-poison antidote kit containing syrup oi ipecac, activated charcoal and a means of administering the proper dosage; One each small, regular and large size aneroid or electronic blood pressure cuff and adult and pediatric stethoscopes. One stethoscope with adult and pediatric attachments is acceptable; One four wheeled, elevating cot with a minimum three inch thick mattress pad with a nonporous cover. The cot must be equipped with restraining straps (chest and thigh area) of at least two inches in width. (chest and thigh area). A crash stable fastener installed per the cot manufacmrer's instructions and compatible with the model cot furnished must secure the specified cot to the floor or side wall. A self contained transport incubator with stand and capable of being secured in the ambulance may be substituted; Two sets of clean cot linen constructed of washable or disposable material in addition to a set on the cot (a set equals two sheets and one pillowcase); Two pillows covered with a nonporous material : Two blankets constructed of washable material; and A firm board of minimum size 14 inches by 32 inches to support the back during manual heart 2:5 NORTH CAROLINA REGISTER September!, 1997 344 PROPOSED RULES compressions ; and compressions. f23) ©nt — child— r est raint—device—to — safely—transport pediat r ic patients in the patient compartment of the ambulance. (d) Category IV ambulances for which permits are issued must have the following medical equipment immediately available to be plaeeti loaded within five minutes on the aircraft: (1) One vehicular mounted and one portable aspirator with rapid drawdown time capable of providing a minimum vacuum of 300 millimeters of mercury and a minimum air flow rate of 16 liters per minute up to the maximum operating altitude of the aircraft. A minimum of three, single use, non-opaque, one piece, rigid suction instruments or appropriate collection containers for manually operated devices and a suction rinsing water bottle must be supplied with this either unit; (2) One each ponable squeeze bag ventilation unit (bag and mask) in adult and child adult, child, and infant sizes with transparent face mask capable of operation down to zero degrees fahrenheit and an attachment for oxygen hookup. A minimum of two one transparent, disposable oxygen supply tubes tube must be supplied with each unit; (3) Six nonmetallic, oropharyngeal airways sanitarily stored together in separate sizes ranging from 55 millimeters through 1 15 millimeters; f4) One bite stick cithe r commercially manufactured or made of three tongue blades taped togethe r and padded; t5)£4] Oxygen unit containing a quantity of oxygen sufficient to supply an appropriate flow rate for the period of time it is anticipated oxygen will be needed, but not less than ten liters per minute for 30 minutes. The oxygen shall be carried in two separate containers, one of which must be portable. The portable oxygen unit shall have a yoke regulator with cylinder contents gauge, flow gauge, and DISS outlets; ffi>(5) Twelve ftmr 4 inch by fotir 4 inch sterile gauze pads individually packaged; fJH(6) Six sterile five 5 inch by nine 9 inch absorbent dressings individually wrapped; ffr>(7) Twelve rolls of roller gauze; ^(8) Four rolls of adhesive tape; H#i(9) Tour Two sterile nonadhering, nonporous dressings for an of)en chest wound. Minimum size shall be 3 inches by 8 inches; H-HUO] Six triangular bandages; H^(l 1) Two ste r ile bum sheets, minimum size of 40 inches by 72 inches; (4^021 A total of 2eee lOOO cubic centimeters of sterile irrigating solution in plastic containers in addition to the fluids carried for intravenous use; <+^(13) One emesis basin; basin, or scalable emesis container; ©ne Two IV pressure bagr bags; An electronic means of measuring blood pressur( while in flight; One stethoscope and manual blood pressure cuff; One ECG monito r /defib r illatoi mam (23)1211 monitor/defibrillator/pacer; One complete kit for endotracheal intubation; One litter and attachment for securing the liner to th( airframe inside the cabin of the aircraft. The litte: must allow for elevation of the patient's head; One blanket constructed of washable material; and Four air sick bags; and Four Three IV hooks. (e) The medical director shall decide the combination o medical equipment specified in Paragraph (d) of this Rule tha is carried on a mission based on what is in the best interest o patient care. (f) All rotary wing aircraft permitted as a Category IN ambulance must have the following flight equipment operationa in the aircraft: (1) Two 360 channel VHF aircraft frequenc; transceivers; (2) One VHF omnidirectional ranging (VOR) receiver; (3) Attitude indicators; (4) One nondirectional beacon (NDB) receiver; (5) One glide scope receiver; (6) One transponder with 4097 code. Mode C; (7) Turn and slip indicator in the absence of thre( attitude indicators; (8) Current FAA approved navigational aids and chart for the area of operations; (9) Radar altimeter; and (10) Loran navigational system. LORAN-C or Satellitt Global Navigational system. (g) Any fixed wing aircraft issued a permit as a Category I\ ambulance must have a current "Instrument Flight Rules certification. (h) Category V ambulances for which permits are issuet shall contain at least the following operational and functiona equipment exclusive of personal equipment carried bj personnel: (1) One portable aspirator capable of a minimim vacuum of 300 millimeters of mercury and minimum air flow rate of 16 liters per minute witl rapid drawdown time. A minimum of three, singlf use, non-opaque, one piece, rigid suction instrument! or appropriate collection containers for manualh (2) (3) operated devices and a suction rinsing water bottk must be supplied with this either unit; One each portable squeeze bag ventilation unit (baj and mask) in adult and child adult, child, and infan sizes with transparent face mask capable of operatioi down to zero degrees fahrenheit and an attachmen for oxygen hookup. A minimum of two oni transparent, flexible, disposable oxygen supply ttibci tube must be supplied with each unit; Six nonmetallic, oropharyngeal airways sanitaril) 345 NORTH CAROLINA REGISTER September 2, 1997 12:t PROPOSED RULES stored together in separate sizes ranging from 55 millimeters through 115 millimeters; f4) One bite stick cithe r commercially manufactured or made of three tongue blades taped together and padded; f5){4} One portable oxygen unit consisting of the following components: 360 liter (D size) or larger oxygen cylinder; yoke regulator with cylinder contents gauge (2000 pounds per square inch) and gravity or non-gravity dependent flow gauge (0-12 liters per minute); a minimum of three transparent, nasal cannulas in adult and child sizes; and a minimum of three each, adult and child, disposable, transparent, oxygen masks with delivery tubes and headband. A full spare cylinder (D size) or larger of oxygen for this unit shall be furnished and stored on the ambulance vehicle; oxygen tanks must show date of last static test; t6)£5] ©nc Two small, one two medium, and one two large size adult extrication collar collars and one two pediatric size extrication collar ; collars: ffl(6) One rigid short backboard. The minimum size must be 14 inches wide by 32 inches long. A stabilization device which is of the design to allow horizontal flexibility and vertical rigidity, equipped with chest and leg straps and accessories for stabilization of the head and neck may be substituted for the rigid short backboard; f6)(7) One Two floatable rigid long backboard backboards a minimum of 16 inches wide by 72 inches long with two straps each for patient stabilization and other accessories for stabilization of the head and neck; f9)£8} Two sets of each rigid padded board splints in the following sizes; three inches wide by 15 inches long, three inches wide by three feet long, and three inches wide by four and one-half feet long. Other splints, in kit form, of inflatable design or rigid laminated and high density polyurethane foam construction are acceptable. A kit must contain at least two full leg and two full arm splints; One child and one adult size lower extremity traction splint with appropriate attachments; Two sandbags constructed of a nonporous material for immobilization purposes. Minimum size must be two inches by four inches by 12 inches.