Emergency medical services system

Code of Massachusetts Regulations

Section: 105-170.00

Jurisdiction: MA

Bluebook Citation: 105 Mass. Code Regs. 170.00

105 CMR: DEPARTMENT OF PUBLIC HEALTH

105 CMR 170.000: EMERGENCY MEDICAL SERVICES SYSTEM

Section

170.001: Purpose 170.002: Authority 170.003: Citation 170.010: Scope 170.020: Definitions 170.050: The State EMS Plan 170.101: Regional Boundaries 170.102: Process for Department Designation of Regional EMS Councils 170.103: Criteria and Conditions for Department Designation of Regional EMS Councils 170.104: Duties and Functions of Regional EMS Councils 170.105: Allocation of Department Funding to Regional EMS Councils 170.106: Distribution and Use of Department Funds by Regional EMS Council 170.107: Grounds for Denial of Designation 170.108: Grounds for Revocation or Refusal to Renew Designation 170.200: Licensure of Ambulance and EFR Services 170.215: Service License and Vehicle Certification Fee 170.220: Finding of Responsibility and Suitability for Service Licensure 170.225: Inspection 170.230: Processing of Service License Applications 170.235: Provisional Service License 170.240: Modification of a Service License 170.245: Transfer or Assignment of a Service License 170.247: Notification of Termination or Other Change of Service 170.248: Notification of Provider Contract to Respond to Emergencies 170.249: Service Zone Agreements 170.250: Display of Service License 170.255: Out-of-state Ambulance Services 170.260: Grounds for Denial of a Service License 170.265: Grounds for Revocation, Suspension, or Refusal to Renew a Service License 170.270: Effect of Suspension, Revocation or Refusal to Renew a Service License 170.275: Waiver 170.285: Certification of Vehicles and Personnel 170.290: Places of Business 170.295: Levels of Advanced Life Support 170.300: Affiliation Agreements 170.303: Registration with the Department’s Drug Control Program 170.305: Staffing 170.307: Memorandum of Agreement for ALS-level EFR Services 170.310: Requirements for Additional Personnel on Ambulances 170.315: Insurance 170.320: Public Access 170.323: Code Black Status System Access 170.325: Advertising 170.330: Written Policies and Procedures for Services 170.333: Duty to Operate in Accordance with Laws, Regulations, Protocols and Other Requirements 170.335: Non-discrimination 170.340: Appointment of Designated Infection Control Officer 170.341: Requirement for Personnel to Be Vaccinated against Influenza Virus 170.342: Requirement for Personnel to Be Vaccinated against Coronavirus Disease 2019 (COVID-19) Caused by the Virus SARS-CoV-2 170.345: Records 170.347: Data Reports to the Department 170.350: Accident Reports and Serious Incident Reporting Requirements 170.355: Responsibility to Dispatch, Treat and Transport 170.357: Point-of-entry Plans 170.360: Responsibility to Provide Appropriate Personnel during Transfer 170.365: Transport of a Deceased Person 170.370: Transport of a Person in a Wheelchair Section: continued

(Mass. Register #1505, 9/29/2023)

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170.373: EMT Use of Patient Restraints 170.375: Dispatch Communications 170.380: Medical Communications 170.385: Service Availability and Backup 170.390: EMS Vehicle Readiness 170.395: Storage Space 170.400: Supplies 170.405: Waivers for Special Projects 170.410: General Requirements Regarding EMS Vehicles 170.415: Certificate of Inspection Required 170.420: Certification Procedure 170.425: Renewal of Certification 170.430: Temporary Certification for EMS Vehicles 170.435: Grounds for Denial, Suspension and Revocation of a Certificate of Inspection 170.440: Safety Inspections 170.445: Registration 170.450: All Ambulances Subject to Classification 170.455: Class I 170.460: Class II 170.465: Class IV 170.470: Class V 170.475: ALS Ambulances 170.480: Equipment, Medication and Supplies 170.485: Display of Certificate of Inspection 170.490: Ambulance Identification 170.500: Service Zone Plans 170.510: Elements of the Service Zone Plan 170.520: The Regional Service Zone Plan 170.530: Review and Approval of Service Zone Plans 170.540: Grounds for Denial of Approval of a Service Zone Plan 170.550: Update of Service Zone Plans and Redesignation of Providers 170.560: Grounds for Revocation of Service Zone Approval 170.705: Deficiencies 170.710: Plan of Correction 170.720: Correction Orders 170.730: Assessment for a Deficiency 170.740: Denial 170.750: Suspension 170.760: Revocation or Refusal to Renew 170.770: Adjudicatory Proceedings 170.780: Nonexclusivity of Enforcement Procedures 170.790: Criminal Enforcement Provisions 170.795: Complaints 170.800: EMS Personnel: General Provisions 170.805: EMS First Responder 170.810: Emergency Medical Technician S Basic 170.820: Advanced Emergency Medical Technician 170.840: Paramedic 170.850: Student Emergency Medical Technician 170.880: Emergency Medical Technicians Trained and/or Certified/Licensed in Other States 170.900: Certification of EMS Personnel Required 170.910: Initial Certification 170.920: Grounds for Denial of Certification 170.930: Renewal of EMS Personnel Certification 170.931: Emergency Medical Technicians Engaged in or Recently Discharged from Active Military Service, or Spouses Who Accompanied Personnel Who Are Engaged in or Recently Discharged from Active Military Service 170.935: Reinstatement of Certification 170.937: Reporting Obligations of EMS Personnel 170.940: Grounds for Suspension, Revocation of Certification, or Refusal to Renew Certification 170.941: Written Examination for EMT 170.942: Examiners and Chief Examiners: Duties and Requirements for Approval

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Section: continued

170.943: Renewal of Approval as a Chief Examiner and Examiner 170.944: Grounds for Denial, Suspension, and Revocation of Examiner and Chief Examiner Approval or Reapproval 170.945: Department-approved EMT Training 170.946: Accreditation of Training Institutions: General Provisions 170.947: Provisional Accrediation 170.948: Finding of Responsibility and Suitability of Applicants for Accreditation 170.950: Duties and Responsibilities of Accredited Training Institutions 170.955: Grounds for Denial of Accreditation 170.957: Grounds for Suspension, Revocation or Refusal to Renew Accreditation 170.960: Approval of Training Programs by Nonaccredited Training Providers 170.964: Standards for Training Programs by Nonaccredited Training Providers 170.970: Request for Subsequent Approval of Training Programs by Nonaccredited Training Providers 170.976: Grounds for Denial, Suspension, or Revocation of Approval of Training Programs by Nonaccredited Providers 170.977: Instructor/Coordinators: Duties and Requirements for Approval 170.978: Renewal of Approval as an Instructor/Coordinator 170.979: Grounds for Denial, Suspension, and Revocation of Instructor/Coordinator Approval or Reapproval 170.1000: Severability

170.001: Purpose

.000 is issued for the purpose of establishing a statewide, community-based Emergency Medical Services (EMS) system, in order to reduce death and disability from illness and injury through the coordination of local and regional emergency medical services resources. It is designed to ensure that properly trained and certified EMS personnel, operating under medical oversight, provide emergency medical care to patients at the scene of their illness or injury, and during transport to appropriate health care facilities. It establishes standards for EMS vehicles and equipment, and standards to ensure safe, adequate transport to an appropriate health care facility in the shortest practicable time. .000 also provides for scheduled, routine transport of non-emergent patients to appropriate destinations.

170.002: Authority

.000 is adopted under the authority of M.G.L. c. 111C and M.G.L. c. 30A, § 2.

170.003: Citation

.000 shall be known and may be cited as .000: Emergency Medical Services System.

170.010: Scope

.000 governs the EMS system, as defined in St. 2000, c. 54, § 1, M.G.L. c. 111C and .020.

170.020: Definitions

The definitions set forth in .020 shall apply for the purpose of 105 CMR 170.000, unless the context or subject matter clearly requires a different interpretation.

Accreditation means the process by which a certificate is issued by the Department pursuant to .946 through 170.950 indicating that the holder has met the requirements for providing Department-approved training for EMTs and EMT-candidates.

Administrative Requirements (A/R) means requirements issued by the Department’s Office of Emergency Medical Services to interpret, clarify and further define the application of certain provisions of .000.

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170.020: continued

Advanced EMT means the level of EMS personnel that has replaced "EMT-Intermediate" as set forth, at a minimum, in the U.S. Department of Transportation's National Highway Traffic Safety Administration's National EMS Scope of Practice Model and as used in its National EMS Education Standards. The Advanced EMT’s clinical practice is defined by the Statewide Treatment Protocols.

Advanced Life Support (ALS) means the pre-hospital use of medical techniques and skills defined by the Statewide Treatment Protocols by Paramedics and Advanced EMTs certified pursuant to .000.

Ambulance means any aircraft, boat, motor vehicle, or any other means of transportation, however named, whether privately or publicly owned, which is intended to be used for, and is maintained and operated for, the response to and the transportation of sick or injured individuals.

Ambulance Service means the business or regular activity, whether for profit or not, of providing emergency medical services, emergency response, primary ambulance response, pre-hospital emergency care, with or without transportation, to sick or injured individuals by ambulance.

Appropriate Health Care Facility means an emergency department, either physically located within an acute care hospital licensed by the Department pursuant to 105 CMR 130.000: Hospital Licensure to provide emergency services, or in a satellite emergency facility approved by the Department pursuant to 105 CMR 130.821: Approval for Satellite Emergency Facility, that is closest by transport time or conforms to a Department-approved point-of-entry plan. EMS personnel may, upon the direction of an emergency department physician, take incoming ambulance patients to one of the following other hospital departments, based on the patient’s medical needs: labor and delivery, cardiac catheterization, operating room, interventional neurology, intensive care unit, pediatric emergency department area, burn resuscitation and treatment area or acute resuscitation area. An appropriate health care facility also means a facility that meets the definition of a community behavioral health center (CBHC) established by the Executive Office of Health and Human Services that is closest by transport time, but only as set out in a Department-approved point-of-entry plan and only for those patients who fit triage criteria set out in a Department-approved point-of-entry plan.

Authorization to Practice means approval granted to an EMT by his or her employing EMS service's affiliate hospital medical director, which enables that EMT to work as an EMT and receive medical control pursuant to the employing service's affiliation agreement and in conformance with the Statewide Treatment Protocols.

Basic Life Support (BLS) means the pre-hospital use of techniques and skills defined by the Statewide Treatment Protocols by EMT-Basics certified pursuant to .000.

Certificate of Inspection means the formal certification, issued pursuant to .415, that the EMS vehicle meets the standards applicable to its type or class of vehicle.

Certification of EMTs means a process by which a certificate is issued by the Department indicating that the holder has met the requirements for an EMT at a specified level of training established by the Department.

Chief Examiner means a person appointed by the Department who is responsible for the organization and operation of a Department-approved EMT examination at a specific site.

CMED means the medical communications subsystem within the statewide EMS communications system.

Code Black Status System means a secure cloud-based system established by the Department to allow hospitals and CMED centers access to real-time information regarding the code black status of all appropriate health care facilities in Massachusetts licensed to provide emergency services.

105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.020: continued

Commission on Accreditation of Allied Health Education Programs (CAAHEP) means the national accrediting organization for educational programs in allied health professions, which reviews and accredits EMS programs in collaboration with its Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP).

Commission on Accreditation of Medical Transport Systems (CAMTS) means the national accrediting organization for air medical and ground transport systems providing critical care services.

Commissioner means the Commissioner of Public Health.

Company means a corporation, a partnership, a business trust, an association, or an organized group of persons, whether incorporated or not; or any receiver, trustee, or other liquidating agent of any of the foregoing while acting in such capacity.

Critical Care Services means the provision by an ambulance service of prehospital or interfacility patient care, stabilization, and transport services to critically ill and injured patients, using medical techniques, pharmacology, and technological life support systems that exceed those in the Statewide Treatment Protocols, including the ALS Interfacility Transfer Protocol, and as set out by the ambulance service and approved by the Department.

Continuing Education means instructional courses for certified EMS personnel to meet training requirements for maintenance of certification.

Department means the Department of Public Health.

Emergency means a condition or situation in which an individual has a need for immediate medical attention, or where the potential for such need is perceived by the individual, a bystander or an emergency medical services provider.

Emergency Medical Services (EMS) means the pre-hospital assessment, treatment and other services utilized in responding to an emergency or provided during the emergency or inter- facility transport of patients to appropriate health care facilities.

EMS First Responder (EFR) means a person certified pursuant to .000 who has, at a minimum, successfully completed a course in emergency medical care approved by the Department pursuant to M.G.L. c. 111, § 201 and 105 CMR 171.000: Massachusetts First Responder Training and who provides emergency medical care through employment by or in association with a licensed EFR service.

EMS First Response means the dispatch and response by the closest, most appropriate EMS personnel or EMS vehicle in the shortest practicable amount of time by a qualified EMS first response service.

EMS First Response Service (EFR Service) means the business or regular activity, whether for profit or not, by a licensed EMS provider, designated as a service zone provider pursuant to a Department-approved service zone plan for the purpose of providing rapid response and EMS.

EMS First Response Vehicle (EFR Vehicle) means any aircraft, boat, motor vehicle or any other means of transportation, whether privately or publicly owned, that is intended and is maintained and operated for the rapid response of EMS personnel, equipment and supplies to emergencies by an EFR service or by an ambulance service and is not utilized for patient transport.

EMS Personnel means EFRs and EMTs.

EMS Plan means a plan that includes an inventory and assessment of EMS resources and a plan for the optimal maintenance, coordination and utilization of those resources: (1) to improve the EMS system and its component elements; and (2) to coordinate with all state and municipal public safety agencies’ mass casualty and other public emergency plans.

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170.020: continued

EMS Provider means the following: (1) an EFR service, an ambulance service, or a hospital or facility approved by the Department to provide EMS including, without limitation, a trauma center, or (2) any individual associated with an EFR service, an ambulance service, or a hospital or facility approved by the Department to provide EMS, who is engaged in providing EMS. Such individuals include, without limitation, an EMT, an EFR, a medical communications system operator and a medical control physician, to the extent such physician provides EMS.

EMS System means all EMS providers and equipment; communications systems linking them to each other; training and education programs; the Regional EMS Councils and all of their operations; EMS plans, protocols, statutes, regulations, administrative requirements and guidelines; and all other components of such system, and their interaction with each other and with patients, providing equally for all patients quality care, operating under the leadership and direction of the Department.

EMS Vehicle means an ambulance or an EMS first response vehicle.

Emergency Medical Technician (EMT) means a person who has successfully completed a full course in emergency medical care approved by the Department, and who is certified by the Department in accordance with .000 to provide emergency medical services to sick or injured persons in accordance with the Statewide Treatment Protocols. The term EMT shall include EMT-Basic, Advanced EMT, and Paramedic.

Emergency Response means the dispatch and response of the closest appropriate ambulance, EMS personnel and other EMS vehicle to an emergency in the shortest practicable amount of time in conformance with the service zone plan.

EMT-Basic means the level "Emergency Medical Technician," or "EMT" as set forth, at a minimum, in the U.S. Department of Transportation's National Highway Traffic Safety Administration's National EMS Scope of Practice Model and as used in its National EMS Education Standards. The term also includes EMT-Basics who are taking the supplemental training required to meet the EMT level of the National EMS Scope of Practice Model, in accordance with administrative requirements of the Department. The EMT-Basic’s clinical practice is defined by the Statewide Treatment Protocols.

First Responder means a member of any of the following entities: a police or fire department; state police participating in highway patrol; an emergency reserve unit of a volunteer fire department or fire protection district, and any persons appointed permanent or temporary lifeguards by the Commonwealth or any of its political subdivisions. A first responder shall not mean a police officer, firefighter or person engaged in police and fire work whose duties are primarily clerical or administrative. First responders are required to successfully complete, at a minimum, the course of emergency medical care that meets the standards of M.G.L. c. 111, § 201 and .000: Massachusetts First Responder Training.

First Responder Agency means a police department, a fire department, the state police participating in highway patrol, an emergency reserve unit of a volunteer fire department or fire protection district, or the Commonwealth or any of its political subdivisions that appoints permanent or temporary lifeguards. A first responder agency shall not mean a service that is a licensed EFR service.

Headquarters means the principal place of business of an Ambulance or EFR service.

Hospital means a hospital that is licensed or certified by the Department pursuant to M.G.L. c. 111, § 51 or other applicable law, with an emergency department, and which is established or maintained for the purpose of caring for persons admitted thereto for diagnosis, medical, surgical or restorative treatment which is rendered within said institution

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170.020: continued

Immediate Dispatch means dispatching, or toning out or calling for an ambulance, to be sent out, without any delay, when a call to respond to an emergency is received. Immediate dispatch includes the toning out for on-call or volunteer personnel to respond to and staff an ambulance.

Initial Training means an educational program that meets or exceeds the current U.S. Department of Transportation's National EMS Education Standards and Instructional Guidelines for EMT-Basic, Advanced EMT or Paramedic, and any additional standards established by the Department, and consists of didactic, clinical and field training, to prepare students to become certified EMTs at the applicable level of care.

Instructor/Coordinator (I/C) means a person approved by the Department to organize and teach the EMT-Basic or Advanced EMT course.

License means an authorization to provide ambulance or EMS first response service, pursuant to the provisions of .000.

Local Jurisdiction means an entity empowered by the legislative body within a city, town, fire district or water district to select service zone providers including, but not limited to, a city council, board of selectmen, board of aldermen, mayor or town manager.

Massachusetts Emergency Medical Care Advisory Board (EMCAB) means the EMS System Advisory Board established under M.G.L. c. 111C, § 13.

Medical Control means the clinical oversight by a qualified physician to all components of the EMS system including, without limitation, the Statewide Treatment Protocols, medical direction, training of and authorization to practice for EMS personnel, quality assurance and continuous quality improvement.

Medical Direction means the authorization for treatment established in the Statewide Treatment Protocols provided by a qualified medical control physician to EMS personnel, whether on-line, via direct communication or telecommunication, or off-line, via standing orders.

National Registry of Emergency Medical Technicians (NREMT) means the national organization that tests and provides NREMT certification to EMTs at all levels, on the basis of which EMTs apply to states for state certification or licensure to work as an EMT.

Paramedic means the level of EMS personnel that has replaced "EMT-paramedic" as set forth, at a minimum, in the U.S. Department of Transportation's National Highway Traffic Safety Administration's National EMS Scope of Practice Model and as used in its National EMS Education Standards. The Paramedic’s clinical practice is defined by the Statewide Treatment Protocols.

Patient means an individual who is sick or injured and requires EMS and/or transportation in an ambulance.

Patient Care Report means a report or other written record, such as a dispatch record, generated by all services to document every response to an EMS call including each time an EMS vehicle is dispatched, whether or not a patient is encountered or ultimately transported by an ambulance service.

Person means an individual, a company, or an entity or an agency or political subdivision of the Commonwealth.

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170.020: continued

Place of Business means the locations owned, leased or used pursuant to an agreement by an EMS provider for EMS purposes including headquarters, branch offices and garages.

Point-of-entry Plan means a plan that is designed to ensure that EMTs transport a patient(s) in their care to the closest appropriate health care facility.

Primary Ambulance Response means first-line ambulance response, pre-hospital treatment and transportation by an ambulance service designated as a service zone provider or recognized in the service zone plan to provide first-line ambulance response, pre-hospital treatment and transportation pursuant to a provider contract.

