Staffing

(A) Each ambulance and EFR service shall at all times maintain an adequate number of EMS personnel to staff EMS vehicles to ensure compliance with the requirements of 105 CMR 170.385 and to carry out its responsibilities of service under the applicable service zone plan(s). (B) BLS Staffing. (1) When a Class I, II or V ambulance transports a patient receiving care at the BLS level, the ambulance must be staffed with at least one EMT, who, is at a minimum, certified at the EMT-Basic level, as set forth in 105 CMR 170.810, who shall be responsible for providing patient care, and one person trained to the first responder level, who meets all the minimum training requirements of 105 CMR 171.000, provided that the conditions set forth in 105 CMR 170.305(B)(1)(a) through (f) are met. For BLS level transports in which the conditions set forth in 105 CMR 170.305(B)(1)(a) through (f) are not met, the ambulance must be staffed with two EMTs, both of whom have at least EMT-Basic level certification. (a) The ambulance service, in conjunction with its affiliate hospital medical director, must establish minimum experience levels and skill competencies for each of its EMT- Basics working in EMT/person trained to the first responder level staffing configurations, as assessed by the affiliate hospital medical director; (b) The ambulance service shall ensure that any person trained to the first responder level it deploys to drive the ambulance meets the following criteria: 1. has a current valid driver’s license in good standing; 2. has no disciplinary history with the Department; 3. discloses to the ambulance service and the Department within five days of a conviction of a misdemeanor or felony in Massachusetts or any other state, the United States, or a foreign country (including a guilty plea, nolo contendre or admission to sufficient facts, even if the plea or admission results in a continuation without a finding), other than a minor traffic violation for which less than $1,000 was assessed. The following traffic violations are not minor and must be reported: conviction for driving under the influence, reckless driving, driving to endanger, and motor vehicle homicide. The ambulance service shall obtain a current Criminal Record Information System (CORI) on each person trained to the first responder prior to deploying them on the ambulance; 4. shall not be under the influence of alcohol, or impaired by any controlled substance, including cannabis, while on duty involved in ambulance transports at an ambulance service; and 5. shall cooperate with, and timely respond to, inquiries and investigations of agents of the Department. (c) The ambulance service is responsible for the actions or omissions of the person trained to the first responder level while that person is on duty for the service involved in ambulance transports. The service shall report to the Department any serious incident involving a person trained to the first responder level in accordance with 105 CMR 170.350; (d) The ambulance service must provide appropriate training to any person trained to the first responder level prior to deployment, including, at a minimum, safe patient moving and stretcher handling techniques; (e) The ambulance service must implement a procedure to ensure a second EMT-Basic is immediately dispatched if the EMT working with a person trained to the first responder level determines appropriate care of the patient's medical condition and needs requires a second EMT-Basic; and (f) The ambulance service must ensure that all BLS-level responses staffed by one EMT and one person trained to the first responder level are reviewed through the quality assurance/quality improvement (QA/QI) program under the service's affiliation agreement, pursuant to 105 CMR 170.300(A)(4). (2) When an EFR service licensed at the BLS level responds to a call, it shall be staffed with a minimum of one EMT certified at a minimum at the EMT-Basic level. (C) ALS Staffing. (1) When a Class I, II or V ambulance transports a patient receiving care at the Advanced level of ALS, the ambulance must be staffed with a minimum of two EMTs, at least one of whom is certified at the Advanced EMT level. (2) When a Class I, II, or V ambulance transports a patient receiving care at the Paramedic level of ALS, the ambulance must be staffed with a minimum of two EMTs, at least one of whom is certified at the Paramedic level, provided that the conditions set forth in 105 CMR 170.305(C)(2)(a) through (f) are met. For ambulance transports of patients receiving care at the Paramedic level in which the conditions set forth in 105 CMR 170.305(C)(2)(a) through (f) are not met, the ambulance must be staffed with a minimum of two EMTs, both of whom are certified at the Paramedic level. (a) The ambulance service's dispatching entity must implement emergency