—A head immobilizer may be substituted for sandbags ; Twelve fbor 4 inch by fbor 4 inch sterile gauze pads individually packaged; Six sterile five 5 inch by nine 9 inch or larger absorbent dressings individually wrapped; Twelve rolls of roller gauze; Four rolls of adhesive tape; Four Two sterile nonadhering, nonporous dressings for an open chest wound. Minimum size shall be three inches by eight inches; Six triangular bandages; fW)(16) Two pairs One pair of Five and one-half inches bandage shears; (+9)£17} Two sterile burn sheets, minimum size of 40 inches by 72 inches; (20)08} A total of 2060 1000 cubic centimeters of sterile irrigating solution in plastic containers in addition to the fluids carried for intravenous use; (2t->(19) One emesis basm; basin, or scalable emesis container: (22)(20) One obstetrical kit containing gloves, scissors or surgical blades, umbilical cord clamps or tapes, dressings, towels, perinatal pad, a bulb syringe, and a receiving blanket; f23) One poison antidote kit containing syrup of ipecac, activated charcoal and a means of administering the prope r dosage; t24)t21i One each small, regular and large size aneroid or electronic blood pressure cuff and adult and pediatric stethoscopes. One stethoscope with adult and pediatric attachments is acceptable; f25)£2Z) One sheet of rubber or heavy plastic, minimum size of 36 inches by 72 inches, or one body bag; f26)(23) One additional floatable litter with patient restraining straps and capable of being secured to the watercraft; and f2y>(24) Two blankets constructed of washable material. Authority G.S. 131E-157(a). .1002 EXTRICATION AND ACCESS EQUIPMENT Category I ambulances for which permits are issued must contain at least the following equipment: (+^ One ten-inch adjustable open end wrench; (2) One sc rewdrive r with flat blade; (3) One sc rewdrive r with Phillips blade ; t4) One hacksaw with a minimum of six blades ; (5) One four-pound hammer with 15-ineh handle; i€) One pai r of plie rs, ten-inch vise-grip; (?) One 24-inch wrecking bar ; (S) One 48-inch c rowbar with pinch point; (^(1) Two pair heavy duty work gloves; H%^{2) Two pair OSIIA approved safety glasses; and (ii->(3) Two OSIIA approved safety helmets. Authority G.S. 131E-157(a). .1003 OTHER EQUIPMENT (a) Ambulances for which permits are issued as Category I, II, or III must have at least the following: (1) One Two operational flashlight: flashlights: (2) A two and one -half five pound fire extinguisher which must be a dry chemical or halogen, all-purpose type with a pressure gauge and approved by Underwriters Laboratories and U.S. Department of Transportation and must be mounted in a quick-release bracket; NORTH CAROLINA REGISTER September 2, 1997 346 PROPOSED RULES (3) "No Smoking" signs placed in cab or cabin and patient compartments; and (4) Electric lights to illuminate the patient compartment which are designed and located so that no glare is reflected into the driver's eyes or line of vision. (b) Institutions or organizations which ope rate Category I\^ ambulances with the State of North Carolina must comply wit Navigational system, navigational radar, or othe comparable radio equipment suited for wate navigation; and (5) Marine radio. if) Institutions or organizations which operate Catcgoiy - all provisions of Chapter 75A Article 1 (Boating Safety Act) the — North Carolina General Statutes including all rule Commission under the author ity of these statutes. Authority G.S. 131E-157(a). .1004 WEAPONS AND EXPLOSIVES FORBroDEN (a) Weapons as defmed by the local county district attorney' office and explosives shall not be worn or carried aboard a ambulance vehicle within the State of North Carolina whei such ambulance vehicle is operating in any patient transpoi capacity or is available for such transport fimction. (b) This Rule shall apply whether or not such weapons an( explosives are concealed or visible. (c) This Rule shall not apply to duly appointed lav enforcement office r s who are serving in an authorized lav enforcement capacity while a passenger , occupant or attendan on an ambulance vehicle, officers. (d) Safety flares are authorized for use on ambulanc' vehicles with the following restrictions: (1) These devices are not stored inside the compartment of the ambulance vehicle: (2) These devices must be packaged and stored so as t( patien ambulances within the State of North Carolina shall be defmed as Ai r Taxi Ope rators unde r Part 135 of Title XIV or Part 91 of the fede ral Aviation Administration's Rules gove rning ai r established—by—the — North—Carolina—Wildlife—Resource operations and as such must hold a current ce rtificate unde r these rules. In addition to the equipment required under this certification: (1) All Category IV ambulances must be equipped with an internal voice communication system to allow for commimication between the medical crew and the flight crew; and (2) All rotary wing Category IV ambulances must be equipped with: (A) An external public address system; (B) A remote control external search light; and (C) A light which illuminates the tail rotor. (c) Institutions or organizations which operate Category IV ambulances must submit to the Division of Facility Services, Office of Emergency Medical Se rvices : Services documentation that operation is coordinated with the local EMS svstem. ^ Copy of current fede ral Aviation Administration Part 135 or 9 1 Certificate. A copy of this document is available for review at the Division of facility Services. Office of Emergency Medical Services, located at 701—Barbour Drive.—Raleigh,—North Carolina or copies may be obtained by contacting the Supe rintendent of Documents. U.S. Government Printing Office, Washington, D.C. 20402; and (2) Documentation that operation is coordinated with the local EMS system. (d) In addition to that required in Paragraph fb) of this Rule, Category IV ambulances approved under Rule .0801(b)(4)(B) of these rules must be equipped with: A two-way voice radio licensed by the Federal Commimications Commission capable of operation on any frequency required in the Public Safety Radio Service or Special Emergency Radio Service to allow communications on an as needed basis with public safety agencies such as fire departments, police departments, ambulance and rescue units, hospitals and local government agencies. (e) In addition to that required in Paragraph (a) of this Rule, Category V ambulances must be equipped with : with the following operational and functional equipment. (1) Two floatable ope rational flashlights; (2) Two five pound fire extinguishers which must be a dry chemical, all-purpose type with a pressure gauge and approved by Underwriters Laboratories and U.S. Department of Transportation and must be mounted in a quick-release bracket; (3) Lighted compass; (4) Radio navigational aids as ADF (automatic directional finder) or LORAN-C, Satellite Global prevent accidental discharge or ignition. Authority G.S. 131E-157(a). SECTION .1100 - COMMUNICATIONS .1103 EQUIPMENT Each ambulance shall be equipped with a two-way radi( capable of establishing radio communications from within th( ambulance service area of the coimty in which the ambulanc( is based to the county designated dispatch coordination cente; in that county and to the emergency department of th( hospital(s) to which patients are routinely transported. Th( radio shall be licensed by the Federal Communicationi Commission (FCC). (1) For an ambulance permitted as a Category ambulance as defined in Rule .0801(b)(1) or i Category 111 ambulance as defined in Rul .0801(b)(3) of this Subchapter, a radio telephone typt device such as a cellular telephone cannot be the soh ai source of two way voice communication. A communication instrument such as a cellulai telephone capable of rapidly establishing two waj voice communication mounted within the driver'! compartment or patient treatment compartment usee to summon emergencv assistance is acceptable as thj sole communications device for an ambulance that i; 347 NORTH CAROLINA REGISTER September!, 1997 12:t PROPOSED RULES permitted as a Category U ambulance, as defined in Rule .08QHb)(2) of this Subchapter. ulhority G.S. 131E-157(a); 143-509(4). SECTION .1200 - TRAINING AND PERFORMANCE OF PERSONNEL 1202 CRITERIA FOR CERTIHED EMT INSTRUCTOR A qualified certified EMT Instructor as defmed in Rule .0802 f this Subchapter shall meet the following criteria: (1) (2) £3} Recognition from the Office of Emergency Medical Services that he meets the following Standards of the Certified EMT Instructor/ Coordinator Recognition Program: (a) Current North Carolina certification as an EMT, EMT-defibrillation technician, EMT-intermediate, CMT-advanccd intermediate, or EMT-paramedic; (b) Two Three years experience within the last five years of direct clinical patient contact in critical or emergency care; (c) Current ce rtification as an American Heart Association—or — American—Red — -or- Cross cardiopulmonary resuscitation (CPR) (d) (e) (f) (g) £4} lo be instructor; Documentation of JOO hours of formal, classroom teaching experience: Successful completion of the U.S. Department of Transportation's, EMT Instructor Course or equivalent; High school diploma or General Education Development certificate; A lead or assistant instructor for six basic rescuer CPR courses within the last three ycarx—and Current affiliation with an approved teaching institution: and Expe rience as an instructor for at least three basic EMT courses or complete practice teaching in one basic EMT course under the supervision of an experienced EMT instructor . Be recommended for certification by the approved teaching institution with which the person is affiliated. Annually attends an EMT Evaluator and Instructor/Coordinator Workshop offered by the Office of Emergency Medical Services. Certification shall be valid for a period not to exceed four years. To recertified as an EMT Instructor, a person shall meet the following criteria: (a) Current North Carolina certification as an EMT. EMT-defibrillation technician. EMT-intermediate. or EMT-paramedic: Current direct clinical patient care experience in critical or emergency care: M (c) Current affiliation with an approved teaching institution: and (d) Be recommended for recertification by the approved teaching institution with which the person is affiliated. The recommendation must address the instructional performance of the candidate as well as the