Primary Ambulance Service means the business or regular activity, whether for profit or not, by a licensed ambulance service, designated under a service zone plan for the purpose of providing rapid response and pre-hospital EMS including, without limitation, patient assessment, patient treatment, patient preparation for transport and patient transport to appropriate health care facilities, in conformance with the service zone plan.

Professional Boundaries means the limits of the professional relationship to ensure a safe interface between a professional, such as EMS personnel, EMS training providers and EMS Examiners and Chief Examiners, and their respective patients, candidates or students. A violation of Professional Boundaries includes an action that is harmful to or exploitative of the patient, student or, candidate and can be either sexual or nonsexual in nature.

Provider Contract means an agreement, written or verbal, with an ambulance service to provide primary ambulance response to facilities with health care professionals on site, or to special events or functions with a dedicated ambulance on site. This definition shall not preclude any other category of provider contract that is recognized by the local jurisdiction in the service zone plan.

Recertification Year means April 1st of one calendar year through March 31st of the next calendar year.

Region means a geographic area of the state defined by the Department as an EMS planning area.

Regional EMS Council means an entity created pursuant to M.G.L. c. 111C, § 4 and designated by the Department to assist the Department in coordinating, maintaining and improving the EMS system in a region.

Regular Operating Area means any local jurisdiction or part thereof in which the ambulance service: (1) is the designated primary ambulance service; (2) has an agreement with the primary ambulance service; (3) has an agreement to provide backup service; (4) has a provider contract; or (5) has a base location.

Service means an EFR service or an ambulance service.

Service Zone means a geographic area defined by and comprised of one or more local jurisdictions, in which a local jurisdiction may select, and the Department shall designate, an EFR service and an ambulance service to provide EMS first response and primary ambulance response to the public within that defined geographic area, pursuant to M.G.L. c. 111C, § 10.

Service Zone Provider means an EMS provider, selected by a local jurisdiction and designated by the Department to provide primary ambulance service or EMS first response, or both, to the public within a service zone. A service zone provider shall be staffed and equipped to be available for primary ambulance service or EMS first response 24 hours per day, seven days per week.

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170.020: continued

Special Population means any person or group of persons with unique medical, physical or social problems that require other than customary emergency medical care.

Statewide Treatment Protocols means the Emergency Medical Services Pre-hospital Treatment Protocols approved by the Department for application statewide.

Trained to the First Responder Level means successful completion, at a minimum, of the course of emergency medical care that meets the standards of M.G.L. c. 111, § 201 and 105 CMR 171.000: Massachusetts First Responder Training.

Training Institution means a school or other entity that offers initial training and/or continuing education, and refers to such school or other organization only with regard to its provision of EMS training programs.

Training Program means an EMS instructional course, offered either as initial training, or continuing education.

Transportation means the conveyence of a patient by ambulance because of medical necessity or extenuating circumstances to prevent significant aggravation or deterioration of the patient's condition, or because the condition of the patient is unknown and could reasonably be suspected to warrant the use of an ambulance, or because the patient could not be moved by any other means.

Trauma means tissue injury due to the direct effects of externally applied mechanical, thermal, electrical, electromagnetic or nuclear energy, as further defined in the Statewide Treatment Protocols. Trauma shall not mean toxic ingestion, poisoning or foreign body ingestion.

Unique Population means the population of a state institution, an industrial plant or a university.

170.050: The State EMS Plan

The Department shall develop and implement the state EMS plan, which shall provide the framework for delivery of quality of EMS accessible to all patients by the local jurisdictions throughout the Commonwealth. This state EMS plan shall consist of the following:

(A) The EMS System regulations, at .000;

(B) All Department-approved service zone plans;

(D) All Department-approved point-of-entry plans;

(E) The Massachusetts Emergency Medical Services Communications Plan, and

(F) The Statewide Mass Casualty Incident Plan.

170.101: Regional Boundaries

The Department recognizes five geographic regions, as they existed on March 30, 2000. In each of these regions, the Department shall designate for a three-year renewable term a single Regional EMS Council to assist in the development of regional emergency medical services systems. Any regional group seeking designation must apply for designation on forms provided by the Department and submit all documents required by the Department for evaluation pursuant to .103.

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170.102: Process for Department Designation of Regional EMS Councils

(A) Designation of Regional EMS Councils shall be made by the Department after appropriate evaluation and investigation of applicants and after a review of documentary evidence which demonstrates that the applicant has met the criteria and conditions for designation as set forth in .103. In addition, the Department shall consult with the Massachusetts Emergency Medical Care Advisory Board.

(B) In the event that two applicants from the same region apply for designation, the Department shall designate the applicant who most completely fulfills the designation criteria.

170.103: Criteria and Conditions for Department Designation of Regional EMS Councils

Each applicant for designation as a Regional EMS Council shall be evaluated on the basis of all of the following criteria and conditions:

(A) Evidence of support for designation as a Regional EMS Council from a substantial number of municipal governments, hospitals, and ambulance services geographically distributed within the area covered by the proposed Regional EMS Council;

(B) A commitment to cooperate with the Department in its effort to carry out its authority and responsibility as defined in M.G.L. c. 111C;

(D) Regional Council Membership and Meetings. (1) Each Council shall be established through a fair and open selection process. It shall be structured so as to reflect equitably the entire geographic region, as well as the interests of the component entities of the EMS system. The Council shall be made up of at least ten persons, but no more than 35 members. At minimum, the Council shall have the following representation: (a) one representing local governments; (b) one designated by a hospital; (c) one designated by a fire suppression service; (d) one designated by a primary ambulance service; (e) one designated by a law enforcement agency; (f) one of whom is a licensed practicing physician with regular and frequent involvement in the provision of emergency care; (g) one of whom is an emergency care nurse; (h) one of whom is an EMT; (i) one of whom is designated by an EMS first response service; and (j) one of whom is a consumer. (2) Council membership shall reflect fairly and equitably representation from each geographic area throughout the region. (3) Meetings shall be held with sufficient frequency to ensure execution of duties and functions and to ensure that adequate information is transmitted to and from the organizations, groups, professions, occupations, services, and/or disciplines and consumers represented by the respective Council members. (4) All meetings, whether held separately or in conjunction with the Regional EMS Council, at which the business of the Council or Councils is conducted, shall be held as required by, and in conformance with M.G.L. c. 30A, § 11A, the open meeting law.

(E) Bylaws: Each Regional EMS Council shall draft and maintain updated bylaws. Bylaws shall be submitted to the Department, as updated, for its review and evaluation, and shall at minimum address the following: (1) A selection process for Council members and officers; (2) Enumerated duties and responsibilities of Council members and officers including requirements for fair and equitable representation of the entire region and all component entities of the EMS system therein served by the Regional EMS Council, and periodic and regular reports to the Council; and

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170.103: continued

(3) A committee structure designed to facilitate duties and functions, and the achievement of the regional EMS plan.

(F) Regional EMS Councils, their members, officers and agents shall comply with M.G.L. c. 268A, the conflict of interest law, and conflict of interest provisions set out in their contracts with the Department.

170.104: Duties and Functions of Regional EMS Councils

Regional EMS Councils shall carry out the following duties and functions:

(A) Assist, support and cooperate with the Department in its efforts to carry out the provisions of M.G.L. c. 111C to coordinate, maintain and improve the EMS system;

(B) Assist the Department with providing information, education and technical assistance on EMS system planning and coordination to local jurisdictions and EMS services in their region;

(D) Develop, submit to the Department for its approval, and implement Department-approved point-of-entry plans that are in conformance with the Statewide Treatment Protocols and other relevant regulations, policies, interpretative guidelines and administrative requirements of the Department. Such point-of-entry plans shall reflect and include, as appropriate, Department designations of hospitals for specialty care services, pursuant to 105 CMR 130.000: Hospital Licensure.

(E) Assist the Department in assuring quality educational programs for EMS personnel by: (1) Evaluating the quality of educational programs; (2) Serving as a central clearinghouse for available training equipment and supplies including equipment and supplies owned by the Department or purchased with funds obtained from the Department; and (3) Reviewing training programs for EMS personnel for the purpose of making recommendations for approval to the Department.

(F) Assist the Department in establishing, coordinating and maintaining communications systems that are compatible with established Department policies and plans;

(G) Forward to the Department all information regarding possible violations of .000 for investigation and enforcement by the Department. The Department may, in its discretion, request that Regional EMS Councils, under the direction of the Department, assist in certain investigations and enforcement;

(H) Develop and maintain up to date a regional EMS plan that is consistent with the state EMS plan pursuant to .050. The Regional EMS Council shall submit the plan to the Department for review and approval prior to its implementation. The plan shall consist of the following: (1) the regional service zone plan pursuant to .520; (2) Regional plans, in accordance with the applicable Department-approved statewide plans, for the following: (a) point-of-entry; (b) EMS communications; (c) accessing critical care and air ambulance services, and (d) EMS response to mass casualty incidents;

(I) Perform the following functions with respect to service zone planning in their regions: (1) Provide planning and technical assistance to local jurisdictions in their region in identifying, coordinating and making optimal use of all available EMS resources within the service zone, and drafting service zone plans;

170.104: continued

(2) Pursuant to M.G.L. c. 111C, § 10(b), consult with the local jurisdiction(s) comprising each service zone in their region and review and recommend their local service zone plans to the Department, for the Department’s review and approval; and

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(3) Assist local jurisdictions in updating and keeping current their service zone plans, and reviewing and recommending updated plans to the Department, for the Department’s review and approval.

(J) Appoint a Regional Medical Director who is a physician board-certified in emergency medicine, with a subspecialty board-certification in EMS preferred;

(K) Prepare and submit annual reports to the Department for its review and evaluation, prior to the commencement of each fiscal year;

(L) Prepare and maintain records relating to Regional EMS Councils’ responsibilities pursuant to M.G.L. c. 111C, .000 and contracts with the Department, and make such records available to the Department in full for inspection upon request; and

(M) Carry out the duties and functions required by the scope of services in Regional EMS Council contracts with the Department.

170.105: Allocation of Department Funding to Regional EMS Councils

(A) All five Regional EMS Councils shall be awarded on an equal basis a baseline annual appropriation to carry out their core duties and functions pursuant to .104 and their contracts with the Department.

(B) The Department may allocate additional funds to selective Regional EMS Councils, on the basis of factors indicating their different resource requirements and volume of duties including, but not limited to, the following: (1) number of cities and towns; (2) number of service zones; (3) number of ambulance services; or (4) unmet communications needs.

170.106: Distribution and Use of Department Funds by Regional EMS Councils

Regional EMS Councils may distribute and use Department funds, consistent with their contracts with the Department, for purposes defined in .000 including: (1) maintaining and operating the Regional EMS Councils; (2) maintaining and operating CMED centers; or (3) carrying out their duties and functions under .104 and contracts with the Department.

170.107: Grounds for Denial of Designation

(A) The Department may deny or refuse to issue designation in the following circumstances: (1) If the applicant fails to meet or conform to the designation criteria and conditions of .103; or (2) If a competing application for designation was already granted.

(B) An applicant denied designation may reapply when the designation criteria and conditions have been met, providing no other applicant has been designated in the interim.

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170.108: Grounds for Revocation or Refusal to Renew Designation

(A) The Department may revoke or refuse to renew the designation of a Regional EMS Council in the following circumstances: (1) Failure to maintain the standards required by the designation criteria and conditions of .103; (2) Failure to fulfill duties and functions as set forth in M.G.L. c. 111C, .000 and contracts with the Department; (3) Engaging in fraud or deceit to obtain or maintain designation, or in carrying out duties and functions under .000 and contracts with the Department; (4) Any action or omission that endangers the health or safety of the public; (5) Violation of a correction order; or (6) Failure to comply with a plan of correction.

(B) Revocation or refusal to renew designation may be appealed in accordance with .760.

170.200: Licensure of Ambulance and EFR Services

(A) No person shall establish, operate or maintain an ambulance or EFR service without a valid license or in violation of the terms of a valid license. All services shall be licensed as provided in .000. Any person who proposes to establish or operate a service shall apply for and obtain from the Department a license before initiating service.

(B) Ambulance services may be licensed at the BLS, ALS, or critical care service level, and EFR services may be licensed at the EMS first response, BLS or ALS level. Licensure as an ambulance service at a particular level of service includes licensure to provide ambulance or EFR service at the same or lower level of service.

(C) Ambulance and EFR service licenses shall identify and reflect the number of EMS vehicles to be operated, the classification of each certified EMS vehicle to be operated and maintained, and the level of service at each place of business. No service shall operate at a level of service above that for which it is licensed.

(D) To be eligible for licensure at the critical care services level, the applicant must document the following: (1) Current licensure from the Department as an ambulance service at the ALS-Paramedic level; (2) Current written affiliation agreement between a hospital and the applicant, meeting the requirements of .300, under which the hospital shall provide oversight of the delivery of critical care services and designate a medical director to have authority over the clinical and patient care aspects of critical care services; and (3) Current accreditation, in good standing, from the CAMTS, its successor(s), or an accreditation program the Department approves as substantially equivalent to CAMTS.

170.215: Service License and Vehicle Certification Fee

A nonrefundable fee established by the Department, pursuant to M.G.L. c. 111C, § 3(b)(21), shall be submitted (1) with the completed application for license form, and (2) upon acquisition of any additional vehicles during the licensure period. The fees are as follows:

(A) Service License. (1) Ambulance BLS: $400.00 biennially (2) Ambulance ALS: $600.00 annually (3) Ambulance Critical Care Services: $750 annually (4) EFR service at EMS first response level only: $100.00 biennially (5) EFR service BLS: $150.00 biennially (6) EFR service ALS: $200.00 annually

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170.215: continued

(B) Ambulance Vehicle and EFR Service Equipment Certification (1) Ambulance, BLS, ALS and critical care: $200.00 per vehicle, for each certificate of inspection. (2) EFR service, ALS: $50.00 for each certificate of inspection of each EFR vehicle’s EMS equipment and supplies.

170.220: Finding of Responsibility and Suitability for Service Licensure

(A) Upon receipt and review of a complete application or reapplication for ambulance or EFR service licensure, the Department shall make a finding concerning the responsibility and suitability of each applicant. Findings may be based upon information concerning persons with a significant financial or management interest in the service. Factors that have significant bearing in determining the responsibility and suitability of an applicant include, but are not limited to, the following: (1) The applicant’s history of prior compliance with .000, .000: Massachusetts First Responder Training; applicable administrative requirements issued by the Department pursuant to .000 and M.G.L. c. 111C; (2) The familiarity and experience of the applicant in operating ambulance services, other emergency medical services or first response services including compliance history in other states in which the applicant has operated a licensed ambulance service; (3) The applicant's ability to provide and sustain on an ongoing basis, sufficient quality and quantity of ambulance or EMS first response service in a service zone or portion thereof, in accordance with a service zone plan, or, prior to the existence of an approved service zone plan, in a geographic area; (4) Any willful or deliberate failure to provide ambulance or EMS first response service to a person for reasons of race, color, religion, sex, sexual orientation, age, national origin, ancestry or disability; (5) Any willful or deliberate failure to provide ambulance or EMS first response service to any patient experiencing an emergency; (6) The ability and willingness to take corrective action when notified by the Department of violations of .000 or .000: Massachusetts First Responder Training; (7) The ability of service administrators to operate the service in a manner sufficient to satisfy the requirements of .000 or .000: Massachusetts First Responder Training and administrative requirements of the Department issued thereunder; (8) Whether the applicant has a past history of patient abuse, mistreatment, or neglect; (9) Whether the financial resources of the applicant are deemed adequate to provide ambulance or EMS first response service sufficient to meet the requirements of 105 CMR 170.000 and the applicable service zone plan, as demonstrated by a current budget or a current annual financial statement; (10) Whether the applicant has any of the following: (a) Conviction of Medicare or Medicaid fraud. (b) Conviction of a crime relating to the operation of the service. (c) Conviction of drug-related offense, rape, assault or other violent crimes against a person. (d) Has been the subject of an order or judgment granting damages or equitable relief in an action brought by the Attorney General concerning the operation of the applicant’s ambulance service, other emergency medical services or first response services. (11) The adequacy of the service's legal capacity to operate, as demonstrated by such documents as articles of incorporation and corporate bylaws; (12) Any attempt to impede the work of a duly authorized representative of the Department or the lawful enforcement of any provisions of M.G.L. c. 111C or .000; and (13) Any attempt to obtain a license or certificate of inspection by fraud, misrepresentation, or the submission of false information.

(B) If the Department is unable to make a finding of responsibility and suitability due to the existence of any of the factors listed in .220(A)(1) through (13), the applicant will then have the burden of persuasion to prove the applicant's responsibility or suitability.

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170.225: Inspection

(A) Ambulance Service Inspection. Agents of the Department may visit and inspect an ambulance service at any time, including: (1) The premises of the ambulance service including the headquarters, garage or other locations; (2) The storage space for linen, equipment and supplies at any premises of the ambulance service; (3) All records of the ambulance service including, but not limited to, employee application forms, policies and procedures; dispatch reports, incident and accident reports, patient care and patient care reports reports; information relating to complaints registered with the service, and all other records, memoranda of agreement and affiliation agreements required by .000; and (4) Any vehicle, equipment and medications used by the service.

(B) EFR Service Inspection. Agents of the Department may visit and inspect an EFR service at any time, including: (1) All records pertaining to the provision of EMS services including, but not limited to, employee records, policies and procedures for EMS personnel; dispatch and EMS response reports; incident and accident reports and patient care reports; memoranda of agreements and affiliation agreements required by .000; and information relating to complaints regarding provision of EMS by the service; and (2) The EMS-related equipment and medications used by the service.

(C) If upon inspection deficiencies are found to exist a service may at the discretion of the Department be licensed upon presentation of a timely written acceptable plan of correction, as described in .710.

170.230: Processing of Service License Applications

(A) The Department shall issue a license to those applicants meeting the requirements of .000. The Department shall act on applications for original licensure within 90 calendar days of receipt of the completed forms and fees.

(B) Applicants for license renewal must submit to the Department the completed forms and fees required by the Department at least 90 calendar days prior to the expiration of their current license.

(C) If the complete renewal application is timely filed with the Department the license shall not expire until the Department makes a determination on the renewal application. If, however, an application is not submitted in a timely fashion in accordance with .230, then the service may not continue to operate after expiration of its license.

(D) A license shall not be renewed if there are any outstanding assessments issued pursuant to .730.

(E) A license at the BLS or ALS level shall remain in effect for a period of up to 24 months, at the discretion of the Department.

(F) A license to provide critical care services shall be coterminous with the period of CAMTS or Department-approved substantially equivalent accreditation on which it is based. If a service’s accreditation, upon which critical care service licensure is issued, has not been maintained, lapses, or expires, the service’s critical care license from the Department shall expire immediately, and the service shall not continue to provide critical care services.

(G) A service licensed to provide critical care services that loses its CAMTS or Department- approved substantially equivalent accreditation on which its licensure at this level is based, shall notify the Department immediately. A service that plans to change its status as accredited, or take action that will result in loss of its accreditation, by CAMTS or an accreditation program approved by the Department as substantially equivalent, shall notify the Department 60 calendar days prior to the proposed effective date of such change.

