Section 16. Medical Rescue Agencies

A. General requirements for all medical rescue agencies: (1) Certification required. A medical rescue agency shall not provide treatment to any patient, nor shall a transport medical rescue agency transport any patient, unless the medical rescue agency holds a valid certificate in accordance with this rule. (2) Level of service. Any medical rescue agency that represents itself as providing any EMS level of service shall make that level of service available. (3) Fees prohibited. Medical rescue agencies shall not charge a fee to the patient. Nothing in this rule shall be construed to prevent a medical rescue agency from negotiating reimbursement agreements. (4) Hygiene and cleanliness. Medical rescue agencies shall maintain clean and hygienic work environments, and shall adopt and implement reasonable infection control practices to prevent the spread of communicable diseases. Medical rescue agencies shall properly maintain and dispose of all biohazard material. (5) Medical rescue emergency motor vehicles. Medical rescue emergency motor vehicles shall provide safe and adequate service, and shall utilize equipment, supplies and facilities that are safe and adequate for the provision of emergency medical services and otherwise consistent with the requirements of this rule. Motor vehicles shall be safe, dependable and suitable for the services rendered. Each motor vehicle shall be maintained in good mechanical and operating condition. The bureau may remove from operation any medical rescue agency vehicle that the bureau determines to be either not road worthy or not response worthy. Transport-capable medical 7.27.10 NMAC 10 rescue vehicles shall be equipped with a heating, cooling and ventilation system capable of providing a reasonable level of comfort inside the motor vehicle. (6) Documentation anical and operating condition. The bureau may remove from operation any medical rescue agency vehicle that the bureau determines to be either not road worthy or not response worthy. Transport-capable medical 7.27.10 NMAC 10 rescue vehicles shall be equipped with a heating, cooling and ventilation system capable of providing a reasonable level of comfort inside the motor vehicle. (6) Documentation. EMS agencies certified under this rule shall annually submit to the bureau a certificate of safety for each of their medical rescue vehicles, to include the date, name, contact telephone number and location of the certified mechanic performing the inspection. (7) Drivers. Any person who regularly drives a certified medical rescue (transport or non-transport) vehicle shall: (a) be at least 18 years of age; (b) hold a valid New Mexico driver’s license or equivalent out-of-state driver's license, equivalent to a class “D” or higher; (c) be in compliance with bureau requirements for an emergency vehicle operator’s course; (d) not have received a driving while intoxicated, driving under the influence, or reckless driving conviction within the past year; (e) not be prohibited by law from driving without a breath alcohol ignition interlock device; (f) not be prohibited by law from operating a motor vehicle for any other reason; (g) annually provide to their EMS agency a copy of the person’s motor vehicle driving record; the medical rescue agency shall validate and submit to the bureau a list of all drivers authorized by the agency together with the agency’s annual report; all driver infractions resulting in the loss or potential loss of driving privileges shall be reported to the bureau. (8) Safety belts. Safety belts shall be utilized by all persons in the forward compartment of emergency motor vehicles. Attending personnel shall wear seat belts when feasible mit to the bureau a list of all drivers authorized by the agency together with the agency’s annual report; all driver infractions resulting in the loss or potential loss of driving privileges shall be reported to the bureau. (8) Safety belts. Safety belts shall be utilized by all persons in the forward compartment of emergency motor vehicles. Attending personnel shall wear seat belts when feasible. Safety belts or other safety restraining devices shall be available for patients being transported, and shall be utilized for patients at all times during patient transport, unless extenuating circumstances prevent their usage. (9) Child restraint systems. Attending personnel shall utilize child restraint systems when feasible and necessary. Child restraint systems shall satisfy all federal and state requirements when in use. (10) Minimum personnel