Historical Note: Chapter 72 of
Title 11, Administrative Rules, incorporates Public Health Regulations
Chapter 48, Ambulances, Ambulance Equipment, Ambulance Services, and
Ambulance Personnel, Department of Health, State of Hawaii. [Eff. AUG
12 1985]
Subchapter 1 General
Provisions
§11-72-1 Purpose The purpose of these rules is to establish standards for the
state comprehensive emergency medical services system providing for the
arrangement of personnel, facilities, and equipment for the coordinated
and effective delivery of health care services under emergency
conditions.
§11-72-2 Definitions
Whenever used in this chapter, unless the context otherwise
provides:
"Advanced life support" or "ALS" means initiating basic life
support care as well as physician-authorized invasive patient care
designed to stabilize and support a patient's condition due to sudden
illness or injury. The care rendered, excluding basic life support,
constitutes the practice of medicine.
"Advanced life support personnel" or "ALS personnel" means
individuals currently certified by the state board of medical examiners
as Mobile Intensive Care Technicians or MICTs.
"Ambulance" means any privately or publicly owned ground motor
vehicle, watercraft, or aircraft that is specially designed or
constructed, equipped pursuant to section 11-72-29 intended to be used
for and maintained or operated for the transportation of patients with
medical conditions unable to use other means of transportation, except
any such ground motor vehicle, watercraft, or aircraft owned or
operated under the direct control of the United States.
"Ambulance service" means the business or regular activity, whether
for profit or not, of transporting either emergency or nonemergency
sick, injured, or otherwise medically or psychologically incapacitated
individuals by ambulances staffed by BLS or ALS personnel.
"Basic life support" or "BLS" means initiating noninvasive
emergency patient care designed to optimize the patient's chances of
surviving the emergency situation. The care rendered consists of all
first-aid procedures needed, but does not include invasive procedures
or other procedures which constitute the practice of medicine.
"Basic life support personnel" or "BLS personnel" means individuals
currently certified by the state board of medical examiners as
Emergency Medical Technicians or EMTs. "Cardiopulmonary Resuscitation"
or "CPR" means an emergency first-aid procedure that consists of
opening and maintaining a patient's airway, ventilating the patient,
and providing artificial circulation by means of external cardiac
compression, as indicated.
"Communications system" means all equipment, personnel, and
procedures established and operated to provide a means for accepting
calls for emergency medical services, for dispatching and coordinating
emergency medical personnel and vehicles, and for conducting medical
communications, such as that between emergency medical services
personnel and a licensed physician in a hospital emergency room
approved by the. director.
"Director" means the director of health or the designated
representative of the director of health.
"Disaster situation" includes "mass casualties", "national
emergency", "natural disaster", or person-caused disaster.
"Emergency ambulance call" means a request that is not prearranged
for assistance requiring an ambulance unit to be dispatched to provide
immediate prehospital medical care to each patient who is sick,
injured, or otherwise medically or psychologically incapacitated.
"Emergency medical services" or "EMS" means the services utilized
in responding to a perceived need for immediate medical care in order
to prevent loss of life or aggravation of physiological or
psychological sickness, injury, or incapacitating condition.
"Mass casualties" means so many persons being injured,
incapacitated, made ill, or killed that ordinary resources for
emergency treatment are strained beyond capacity.
"Medical attendant" means a State of Hawaii licensed physician,
State of Hawaii licensed registered nurse, state certified BLS
personnel, or state certified ALS personnel.
"Medical direction off-line" means a system of medical support
which includes the review and monitoring of prehospital emergency
services,. this support being provided by physicians experienced in the
conduct and the delivery of prehospital emergency medical
services.
"Medical direction on-line" means advice, assistance, supervision,
and control provided from a state designated regional medical facility
staffed by emergency physicians supplying professional support through
radio, telephonic, or any written or oral communication for on-site and
in- transit basic and advanced life support services given by
prehospital field personnel.
"Person-caused disaster" means accidents caused by persons
including, but not limited to fire, explosion, radiation, and hazardous
material spills that result in hazard, illness, injury, or death to
large numbers of citizens, or that presents a potential for such
hazard, illness, injury, or death.
"Phased emergency response system" means the equipment, supplies,
medications, transportation, personnel, and procedures arranged to
provide the coordinated delivery of prehospital emergency medical
services by identified private individuals, public safety personnel,
and state and private and other agencies in a timely pattern that
progresses from the CPR or first aid trained individual to more
advanced levels of emergency medical care in order to provide a
continuum of emergency medical care to a patient, from the time of
occurrence of an emergency incident until admission for treatment in
the emergency room or medical facility.
"State comprehensive prehospital emergency medical services system"
means the state program established to provide for the arrangement of
personnel, facilities, and equipment for the effective and coordinated
delivery of health care services under emergency conditions throughout
the State, whether occurring as a result of a patient's condition or of
natural disasters or other causes. The state comprehensive medical
services system is designed to provide services on the islands of Oahu,
Hawaii, Kauai, Maui Lanai, and Molokai.