170.235: Provisional Service License

(A) Pursuant to M.G.L. c. 111C, § 6(c), the Department may issue a provisional license to an applicant for renewal of a license when it does not meet the requirements of .000, provided that:

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(1) the applicant has demonstrated to the Department's satisfaction a good faith intention to meet all such requirements; (2) the Department finds the applicant provides adequate emergency medical care; and (3) the Department finds the applicant evidences a potential for full licensure within a reasonable period, not to exceed six months.

(B) The Department bases its decision to issue a provisional license to a service when it identifies, upon inspection, significant, multiple and/or repeat health and safety deficiencies, uncorrected from prior inspections and plans of correction. Such significant health and safety deficiencies include, but are not limited to, the following: (1) Medical equipment/medication deficiencies including, but not limited to the following: (a) biohazard contamination to vehicle or equipment; (b) inoperable or improperly assembled portable or installed suction system; (c) missing all jump kits or required equipment/supplies, including missing/inoperable defibrillator or patient movement equipment; (d) missing or expired/unusable medications; and (e) empty/missing installed or portable oxygen tanks (if they cannot be immediately replaced/corrected). (2) Vehicle deficiencies including, but not limited to, the following: (a) vehicle inoperable; (b) door hinges separation/damage; (c) door skin separation; (d) rear door stress cracks/metal fatigue; (e) suspension mount cracks or separations; (f) driver’s gauges obstructed, and/or not backlit/visible, or any not functional; (g) emergency lights inoperable; (h) Original equipment manufacturer (OEM) lights inoperable; (i) scene lighting S inoperable on any one side of vehicle; (j) siren/audible warning system inoperable; (k) windshield cracks obstructing driver’s view; (l) invalid state motor vehicle safety inspection sticker; (m) cab/chassis floorboard holes; (n) excessive body damage or chassis corrosion/rust; (o) box or cab separation from mounts; (p) failure or inoperable or missing patient/occupant restraint device/system; and (q) vehicle not in a state of readiness, due to temperature of equipment/ medications/supplies, related to garaging or otherwise unable to respond to a call at any time. (3) Service operations deficiencies including, but not limited to, the following: (a) failure to maintain a current, valid affiliation agreement, or failure to comply with affiliation agreement requirements; (b) EMS personnel not maintaining current, valid required credentials (including EMT certification; CPR/ACLS credentials and driver’s license); (c) allowing uncertified personnel to act as EMTs at any level; (d) unsafe conditions in service locations/garages, including hazards; (e) identified drug security failures or other drug storage violations; and (f) failure to maintain patient care reports.

(C) The applicant shall submit, on a form required by the Department, a written plan for meeting the appropriate requirements and the plan must be approved by the Department.

(D) A provisional license shall expire six months after issuance. The Department shall in no case issue more than two consecutive provisional licenses to the same service.

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170.235: continued

(E) An initial license application may be required by the Department at the conclusion of the provisional licensure period at the discretion of the Department or after issuance of two consecutive provisional licenses.

170.240: Modification of a Service License

(A) Pursuant to M.G.L. c. 111C, § 8(a), any service seeking to modify any term of its license shall obtain the approval of the Department prior to making any modification. A service shall request approval to modify on forms provided by the Department.

(B) Approval for a license modification shall be required for, but not limited to, the following: (1) When a new certification for an EMS vehicle is issued or when a certification is revoked by the Department or deleted by the service; (2) When a change is made in the level of service; or (3) When a service adds or deletes a place of business from which services are provided.

(C) The Department shall not grant approval for a license modification unless it finds that the modification requested is in the public interest. If the modification requested involves a substantial change in the nature and scope of services, the Department shall also find that such change serves a need for emergency medical care before approving the modification.

170.245: Transfer or Assignment of a Service License

Pursuant to M.G.L. c. 111C, § 8(b), no licensee shall transfer or assign in any manner, voluntarily or involuntarily, directly or indirectly, or by transfer of control of any company or of any asset or any equity interest in any entity, the license issued to the licensee or any rights thereunder, without first applying in writing to the Department for permission to transfer or assign the license. The Department shall grant or deny the request in writing within 60 calendar days of the filing of the request. No transfer of a license shall be effective without written prior approval by the Department.

(A) In order to grant written permission to transfer or assign, the Department shall make the following findings: (1) That the transferee or assignee is responsible and suitable to maintain a service, pursuant to .220; and (2) That the transferee meets the applicable requirements for licensure, as provided in .000.

(B) Pursuant to M.G.L. c. 111C, § 8(b), if an application for transfer or assignment is denied, the Department shall issue a denial order. Such an order shall include a statement of the reasons for denial and provisions of the law relied upon, and shall be subject to judicial review through a petition for a writ of certiorari brought within 30 calendar days under the provisions of M.G.L. c. 249, § 4.

(C) A transferee shall provide such information as requested by the Department to update the Department's records following transfer.

(D) The terms of the license shall not be altered, amended, or modified by a transfer of the license. Upon approval of the transfer, the new licensee may apply for a modification of the transferred license pursuant to .240.

(E) Upon the Department’s approval of a transfer of the license, the licensee shall turn over to the transferee, prior to the effective date of the transfer, all records of the service subject to the inspection of the Department pursuant to .225.

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170.247: Notification of Termination or Other Change of Service

(A) A service shall give written notice in accordance with .247(B) of the following types of changes with regard to its service delivery: (1) Termination of services; (2) Change in the level of service delivered to a service zone or local jurisdiction; (3) Temporary cessation of services; or (4) Sudden event that interferes with the level of service it can provide.

(B)(1) Notice of changes in .247(A) must be provided in writing to the following entities: (a) the Department; (b) the appropriate Regional EMS Council; and (c) the service zone in which it operates or in which it is a designated provider, and prior to the existence of service zones, the appropriate local jurisdiction(s). (2) Notice of changes in .247(A)(1) and (2) must be provided at least 90 calendar days prior to the effective date of the change, or as soon as the service is aware of the need for the termination or change. (3) Notice of changes in .247(A)(3) and (4) must be provided as soon as the service is aware of the need for the change. (4) A notice of changes in service delivery shall be accompanied by a plan to prevent a disruption in EMS service, subject to the approval of the Department.

170.248: Notification of Provider Contract to Respond to Emergencies

All services shall provide written notification to the appropriate local jurisdiction(s) of all provider contracts they have for primary ambulance response within the service zone. Services shall provide notice to the local jurisdiction(s), at minimum, when an initial provider contract is established, a provider contract is terminated or renewed, or any changes are made to the provisions of a provider contract relating to emergency calls. For contracts to provide coverage at special events including multi-jurisdictional special events, at venues with which the service does not have a prior existing provider contract for primary ambulance response on a regular basis, advance written notice shall be provided to all local jurisdictions implicated by the events.

170.249: Service Zone Agreements

(A) The local jurisdiction shall ensure that the designated primary ambulance service executes a service zone agreement with each ambulance service that notifies it, in accordance with .248, that the ambulance service has a provider contract for primary ambulance response in the service zone. The service zone agreement shall, at a minimum: (1) Coordinate and optimize the use of resources for primary ambulance response, and ensure an appropriate response to emergencies; (2) Reflect the service zone’s performance standards for primary ambulance response that the ambulance service with a provider contract must meet; and (3) Define the process for notification of an EFR service, if any, of primary ambulance response calls received by the ambulance service with a provider contract. Such process shall comply with the provisions of .355(B)(1) and .510(I)(3)(f).

(B) Copies of the service zone agreements shall be included in the service zone plan.

(C) Specific provider contracts for one-time special events may not be known at the time the service zone plan is developed. Such contracts and performance standards applicable to them may be referenced generally in the plan, provided that the ambulance service with a provider agreement gives written notice of the contract to the local jurisdiction(s), prior to the event.

170.250: Display of Service License

Each service shall publicly display its license to operate in its headquarters, and shall publicly display a copy of its license in all of its other places of business.

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170.255: Out-of-state Ambulance Services

(A) Ambulance services located in and licensed in another state are not required to be licensed in accordance with .000 if they are transporting patients from locations outside of Massachusetts to locations within Massachusetts.

(B) No ambulance service shall regularly operate in Massachusetts unless the ambulance service is licensed in accordance with the provisions set forth in .000. An out-of-state ambulance service shall be deemed to be regularly operating in Massachusetts if: (1) the service advertises in Massachusetts, or otherwise solicits business in Massachusetts; (2) the service has a contractual agreement to provide ambulance service in Massachusetts; or (3) the service transports persons from locations within Massachusetts on a routine or frequent basis.

(C) Out-of-state ambulance services which provide only backup service to Massachusetts ambulance services are exempt from the requirements of .255(B). However, such a service must be in compliance with all applicable licensing laws and regulations in the state in which the backup ambulance service is based.

(D) If an out-of-state ambulance service regularly operates in Massachusetts, within the meaning of .255(B), that service shall either maintain a place of business within Massachusetts or make acceptable provisions for Department inspection of the service's vehicles and records. Such service shall meet all requirements imposed by M.G.L. c. 111C and .000 including being subject to enforcement and penalties for failure to comply, pursuant to .710 through 170.730, unless such requirements are waived by the Department.

170.260: Grounds for Denial of a Service License

(A) Grounds for license denial include, but are not limited to, the following: (1) Failure to submit a license application in accordance with the requirements of 105 CMR 170.000. (2) Failure to satisfy the Department as to any of the grounds for determining the responsibility and suitability of the applicant under .220. (3) Failure to meet the applicable requirements for licensure, as specified in .000. (4) Failure to comply with .303 regarding registration in accordance with M.G.L. c. 94C. (5) Fraud, deceit or knowing submission of inaccurate or incomplete data to the Department, either orally or in writing.

(B) Denial of a service license may be appealed in accordance with .760.

170.265: Grounds for Revocation, Suspension, or Refusal to Renew a Service License

(A) Grounds for license revocation, suspension, or refusal to renew a license include, but are not limited to, the following: (1) Violation of any applicable requirement prescribed under M.G.L. c. 111C; (2) Violation of a correction order; (3) Engaging in, or aiding, abetting, causing, or permitting any act prohibited under M.G.L. c. 111C; (4) Failure to allow the Department to inspect the service or parts thereof; (5) Use of EMS personnel who are not certified or not qualified to carry out the required level of patient care; (6) Failure to comply with a plan of correction; (7) Operation or maintenance of an EMS vehicle, EMS equipment or service in a manner that endangers the public health or safety; (8) Failure to meet the licensure requirements of .000; (9) Conviction of the licensee or a person with a significant financial or management interest in the service of Medicare or Medicaid fraud or other criminal offense related to the operation of the service;

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170.265: continued

(10) Conviction of the licensee or a person with a significant financial or management interest in the service of a criminal offense such as drug-related offenses, rape, assault, or other violent crime against a person, which indicates that continued operation of the service may endanger the public health or safety; (11) Failure to comply with .303 regarding M.G.L. c. 94C registration; (12) Failure to submit an acceptable plan of correction as required under .710; (13) Failure to pay a deficiency assessment levied in accordance with .730; (14) Failure to provide certification of compliance with all laws relating to taxes, or to provide a certificate of good standing from the Commissioner of Revenue, in accordance with M.G.L. c. 62C, § 49A; (15) Any attempt to impede the work of a duly authorized representative of the Department or the lawful enforcement of any provisions of M.G.L. c. 111C or .000; or (16) Any attempt to obtain or maintain a license or certificate of inspection by fraud, misrepresentation or the submission of false information.

(B) Revocation, suspension, or refusal to renew a service license may be appealed in accordance with .760.

170.270: Effect of Suspension, Revocation or Refusal to Renew a Service License

Pursuant to M.G.L. c. 111C, § 16, suspension or revocation of a license or refusal to renew a license shall result in the simultaneous revocation of the certificate(s) of inspection or refusal to renew certificate(s) of inspection for the service’s EMS vehicles.

170.275: Waiver

An applicant for a license, or a licensee under .000, may apply to the Department for a temporary waiver of those requirements with which the service is unable to comply. A temporary waiver may be renewed, in accordance with administrative requirements of the Department.

(A) An applicant for a waiver shall submit the following in writing: (1) Evidence of a prior good faith effort to comply with each requirement for which a waiver is requested; (2) A statement documenting why the service cannot comply with each requirement for which a waiver is requested, including any financial or other significant hardship resulting from efforts to comply; (3) A statement documenting why noncompliance with each requirement will not cause the service to be unable to render adequate care; (4) Reasons why compliance with each requirement is not possible for a given period of time; and (5) A plan for compliance with each requirement within the period requested by the waiver.

(B) The Department may grant a waiver of one or more requirements upon satisfactory documentation by the applicant for the waiver and a finding by the Department that the applicant: (1) Has made a good faith effort to comply with the requirements for which waiver is requested; (2) Would suffer undue hardship if compliance were required; (3) Has adopted alternative procedures or features that are functionally equivalent to the requirement to be waived; and (4) Has instituted the alternative procedures or features, which adequately protect the health and safety of the patients served by the service and do not limit the service's ability to provide adequate services.

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170.275: continued

(C) Pursuant to M.G.L. c. 111C, § 9, the Department may grant a licensee a temporary waiver of the EMT certification requirement set forth in .910 for an individual who has completed the Department-approved EMT training course requirements, or Department- approved equivalent training, in accordance with provisions set out in the Department’s administrative requirements for temporary waivers. Application for such a waiver shall be submitted on a form provided by the Department and shall include: (1) a copy of the individual's current training card in basic life support cardiopulmonary resuscitation, as required in .810(C)(1); and (2) a copy of the individual's valid motor vehicle operator's license.

(D) The application for a waiver shall be granted or denied within 30 days of receipt of the completed application. The Commissioner or his or her designee shall evaluate the waiver request and consider whether or not it is in the public interest to grant the waiver. The decision of the Commissioner or his or her designee shall be final.

(E) All waivers granted pursuant to .275 are subject to revocation by the Department if the licensee or applicant for a license fails to abide by the requirements of the waiver. A licensee or applicant for a license whose waiver is revoked by the Department may appeal that action, in accordance with .760.

(F) Waivers granted to ambulance services pursuant to .275 are coterminous with the service license and expire with the service’s license expiration date.

170.285: Certification of Vehicles and Personnel

Each service shall:

(A) Ensure that the EMS vehicle(s) it operates and maintains comply with all applicable standards for certification set forth in .000, applicable motor vehicle standards under M.G.L. c. 90 and other relevant laws and regulations;

(B) Ensure that the EMS personnel who work for it comply with the applicable standards set forth in .000;

(C) Ensure that EMS personnel carry on their person or in the EMS vehicle on which they are working, documentation (in electronic or print format) of their current certification level and current cardiopulmonary resuscitation training, and a valid motor vehicle operator's license; and

(D) Verify its EMTs' credentials by examining all required documentation (in electronic or print format) of current status. In the case of an EFR service at the EMS first response level, it shall be responsible for current certification of its EFRs who are not EMTs, and for verifying these EFRs' current credentials by examining all required documentation of current status.

170.290: Places of Business

Each service’s places of business shall meet the requirements of .000 applicable to its level of service.

170.295: Levels of Advanced Life Support

A service may provide only those advanced life support services that are consistent with the level of service for which the service is licensed. Licensure at any ALS level includes licensure for the provision of BLS-level services. The levels of licensure for ALS services are:

(A) Advanced Level: services related to airway and circulatory maintenance pursuant to the Statewide Treatment Protocols and any other procedure which is consistent with Department- approved training for Advanced EMT.

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170.295: continued

(B) Paramedic Level: services related to the treatment of cardiac or respiratory arrest, poisoning, drug overdose or other major trauma or illness pursuant to the Statewide Treatment Protocols and any other procedure which is consistent with Department-approved training for Paramedics.

170.300: Affiliation Agreements

(A) To be licensed to provide ALS services, each ambulance or EFR service must have a current written contract, called an affiliation agreement, with one or more hospitals licensed by the Department to provide medical control, in accordance with .300(D). This agreement shall contain a reasonable and effective plan for medical control and include the following features: (1) Treatment protocols and point-of-entry plans using regional guidelines that are in conformance with the Statewide Treatment Protocols, and other relevant regulations, policies and administrative requirements of the Department; (2) Designation of an affiliate hospital medical director, who shall have authority over the clinical and patient care aspects of the affiliated EMS service including, but not limited to, the authorization to practice of its EMS personnel; (3) Provision of on-line medical direction in accordance with the Statewide Treatment Protocols 24 hours per day, seven days per week, by a hospital-based physician; (4) Operation of an effective quality assurance/quality improvement (QA/QI) program coordinated by the affiliate hospital medical director and with participation of on-line medical direction physician(s) and service medical director, if different from the affiliate hospital medical director, that includes, but is not limited to, regular review of patient care reports and other statistical data pertinent to the EMS service’s operation, in accordance with the hospital’s QA/QI standards and protocols; (5) Operation of a program for skill maintenance and review for EMS personnel; (6) Ensuring EMS personnel have access to remediation, training and retraining, as necessary, under the oversight of the affiliate hospital medical director or his or her designee; (7) Regular consultation between medical and nursing staffs and EMS personnel providing ALS services including, but not limited to, attendance at morbidity and mortality rounds and chart reviews; (8) A procedure by which a physician can maintain recorded direct verbal contact with the EMS personnel regarding a particular patient’s condition and order, when appropriate, the administration of a medication or treatment for a patient, to which such physician or his or her designee shall sign the patient care report documenting the patient’s care and transport by the EMS personnel; (9) Policies and procedures for obtaining medications, in accordance with the level of licensure of the EMS service, from the hospital’s pharmacy; (10) A procedure by which the service shall notify its affiliate hospital medical director within 72 hours of Department action against any EMT’s or EFR’s certification (denial, suspension, revocation or refusal to renew certification), or other Department disciplinary action (letter of censure, letter of clinical deficiency, advisory letter) against any EMS personnel employed by the service; and (11) If the service has more than one affiliation agreement, in accordance with 105 CMR 170.300(D), the identity of all hospitals with which the service has affiliation agreements and policies and procedures that set forth the duties and responsibilities of each affiliate hospital.

(B) To be licensed to provide BLS services, each ambulance or EFR service must have a current written contract, called an affiliation agreement, with one hospital licensed by the Department to provide medical control; except that more than one ambulance or EFR service at the BLS level that each averages less than 200 calls per year may be covered by the same written contract for medical control. BLS affiliation agreements shall meet all the requirements of .300(A), in accordance with these services’ licensure level.

(C) An affiliation agreement, shall be kept current, be reviewed and updated or renewed at intervals of no more than every four years.

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170.300: continued

(D) A service that has bases of operation in more than one EMS region shall maintain an affiliation agreement in each of the EMS regions in which it operates. A service that maintains more than one place of business within a single EMS region may maintain more than one affiliation agreement, provided that the Department approves the additional agreement. No service that maintains a single place of business may enter into more than one affiliation agreement.

(E) On-line medical direction may be delegated by the affiliate hospital to physicians at another hospital licensed by the Department to provide medical control. If on-line medical direction is routinely delegated to physicians at another hospital, then such hospital may be a party to the affiliation agreement between the service and the affiliate hospital.

170.303: Registration with the Department’s Drug Control Program

Each service that possesses controlled substances and instruments for administration of controlled substances, in accordance with its level of service and the Statewide Treatment Protocols, shall be registered with the Commissioner, in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C. For the purpose of applying for licensure, it shall be sufficient for the service to document that a complete application for registration was submitted to the Commissioner.

