290-5-30.01

Under the authority of the O.C.G.A. Chapter 31-11, these rules establish standards for ambulance services, medical first responder services, neonatal transport services, designation of trauma centers and base station facilities, training and licensing requirements for medics, instructor licensing and course approval requirements for emergency medical technician, cardiac technician and paramedic training programs, and others as may be related to O.C.G.A. Chapter 31-11. These rules shall be reviewed at a minimum of every four years by the State Office of EMS and revised as necessary.

290-5-30.02

Definitions

The following definitions shall apply in the interpretation of these standards:


    (a) "Advanced Cardiac Life Support (ACLS)" means current successful completion of a course utilizing nationally recognized advanced cardiac care standards as approved by the Department. 

    (b) "Advanced Life Support" (ALS) means the assessment, and if necessary, treatment and/or transportation by ambulance, utilizing medically necessary supplies and equipment provided by at least one individual licensed above the level of Emergency Medical Technician-Basic. 

    (c) "Advanced Life Support (ALS) Assessment" means an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient’s reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. 

    (d) "Advanced Life Support (ALS) Intervention" means a procedure that is, in accordance with state and local laws, beyond the scope of authority of the Emergency Medical Technician-Basic. 

    (e) "Ambulance" means a motor vehicle registered by the department that is specially constructed and equipped and is intended to be used for emergency transportation of patients. 

    (f) "Ambulance Provider" means an agency or company providing ambulance service that is operated under a valid license from the department. 

    (g) "Ambulance Service" means the providing of emergency care and transportation on the public streets and highways of this state for a wounded, injured, sick, invalid, or incapacitated human being to or from a place where medical care is furnished. 

    (h) "Approved" means acceptable to the department based on its determination as to conformance with existing standards. 

    (i) "Basic Life Support" (BLS) means treatment and/or transportation by ground ambulance vehicle and/or treatment with medically necessary supplies and services involving non-invasive life support measures. 

    (j) "Base of Operations" means the primary location at which administration of the service occurs and where records are maintained. An EMS Provider must designate one Base of Operations location within the State of Georgia. US. 

    (k) "Base Station Facility" means a facility responsible for providing direct physician control of emergency medical services. 

    (l) "Board" means the Board of Human Resources. 

    (m) "Cardiac Technician" means a person who has been licensed by the department after having successfully completed a cardiac technician training program approved by the department. 

    (n) "Clinical Preceptor" means a licensed emergency medical technician, paramedic, IV team member, registered nurse, physician’s assistant, allied health professional or physician who meets the requirements for preceptors as established by the department. 

    (o) "Commissioner" means Commissioner of the Department of Human Resources. 

    (p) "Communication Protocols" means guidelines that specify which emergency interventions require direct voice order from medical control in the rendering of prehospital emergency medical care to a patient and may include other guidelines relative to communication between medics and medical control. 

    (q) "CPR Certification" means successful completion of a course in cardiopulmonary resuscitation approved by the department. 

    (r) "Department" means the Department of Human Resources. 

    (s) "First Responder" means an individual who has successfully completed an appropriate first responder course approved by the department and otherwise meets the eligibility requirements set forth in this chapter. 

    (t) "District Emergency Medical Services Medical Director" means a person, having approval of the Regional EMS Council and Office of Emergency Medical Services, who is: a physician licensed to practice medicine in this state; familiar with the design and operation of prehospital emergency services systems; experienced in the prehospital emergency care of acutely ill or injured patients; and experienced in the administrative processes affecting regional and state prehospital emergency medical services systems. The terms "District Emergency Medical Services Medical Director" and "Regional Medical Director" are synonymous. 

    (u) "Emergency" means responding immediately to a request for a non-planned response or an emergency as perceived by a prudent layperson. 

    (v) "Emergency Medical Service" or "EMS" means ambulance services, medical first responder services, and/or neonatal transport services licensed by the department. 

    (w) "Emergency Medical Service Advisory Council" or "EMSAC" means an advisory council established pursuant to the provisions of O.C.G.A. Section 50-4-4 and Georgia Department of Human Resources Administrative Order No. 9, the purpose of which is to advise the department in matters essential to its operations with respect to emergency medical services. 

    (x) "Emergency Medical Service Instructor - Level I" means an individual qualified to teach continuing education, community education, and first responder programs and is currently licensed by the department. 

    (y) "Emergency Medical Service Instructor - Level II" means an individual qualified to teach and coordinate Emergency Medical Technician-Basic and Emergency Medical Technician-Intermediate courses, in addition to the courses taught at Level I, and is currently licensed by the department. 

    (z) "Emergency Medical Service Instructor - Level III" means an individual qualified to teach and coordinate Emergency Medical Technician - Paramedic courses, in addition to the courses taught at Level I and Level II, and is currently licensed by the department. 

    (aa) "Emergency Medical Services Medical Directors Advisory Council" (EMSMDAC) means a council established by the Department to advise the Office of Emergency Medical Services on issues essential to its operation related to medical direction of the EMS system. 

    (bb) "Emergency Medical Services Personnel" means any first responder, licensed emergency medical technician-basic, licensed emergency medical technician-intermediate, licensed cardiac technician, or licensed emergency medical technician-paramedic. 

    (cc) "Emergency Medical Systems Communications Program" means any program established pursuant to Public Law 93-154, entitled the Emergency Medical Services Systems Act of 1973, which serves as a central communications system to coordinate the personnel, facilities, and equipment of an emergency medical services system and which: 

        1. Utilizes emergency medical telephonic screening; 

        2. Utilizes a publicized emergency telephone number; and 

        3. Has direct communication connections and interconnections with the personnel, facilities, and equipment of an emergency medical services system. The terms "Emergency Medical Systems Communications Program" and "Regional Ambulance Zoning Plan" are synonymous. 

    (dd) "Emergency Medical Technician-Basic" or "EMT-B" means a person who has been licensed by the department after having successfully completed an emergency medical technician-basic training program approved by the department. 

    (ee) "Emergency Medical Technician-Intermediate" or "EMT-I" means a person who has been licensed by the department after having successfully completed an emergency medical technician - intermediate training program approved by the department. 

    (ff) "Emergency Medical Technician-Paramedic" means a person who has been licensed by the department after having successfully completed an emergency medical technician-paramedic training program approved by the department. The term "Emergency Medical Technician-Paramedic" is synonymous with the term "Paramedic". 

    (gg) "First Responder Vehicle" means a motor vehicle registered by the department for the purpose of providing response to emergencies by medical first responders. 

    (hh) "Guidelines" (See "medical protocol") 

    (ii) "Health District" means the geographical district designated by the department in accord with O.C.G.A. Section 31-3-15. It may also mean emergency medical services region. 

    (jj) "Inactive Status" in the context of a license or designation issued by the department means said license, or designation is no longer valid due to failure to meet current required standards. 

    (kk) "Infant" means a child up to one year of age. 

    (ll) "Invalid Car" means a non-emergency transport vehicle used only to transport persons who are convalescent, or otherwise nonambulatory, and do not require medical care during transport. 

    (mm) "License" when issued to a person signifies that its facilities, vehicles, personnel and operations comply with O.C.G.A. Chapter 31-11,U Rules and Regulations, and policies of the department. 

    (nn) "License Officer" means the Commissioner of Human Resources or his designee. 

    (oo) "License Renewal Cycle" means a period of time established by the OEMS for renewal of licenses. The term recertification as it applies to individuals is synonymous with license renewal. 

    (pp) "Local Coordinating Entity" means the public or nonprofit private entity designated by the board to coordinate and administer the emergency medical services system for each health district, and make recommendations to the department on other EMS related issues. The terms "Local Coordinating Entity" and "Regional EMS Council" are synonymous. 