requirements. All medical rescue agencies (transport and non-transport) shall maintain the following minimum personnel requirements during patient treatment and transportation: (a) a minimum of one New Mexico licensed EMS provider shall be present at the scene of an emergency; (b) for transport of a patient, a minimum of one qualified New Mexico-licensed EMS provider shall be present in the patient compartment of the medical rescue vehicle at all times while the compartment is occupied by a patient; (c) healthcare personnel not licensed as an EMS provider may accompany and monitor a patient in the patient compartment of a medical rescue vehicle, provided that at least one qualified New Mexico- licensed EMS provider is also present in the patient compartment, subject to the policies of the EMS agency. (11) Mutual aid. All medical rescue agencies (transport and non-transport) shall develop mutual aid plans with appropriate EMS agencies and PRC regulated ambulance services tor a patient in the patient compartment of a medical rescue vehicle, provided that at least one qualified New Mexico- licensed EMS provider is also present in the patient compartment, subject to the policies of the EMS agency. (11) Mutual aid. All medical rescue agencies (transport and non-transport) shall develop mutual aid plans with appropriate EMS agencies and PRC regulated ambulance services. A medical rescue agency may provide mutual aid to another EMS agency pursuant to a mutual aid agreement only in the event that the other agency cannot respond to a call for service, and only in the following circumstances: (a) in mass casualty or disaster situations, when requested by state or local authorities in accordance with established local emergency plans; (b) when requested by another EMS agency or a licensed EMS provider during an emergency and in accordance with established mutual aid agreements; (c) when requested by a law enforcement agency or officer; or (d) in a non-emergency, when the responsible local provider’s resources are exhausted, pursuant to arrangements made by the responsible local provider for (and for the coordination of) such necessary mutual aid. (12) Unauthorized persons. A medical rescue agency shall not transport any person who is not a patient (including but not limited to a hitchhiker), other than an on-duty employee of the medical rescue agency, a person authorized by the medical rescue agency to be transported, or a bureau representative on official business, unless the person’s transport is necessitated by an emergency. (13) Accident reports horized persons. A medical rescue agency shall not transport any person who is not a patient (including but not limited to a hitchhiker), other than an on-duty employee of the medical rescue agency, a person authorized by the medical rescue agency to be transported, or a bureau representative on official business, unless the person’s transport is necessitated by an emergency. (13) Accident reports. Every medical rescue agency shall report to the bureau every accident that occurs in the course of the medical rescue agency’s operations within the state on either public or private property that results in the death of a person, injury to a person that requires treatment by a physician, or damage to property belonging to either the medical rescue agency or any other person to an apparent extent of two thousand five hundred dollars ($2,500.00) or more. 7.27.10 NMAC 11 (a) In the event that an EMS vehicle operated by a medical rescue agency is involved in a collision that results in a person’s death, the medical rescue agency shall, within twenty-four hours of learning of the person’s death, submit a copy of the police report of the collision to the bureau. (b) Police reports of all other collisions involving an EMS vehicle operated by a medical rescue agency shall be submitted to the bureau by the medical rescue agency no later than fifteen days after the date of the collision. (c) If a medical rescue agency learns after submitting a police report to the bureau that an individual who was involved in a collision involving an EMS vehicle operated by the agency has died, the agency shall file an amended copy of the police report with the bureau no later than fifteen days after learning of the person’s death agency no later than fifteen days after the date of the collision. (c) If a medical rescue agency learns after submitting a police report to the bureau that an individual who was involved in a collision involving an EMS vehicle operated by the agency has died, the agency shall file an amended