170.305: 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 .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 .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 .000, provided that the conditions set forth in .305(B)(1)(a) through (f) are met. For BLS level transports in which the conditions set forth in .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;

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170.305: continued

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 .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 .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;

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170.305: continued

(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 .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 .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 .000, unless such persons qualify as additional personnel in accordance with .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.

170.307: Memorandum of Agreement for ALS-level EFR Services

(A) An ALS-level EFR service must maintain a current memorandum of agreement with either: (1) the primary ambulance service designated in its service zone, provided that it is at the same level of ALS licensure or higher; or (2) another transporting ALS ambulance service at the same or higher level of ALS licensure, provided that the agreement is coordinated through the primary ambulance service.

(B) The memorandum of agreement shall establish protocols for: (1) medical control and medical direction that include, at a minimum, confirmation of the ALS-level EFR service’s current affiliation agreement that complies with .300; (2) interaction of EMS personnel; (3) direct communication between the EFR vehicle and the transporting ambulance and its dispatch center; and (4) assuring continuity of ALS care, begun at the scene, throughout transport.

105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.310: Requirements for Additional Personnel on Ambulances

Additional personnel, beyond the minimum staffing requirements for ambulances under .305, may function on an ambulance according to the provisions listed in .310(A) and (B).

(A) Such personnel must be currently certified in Basic Life Support cardiopulmonary resuscitation through completion of a course provided by a nationally recognized organization and reflecting current cardiopulmonary resuscitation (CPR) and emergency cardiac care resuscitation science and treatment recommendations issued by the International Liaison Committee on Resuscitation (ILCOR)'s International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR), or successor body. Their function may include the operation of a Class I, II or V ambulance if permitted by the written policies and procedures of the ambulance service; provided, however, that additional personnel may operate the vehicle only if the supervising EMT on the ambulance makes a determination that the care of the patient will be significantly improved by having both EMTs remain with the patient during transport;

(B) A registered nurse, physician or other health care professional may render care to a patient during the transport of a patient(s) by an ambulance from a hospital or other transferring facility when designated to do so by the transferring facility.

170.315: Insurance

(A) No original or renewal license shall be issued, except in the case of services owned or operated by an agency or political subdivision of the Commonwealth, to an applicant for an original or renewal license, which operates its EMS vehicles in direct connection with a place of business in Massachusetts, unless the applicant has satisfied the insurance requirements necessary to register each of its Class I, II, and V ambulances and its applicable EFR vehicles as a motor vehicle with the Massachusetts Registrar of Motor Vehicles, pursuant to M.G.L. c. 90, § 3 and § 34A through 34O, and in addition, has satisfied the minimum limits set out in .315(B).

(B) Each service shall carry the following insurance coverage for each of its EMS vehicles: (1) A minimum of $100,000 on account of injury to or death of any one person; (2) Subject to the limit as respects injury to or death of one person, a minimum of $500,000 on account of any one accident resulting in injury to or death of more than one person; and (3) A minimum of $25,000 because of injury to or destruction of property of others in any one accident.

(C) Each service shall file with the Department proof of contracts of insurance. The proof of contracts of insurance shall disclose that at least the minimum levels of insurance coverage set out in .315(B) are carried by the service for each of its EMS vehicles.

170.320: Public Access

(A) Every ambulance service shall have a telephone with a publicly listed number to accept calls from the public within its regular operating area.

(B) Every ambulance service licensed to operate a Class I, IV, and Class II ambulances used as backup for a Class I shall have a telephone number that is publicly listed. The service shall provide that the telephone will be answered on a 24-hour-a-day basis either by the service or its first backup as required in .385. The service must have telephone capability for receiving two phone calls simultaneously.

(C) Exception: An ambulance service that, according to its written policy, does not respond to calls from the general public but responds only to calls from a unique population is exempt from the requirements of .320(A) and (B). However, the ambulance service shall have a telephone number made known to the unique population it serves and the telephone must be answered either by the service or its first backup as required in .385 during the period when that population might require service.

105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.323: Code Black Status System Access

All ambulance services shall have the ability to access the Department’s code black status system through communication with a CMED or hospital connected to the code black status system.

170.325: Advertising

(A) No person shall advertise by any means including, but not limited to, signs or symbols on the vehicle, that he or she operates or maintains a service, unless the service is licensed and its EMS personnel and EMS vehicles are certified as required in .000.

(B) No person shall engage in any advertising that is deceptive or misleading to the public or for services other than those for which it is currently licensed, for which its EMS personel and EMS vehicles are certified and for which it is placed in service.

(C) Prior to transfer of ownership of an EMS vehicle, a licensed service, if it knows that the vehicle will be removed from service and will no longer be certified, shall ensure that all vehicle markings and emblems required by .000 are removed.

170.330: Written Policies and Procedures for Services

(A) Each ambulance service shall have written policies and procedures consistent with .000, the accepted standards of care for EMTs and applicable laws. These policies shall set out guidelines for operating and maintaining the service and ambulances, and shall be provided to EMTs. These policies shall be comprehensive, reflect current day-to-day operations, and address at minimum the following: (1) Certification and recertification of EMTs; (2) Orientation of all ambulance service employees; (3) Responsibility to dispatch, treat and transport in accordance with .355; (4) Duties of transportation and policies relating to delivery of patients to appropriate health care facilities in accordance with .020; (5) Nondiscrimination; (6) Backup services including provisions for when such services are to be used and timely dispatch in accordance with standards set out in the applicable Department-approved service zone plan, to backup services when needed; (7) Arrangements for securing additional EMS personnel at appropriate certification levels, in order to staff ambulances in accordance with .305; (8) Dispatch; (9) Communications; (10) Stocking of supplies; (11) Use of lights and warning signals; (12) Staffing of ambulances; (13) Conduct of personnel; (14) Acquisition, security and disposal of controlled substances and other drugs, in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C; (15) Maintenance of biomedical equipment and devices according to manufacturers’ recommendations; (16) Ensuring timely leaving/transmission of patient care reports at receiving hospitals; (17) Arrangements for securing additional appropriately trained personnel to assist EMTs, whether in providing ALS services in accordance with .305(C) or for other purposes; (18) For ALS services, the hours during which ALS service will be provided, if the service is not yet operating 24 hours per day, seven days per week, in accordance with .385(C); (19) For ALS-Paramedic services that staff with one paramedic and one other certified EMT, all policies required by .305(C)(2); (20) Mechanical failures; (21) Inspection authorities; (22) Infection control procedures including designated infection control officer;

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170.330: continued

(23) Compliance with the Statewide Treatment Protocols; (24) Training and skill competency assurance of EMS personnel for new or updated equipment; changes and updates to .000, the Statewide Treatment Protocols; administrative requirements, advisories and memoranda issued by the Department; and as otherwise required by any provision of .000 or the Statewide Treatment Protocols; (25) Rights of parents of patients who are minors, including the right to accompany the patient in the ambulance in accordance with M.G.L. c. 111C, § 17; (26) Mandated reporting; (27) EMT use of patient restraints in accordance with .373 and the Statewide Treatment Protocols; (28) Sanitary practices; and (29) Disposal of hazardous waste. . (B) Each EFR service shall have written policies and procedures consistent with 105 CMR 170.000 and .000: Massachusetts First Responder Training, the accepted standards of care for EMTs and EFRs and applicable laws. The policies shall establish guidelines for operating and maintaining the EFR service and shall be made available to all EMTs and EFRs working for or with the service. These policies shall address the following: (1) Certification and recertification of EMTs; (2) Orientation of all EMTs and EFRs; (3) Service’s responsibility for its EFRs meeting certification and recertification requirements; (4) Transfer of patient care and patient care information from the EFR service to the transporting ambulance service; (5) Dispatch; (6) Communications; (7) Stocking of supplies; (8) Conduct of EMS personnel; (9) EMS inspection authorities; (10) Infection control procedures; (11) EMT compliance with the Statewide Treatment Protocols; (12) Maintenance of biomedical equipment and devices according to manufacturers’ recommendations; and (13) Use of visible and audible warning signals.

(C) In addition to the policies and procedures required under .330(A), each service licensed at the critical care services level must maintain comprehensive critical care services policies, procedures, protocols and standing orders for patient care, as required by CAMTS or an accreditation program the Department approves as substantially equivalent to CAMTS. All clinical policies, procedures, protocols and standing orders must be: (1) Developed in conjunction with, and approved by, the affiliate hospital medical director providing oversight for the critical care services provided by the service; (2) Reviewed and updated as appropriate, with at minimum an annual review and approval of the affiliate hospital medical director, and (3) Submitted to the Department on an annual basis.

(D) Standards for the contents of the procedures and policies are established separately by the Department as administrative requirements.

170.333: Duty to Operate in Accordance with Laws, Regulations, Protocols and Other Requirements

Each service shall operate, and shall ensure that its agents operate, in accordance with M.G.L. c. 111C, .000, all other applicable laws and regulations, the Statewide Treatment Protocols, where relevant, administrative requirements and advisories of the Department, and the service’s established policies and procedures that are consistent with .000.

105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.335: Non-discrimination

In accordance with requirements of federal and state anti-discrimination statutes, no person shall discriminate on the grounds of race, color, religion, sex, sexual orientation, age, national origin, ancestry or disability in any aspect of the provision of ambulance or EMS first response service or in employment practices.

170.340: Appointment of Designated Infection Control Officer

Each service shall ensure that its EMS personnel are informed of the requirements relating to the reporting of exposures to the infectious diseases set forth in 105 CMR 172.000: Implementation of Massachusetts General Laws C. 111, § 111C, Regulating the Reporting of Infectious Diseases Dangerous to the Public Health, and shall appoint one official of the service to act as a designated infection control officer to:

(A) Receive notifications and responses from health care facilities regarding exposures to infectious diseases dangerous to the public health, as defined in 105 CMR 172.001: Definitions;

(B) Report said exposures to EMS personnel; and

170.341: Requirement for Personnel to Be Vaccinated against Influenza Virus

(A) Definitions. 1. For purposes of .341, personnel means an individual or individuals who either work at or come to the licensed service or site or EMS vehicle and who are employed by or affiliated with the service, whether directly, by contract with another entity, or as an independent contractor, paid or unpaid including, but not limited to, employees, members of the medical staff, contract employees or staff, students, and volunteers, whether or not such individual(s) provide direct care. 2. For purposes of .341, the requirement for influenza vaccine or vaccination means immunization by either influenza vaccine, inactivated or live; attenuated influenza vaccine including seasonal influenza vaccine pursuant to .341(B); and/or other influenza vaccine pursuant to .341(C). 3. For purposes of .341, mitigation measures mean measures that personnel who are exempt from vaccination take to prevent viral infection and transmission.

(B) Each service shall ensure all personnel are vaccinated annually with seasonal influenza vaccine, consistent with any guidelines of the Commissioner, unless an individual is exempt from vaccination in accordance with .341(F).

(C) Each service also shall ensure all personnel are vaccinated against other pandemic or novel influenza virus(es) as specified in guidelines of the Commissioner, unless an individual is exempt from vaccination in accordance with .341(F). Such guidelines may specify: 1. The categories of personnel to be vaccinated and the order of priority of vaccination of personnel, with priority for personnel with responsibility for direct care; 2. The influenza vaccine(s) to be administered; 3. The dates by which personnel must be vaccinated; and 4. Any required reporting and data collection relating to the personnel vaccination requirement of .341(C).

(D) Each service shall provide all personnel with information about the risks and benefits of influenza vaccine.

(E) Each service shall notify all personnel of the influenza vaccination requirements of .341 and shall, at no cost to any personnel, provide or arrange for vaccination of all personnel who cannot provide proof of current immunization against influenza unless an individual is exempt from vaccination in accordance with .341(F).

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170.341: continued

(F) Exemptions. 1. Subject to the provisions set forth in .341(F)(2), a service shall not require an individual to receive an influenza vaccine pursuant to .341(B) or (C) if the individual declines the vaccine. 2. For any individual subject to the exemption, a service may require such individual take mitigation measures, consistent with guidance from the Department. 3. An individual who is exempt from vaccination shall sign a statement certifying that they are exempt from vaccination and they received information about the risks and benefits of influenza vaccine.

(G) Unavailability of Vaccine. A service shall not be required to provide or arrange for influenza vaccination during such times the vaccine is unavailable for purchase, shipment, distribution or administration by a third-party or when complying with an order of the Commissioner restricting the use of the vaccine. A service shall obtain and administer influenza vaccine in accordance with .341 as soon as vaccine becomes available.

(H) Documentation. 1. A service shall require and maintain for each individual proof of current vaccination against influenza virus pursuant to .341(B) or (C), or the individual's exemption statement pursuant to .341(F). 2. Each service shall maintain a central system to track the vaccination status of all personnel. 3. If a service is unable to provide or arrange for influenza vaccination for any individual, it shall document the reasons such vaccination could not be provided or arranged for.

(I) Reporting and Data Collection. Each service shall report information to the Department documenting the facility's compliance with the personnel vaccination requirements of .341, in accordance with reporting and data collection guidelines of the Commissioner.

(J) .341 establishes requirements for influenza vaccination of ambulance service personnel. Nothing in .000 shall be read to prohibit services from establishing policies and procedures for influenza vaccination of personnel that exceed the requirements set forth in .341.

170.342: Requirement for Personnel to Be Vaccinated against Coronavirus Disease 2019 (COVID-19) Caused by the Virus SARS-CoV-2

(A) Definitions. 1. For purposes of .342, personnel means an individual or individuals who either work at or come to the licensed service or site or EMS vehicle and who are employed by or affiliated with the service, whether directly, by contract with another entity, or as an independent contractor, paid or unpaid including, but not limited to, employees, members of the medical staff, contract employees or staff, students, and volunteers, whether or not such individual(s) provide direct care. 2. For purposes of .342, COVID-19 vaccination means being up to date with COVID-19 vaccines as recommended by the Centers for Disease Control and Prevention (CDC). 3. For purposes of .342, mitigation measures mean measures that personnel who are exempt from vaccination take to prevent viral infection and transmission.

(B) Each service shall ensure all personnel have received COVID-19 vaccination in the timeframe specified in Department guidelines, unless an individual is exempt from vaccination in accordance with .342(E).

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170.342: continued

(D) Each service shall notify all personnel of the COVID-19 vaccination requirements of 105 CMR 170.342 and shall, at no cost to any personnel, provide or arrange for vaccination of all personnel who cannot provide proof of current vaccination against COVID-19 unless an individual is exempt from vaccination in accordance with .342(E).

(E) Exemptions. 1. Subject to the provisions set forth in .342(E)(2), a service shall not require an individual to receive a COVID-19 vaccine pursuant to .342(B) if the individual declines the vaccine. 2. For any individual subject to the exemption, a service may require such individual take mitigation measures, consistent with guidance from the Department. 3. An individual who is exempt from vaccination shall sign a statement certifying that they are exempt from vaccination and they received information about the risks and benefits of COVID-19 vaccine.

(F) Unavailability of Vaccine. A service shall not be required to provide or arrange for COVID-19 vaccination during such times the vaccine is unavailable for purchase, shipment, distribution, or administration by a third-party or when complying with an order of the Commissioner restricting the use of the vaccine. A service shall obtain and administer COVID-19 vaccine in accordance with .342 as soon as vaccine becomes available.

(G) Documentation. 1. A service shall require and maintain for each individual proof of current vaccination against COVID-19 virus pursuant to .342(B), or the individual's exemption statement pursuant to .342(E). 2. Each service shall maintain a central system to track the vaccination status of all personnel. 3. If a service is unable to provide or arrange for COVID-19 vaccination for any individual, it shall document the reasons such vaccination could not be provided or arranged for.

(H) Reporting and Data Collection. Each service shall report information to the Department documenting the service's compliance with the personnel vaccination requirements of 105 CMR 170.342, in accordance with reporting and data collection guidelines of the Commissioner.

(I) .342 establishes requirements for COVID-19 vaccination of ambulance service personnel. Nothing in .000 shall be read to prohibit services from establishing policies and procedures for COVID-19 vaccination of personnel that exceed the requirements set forth in .342.

170.345: Records

Each service shall prepare and maintain records, in electronic or print format, that are subject to, and shall be available for, inspection by the Department at any time upon request. Records shall be stored in such a manner as to ensure reasonable safety from water and fire damage and from unauthorized use, for a period of not less than seven years. Services shall also store and maintain the records of any service(s) they acquire, in the same manner.

(A) Records for services shall include at a minimum, as applicable, the following: (1) service policies and procedures; (2) EMS personnel training records; (3) EMS personnel and employment files and records; (4) documentation of EMS personnel’s current CPR and ACLS training credentials, as applicable for their certification level, EMT or EFR certification and valid motor vehicle operator's license, including when and by whom verification required by .285 was completed; (5) all data from cardiac monitors and other equipment used in patient care, downloaded and readily accessible, either in electronic or paper format, for continuous quality improvement as well as Department review upon request;

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170.345: continued

(6) For services licensed at the critical care service level, documentation of compliance with all CAMTS or Department-approved substantially equivalent accreditation standards including, but not limited to, continuous quality improvement (CQI); training and orientation of critical care transport personnel; continuing clinical education, skills maintenance and requirements for ongoing demonstration of clinical competency of its critical care medical crews. (7) preventive maintenance and repair records for ambulances and biomedical equipment and devices; (8) current vehicle registrations; (9) current Federal Aviation Administration (FAA) certifications and licenses for Class IV ambulances and pilots; and (10) Federal Communications Commission (FCC) licenses.

(B) Patient Care Report Preparation and Contents. Each service shall maintain dispatch records, in either computer-aided (CAD) or handwritten form, and written patient care reports, for every EMS call including, but not limited to, cases in which no treatment is provided, the patient refuses treatment or there is no transport. Each patient care report shall be accurate, prepared contemporaneously with or as soon as practicable after, the EMS call that it documents. EMS personnel shall provide a verbal report to receiving staff at the time of patient transfer of care. Each written patient care report shall, at a minimum, include the data elements pertaining to the call as specified in administrative requirements of the Department. All EMS personnel on the ambulance or ambulances dispatched to the patient are responsible for the accuracy of the contents of their respective patient care reports, in accordance with their level of certification. In addition, an ambulance service that does not transport must include in the patient care report the reasons for not transporting including, if applicable, the signed informed refusal form from the patient(s). All baseline printouts from equipment used in the care of the patient, and those parts of printouts that correspond to clinical interventions or clinically relevant changes in the patient's condition, shall be available as part of the patient care report

(C) Patient Care Reports and Unprotected Exposure Form Submission. (1) EMS personnel at the scene who are not transporting the patient shall keep the original patient care reports, and ensure that a copy of such patient care report is timely delivered to the health care facility to which the patient is transported, in accordance with service zone plan procedures. The receiving health care facility shall keep such patient care reports with the patient’s medical record. (2) Each service shall ensure that the EMS personnel on each transporting ambulance shall leave a copy of the patient care reports at the receiving health care facility with the patient at the time of transport. The receiving health care facility shall keep such patient care reports with the patient’s medical record. (3) EMS personnel at the scene who are not transporting the patient shall ensure that an unprotected exposure form, as defined in 105 CMR 172.001: Definitions, when appropriate, is timely delivered to the receiving health care facility, in accordance with service zone plan procedures. The EMTs on each transporting ambulance shall also submit an unprotected exposure form, as appropriate, to the receiving health care facility.