[Eff. AUG 12 1985] (Auth: HRS §§321-223, 321-233) ( Imp: HRS
§§321-222, 321-223, 321-226, 321-228, 321-233)
§11-72-3 Severability
If any provision of these rules, or the application thereof to any
person or circumstance is held invalid, the invalidity does not affect
other provisions or applications of these rules that can be given
effect without the invalid provision or application, and to this end
the provisions of these rules are severable.
[Eff. AUG 12 1985] (Auth: HRS §321-233) (Imp: HRS
§321-233)
§11-72-4 Waivers
The director may waive any section or portion of these rules if it is
necessary in order to ensure public safety and welfare.
§11-72-5 Penalties In addition to any other appropriate action to enforce this
chapter, the director may assess fines as provided in Section 321-18,
Hawaii Revised Statutes after a hearing held in accordance with Chapter
91, Hawaii Revised Statutes.
Subchapter 2 System
Development Criteria, Administration and Components
§11-71-8 Development Criteria and Plans
The department of health shall establish, administer, and maintain
the state comprehensive emergency medical services system, which shall
consist of the emergency medical services systems in the counties of
Hawaii, Maui, Kauai, and the city and county of Honolulu by applying
the following criteria in the development and administration of an
emergency medical services system in a county:
Consideration of the entire county and all its residents in
providing emergency medical services;
Application of emergency medical services component standards
throughout the county in determining needs and setting priorities;
Delineation of administrative responsibility for overall system
implementation of specific components within a system;
Standardization of emergency medical services throughout the
counties insofar as possible;
Development of budget and implementation schedules to reflect
existing and future resources and expenditures; and
Accessibility to emergency medical services as required by the
state comprehensive emergency medical services system to all
individuals regardless of the ability of the individual to pay therefor
or of the lack of prepaid health care coverage or proof of such ability
or coverage.
The department of health, in consultation with the state emergency
medical services advisory committee, shall develop an emergency medical
services system plan for each county that shall include the following
elements:
Public access to emergency services through telephone
communication, through a single seven-digit number or through an
emergency "911" telephone number;
Central dispatch to expedite emergency medical services and assist
in the coordination of emergency services;
Coordination with emergency medical services' activities of public
safety agencies and with the public to provide first response
assistance to emergencies, including disaster situations;
Emergency ambulance vehicles in compliance with section 11-72-45,
Hawaii Administrative Rules;
A communications system consisting of a "911" or similar system for
receiving and referring calls for emergency service from the public; a
central dispatch system for dispatching and coordinating emergency
medical personnel and vehicles; and a telecommunications system for
coordination of medical communications between emergency medical
services personnel and emergency physicians;
Prescribed prehospital standing orders for the guidance of trained
advanced life support personnel;
Quality assurance control of emergency medical services system;
and
The identification of the readiness and capabilities of hospitals
and their staffs to adequately, expeditiously, and efficiently receive
and treat emergency patients.
The emergency medical services system plan for each county shall
identify the levels of emergency medical services components of an
emergency medical services system prescribed in section 11-72-9 and the
respective roles of state and county agencies in providing such
services, and shall describe the existing and proposed emergency
medical services personnel, resources, services, and facilities called
for by each county plan.
The emergency medical services system plan for each county shall be
integrated into the state master plan for emergency medical services,
which shall be submitted to the legislature.
[Eff. AUG 12 1985] (Auth: HRS § 321-233) (Imp: HRS
§§321-223, 321-224, 321-225)
§11-72-9 System Components
An emergency medical services system in the State shall include
emergency medical services personnel and training, communications,
emergency medical ambulance services, coordination of available public
safety agencies, consumer education and participation in policy making,
categorization of emergency facilities, coordination with specialized
care services, prehospital standard medical recordkeeping, and quality
assessment and assurance.
§11-72-10 EMS District Medical Directors
There shall be a qualified physician as district EMS medical director
in each county who shall be experienced in the conduct and delivery of
prehospital emergency medical services in the State and who shall be
responsible for the off-line medical management of the emergency
medical services system in the county to include medicom communications
review, medical-surgical case reviews of ambulance patient care report
forms generated in the county, monthly base station meetings to review
selected cases, counseling of ambulance personnel in the county, and
recommendation of continuing education programs for the ambulance
personnel in the county; participation in continuing education programs
in the county.
Lay citizens trained in CPR techniques or first aid, or both;
First responders;
Telecommunicators (including public safety dispatchers);
Basic life support personnel (EMTs);
Advanced life support personnel (MICTs);
Prehospital registered nurses;
Emergency room or department registered nurses
Specialized care registered nurses;
Emergency physicians;
Specialty physicians;
District EMS medical directors;
Medicom physicians; and
EMS training personnel.
There shall be an adequate number of personnel in the following
categories:
A sufficient number of trained "911" and public safety dispatchers
to provide staffing twenty-four hours daily at each designated EMS
communications facility;
At least two EMTs on each basic life support ambulance;
At least one EMT and one MICT on each advanced life support
ambulance and;
At least one district EMS medical director in the system in each
county.
