The purpose of this rule is to ensure the consistent quality of medical care delivered by air ambulance services in the state of Washington.
(1) Air ambulance services must:
(a) Comply with all regulations and standards in this chapter pertaining to verified ambulance services and vehicles, except that WAC 246-976-290
are replaced for air ambulance services by subsection (4)(b) and (c) of this section;
(b) Comply with the standards in this section for all types of transports, including interfacility and prehospital transports;
(c) Provide proof of compliance with Federal Acquisition Regulation (FAR), 14 C.F.R. Part 135 (October 10, 1978) of the operating requirements; commuter and on demand operations and rules governing persons on board such aircraft.
(2) Air ambulance services currently licensed or seeking relicensure must have and maintain accreditation by the commission on accreditation of medical transport services (CAMTS) or another accrediting organization approved by the secretary as having equivalent requirements as CAMTS for aeromedical transport.
(3) Air ambulance services requesting initial licensure that are ineligible to attain accreditation because they lack a history of operation at the site, must meet the criteria of subsections (4) and (5) of this section and within four months of licensure must have completed an initial consultation with CAMTS or another accrediting organization approved by the secretary as having equivalent requirements as CAMTS for aeromedical transport. A provisional license will be granted for no longer than two years at which time the service must provide documentation that it is accredited by CAMTS or another accrediting organization approved by the secretary as having equivalent requirements as CAMTS for aeromedical transport.
(4) Air ambulance services must provide:
(a) A physician director:
(i) Licensed to practice in the state of Washington;
(ii) Trained and experienced in emergency, trauma, and critical care;
(iii) Knowledgeable of the operation of air medical services; and
(iv) Responsible for supervising and evaluating the quality of patient care provided by the air medical flight personnel;
(b) If the air medical service utilizes Washington certified EMS personnel:
(i) The physician director must be a delegate of the MPD in the county where the air service declares its primary base of operation.
(ii) Certified EMS personnel must follow department-approved MPD protocols when providing care;
(c) Sufficient air medical personnel on each response to provide patient care, specific to the mission, including:
(i) One specially trained, experienced registered nurse or paramedic; and
(ii) One other person who must be a physician, nurse, physician's assistant, respiratory therapist, paramedic, EMT, or other appropriate specialist appointed by the physician director. If an air ambulance responds directly to the scene of an incident, at least one of the air medical personnel must be trained in prehospital emergency care;
(d) Aircraft that, when operated as air ambulances:
(i) Are configured so that the medical personnel can access the patient. The configuration must allow medical personnel to begin and maintain advanced life support and other treatment;
(ii) Allow loading and unloading the patient without excessive maneuvering or tilting of the stretcher;
(iii) Have appropriate communication equipment:
(A) The capability to communicate between flight personnel, hospitals, medical control, and the services communication center;
(B) Helicopters must also have the capability to communicate with ground EMS services and public safety vehicles;
(iv) Are equipped with:
(A) Airway management equipment, including:
(III) Ventilation and intubation equipment, adult and pediatric;
(B) Cardiac monitor/defibrillator;
(C) Supplies, equipment, and medication as required by the program physician director, for emergency, cardiac, trauma, pediatric care, and other missions; and
(D) The ability to maintain appropriate patient temperature;
(v) Have interior lighting for patient care; and
(vi) Helicopter aircraft must have a protective barrier sufficiently isolating the cockpit, to minimize in-flight distraction or interference.
(5) All air medical personnel must:
(a) Be certified in ACLS;
(b) Be trained in:
(i) Emergency, trauma, and critical care;
(ii) Altitude physiology;
(iii) EMS communications;
(iv) Aircraft and flight safety; and
(v) The use of all patient care equipment on board the aircraft;
(c) Be familiar with survival techniques appropriate to the terrain;
(d) Perform under protocols.
(a) If aeromedical evacuation of a patient is necessary because of a life threatening condition and a licensed air ambulance is not available, the nearest available aircraft that can accommodate the patient may transport. The physician ordering the transport must justify the need for air transport of the patient in writing to the department within thirty days after the incident.
(b) Excluded from licensure requirements are:
(i) Air services operating aircraft for primary purposes other than civilian air medical transport. These services may be called to initiate an emergency air medical transport of a patient to the nearest available treatment facility or rendezvous point with other means of transportation. Examples are: United States Army Military Assistance to Safety and Traffic, United States Navy, United States Coast Guard, Search and Rescue, and the United States Department of Transportation;
(ii) Air ambulance services that solely transport patients into Washington state from points originating outside of the state of Washington.
[Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 11-07-078, § 246-976-320, filed 3/22/11, effective 5/15/11. Statutory Authority: RCW 18.73.140. 00-22-124, § 246-976-320, filed 11/1/00, effective 12/2/00. Statutory Authority: Chapters 18.71, 18.73, and 70.168 RCW. 00-08-102, § 246-976-320, filed 4/5/00, effective 5/6/00. Statutory Authority: RCW 43.70.040 and chapters 18.71, 18.73 and 70.168 RCW. 93-01-148 (Order 323), § 246-976-320, filed 12/23/92, effective 1/23/93.]