    (qq) "Local Medical Director" means a physician licensed to practice in this state, who provides medical direction to a service licensed by the department and is subject to the approval of the Regional EMS Council after interview by the District Emergency Medical Service Medical Director. The terms "Local Medical Director", "Ambulance Service Medical Director" and "Medical Advisor" are synonymous. 

    (rr) "Medic" means any licensed emergency medical technician- basic, emergency medical technician-intermediate, cardiac technician or paramedic. 

    (ss) "Medical Advisor" (See "Local Medical Director"). 

    (tt) "Medical Control" means 

        (a) the immediate and concurrent clinical guidance from a physician to emergency medical services personnel regarding the prehospital management of a patient; or 

        (b) the physician responsible for providing immediate and concurrent clinical guidance to emergency medical services personnel. 

    (uu) "Medical Control Physician" means the physician providing immediate and concurrent clinical guidance to emergency medical services personnel regarding the prehospital management of a patient. 

    (vv) "Medical Direction" means the administrative process of providing medical guidance and/or supervision by a physician to emergency medical services personnel. This may include system design, education, critique, and quality improvement. 

    (ww) "Medical First Responder Service" means an agency or company duly licensed by the department that provides on-site care until the arrival of a licensed ambulance. 

    (xx) "Medical Protocol" means a prehospital treatment guideline, approved by the local EMS medical director, used to manage an emergency medical condition in the field by outlining the permissible and appropriate medical treatment that may be rendered by emergency medical services personnel to a patient experiencing a medical emergency. Portions of the medical protocol may be initiated by the EMS personnel as standing orders, while other portions of the medical protocol may require direct on-line medical control contact for authorization, as specified in the protocol. 

    (yy) "Neonatal Transport Personnel" means licensed or certified health care professionals specially trained in the care of neonates. 

    (zz) "Neonatal Transport Service" means an agency or company duly licensed by the department that provides emergency care and transportation of a neonate to a place where medical care is furnished. 

    (aaa) "Neonatal Transport Vehicle" means a motor vehicle registered by the department that is equipped for the purpose of transporting neonates to a place where medical care is furnished. 

    (bbb) "Neonate" means an infant 0 - 184 days of age, as defined by the Georgia Regional Perinatal Care Program. 

    (ccc) "Office of Emergency Medical Services" (OEMS) means the regulatory subdivision of the Georgia Department of Human Resources, Division of Public Health directly responsible for the Statewide Emergency Medical Services system working in conjunction with and through Regional EMS Offices. 

    (ddd) "Reasonable Distance" means that distance established by the local medical director based on the ambulance service's geographical area of responsibility, the ambulance service's ability to maintain emergency capabilities and hospital resources. 

    (eee) "Recertification Cycle" (See License Renewal). 

    (fff) "Regional Ambulance Zoning Plan" (See "Emergency Medical Systems Communications Program"). 

    (ggg) "Regional EMS Council" (See Local Coordinating Entity).


    (hhh) "Regional Emergency Medical Services Communications Plan" means a plan for the purpose of consolidating and coordinating applicable telecommunications services and facilities into an integrated system within a health district, which insures that the goals and objectives of the State Emergency Medical Services Communication Plan are addressed. 

    (iii) "Regional Medical Director" (See "District Emergency Medical Services Medical Director"). 

    (jjj) "Reserve Ambulance" means an ambulance that temporarily does not meet the standards for ambulance equipment and supplies in these rules and policies of the OEMS. 

    (kkk) "Satellite Station" means a fixed location owned or leased and used by the EMS Provider from which emergency vehicles respond. Such location(s) must be on record with the State and Regional EMS Offices. 

    (lll) "Specialty Care Transport" means transportation in a licensed ambulance or neonatal unit between health care facilities during which certain special skills above and beyond those taught in state approved initial paramedic education are utilized. Nothing in this section authorizes a medic to operate beyond his/her scope of practice. 

    (mmm) "Standing Order" means the prior written authorization by the local EMS medical director for EMS personnel within that service to provide certain elements of a medical protocol to a patient experiencing a medical emergency prior to establishing direct voice communication with medical control. Standing orders commonly authorize the use of certain medications or invasive procedures, and they are a subset of a medical protocol. 

    (nnn) "State Emergency Medical Services Communication Plan" means a plan approved by the Georgia Technology Authority or its successor agency, for the purpose of consolidating and coordinating telecommunications services and facilities into an integrated system for the state of Georgia.

290-5-30.03

(1)  Purpose. Pursuant to the provisions of O.C.G.A. Section 50-4-4 and Department of Human Resources Administrative Order #9 there is established an Emergency Medical Services Advisory Council to the department. The purpose of this council is to advise the department in matters essential to its operations with respect to emergency medical services system.

(2)  General Provisions.
    a.  Council recommendations are advisory and are not binding on the department or agencies under contract to the department.
    b.  The Council shall be composed of members who collectively are knowledgeable in the field of emergency medical service systems and all components thereof, who represent a broad section of Georgia's citizens, including consumers of services, providers of services, and recognized experts in the field.
    c.  Members shall be appointed by the commissioner, subject to approval of the board, for a term specified in the council bylaws.
    d.  The Council shall adopt bylaws for its self-government subject to the approval of the department and shall conduct its business according to established rules of order in keeping with the Georgia Open Records Act. Said bylaws shall address frequency of meetings, recording of minutes, creation and function of committees, and other issues relevant to the function of an advisory council.
    e.  Staff assistance and expenses essential to the operations of the Council shall be provided from the resources of the Division of Public Health and are subject to the Division's approval.
    f.  Responsibilities shall include, but not be limited to: reviewing and providing comment on legislative activities, standards, and policies which affect those persons, services, or agencies regulated under these rules and O.C.G.A. Chapter 31-11; and, participating as an advocacy body to improve Georgia's statewide emergency medical services systems and all components thereof.

290-5-30.04

(1)  Purpose. The Department shall establish an Emergency Medical Services Medical Directors Advisory Council (EMSMDAC) to advise the OEMS on issues essential to its operation related to medical direction of the EMS system.

(2)  General Provisions.
    (a)  The council members shall be appointed by the commissioner, subject to approval of the Board, for a term specified in council bylaws.
    (b)  The Council shall be composed of physician members who collectively are knowledgeable in the field of EMS systems and all components thereof, and who represent a broad section of the Georgia’s EMS programs and the medical community.
    (c)  The Council shall adopt bylaws for its self-government subject to the approval of the department and shall conduct its business according to established rules of order, in keeping with the Georgia Open Records Act. Said bylaws shall address frequency of meetings, recording of minutes, creation and function of committees, and other issues relevant to the function of an advisory council.

(3)  Responsibilities of EMSMDAC shall include, but not be limited to:
    (a)  Act as a liaison with the medical community, medical facilities, and appropriate governmental entities;
    (b)  Advise and provide consultation to OEMS on practice issues related to the care delivered by entities and personnel under the jurisdiction of the OEMS;
    (c)  Advise on and review matters of medical direction and training in conformity with accepted emergency medical practices and procedures;
    (d)  Recommend and review policies and procedures affecting patient care rendered by Emergency Medical Services personnel;
    (e)  Advise on the scope and extent of EMS practice for the emergency medical services of Georgia;
    (f)  Advise on the formulation of medical, communication and emergency transportation protocols; and
    (g)  Advise on quality improvement issues related to patient care rendered by Emergency Medical Services personnel.