Because the state has no direct control in the following areas,
there shall be reasonable efforts to have an adequate number of
personnel in the following categories:
At least twenty per cent of the resident population of each county
currently trained in CPR by June 30, 1985;
At least fifty per cent of all field police, fire, and lifeguard
personnel currently trained as first responders by June 30, 1985;
Emergency service nursing personnel that meet the 1984 Joint
Commission on Accreditation of Hospitals staffing standards for
hospital emergency services;
Emergency physicians that meet the 1984 Joint Commission on
Accreditation of Hospitals staffing standards for hospital emergency
services.
State-funded courses used for training and retraining of the EMS
personnel shall include:
State-approved CPR training, using at least the American Heart
Association heart-saver course;
State-approved public safety first responder training using at
least the United States Department of Transportation "Emergency
Training Course" dated Hatch 1979;
State approved EMT training;
State approved MICT training; and
Any other state-approved BLS or ALS training.
The department of health shall approve all basic life support and
advanced life support courses as required by the board of medical
examiners.
There shall be annual refresher or continuing education sessions
available for public safety first responder, EMT, and MICT emergency
medical services personnel in each county.
[Eff. AUG 12 1985] (Auth: HRS § 321-233) (Imp: HRS
§§321-222, 321-224, 321-229).
§11-72-16 Communications
There shall be a communications system that includes a medical
radio communications system for emergency medical services, including
disaster response, established consistent with the regulations of the
Federal Communications Commission.
The personnel, facilities, and equipment of the emergency medical
services system in each county shall be linked by a county central
communications system so that requests for emergency medical services
shall be handled by a communications facility that:
Utilizes or will utilize by June 30, 1985, the universal emergency
telephone number "911" or another appropriate single-access number;
and
Will have direct two-way radio communications with the personnel,
facilities, and equipment of the county emergency medical services
system and with the state comprehensive emergency medical services
system.
Each county communications system shall include a central emergency
medical services dispatch center responsible for receiving and
coordinating all requests for emergency medical services and for
providing liaison with other public safety and emergency response
systems in order to provide the most effective and efficient management
of the immediate problem.
[Eff. AUG 12 1985] (Auth: HRS §321-233) (Imp: HRS
§§321-224, 321- 226)
§11-72-17 Emergency
Medical Ambulance Services
There shall be an adequate number of emergency medical ambulances
based on the following:
Identification of ambulance districts consisting of homogenous
geographic areas that are either urban or rural;
Establishment, within the prescribed ambulance districts, of
ambulance sectors that shall be designated as the geographic area in
which one ambulance unit is capable of responding within the
appropriate response standards prescribed herein;
Emergency ambulance response in its service area for ninety-five
percent of all calls within the average of twenty minutes, which
response time shall be computed from the time the emergency medical
services dispatch center notifies the ambulance to the time the
ambulance arrives at the scene-of the emergency; and
Provision of backup emergency ambulances as prescribed in Section
11- 72-28(b).
All ground and air ambulance vehicles and personnel staffing those
vehicles shall conform to the licensing and certification requirements
of this chapter. (c) There shall be appropriate transfer agreements
between physicians, the hospitals and the emergency ambulance services
for the transfer of seriously injured, ill, or psychiatrically
incapacitated individuals from one care facility to another.
[Eff. AUG 12 1985] (Auth: HRS §§321-227, 321- 233) (Imp: HRS
§§321-224, 321-226, 321-227)
§11-72-18 Coordination of Available Public Safety
Agencies
Each county shall designate the specific role its public safety
personnel shall play in providing emergency medical services as part of
the phased response system established within the county and
include:
Statements relative to the effective utilization and sharing of
personnel, facilities, and equipment;
Linkage with the county medical radio communications system;
Utilization of appropriately trained personnel; and
Cooperative operating procedures and mutual aid plans with other
state and county emergency response systems to include civil defense,
private hospitals, military, and the American Red Cross.
[Eff. AUG 12 1985] (Auth: HRS §321- 233) (Imp: HRS
§§321-224, 321-226)
§11-72-19 Consumer Education and Participation in
Policy Making
An emergency medical services system shall provide programs of
consumer information and education, taking into account the needs of
visitors as well as residents of the area, to inform the public of the
means of obtaining emergency medical services.
These programs shall stress the general dissemination of
information regarding appropriate methods of medical self-help and
first aid as well as the availability of first-aid training programs in
the area; and
There shall be a program of consumer information and education
relating to CPR programs in order to encourage at least twenty percent
of the residents of each county to be certified in CPR. (b) Any person
in each county shall be able to participate and provide input to the
making of policy through membership on or through communications with
the state emergency medical services advisory committee.