number of courses taught during the previous certification period. Authority G.S. 131E-159(b). .1203 EDUCATIONAL PROGRAMS A training An educational program intended to qualify personnel as Ambulance Attendants or Emergency Medical Technicians must be approved by the Office of Emergency Medical Services following guidelines established by the Commission and offered by an approved teaching institution. Authority G.S. 131E-1 59(b). .1204 AEROMEDICAL FLIGHT CREW MEMBERS (a) All flight crew members who operate as the pilot in command and who fly rotary wing aircraft as air ambulances must meet, at a minimum, the following criteria: (1) 2,000 hours helicopter flight time; Commercial rotocraft certificate; Instrument helicopter rating; Ten hours additional flight training when making a transition from single to twin engine aircraft; Five hours additional flight training when making a transition from one model aircraft to another; Ten Four hours flight time orientation of which two should be day time and two should be night time for new pilots if unfamiliar with the program service area including night flights; and area; and Ftve Two hours flight time orientation for new pilots if familiar with the program service area including night flights. (b) All flight crew members and medical crew members, including specialty teams must meet, at a minimum, the following criteria: (1) Fly an average of at least five missions per month per six month period or complete refresher training in aircraft safety every six months; and (2) Complete refresher training in aircraft safety on an annual basis. (c) Relief pilots utilized by the program may assume operational duties at the discretion of the Lead Pilot/Aviation Site Manager. Authority G.S. 131E-1 59(b). .1205 AMBULANCE ATTENDANT PERFORMANCE Ambulance attendants trained educated in approved t raining programs and certified by the Office of Emergency Medical Services may assist the emergency medical technician in (2) (3) (4) (5) (6) (7) 2:5 NORTH CAROLINA REGISTER September 2, 1997 348 PROPOSED RULES performing any of the following procedures if allowed by the County Emergency Medical Services System in which they function: (1) Patient assessment; (2) Basic life support techniques in accordance with the American Heart Association or American Red Cross including airway management and cardiopulmonary resuscitation; (3) Hemorrhage control; (4) Oxygen administration; (5) Treatment for shock; (6) Bandaging and dressing soft tissue injuries; (7) Splinting fractures and dislocations; (8) Treatment of injuries to the skull, spine, and chest; (9) Assisting in normal and abnormal childbirth; (10) Lifting and moving patients for transfer to a medical facility; (11) Treatment of injuries as a result of exposure to heat and cold; (12) Treatment of bums; and (13) Providing of basic life support for medical emergencies, emergencies; and (14) Use of an automated external defibrillator. Authority G.S. 131E-159(b). .1206 EMERGENCY MEDICAL TECHNICIAN PERFORMANCE Emergency Medical Technicians trained educated in approved t raining programs and certified by the Office of Emergency Medical Services may perform any of the following procedures if allowed by the County Emergency Medical Services System in which they function: (1) Patient assessment; (2) Basic life support techniques in accordance with the American Heart Association or American Red Cross including airway management and cardiopulmonary resuscitation; (3) Oxygen administration; (4) Hemorrhage control; (5) Treatment for shock; (6) Bandaging and dressing soft tissue injuries; (7) Application of military anti-shock trousers; (8) Splinting fractures and dislocations; (9) Treatment of injuries to the head, face, eye, neck, and spine; (10) Treatment of injuries to the chest, abdomen and genitalia; (11) Provision of basic life support for medical injuries; (12) Assisting in normal and abnormal childbirths; (13) Treatment of injuries as a result of exposure to heat and cold; (14) Treatment of bums; (15) Lifting and moving patients for transfer to a medical facility; and (16) Extrication of patients from confined areas, areas; and (17) Use of an automated extemal defibrillator. Authority G.S. 131E-159(b). SECTION .1300 - CERTIFICATION REQUIREMENTS FOR BASIC LIFE SUPPORT PERSONNEL .1301 CERTIFICATION REQUIREMENTS: AMBULANCE ATTENDANT (a) To become certified as an Ambulance Attendant, J person shall successfully complete either of the followin] options : options within one year of the approved educational program course completion date: (1) OPTION I (A) (B) Be at least 18 years of age; Successfully complete, within one year prioi to — application, complete an Ambulance Attendant training approved program meetin: the requirements of the "North Carolina Ambulance Attendant Curriculum Outline" Outline." dated February \994—and incorporated he rein by refe rence including subsequent amendments and editions.—This document may be obtained free of charge from—the — Office—of Emergency—Medical Services, P.O. Box 29530, Raleigh, NC 27626-0530. When training the approved (2) educational program was completed over one year prior to application, a person shall submit evidence of completion of continuing education in emergency medicine taken in the past year to the Office of Emergency Medical Services; (C) Pass a basic life suppon practical examination administered by the Office of Emergency Medical Services; and (D) Pass either an Ambulance Attendant written examination or an oral examination, at the option of the applicant, administered by the Office of Emergency Medical Services; or OPTION II (A) (B) Be at least 18 years of age; Successfully complete, within one year prior to — application, complete an approved Emergency Medical Technician training program meeting the requirements of the "North Carolina Emergency Medical Technician Curriculum Outline" Outline dated February 1 994 and incorporated herein by refe rence including subsequent amendments and editions. This document may be obtained free of charge from the Office of Emergency Medical Services, P.O. Dux 29530, Raleigh; NC 27620-0530. When training the approved educational program was completed over one year prior to application, a person shall submit evidence of completion of continuing 349 NORTH CAROLINA REGISTER September 2, 1997 12:5 PROPOSED RULES education in emergency medicine taken in the past year to the Office of Emergency Medical Services; (C) Pass a basic life support practical examination administered by the Office of Emergency Medical Services; and (D) Complete an Emergency Medical Technician written examination administered by the Office of Emergency Medical Services and achieve a minimum score of 55%. 70% on the Ambulance Attendant Subset contained within the Emergencv Medical Technician written examination. (b) Persons holding current certification equivalent to an Ambulance Attendant with the National Registry of Emergency /ledical Technicians or in another state where the training ducation and certification requirements have been approved for egal recognition by the Office of Emergency Medical Services nay become certified by: (1) Presenting evidence of such certification for verification by the Office of Emergency Medical Services; and (2) Be at least 18 years of age. (c) Certification obtained through legal recognition shall be 'alid for a period not to exceed the length of the current lertification or a period not to exceed four years whichever is hotter. No certification shall be valid for a period exceeding our years. Persons who live in a state that borders North Carolina and are currently affiliated with an ambulance )rovider in North Carolina may continue to obtain a North Carolina certification through legal recognition if they continue meet the recertification requirements in the state in which hey reside. Persons who live in North Carolina and are :urrently certified in another state that borders North Carolina nay continue to obtain a North Carolina certification through egal recognition if they continue to meet the recertification equirements in the state in which they are certified. Persons vho were previously certified in North Carolina and are urrently certified in another state or with the National Registry )f Emergency Medical Technicians, shall present evidence of :ontinuing education and skill evaluation prior to becoming :ertified through legal recognition. (d) To become recertified as an Ambulance Attendant a )erson must successfully complete either of the following )ptions: (1) OPTION I (A) A continuing education program consisting of a minimum of 48 hours during each two year period of the person's four year certification period taught or coordinated by a Qualified conducted under the direction of a Certified EMT Instructor. The continuing education program shall meet the requirements set forth in the "Guidelines for Initial Education, Refresher Education, Continuing Education and Performance Evaluation of Emergency Medical Services Basic Life Support Personnel" dated February 1 994 Personnel": or and — incorporated—he rein—by— r eference including—subsequent—amendments—and editions. This document may be obtained free of charge from the Office of Emergency Medical Se rvices, P.O. Box 29530, Raleigh, NC 27626-0530; (B) A continuing education program consisting of a minimum of 48 hours during each two year period of the person's