copy of the police report with the bureau no later than fifteen days after learning of the person’s death. (d) For the purposes of this section, a medical rescue agency that has submitted a uniform accident report of the collision to the motor vehicle division of the New Mexico taxation and revenue department may submit a copy of that report to the bureau instead of a police report; provided that the deadline for the submission to the bureau of a uniform accident report shall be the same as the deadline for the submission of a police report. B. Additional requirements for transport medical rescue agencies. Transport medical rescue agencies shall meet the following requirements in order to be certified by the bureau. (1) All transport medical rescue vehicles shall carry appropriate supplies and equipment, including the minimum required equipment identified in this rule. (2) Patient transport is allowed in two distinct situations: (a) saving of life or limb: when a transport medical rescue agency is dispatched without the intent to transport, but transports patient(s) due to life or limb-saving necessity; (b) system demand: a transport medical rescue agency may transport a patient when there is no ambulance service available, or may intercept with any air or ground ambulance service when it is beneficial for the patient ns: (a) saving of life or limb: when a transport medical rescue agency is dispatched without the intent to transport, but transports patient(s) due to life or limb-saving necessity; (b) system demand: a transport medical rescue agency may transport a patient when there is no ambulance service available, or may intercept with any air or ground ambulance service when it is beneficial for the patient. (3) All transport medical rescue agencies shall additionally maintain the following agreements and protocols: (a) a fully executed written agreement between the public regulation commission-certificated ambulance service serving the area and the transport medical rescue agency that describes the transport protocol to be followed; (b) a written medical protocol that clearly specifies situations when transport is allowed and has been approved by the transport rescue agency medical director. [7.27.10.16 NMAC - N, 3/15/2010] 7.27.10.17 MINIMUM REQUIRED EQUIPMENT FOR NON-TRANSPORT MEDICAL RESCUE VEHICLES: All non-transport medical rescue agencies shall stock and equip non-transport medical rescue vehicles with the following minimum required equipment and supplies. Supplies shall be maintained in sufficient quantities to assure the safe and adequate provision of emergency medical services in response to one or multiple incidents. A. Forward compartment: (1) vehicle registration; (2) U. S. department of transportation emergency response guidebook (most current edition); (3) maps or navigational equipment; (4) service specific protocols and resource guides; (5) patient care reports or reporting system; (6) hand sanitizer; (7) flashlight (battery powered, hand crank, with mounted battery charging system); (8) fire extinguisher (ten pounds, ABC type or functional equivalent, charged); (9) spotlight or auxiliary lighting system; (10) roadway warning devices (safety flares, emergency lights, safety cones); (11) vehicle jack; (12) spare tire; and (13) tire wrench. B care reports or reporting system; (6) hand sanitizer; (7) flashlight (battery powered, hand crank, with mounted battery charging system); (8) fire extinguisher (ten pounds, ABC type or functional equivalent, charged); (9) spotlight or auxiliary lighting system; (10) roadway warning devices (safety flares, emergency lights, safety cones); (11) vehicle jack; (12) spare tire; and (13) tire wrench. B. Communications equipment: (1) radio communications (portable or affixed); (2) equipment sufficient to establish and maintain direct or repeated communications with area 7.27.10 NMAC 12 dispatch and secondary providers; and (3) N.M. EMSCOM radio system capable of cellular and text/data transmissions (optional), spare batteries / charger system. C. Personal protective equipment (PPE): (1) EMS turnout gear; (2) helmets with face shield; (3) gloves (work gloves or leather gloves); (4) eye protection (glasses or goggles); (5) hearing protection; (6) safety vest / jacket (ANSI 2008 compliant; break-away, reflective, high visibility coloration); (7) exam gloves (assorted sizes); (8) disposable splash protection (gowns, scrubs, eye shielding, etc.); (9) tyvex coveralls (optional); and (10) N-95 mask (or a mask better than a particulate mask). D. Diagnostic equipment: (1) aneroid