[Eff. AUG 12 1985] (Auth: HRS §§321-224, 321-226, 321-233)
(Imp: HRS §§321-224, 321-226)
§11-72-20 Categorization of Emergency
Facilities
All hospitals and specialized care facilities in the state that
provide emergency medical services shall be categorized every 1-3
years, in order to identify the readiness and capability of each
hospital within each county to provide definitive treatment of
consumers, especially those with serious or critical injuries or
illnesses, and its capacity to provide emergency medical care.
The categorization of hospitals and specialized care facilities
shall be based on the Guidelines for the Categorization of Hospital
Emergency Capabilities, 1971 developed by the American Medical
Association Commission on EMS.
[Eff. AUG 12 1985] (Auth: §§321-226, 321-233) (Imp: HRS
§ 321-226)
§11-72-21 Coordination With Specialized Care
Units
There shall be appropriate treatment, triage, and transfer
protocols for emergency management of seriously ill patients for use by
all acute care facilities and specialty physicians in the areas of
trauma, burns, acute cardiac, spinal cord injuries, poison, high-risk
infant, behavioral disorders, high-risk maternal, and pediatric.
Information relating to the numbers, types, and capabilities of the
specialized care facilities shall be distributed to all acute care
facilities and to the lead emergency physician in each emergency room
or department in order to assist the emergency physician or the
patient's physician in arranging for the most appropriate level of
follow up care for an emergency patient.
[Eff. AUG 12 1985] (Auth: HRS §321-233) (Imp: HRS
§§321-224, 321-226)
§11-72-22 Prehospital Standard Medical
Recordkeeping
During or immediately after the time of patient care, an ambulance
patient care report form shall be prepared for each patient, with at
least copies as follows: original copy retained by the ambulance
service, one copy to medical facility, if patient is transported to
such, and one copy to be retained by the ambulance service to provide
to the director of health, if requested by the director of health. The
ambulance patient care report shall include a copy of the dispatch
card, if utilized, and the following information, on a
department-approved standardized form:
Patient identification/name;
Residence;
Date of birth, and age;
Sex;
Date and time call was received;
Dispatch incident run number;
Ambulance unit identification;
Crew identification;
Time of emergency vehicle departure;
Location of incident;
Time of arrival at incident location;
Patient's condition observed by arriving crew;
Preliminary impression;
Anatomical sites of injury or illness;
Degree of urgency or severity of patient's condition;
Aid or treatment provided by crew;
Time of departure from incident location;
Outcome or destination of run; and
Time of arrival at destination.
Section 11-72-22(a) shall apply with equal force, for the data
obtainable, in case any patient dies before being transported in the
ambulance or dies while being transported in an ambulance or dies at
any time prior to the acceptance of the patient into the responsibility
of the hospital or medical or other authority if the patient is still
under the care or responsibility of the ambulance service.
The prehospital data to be recorded on the provided ambulance
patient care report form and the available emergency room and hospital,
inpatient data shall be used for the purposes of obtaining follow-up
data. Any data recorded, collected, or evaluated for the prehospital
emergency medical data system shall comply with applicable federal and
state guidelines and statutes relating to the privacy of medical data
and a patient's condition.
There shall be a review and evaluation on an ongoing and periodic
basis to determine the adequacy of prehospital emergency medical
services and identify areas for improvement of services or correction
of deficiencies.
Prehospital emergency medical services and systems established in
the state shall be evaluated as to the availability and quality of
emergency medical care being provided to assure a reasonable standard
of performance by individuals and organizations providing such
services.
Periodic reports on the effectiveness of the state comprehensive
emergency medical services system shall be made available to federal
and state legislative and executive agencies by the director of health
upon request.
[Eff. AUG 12 1985] (Auth: HRS §321-233) (Imp: HRS
§§321-224, 321- 225. 321-226)
The minimum levels of emergency ambulance services for each of the
six major islands of the State shall be as follows:
Oahu: advanced life support in thirteen locations;
Hawaii: advanced life support in six locations;
Maui: advanced life support in four locations and basic life
support in one location;
Kauai: advanced life support in two locations and basic life
support in one location;
Molokai: advanced life support in one location; and
Lanai: basic life support in one location.
Each island emergency ambulance services system shall have, on the
island, one backup ambulance vehicle for every four ambulance vehicles
in service on that island, or as determined by the director of
health.
The minimum staff for responding to an emergency ambulance call
shall be one mobile intensive care technician and one emergency medical
technician for advanced life support;
The minimum staff for responding to an emergency ambulance call
shall be two emergency medical technicians for basic life support,
except hospital-based ambulance service shall be one emergency medical
technician and one registered nurse licensed in the State of Hawaii,
provided that:
The nurse has satisfactorily completed the department of health's
prehospital emergency care nursing course; and
A written exemption to the ambulance service licensing requirements
specified in this part be granted by the director of health.
Air ambulance services shall be staffed by a State of Hawaii
licensed physician, State of Hawaii registered nurse or mobile
intensive care technician for advanced life supports or one emergency
medical technician for basic life support.