four year certification period conducted under the direction of a Medical Director as defined in 21 NCAC 32H .0102(8). The continuing education program shall meet the requirements set forth in the "Guidelines for Continuing Education and Performance Evaluation of Emergency Medical Services Advanced Life Support Personnel" i and tB)£Q A basic life support skill evaluation(s) approved by the Office of Emergency Medical Services conducted under the direction of a Qualified Certified EMT Instructor or Medical Director as defmed in 21 NCAC 32H .0102(8) assessing the ability to perform the skills of an Ambulance Attendant; or (2) OPTION II (A) A continuing education program consisting of a minimum of 96 hours during the person's four year certification period. The continuing education program shall meet the requirements set forth in the "Guidelines for Initial Education, Refresher Education, Continuing Education and Performance Evaluation of Emergency Medical Services Basic Life Support Pe rsonnel"—dated February—^994 Personnel " ; and and incorporated he rein by reference including subsequent amendments and editions. This document may be obtained free of charge from the Office of Emergency Medical Services, P.O. Box 29530, Raleigh, NC 27626-0530 ; (B) A basic life support practical examination administered by the Office of Emergency Medical Services; or (3) OPTION III (A) An approved Ambulance Attendant refresher course consisting of a minimum of 48 hours during the person's last year of certification. This refresher course shall meet the "Guidelines for Initial Education, Refresher Education, Continuing Education and Performance Evaluation of Emergency Medical Services Basic Life Support Pe rsonnel" dated February 1 994 Personnel": and incorporated herein by refe rence including (2:5 NORTH CAROLINA REGISTER September 2, 1997 350 PROPOSED RULES subsequent amendments and editions.—This doeument may be obtained free of charge from—the — Office—of Emergency—Medical Sci' viccs, P.O. Box 29530. Raleigh, NC 27626-0530 : (B) A basic life suppon practical examination administered by the Office of Emergency Medical Services; and (C) Afte r Septembe r 30, 1 996, an Ambulance Attendant A written examination or an oral examination, at the option of the applicant, administered by the Office of Emergency Medical Services. Authority G.S. 131E-I59(aj: 1984 S.L., c. 1034. .1302 CERTIFICATION REQUIREMENTS: EMERGENCY MEDICAL TECHNICIAN (a) To become certified as an Emergency Medical Technician, a person shall meet the following c r ite r ia ; criteria within one year of the approved educational program course completion date: (1) Be at least 18 years of age; (2) Successfully complete, within one year prior to application, complete an approved Emergency Medical Technician training program meeting the requirements of the "North Carolina Emergency Medical Technician Curriculum Outline"—dated Tcbruary 1994 Outline." and incorporated he rein by refe rence including subsequent amendments and editions.—This document may be obtained free of charge from the Office of Emergency Medical Se rvices, P.O. Box 29530. Raleigh, NC 27626-0530. When training the approved educational program was completed over one year prior to application, a person shall submit evidence of completion of continuing education in emergency medicine taken in the past year to the Office of Emergency Medical Services; (3) Pass a basic life support practical examination administered by the Office of Emergency Medical Services; and (4) Pass an Emergency Medical Technician written examination administered by the Office of Emergency Medical Services. (b) Persons holding current certification equivalent to an Emergency Medical Technician with the National Registry of Emergency Medical Technicians or in another state where the t raining educational and certification requirements have been approved for legal recognition by the Office of Emergency Medical Services may become certified by; (1) Presenting evidence of such certification for verification by the Office of Emergency Medical Services; and (2) Be at least 18 years of age. (c) Certification obtained through legal recognition shall be valid for a period not to exceed the length of the current certification or a period not to exceed four years whichever i; shorter. No certification shall be valid for a period exceeding four years. Persons who live in a state that borders Nortl Carolina and are currently affiliated with an ambulancf provider in North Carolina may continue to obtain a Nortl Carolina certification through legal recognition if they continu( to meet the recertification requirements in the state in whicl they reside. Persons who live in North Carolina and ar( currently certified in another state that borders North Carolini may continue to obtain a North Carolina certification througl legal recognition if they continue to meet the recertificatioi requirements in the state in which they are certified. Person who were previously certified in North Carolina and ar( currently certified in another state or with the National Registr; of Emergency Medical Technicians, shall present evidence o continuing education and skill evaluation prior to becominj certified through legal recognition. (d) To become recertified as an Emergency Medica Technician a person shall successfully complete either of thi following options: (1) OPTION I (A) A continuing education program consisting o a minimum of 48 hours during each two yea period of the person's four year certificatioi period taught or coordinated by a Qualifiei conducted under the direction of a Certifiei EMT Instructor. The continuing educatio: program shall meet the requirements set fort in the "Guidelines for Initial Education Refresher Education, Continuing Educatio and Performance Evaluation of Emergenc Medical Services Basic Life Suppoi Pe rsonnel" dated February 1 994 Personnel" or and — incorporated herein by— r cferenci including—subsequent—amendments—an editions. This document may be obtained fre of charge from the Office of Emergenc; m Medical Services. P.O. Box 29530. Raleigh NC 27626-0530. A continuing education program consisting o a minimum of 48 hours during each two yea period of the person's four year certificatio period conducted under the direction of Medical Director as defined in 2\ NCAC 321 .0102(8). The continuing education prograr tfi)iCl shall meet the requirements set forth in th "Guidelines for Continuing Education an Performance Evaluation of Emergenc Medical Services Advanced Life Suppoi Personnel"; and A basic life support skill evaluation(s| approved by the Office of Emergency Medic; Services conducted under the direction of Qualified Certified EMT Instructor or Medic Director as defmed in 21 NCAC 32H .0102(J assessing the ability to perform the skills of a Emergency Medical Technician; or ( 351 NORTH CAROLINA REGISTER September!, 1997 12: PROPOSED RULES (2) OPTION II (A) A continuing education program consisting of a minimum of 96 hours during the person's four year certification period. The continuing education program shall meet the requirements set forth in the "Guidelines for Initial Education, Refresher Education, Continuing Education and Performance Evaluation of Emergency Medical Services Basic Life Support Personnel " —dated Tcbruary—W94 Personnel"; and and incorporated herein by reference including subsequent amendments and editiom. This document may be obtained free of charge from the Office of Emergency Medical Services, P.O. Box 29530. Raleigh, NC 27626-0530; (B) A basic life support practical examination administered by the Office of Emergency Medical Services; or (3) OPTION III (A) An approved Emergency Medical Technician refresher course consisting of a minimum of 48 hours during the person's last year of certification. This refresher course shall meet the "Guidelines for Initial Education, Refresher Education, Continuing Education and Performance Evaluation of Emergency Medical Services Basic Life Support Pe rsonnel" dated February 1 994 Personnel"; and incorporated herein by refe rence including subsequent amendments and editions.