290-5-30.05

(1)  Purpose. The board shall have the authority on behalf of the state to designate a public or nonprofit local entity to coordinate and administer the regional ambulance zoning plan (Emergency Medical Systems Communication Program), provide the guidance for developing the regional emergency medical services communication plan, make recommendations for the designation of base station facilities, make recommendations for the designation of trauma centers and to serve in an advisory capacity to the department and to perform other duties as directed by the department. Upon approval of the regional EMS council bylaws, the board will ensure that the council will be composed of individuals who are both knowledgeable or interested in the emergency medical services system and representative of the interest of a broad cross-section of the health district's citizens including consumers, private health care providers, public health care providers, and governmental entities.

(2)  Duties of the Regional EMS Council shall include:
    (a)  Recommend to the board or its designee the Regional Ambulance Zoning Plan.
    (b)  Develop the Regional Emergency Medical Services Communications Plan.
    (c)  Recommend to the board or its designee the designation of Base Station Facilities.
    (d)  Recommend to the Board or its designee the designation and redesignation of Trauma Centers as specified in department policy and in these Rules.
    (e)  Make other recommendations or provide other functions as directed by the department, rules and regulations or statute.
    (f)  Recommendations. Regional EMS council recommendations directed to the department are advisory and not binding to the department unless expressly stated otherwise in statute or these rules and regulations.

290-5-30.06

(1)  Applicability.
    (a)  This section shall not prevent any hospital or medical facility from providing medical care to any trauma patient.
    (b)  No hospital or medical facility shall hold itself out or advertise to be a designated trauma center without first meeting the requirements of these rules.

(2)  Designation.
    (a)  The OEMS shall define in policy the process for trauma center designation and redesignation.
    (b)  The OEMS has the authority to review, enforce and recommend removal of trauma center designation for trauma centers failing to comply with applicable statutes, Rules and Regulations and department policy.
    (c)  Designation will be for a period of three (3) years.
    (d)  Each designated trauma center will be subject to periodic review

290-5-30.07

 (1)  Applicability.
    (a)  No person shall operate, advertise, or hold themselves out to be an ambulance service in the state of Georgia without being in compliance with the provisions of O.C.G.A. Chapter 31-11 and these rules and regulations and without being duly licensed by the department. However, this Rule shall not apply to the following:
        1.  An ambulance or ambulance service operated by an agency of the United States government;
        2.  A vehicle rendering assistance temporarily in the case of a major catastrophe or disaster which is beyond the capabilities of available Georgia licensed ambulance services;
        3.  An ambulance operated from a location outside of Georgia and transporting patients picked up beyond the limits of Georgia to locations within Georgia;
        4.  An invalid car or the operator thereof.
        5.  An ambulance service licensed to operate in another state and transporting patients picked up at a medical facility within the limits of Georgia to locations outside the limits of Georgia unless such ambulance is pre-positioned within the limits of Georgia prior to receiving the request for transport.
    (b)  No provision of these rules shall be construed as prohibiting or preventing a municipality from fixing, charging, assessing or collecting any license fee or registration fee on any business or profession or anyone engaged in any related profession governed by the provisions of these rules, or from establishing additional regulations regarding ambulance service as long as there is no conflict with these rules.

(2)  Application for a License or provisional license shall be made to the license officer in the manner and on the forms approved by the license officer.

(3)  Renewal of License. Renewal of any license issued under the provisions of O.C.G.A. Chapter 31-11 shall require conformance with all the requirements of these rules and regulations as upon original licensing.

(4)  Standards for Ambulances.
    (a)  General.
        1.  Ambulances must be maintained on suitable premises that meet the county health code and/or the department's specifications. The OEMS is authorized to establish policy to define minimal standards for suitable premises and base of operations. Ambulances including raised roof van or modular type, must be of a design approved by the department that meets a 60-inch headroom requirement in the patient compartment. The interior of the patient compartment shall provide a minimum volume of 30 cubic feet of enclosed and shelf storage space that shall be conveniently located for medical supplies, devices, and installed systems as applicable for the service intended. The ambulance must be properly equipped, maintained, and operated in accordance with other rules and regulations contained herein and be maintained and operated so as to contribute to the general well-being of patients. Heat and air conditioning must be available and operational in both the patient compartment and driver compartment.
        2.  All ambulances must be equipped with approved safety belts for all seats.
        3.  Prior to their use, ambulances must be inspected and approved by the department and so registered by affixing a department decal at a location specified by the department.
        4.  Each ambulance service may place one-third (rounded to nearest whole number) of its registered ambulances in reserve status, e.g.
          2 to 4 registered ambulances - 0 to 1 may be reserve ambulances
          5 to 7 registered ambulances - 0 to 2 may be reserve ambulances
          8 to 10 registered ambulances - 0 to 3 may be reserve ambulances
          11 to 13 registered ambulances - 0 to 4 may be reserve ambulances et cetera. When a reserve ambulance is placed in service (ready to respond to an emergency call) it must meet the provisions of these rules and policies of the OEMS.
        5.  Prior to disposal by sale or otherwise, an ambulance removed from service must be reported to the department and have the department's decal removed.
        6.  All registered ambulances shall have on both sides of the vehicle an identification number designated by the department. The name of the service shall be on each side of the vehicle in at least 3-inch lettering for proper identification.
    (b)  Insurance:
        1.  Every ambulance operated by persons engaged in providing ambulance service shall have at least $1,000,000 combined single limit (CSL) insurance coverage.
        2.  No ambulance shall be registered nor shall any registration be renewed unless the ambulance has insurance coverage in force as required by this section. A certificate of insurance or satisfactory evidence of self-insurance shall be submitted to the license officer for approval prior to the issuance or renewal of each ambulance license. Satisfactory evidence that such insurance is at all times in force and effect shall be furnished to the license officer, in such form as he may specify, by all licensees required to provide proof of such insurance under this section. Any lapse in insurance coverage will lead to immediate revocation of the ambulance service license.
        3.  EMS providers must maintain a file, as defined in departmental policy, of all maintenance records on each vehicle registered by the department.
    (c)  Service License Fee:
        1.  Every ambulance service, whether privately operated or operated by any political subdivision of the state or any municipality, as a condition of maintaining a valid license shall pay an annual license fee to the license officer in an amount to be determined by the Board of Human Resources. The amount of said license fee may be periodically revised by said board. Said license fee shall become due and payable upon the initial issuance of the license and each year thereafter on the anniversary date of the initial license issuance.
    (d)  Communication:
        1.  Each registered ambulance shall be equipped with a two-way communication system that provides ambulance-to-hospital communication that meets the standard set in the Regional EMS Communication Plan.
        2.  All ambulance providers shall have two-way radio communication between each ambulance and the location receiving requests for emergency service.
        3.  The ambulance radio shall be able to operate within the regional emergency medical services communications plan.
    (e)  Infectious Disease Exposure Control:
        1.  Each ambulance service shall have an exposure control plan approved by the local medical director.
        2.  Ambulance providers and emergency medical services personnel shall comply with all applicable local, state, and federal laws and regulations in regard to infectious disease control procedures.
    (f)  Equipment and Supplies:
        1.  All equipment and supplies must be maintained in working order and shall be stored in an orderly manner so as to protect the patient and be readily accessible when needed.
        2.  Expiration dates must be adhered to.
        3.  In order to substitute any item for the required items, written approval must be obtained from the OEMS. The OEMS shall have authority to grant exceptions and substitutions and shall maintain and distribute an up-to-date policy listing of all approved exceptions and substitutions.
        4.  The OEMS shall establish through policy the minimum equipment and supplies required on each ambulance; however, other equipment and supplies may be added as desired.