[Eff. AUG 12 1985] (Auth: HRS §§321-228, 321-233) ( Imp: HRS
§321-228)
§11-72-30 Licensing and Certification
Each advanced life support and basic life support unit, and all
vehicles and equipment used, shall be in compliance with the ambulance
licensing and personnel certification standards as prescribed by this
chapter.
Effective upon adoption of this section, the fee for emergency
ambulance services for each patient treated and transported to a
medical facility or to a location for aeromedical transport, including
but not limited to airports helipads or helicopter landing sites, shall
be according to the following schedule.
Ambulance service fee schedule:
Advanced life support (ALS) emergency transport, no
specialized ALS services rendered,
all inclusive (mileage and supplies);
$400
ALS ground emergency transport, specialized ALS
services rendered, all inclusive (mileage and supplies);
$450
Basic life support (BLS) ground emergency transport,
no specialized ALS services rendered, all inclusive
(mileage and supplies); and
$375
ALS emergency aeromedical helicopter transport for the
island of Hawaii, all inclusive (mileage and
supplies).
$2,250
The fee schedule set forth in subsection (a) may be increased on
July 1 of each year. Fees, however, may not be increased more than ten
percent each year. The fee increase shall be based upon projected
revenue collected to equal no less than fifty percent of the preceding
fiscal year's ambulance service direct contract cost.
Fees for emergency ambulance services shall be collected by the
director of health or by a county or other agency under contract with
the department of health. The revenue collected shall be deposited by a
county or other authorized agency into the state general fund, except
amounts necessary to provide for collection services for bad debt
accounts."
[Eff. 09/28/81 ;am JUL 01 1996 ] (Auth: HRS §§321-232, 38-2,
38-10) (Imp: HRS §321-232)
§11-72-32 Determination of Ability to Pay
No emergency medical services provided by or under contract with
the department of health shall be denied to any person on the basis of
the ability of the person to pay therefor or because of the lack of
prepaid health care coverage or proof of such ability or coverage.
The department of health or its designate shall make every
reasonable effort to collect any fee for emergency ambulance service
assessed under Section 11-72-31. In the event of nonpayment of any fee
assessed under Section 11-72-31, the department of health or its
designate shall determine whether that person is financially able to
pay such fee. The county or other entity or agency that provided the
emergency medical services shall forward records relating to services
to the department of health or its designate. If the department of
health or its designate finds that a person is financially able to pay,
the department of health or its designate shall continue every
reasonable effort to collect such fees or, if the cost of the provided
services were borne by the county or other entity or agency, the
department of health or its designate shall notify the county or other
entity or agency that it may proceed to collect the unpaid fee. If the
department of health or its designate finds that a recipient of
services is without sufficient resources to pay for the service,
further action to collect the fees may be terminated.
The department of health or its designate shall determine ability
to pay by using criteria based on the 1985 income poverty guidelines
for Hawaii and established by the U.S. Department of Health and Human
Services, which are published annually in the Federal Register.
The department of health shall determine that a recipient of
services is without sufficient resources to pay fees if the recipient's
annual family income is at or below the appropriate maximum family
income specified in subsection (c) when calculated by either of the
following methods:
Multiplying by four the recipient's family income for the three
months preceding the determination of ability to pay; or
Using the recipient's actual family income for the twelve months
preceding the determination of ability to pay.
[Eff. AUG 12 1985] (Auth: HRS §§321-232, 321-233) (Imp: HRS
§321-232)
The director of health may contract for the provision of emergency
medical ambulance services with a county which applies to the director
for direct operation of such services provided that the county:
Develops a detailed budget including a line item description of
services to be funded and other related costs for review and
analysis;
Provides evidence that the county will satisfactorily provide this
required level of emergency ambulance services, will plan, coordinate,
and facilitate the development of components in the EMS service
area;
Provides evidence of administrative capability and supporting
resources for the provision of emergency medical ambulance
services;
Permits an annual audit and evaluation of expenditures, procedures,
calls, and operations in order to determine the adequacy and cost
effectiveness of services rendered; and
Provides a description of existing emergency ambulance units,
locations, personnel, and level of personnel, including an inventory of
vehicles, medical and non medical equipment and supplies.
If the director of health determines that a county's application
satisfactorily provides the required information and if the county and
the director agree upon the amount of compensation for the services to
be performed and appropriated and allocated funds are available in the
agreed upon amount, then the department of health may contract with the
county for the provision of emergency medical ambulance services.
If a county does not apply to the director of health for the
operation of emergency medical ambulance services, the director shall
operate services or contract with a private agency for such services
according to the emergency medical services system plan of the
county.
[Eff. AUG 12 1985] (Auth: HRS §§321-228, 321-233) (Imp: HRS
§321-228)
§11-72-38 Other System Components
The director of health may contract for the provision of emergency
medical services or any necessary component of an emergency medical
services system in a county.
[Eff. AUG 12 1985] (Auth: HRS §§321-228, 321-233) (Imp: HRS
§321-228)
§11-72-43 License Required to Operate Ambulance
Services
No person, either as owner, agent, or otherwise shall furnish,
operate, conduct, maintain, advertise, or otherwise be engaged in or
profess to be engaged in ambulance service in the state without holding
a valid ambulance service license issued pursuant to these
regulations.