—This document may be obtained free of charge from—the — Office—of Emergency—Medical Services, P.O. Box 29530, Raleigh, NC 27626-0530; (B) A basic life support practical examination administered by the Office of Emergency Medical Services; and (C) After September 30, 1 996, an An Emergency Medical Technician written examination administered by the Office of Emergency Medical Services. [uthority G.S. 131E-159(b): 1984 S.L., c. 1034. SECTION .1400 - ADMINISTRATION 1401 LICENSE, PERMIT OR CERTIFICATION DENIAL, SUSPENSION, AMENDMENT OR REVOCATION (a) The Department may deny, suspend, or revoke the lermit of a specific vehicle for any of the following reasons: (1) Failure to substantially comply with the requirements of Section .0900 of this Subchapter; (2) Obtaining a permit through fraud or misrepresentation; or (3) Failure to provide emergency medical care to the defmed ambulance service area in a timely and professional manner. (b) The Department may issue a temporary permit for a specific vehicle whenever the Department finds that: (1) the ambulance provider to which that vehicle is assigned has substantially failed to comply with the provisions of G.S. 13 IE, Article 7 and the rules adopted imder that article; and (2) there is a reasonable probability that the ambulance provider can remedy the permit deficiencies within a reasonable length of time; and (3) there is a reasonable probability that the ambulance provider will be able thereafter to remain in compliance with the rules regarding ambulance permits for the foreseeable future. (c) The Department shall give the ambulance provider written notice of the temporary ambulance permit. This notice shall be given personally or by certified mail and shall set forth: ( 1 ) the length of the temporary ambulance permit not to exceed 60 days; (2) a copy of the ambulance inspection form; (3) the statutes or rules alleged to be violated; and (4) notice to the ambulance provider's right to a contested case hearing on the temporary ambulance permit. (d) The temporary ambulance permit shall be effective immediately upon its receipt by the ambulance provider. The temporary ambulance permit shall remain in effect imtil: (1) the Department restores the vehicle to full permitted status; or (2) the Department revokes the vehicle's ambulance permit. (e) The Department may deny, suspend, or revoke the certification of a field technician BLS professional or certified EMT instructor for any of the following reasons: (1) Failure to comply with the applicable performance and certification requirements as found in Sections .1200 and .1300 of this Subchapter; (2) Obtaining or attempting to obtain certification or rccertification through fraud or misrepresentation; Immoral or dishonorable conduct; (3) Aiding a person in obtaining or attempting to obtain certification or rccertification through fraud or misrepresentation; Making false statements or representations to the Office of Emergency Medical Services or willfully concealing of material information in connection with an application for certification: (4) Failure—to — competently—perform—the — skills—or procedures enumerated in Section .1200 of this Subchapte r; Being unable to perform as a BLS professional with reasonable skill and safety to patients and the public by reason of illness. drunkenness, excessive use of alcohol, drugs, chemicals, or ajiy other type of material or by reason 2:5 NORTH CAROLINA REGISTER September 2, 1997 352 PROPOSED RULES of any physical or mental abnormality: (5) Performance of a skill or procedure which is not within the scope and responsibility of the certificate holder; Unprofessional conduct, including but not limited to a failure to comply with the rules relatin g to the proper function of a BLS professional or certified EMT instructor contained in this Subchapter or the performance of or attempt to perform a procedure which is detrimental to the health and safety of a patient or which is beyond the scope and responsibility of the BLS professional or certified EMT instructor; (6) Pe r fo rmance—of—a—skiti—or—procedure—that—is detr imental to the health and safety of a patient ; Conviction in any court of a crime inyolving moral turpitude, a conviction of a felony, or conviction of a crime involving the function of a BLS professional: (7) Any felony conviction: By false representations obtaining or attempting to obtain money or anything of value from a patient: (8) A misdemeanor conviction of the use, possession, or distribution of illegal drugs within the past five years ; or Adjudication of mental incompetence: (9) Conviction of driving while impaired within the past five years. Lack of professional competence to practice with a reasonable degree of skill and safety for patients including but not limited to a failure to perform a prescribed procedure, failure to perform a prescribed procedure competently or performance of a procedure which is not within the scope of the official duties of the BLS professional: (10) Failure to respond within a reasonable period of time and in a reasonable maimer to inquires from the Office of Emergency Medical Services concerning any matter relating to the practice of a BLS professional or certified EMT instructor: (11) Testing positive for substance abuse by blood, urine or breath testing while on duty as a BLS professional or certified EMT instructor: or (12) Representing or allowing others to represent that the BLS professional or certified EMT instructor has a certification that the BLS professional or certified EMT instructor does not in fact have. (f) The Department shall deny any application for an Ambulance Provider License upon becoming aware that the applicant is not in substantial compliance with G.S. 13 IE, Article 7 and the rules adopted under that article. (g) The Department may amend any Ambulance Provider License by reducing it from a full license to a provisional license whenever the Department finds that: (1) the licensee has substantially failed to comply with the provisions of G.S. 131E, Article 7 and the rules adopted under that article; and (2) there is a reasonable probability that the licensee can remedy the licensure deficiencies within a reasonable length of time; and (3) there is a reasonable probability that the licensee will be able thereafter to remain in compliance with the licensure rules for the foreseeable future. (h) The Department shall give the licensee written notice of the amendment to the Ambulance Provider License. This notice shall be given personally or by certified mail and shall set forth: (1) the length of the provisional Ambulance Provider License; (2) the facmal allegations; (3) the statutes or rules alleged to be violated; and (4) notice to the ambulance provider's right to a contested case hearing on the amendment of the Ambulance Provider License. (i) The provisional Ambulance Provider License shall be effective immediately upon its receipt by the licensee and shall be posted in a prominent location at the primary business location of the ambulance provider, accessible to public view, in lieu of the full license. The provisional license shall remain in effect until: (1) the Department restores the licensee to full licensure status; or (2) the Department revokes the licensee's license. (j) The Department may revoke or suspend an Ambulance Provider License whenever: (1) the Department finds that: (A) the licensee has substantially failed to comply with the provisions of G.S. 131E, Article 7 and the rules adopted imder that article; and (B) it is not reasonably probable that the licensee can remedy the licensure deficiencies within a reasonable length of time; or (2) the Department finds that: (A) the licensee has substantially failed to comply with the provisions of G.S. 13 IE, Article 7 and the rules adopted under that article; and (B) although the licensee may be able to remedy the deficiencies within a reasonable period of time, it is not reasonably probable that the licensee will be able to remain in compliance with licensure rules for the foreseeable future; or (3) the Department finds that there has been any failure to comply with the provision of G.S. 131E, Article 7 and the rules adopted under that article that endanger the health, safety or welfare of the patients cared for and transported by the licensee. (k) The issuance of a provisional Ambulance Provider License is not a procedural prerequisite to the revocation or suspension of a license pursuant to Paragraph (j) of this Rule. Authority G.S. 13IE- 155.1; 131E-156; 131E-157(a); 131E-159(b). .1403 APPLICATION PROCEDURES, REQUIRED FORMS (a) All applications for licensure, certification, or recertification must be filed with the Office of Emergency 353 NORTH CAROLINA REGISTER September 2, 1997 12:5 PROPOSED RULES Medical Services on the appropriate forms. (b) At a minimum, the following forms are required for application: (1) Certification Application Form for certification of persoimel; and (2) Certified Instructor Application Form: and i^Q} Ambulance Provider License Application Form for issuance of licenses. (c) The following documents are required for educational and evaluation programs incorporated herein by reference including subsequent amendments and editions. Copies of these documents are available free of charge from the Office of Emergencv Medical Services. PO Box 29530. Raleigh. NC 27626-0530. (1) "North Carolina Ambulance Attendant Curriculum Outline": (2) "North Carolina Emergency Medical Technician Curriculum Outline": (3) "Guidelines for the Initial Education. Refresher Education. Continuing Education and Performance Evaluation of Emergency Medical Services Basic Life Support Personnel " : (4) "Guidelines for Continuing Education and Performance Evaluation of Emergency Medical Services Advanced Life Support Personnel" fe)(d} EMS providers shall complete all forms, surveys, and requests for data, as required by these Rules. Authority G.S. 131E-155.1; 131E-157(a); 131E-159(b). TITLE 13 - DEPARTMENT OF LABOR Notice is hereby given in accordance with G.S. 150B-21.2 that the Department of Labor, Division of Occupational Safety and Health intends to amend rule cited as 13 NCAC 7F .OWL Notice of Rule-making Proceedings was published in the Register on March 14, 1997. Proposed Effective Date: July 1, 1998 A Public Hearing will be conducted at 10:00 a.m. on September 17, 1997 at the NCDOL: Health, 319 Chapanoke Road, Suite 105, Conference Room A, Raleigh, NC. Division of Occupational Safety and Reason for Proposed Action: This amendment to 13 NCAC 07F .0101 (1) reformats portions of the rule to make it easier to correlate the State requirements with the previously adopted requirements of 29 CFR 1910. 