(5)   Records of Ambulance Services.
    (a)   Records of each ambulance response shall be made by the ambulance service in a manner, frequency and on such printed or electronic prehospital care report forms as may be approved by the department. A printed or electronic prehospital care report utilizing the set of data elements approved by the department must be completed for each response initiated and/or completed by the EMS provider. These prehospital care reports must contain the signature of the medics and the licensed physician or licensed professional nurse or paramedic receiving the patient. When orders are received or standing orders/protocols implemented, the prehospital care report shall be signed by the physician except when a designated base station facility is used for medical control. When a designated base station is used, recording of the medical control patient log number on the prehospital care report may substitute for the physician's signature. Such records shall be available for inspection by the department, or its authorized agents, during reasonable business hours. An electronic file of all responses, in a format approved by the department, or a copy of all prehospital care reports for ambulance responses each month must be forwarded to the department by the tenth (10th) of the following month. The department will define a subset of the data that must be provided.
    (b)  Training records for each employee containing pertinent information regarding licensing as a medic, and any other department required courses shall be maintained and readily available for the department, or its authorized agents, upon request at the base location.
    (c)  A dispatch record shall be maintained on all calls received. The record shall be maintained for a minimum of three (3) years and shall contain at a minimum, when applicable, but not be limited to, the following:
        1.  Date call received;
        2.  Time call received;
        3.  Source of call;
        4.  Call back telephone number;
        5.  Location of patient;
        6.  Apparent problem(s);
        7.  Unit dispatched and time of dispatch;
        8.  Time arrived at scene;
        9.  Time left scene;
        10.  Time arrived at patient’s destination; and
        11.  Destination of patient.

(6)  General Provisions for Ambulance Services.
    (a)  No person shall operate an ambulance service in the state of Georgia without having a valid license or provisional license issued by the license officer pursuant to the provisions of this chapter.
    (b)  No person shall make use of the word "ambulance" to describe any ground transportation or facility or service associated therewith which such person provides or to otherwise hold oneself out to be an ambulance service unless such person has a valid license issued pursuant to the provisions of this chapter or is exempt from licensing under this chapter.
    (c)  Each ambulance while transporting a patient shall be manned by not less than two Emergency Medical Services Personnel (emergency medical technician-basic, emergency medical technician-intermediate, cardiac technician, and/or paramedic), one of whom must be in the patient compartment. Only one individual licensed at the emergency medical technician - basic level can be used to satisfy this requirement. If advanced life support is being rendered, personnel qualified to administer the appropriate level of advanced life support must be in the patient compartment and responsible for patient care.
    (d)  When a medic possesses an additional Georgia healthcare provider license, the medic may perform to the higher level of training for which he/she is qualified under that license when directed to do so by a physician, either directly or by approved protocols.
    (e)  Interhospital transfers shall be conducted by licensed ambulance services in registered ambulances when the patient requires, or is likely to require, medical attention during transport. The transferring or receiving physician may request the highest level of emergency medical services personnel available and/or additional qualified medical personnel to attend the patient during the interhospital transfer. If requested, the ambulance service must allow the highest level medical personnel available to attend to the patient during the interhospital transfer.
    (f)  Ambulance services shall be provided on a twenty-four hour, seven day a week basis.
    (g)  Personnel shall be available at all times to receive emergency telephone calls and provide radio communications.
    (h)  Sufficient licensed personnel shall be immediately available to respond with at least one ambulance. When the first ambulance is on a call, ambulance providers shall respond to each additional emergency call within their designated geographic territory as requested provided that medics and an ambulance are available. If medics and an ambulance are not available, the ambulance provider shall request mutual aid assistance. If mutual aid assistance is not available the ambulance provider shall respond with its next available ambulance.
    (i)  Medical Direction for Ambulance Services.
        1.  To enhance the provision of emergency medical care, each ambulance service, except those in counties with populations less than 12,000, shall be required to have a medical director. The local medical director shall be a physician licensed to practice medicine in the state of Georgia and subject to approval by the regional EMS council. The local medical director must have agreed in writing to provide medical direction to a specific ambulance service. If an ambulance provider is unable to obtain a medical director due to unavailability or refusal of physicians to act as the local medical director, the district health director or his designee may serve as medical director until the services of a physician are available
        2.  The local medical director shall serve as medical authority for the ambulance service, serving as a liaison between the ambulance service and the medical community, medical facilities and governmental entities.
        3.  It will be the responsibility of the local medical director to provide for medical direction and training for the ambulance service personnel in conformance with acceptable emergency medical practices and procedures.
        4.  Duties of the local medical director shall include but not be limited to the following:
            a.  The approval of policies and procedures affecting patient care;
            b.  The formulation of medical protocols and communication protocols; and
            c.  The formulation and evaluation of training objectives;
            d.  Performance evaluation; and
            e.  Continuous quality improvement of patient care.
        5.  All emergency medical services personnel shall comply with appropriate policies, protocols, requirements, and standards of local medical director for that service, or the policies, protocols, requirements, and standards provided by the regional medical director for those services not having a medical director, provided that such policies are not in conflict with these Rules and Regulations or other state statutes.
    (j)  Control of patient care at the scene of an emergency shall be the responsibility of the individual in attendance most appropriately trained and knowledgeable in providing prehospital emergency stabilization and transport. When a medic arrives at the scene of a medical emergency, and contact is made with medical control by that medic, a physician/patient relationship is established between the patient and the physician providing medical control. The physician is responsible for the management of the patient and the medic acts as an agent of medical control unless a patient's physician is present. When a physician other than the patient's physician on the scene of a medical emergency properly identifies himself and demonstrates his willingness to assume responsibility for patient management and documents his intervention by signing the patient care report, the medic should place the intervening physician in communication with medical control. If there is disagreement between the intervening physician and the medical control physician, or if the intervening physician refuses to speak with medical control, the medic should continue to take orders from the medical control physician.
    (k)  Any ambulance that arrives at the scene of an emergency without having been requested or designated responsible by the regional zoning plan, shall provide the emergency medical care necessary to sustain and stabilize the patient until the arrival of the designated ambulance provider. A non-designated ambulance provider shall not transport a patient from the scene of a medical emergency except under the following conditions:
        1. The designated ambulance is canceled by the appropriate dispatching authority with approval of the responding designated ambulance provider; or
        2. Medical control determines that the patient's condition is life-threatening or otherwise subject to rapid and significant deterioration and there is clear indication that, in view of the estimated time of arrival of the designated ambulance the patient's condition warrants immediate transport. (In the event the medic is unable to contact medical control, the medic will make this decision.) The transporting ambulance service shall file a copy of the emergency trip report including an explanation of the incident to the department within seven (7) calendar days of the transport.
    (l)  Hospital Destination of Prehospital Patients.
        1.  When a patient requires initial transportation to a hospital, the patient shall be transported by the ambulance service to the hospital of his/her choice provided:
            a.  The hospital chosen is capable of meeting the patient's immediate needs;
      b.  The hospital chosen is within a reasonable distance as determined by the medic's assessment in collaboration with medical control so as to not further jeopardize the patient's health or compromise the ability of the EMS system to function in a normal manner; and
      c.  The hospital chosen is within a usual and customary patient transport or referral area as determined by the local medical director.
        2.  If the patient's choice of hospital is not appropriate or if the patient does not, can not, or will not express a choice, the patient's destination will be determined by pre-established guidelines. If for any reason the pre-established guidelines are unclear or not applicable to the specific case, then medical control shall be consulted for a definitive decision.
        3.  If the patient continues to insist on being transported to the hospital he/she has chosen, then the patient shall be transported to that hospital after notifying local medical control of the patient's decision. The choice of hospital for the patient may be selected pursuant to O.C.G.A. Section 31-9-2.
        4.  If the patient does not, cannot, or will not express a choice of hospitals, the ambulance service shall transport the patient to the nearest hospital believed capable of meeting the patient's immediate medical needs without regard to other factors, e.g., patient's ability to pay, hospital charges, county or city limits, etc.
    (m)  Ambulance providers shall not misrepresent or falsify any information on forms filed with the department or completed as a result of any ambulance response.
    (n)Ambulance providers shall not employ, continue in employment, or use as EMS personnel any individuals who are not properly licensed under the applicable provisions of O.C.G.A. Chapter 31-11 and these rules and regulations

 290-5-30.08

(1) Applicability
    (a) Any ambulance provider may utilize a registered ambulance for the transport of neonates.
    (b) No person shall hold themselves out to be a licensed neonatal transport service, or advertise as such without meeting the following requirements and without being duly licensed by the department. However, the provisions of this chapter shall not apply to any neonatal transport vehicle operated by an agency of the United States government.