medical dispatch (EMD) in accordance with State 911 Department standards, or otherwise have policies in place, provided by the ambulance service as approved by its affiliate hospital medical director, for screening of calls requesting an ambulance for patient acuity, to ensure dispatch of appropriate EMS staff; (b) The ambulance service must implement criteria, approved by its affiliate hospital medical director and in accordance with administrative requirements of the Department, for determining those EMS calls when two Paramedics would be required to provide appropriate care, based on the patient's medical condition and acuity; (c) The ambulance service must implement a procedure to ensure a second Paramedic is immediately dispatched if the EMTs determine appropriate care of the patient's medical condition and needs requires a second Paramedic; (d) The ambulance service must provide appropriate training, in accordance with administrative requirements of the Department including orientation and mentoring to its EMTs who work in Paramedic/Basic or Paramedic/Advanced staffing configurations, so that each EMT understands his or her role, consistent with his or her certification level, in caring for patients receiving paramedic-level care; (e) The ambulance service, in conjunction with its affiliate hospital medical director and in accordance with administrative requirements of the Department, must establish minimum experience levels and skill competencies for each of its Paramedics/Advanced and EMT-Basics working in Paramedic/Basic or Paramedic/Advanced staffing configurations, as assessed by the affiliate hospital medical director, which shall include having had previous experience caring for emergency patients while working at their current levels of EMT certification on an ambulance; (f) The ambulance service must ensure that all paramedic-level responses staffed by EMTs who work in Paramedic/Basic and Paramedic/Advanced staffing configurations are reviewed through the quality assurance/quality improvement (QA/QI) program under the service's affiliation agreement, pursuant to 105 CMR 170.300(A)(4). (3) When a Class IV ambulance transports a patient being provided advanced life support services, the ambulance must be staffed with at least two EMTs and one pilot. One EMT must be a registered nurse certified, at a minimum, as an EMT-Basic. The second EMT shall, at a minimum, be a certified Paramedic. Both EMTs shall have additional training in the emergency care services to be used on the aircraft. However, in cases in which there exist special patient needs, such as during an inter-hospital intensive care transport, another registered nurse, a physician's assistant or a physician may be substituted in place of the Paramedic. (4) When an ALS-level EFR service responds to a call, it shall send a minimum of one EMT certified at the Advanced or Paramedic level, in accordance with its level of ALS licensure. Minimum staffing during transport shall be ensured pursuant to 105 CMR 170.307. (D) Critical Care Service Staffing. Each critical care service transport must be staffed with the following personnel: (1) An appropriately licensed driver or pilot, meeting CAMTS or Department-approved substantially equivalent accreditation requirements; and, (2) A medical crew, consisting of at least two persons, as follows: (a) One of whom at a minimum is licensed in Massachusetts as a registered nurse, and certified as an EMT-Basic, and meets CAMTS or Department-approved substantially equivalent accreditation requirements for personnel credentials; and (b) One of whom is licensed in Massachusetts as a physician, or, at a minimum, is certified as a Paramedic and meets CAMTS or Department-approved substantially equivalent accreditation requirements for personnel credentials. (E)(1) Persons providing advanced life support services may employ only those techniques for which they have been certified under 105 CMR 170.000, unless such persons qualify as additional personnel in accordance with 105 CMR 170.310. (2) If ALS care is initiated by an EMT associated with an ambulance service or an ALS- level EFR service, an EMT certified at least at the same level as the EMT who initiated care must attend the patient on the ambulance with appropriate equipment and continue ALS- level care until transport is concluded. (3) The EMT functioning at the highest level of training and certification for their service must attend a patient requiring ALS service at the scene and during transport. (4) EMTs staffing a critical care service transport shall use those techniques, medications and patient care procedures that comply with their critical care service’s clinical practice protocols and standing orders that meet the requirements of CAMTS or an accreditation program the Department approves as substantially equivalent to CAMTS.