(D) Personal and medical information, whether oral or written, obtained by EMS personnel or services in the course of carrying out EMS shall be maintained confidentially. Such information contained in communications and records maintained by services pursuant to .345 shall be released as required in .345(C), and additionally only as follows: (1) To the patient or the patient’s attorney or legally authorized representative upon written authorization from the patient or the patient’s legally authorized representative; (2) To the Department in connection with a complaint investigation pursuant to .795; (3) Upon proper order in connection with a pending judicial or administrative proceeding, and as otherwise required by law; or (4) Pursuant to the requirements of M.G.L. c. 111C, § 3(15).

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170.345: continued

(5) Exceptions: No provision of .345(D) shall be construed to: (a) Prevent any third-party reimburser from inspecting and copying, in the ordinary course of determining eligibility for or entitlement to benefits, records relating to treatment, transport or other services provided to any person, including a minor or incompetent, for which coverage, benefit or reimbursement is claimed, so long as the policy or certificate under which the claim is made provides that such access to such records is permitted, or (b) Prevent access to any such records in connection with any peer review procedures applied and implemented in good faith.

170.347: Data Reports to the Department

Each ambulance service shall comply with all requirements established by the Department for submission of data to the Department including, but not limited to, data pertaining to prehospital care and transport of trauma patients to appropriate health care facilities. Data submission requirements shall be specified in administrative requirements of the Department. Such administrative requirements and amendments thereto shall be circulated to all ambulance services for review and comment at least 60 calendar days prior to adoption.

170.350: Accident Reports and Serious Incident Reporting Requirements

(A) Each licensed service shall file a written report with the Department within seven calendar days of the following incidents. and immediately notify the Department by electronic mail or telephone if the incident results in injury or death, involving its service, personnel or property: (1) fire affecting an EMS vehicle or service place of business; (2) theft of an EMS vehicle; and (3) a motor vehicle crash involving an EMS vehicle reportable under M.G.L. c. 90, § 26 relating to the mandatory reporting of any crash involving a motor vehicle resulting in personal injury, death, or property damage. For the purpose of .350(A)(3), the written report shall be a copy of the approved Registry of Motor Vehicles’ “Operator’s Report of Motor Vehicle Accident,” or in the case of a Class IV ambulance, a copy of the approved report form submitted to the FAA.

(B)(1) Each licensed service or accredited training institution shall immediately notify the Department by electronic mail or telephone and file a written report with the Department within seven calendar days of other serious incidents involving its service, personnel or property. Serious incidents are medication errors, whether or not they result in injury to a patient, and other incidents that create a significant risk of substantial or serious injury to the health, safety or well-being of a patient not ordinarily expected as a result of the patient’s condition. Such reportable incidents include, but are not limited to, the following: (a) medication errors; (b) failure to assess and provide treatment in accordance with the Statewide Treatment Protocols resulting in injury; (c) medical, EMS system or communications failure, or equipment failure or user error resulting in injury or delay in response or treatment; and (d) undue delay in response or treatment for any reason, resulting in injury. (2) Within 30 calendar days of filing a serious incident report, the service shall file with the Department the following: (a) an investigation report of the incident including the service's findings about the causes of the incident; and (b) a plan of correction and preventability, reflecting participation of, and review by, the affiliate hospital medical director, addressing the corrective measures the service took upon discovery and investigation of the incident, both with respect to the specific personnel and equipment involved in the incident, as well as to policies, procedures, training, orientation, and other such changes to prevent such incident from recurring in the future, if the incident is preventable.

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105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.355: Responsibility to Dispatch, Treat and Transport

(A) No service, or agent thereof including, but not limited to, its EMS personnel, shall refuse in the case of an emergency to dispatch an available EMS vehicle and to provide emergency response, assessment and treatment, within the service’s regular operating area, in accordance with the Statewide Treatment Protocols, at the scene or during transport, or to transport a patient to an appropriate health care facility in accordance with the applicable service zone plan.

(B) Primary Ambulance Response. (1) Upon receipt of a call to respond to an emergency, the service zone’s primary ambulance service, or a service operating pursuant to a service zone agreement, and the closest appropriate designated EFR service(s), if any, shall be immediately notified and dispatched in accordance with the applicable service zone plan and .510(I)(3)(f). (2) When the primary ambulance service receives a call, it shall ensure that the closest ambulance is immediately dispatched, in accordance with the service zone plan. If the primary ambulance service dispatcher believes at the time the call is received that an ambulance is not available for immediate dispatch, or believes that another ambulance service has the capacity to reach the scene in a significantly shorter period of time, the dispatcher shall immediately contact the ambulance service with the closest ambulance, in accordance with the service zone plan. (3) When an ambulance service with a provider contract providing primary ambulance response pursuant to a service zone agreement receives a call for primary ambulance response, if it believes at the time the call is received that it cannot meet the service zone standards for primary ambulance response, the ambulance service must immediately refer the call to the primary ambulance service, unless otherwise provided in the service zone plan. (4) When an ambulance service other than the primary ambulance service receives a call to provide primary ambulance response that is not pursuant to a provider contract and a service zone agreement, it must immediately refer the call to the primary ambulance service.

(C) Prior to the approval of a service zone plan. (1) No service, or agent thereof including, but not limited to, its EMS personnel, shall refuse in the case of an emergency to dispatch an available ambulance and to provide emergency response, assessment and treatment, within the service’s regular operating area, in accordance with the Statewide Treatment Protocols, at the scene or during transport, or to transport a patient to an appropriate health care facility. (2) Upon receipt of a call to respond to an emergency, the ambulance service shall immediately dispatch a Class I ambulance. (3) If the ambulance service dispatcher believes at the time a call is received that a Class I ambulance is not available for immediate dispatch, the dispatcher shall immediately contact the ambulance service’s backup service pursuant to .385. If the ambulance service dispatcher believes that another ambulance service has an ambulance that can reach the scene in a significantly shorter period of time, the dispatcher shall immediately notify: (a) The other ambulance service, which shall immediately dispatch an ambulance, and (b) Police or fire in the town in which the emergency has occurred.

(D) As soon as there is a Department-approved service zone plan, no ambulance service shall provide primary ambulance response in a service zone, unless: (1) It is the designated primary ambulance service; or (2) It is acting pursuant to a service zone agreement, in accordance with a Department- approved service zone plan and .249.

(E) Each service whose regular operating area includes all or part of the service zone in which a mass casualty incident occurs must immediately dispatch available EMS resources upon request by the primary ambulance service.

170.357: Point-of-entry Plans

Each ambulance service shall ensure that its EMTs deliver patients in accordance with regional point-of-entry plans approved by the Department. No ambulance service shall develop a point-of-entry plan independent of a Department-approved regional point-of-entry plan.

105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.360: Responsibility to Provide Appropriate Personnel during Transfer

No ambulance service or agent thereof shall transport a patient between health care facilities who is receiving medical treatment that is beyond the training and certification capabilities of the EMTs staffing the ambulance unless an additional health care professional with that capability accompanies the patient. For this purpose, medical treatment received by a patient includes, but is not limited to, intravenous therapy, medications, respirators, cardiac monitoring, advanced airway support, or other treatment or instrumentation.

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105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.365: Transport of a Deceased Person

An ambulance shall not be used to transport a dead body except in special circumstances where it is in the interest of public health and/or safety to do so.

170.370: Transport of a Person in a Wheelchair

Disabled persons in wheelchairs shall not be transported in an ambulance unless required by medical necessity. In each such instance the disabled person must be transferred to an ambulance cot and the patient care report shall contain the nature of the person's illness or injury requiring transport by ambulance.

170.373: EMT Use of Patient Restraints

(A) EMTs may restrain a patient who presents an immediate or serious threat of bodily harm to himself or others, in accordance with administrative requirements or protocols of the Department.

(B) Documentation. EMTs shall thoroughly document all uses of restraints on their patient care report, and at a minimum include the following: reason for restraint use, time of application, types of restraints used, patient position, number of EMS personnel and first responders used to restrain the patient, and issues encountered during transport.

170.375: Dispatch Communications

Each service shall provide two-way mobile radio communications between each of its EMS vehicles and a dispatcher.

170.380: Medical Communications

(A) Each ambulance service licensed to operate Class I, IV, and/or V ambulances and Class II ambulances, if they are used as backup for Class I ambulances, shall, at a minimum, provide for the relay of medical information through a dispatcher to appropriate health care facilities to which the ambulance service routinely transports patients.

(B) Each BLS ambulance service licensed to operate a Class I ambulance shall provide its Class I ambulances with equipment for direct two-way mobile radio contact between its Class I ambulances and those appropriate health care facilities similarly equipped to which the ambulance routinely transports patients.

(C) Each service licensed at the ALS level must have adequate portable two-way radio communications equipment to utilize the system of medical direction including a portable radio that can be transported to the scene of the emergency.

(D) All BLS and ALS services’ communications and communications equipment must comply with the standards and requirements of the Massachusetts Emergency Medical Services Communications Plan.

170.385: Service Availability and Backup

(A)(1) Each EFR service at the EMS first response and BLS levels shall ensure that the level of service for which it is licensed is available to the public within the service’s regular operating area 24 hours per day, seven days per week, by providing the service’s own personnel and EMS vehicles, or supplementing its own EMS staff through written agreement(s) with other service(s). (2) Each ambulance service licensed to operate and maintain Class I or IV ambulances shall ensure that BLS emergency ambulance service is available to the public within the service's regular operating area 24 hours per day, seven days per week, by providing the service's own personnel and EMS vehicles, or by written agreement(s) with other service(s).

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170.385: continued

(3) Adequate backup for ambulance services shall consist of, at a minimum, both first and second backup as defined in .385(A)(3)(a) and (b), and shall meet any additional requirements of the applicable service zone plan. First and second backup vehicles shall be at least two separate ambulances. (a) First Backup. 1. First backup for a Class I ambulance shall be either a Class I or II ambulance; 2. First backup for a Class IV air ambulance shall be another Class IV air ambulance, a Class I ambulance, or a Class II ambulance. (b) Second Backup. 1. Second backup for a Class I ambulance shall be either a Class I, II, or V ambulance. 2. Second backup for a Class IV air ambulance shall be either a Class IV, a Class I ambulance, a Class II ambulance, or a Class V ambulance.

(B) Exception: An ambulance service that responds only to calls from a unique population is exempt from the requirements of .385(A). However, the ambulance service shall provide service either with its own personnel and ambulance(s) or by written arrangements for adequate backup during the hours when the unique population it serves might require service.

(C)(1) Each service licensed to provide advanced life support service shall ensure that ALS service is available to the public within the service's regular operating area, in accordance with the applicable service zone plan, 24 hours per day, seven days per week, by providing the service's own personnel and EMS vehicles, or by written agreement(s) with other service(s). (2) Adequate ALS backup for ambulance services shall consist of the following minimum requirements, and shall meet any additional requirements of the applicable service zone plan. (a) For a Class I ambulance, a Class I or II ambulance, operated by an ALS licensed ambulance service staffed and equipped to provide ALS at a level of service equal to or greater than the ALS service being backed up; (b) For a Class IV ambulance, another Class IV ambulance, a Class I ambulance or a Class II ambulance operated by an ALS licensed ambulance service staffed and equipped to provide ALS at a level of service equal to or greater than the ALS service being backed up. (3)(a) Each service applying for an initial ALS license shall have three years from the date the ALS license is first issued within which to meet the standards of ALS service delivery in .385(C)(1). (b) Each ALS-Advanced service applying for an upgrade in license to the ALS- Paramedic level shall have three years from the date the ALS-Paramedic license is issued within which to meet the standards of .385(C)(1) as it applies to ALS- Paramedic service. (c) In the interim period, each service included in .385(2)(a) or (b)shall ensure that ALS service at the level of licensure for which it is applying is available to the public within its regular operating area at a minimum eight hours per day, seven days per week. (4) Exceptions: (a) An ambulance service that responds only to calls from a unique population is exempt from the requirements of .385(C)(1) and (2). However, the ambulance service shall provide service either with its own personnel and ambulance(s) or by written arrangements for adequate backup during the hours when the unique population it serves might require service. (b) If no ALS ambulance service exists in an adjacent city or town, the ambulance service is exempt from the ALS backup requirements of .385(C)(1) and (2).

105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.390: EMS Vehicle Readiness

Each service shall ensure that each of its EMS vehicles that are in current operation and needed to comply with the applicable service zone plan, are ready to respond to a call at any time. Each service shall implement a system to verify that EMS vehicles are in ready working order, and that each EMS vehicle has all the required equipment, drugs and supplies to respond in accordance with the Statewide Treatment Protocols, to a call at any time. Each service shall ensure the following:

(A) Each EMS vehicle in current operation and needed to comply with the applicable service zone plan is housed in a secured, temperature-controlled fully enclosed garage owned or operated by the service, whenever the vehicle’s expected time between calls would compromise vehicle, drugs and equipment performance and readiness or when its EMS personnel need facilities only available at a garage;

(B) EMS vehicles, their interior and all equipment, are kept clean and sanitary, in accordance with standards established in administrative requirements of the Department;

(C) EMS vehicles’ temperature controls are functioning correctly, so that all drugs and equipment are maintained in conformance with manufacturers’ recommendations and in proper condition for immediate use, and that the patient compartment is heated or cooled, depending on the season; and

(D) EMS vehicles are kept in a secured area, free of debris and hazards.

170.395: Storage Space

Adequate and clean enclosed storage space for linens, equipment and supplies shall be provided and accessible to EMTs at each place of business. These storage spaces shall be so constructed to ensure cleanliness of equipment supplies to permit thorough cleaning and ensure equipment, drugs and supplies are maintained within manufacturers’ recommended temperature ranges.

170.400: Supplies

An adequate amount of medical supplies, as described in the Department's administrative requirements, and linen for stocking EMS vehicles shall be stored wherever EMS vehicles are garaged, unless a service has established centralized supply hubs containing the required supplies, a system for timely field replacement of supplies from support units, or unless a service obtains all medical supplies and linen from a hospital pursuant to a written agreement with the hospital.

170.405: Waivers for Special Projects

At the discretion of the Department, regulations established in this chapter may be waived for special projects which demonstrate innovative delivery of emergency medical care services. Proposals for special projects must be submitted to the Department in writing and no regulatory standards will be waived without explicit Department approval. Special projects will be considered experimental in nature and will be reviewed and renewed at such time periods as the Department shall establish.

170.410: General Requirements Regarding EMS Vehicles

Each service shall ensure that each EMS vehicle for which the service is licensed to operate is certified and conforms to the applicable standards set forth in .000. No EMS vehicle shall be operated or maintained except by a licensed service that meets the applicable requirements of .000.

(A) Ambulances. The Department may, prior to certification, inspect the ambulance, equipment and supplies for conformance with the standards set forth in .000 and the Department’s administrative requirements. Authorized personnel of the Department may inspect, at any time and without prior notice, any ambulance, equipment and supplies. For the purposes of .410(A), such inspection includes, but is not limited to, ambulances, equipment, supplies, the garage, records and files.

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170.410: continued

(B) EFR Vehicles. Each EFR service shall submit to the Department a written affirmation that its EFR vehicles, owned or operated by the EFR service, have passed safety inspection(s) as required by federal, state or local law. Prior to certification, the Department may inspect each vehicle’s EMS equipment and supplies for conformance with the standards set forth in .000 and the Department’s administrative requirements. Authorized personnel of the Department may inspect at any time and without prior notice, the EMS equipment and supplies in the vehicles, and audit EFR vehicle records and files, as well as other records and files as set forth in .225.

170.415: Certificate of Inspection Required

(A) No person shall operate, maintain, or otherwise use any aircraft, boat, motor vehicle, or any other means of transportation as an EMS vehicle without a valid certificate of inspection. This applies to temporary replacement or additional ambulances or EFR vehicles an EMS service plans to deploy.

(B) Exception. Uncertified vehicles may be used to render emergency medical transportation in the case of a major catastrophe when the number of certified ambulances capable of emergency dispatch in the locality of the catastrophe is insufficient to render the required emergency medical transportation services, pursuant to a statewide mass casualty incident plan.

170.420: Certification Procedure

(A) To request a certificate of inspection, the applicant must complete and submit forms supplied by the Department, provided that a service license application has been filed.

(B) The applicable inspection fee established in .215(B) shall be submitted with a completed application form for certification.

170.425: Renewal of Certification

(A) Pursuant to M.G.L. c. 111C, § 7, certification for each EMS vehicle shall terminate on the same date that the license for the service expires. Renewal applications shall be submitted to the Department no later than 90 calendar days prior to the date of the expiration of the certificate. An applicant for renewal of a certificate of inspection shall follow the procedures set forth in .420. A renewal certificate shall not be issued if there are any outstanding assessments.

(B) If the applicant has applied for a renewal of a certificate of inspection and the Department is unable to inspect the vehicle, the current certificate of inspection shall remain in full force and effect until such time as the Department takes action on the renewal application, which shall ordinarily be within 30 days after the date the certificate expires.

170.435: Grounds for Denial, Suspension and Revocation of a Certificate of Inspection

(A) The Department may deny, suspend, revoke, or refuse to renew a certificate of inspection for the following grounds, including: (1) Failure of an ambulance to comply with vehicle specifications for the appropriate class established in .000 and the Department’s administrative requirements; (2) Failure of an EFR vehicle to comply with the applicable requirements of 105 CMR 170.000 and the EFR service’s written statement that it has met all safety and other vehicle inspection standards required by law; (3) Failure to comply with the equipment requirements of .000 and the Department’s administrative requirements; (4) Failure to comply with a Department-approved plan of correction; (5) Failure of a service to allow the Department to inspect, as provided for in 105 CMR 170.410; or (6) Lack of sufficient certified and qualified EMS personnel to staff the EMS vehicle as required by .000 and the applicable service zone plan.

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170.435: continued

(B) The Department may refuse to issue or renew a certificate of inspection if the Department has initiated action to suspend or revoke the license of the service.

170.440: Safety Inspections

Each EMS vehicle shall be kept in good repair and operating condition, as demonstrated by, at a minimum, a valid inspection sticker from the appropriate registering agency for the type of vehicle. Periodic inspection of ambulances by the Department shall be in addition to other federal, state or local safety inspections required for the vehicle under law or ordinance. A violation of required safety inspections shall be a violation of .000.

170.445: Registration

Each EMS vehicle shall be registered with the appropriate registering agency for the type of vehicle.

170.450: All Ambulances Subject to Classification

All ambulances shall conform to the minimum standards of one of the classes set out in .455, 170.460, 170.465 and 170.470, and shall be certified accordingly as provided in .415 and 170.420. There are three classes of ground ambulances (Class I, II and V), and one class of air ambulance (Class IV).

170.455: Class I

A Class I ambulance shall be used primarily for emergency dispatch to and transport of sick and injured persons from the scene of an emergency. A Class I ambulance may also be used for scheduled transportation by prior appointment of persons having known and non-emergent medical condition. It shall meet the following minimum requirements:

(A) Vehicle Design and Construction. (1) An ambulance service may put into operation a Class I vehicle which conforms with the specifications set out in administrative requirements of the Department which are in effect at the date of vehicle production. In the case of municipal services, standards are those in effect at the date of acceptance of a manufacturer's bid. (2) The Commissioner or his or her designee may waive specific requirements included in the specifications referenced in .455(A)(1) where alternatives provide comparable protection of the public health and safety. Requests for waivers or variations must be filed and approved by the Department before the bid or order process is undertaken. Such requests for waiver or variations are not subject to the general waiver requirement set forth in .275.