No ambulance shall be operated for ambulance services and no
individual shall drive, ride in, or permit it to be operated for such
purposes in the state unless it is operated under a valid ambulance
service license and staffed at least by 2 primary crew members.
This section does not apply to:
The operation of a fire department rescue vehicle with minimum
staffing required when it is used during a period of non-availability
of an ambulance.
The operation of any vehicle, when, during a period of
non-availability of an ambulance or when, under conditions making a
patient inaccessible to an ambulance, the vehicle is used for the
extrication or transportation of a patient.
Assistance rendered to a licensed ambulance service or certified
BLS or ALS personnel in the case of:
A major catastrophe or disaster beyond the capabilities of the
available licensed ambulance services; or
An emergency declared by the director to ensure that patient
transportation services are not interrupted or seriously deficient. (4)
Ambulance service insufficiency in areas in regard to sufficient
emergency ambulance calls to support full staffing of conforming
ambulances and equipment as determined by the director. Exceptions
under this paragraph may be granted by the director after full
consideration of written and oral submissions respecting the proposed
exception.
[Eff. AUG 12 1985] (Auth: HRS §§321-223, 321-224, 321-227,
321-228, 321-233) (Imp: HRS §§321-224 321-233)
§11-72-44 Applications for Ambulance Service
Licenses; Application Fee
Applications for an ambulance service license shall be made upon
forms, prepared and prescribed by the director.
Each application for an ambulance service license shall be
accompanied by a nonrefundable fee of $10.
[Eff. AUG 12 1985] (Auth: HRS §§321-223, 321-224, 321-227,
321-228, 321-233) (Imp: HRS §§321-223, 321-224, 321-227,
321-233)
§11-72-45 Standards of Licensed Ambulance Services;
Ambulances
Each licensed ambulance service ambulance shall, at all times when
in, use as such:
Be suitable for the transportation of patients with respect to
health, sanitation, and safety;
In the case of ground motor ambulance, conform to the document
entitled Motor Vehicle Ambulance Design and Performance Standards,
dated July 15, 1985 and available from the department. In the case of
aircraft, conform to the document entitled Essential Equipment and
Requirements for Air Ambulance Services, dated July 15, 1985 and
available from the department;
Have a state-licensed physician medical director and be staffed by
primary crew members;
Contain equipment conforming with the standards, requirements, and
regulations prescribed in Section 11-71-55;
Conform with all applicable laws relating to health, sanitation,
and safety;
Be maintained in suitable premises with facilities for washing and
disinfecting equipment; handling linen and supplies; storing supplies
in a clean, dry location; storing personal effects and maintaining
cleanliness and orderliness of premises, and disposing of wastes in an
acceptable manner.
An ambulance service shall notify the director of any change of
ownership of an ambulance within ten working days after the sale or
other transfer of ownership.
Any additional or replacement ambulance acquired by an ambulance
service shall conform with all the requirements applicable upon
original licensing.
Each ambulance service, ambulance, equipment, and the premises
designated in the application, and the following records relating to
maintenance and operation shall be open to inspection by the director
or his designee during usual hours of operation:
Personnel records of each ambulance service employee, including
evidence of certification required in Hawaii Revised Statutes Sections
453- 31 to 453-32, and Administrative Rules 16-85-53 to 16-85-56;
Vehicle records for each .ambulance, including preventative and
corrective maintenance records, vehicle registration records, and
records of department of transportation vehicle safety
inspections;
Records of ambulance service activity; trip records, patient care
reports as specified in Section 11-72-22;
Written policies and procedures, including a copy of these
regulations, which provide to its employees guidelines for operating
and maintaining the service and ambulances.
No official entry made upon a license may be defaced, removed, or
obliterated.
No person, either as owner, agent or otherwise, shall advertise or
profess to be engaged in ambulance service in the state unless that
person possesses a valid ambulance license, and all information
contained in such advertisements, signs or other publicity is accurate
and does not mislead or result in misrepresentation to the public.
[Eff. AUG 12 1985 ] (Auth: HRS §§321-223, 321-224, 321-226,
321-227, 321-228, 321-233) (Imp: HRS §§ 321-223, 321-224,
321-226, 321-227, 321-228, 321-233)
§11-72-46 Standards for Ambulance Services; Liability
Insurance
No ambulance shall be operated in the State of Hawaii unless there
is at all times in force and in effect insurance coverage, issued by an
insurance company licensed to do business in the State of Hawaii, for
each and every ambulance owned or operated by or for the applicant
licensee providing for the payment of benefits and including, but not
limited to, the following:
No-fault insurance policy (motor vehicle):
No-fault benefits, as defined in Chapter 294-2, Hawaii Revised
Statutes with respect to any accidental harm arising out of a motor
vehicle accident.
