OAR 333-255-0070: Ground Ambulance Staffing and Response Requirements

(1) A licensed ambulance service shall provide one of the following transport services using a licensed ground vehicle: (a) Basic life support – the maximum functions that may be assigned to an Emergency Medical Responder (EMR) or Emergency Medical Technician (EMT) in accordance with OAR 847-035-0030; (b) Advanced life support – the maximum functions that may be assigned to an Advanced Emergency Medical Technician (AEMT), EMT-Intermediate or Paramedic in accordance with OAR 847-035-0030; or (c) Specialty care as defined in these rules. (2) It is the licensed ambulance service responsibility to ensure that all emergency medical services (EMS) providers are practicing within their scope as identified in OAR 847-035-0030. (3) A licensed ground ambulance shall have at a minimum: (a) If providing basic life support: (A) One qualified driver that meets the requirements specified in OAR 333-250-0270, and one EMS provider licensed as an EMT or higher or an ambulance-based clinician; or (B) Two EMS providers, one of which must be licensed as an EMT or higher, or two ambulance-based clinicians. (b) If providing advanced life support, one EMS provider licensed as an EMT or higher and one AEMT, EMT-Intermediate, Paramedic or an ambulance-based clinician. (c) EMS providers accompanying patients in the patient compartment of an ambulance vehicle must be licensed at a level appropriate for any treatment interventions initiated on scene or likely to be required during transport. This requirement does not apply to an interfacility transfer or in the case of a disaster or a multiple patient incident consisting of more than five patients or as determined by an incident commander. (d) If both crew members must be present in the patient compartment due to the patient's condition, then the driver of the ambulance shall be a licensed EMS provider or a qualified driver that meets the requirements of OAR 333-250-0270. (4) Notwithstanding subsection (3)(b) of this rule, a rural ambulance service is permitted to operate a ground ambulance providing advanced life support with a qualified driver and one EMS provider licensed as an AEMT or higher, or an ambulance-based clinician if the rural ambulance service: (a) Notifies in writing the county governing body responsible for the applicable ambulance service area and the ambulance service plan administrator of the reduced staffing. Both the county governing body and ambulance service plan administrator will notify the ambulance service in writing that they do not object to the reduced staffing; (b) Notifies in writing the licensed ambulance service's EMS medical director of the reduced staffing and the EMS medical director notifies the licensed ambulance service in writing that they do not object to the reduced staffing; and (c) Notifies the Oregon Health Authority (Authority) in writing by electronic or US Postal Service mail, the following: (A) A description of efforts made to comply with the staffing requirements in subsection (3)(b) of this rule; and (B) A copy of the county’s notice that it does not object. (5) If a rural ambulance service is operating with reduced staffing pursuant to section (4) of this rule it must: (a) Document and track the date and time of calls, and make available, upon request, any associated electronic patient care reports (ePCRs) to the Authority; (b) Make a continuous effort to attempt to comply with the staffing requirements in subsection (3)(b) of this rule; and (c) Comply annually with the requirements of section (4) of this rule. (6) A licensed ambulance service staffed entirely or partly by volunteers may respond to an emergency scene without a full crew as required by section (3) of this rule if approved by the Authority. (a) The licensed ambulance service must submit an application requesting an exemption in a format prescribed by the Authority and include the following information prior to submission to the Authority: (A) Documentation showing that the application has been approved by: (i) The EMS medical director of the licensed ambulance service agency; (ii) The governing body of each municipality for which the exemption is being requested; and (iii) The county governing body and ambulance service plan administrator; (B) A description of and provision for the following requirements: (i) Timely arrival of a two-person crew at the scene; (ii) An alerting system which shall make known to the intended responders the location of the emergency; (iii) Either two-way radio communication between responders such that response can be coordinated by responding personnel, or a fixed schedule of assigned personnel, with designation of the parties who are to respond directly to the scene of an emergency and parties who are to operate the ambulance; (iv) Personnel responding directly to the scene of an emergency must be individually equipped with the necessary medication or equipment to provide initial patient care, including uniform or personal protective clothing, disposable gloves and a pocket ventilation mask or other appropriate ventilatory adjuncts; and (v) Copies of approved standard operating procedures or standing orders, which address the number of personnel to respond to the scene, organizational policies regarding the operation of motor vehicles by personnel responding to the scene and prohibiting entry into dangerous scenes; (b) The full volunteer or part volunteer licensed ambulance service shall ensure that neither of the following occur: (A) A licensed ambulance vehicle driven by a person not licensed as an EMT arrives at an emergency scene but an EMT or higher fails to arrive or arrives substantially later than the responding ambulance; or (B) A licensed ambulance vehicle driven by an EMT or higher arrives at the scene but no other qualified driver, as specified by these rules, arrives at the scene to operate the ambulance; and (c) Whenever possible, the full volunteer or part volunteer licensed ambulance service operating under an exemption granted pursuant to this rule must endeavor to ensure that a qualified driver who is not licensed as an EMT or higher is trained to the EMR level and meets the requirements for a qualified driver as specified in OAR 333-250-0270. (d) The licensed ambulance service must have the written approval from the Authority before operating under an exemption. (e) A full volunteer or part volunteer licensed ambulance service approved to respond to an emergency scene without a full crew must comply with subsections (5)(a) and (b) of this rule.