(B) Vehicle Equipment. A Class I ambulance shall be equipped at a minimum with the vehicle equipment specified in the administrative requirements entitled Vehicle Equipment Guidelines - Class I. Amendments to such administrative requirements shall be circulated to licensees for review and comment at least 60 calendar days prior to adoption.

(C) Medical Equipment and Supplies. A Class I ambulance shall be equipped at a minimum with medical equipment and supplies as specified in the administrative requirements entitled Medical Equipment and Supplies - Class I. Amendments to such administrative requirements shall be circulated to licensees for review and comment at least 60 calendar days prior to adoption.

170.460: Class II

A Class II ambulance shall be used for scheduled transportation by prior appointment of persons having known and non-emergent medical conditions. In addition it may be used as a backup ambulance in emergency situations when a Class I ambulance is not available. It shall meet the following minimum requirements:

105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.460: continued

(A) Vehicle Design and Construction. (1) A Class II vehicle shall meet or exceed the specifications set out in administrative requirements of the Department. In the case of municipal services, standards are those in effect at the date of acceptance of a manufacturer's bid. (2) The Commissioner or his or her designee may waive specific requirements included in the specifications referenced in .460(A)(1) where alternatives provide comparable protection of the public health and safety. Requests for waivers of variations must be filed and approved by the Department before the bid or order process is undertaken. Such requests for waiver or variation are not subject to the general waiver requirement set forth in .275.

(B) Vehicle Equipment. A Class II ambulance shall be equipped at a minimum with the vehicle equipment specified in the administrative requirements entitled Vehicle Equipment Guidelines - Class II. Amendments to such administrative requirements shall be circulated to licensees for review and comment at least 60 calendar days prior to adoption.

(C) Medical Equipment and Supplies. A Class II ambulance shall be equipped at a minimum with medical equipment and supplies as specified in the administrative requirements entitled Medical Equipment and Supplies - Class II. Amendments to such administrative requirements shall be circulated to licensees for review and comment at least 60 calendar days prior to adoption.

(D) Class II ambulances shall not be dispatched to the scene of an emergency, except as a backup when a Class I ambulance is demonstrably unavailable, according to the provisions of .385.

170.465: Class IV

A Class IV air ambulance is an aircraft used to provide safe air transportation of sick or injured persons. A Class IV air ambulance shall meet the following minimum requirements:

(A) Aircraft Design and Construction. (1) The aircraft shall conform to all applicable Federal Aviation Administration standards. (2) The aircraft shall be capable of carrying a patient(s), on a stretcher, in a horizontal position. The stretcher shall be firmly secured with quick-release fasteners. (3) The patient(s) cabin area shall provide a minimum of 30 inches of clear space over the torso half of the stretcher, measured along the centerline of stretcher. (4) The patient(s) cabin area shall provide sufficient room for an EMT to care for a patient(s). At a minimum, the EMT shall have free access to the torso half of the stretcher. (5) The aircraft door(s) must be of sufficient size as to allow for easy loading of a stretcher(s) in a horizontal or any elevated position. (6) The aircraft cabin must be of sufficient size to allow for effective use of medical equipment. All life support equipment and supplies must be easily available to the EMT from within the cabin.

(B) Medical Equipment and Supplies. A Class IV air ambulance shall be equipped at a minimum with medical equipment and supplies as specified in the administrative requirements entitled Medical Equipment and Supplies - Class IV. Amendments to such administrative requirements shall be circulated to licensees for review and comment at least 60 calendar days prior to adoption.

170.470: Class V

A Class V ambulance is a vehicle that does not meet the minimum vehicle design and construction standards of any other class of ambulance. A Class V ambulance may be dispatched to the scene of an emergency to bring trained personnel and appropriate equipment and supplies. It shall meet the following minimum requirements:

105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.470: continued

(A) Vehicle Equipment. A Class V ambulance shall be equipped at a minimum with the vehicle equipment specified in the administrative requirements entitled Vehicle Equipment Guidelines - Class V. Amendments to such administrative requirements shall be circulated to licensees for review and comment at least 60 calendar days prior to adoption.

(B) Medical Equipment and Supplies. A Class V ambulance shall be equipped at a minimum with medical equipment and supplies as specified in the administrative requirements entitled Medical Equipment and Supplies - Class V. Amendments to such administrative requirements shall be circulated to licensees for review and comment at least 60 calendar days prior to adoption.

(C) A Class V ambulance shall not be used to transport a patient to a hospital or other appropriate health care facility except as a backup ambulance when the Class I ambulance and its first back-up, as set forth in .385, are demonstrably unavailable.

(D) A service licensed to operate and maintain a Class V ambulance, must also be licensed to operate and maintain a Class I ambulance, or provide evidence of a written cooperative arrangement by which a Class I ambulance, and its first and second backup as required in .385, are readily available to provide emergency medical transportation in the regular operating area of the service.

170.475: ALS Ambulances

Only certified Class I and Class IV ambulances shall be used for transport of patients receiving ALS care, except that a certified Class II or Class V ambulance may be used as a backup ambulance according to pre-arranged agreement, if the vehicle meets all other ALS requirements contained herein and is in accordance with .470(C).

170.480: Equipment, Medication and Supplies

(A) All EMS vehicles shall be equipped and staffed to provide care at the level of service for which the EMS vehicle is put into service, in accordance with the Statewide Treatment Protocols and the applicable service zone plan. When responding to a call, each EMS vehicle shall carry the equipment, supplies and medications required by the Department’s administrative requirements for its type or classification.

(B) All equipment on EMS vehicles shall be maintained in good working order at all times, in accordance with the manufacturer’s recommendations and/or specifications. All equipment on EMS vehicles shall be used by the service’s EMS personnel only in accordance with the manufacturer’s recommendations and/or specifications.

(C) All medications shall be stored and maintained in conformance with the manufacturer’s recommendations and shall be used by the service’s EMS personnel in accordance with the Statewide Treatment Protocols.

170.485: Display of Certificate of Inspection

Each ambulance service shall display the Department-issued certificate of inspection in the ambulance for which it was issued, in a manner so that the certificate is readily visible to any person in the patient compartment of the ambulance.

170.490: Ambulance Identification

(A) All ambulance services shall comply with the requirements for vehicle markings, emblems, and warning devices in the specifications set out in administrative requirements of the Department with regard to their Class I and Class II ambulances.

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170.490: continued

(B) Each certified ambulance shall be equipped with emergency warning lights and audible warning devices as provided for in the class for which the vehicle is certified.

(C) The use of emergency warning lights and/or audible warning devices is permitted only as needed when an ambulance is on a call for the purpose of an emergency transport of a sick or injured person or at the scene or en route to the scene of an emergency.

(D) Each certified Class I or Class II ambulance shall have the name under which the ambulance service is licensed prominently lettered on the back and sides of the vehicle.

(E) No ambulance may display any words, markings or lettering which indicate or represent a special care ambulance, unless the use of each such identifier has been approved by the Department.

170.500: Service Zone Plans

(A) Pursuant to M.G.L. c. 111C, § 10, each local jurisdiction shall be covered by a service zone plan approved by the Department that: (1) identifies and makes optimal use of all available EMS resources; (2) sets out how emergency response is coordinated and carried out; and (3) ensures the dispatch and response of the closest, appropriate, available EMS resources.

(B) Service zone plans shall be developed by the local jurisdiction(s), with technical assistance, review and recommendation for approval by the applicable Regional EMS Council. The local jurisdiction(s) shall develop the service zone plan with input from the following, at a minimum: (1) first responder agencies operating in the service zone including municipal fire and rescue departments; (2) emergency first response (EFR) services operating in the service zone; (3) all ambulance services providing primary ambulance response pursuant to provider contracts in the service zone; (4) all other ambulance services operating in the service zone; and (5) the health care facilities, including nursing homes, that appear in the service zone inventory pursuant to .510(A)(5).

(C) A service zone plan may cover a single local jurisdiction or multiple local jurisdictions. If a plan covers more than one local jurisdiction, it must be approved by each of the local jurisdictions covered by the plan. If a service zone plan covers local jurisdictions in more than one EMS region, it must be reviewed by each of the applicable Regional EMS Councils.

170.510: Elements of the Service Zone Plan

Local jurisdictions shall ensure that each service zone plan contains, at a minimum, the following elements:

(A) A current inventory of EMS and public safety providers and resources including, but not limited to: (1) the designated primary ambulance service; (2) ambulance services that have service zone agreements with the designated primary ambulance service for primary ambulance response in the service zone, in accordance with .249; (3) all other ambulance services whose regular operating area includes in whole or in part any local jurisdiction in the service zone; (4) designated EFR service(s), if any; (5) health care facilities, including nursing homes; (6) first response agencies and locations of trained first responders;

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170.510: continued

(7) others in the community trained to provide emergency response, such as ski patrols, and EMTs at schools or senior citizens’ centers; (8) emergency medical dispatch and public safety answering point (PSAP); and (9) automatic/semi-automatic defibrillators and their locations.

(B) An open, fair and inclusive process for the selection and changing of EMS service delivery or designated service zone providers.

(C) Criteria for the selection of designated service zone providers. Potential service zone providers shall be evaluated on their ability to meet local standards for specific EMS performance criteria. Local standards shall at minimum meet any and all relevant standards in .000. Specific EMS performance criteria include, but are not limited to, the following: (1) response time; (2) adequate backup; (3) deployment of resources; (4) level of service and level of licensure of designated service zone providers; (5) medical control; and (6) appropriate health care facility destinations, in accordance with the applicable Regional EMS Council’s point-of-entry plan, as approved by the Department.

(D) Recommended service zone providers, chosen in accordance with the process and criteria established in the service zone plan, pursuant to .510(B) and (C). The local jurisdiction shall recommend for designation one primary ambulance service, and may recommend one or more EMS first response services as service zone providers.

(E) Service zone agreements, pursuant to M.G.L. c. 111C, § 10(d) and .249.

(F) A process for monitoring compliance with the service zone’s local standards for specific EMS performance criteria.

(G) A medical control plan, which shall at a minimum, consist of collection, review and monitoring of current affiliation agreements, consistent with .300, of EMS services operating in the service zone.

(H) Operational plan for coordinating the use of all first responder agencies in the service zone that are not EMS first response services, and others trained as first responders, and voluntarily providing first response services, including the location of each of these agencies and persons.

(I) Operational plan for ensuring dispatch and response to emergencies of the closest, appropriate, available EMS services, in accordance with .355, including: (1) Coordination and optimal use of all licensed services for emergency response, including the following: (a) primary ambulance service; (b) ambulance services with service zone agreements with the primary ambulance service, pursuant to .249; (c) ambulance services who have backup agreements with services referenced in .510(I)(1)(a) and (b); and (d) EFR services, if any. (2) Location of all licensed EMS services; and (3) Clear criteria for determining which ambulance service has the closest appropriate ambulance, and when EFR services, if any, should be dispatched, based on factors including, but not limited to, the following: (a) type of emergency or patient condition; (b) base locations of services; (c) hours of operation; (d) number, hours and location of EMS personnel; (e) services’ capabilities; and

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170.510: continued

(f) No service zone plan may include criteria for the notification and dispatch of a designated EFR service to a facility licensed pursuant to M.G.L. c. 111, § 71 or certified pursuant to M.G.L. c. 19D, where there is a licensed health care professional on-site 24 hours per day seven days per week, and where there is a provider contract in place to provide primary ambulance response, unless a licensed health care professional at such facility requests primary ambulance response by dialing the emergency telephone access number 911, or its local equivalent. Nothing herein shall bar any person from dialing 911 or its local equivalent.

(J) Procedures for delivery of patient care reports and unprotected exposure forms to receiving health care facilities.

170.520: The Regional Service Zone Plan

Each Regional EMS Council shall adopt a regional service zone plan, subject to the approval of the Department, which shall consist of a compilation of the service zone plans covering all the local jurisdictions in the region.

170.530: Review and Approval of Service Zone Plans

(A) Regional EMS Council Review. Local jurisdictions shall submit service zone plans to their Regional EMS Council. Each local jurisdiction must be covered by a service zone plan approved in accordance with .530. (1) The Regional EMS Council shall review each service zone plan. The Council shall verify that all elements of .510 are addressed, and all local EMS and public safety resources are identified and optimally used in the operational plans. If the service zone plan meets these criteria, the Regional EMS Council shall recommend approval of the plan to the Department. (2) If the Regional EMS Council finds that a service zone plan has not adequately addressed all elements of .510, it shall return the plan to the local jurisdiction(s) with a letter identifying the deficiencies and notify the Department. The Council shall provide technical assistance to the local jurisdiction(s), as needed. After the plan’s revision, if the Regional EMS Council finds that the service zone plan continues to be deficient, the Council shall recommend to the Department that the plan be denied. (3) Within six months of the submission of a service zone plan to a Regional EMS Council, the Council shall forward its recommendation regarding that plan to the Department.

(B) Department Review and Approval. The Department shall review all local service zone plans submitted by Regional EMS Councils. The Department shall assess each service zone plan in accordance with the elements of .510. The Department shall have ultimate authority to approve a service zone plan. It shall issue its decision to the local jurisdiction and the appropriate Regional EMS Council within six months of the plan’s submission to the Department.

170.540: Grounds for Denial of Approval of a Service Zone Plan

(A) The Department may deny approval of a service zone plan if: (1) the applicant fails to meet each of the elements of .510; or (2) the applicant submits inaccurate or incomplete information to obtain service zone plan approval or designation of a service zone provider.

(B) A local jurisdiction(s) may appeal the Department’s denial of approval of a service zone plan, in accordance with .760.

105 CMR: DEPARTMENT OF PUBLIC HEALTH

170.550: Update of Service Zone Plans and Redesignation of Providers

(A)(1) Each local jurisdiction shall promptly report to its Regional EMS Council any changes to its approved service zone plan. (2) Regional EMS Councils shall ensure that local service zone plans are updated, so that regional service zone plans are updated accordingly. (3) Regional EMS Councils shall regularly report updates in local and regional service zone plans to the Department.

(B) The local jurisdiction(s) covered by an approved service zone plan shall carry out the plan’s selection process for service provider and service delivery changes, at a minimum, when: (1) the local jurisdiction(s) propose(s) to change a designated service provider; (2) the local jurisdiction(s) propose(s) an upgrade in level of service that a service zone provider is unable to provide; (3) the local jurisdiction(s) propose(s) a downgrade in the level of services; or (4) a designated service zone provider informs the local jurisdiction(s) of its intention to make changes to its delivery of services so that it no longer conforms to the requirements of the approved service zone plan.

170.560: Grounds for Revocation of Service Zone Approval

(A) The Department may revoke the approval for a local jurisdiction(s)’s service zone plan for: (1) Failure to adhere to the approved service zone plan; (2) Failure to carry out its selection process for EMS service delivery and service zone provider designation changes, pursuant to .550; (3) Knowingly making an omission of a material fact or false statement orally or in any application or document filed with or obtained by the Department or Regional EMS Council; (4) Violation of a correction order; or (5) Failure to comply with a plan of correction.

(B) A local jurisdiction(s) covered by a service zone plan may appeal the Department’s revocation of approval for its service zone plan, in accordance with .760.

(C) If approval of a service zone plan is revoked, the Department may designate an interim service zone provider(s) under a temporary service zone plan to ensure continuation of EMS services. An interim plan will remain in effect until the local jurisdiction(s)’ subsequent service zone plan is approved.

170.705: Deficiencies

(A) A deficiency means noncompliance with .000 for any person certified, licensed, designated or otherwise approved by the Department pursuant to M.G.L. c. 111C. The Department may find that a deficiency exists upon inspection or other information, such as information that may come through the complaint procedure, as set forth in .795.

(B) A deficiency may result in the following: (1) an advisory letter, a letter of clinical deficiency, a notice of serious deficiency, a cease and desist order, letter of censure; (2) a correction order as set forth in .720; (3) an assessment as provided in .730; or (4) a denial, suspension, revocation or refusal to renew a license, certification, certificate of inspection, designation or other form of approval.

170.710: Plan of Correction

(A) The Department may require any person certified, licensed, designated or otherwise approved by the Department pursuant to M.G.L. c. 111C to submit a written plan of correction for each existing deficiency.

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(B) The person shall specify in the plan of correction the manner in which the correction shall be made and the date by which the deficiency shall be corrected.

(C) The plan of correction must be submitted to the Department no later than ten calendar days after written notice of deficiencies and request by the Department for submission of a plan. The person or his or her agent may be required to submit a plan of correction immediately at the completion of the inspection if deficiencies are found upon inspection which threaten health and safety.

(D) The Department shall attempt to approve or deny the plan of correction within ten calebdar days of receipt of the plan. Failure to respond to a submitted plan of correction shall not be deemed to be an acceptance of the plan of correction.

(E) Failure to submit an acceptable and timely plan of correction or failure to correct in accordance with the plan are grounds for enforcement action including suspension or revocation of a license, certification, certificate of inspection, designation or other form of approval.

170.720: Correction Orders

The Department may order any person certified, licensed, designated or otherwise approved by the Department pursuant to M.G.L. c. 111C, to correct a deficiency by issuing a correction order. Pursuant to M.G.L. c. 111C, § 15, each correction order shall contain the following:

(A) A description of the deficiency or deficiencies;

(B) The period within which the deficiency must be corrected, which shall be reasonable under the circumstances. In the case of a deficiency that endangers the public health or safety, which is identified in the course of an inspection or investigation, the Department or its agent may suspend a certificate, license, designation or other form of approval effective immediately, provided that the person affected shall be promptly afforded an opportunity for a hearing pursuant to M.G.L. c. 111C, § 16;

(C) The provisions of the law and regulations relied on in citing the deficiency. (1) With respect to orders other than immediate suspensions, within seven calendar days of receipt of the correction order, the affected person may file a written request with the Department for administrative reconsideration of the order or any portion thereof. Such request shall contain sufficient information to allow the Department to adequately reconsider the issuance of the order. Failure of the Department to act upon the written request within seven days of the filing of the request shall be deemed a denial of the request. (2) If the Department makes a finding in writing that the person has made a good faith effort to correct the deficiency within the period prescribed for correction and that the correction cannot be completed by the prescribed date, the Department may permit the person to file a plan of correction on a form provided by the Department. (3) In the event that a plan of correction is not approved by the Department, the Department shall set another date by which the correction shall be made. If the correction is not made by that date, then the Department may follow the procedure for assessment of a deficiency set forth in .730.

170.730: Assessment for a Deficiency

Pursuant to M.G.L. c. 111C, § 15, the Department may assess a person ordered to correct deficiencies, $500.00 per deficiency for each day the deficiency continues to exist beyond the date prescribed for correction in the correction order, as set forth in .720 or in such further extension as may be granted, as provided in .720(C)(2).

(A) Notice and Opportunity for a Hearing. Pursuant to M.G.L. c. 111C, § 15(b), before making an assessment, the Department shall give the affected person notice of the assessment. The notice shall contain a description of the deficiency, the period for correction, and provision of the law and regulations relied upon. The affected person may file with the Department within 14 calendar days of receipt of notice a written request for an adjudicatory hearing.

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(B) Payment of the Assessment. If after hearing, or waiver thereof, the Department determines that it is appropriate to make an assessment, then, in accordance with M.G.L. c 111C, § 15(c), the assessment shall be due and payable to the Commonwealth on the 30th day after notification to the affected person.