1000 and other related standards, (2) removes information related to interim requirements that have expired, (3) corrects errors in computational formulas, units of measure, and other entries, (4) adopts the existing federal standardfor silica, and (5) removes information that repeats the content offederal standards fRef: G.S. 1508-19(4)]. Note: The attached edited pages also reflect a Notice of Text & Hearing submittal published in the August I, 1997 NC Register. Comment Procedures: The purpose of this anrwuncement is to encourage all interested and potentially affected persons or parties to make their views known to the Division of Occupational Safety and Health (OSH) whether in favor of or opposed to any and all provisions of the proposal being noticed. Written comments, data, or other information relevant to this proposal must be submitted within 30 days (October 3, 1997). Written comments may be submitted to: Peggy D. Morris, Division of Occupatiorml Safety and Health at NCDOL: Division of Occupational Safety and Health, 319 Chapanoke Road, Suite 105, Raleigh. NC 27603-3432, Phone: (919) 662-4581 or 1-800-LABORNC, FAX: (919) 662-4582. Fiscal Note: This Rule does not affect the expenditures or revenues of state or local government funds, a substantial economic impact of at least five million dollars ($5,000,000) in a 12-month period. This Rule does not have CHAPTER 7 - OFFICE OF OCCUPATIONAL SAFETY AND HEALTH SUBCHAPTER 7F - STANDARDS SECTION .0100 - GENERAL INDUSTRY STANDARDS .0101 GENERAL INDUSTRY fa) The provisions for the Occupational Safety and Health Standards for General Industry, Title 29 of the Code of Federal Regulations Part 1910 promulgated as of February 28,1 997, August 4, 1997. and exclusive of subsequent amendments, are incorporated by reference except as follows: 12:5 NORTH CAROLINA REGISTER September 2, 1997 354 PROPOSED RULES (1) Subpart H - Hazardous Materials, 29 CFR 1910.120, Hazardous waste operations and emergency response, §1910. 120(q)(6) is amended by adding a new level of training: "(vi) First responder operations plus level. First responders at operations plus level are individuals who respond to hydrocarbon fuel tank leaks where the leaking tanks contain a hydrocarbon fuel which is used to propel the vehicle on which the tank is located. Only those vehicles designed for highway use or those used for industrial, agricultural or construction purposes are covered. First responders at the operations plus level shall have received at least training equal to first responder operations level and, in addition, shall receive training or have had sufficient experience to objectively demonstrate competency in the following areas and the employer shall so certify: (A) Know how to select and use proper specialized personal protective equipment provided to the first responder at operations plus level; (B) Understand basic hazardous materials terms as they pertain to hydrocarbon fuels; (C) Understand hazard and risk assessment techniques that pertain to gasoline, diesel fuel, propane and other hydrocarbon fuels; (D) Be able to perform control, containment, or confinement operations for gasoline, diesel fuel, propane and other hydrocarbon fuels within the capabilities of the available resources and personal protective equipment; and (E) Understand and know how to implement decontamination procedures for hydrocarbon fuels." (2) Subpart I -- Personal Protective Equipment -- 29 CFR 1910.132, General requirements, is amended at 29 CFR 1910.132(b) to read: "(b) Equipment. (1) Employer-provided equipment. It is the responsibility of the employer to provide, at no cost to the employee, all personal protective equipment which the employee does not wear off the jobsite for use off the job. (2) Employee-owned equipment. Where employees provide their own protective equipment, the employer shall be responsible to assure its adequacy, including proper maintenance, and sanitation of such equipment." (3) Subpart R -- Special Industries - incorporation by reference of final rule for 29 CFR 1910.269, Electric Power Generation, Transmission, and Distribution, including Appendices A through E, published in 59 FR (January 31, 1994) pages 4437 - 4475, all typographical and grammatical corrections to 1910.269 as published in 59 FR (June 30, 1994) pages 33660 - 33664, and the amendment to 1910.269(g)(2)(i) as published in 59 FR (August 9, 1994) page 40729, except that 29 CFR 1910.269(g)(2)(v) is amended to read: "(v) Fall arrest equipment, work positioning equipment, or travel restricting equipment shall be used by employees working at elevated locations more than 4 feet (1.2 m) above the ground on poles, towers or similar structures if other fall protection has not been provided. A fall protection system as defined in 29 CFR 1926, Subpart M - Fall Protection, is required to be used by all employees when ascending, descending or changing locations on poles, towers or similar structures. However, the use of non-locking snap hooks with any fall protection system is prohibited as of July 1, 1995. Qualified employees may free climb wood poles if the employer can ensure (1) that the employee is able to comfortably and safely grip the pole with both hands while climbing, (2) that the pole is free from attachments or any configurations of attachments that will materially impair the ability of a qualified employee to safely free climb the pole, (3) that the pole is otherwise free from impediments, contaminants or conditions of any type, including but not limited to ice, high winds or chemical treatments which materially impair the ability of a qualified employee to safely free climb the pole, and (4) that the employee is able to climb such structures without material physical impairments including over-exertion, lack of sleep or other physical stresses." 29 CFR 1910.269 as amended above is effective January 1, 1995, except that employers have until July 1, 1995, to implement the use of locking snap hooks, and employers have until January 1, 1996, to design and implement a system of fall protection for use by employees while ascending, descending or changing locations on towers. Also, 29 CFR 1910.269(a)(2) Training is effective January 31, 1995, and 29 CFR 1910.269(v)(ll)(xii) is effective February 1, 1996. (4) Subpart Z - Toxic and Hazardous Substances: tal (t4c) 29 CFR 1910.1000 Air Contaminants: Revision of 1 9 10.1000 (a) and (f), removal of Table Z-2 and Table Z-3 and re-adoption of revised permissible exposure limits as Table Z-1 as or iginally published in 54 FR (January 1 9 , 1 989) pages 2923 - 2958 as follows: "§1 9 10.1000 Air contaminants. An employee's exposure to any substance listed in Table Z-1 of this section shall be limited in accordance with the requirements of the following paragraphs and sections. (a) Table Z- l.(l) Substances with limits designated by "C" - Ceiling Limits. An employee's exposure to any substance in Table Z-1. the exposure limit of which is followed by a "C". shall at no time exceed the exposure limit given for that substance in Table Z- 1 . (2) Current peivtissible e.vposure limits. An employee's exposure to any substance listed in Table Z-1 shall not exceed the Time Weighted Average (TWA), Short Term Exposure Limit (STEL) and Ceiling Limit specified for that substance in Table Z-1 under the Current PEL column. 355 NORTH CAROLINA REGISTER September 2, 1997 12:5 PROPOSED RULES (3) Skin Desigtiation. To prevent or reduce skin absorption, an employee's skin exposure to substances listed in Table Z-1 with an "X" in the Skin Designation column following the substance name shall be prevented or reduced to the extent necessary in the ci rcumstances through the use of gloves, coveralls, goggles, or other appropriate personal protective equipment, engineering controls or work practices. (4) Definitions. The following definitions arc applicable to the Current PEL column of Table Z-1 : (i) Time weighted average (TWA) is the employee's average airborne exposure in any 8-hour work shift of a 40-hour work week which shall not be exceeded. (ii) Short term exposure limit (STCL) is the employee's 15-minute time weighted average exposure which shall not be exceeded at any time during a work day unless another time limit is specified in a parenthetical notation below the limit. If another time period is specified, the time weighted average exposure over that time period shall not be exceed at any time during the working day. (iii) Ceiling is the employee's exposure which shall not be exceeded during any part of the work day. If instantaneous monitoring is not feasible, then the ceiling shall be assessed as a I5-minuic time weighted ave rage exposure which shall not be exceeded at any time over a working day. (5) — Additional Definitions. The terms "substance," "air contaminant, ' and "material" arc equivalent in meaning for 29 CFR 1 9 10.1000. (b) and (c) are resen'ed. (d) and (e) are not amended. if) Effective dates. (1) The effective date for the pe rmissible exposure limits specified in the following Current PCL column of Table Z-1 is March 7, 1 997. iii The equation in 29 CFR 1910.1000(d)(l)(i) is clarified to read as follows: E ^ icx, ± Cbib ± . . . cj:^ (iil The equation in 29 CFR 1910. 1000(d)(2)(i) is clarified to read as follows: E, = (C,/L,} + tC,/L,l + . . AC^^i (iii) The permissible exposure limits as originally published in 54 PR (January 19. 