sphygmomanometer, blood pressure cuffs (with infant, pediatric, adult, and obese sizes); (2) stethoscope (more than one); (3) glucose monitoring instrument (portable); (4) pulse oximeter (portable); (5) end-tidal CO2 monitoring device (disposable, colormetric); (6) penlights; and (7) shears (trauma or equivalent). E. Cardiac equipment: (1) semi-auto external defibrillator; (2) defibrillator pads (extra); and (3) defibrillator batteries (extra). F t, pediatric, adult, and obese sizes); (2) stethoscope (more than one); (3) glucose monitoring instrument (portable); (4) pulse oximeter (portable); (5) end-tidal CO2 monitoring device (disposable, colormetric); (6) penlights; and (7) shears (trauma or equivalent). E. Cardiac equipment: (1) semi-auto external defibrillator; (2) defibrillator pads (extra); and (3) defibrillator batteries (extra). F. Bandages/dressings: (1) triangular bandages; (2) universal dressings (approximately ten inches by thirty inches); (3) gauze pads (four inches by four inches); (4) bandages - soft roller (self-adhering); (5) bandages - elastic (band aids, assorted sizes); (6) occlusive dressings (sterile, individually wrapped); (7) adhesive tape (various sizes: one inch, two inch, duct tape ('medical' - white); (8) cold packs; (9) heat packs; and (10) burn sheets. G. Respiratory equipment: (1) mounted electric or manifold operation suction aspirator (that meets GSA standard); (2) portable suction aspirator (as approved by the bureau); (3) sterile suction catheters and tubing (rigid and soft, if applicable; assorted sizes); (4) bag-valve-mask resuscitator (BVM) (disposable, with transparent adult mask); the BVM shall be capable of operation in cold weather, shall be capable of use with an oxygen supply and shall be capable of delivering approximately 100% oxygen; (5) pediatric bag-valve-mask resuscitator (disposable, with transparent child and infant mask); the pediatric BVM shall be capable of operation in cold weather, shall be capable of use with an oxygen supply, and shall be capable of delivering 100% oxygen; (6) adult oxygen masks with reservoir (non-rebreather or partial non-rebreather); (7) adult oxygen masks (simple); (8) pediatric oxygen masks with reservoir (non-rebreather or partial non-rebreather); (9) pediatric oxygen masks (simple); (10) nasal cannulas; (11) oxygen supply tubing; (12) oropharyngeal airways (with adult, child and infant sizes); (13) nasopharyngeal airways (with adult, child and infant sizes); (14) laryngeal ervoir (non-rebreather or partial non-rebreather); (7) adult oxygen masks (simple); (8) pediatric oxygen masks with reservoir (non-rebreather or partial non-rebreather); (9) pediatric oxygen masks (simple); (10) nasal cannulas; (11) oxygen supply tubing; (12) oropharyngeal airways (with adult, child and infant sizes); (13) nasopharyngeal airways (with adult, child and infant sizes); (14) laryngeal, supraglottic, multi-lumen or laryngeal airway devices (device not intended to be 7.27.10 NMAC 13 placed into the trachea); (15) oxygen: fixed system (minimum of two wall-mounted oxygen outlets and one flow meter); system shall include a yoke-type pressure reducer gauge and an approved cylinder retaining device that meets DOT standards; the system shall be capable of delivering an oxygen flow of at least 15 liters per minute; if oxygen source is of a size less than “M” cylinder, an additional full spare cylinder for the fixed system shall be carried in the ambulance; and (16) oxygen: two portable cylinders; each unit shall consist of at least a “D” cylinder or equivalent, yoke, pressure gauge, flowmeter and cylinder wrench; the unit shall be capable of delivering an oxygen flow of at least 15 liters per minute; cylinder holders with a quick-release fitting shall be furnished to allow the use of the portable unit outside the vehicle. [7.27.10.17 NMAC - N, 3/15/2010] 7.27.10.18 MINIMUM REQUIRED EQUIPMENT FOR TRANSPORT MEDICAL RESCUE VEHICLES: All transport medical rescue agencies shall stock and equip transport medical rescue vehicles with the minimum equipment and supplies required in this rule to be stocked in non-transport medical rescue vehicles by non-transport medical rescue agencies. Additionally, all transport medical rescue agencies shall stock and equip transport medical rescue vehicles with the following minimum equipment and supplies. Supplies shall be maintained in sufficient quantities to assure the safe and adequate provision of emergency medical services in response to one or multiple incidents. A sport medical rescue vehicles by non-transport medical