(C) Further Enforcement Procedures. By levying an assessment, the Department does not waive its right to invoke other enforcement procedures, such as modification of a license, as provided in .240, suspension of a license, certification or certificate of inspection, as provided in .750, or revocation or refusal to renew a license, certification or certificate of inspection, as provided in .760.

170.740: Denial

(A) If a license, certification, certificate of inspection, designation or other form of approval is denied on the basis of disputed facts, then the denied applicant may request in writing an adjudicatory hearing within 14 calendar days of notice of denial, provided that the applicant submits written evidence which the applicant would offer at a hearing sufficient to support the applicant's factual allegations.

(B) If a license, certification, certificate of inspection, designation or other form of approval is denied by the Department on the basis of facts over which there is no material dispute, then the applicant shall be notified in writing of the reasons for the denial. Any applicant aggrieved by a denial on the basis of undisputed facts is not entitled to an adjudicatory hearing but may seek judicial review under M.G.L. c. 30A, § 14.

170.750: Suspension

(A) Pursuant to M.G.L. c. 111C, § 16, the Commissioner may, without a hearing, if the Commissioner finds that public health or safety is endangered, suspend a license, certification, certificate of inspection, designation or other form of approval. Written notice of the reasons for the suspension shall promptly be issued by the Department. The affected person shall also be notified in writing of the right to an adjudicatory hearing and shall be promptly afforded an opportunity for a hearing provided that written request for a hearing is submitted within 14 calendar days after notification of suspension.

(B) After hearing or waiver thereof, the Department may modify a license, certification, certificate of inspection, designation or other form of approval, or suspend, revoke or refuse to renew a license, certification, certificate of inspection, designation or other form of approval.

(C) Upon receipt of notice of the Department's final decision, the affected person must immediately return for the term of the suspension any license, certification, certificate of inspection, designation or other form of approval previously issued.

170.760: Revocation or Refusal to Renew

(A) If the Department initiates action to revoke or refuse to renew a license, certification, certificate of inspection, designation or other form of approval, the affected person shall be notified in writing of the reasons for the Department's action and of his/her right to an adjudicatory proceeding.

(B) Written request for a hearing must be submitted within 14 calendar days of receipt of notification of Department action.

(C) After hearing or waiver thereof, the Department may modify a license, certification, certificate of inspection, designation or other form of approval, revoke or refuse to renew a license, certification, certificate of inspection or other form of approval.

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(D) Upon receipt of notice of the Department's final decision, the affected person must immediately return to the Department any license, certification, certificate of inspection, designation or other form of approval previously issued.

170.770: Adjudicatory Proceedings

(A) All adjudicatory proceedings will be conducted in accordance with M.G.L. c. 30A and 801 CMR 1.00: Standard Rules of Practice and Procedure.

(B) The Commissioner shall designate a Presiding Officer to conduct a hearing and render a tentative decision, containing findings of fact and rulings of law. If the Presiding Officer finds any single ground for denial, revocation, suspension, or refusal to renew any license, certification, certificate of inspection, designation or other form of approval, the Presiding Officer shall render a decision affirming the action initiated by the Department.

170.780: Nonexclusivity of Enforcement Procedures

None of the enforcement procedures contained in .000 are mutually exclusive. With the exception of an assessment, as provided in .730, which shall be preceded by a correction order, as provided in .720, any enforcement procedures may be invoked simultaneously if the situation so requires.

170.790: Criminal Enforcement Provisions

The Department may elect to enforce any section of .000 or provisions of M.G.L. c. 111C by seeking to have criminal sanctions imposed. M.G.L. c. 111C, § 19 provides that no person shall:

(A) Establish, maintain or hold itself out as a service without a valid license or in violation of the terms of a valid license;

(B) Operate, maintain, otherwise use, or hold out any aircraft, boat, motor vehicle, or other means of transportation as an EMS vehicle without a valid certificate of inspection;

(C) Provide EMS or hold oneself out as, or use the title of emergency medical technician, paramedic or the acronym EMT, or EMS first responder, or any other title or acronym used by the Department in the certification of EMS personnel in violation of M.G.L. c. 111C, § 9;

(D) Establish or maintain a trauma center, a service zone provider or any other entity, service or operation requiring designation or approval of the Department pursuant to M.G.L. c. 111C and .000, or hold itself out as such, without such valid designation or approval;

(E) Obstruct, bar, or otherwise interfere with an inspection or investigation undertaken under authority of M.G.L. c. 111C or .000;

(F) Knowingly make an omission of a material fact or a false statement, orally or in any application or other document filed with or obtained by the Department or any other entity in the EMS system; or

(G) Violate or fail to observe any requirements of .000, or of any rule, regulation, administrative requirement, protocol or order under M.G.L. c. 111C or .000;

(H) Whoever engages in, aids, abets, causes, or permits any act prohibited under M.G.L. c. 111C, § 19 and .790 shall be punished by a fine of not less than $100.00 and not more than $1,000.00 for each offense. A separate and distinct offense shall be deemed to have been committed on each day during which any prohibited act continues after written notice by the Department to the offender. The Commissioner shall report each suspected offense to the Attorney General for investigation and, if appropriate, prosecution in the courts of the Commonwealth.

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170.795: Complaints

As interest requires, the Department shall investigate every complaint received including, but not limited to, reports received pursuant to 105 CMR 130.1503(A)(3) or .350, about practices or acts which may violate M.G.L. c. 111C or any provision of .000.

(A) If the Department finds that an investigation is not required because the alleged act or practice is not in violation of M.G.L. c. 111C or .000 or any administrative requirement, protocol or order of the Department pursuant thereto, the Department shall notify the complainant of this finding and the reasons on which it is based.

(B) If the Department finds that an investigation is required, because the alleged act or practice may be in violation of M.G.L. c. 111C or .000 or any administrative requirements, protocol or order of the Department pursuant thereto, the Department shall investigate. If a finding is made that the act or practice does constitute such a violation, the Department shall apply whichever enforcement procedure(s), as provided in .705 through 170.795, is appropriate to remedy the situation and the Department shall notify the complainant of its action in this matter.

(C) Investigation of complaints may lead to enforcement actions, including an advisory letter, a letter of clinical deficiency a letter of censure; a cease and desist order; a correction order, as set forth in .720; an assessment, as provided in .730; or a revocation, suspension or refusal to renew a license, certification, certificate of inspection, designation or other form of approval, or a modification of a license by the Department. The Department may specify in any such enforcement action taken against an EMT or EFR a requirement to undergo and successfully complete remedial training, in accordance with terms set out in the enforcement action.

170.800: EMS Personnel: General Provisions

(A) There shall be four levels of function and training for EMS personnel: EFR, EMT-Basic, Advanced EMT and Paramedic.

(B) No certified EMT or EFR may perform functions for which the individual is not properly trained and certified, except: (1) pursuant to and in accordance with the requirements of a waiver for a special project as set forth in .405; or (2) an EMT-Paramedic serving on a critical care medical crew of a service licensed at the critical care level, operating in compliance with the service’s clinical practice protocols and standing orders that meet CAMTS or Department-approved substantially equivalent accreditation standards. However, when working with an EMS service that is not licensed at the critical care level, the EMT-Paramedic shall perform and function in accordance with .800(C).

(C) EMS personnel working in connection with a licensed service shall provide care in conformance with the Statewide Treatment Protocols, where relevant, and only up to the level of the license of that service.

(D) EMS personnel shall operate in accordance with M.G.L. c. 111C, .000, all other applicable laws and regulations, administrative requirements of the Department, and their service’s established policies and procedures that are consistent with .000.

(E) EMS personnel shall have current, valid EMT certification, CPR or ACLS credentials, as appropriate to their level of certification, and a current, valid driver’s license, in order to function as an EMT on the ambulance in any role;

(F) EMS personnel shall not be under the influence of alcohol, or impaired by any controlled substance, including cannabis, while on duty at an ambulance service as an EMT or when responding or assisting in the care of a patient, or while in EMS educational programs and field or clinical internship components of educational programs.

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(G) EMS personnel shall cooperate with, and timely respond to, inquiries and investigations of agents of the Department.

170.805: EMS First Responder

(A) The functions of an EFR shall include: (1) first aid; (2) cardiopulmonary resuscitation including use of automatic/semi-automatic defibrillation; (3) operation of EFR vehicles; and (4) other intervention(s) approved by the Department.

(B) EFRs shall provide the functions described in .805(A) in conformance with Department-approved training.

(C) The minimum training requirement for certification as an EFR includes: (1) successful completion of the training required by .000: Massachusetts First Responder Training; (2) within each three-year term of certification, successful completion of a Department- approved EFR continuing education course; and (3) any other training designated by the Department in administrative requirements.

170.810: Emergency Medical Technician S Basic

(A) The functions of an EMT-Basic include: (1) Provision of basic emergency medical care for patients at the scene and/or while in transit in an ambulance; (2) Operation of Class I, II, and V ambulances; and (3) Other duties as consistent with level of training and certification.

(B) The minimum training requirement for certification as an EMT-Basic is successful completion of Department-approved EMT-Basic initial training, or successful completion of Department-approved equivalent training.

(C) The supplemental training requirements of a certified EMT-Basic are as follows: (1) Successful completion of a course provided by a nationally recognized organization and reflecting current cardiopulmonary resuscitation (CPR) and emergency cardiac care resuscitation science and treatment recommendations issued by the International Liaison Committee on Resuscitation (ILCOR)'s International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) or successor body, as documented by a current training certificate, renewed biennially, in Basic Cardiac Life Support health care professional CPR. CPR training must be obtained through an instructor-led program or blended learning experience with an in-person hands-on skills evaluation, and must include a cognitive examination; and (2) Within the two-year term of the certification, successful completion of continuing education topical hours, and submission of documentation of such completion of training through the Department-designated web-based continuing education tracking platform in accordance with Department standards for the EMT. The Department shall establish standards for continuing education in administrative requirements.

(D) An EMT-Basic may may initiate Basic Life Support level skills, in accordance with the Statewide Treatment Protocols.

170.820: Advanced Emergency Medical Technician

(A) The functions of an Advanced EMT include: (1) The functions of an EMT-Basic as set forth in .810; and (2) The provision of limited advanced life support related to airway and circulatory maintenance in accordance with the Statewide Treatment Protocols.

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(B) The minimum training requirements for certification as an Advanced EMT are as follows: (1) Successful completion of the requirements for training as an EMT-Basic; and (2) Successful completion of Department-approved Advanced EMT initial training, or successful completion of Department-approved equivalent training.

(C) The supplemental training requirements of a certified Advanced EMT are as follows: (1) Conformance with the requirements of .810(C)(1); and (2) Within the two-year term of certification, successful completion of continuing education topical hours, and submission of documentation of such completion of training through the Department-designated web-based continuing education tracking platform, in accordance with Department standards for the Advanced EMT. The Department shall establish standards for continuing education in administrative requirements.

(D) An Advanced EMT may initiate Advanced Life Support-Advanced level skills, in accordance with the Statewide Treatment Protocols.

170.840: Paramedic

(A) The functions of a Paramedic include: (1) The functions of an Advanced EMT as set forth in .820; and (2) The provision of advanced life support related to treatment of cardiac or respiratory arrest, poisoning, overdose, or other major trauma or illness, in accordance with the Statewide Treatment Protocols.

(B) The minimum training requirements for certification of a Paramedic are as follows: (1) Successful completion of the requirements for training as an EMT-Basic or Advanced EMT; (2) Successful completion of Department-approved Paramedic initial training, or successful completion of Department-approved equivalent training; and (3) Successful completion of a course provided by a nationally recognized organization and reflecting current cardiopulmonary resuscitation (CPR) and emergency cardiac care resuscitation science and treatment recommendations issued by the International Liaison Committee on Resuscitation (ILCOR)'s International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) or successor body, as documented by a current training certificate, renewed biennially, in Advanced Cardiac Life Support CPR. ACLS training must be obtained through an instructor-led program or blended learning experience with an in-person hands-on skills evaluation, and must include a cognitive examination.

(C) The supplemental training requirements of a certified Paramedic are as follows: (1) Conformance with the requirements of .810(C)(1) and 170.840(B)(3), as documented by a current training card for each course, both renewed biennially; and (2) Within the two-year term of certification, successful completion of continuing education topical hours, and submission of documentation of such completion of training through the Department-designated web-based continuing education tracking platform, in accordance with Department standards for the Paramedic. The Department shall establish standards for continuing education in administrative requirements.

(D) A Paramedic may initiate Advanced Life Support-paramedic level interventions in accordance with the Statewide Treatment Protocols.

170.850: Student Emergency Medical Technician

A person, duly enrolled in a Department-approved Emergency Medical Technician training program, may function as an EMT at the level for which he or she is being trained under the following restrictions:

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(A) Any and all patient contact by the student is directly supervised and evaluated by an on-site health care professional authorized to do so by the Department-accredited training institution offering the initial training program, and is in compliance with .000 and the Department’s administrative requirements.

(B) The student shall have successfully completed any and all non-clinical training requirements prior to patient contact for the type(s) of treatment or care being provided.

(C) The student complies with all policies and procedures of the training program sponsor, the health care facility responsible for the patient's care and the Department.

170.880: Emergency Medical Technicians Trained and/or Certified/Licensed in Other States

(A) A person trained as an emergency medical technician in another state, but who is not certified, licensed or otherwise authorized as an emergency medical technician by another state who applies for Massachusetts certification as an EMT at any level, must document that he or she holds current NREMT certification for the level of EMT certification for which the person is applying for initial certification. The applicant shall be required to meet all other certification requirements of .910.

(B) A person currently certified, licensed or otherwise authorized as an emergency medical technician by another state who applies for Massachusetts certification as an EMT based on these out-of-state EMT credentials must (1) document that he or she holds current NREMT certification at their level of certification, licensure or authorization by the other state (2) provide documentation from the other state regarding their EMT certification or license being in good standing and disciplinary history; and (3) meet all the requirements of .910.

170.900: Certification of EMS Personnel Required

No person shall use the title Emergency Medical Technician, EMT, EMS first responder or EFR or serve as an EMT or EFR unless the person is currently certified by the Department as an EMT or EFR, respectively; provided, however, that persons may serve as additional personnel who meet the requirements of .310.

170.910: Initial Certification

(A) In order to be eligible to be certified as an EMT, a person must: (1) Be 18 years of age or older; (2) Be free of any physical or mental disability or disease which could reasonably be expected to impair the ability to be an EMT, or which could reasonably be expected to jeopardize the health and safety of the patient; (3) Meet the training requirements applicable to the level of certification for which the person is applying, as specified in .800; and (4) Successfully complete a Department-approved psychomotor examination, meeting the requirements of the NREMT; the NREMT cognitive computer- based examination; and obtain NREMT certification.

(B) To apply for certification as an EMT, a person must: (1) Complete and submit an application form provided by the Department, or as otherwise in accordance with Department procedural requirements, and the payment of the nonrefundable certification fee of $150.00; and (2) Maintain documentation of current NREMT certification.

(C) The Department shall issue certification to applicants who have completed and submitted the documentation required under .910(B)(1) and (2), submitted the appropriate fee in accordance with .910(B)(1), and met the training, examination, and other requirements set forth in .800 and 170.910(A)(1) through (5). Each certification shall be valid for two years.

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(D)(1) EFR Certification. The Department shall issue certification to EFRs based on written submissions by EFR services documenting that their EFRs meet the following requirements: (a) completion of the Department’s application form; (b) completion of the minimum training requirements for EFRs, pursuant to 105 CMR 170.805 and .000: Massachusetts First Responder Training; and (c) remain current in all requirements necessary to maintain certification. (2) EFR certification shall be valid for three years. (3) Complete records maintained by EFR services pertaining to EFRs’ training and certification status shall be subject to periodic audits at any time by the Department. (4) EMTs who work for EFR services do not have to be additionally certified as EFRs.

(E) No certification shall be valid if it was obtained through fraud, deceit or the submission of inaccurate or incomplete data.

170.920: Grounds for Denial of Certification

(A) The Department may deny certification on any of the following grounds: (1) Failure to meet Department-approved training requirements for a particular level of certification; (2) Failure to conform to the requirements of .910; (3) Any actions or omissions which would indicate that the health or safety of the public would be at risk should certification be granted; (4) Any failure to exercise reasonable care or commission of gross misconduct including, but not limited to, committing an act of violence, a violation of professional boundaries with a patient, or a drug-related offense; (5) Any previous violation of M.G.L. c. 111C or .000; (6) Any attempt to serve as an EMT or to obtain certification through fraud, deceit or knowing submission of inaccurate data or omission of a material fact; (7) Any action(s) while working as any type of health care professional other than an EMT which would constitute a violation of .000 or M.G.L. c. 111C; and (8) Any disciplinary violations in Massachusetts or another jurisdiction (state, United States or foreign) by a governmental licensing or certification authority, or by the NREMT, against an EMT or other health care license or certification held by the applicant, for acts or conduct substantially similar to that which would constitute grounds for discipline by the Department.

(B) Conditions for reapplication shall be specified by the Department at the time of the denial of certification.

170.930: Renewal of EMS Personnel Certification

(A) Renewal of EMT Certification. (1) All EMTs must renew certification every two years upon expiration of original certification. To be eligible for recertification, all EMTs must: (a) Meet the requirements of .810(C), 170.820(C) and 170.840(C), as applicable, with respect to continuing education and completion and submission of documentation through the Department-designated web-based continuing education tracking platform, or through alternative means for those granted military extensions or hardship waivers by the Department, within the time period specified by the Department in administrative requirements; (b) Apply for a renewal of certification on a form provided by the Department, or as otherwise in accordance with Department procedural requirements within the time period specified by the Department in administrative requirements; and (c) Submit a nonrefundable fee of $125.00 with a completed application form, or as otherwise in accordance with Department procedural requirements, for certification.

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(2) NREMT-related Certification Requirements for Renewal. (a) EMTs who are currently NREMT certified must maintain documentation of current NREMT certification, in accordance with the provisions of .930(A)(1)(b); (b) EMTs who were never NREMT certified may apply for NREMT certification. If they do apply for NREMT certification, EMTs shall maintain documentation of current NREMT certification with the next renewal of certification after receipt of NREMT certification, in accordance with the provisions of .930(A)(1)(b); and (c) All EMTs, whether NREMT and Massachusetts certified, or solely Massachusetts certified, must enter, manage and submit their continuing educational requirements through the Department-designated continuing education tracking platform, or through alternative means for those granted military extensions or hardship waivers by the Department, in accordance with Department procedural requirements. (d) One-year Alignment: EMTs whose NREMT certification expiration date is one year after their Massachusetts certification expiration date shall apply for one-year alignment, advancing their Massachusetts certification expiration date one year to match their NREMT certification expiration date. To do so, the EMT must submit a nonrefundable fee in the amount of half the recertification fee in .930(A)(1)(c), with a completed application form, or as otherwise specified in accordance with Department procedural requirements for certification, no later than one year after the expiration of their Massachusetts certification. Once these expiration dates are aligned, the EMT may apply for renewal of their Massachusetts certification. Late certification under 105 CMR 170.930(A)(4) does not apply to one-year alignment. (3) The Department shall issue a renewed EMT certification to an applicant who documents completion of the requirements of .930(A)(1) and (2) and who was not the subject of any prior Department enforcement actions that would preclude their recertification. A person holding an expired certification may not serve as an EMT until properly certified. (4) Late Certification and Fee; Hardship Waivers: An EMT whose certification has expired for two years or less, and who has met their continuing education requirements prior to the expiration of their certification may renew their certification in accordance with procedures specified in Department administrative requirements. The Department may assess a fee of $50 for renewal of certification expired for two years or less. An EMT whose certification is about to expire, or has expired for 30 calendar days or less, who has not met their continuing education requirements and who documents significant hardship, may seek a hardship waiver to renew their certification in accordance with procedures specified in Department administrative requirements.