(2) Application for Neonatal Transport Service License Application for a License shall be made to the license officer in the manner and on the forms prescribed by the license officer.

(3) License Fee.
    (a) As a condition of maintaining a valid license, every neonatal transport service, whether privately operated or operated by any political subdivision of the state or any municipality, shall pay an annual license fee to the license officer in an amount to be determined by the Board of Human Resources. The license fee may be periodically revised by the Board. The license fee shall become due and payable upon the initial issuance of the license and each year thereafter on the anniversary date of the initial license issuance.
        1.  This fee shall not be applicable in cases where the provider is also licensed as an ambulance service, uses the vehicles for dual-purposes, and pays the fee under the ambulance license.

(4) Renewal of License. Renewal of any license issued under the provisions of these rules shall require conformance with all the requirements of these rules as upon original licensing.

(5) Standards for Neonatal Transport Vehicles.
    (a)  General.
        1.  A registered neonatal transport vehicle is a special type of vehicle and must be maintained on suitable premises that meets the county health code and/or the department's specifications. The OEMS is authorized to establish policy to define minimum standards for suitable premises and base of operations.
        2.  The registered vehicle must be properly equipped, maintained, and operated in accordance with these rules and regulations so as to contribute to the general well-being of patients. Heat and air conditioning must be available and operational in both the patient compartment and driver compartment.
        3.  The vehicle must have sufficient floor space to accommodate two neonatal transport isolettes and a crew of three in the patient compartment.
        4.  Each vehicle must be equipped with an electrical generator of at least 3.0 kilowatt output and an electrical inverter or motor generator of at least 1000 watts capacity.
        5.  There must be at least one compressed air outlet and one oxygen outlet available to each isolette.
        6.  There must be at least one duplex electrical outlet available to each isolette.
        7.  There must be at least one electrical wall-mounted suction outlet in the vehicle.
        8.  All registered neonatal transport vehicles must be equipped with approved safety belts for all seats.
        9.  Registered neonatal transport vehicles must be inspected and approved by the department and so designated by affixing a department decal at a location specified by the department.
        10.  Prior to disposal by sale or otherwise, a registered neonatal transport vehicle removed from service must be reported to the department and have the department's decal removed.
        11.  The name of the service shall be on each side of the vehicle in at least 3-inch lettering for proper identification. In addition to the name of the service, each vehicle shall have the words "neonatal" or "neonatal transport" prominently displayed on each side of the vehicle.
    (b) Insurance.
        1.  Every registered neonatal transport vehicle shall have at least $1,000,000 combined single limit (CSL) insurance coverage.
        2.  No neonatal transport vehicle shall be registered nor shall any registration be renewed unless the vehicle has insurance coverage in force as required by this section. A certificate of insurance or satisfactory evidence of self-insurance shall be submitted to the license officer for approval prior to the issuance or renewal of each neonatal transport service license. Satisfactory evidence that such insurance is at all times in force and effect shall be furnished to the license office, in such form as the license officer may specify, by all licensees required to provide proof of such insurance under this section. Any lapse in insurance coverage will lead to immediate revocation of the neonatal transport service license.
        3.  Neonatal transport providers must maintain a file, as defined in departmental policy, of all maintenance records on each vehicle registered by the department.
    (c) Communication.
        1.  Each registered neonatal transport vehicle shall be equipped with a two-way communication system that provides ambulance-to-hospital communication that meets the standard set in the Regional EMS Communication Plan.
        2.  The neonatal transport vehicle radio shall be able to operate within the regional emergency medical services communication plan.
    (d)  Infectious Disease Exposure Control.
        1. Each neonatal transport service shall have an exposure control plan approved by the local medical director.
        2. Neonatal transport providers and emergency medical services personnel shall comply with all applicable local, state and federal laws and regulations in regard to infectious disease control procedures.
    (e)  Equipment and Supplies.
        1.  All equipment and supplies must be maintained in working order and shall be stored in an orderly manner so as to protect the patient and shall be readily accessible when needed.
        2.  Expiration dates must be adhered to. 3. In order to substitute any item from the required items, written approval must be obtained from the OEMS. The OEMS shall have authority to grant exceptions and substitutions and shall maintain and distribute an up-to-date policy listing of all approved exceptions and substitutions. 4. Vehicles approved to operate as both a neonatal transport vehicle and an ambulance must be inspected as both. 5. The OEMS shall establish through policy the minimum equipment and supplies required for each neonatal transport unit while being used to transport neonates; however, other equipment may be added as desired.
    (f)  Supplies and Medications.
        1.  The types and quantities of supplies and medications to be carried in the vehicle while being used to transport neonates shall be determined by the medical director of the neonatal transport service in conformance with current medical standards of care in the treatment and transportation of neonates.
        2.  A listing of the supplies and medications shall be updated at least annually and signed by the medical director and a copy thereof is to be in the vehicle at all times. This list shall be used for any inspection purposes by the department.
    (g)  Personnel.
        1.  Neonatal transport personnel shall function under protocols developed by the medical director.
        2.  Neonatal transport personnel with appropriate skills to treat and transport a neonate must be in the patient compartment during transport. Documentation attesting to their qualifications shall be signed by the local medical director and on file at the base location.
        3.  The driver of the vehicle shall be a Georgia licensed medic (emergency medical technician-basic, emergency medical technician-intermediate, cardiac technician, or paramedic).
        4.  A minimum of two (2) patient care personnel shall be in the patient compartment and shall consist of any combination of the following during initial transport to the tertiary care center as determined by the local medical director:
            a.  Paramedic;
            b.  Registered Nurse;
            c.  Respiratory Care Technician;
            d.  Physician’s Assistant; or
            e.  Physician. Only one (1) of the above shall be required in the patient compartment during transport back to the initial referring facility.
    (h)  Records of Neonatal Transport Response.
        1. Records of each neonatal transport response shall be made by the neonatal transport service in a manner, frequency and on such prehospital care report forms as may be approved by the department. A printed or electronic prehospital care report utilizing the set of data elements approved by the department must be completed for each response initiated and/or completed by the neonatal transport provider. This data portion of the form is not considered part of the patient's medical record.
        2. These prehospital care reports must contain the signature of the neonatal transport personnel and the licensed physician or licensed professional nurse or paramedic receiving the patient. When orders are received or standing orders and or protocols implemented, the prehospital care report shall be signed by the physician except when a designated base station facility is used for medical control. When a designated base station is used, recording of the medical control patient log number on the prehospital care report may substitute for the physician's signature.
        3. Such records shall be available for inspection by the department, or its authorized agents, during reasonable business hours. A detailed electronic file of all responses, in a format approved by the department, or a copy of all prehospital care reports for ambulance responses must be forwarded to the department by the tenth (10th) of the following month. The department will define a subset of the data that must be provided.
    (i)  A dispatch record shall be maintained on all calls received. The record shall contain at a minimum, when applicable, but not be limited to, the following:
        1.  Date call received;
        2.  Time call received;
        3.  Source of calls;
        4.  Call back telephone number;
        5.  Location of patient;
        6.  Apparent problem(s);
        7.  Unit dispatched and time of dispatch;
        8.  Time arrived at scene;
        9.  Time left scene;
        10.  Time arrived at transferring facility (if applicable);
        11.  Time left transferring facility (if applicable);
        12.  Time arrived at receiving facility; and
        13.  Destination of patient.