rescue agencies. Additionally, all transport medical rescue agencies shall stock and equip transport medical rescue vehicles with the following minimum equipment and supplies. Supplies shall be maintained in sufficient quantities to assure the safe and adequate provision of emergency medical services in response to one or multiple incidents. A. Patient compartment: (1) multi-level stretcher (may be power assisted, two-person); (2) shoulder / chest and lower extremity straps (capable of securing adult and pediatric patients); (3) pillow (disposable, with a vinyl cover or a rolled blanket); (4) blankets; (5) stretcher pad (bed) covers (e.g., sheets); (6) patient restraints (two ankle and two wrist, leather or nylon); (7) sharps container; (8) emesis basins (emesis bags or equivalent); and (9) body bags. B. Pharmocological equipment for first response through ALS: (1) appropriate medications with the contents established and approved by the service medical director, within applicable N.M. scopes of practice, with a list of contents and earliest expiration dates affixed to the outside of the kit; drug kits must be maintained in a temperate, controlled environment and shall not be left unsecured; and (2) mark I plus kit. C. Pediatrics: (1) pediatric restraint system or car seat (may be a fold-down jumpseat with a child restraint system); (2) obstetrical kit (sterile package), to include at a minimum: a receiving blanket, a sterile bulb aspirator, a wrapped sanitary napkin, a sterile pair of scissors or scalpel blade, four-inch gauze pads, one pair of sterile gloves, two cord clamps and a plastic bag for placenta; all items shall be kept in a container with an identifying label that specifies the contents; (3) foil blanket; and (4) pediatric drug dosage tape or chart. D to include at a minimum: a receiving blanket, a sterile bulb aspirator, a wrapped sanitary napkin, a sterile pair of scissors or scalpel blade, four-inch gauze pads, one pair of sterile gloves, two cord clamps and a plastic bag for placenta; all items shall be kept in a container with an identifying label that specifies the contents; (3) foil blanket; and (4) pediatric drug dosage tape or chart. D. Intravenous therapy: (1) intravenous solution (normal saline) (1000 ml); (2) intravenous catheters (various sizes); (3) intraosseous needles; (4) tubing/infusion kits; (5) pediatric fluid volume control device (i.e., burretrol or volutrol); and (6) arm boards (for pediatrics). E. Immobilization devices: (1) extremity immobilization devices (two full arms and two full legs, or equivalent); (2) short spinal extrication device (KED or equivalent), infant or pediatric immobilization; equipment shall be identified for the safe transport of infant / pediatric patients, as approved by the EMS agency’s medical director with guidelines and operating procedures provided by the agency / department; (3) pediatric immobilization device (as approved by the department); equipment shall be identified 7.27.10 NMAC 14 for the safe transport of infant / pediatric patients, as approved by the EMS agency’s medical director with guidelines and operating procedures provided by the agency / department; (4) spine boards (long; at least 16" wide by 72" in length with a minimum of three straps); (5) lateral cervical immobilization devices (commercial devices, foam blocks, blanket rolls); (6) cervical immobilization collars (hard type, minimum two adult, two medium, two child); and (7) traction splint (lower extremity, adjustable). F ines and operating procedures provided by the agency / department; (4) spine boards (long; at least 16" wide by 72" in length with a minimum of three straps); (5) lateral cervical immobilization devices (commercial devices, foam blocks, blanket rolls); (6) cervical immobilization collars (hard type, minimum two adult, two medium, two child); and (7) traction splint (lower extremity, adjustable). F. Rescue/extrication equipment: (1) tarp or blankets; (2) seatbelt cutter or trauma shears; (3) spring loaded center punch / window punch; (4) rescue ax or halligan tool; (5) flathead screwdriver (minimum six inches); (6) three-pound hammer; (7) hacksaw with extra bimetal-type blades; (8) duct tape; (9) one ton “come-a-long” winch; (10) rescue-rated chains or straps (minimum of two); (11) hydraulic spreader / cutter / ram (combi-tool); (12) air chisel-air cylinder, regulator, air hose (optional); (13) air bags-air cylinder, regulator, air hose (optional); (14) winch with recovery straps and blocking equipment; and (15) stabilization equipment (cribbing, blocks, struts).