Every ALS ambulance, when responding to and transporting patients requiring

Every ALS ambulance, when responding to and transporting patients requiring care beyond the basic life support level, must be occupied by a driver with a valid EMS driver's license and one (1) person who possesses a valid Advanced EMT or Paramedic state certificate or one (1) person who possesses a valid medical/nursing license. Specific considerations apply to tiered response. Tiered response may be used to maximize capabilities and improve outcomes. Tiered response requires the use of technology and resources to prioritize incoming EMS calls and assign the proper level of care response. Ambulance services proposing to operate tiered response shall meet the following criteria in order to be approved by BEMS: 1. Licensed 911 EMS providers may utilize tiered response protocols; however, said protocols must be approved by the ambulance service’s off- line medical director and the State EMS Medical Director; a. Required documentation to be submitted to BEMS: i. A letter from the ambulance service’s owner/operator requesting approval to operate tiered response; ii. A copy of the ambulance service’s tiered response protocol with a letter from the ambulance service’s off-line medical director verifying his/her approval of said protocol; 1. Said protocol shall allow for paramedics, AEMTs or EMTs to respond to emergency calls, care for patients experiencing emergency conditions, transport patients experiencing emergency conditions, and transfer the care of patients experiencing said conditions to providers in the clinical setting; 2. Said protocol shall include the use of computerized dispatch resources, and specifically for the purpose of prioritizing calls and assigning the proper level of care for response (services which do not possess this resource may partner with a third-party vendor for dispatch resources to meet this requirement); all incoming emergency calls must be screened at dispatch and assigned the most appropriate level of care response; 3. Said protocols shall provide for on-line medical control guidance to field crews as needed during response and operations; 2. Tiered response ambulance services shall provide one (1) paramedic capable unit for every 3-tiered response units in the event advanced life support proves necessary; 3. When paramedic level of care is warranted and initiated, the paramedic shall continue care until care is turned over to clinical staff of equal or greater level of training/education in the emergency department as required by regulation and local protocol; 4. Ambulance services utilizing tiered response shall provide specific performance improvement data relevant to tiered response as requested from BEMS; 5. While the rules in this Part provide an option for tiered response, each respective ambulance service is responsible for ensuring compliance with county contractual obligations.