Liability coverage for all damages arising out of bodily injury to
or death of any one person as a result of any one motor vehicle
accident.
Liability coverage for all damages arising out of injury to or
destruction of property, including motor vehicles and including the
loss of use thereof, as a result of any one motor vehicle
accident.
Professional or Occupational Liability or Bodily Injury Insurance (
other than motor vehicle) in an amount of not less than that specified
by the director.
The insurance policies required by this section shall be submitted
to the director for approval prior to the issuance of the ambulance
service license.
[Eff. AUG 12 1985] (Auth: HRS §§321-223, 321-224, 321-226,
321- 227, 321-228, 321-233) (Imp: HRS §§321-223, 321-224,
321-226,321-227)
§11-72-47 Licensing Duties of Director; Licensing
Fee
Within thirty days after receipt of an application for an ambulance
service license, an investigation will be made of the applicant and the
proposed operations;
Prior to issuance or denial of an ambulance service license, an
inspection will be made of the ambulances, equipment and supplies, and
premises designated in the application;
A non-transferable license or denial of the application will be
issued not later than sixty days of receipt of an application; each
license issued to an ambulance service shall specify the ambulances
authorized to be operated under the license and shall be valid for a
period of one year unless earlier amended, suspended, revoked, or
terminated;
The ambulance service license not shall be transferable nor
assignable;
A license will be issued upon receipt of an initial licensing fee
of $ 25 after finding that:
When required under Chapter 323D, Hawaii Revised Statutes, finding
that a certificate of need has been issued.
Each such ambulance and its required equipment and the premises
designated in the application meet the standards of these
regulations;
Only state certified drivers, basic life support personnel,
advanced life support personnel, and prehospital registered nurses are
employed in such capacities; and
All the requirements of these regulations and all other applicable
laws and ordinances have been met.
Subsequent to issuance of an ambulance service license, an
inspection shall be made of each ambulance authorized under the license
and of equipment and premises at least annually and immediately
following any disabling vehicular collision and subsequent repair in
which an ambulance is involved.
Within sixty days a copy of each initial, periodic, or other
investigation and inspection report will be transmitted to the
applicant or ambulance service to whom it refers.
[Eff. AUG 12 1985] (Auth: HRS §§ 321-223, 321-224, 321-226,
321-227, 321-228, 321-233) (Imp: HRS §§321-223, 211-224,
321-226, 321-227)
§11-72-48 Renewal of Ambulance Service License;
Fee
Annual renewal of an ambulance service license shall be obtained
prior to expiration.
The annual renewal fee for a license that has not expired or been
suspended or revoked shall be $20.
The annual renewal fee for a license that has expired for one to
fifty- nine days shall be $25.
[Eff. AUG 12 1985] (Auth: HRS §§321-223, 321-224, 321-226,
321-227, 321-228, 321-233) (Imp: HRS §§321-223, 321-224,
321-226, 321-227, 321-233)
§11-72-49 Revocation of Ambulance Service
License
The director may suspend or revoke an ambulance service license for
failure of a licensee to comply and to maintain compliance with, or for
violation of, an applicable provision, standard, or requirement of
these regulations or of any other applicable law or ordinance or
regulation promulgated thereunder, but only in compliance with the
procedures and requirements of Chapter 91, Hawaii Revised Statutes.
Upon suspension, revocation, or termination of an ambulance service
license the ambulance service shall cease operations as such and no
person shall permit the ambulance service to continue operations.
[Eff. AUG 12 1985] (Auth: HRS §§321-223, 321-224, 321-226,
321-227, 321-233) (Imp: HRS §§ 321-223, 321-224, 321-226,
321-227, 321-233)
§11-72-55 Standards for Ambulance Equipment and
Supplies
Required equipment in each licensed ambulance in use as such shall
include:
Telecommunications equipment for communications with a dispatch
center;
Telecommunications equipment capable of providing communication
with emergency medical facilities or emergency medical physicians;
Equipment for light rescue and extrication is required unless a
fully-equipped rescue service is able to correspond with the ambulance
on a call for which those materials are needed;
Medical equipment and supplies including, but not limited to, the
equipment and supplies prescribed in the documents-entitled Essential
Equipment for Basic Life Support Ambulance Service Standards dated July
15, 1985 and Essential Equipment for Advanced Life Support Ambulance
Service Standards dated July 15, 1985 and available from the
department; and
In the event of an emergency declared by the director, or a
disaster, or a catastrophe, a readily accessible source of additional
supplies, as delineated by the director. (b) The director shall enforce
the equipment and supplies requirements set forth in Section
11-72-45(a).
[Eff. AUG 12 1985] (Auth: HRS §§321-223 321- 224, 321-226,
321-227, 321-233) (Imp: HRS §§321-223, 321-224, 321-226, 321-
227, 321-233)
§11-72-60 Application for Prehospital Registered
Nurses Certificates by the Application Fees
Application for certificates by the department for prehospital
registered nurse shall be made upon forms prepared for such by the
department.