(6) General Provisions.
    (a)  The local medical director shall be a physician licensed to practice medicine in the state of Georgia, be a member of the staff of the neonatal intensive care facility from which the service originates or with which the service is contracted, and provide medical direction for the neonatal transport service.
    (b)  Neonatal transport services shall be provided on a twenty-four hour, seven day a week basis.

 290-5-30.09

(1) Applicability.
    (a) No person shall hold himself out to be a medical first responder service, or advertise as such in the state of Georgia without first meeting the following requirements and being duly licensed by the department.
    (b) However, the provisions of this chapter shall not apply to:
        1. Any first responder unit operated by an agency of the United States government.
        2. Any rescue organization duly licensed by the Georgia Emergency Management Agency to include its individual members.
        3. Any person or designated first responder unit directly requested to the scene of an emergency by an appropriate public safety agency or ambulance service for the purpose of rendering on-site care, rescue and/or extrication, until the arrival of a duly licensed ambulance service or duly licensed medical first responder service. This includes agencies routinely requested to the scene in this manner that cannot or chooses not to meet the requirements of these rules.
        4. Any supervisory vehicle of a licensed ambulance service.
        5. A person, rendering assistance temporarily in the case of a major catastrophe or disaster which is beyond the capability of licensed medical first responder services or licensed ambulance services.

(2) Application for a License.
    (a) Application for a License shall be made to the license officer in the manner and on the forms approved by the license officer.

(3) Renewal of License. Renewal of any license issued under the provisions of the rules shall require conformance with all the requirements of these rules as upon original licensing.

(4) Standards for First Responder Vehicles.
    (a) General.
        1. Registered first responder vehicles must be maintained on suitable premises that meet the county health code and/or the department's specifications. The OEMS is authorized to establish policy to define minimum standards for suitable premises and base of operations. The registered vehicle must be properly equipped, maintained, and operated in accordance with other Rules and Regulations contained herein.
        2. All registered first responder vehicles must be equipped with approved safety belts for all seats.
        3. Registered first responder vehicles must be inspected and approved by the department and so designated by affixing a department decal at a location specified by the department.
        4. Prior to disposal by sale or otherwise, a registered first responder vehicle removed from service must be reported to the department and have the department's decal removed.
        5. All registered first responder vehicles shall have on both sides of the vehicle an identification number designated by the department. The name of the service shall be on each side of the vehicle in at least 3-inch lettering for proper identification.
    (b) Insurance.
        1. Every registered first responder vehicle shall have at least $1,000,000 combined single limit (CSL) insurance coverage.
        2. No medical first responder vehicle shall be registered nor shall any registration be renewed unless the vehicle has insurance coverage in force as required by this section. A certificate of insurance or satisfactory evidence of self-insurance shall be submitted to the license officer for approval prior to the issuance or renewal of each medical first responder service license. Satisfactory evidence that such insurance is at all times in force and effect shall be furnished to the license officer, in such form as the license officer may specify, by all licensees required to provide proof of such insurance under this section. Any lapse in insurance coverage will lead to immediate revocation of the medical first responder service license.
        3. Medical first responder providers must maintain a file, as defined in departmental policy, of all maintenance records on each vehicle registered by the department.
    (c) Communication.
        1. Each registered first responder vehicle shall be equipped with a two-way communication system that provides ambulance-to-hospital communication that meets the standard set in the Regional EMS Communication Plan.
        2. All medical first responder providers shall have two-way radio communication between each ambulance and the location receiving requests for emergency service.
        3. The registered first responder vehicle radio shall be able to operate within the regional emergency medical services communication plan.
    (d) Infectious Disease Exposure Control
        1. Each medical first responder service shall have an exposure control plan approved by the local medical director.
        2. Medical first responder providers and emergency medical services personnel shall comply with all applicable local, state and federal laws and regulations in regard to infectious disease control procedures.
    (e) Equipment and Supplies
        1. All equipment and supplies must be maintained in working order and shall be stored in an orderly manner so as to protect the patient and shall be readily accessible when needed.
        2. Expiration dates must be adhered to.
        3. In order to substitute any item from the required items written approval must be obtained from the OEMS. The OEMS shall have authority to grant exceptions and substitutions and shall maintain and distribute an up-to-date policy listing of all approved exceptions and substitutions.
        4. The OEMS shall through policy establish the minimum equipment and supplies required on medical first responder units; however, other equipment and supplies may be added as desired.

(5) Records of Medical First Responder Services.
    (a) Records of each medical first responder response shall be made by the medical first response service in a manner, frequency and on such prehospital care report forms as may be approved by the department. A printed or electronic prehospital care report utilizing the set of data elements approved by the department must be completed for each response initiated and/or completed by the medical first responder provider. This data portion of the form is not considered part of the patient's medical record.
    (b) These prehospital care reports must contain the signatures of the medics and the licensed physician or licensed professional nurse or paramedic receiving the patient. When orders are received, or standing orders and or protocols implemented, the prehospital care report shall be signed by the physician except when a designated base station facility is used for medical control. When a designated base station is used, recording of the medical control patient log number on the prehospital care report may substitute for the physician's signature.
    (c) Such records shall be available for inspection by the department, or its authorized agents, during reasonable business hours. A detailed electronic file of all responses, in a format approved by the department, or a copy of all prehospital care reports for ambulance responses must be forwarded to the department by the tenth (10th) of the following month. The department will define a subset of the data that must be provided.
    (d) Training records for each employee containing pertinent information regarding licensing as a medic, and any other department required courses shall be maintained and readily available for the department, or its authorized agents, upon request, at the base location.
    (e) A dispatch record shall be maintained on all calls received. The record shall contain at a minimum, when applicable, but not be limited to, the following:
        1. Date call received.
        2. Time call received;
        3. Source of call;
        4. Call back telephone number;
        5. Location of patient;
        6. Apparent problem(s);
        7. Unit dispatched and time of dispatch; and
        8. Time arrived at scene.

(6) General Provisions: Medical First Responder Services.
    (a) Each registered first responder vehicle when on an emergency call shall be manned by at least one of the following: emergency medical technician-basic, emergency medical technician-intermediate, cardiac technician, or paramedic. If advanced life support is being rendered, there must be at least one emergency medical technician-intermediate, cardiac technician or paramedic responsible for patient care.
    (b) Medical first responder services shall be provided on a twenty-four hour, seven day a week basis.
    (c) Personnel shall be available at all times to receive emergency telephone calls and provide radio communications.
    (d) Sufficient licensed personnel shall be immediately available to respond with at least one registered first responder vehicle. When the first registered first responder vehicle is on a call, providers shall respond to each additional emergency call within their designated geographic territory as requested providing a medic and a registered first responder vehicle are available. If a medic and a registered first responder vehicle are not available, the medical first responder service shall request mutual aid assistance. If mutual aid assistance is not available the provider shall respond with its next available registered vehicle.
    (e) The driver of a registered first responder vehicle, when responding to an emergency call, is authorized to operate the vehicle as an emergency vehicle pursuant to the provisions of O.C.G.A. Section 40-6-6.
    (f) Medical Direction for Medical First Responder Services.
        1. To enhance the provision of emergency medical care, each medical first responder service, except those in counties with populations less than 12,000, shall be required to have a medical director. The medical director shall be a physician licensed to practice medicine in this state. If a medical first responder service is unable to obtain a medical director, due to unavailability or refusal of physicians to act as medical director, the district health director or his designee shall serve as local medical director until the services of a physician are available.
        2. It will be the responsibility of the local medical director to provide medical direction and training when appropriate for the medical first responder service personnel in conformance with acceptable emergency medical practices and procedures. These responsibilities include: the formulation of policies and procedures affecting patient care; the formulation and evaluation of training objectives and performance; and quality control of patient care, including the evaluation of protocols, procedures and field techniques in accordance with department regulations.
        3. The medical director of a medical first responder service must coordinate the medical protocols and procedures of the service with the medical director of a local licensed ambulance service.
    (g) Medical first responder services shall not misrepresent or falsify any information on forms filed with the department.
    (h) Medical first responder services shall not employ, continue in employment, or use as medics (emergency medical technician-basics, intermediates, cardiac technicians or paramedics) individuals who are not properly licensed under the applicable provisions of O.C.G.A. Chapter 31-11 and these Rules and Regulations.
    (i) Medical first responder services are required to notify the area dispatch center designated by the regional ambulance zoning plan as responsible for distributing ambulance calls prior to departure on any direct calls received.