1989) pages 2331-2983 are incorporated except as otherwise specified or noted in this Rule, (iv) Employee exposure to the toxic and hazardous substances listed in the following tables shall be limited to the specified values. PERMISSIBLE EXPOSURE LIMITS FOR AIR CONTAMINANTS NOTE: Because of the length of the table, explanatory Footnotes applicable to all substances are given below. Footnote (1) The PELs are 8-hour TWAs unless otherwise noted; a (C) designation denotes a ceiling limit.—They are to be detci'mined from breathing-zone air samples. Footnote (2) Parts of vapor or gas pe r million parts of contaminated ai r by volume at 25 degrees C and 760 tor r. Footnote (3) Milligrams of substance pe r cubic meter of air . When entry is in this column only, the value is exact; when listed with a ppm entry, it is approximate. Footnote (4) The CAS number is for information only. Enforcement is based on the substance name. Footnote f^ £11 Regarding Styrene Only: OSHNC recognizes that the permissible exposure limits for styrene may not be achievable solely through engineering and work practice controls for boat-building and operations comparable to boat building. Comparable of)erations are those that (1) employ the manual layup and sprayup process, (2) the manufactured items that utilize the same equipment and technology as that found in boat building, and (3) the same considerations of large part size, configuration interfering with air-flow control techniques, and resin usage apply. Examples of operations comparable to boat building would include the manufacture of large above-ground or below-ground storage tanks, large parts for recreational vehicles, and large duct work. Because it is impossible to define in advance every manual layup and sprayup process for which compliance may not be feasible solely through engineering and work practice controls, some guidelines concerning part size and configuration issues are necessary. The primary question for manual layup and sprayup operations is whether the part's size and configuration interfere with normal air-flow techniques. For operations making parts (such as tubs and vanities) that do not meet the guidelines described, beginning April 1, 1996, the hierarchy of controls specified in 29 CFR 1910.10(X)(e) will apply to reduce styrene exposures to the new 50 ppm TWA and 100 ppm STEL. In consequence, the burden of proof will be on the employer to show that engineering and work practice controls are not feasible for specific operations. However, with respect to boat-building operations the burden of proof would be on OSHNC to prove that the level could be attained solely through engineering and work practice controls. Footnote f6) {21 Regarding Acrylamide. Carbon Dioxide and Silica only: no change was made to the PEL. The federal standards at 29 CFR 1910.1000 are adopted. Footnote irf) £31 Regarding Subtilisins only: PELs for this substance is are not included in Table Z-1 below, adopted. 12:5 NORTH CAROLINA REGISTER September 2, 1997 356 PROPOSED RULES TABLE Z- 1. LIMITS FOR AIR CONTAMINANTS SUBSTANCE NCnVIBER FORMER PEL CURRENT PEL Acetaldch^ dc 75-07-0 200 ppm TWA 100 ppm TWA 150 ppm STEL Acetic acid 64-1 9 -7 10 ppm TWA 10 ppm TWA Aceiic anhydride 108-24-7 5 ppm TWA 5 ppm TWA (C) Acetone €Mr^ 1000 ppm TWA 750 ppm TWA 1000 ppm STEL 75-05-8 40 ppm TWA 40 ppm TWA 60 ppm STEL !-Aceiylaminofluorene —see 1 9 10.1014 53- 96-3 Acetylene dichlor idc —!^ee 1.2-Dichloroeihylenc Ac^rteTtc-frfrabromide 79-27-6 ppm TWA ppm TWA Acetylsalicylic acid —(Aspi rin) 50-70-2 5 mg/m^ TWA Acrolein 107-02-0 0.1 ppm TWA 0.1 ppm TWA 0.3 ppm STEL Acrv' lamide 79 -06-1 0.3 mg/m^^FWA 0.3 mg/m' TWA Acrv ' lic acid 79-10-7 No former PEL 10 ppm TWA X Ac rs'lonitriic: see 1 9 10.1045. 107-13-1 Aldr in 309-00-2 0.25 mg/m^ TWA 0.25 mg/m^ TWA Allyl alcohol 107-18-6 2 ppm TWA 2 ppm TWA 4 ppm STEL Allvl chloride 107-05-1 1 ppm TWA 1 ppm TWA 2 ppm STEL Allyl glycidyl ethe r (AGE) 106- 92-3 10 ppm (C) 5 ppm TWA 10 ppm STEL Allyl propyl disulFidc 2179 -5 9-1 2 ppm TWA 2 ppm TWA 3 ppm STEL alpha-Alumina Total Dust —Rcspi r able fraction 1344-28-1 15 mg/m'"-TWA 4e-^ng/ffl'^FWA 5 mg''m*^FWA 357 NORTH CAROLINA REGISTER September 2, 1997 12:5 PROPOSED RULES Aluminum (as Al) Metal Total dust Rcspirablc fraction —Welding fumes Alkyls 7429-90-5 7429-90-5 45-mg/ffl''-TWA 5-^Hg/iR'-TWA 45-^fif/ffi'-^FWA J nig/m 1 w/\ 5-^ng/fH'-TWA 5 mg/m*-^FWA ^ /..-^ T^H r A X—Ills/ in I vv /\ Aluminum (soluble salts) 7429-90-5 mg/m*-^FWA 4-Aminodiphenyl ; see 1 9 10.1011 92-67-1 2-Aminoethanol ; —sec Ethanolamine 2-Aminopyridine 504-29-0 0.5 ppm TWA Amitrol 61-82-5 No fo rmer PEL 0.2 mg/m^^FWA Ammonia 7664-41-7 50 ppm TWA 35 ppm STCL Ammonium ehloride fume 12125-02-9 No former PEL 10 mg/m^ TWA 20 mg/m^ STEL Ammonium sulfamate —Total dust —Rcspirable fraction 7773-06-0 15 mg/m^ TWA 5 mg/m^ TWA 10 mg/m^ TWA 5 mg/m^ TWA 'i-Amyl acetate 620-63-7 100 ppm TWA 100 ppm TWA jec-Amyl acetate 626-30-0 125 ppm TWA 125 ppm TWA Aniline and homologs 62-53-3 5 ppm TWA 2 ppm TWA X Anisidinc (i?-. /^-isomers). 29 1 9 1-52-4 0.5 mg/m^ TWA 0.5 mg/m^ TWA Antimony and compounds (as Sb) 7440-36-0 0.5 mg/m^ TWA 0.5 mg/m^ TWA ANTU (Alpha naphthylthiourea) 86-88-4 0.3 mg/m» TWA 0.3 mg/m^ TWA Arsenic, inorganic— compounds (as As) ; see 1 9 10.1018 Varies with compound Arsenic, organic compounds (as As) 0.5 mg/m^ TWA 0.5 mg/m^ TWA Arsine 7784-42-1 0.05 mg/m^ TWA 0.05 ppm TWA Asbestos; sec 1 9 10.1001 Atrazine 1 9 12-24-9 No former PEL 5 mg/m^ TWA Azinphos-mcthyl 86-50-0 0.2 mg/m^ TWA 0.2 mg/m^ TWA Barium, soluble compounds (as Da) 7440-39-3 0.5 mg/m» TWA 0.5 mg/m» TWA 12:5 NORTH CAROLINA REGISTER September 2, 1997 358 PROPOSED RULES Barium sulfate —Total dust —Rcspi rablc fraction 7727-43-7 15 mgfm^ TWA 5 mg/m' TWA 10 mg/m^ TWA 5 mg/m^ TWA Dcnomyl —Total dust —Rcspi rablc fraction 17004-35- 15 mg/m^ TWA 5 mg/m^ TWA 10 mg/m^ TWA 5 mg/m^ TWA Benzene: Sec 1 9 10.1028 See Table Z-2 for the limits applicable in the ope rations or sectors excluded in 1 9 10.1028(d) 71-43-2 Be nzidme : Sec 1910.1010 92-07-5 p-Bcnzoquinone ;—scc- Quinone. Bcnzo(a)py rcnc: see— Coal tar pitch volatilcs Benzoyl pe roxide 94-36-0 5 mg/m^ TWA 5 mg/m= ' TWA Benzyl chloride 100-44-7 5 mg/m^ ' TWA 5 mg/m^ TWA Beryllium and bciyllium compounds (as Be) 7440-41-7 Table Z-2 0.002 ppm TWA 0.005 ppm STEL (30 minute)— 0.025 ppm (C) Biphenyl; see Diphenyl. Bismuth telluridc, Total dust Rcspi rablc fraction 1304-02-1 15 mg/m^ TWA 5 mg/m^ TWA 15 mg/m' TWA 5 mg/m' TWA Bismuth telluridc, Se-doped 1304-82-1 No forme r PCL 5 mg/m^ TWA Borates, tet ra (anhydr ) 1330-43-4 No former PEL 10 mg/m^ TWA Borates, tetra (decahyd) 1303-96-43 No former PEL 10 mg/m^ TWA Borates, tetra (pentahyd) 12179-04-3 No former PEL 10 mg/m^ TWA Boron oxide —Total dust —Rcspi rablc fraction 1303-06-2 15 mg/m^ TWA 5 mg/m^ TWA 10 mg/m^ TWA 5 mg/m^ TWA Boron t ribromidc 10294-33-4 No former PEL 1 ppm (C) Boron trifluoride 7637-07-2 1 ppm TWA (C) 1 ppm TWA (C) Bromacil 314-40-9 No forme r PEL 1 ppm TWA Bromine 7726-95-6 0. 1 ppm TWA 0.1 ppm TWA 0.3 ppm STEL Bromine pcntafluor idc 7789-30-2 0. 1 ppm TWA 359 NORTH CAROLINA REGISTER September 2, 1997 12:5 PROPOSED RULES Di'omoform 75-25-2 0.5 ppm TWA 0.5 ppm TWA ^ Butadiene—(1.3-Dutadicne) Sec 29 CrR 1 9 10.1051; 29 CrR 1910.1 9(1) 106-99-0 Butane 106-97-8 No former PEL 800 ppm TWA Dutanethiol; See Butyl mcrcaptan 2-Butanone (Methyl ethyl ketone) 78-93-3 200 ppm TWA 200 ppm TWA 300 ppm STEL -Buioxyethanol 111-76-2 50 ppm TWA 25 ppm TWA / i-Butyl-acetatc 123-06-4 150 ppm TWA 150 ppm TWA 200 ppm STEL 5fi."-Butyl acetate 105-46-4 200 ppm TWA 200 ppm TWA fgrf-Butyl aeetate 540-00-5 200 ppm TWA 200 ppm TWA >i-Butyl aerylate 141-32-2 No forme r PEL 10 ppm TWA »-Butyl alcohol 71-36-3 100 ppm TWA 50 ppm (C) 5ei-"-Butyl alcohol 78-92 150 ppm TWA 100 ppm TWA /i?;T-Butyl alcohol 75-65-0 100 ppm TWA 100 ppm TWA 150 ppm STEL Butylamine 109-73-9 5 ppm (C) 5 ppm (C) /g/-f-Butyl ehromate (as CrO(3)) 1189-85-1 0.1 mg/m^C) 0.1 mg/mMC) «-Butyl glycidyl ether (DGE) 2426-00-6 50 ppm TWA 25 ppm TWA H-Butyl lactate 138-22-7 5 ppm TWA ; i-Butyl mcrcaptan 109-79-5 0.5 ppm TWA Butyl mcrcaptan 109-79-5 10 ppm TWA 0.5 ppm TWA o-sec-Butylphcnol 89-72-5 No former PEL 5 ppm TWA /> -tert-Butyltoluenc 98-51-1 10 ppm TWA 10 ppm TWA 20 ppm STEL Cadmium (as Cd); sec 1 9 10.1027 7440-43-9 Calcium Carbonate Total dust Respirablc fraction 1317-65-3 15 mg/m'' TWA 5 mg/m' TWA 15 mg/m^ TWA 5 mg/m^ TWA Calcium cyanamidc 156-62-7 No former PEL 0.5 mg/m^ TWA Calcium hydroxide 1305-62-0 No former PEL 5 mg/m^ TWA 12:5 NORTH CAROLINA REGISTER September!, 1997 360 PROPOSED RULES Calcium oxide 1305-76-8 5 mg/m^ TWA 5 mg/m^ TWA Calcium silicate —Total dust —Respi rablc fraction 1344-95-2 15 mg/m' TWA 5 mg/m^ TWA 15 mg/m^ TWA 5 mg/m^ TWA Calcium sulfate —Total dust —Rcspirablc fraetiion 7776-18-9 15 mg/m-' TWA 5 mg/m^ TWA 15 mg/m^ TWA 5 mg/m^ TWA Camphor , synthetic 76-22-2 2 mg/m^ TWA 2 mg/m^ TWA Caprolaetam (dust) 105-60-2 No forme r PEL 1 mg/m' TWA 3 mg/m^ STEL Caprolaetam (vapor) 105-60-2 No former PEL 5 ppm TWA 10 ppm STEL Captafol (Difolatan) 2425-06-1 No former PEL 0.1 mg/m-'TWA Captan 133-06-2 No forme r PEL 5 mg/m^ TWA Carbaryl (Sevin) 63-25-2 5 mg/m^ TWA 5 mg/m^ TWA Carbofuran 1563-66-2 No former PEL 0. 1 mg/m^ TWA Carbon black 1333-06-4 3.5 mg/m^ TWA 3.5 mg/m^TWA Carbon dioxide 124-30-9 5000 ppm TWA 5000 ppm TWA Carbon disulfide 75-15-0 Table Z-2 20 ppm TWA 30 ppm (O* 100 ppm Peak* *Maximum duration is 30 min. for 8-hr . shift. Carbon monoxide 630-00-0 50 ppm TWA 35 ppm TWA 200 ppm (C) Carbon tctrabromidc 558-13-4 No former PEL 0. 