The application forms shall request the following information:
Applicant's name, mailing address, home address, telephone number,
age, sex, color of eyes, color of hair;
Verification that applicant age is 21 years or older;
Such other information as the director requires for the purposes of
these regulations.
The following information shall be obtained in conjunction with the
application:
For certification as a prehospital registered nurse the applicant
must show proof of possession of a certificate from a state-approved
prehospital registered nurse course and evidence of a current valid RN
license from the State of Hawaii.
Each application for a prehospital registered nurse personnel
certificate shall be accompanied by a nonrefundable fee of $2.
[Eff. AUG 12 1985] (Auth: HRS §§321-227, 321-233) (Imp: HRS
§§321-226, 321-227)
§11-72-61 Standards for Prehospital Registered Nurse
Certification; Initial Certificate Fees
Within thirty days after a completed written application form is
filed with the department, an investigation will he made of the
applicant for certification.
A certificate will be issued or the application denied not later
than sixty days of receipt of an application unless earlier suspended,
revoked, or terminated.
A certificate shall be issued after finding that the applicant:
Is not addicted to intoxicating liquors or any drugs;
Is able to speak, read, and write the English language;
Has been found by a licensed physician upon examination attested to
on a physical examination form approved by the director to be suitable
for the work;
Has duly completed all other requirements.
A certificate for a prehospital registered nurse shall not be
assignable or transferable.
BLS or ALS personnel may serve as the driver of a ground motor
ambulance when necessary, provided they possess the proper State of
Hawaii driver's license and meet all other applicable DOT
requirements.
No official entry made upon a certificate may be defaced, removed,
or obliterated.
The director may suspend or revoke a driver or prehospital
registered nurse certificate for failure of the certificate holder to
comply, and to maintain compliance with, or for violation of, the
provisions of this section or any other applicable law, ordinance, or
regulation, in accordance with the provisions of the Hawaii Revised
Statutes Chapter 91.
§11-72-62 Renewal of Prehospital Registered Nurse
Certificates; Fees
Renewal of any prehospital registered nurse certificate by the
state department of health, except for reasons of suspension,
revocation, or expiration of more than sixty days, shall require
presentation of the following, 60 days prior to the expiration of the
certificate:
A current valid State of Hawaii registered nurse license and
prehospital registered nurse refresher training, as approved by the
director.
The annual renewal fee for a certificate that has not expired or
been suspended or revoked shall be $2.00.
Renewal of certificates expired for one to sixty days shall require
completion of a renewal application and a late renewal fee totaling
$5.00.
Renewal of certificates which have been suspended, revoked or
expired for more than sixty days shall require conformance with all the
requirements of these regulations as upon original certification, with
the entire renewal fee being $10.00.
[Eff. AUG 12 1985] (Auth: HRS §§321-223, 321-224, 321-226,
321-227, 321-228, 321-233) (Imp: HRS §§321-223, 321-224,
321-226, 321-227, 321-233)
§11-72-63 Revocation or Suspension of Prehospital
Registered Nurse Certificate
The director may, subject to Chapter 91, Hawaii Revised Statutes,
suspend or revoke a prehospital registered nurse certificate provided
by the department for:
Failure of the certificate holder to comply and to maintain
compliance with, or for his violation of the provisions of this section
or any other applicable law, ordinances, or regulation.
Being habituated to the excessive use of drugs or alcohol; or being
addicted to, dependent on, or a habitual user of a narcotic,
barbiturate, amphetamine, hallucinogen, or other drug having similar
effects.
Providing services while the ability to practice is impaired by
alcohol, drugs, physical disability, or mental instability.
Professional misconduct or gross carelessness or manifest
incapacity in the provison of services.
Conduct or practice contrary to recognized standards of ethics of
the occupation.
Violation of the conditions or limitations upon which a certificate
is issued.
Fraudulent obtaining of certificate.
If any such certificate is revoked, limited, or suspended by the
director of the department subject to Chapter 91, Hawaii Revised
Statutes, for any act or condition listed in this section, the holder
of the certificate shall be notified in writing by the department of
the revocation or suspension. Any certificate which has been revoked
under this section may be restored by the director of the department,
subject to Chapter 91 Hawaii Revised Statutes.
[Eff. AUG 12 1985] (Auth: HRS §§321-223, 321-224, 321-226,
321-227, 321-228, 321-233) (Imp: HRS §§321-223, 321- 224,
321-226, 321-227, 321-233)
§§11-72-64 - 68
(Reserved)
Notice: The above is an excerpt
from State of Hawaii Administrative Rules Title 11, Department of
Health and is presented for general informational purposes only.
Content is as that which may be found in the original, however,
formatting of the text is not identical. Copies of the official text of
the Hawaii Administrative Rules are available at the Office of the
Lieutenant Governor, law libraries throughout the State of Hawaii, and
select law libraries throughout the world. Some of the branches of the
Hawaii State
Public Library System may also have copies; however, please call in
advance to see if the particular Chapter of the Rule you desire is
available.