(7) Provision of Part-time Medical First Responder Services. Medical first responder services may choose to provide part-time or less than a twenty-four hour, seven-day a week service by entering into contracts to provide such service with any operator of a public or private gathering place which is routinely open to the public during specified times but not a twenty-four hour, seven day a week basis. In such case, medical first responder service must be provided during all times the gathering place is open to the public. However, in the case of a college or university, medical first responder service may be provided at such times the student enrollment or other considerations require. Owners and operators of such public or private gathering places may also provide their own medical first responder service, so long as provision of such service complies with the provisions of these rules. Each such provider shall file with the license officer and the designated ambulance service a report containing the time periods during which medical first responder service is to be provided. Any changes in such time periods must also be filed ahead of time with the license officer and the designated ambulance service. Such medical first responder services are subject to the Rules and Regulations governing medical first responder services except for the twenty-four hour, seven-day a week requirement.

 290-5-30.10

(1) Procurement of Pharmaceuticals. Medical directors of licensed ambulance services, medical first responder services, or neonatal transport services are authorized to contract with licensed pharmacies to furnish dangerous drugs and controlled substances for the vehicles of their particular services. Such dangerous drugs and controlled substances shall be furnished, secured, and stored in the manner provided for in O.C.G.A. Section 26-4-116.

(2) Storage of Pharmaceuticals. Drugs and biologicals shall not be left unattended on vehicles unless such vehicles are maintained in environmentally controlled facilities, or the drugs and biologicals are kept in environmentally controlled boxes in the patient compartment or in the patient compartment when the compartment is maintained at a temperature within the range specified by pharmaceutical manufacturers, and such vehicles are locked. Drugs and biologicals shall not be left outside of kits on open shelves or compartments. Narcotics must be maintained under double locks. The theft of any drugs and/or biologicals must be reported immediately to the proper local and state authorities, as well as to the Regional EMS Office.

290-5-30.11

(1) The department and its duly authorized agents are hereby authorized to enter upon and inspect licensed emergency services, including registered vehicles, facilities, records applicable to licensure, call logs, vehicle maintenance records, patient care reports, communication tapes, and personnel licensing records in a reasonable manner in regards to the operation of emergency medical services. Inspections will be made during reasonable business hours. The OEMS is authorized to set policy for such inspections and records.

    (a) Inspections of each service will be made quarterly. If during a quarterly inspection a service receives an evaluation with no deficiencies, that service may be exempt from the next consecutive quarterly inspection. Every service will be inspected a minimum of two times per year.

    (b) During an inspection, the department's inspection agent will fully inspect at a minimum one registered emergency vehicle or one forth of the vehicle fleet, whichever is the greater number.

(2) When the department conducts an inspection, the findings shall be recorded on an inspection report form provided for this purpose. The provider or authorized representative shall sign the inspection form acknowledging the inspection. Signing this form does not indicate agreement with the findings thereon. A copy of the inspection form shall be furnished to the provider.

(3) Inspections of drugs and biologicals will be handled in accordance with policies established by the department and state and federal laws and regulations where applicable.

 290-5-30.12

(1) No person shall practice as an Emergency Medical Technician - Basic, Emergency Medical Technician - Intermediate, or Emergency Medical Technician - Paramedic without department approval. Certifications issued to Emergency Medical Services Personnel prior to these rules are considered licenses upon adoption of these rules.

(2) The requirements for license application for each level are:

    (a) Emergency Medical Technician – Basic.
        1. All applicants for licensure at the Emergency Medical Technician - Basic level must provide information to the department on forms prescribed by the department;
        2. Documentation attesting to the successful completion of the appropriate department approved Emergency Medical Technician - Basic course;
        3. Documentation attesting to current CPR certification;
        4. A notarized birth certificate or other documentation establishing that the applicant is at least 18 years of age;
        5. A current passport style photograph;
        6. Documentation of high school graduation or its equivalent;
        7. A statement as to alcohol or drug dependency; and
        8. Proof of registration as required by the Department.

    (b) Emergency Medical Technician – Intermediate.
        1. All applicants for licensure at the Emergency Medical Technician - Intermediate level must provide information to the department on forms prescribed by the department;
        2. Documentation attesting to the successful completion of the appropriate department approved Emergency Medical Technician - Intermediate course;
        3. Documentation attesting to current CPR certification;
        4. A notarized birth certificate or other documentation establishing that the applicant is at least 18 years of age;
        5. A current passport style photograph;
        6. Documentation of high school graduation or its equivalent;
        7. A statement as to alcohol or drug dependency; and
        8. Proof of registration as required by the Department.

    (c) Emergency Medical Technician – Paramedic.
        1. All applicants for licensure at the Emergency Medical Technician - Paramedic level must provide information to the department on forms prescribed by the department;
        2. Documentation attesting to the successful completion of the appropriate department approved Emergency Medical Technician - Paramedic course;
        3. Documentation attesting to current CPR/ACLS certification;
        4. A notarized birth certificate or other documentation establishing that the applicant is at least 18 years of age;
        5. A current passport style photograph;
        6. Documentation of high school graduation or its equivalent;
        7. A statement as to alcohol or drug dependency; and
        8. Proof of registration as required by the Department.

(3) Fees.
    (a) All applications for initial licensure and license renewal must be accompanied by a fee payable to the department in an amount and form determined by the OEMS.
    (b) The OEMS may issue refunds for cause. Refunds may be issued under the following circumstances:
        1. Licensing fees may be refunded to applicants who withdraw their applications prior to consideration by the department. Application fees will be withheld to cover the cost of processing the applications.
        2. No refunds are made in a case where the department reviews and denies an application.
        3. Renewal fees and inactive license fees are non-refundable.

(4) Licensing of Convicted Individuals.
    (a) The OEMS may refuse to issue a license to an applicant if said applicant has been convicted in any court of any felony or other criminal offense.
    (b) Each case will be judged in accordance with the seriousness of the conviction.
        1. General denial - licensing of individuals convicted of certain crimes presents an unreasonable risk to public health or safety.
        2. Presumptive denial - applications for licensure by individuals will be denied except in extraordinary circumstances, and then will be granted only if the applicant establishes by clear and convincing evidence that licensure will not present an unreasonable risk to public health or safety.
        3. Discretionary denial - applications for licensure by individuals convicted of any crimes including driving under the influence (DUI), but not including minor traffic violations, may be denied after consideration of all the relevant factors involved.

(5) Any currently licensed emergency medical services personnel may voluntarily surrender a license by notifying the OEMS in writing.