1 ppm TWA 0.3 ppm STEL Carbon tetrachloride 56-23-5 Table Z-2 2 ppm TWA Carbonyl fluoride 353-50-4 No former PEL 2 ppm TWA 5 ppm STEL Catechol (Pyrocatcchol) 120-00-9 No forme r PEL 5 ppm TWA ^ Cellulose —Total dust —Rcspirablc fractic 9004-34-6 15 mg/m^ TWA 5 mg/m-' TWA 15 mg/m^ TWA 5 mg/m^ TWA Cesium hydroxide 21351-79-1 No former PEL 2 mg/m^ TWA Chlordane 57-74-9 0.5 mg/m^ TWA 0.5 mg/m^ TWA Chlorinated camphene 8001-35-2 0.5 mg/m' TWA 0.5 mg/m' TWA 1 mg/m^ STEL Chlorinated diphcnyl oxide 557J0-99-5 0.5 mg/m^ TWA 0.5 mg/m^ TWA 361 NORTH CAROLINA REGISTER September 2, 1997 12:5 PROPOSED RULES n ^ nnm TU/ A Chlorine 1 ppili i^> • Chlorine dioxide U.J ppm 3 1 iiL Chlorine trinuoride 7790-91-2 fcnteroacetaldehyac 107-20-0 1 ppm ti^; 1 ppm {K^} ct-Chloroacetophc none (1 ncnacyi cnioriue) Chloroac-etyl chloride /7-U4 y Chlorobenzenc T/TOP ^ 1 I o-Chlorobenzyhdene X maiononitriie Chterobromomethane Tl 07 ^ 200 ppm TWA z-L.nioro-1 ,j-outauicnc; 3CC pffu-cnioroprcnc Chlorodifluoromethane CT ,1iiO "^ 1 '^ Lhlorodipneny1 ?f t 1 riH"' '''^ " Lhlorodiphcnyl X 1 /^i_l_ „ T Ltnyicnc cnioronyurin ^,^r* cnioroiorni ^ 1 T oo 1 i_nioromctnyi mcinyi 107-30-2 cincr; sec i^iu.iuuo i-cnioro-i nitropropanc OUU z5-7 ^u ppm I 2 ppm TWA WA /-•Ul . CT .1 "7/^ 1 ^ T 1 r\Ar\ rk«at> X^l^A /ni-i 7G-06-2 U. 1 ppm 1 WA 0. 1 ppm 1 WA lZO-'7T?-C5 ?t iNo lormcr r'LL 5U ppm 1 WA 12:5 NORTH CAROLINA REGISTER September 2, 1997 362 PROPOSED RULES t?-Cholorotolucne 95 -49-8 No fonnc r PEL 50 ppm TWA 2-Chloro-6 (trichlo romcthyl) pyr idine —Total dust —Respi rablc fraction 1 929-82-4 15 mg/m^ TWA 5 mg/m^ TWA 15 mg/m^ TWA 5 mg/m^ TWA Chlorpyrifos 2921-88-2 No fo rmer PEL 0.2 mg/m^ TWA X Chromic acid and— chromates (as CrO(3)) Var ies with compound Tabl e Z-2 0.1 ppm (C) Chromium (II) compounds (as Cr ) 7440-47-3 0.5 mg/m^ TWA 0.5 mg/m^ TWA Chromium (III)— compounds (as Cr ) 7440-47-3 0.5 mg/m^ TWA 0.5 mg/m^ TWA Chromium metal and insol. salts (as Cr ) 7440-47-3 mg/m^ TWA mg/m^ TWA ChPi'senc: sec Coal tar pitch volatilcs Clopidol —Total dust —Rcspi rable fraction 2971-90-0 15 mg/m^ TWA 5 mg/m^ TWA 15 mg/m^ TWA 5 mg/m^ TWA Coal dust (less than— 5% SiO(2)). respi rable fraction Table Z-3 2 mg/m^ TWA Coal dust (greate r than or equal to 5% SiO(2)). respi rable fraction Table Z-3 0.1 mg/m^ TWA Coal tar pitch volatilcs (benzene soluble fraction), anthracene. DaP,— phenanthrene. ac r idinc, ehryscnc, pyrene. 65966-93-2 0.2 mg/m^ TWA 0.2 mg/m^ TWA Cobalt, metal; dust and fume (as Co) 7440-48-4 0. 1 mg/m-^ TWA 0.05 mg/m^ TWA Cobalt earbonyl (as Co) 10210-68-1 No former PEL 0.1 mg/m^TWA Cobalt hydrocarbonyl (as Co) 16842-03-0 No former PEL 0.1 mg/m^ TWA Coke oven emissions; see 1 9 10.1029 Coppe r —Fume (as Cu) —Dusts and mists (as Cu) 7440-50-0 0.1 mg/m-^TWA 1 mg/m^ TWA 0.1 mg/m^TWA 1 mg/m^ TWA 363 NORTH CAROLINA REGISTER September 2, 1997 12:5 PROPOSED RULES Cotton dust, raw, (c); See 1910.104-3 of waste recycling recycling (blending. (blending, sorting. sorting, cleaning and Cleaning ana wiiiowmg) ana garnetling 1 1/^1 7fi 7 Total dust Rcspirabie fraction. 5 mg/m-^ TWA ,, X Crcsol, all isomers 123-73-9 4170-30-3 Crotonaldehydc 299-86-5 C M*.•/•! X^l^ A Crufomate Cumene X Cyanamidc Cyanides (as Cn) vanes witn compounu Cyanogen 4ou ly-s INO roi'incr i LL lu ppm 1 WA . Cyanogen chloride 3Uo / / 4 iNO rormcr I'LL U.J ppm (L ) 1 lU-OZ-/ juu ppm 1 WA juu ppm 1 WA iCiQ Q1 n X 1 no o.-! 1 Cyclohexanonc 25 ppm TWA Cyclohexene 110-83-8 jOU ppm 1 WA lUO *7l INO rormcr I'LL lu ppni 1 WA cyeionitc 121-02-4 [NO rormcr i'll 1 .zf mg/m*' 1 X WA ^ , .J-DHZ- y^- f /5 ppm i WA TOT riT T 1 JlZl- /U-5 pjo lormcr r'LL 5 mg/m*^ 1 WA fi-l "7^ "7 \C\ aM.a /.M^ TAl r A 1 (T «.«/ '^ XAl^ A lU mg/m-^ 1 WA 1 TTfi"^ '' ^ '^ C\ (\^ r-i»Ma XAlf li X QA/^ r ^ n 1 r\ 1 M* ra /ii 1 ^ TW I \ ?€ i2;5 NORTH CAROLINA REGISTER September 2, 1997 364 PROPOSED RULES Diacetonc alcohol (4-nydroxy-4-methyl- —2-pcntanone) 123-42-2 50 ppm TWA 50 ppm TWA 1,2-Diaminocthanc : sec Cthvlcncdiamine Diazinon 333-41-5 No fo rme r PEL 0.1 mg/m^TWA Diazomcthanc 334-88-3 0.2 ppm TWA 0.2 ppm TWA Diboranc 1 9287-45-7 0.1 ppm TWA 0. 1 ppm TWA 1.2-Dibromo-3- chloropropanc (DDCP) sec 1 9 10.1044 96-12-8 1.2-Dibromoethane: sec ethylene dibromidc 2-N-Dibutvlaminoethanol 102-81-8 No forme r PEL 2 ppm TWA Dibutyl phosphate 107-66-4 ppm TWA 1 ppm TWA 2 ppm STEL Dibutyl phthalatc 84-74-2 5 mg/m^ TWA 5 mg/m' TWA Dichloroacctvlenc 7572-29-4 No fo rme r PEL 0.1 ppm (C) i?-Dichlorobcnzene 95-50-1 50 ppm (C) 50 ppm (C) /7-DichloTObcnzcnc 106-46-7 75 ppm TWA 75 ppm TWA 110 ppm STEL 3.3' -Dichlorobenzidinc ; sec 1 9 10.1007 9 1-94-1 Dichlorodifluoromcthanc 75-71-8 1000 ppm TWA 1000 ppm TWA l,3-Dichloro-5.5- dimcthvl hvdantoin 118-52-5 0.2 mg/m^ TWA 0.2 mg/m^ TWA 0.4 mg/m^ STEL Dichlorodiphcnyltri-— chlorocthanc (DDT) 50-29-3 1 mg/m-' ' TWA 1 mg/m^ TWA 75-34-3 100 ppm TWA 100 ppm TWA 1.2-Dichlorocthane: sec Ethylene dichloridc 1.2-Dichloroethylene 540-5 9-0 200 ppm TWA 200 ppm TWA Dichlorocthyl ethe r 111-44-4 15 ppm (C) 5 ppm TWA 10 ppm STEL Dichloromcthane: see Methylene chloride Dichloromonofluoro-me thane 75-43-4 1000 ppm TWA 10 ppm TWA 365 NORTH CAROLINA REGISTER September!, 1997 12:5 PROPOSED RULES T7T-l-''Cnloro -1- 2 ppm TWA 1,3 Dichloropropene 54Z-/5-0 X 2 , 2-Dichloropropionic acid Dichlorotctrafluoro- Dichlorvos (UDVP) ^T TT 1 X Dicrotopnos No former PCL X . Bicyclopentadienc t I- fj-u Dicyclopcntadienyl iron lotal dust Rcspirable fraction 3 mg/m-^ 1 w/\ Dieldrin uU 5 / 1 X • Diethanolaminc 111-42-2 iNo lornicr 1 i^l J ppm 1 \VA . Diethylamine zs ppm 3 1 cu 2 Diethylaminocthanol 1 r\r\ T7 Q X uictnyi ctncr; sec litnyi ether r\r; Tin Uiethyl Ketone a A r r ^ Uiethyl phtnalate o4 oo I 5 mg/m-* 1 WA uictnyicnc tnaminc 1 1 1 -4U-U nJo lorincr 1 ul 1 ppm 1 WA r^n j-1 .1 -7 c /: 1 r. 1 An T->,MIM XMf A ITTP '^'^ ^ iiJo-U/-3 U.5 ppm (L) U. 1 ppm 1 WA 1 rvo OT CA •»»«> xnr A TC M-iiii-i T^^^ i\ ^.. 1 r\o 1 n 10o-tS-9 J ppm-T-WA 5 ppm TWA X 4-Dimcthylaminoazo- — benzene; sec i7iu. 1U13 wJ 1 1 / sec Mctnyiai 127-19-5 10 ppm X 1 WA lO ppm-l-WA i2;5 NORTH CAROLINA REGISTER September 2, 1997 366 PROPOSED RULES Dimcthylaminc 124-40-3 10 ppm TWA 10 ppm TWA Dimethylaminobcnzcnc : sec Xylidinc Dimcthylanilinc (N.N-Dimcthylaniline) 121-09-7 5 ppm TWA 5 ppm TWA 10 ppm STEL ^^ Dimcthylbcnzcnc : sec Xylene Dimethyl- 1 .2-dibromo-2 2-dichloroethyl phosphate 300-76- 5 3 mg/m^ TWA 3 mg/m^ TWA Dimcthylformamidc 60-12-2 10 ppm TWA 10 ppm TWA i!.6-Dimethyl-4- heptanone ; see Diisobutvl ketone 1 . 1 -Dimethy Ihydrazine . 57-14-7 0.5 ppm TWA 0.5 ppm TWA Dimcthylphthalate 131-11-3 5 mg/m^ TWA 5 mg/m^ TWA 77-78-1 1 ppm TWA 0.1 ppm TWA X Dinitolmidc (3.5-dinit ro-— o-toluamide) 148-01-6 No forme r PEL 5 mg/m^ TWA Dinitrobcnzene (all isomers)— (ortho) (mcta) ( para) 528-29-0 99-65-0 100-25-4 1 mg/m^ TWA 1 mg/m-' TWA 534-52-1 0.2 mg/m^TWA 0.2 mg/m^'TWA 25321-14-6 1.5 mg/m^TWA 1.5 mg/m^TWA Dioxane— (Diethylcne dioxide) 123-9 1-1 100 ppm TWA 25 ppm TWA X Dioxathion 78-34-2 No forme r PEL 0.2 mg/m^ TWA Diphcnyl (Diphenyl) 92-52-4 0.2 ppm TWA 0.2 ppm TWA Diphenylamine 122-39-4 No forme r PEL 10 mg/m^ TWA Diphenylmethane diisocyanatc; sec— Methylene bisphenyl isocyanate Dipropyl ketone 123-1 9-3 No forme r PEL 50 ppm TWA methyl ethe r 34590-94-8 100 ppm TWA 100 ppm TWA 150 ppm STEL X Diquat 85-00-7 No former PEL 0.5 mg/m^ TWA 367 NORTH CAROLINA REGISTER September 2, 1997 12:5 PROPOSED RULES Ui-sec octyl phthalate (Di-(2-cthylhcxyl) phthalate) 117-81-7 5 mg/m^ TWA 5 mg/m^ TWA 10 mg/m^ STEL Disulfiram (Antabuse) 97-77-8 No forme r PEL 2 mg/m-^ TWA Disulfoton 298-04-4 No former PEL 0.1 mg/m^ TWA 2,6-Di-fe>?-butyl-p- crcsol 128-37- No former PEL 10 mg/m^TWA ©Toron 330-54-1 No former PEL 10 mg/m^ TWA Divinyl benzene 100-57-6 No former PEL 10 ppm TWA Emery Total dust Rcspi rable fracttorr 12415-34-8 15 mg/m^ TWA 5 mg/m^ TWA 10 mg/m'' TWA 5 mg/m^ TWA Endosulfan 115-29-7 No former PEL 0.1 mg/m^ TWA linurin 72-20-8 0.1 mg/m^TWA 0.1 mg/m^TWA Epichlorohydrin 106-09-0 5 ppm TWA 2 ppm TWA X TTTTT 2104-64-5 0.5 mg/m^ TWA 0.5 mg/m= ' TWA 1,2-Epoxypropanc ; see Propylene oxide 2,3-Epoxy-l-propanol; see Glycidol Ethanethiol; see— Ethyl mercaptan Ethanolaminc 141-43-5 3 ppm TWA 3 ppm TWA 6 ppm STEL Ethion 563-12-2 No former PEL 0.4 mg/m^ TWA 2-Ethoxyethanol (Cellosolvc) 110-00-5 200 ppm TWA 200 ppm TWA 2-Ethoxyethyl acetate (Cellosolve aeetate) 111-15-9 100 ppm TWA 100 ppm TWA Ethyl acetate 141-70-6 400 ppm TWA 400 ppm TWA Ethyl ac rylate 140-88-5 25 ppm TWA 5 ppm TWA 25 ppm STEL X Ethyl alcohol (Ethanol) 64-17-5 1000 ppm TWA 1000 ppm TWA Ethylamine 75-04-7 10 ppm TWA 10 ppm TWA Ethyl amyl ketone (5-Methyl-3-— hcptanone) 106-68-3 25 ppm TWA 25 ppm TWA 12:5 NORTH CAROLINA REGISTER September!, 1997 368 PROPOSED RULES Ethyl benzene 100-41-4 100 ppm TWA 100 ppm TWA 125 ppm STCL Ethyl bromide 74-96-4 200 ppm TWA 200 ppm TWA 250 ppm STEL Ethyl butyl ketone (3-Heptanone) 106-35-4 50 ppm TWA Ethyl chloride 75-00-3 1000 ppm TWA 1000 ppm TWA Ethyl ether 60-29-7 400 ppm TWA 400 ppm TWA 500 ppm STEL Ethyl formate 109-94-4 100 ppm TWA 100 ppm TWA Ethyl mereaptan 75-08-1 10 ppm (C) 0.5 ppm TWA Ethyl silicate 78-10-4 10 ppm TWA Ethylene chlorohydrin 107-07-3 5 ppm TWA 1 ppm (C> Ethylcnediaminc 107-15-3 10 ppm TWA 10 ppm TWA Ethylene dibromide 106-93-4 20 ppm TWA 20 ppm TWA Ethylene dichloride— (1.2-Dichl