EMS Regulations in Alabama

Pre-hospital care in Alabama is regulated by the Department of Public Health through the State Board of Health and its emergency medical services (EMS) division. The rules and regulations the govern the EMS Division are found in Department of Public Health Chapter 420-2-1 (Emergency Medical Services) of the Alabama Administrative Code.

Operations

• There are several requirements for an individual, corporation or other entity to receive an ambulance service operator license from the state board of health and the accompanying license certificate from the EMS division.

  The perspective operator must pay a $25.00 (as of August, 2010) annual non-transferable license and certificate fee; ensure and verify all intended ambulances comply with state statutes on vehicle, equipment, personnel and services; ensure each ambulance crew consist of, at minimum, two qualified staff on each ambulance, one being a licensed ambulance driver and the other being a licensed emergency medical technician (EMT); follow all applicable transport protocols and medical direction assignments; and secure at least $1 million in liability insurance.

  All ambulance service operators are assigned to an online medical direction hospital and must obtain their own licensed physician to serve as its off­line medical director.

  The state board of health also requires that all ambulance service operators have written plans to deal with medical call-taking, emergency medical dispatch and biohazardous waste procedures. These plans must be available for inspection.

Vehicles

• The state board of health issues separate non-transferable decal permits for vehicles used as ambulances once the EMS division inspects and approves the vehicles. When they inspect a vehicle, they look for the ambulance to comply with the General Services Administration (GSA) federal vehicle specification number KKK-A-1822F (Star-of-Life Ambulance) including being equipped with, at minimum, the list of standard basic life support (BLS) equipment required by GSA. The inspection will also reveal a communications system that conforms to the state board of health-approved regional, medical direction and accountability plan and a biohazardous waste disposal system in compliance with practices prescribed by the Alabama Department of Environmental Management (ADEM).

  The EMS division also requires all ambulances to be always sanitized clean, free of dents, cracks, and rust and all parts in proper working order.

Personnel

• The only personnel permitted to be in an ambulance in service are the licensed EMT-basic, the licensed EMT-intermediate and the licensed EMT-paramedic.

  The EMT-basics perform such tasks as: patient assessment; vital signs and patient history; patient lifting and moving; patient airway; cardiopulmonary resuscitation (CPR); administration of activated charcoal, syrup of ipecac, and glucose paste; spine, fractured bone and joint immobilization; assisting patient with self-administration of oxygen, nitroglycerin, auto­ inhalers and auto-injection epinephrine; bleeding and shock control; bandaging and splinting; assistance with emergency childbirth; and scene management.

  The EMT-intermediates execute the following responsibilities: administration of intravenous Dextrose 50 percent and other fluids including intraosseous infusion; placement of oral and nasal endotracheal tubes and approved esophageal blind insertion devices; proper usage of cardiac and 12-lead EKG monitoring equipment and manual defibrillators; and administration of aspirin.

  The EMT-paramedics have many duties: external cardiac pacing; nasogastric tube placement; and thorax needle decompression.

  The ambulance drivers will not be permitted to discharge their obligations in driving the ambulance unless they have: reached the age of 21 years; held an Alabama driver's license with a good driving record for at least two years; demonstrated a familiarity with any laws and ordinances related to emergency vehicle operation; tested 20/20 vision (correctable) in at least one eye with 180 degrees peripheral vision; completed the apparatus operator course at the Alabama Fire College; and maintained a current CPR course completion card.

Eligibility

• EMT-basics in Alabama are obligated to be: at least 18-years-old, Alabama residents; a high school or GED program graduate. In addition to this, EMT-intermediates and EMT-paramedics must know arithmetic and algebra.

Exemptions

• There are some entities not required to adhere to EMS division regulations. They are: members of the Alabama Association of Rescue Squad, Inc.; federal agencies; ambulances that assist in a major catastrophe, emergency or natural disaster; private or industrial ambulance services used exclusively for a business or industry at no cost; and ambulance services headquartered outside Alabama that transport patients into Alabama.