 290-5-30.13

(1) Licensed Emergency medical services personnel, on a schedule and in the manner established by the OEMS, shall submit a license renewal fee pursuant to these rules and provide evidence satisfactory to the department of having met the continuing education requirements of this section. Failure to do so shall be cause for immediate license revocation. Certifications issued to Emergency Medical Services Personnel prior to these rules are considered licenses upon adoption of these rules.

    (a) The continuing education requirement shall be met by completing approved continuing education of not less than forty (40) contact hours for each 24-month period of the license renewal cycle, with subject matter that includes cardiac care, pediatric care and trauma care. All continuing education must be consistent with the appropriate level EMT course curriculum or above. Training to maintain CPR certification shall be in addition to the continuing education requirement. Training to maintain ACLS or equivalent shall be in addition to the forty (40) required biennial hours of continuing education, but only has to be taken one time during each two-year period.

    (b) Continuing education that meets the requirements of this section must be approved in writing by either the department, a regional medical director or local medical director. The local medical director may approve continuing education for the emergency medical services personnel within the ambulance service for which he/she is responsible. If approved by the local medical director, a description of the training shall be filed with the regional EMS office prior to the beginning of the continuing education on a form approved by the department.

    (c) Individuals who become licensed or reinstated as emergency medical services personnel during any license renewal cycle shall be considered to have satisfied the requirements of this section for that license renewal cycle.

    (d) Licensed emergency medical services personnel shall make available, upon request, all continuing educationn documents to the department.

    (e) EMS personnel are not required to maintain registration by the National Registry of Emergency Medical Technicians after the initial license renewal period.

(2) Individuals seeking license renewal must submit to OEMS a statement as to alcohol or drug dependency;

(3) The OEMS is authorized to perform random audits of license renewal documentation during each license renewal cycle.

(4) EMS personnel failing to submit required license renewal documents by the specified date will not be permitted to perform the duties of a licensed individual.

(5) A license shall be expired if the holder of the license fails to furnish the department with evidence that he/she has met the continuing education requirements during the license renewal cycle.

    (a) The penalty period for late renewal is the six (6) month period immediately following the expiration date for the last license renewal cycle. During this period, a penalty fee for late renewal applies. The penalty fee shall be double the established fee for the level of licensure or $100.00, which ever is greater.

    (b) EMS personnel shall not practice after the expiration date of the license.

    (c) Following the expiration of the penalty period, the department shall revoke the license of any EMS personnel for failure to renew. Such revocation removes all rights and privileges to practice in this State. Revocation for failure to renew may be reported to the public and to other state licensing boards, and will be reported as a revocation for failure to renew and will not be treated as a disciplinary revocation.

    (d) A license that has been so revoked for a period not greater than four years may be reinstated upon the holder providing evidence of training equivalent to the continuing education requirements of this section, successfully challenging the required tests approved and administered by the department, and paying the applicable penalty fee for each license renewal cycle. An individual seeking reinstatement, who fails any of the required tests on the first attempt must complete the initial licensure process beginning with the emergency medical technician training course. A license that has been so revoked for a period greater than four years may be reinstated upon the holder completing the initial licensure process beginning with the emergency medical technician training course.

(6) The OEMS has the authority to mandate a specific license renewal and/or continuing education module(s).

(7) The department shall be authorized to waive the continuing education requirements in cases of hardship, disability, illness, or under such other circumstances as the department deems appropriate

 290-5-30.14

(1) Applicants seeking reciprocity must possess current registration as required by the Department, at the level for which reciprocity is sought.

(2) Applicants must comply with all provisions of DHR Rules and Regulations Chapter 290-5-30 and OEMS Policies

290-5-30.15

(1) Emergency medical services personnel shall at all times while on duty, wear visible identification to include name, company name and license level and may include the State EMS patch or embroidered facsimile, along with license level rocker. Patches of other certifying or licensing agencies are not an acceptable substitute.

 290-5-30.16

(1) All emergency medical service courses must be approved in writing by the department prior to the course starting date.

(2) In order for any course to be approved, the course coordinator must be a currently licensed instructor at the applicable level.

(3) A complete course application must be submitted by the sponsoring agency to the department at least four weeks in advance of the actual starting date of the proposed course on forms prescribed by the department.

(4) Emergency medical service courses may be offered at hospitals, technical colleges or institutions, the Georgia Public Safety Training Center, regional EMS offices, and other institutions as approved by the department. The sponsoring agency of the course must be affiliated with or contracted with a licensed hospital and licensed ambulance service which is capable of supporting the appropriate level of clinical practical experience.

(5) The department shall establish standards for all emergency medical service courses.

(6) All approved courses are subject to monitoring by the department including unannounced on-site evaluations and other methods as deemed appropriate by the department.

290-5-30.17

(1) Eligibility for Instructor Licensing. All applicants for instructor licensure must meet the following requirements:

(a) Emergency Medical Services Instructor - Level I.
1. Written recommendation from the local medical director;
2. Current Georgia licensure as an emergency medical technician - intermediate, cardiac technician, paramedic, registered nurse, physician’s assistant, or physician;
3. Current certification as a cardiopulmonary resuscitation instructor; and
4. Current certification as a first responder instructor.

(b) Emergency Medical Services Instructor - Level II.
1. Current Georgia licensure as a cardiac technician, paramedic, registered nurse, physician’s assistant, or physician;
2. Current certification as a cardiopulmonary resuscitation instructor;
3. Successful completion of a department administered course with curriculum specific to Georgia's emergency medical service system; and
4. Demonstrate proficiency by the successful completion of practical and written examinations administered or approved by the department.

(c) Emergency Medical Service Instructor - Level III.
1. Current Georgia licensure as a paramedic, registered nurse, physician’s assistant, or physician;
2. A minimum of an associate degree or ninety (90) quarter hours of college credit (or semester equivalent) from a regional or nationally accredited institution;
3. Current certification as a cardiopulmonary resuscitation instructor;
4. Current certification as an advanced cardiac life support instructor, pediatric advanced life support instructor, basic trauma life support instructor, and geriatric life support instructor, or equivalents as approved by the OEMS;
5. Successful completion of a department administered course with curriculum specific to Georgia's emergency medical service system; and
6. Demonstrate proficiency by the successful completion of practical and written examinations administered or approved by the department.

(2) Licensure of Instructors.

(a) Candidates must complete an application form and provide other documentation as prescribed by the department.
(b) No individual shall hold oneself out as an emergency medical service instructor at any level unless licensed by the department.
(c) Initial licensure shall be for a period of time specified by the department.

(3) License Renewal for Emergency Medical Service Instructors.

(a) Emergency medical service instructors shall provide satisfactory evidence of having met the license renewal requirements of this section in a manner, and on forms approved by the department. Failure to do so shall result in OEMS placing the instructor license in an inactive status.

(b) The emergency medical service instructor - level I and emergency medical service instructor - level II must:
1. Maintain a license as an emergency medical technician, cardiac technician, paramedic, registered nurse, physician’s assistant or physician; and
2. Maintain certification as a cardiopulmonary resuscitation instructor.

(c) The emergency medical service instructor - level III must:
1. Maintain a license as a paramedic, registered nurse, physician’s assistant, or physician; and
2. Maintain certification as an Advanced Cardiac Life Support instructor.

(d) The instructor must teach a minimum of twenty (20) hours per year in approved courses during the license period.

(e) The instructor must participate in a minimum of twelve (12) hours per year of continuing education in instructional techniques approved by the department.

(4) Inactive Status for Instructors. Any instructor who does not meet the above requirements will be placed in an inactive status.

(5) Reinstatement of Instructor Status. Any instructor whose license is placed in an inactive status for a period of not more than four (4) years, may be reinstated to an active status by meeting the following requirements:

(a) The eligibility for instructor licensure standards at the appropriate level;