(B) Renewal of EFR Certification. (1) EFR certification must be renewed every three years. Each EFR service shall ensure that training and documentation requirements for recertification are met for each of its certified EFRs. (2) Each EFR service shall submit to the Department all information required for renewal of EFR certification, as listed in the administrative requirements of the Department. (3) If training and documentation requirements are met for any individual EFR, the Department shall renew certification, provided there are no past actions of the Department with respect to that individual precluding recertification. (4) A person whose certification has expired may not serve as an EFR until properly certified. The EFR service shall not utilize such a person as an EFR.

170.931: Emergency Medical Technicians Engaged in or Recently Discharged from Active Military Service, or Spouses Who Accompanied Personnel Who Are Engaged in or Recently Discharged from Active Military Service

(A) An EMT who is engaged in, or recently discharged from, active military service in the armed forces of the United States including the reserve or national guard or who accompanied his or her spouse who is engaged in, or recently discharged from such active military service, may apply for extension of his or her Massachusetts certification, as specified in administrative requirements of the Department.

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(B) An applicant for EMT certification who is engaged in, or recently discharged from, active military service in the armed forces of the United States including the reserve or national guard, or who accompanied his or her spouse who is engaged in, or recently discharged from, such active military service, may apply to the NREMT for extension of eligibility to take the certification exams.

(C) An EMT who is a member of the reserves or national guard and engages in regularly scheduled annual training for reservists or the spouse of such an EMT, is not eligible for the extensions permitted under .931 for such training.

170.935: Reinstatement of Certification

A person whose certification has expired by more than two years, and who is not eligible for recertification as required by .930 or who has been refused recertification under the provisions of .940(A), may apply to the Department for reinstatement of certification in accordance with .935(A).

(A) To apply for reinstatement at the EMT-Basic level, a person must: (1) Successfully complete all NREMT education and certification requirements; (2) Submit a completed application form provided by the Department; (3) Submit a nonrefundable fee established by the Department with the completed application form for reinstatement of certification; (4) Successfully complete a Department-approved psychomotor examination, meeting the requirements of the NREMT within one year of the date of the Department’s approval of the application to proceed to the psychomotor examination; and (5) Meet the requirements of .910(A)(1) through (5). (6) If a person seeking reinstatement as an EMT-Basic holds current NREMT certification, they must submit a completed initial application form provided by the Department and submit a nonrefundable fee established by the Department with the completed application form.

(B) To apply for reinstatement at the Advanced EMT or Paramedic level, a person must: (1) Successfully complete all NREMT education and certification; (2) Submit a completed application form provided by the Department; (3) Submit a nonrefundable fee established by the Department with the completed application form for reinstatement of certification; and (4) Meet the requirements of .910(A)(1) through (5). (5) If a person seeking reinstatement as an Advanced EMT or Paramedic holds current NREMT certification, they must submit a completed initial application form provided by the Department and submit a nonrefundable fee established by the Department with the completed application form.

(C) The Department shall reinstate certification to an applicant who has properly qualified under .935(A). The certification shall be valid for two years.

(D) Previously certified EMTs not qualified for reinstatement under .935, but who desire to be certified, must comply with all initial certification requirements as specified in .910.

170.937: Reporting Obligations of EMS Personnel

(A) Each EMT or EFR shall file a written report with the service in conjunction with which he or she provides EMS, and with the Department within five calendar days of the following: (1) The EMT’s or EFR’s 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 finding), other than a minor traffic violation for which less than $1000 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;

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(2) Loss or suspension of the EMT’s or EFR’s driver’s license; (3) Disciplinary action taken by another governmental licensing jurisdiction (state, United States or foreign) or the NREMT, against an EMT or other health care certification or license held by an EMT or EFR; or (4) Suspension or revocation of authorization to practice by the EMT's or EFR's affiliate hospital medical director.

(B) Each EMT or EFR shall file a written report with the service in conjunction with which he or she works as an EMT or EFR within five calendar days of notice of proposed Department disciplinary action or final Department action against the EMT’s or EFR’s certification (letter of censure, denial, suspension, revocation or refusal to renew certification), or other Department response to identified deficiency, cease and desist order, letter of clinical deficiency, notice of serious deficiency, advisory letter) against the EMT or EFR.

(C) The Department shall review and assess the information it receives under .937(A) in accordance with procedures established in a written policy. Any Department action to deny, suspend, revoke or refuse to renew an EMT or EFR certification, under .940, shall proceed in accordance with .740 through 170.780, as applicable to the Department action taken.

170.940: Grounds for Suspension, Revocation of Certification, or Refusal to Renew Certification

The Department may suspend or revoke certification, or refuse to renew certification, of any EMT on the following grounds:

(A) Failure to meet training requirements for renewal of certification;

(B) Failure to meet the requirements of .800 or 170.900;

(C) Failure to exercise reasonable care, judgment, knowledge, or ability in the performance of duties or to perform those duties within the scope of his or her training and certification, and in accordance with the Statewide Treatment Protocols;

(D) Gross misconduct in the exercise of duties including, but not limited to, committing an act of violence, a violation of professional boundaries with a patient or student, or a drug-related offense;

(E) Commission of any criminal offense relating to the performance of duties including any conviction relating to controlled substances violations;

(F) Any condition or action that endangers the health or safety of the public;

(G) Being under the influence of alcohol, or impaired by a controlled substance, including cannabis, while on duty at an ambulance service or when responding or assisting in the care of a patient, or while in EMS educational programs and field or clinical internship components of EMS educational programs.

(H) Refusal to surrender a certificate in violation of .750(C);

(I) When conducting training programs, committing gross misconduct including, but not limited to, committing an act of violence, a violation of professional boundaries with a student, or a drug-related offense, and failure to conduct such program(s) in accordance with the provisions of .945 through 170.978 and/or the standards and procedures established in the administrative requirements published separately by the Department;

(J) When acting as any type of health care professional or providing health care services in a setting other than while working for an ambulance service, failure to exercise reasonable care and judgment, and/or commission of gross misconduct including, but not limited to, committing an act of violence, a violation of professional boundaries with a patient, or a drug-related offense;

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(K) Violation of a correction order;

(L) Failure to submit a plan of correction, when required to by the Department in accordance with .710;

(M) Failure to comply with a Department-approved plan of correction, or a Department correction order pursuant to .720;

(N) Failure to pay a deficiency assessment levied in accordance with .730;

(O) Knowingly make an omission of a material fact or a false statement, orally or in any application or other document filed with or obtained by the Department or any other entity in the EMS system;

(P) Failure to complete a patient care report, as required by .345;

(Q) Having been disciplined in Massachusetts or another jurisdiction (state, United States or foreign) by a governmental licensing or certification authority, or by the NREMT, against an EMT or other health care certification or license held by the EMT, for acts or conduct substantially similar to that which would constitute grounds for discipline by the Department;

(R) Failure to meet reporting obligations in accordance with .937; or

(S) Any violation of M.G.L. c. 111C or .000.

170.941: Written Examination for EMT

The Department shall approve a written examination to be administered to persons who have applied for certification as an EMT. The written examination shall test a person's competence in the cognitive knowledge related to the level of certification for which application is made.

170.942: Examiners and Chief Examiners: Duties and Requirements for Approval

The Department shall approve personnel as Chief Examiners and Examiners, who shall be the sole persons authorized to oversee and administer, respectively, the practical skills examination required pursuant to .910(A)(5).

(A) Duties of a Chief Examiner. The duties and responsibilities of a Chief Examiner include, but are not limited to, the following: (1) Overseeing the administration of the psychomotor examination as the Department’s and NREMT's representative, to ensure that exam administration conforms to Department’s and NREMT's standards including use of current Department or NREMT skill sheets at all EMT levels; (2) Complying with conflict of interest requirements set out in the Department’s Examiner’s Manual; (3) Monitoring Examiners and regularly evaluating in writing their competency and effectiveness; and (4) Functioning in accordance with the procedures set forth in the Department’s Examiner’s Manual.

(B) Persons seeking Department approval as a Chief Examiner shall submit an application on a form provided by the Department. The minimum requirements for approval as a Chief Examiner are as follows: (1) Current certification in good standing, with no disciplinary history with the Department. as an EMT at a level equal to or greater than the EMT level for which the test is administered;

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(2) Successful completion, documented by a current training certificate, renewed biennially, of an instructor's course in Basic Life Support cardiopulmonary resuscitation provided by a nationally recognized organization and reflecting current cardiopulmonary resuscitation (CPR) and emergency cardiac care resuscitation science and treatment recommendations issued by the International Liaison Committee on Resuscitation (ILCOR)'s International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) or successor body; (3) At least five years of experience within the last ten years in providing pre-hospital emergency medical care as an EMT at a level equal or greater than the EMT level for which the test is administered; (4) Successful completion of Chief Examiner training, orientation and internship requirements of the Department; (5) Current Department approval as an Examiner or successful completion of supplemental Chief Examiner training, in addition to that required under .942(B)(4), as required by the Department; (6) A favorable evaluation by the Department; and (7) For ALS Chief Examiners currently credentialed by NREMT as an Advanced Level Representative. For BLS Chief Examiners, currently credentialed by NREMT in accordance with any NREMT requirements for BLS-level psychomotor examinations.

(C) Duties of an Examiner. The duties and responsibilities of an Examiner include, but are not limited to, the following: (1) Administering the psychomotor examination in accordance with the Department's and NREMT standards including providing a fair, impartial, accurate and knowledgeable assessment of each candidate’s performance of required practical skills; (2) Complying with conflict of interest provisions set out in the Department’s Examiner’s Manual; (3) Working at the direction of the Chief Examiner on-site; and (4) Functioning in accordance with the procedures set forth in the Department’s Examiner’s Manual.

(D) Persons seeking Department approval as an Examiner shall submit an application on a form provided by the Department. The minimum requirements for approval as an Examiner are as follows: (1) Current certification as an EMT at a level equal to or greater than the EMT level for which the test is administered; (2) Successful completion, documented by a current training certificate, renewed biennially, of an instructor's course in Basic Life Support cardiopulmonary resuscitation provided by a nationally recognized organization and reflecting current cardiopulmonary resuscitation (CPR) and emergency cardiac care resuscitation science and treatment recommendations issued by the International Liaison Committee on Resuscitation (ILCOR)'s International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) or successor body; (3) At least two years' experience in providing pre-hospital emergency medical care as an EMT at a level equal to or greater than the EMT level for which the test is administered; (4) Successful completion of an Examiner training and orientation provided by the Department; (5) Successful completion of an internship under a Chief Examiner; (6) A favorable evaluation by the Department; and (7) Currently credentialed by NREMT in accordance with any NREMT requirements for psychomotor examiners, as applicable to EMT level for which test is administered. (8) Exception: The Department may waive any of the requirements listed in .942(D)(1) through (5) for Examiners who administer psychomotor examinations for EMTs at the Advanced EMT or Paramedic level. Requirements may be waived for a person seeking such approval if: (a) The person is a registered nurse or physician and has clinical training and experience the Department determines is appropriately suited for administering a particular type(s) of station(s) for the practical portion of an examination; or

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(b) The person is, or has been, an instructor in a Department-approved Paramedic training program and the Department determines the person’s expertise and familiarity with the education and performance of ALS personnel qualified him or her to administer examinations.

(E) The Department may issue approval as a Chief Examiner or Examiner to an applicant who has successfully met all the requirements of .942 applicable to the requested level of approval. The term of such approval shall run concurrently with the term of the applicant’s EMT certification.

170.943: Renewal of Approval as a Chief Examiner and Examiner

The Department may renew approval of a Chief Examiner or Examiner for an additional term to run concurrently with his or her EMT certification. A Chief Examiner or Examiner must apply for renewal or approval on a form provided by the Department, no later than 60 calendar days prior to the expiration of the current approval. A person with an expired approval as a Chief Examiner or Examiner may not oversee or administer, as applicable, the Department’s psychomotor examination.

(A) To be eligible for renewal of approval, a Chief Examiner or Examiner must: (1) Continue to meet the requirements of .942 applicable to his or her level of approval, except that Chief Examiners or Examiners approved by the Department prior to January 6, 2023, may continue to have at least two years of experience in providing pre- hospital emergency medical care as an EMT at a level equal to or greater than the EMT level for which the test is administered; and (2) During the term of the immediate past approval period, have received a favorable evaluation from the Department as a Chief Examiner or an Examiner, as applicable. The Department’s evaluation of an Examiner will be based, at a minimum, on evaluations by Chief Examiners.

(B) The Department shall provide written confirmation of renewed approval as a Chief Examiner or Examiner, as applicable, to an applicant who successfully documents completion of the requirements of .943 and against whom there are no past enforcement actions of the Department with respect to that applicant, either as an EMT, a Chief Examiner or an Examiner, precluding renewed approval.

170.944: Grounds for Denial, Suspension, and Revocation of Examiner and Chief Examiner Approval or Reapproval

Approval or reapproval as an Examiner and/or Chief Examiner may be denied, suspended or revoked by the Department on the following grounds:

(A) Failure to meet the requirements of .942 or 170.943;

(B) Failure to function during an examination for EMT in accordance with Department standards and procedures established separately as administrative requirements and set forth in the Examiner's Manual;

(C) Interfering with or deviating from the Department examination process for EMT certification so as to improperly influence or attempt to influence the outcome of an examination;

(D) Failure to exercise reasonable care, judgment, knowledge, or ability in the performance of duties as an EMT, as an Examiner, Chief Examiner and/or in conducting any program regulated by the Department, or to perform those duties within the scope of his or her training and certification and/or approval;

(E) Gross misconduct in the exercise of duties as an EMT, an Examiner, a Chief Examiner, and/or in conducting any program regulated by the Department including, but not limited to, committing an act of violence, a violation of professional boundaries with a patient, student, or candidate, or a drug-related offense;

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(F) Commission of any criminal offense relating to the performance of duties as an EMT, an Examiner, or a Chief Examiner including, but not limited to, any conviction relating to drug- related offense, or any crime that endangers the public health and safety;

(G) Any condition or action that endangers the health or safety of the public; or

(H) Any violation of M.G.L. c. 111C or .000.

170.945: Department-approved EMT Training

(A) All initial training programs must be provided by training institutions accredited by the Department pursuant to .946.

(B) All initial paramedic training programs shall have received accreditation from CAAHEP, or, have initiated the process to obtain such accreditation, as documented by a Letter of Review. Paramedic training programs that have received a Letter of Review must maintain their Letter of Review and achieve CAAHEP accreditation in accordance with CAAHEP Letter of Review process.

(C) All continuing education must either: (1) Be provided by training institutions accredited by the Department pursuant to .946, or (2) Have received individual program approvals by the Department pursuant to .960.

170.946: Accreditation of Training Institutions: General Provisions

(A) Eligibility. A training institution seeking Department accreditation shall be an organization capable of providing programmatic and fiscal oversight of, and assuming accountability for, the instruction, operation, performance and evaluation of the training of EMTs and EMT-candidates. To be eligible to apply for accreditation, the training institution must provide, either directly or through contractual arrangements with a Department-accredited training institution or post- secondary educational institution, a basic infrastructure that: (1) Employs quality assurance/quality improvement procedures for assessing the institution’s performance; (2) Adequately assesses the performance of instructors and assumes clear accountability for its instructors; (3) Adequately assesses the performance of its students; (4) Provides its students with adequate access to research and learning tools and materials including, but not limited to, library facilities, computers, audio-visual educational aids and other technology determined to be necessary by the Department; (5) Provides adequate classroom facilities and practical skills training areas; (6) Provides adequate opportunities for students to complete clinical and field internships in a timely manner; (7) Provides adequate administrative support; and (8) Institutions providing paramedic training programs must have current CAAHEP ac- creditation of the paramedic training program, or a Letter of Review. Those that have a Letter of Review must maintain such Letter in accordance with CAAHEP Letter of Review process.

(B) Level of Accreditation. An applicant for accreditation shall specifically seek, and the Department shall grant qualified training institutions accreditation, at the BLS, ALS-Advanced and/or ALS-Paramedic level(s) of training.

(C) Application Process. An applicant for accreditation shall: (1) Complete and submit an application form provided by the Department; (2) Undergo an on-site evaluation by the Department; (3) Submit a nonrefundable accreditation fee of $1,500.00 for the entire term of accreditation.

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(D) The Department shall accredit an applicant training institution in either one of two ways: (1) Full Review: After receipt of a completed application, the Department makes a finding, based on review of the applicant, that: (a) The applicant is eligible, in accordance with .946(A); (b) The applicant is responsible and suitable, in accordance with .948; and (c) The applicant is capable of meeting the duties and responsibilities of accredited training institutions, pursuant to .950.

(2) Substantially Equivalent Review: The Department confirms a training institution has current accreditation in good standing that meets Department approval as substantially equivalent to the Department’s process. (a) A training institution may submit to the Department a letter of intent to seek accreditation based on substantially equivalent accreditation and attesting to its capability of, and commitment to, meeting the duties and responsibilities for accredited institutions, pursuant to .950, and documentation of its current accreditation. (b) Accreditation on the basis of substantially equivalent accreditation shall run concurrent with the term of the substantially equivalent accreditation. The training institution shall submit documentation of maintenance of such accreditation. If such substantially equivalent accreditation is not maintained, the training institution’s Department accreditation expires, unless the training institution submits an application and successfully meets the requirements of .946(D)(1) and the Department’s administrative requirements.

(E) Term. Accreditation by the Department shall be for a term of no longer than three years. A complete renewal of accreditation application and accreditation fee must be filed with the Department six months prior to the expiration of accreditation.

170.947: Provisional Accreditation

(A) The Department may issue provisional accreditation to an applicant for either accreditation or renewal of accreditation when the applicant does not meet the requirements of .946 through 170.950, provided that the applicant has demonstrated to the Department’s satisfaction a good faith intention to meet all such requirements and provided that the Department finds the applicant has provided adequate EMT training and evidences a potential for full accreditation within a reasonable period not to exceed one year.

(B) In order to be provisionally accredited, the applicant training institution shall document in writing a plan for meeting all the requirements for full accreditation, and the Department must have approved the plan.

(C) Provisional accreditation shall expire one year after the date on which it was issued, and may be renewed for one additional year, subject to Department review and approval. The Department shall in no case issue provisional accreditation more than two consecutive times to the same training institution.

(D) During the period of its provisional accreditation, the training institution shall timely submit to the Department documentation and other information as may be required, in accordance with administrative requirements of the Department.

170.948: Finding of Responsibility and Suitability of Applicants for Accreditation

(A) Upon receipt and review of an application for accreditation, the Department shall make a finding concerning the responsibility and suitability of the applicant training institution. Findings may be based upon information concerning persons with a significant financial or management interest in the training institution. A determination of responsibility and suitability shall be based on factors including, but not limited to, the following:

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(1) The applicant’s history, if any, of prior compliance with .000, 105 CMR 171.000: Massachusetts First Responder Training, M.G.L. c. 111C, and 105 CMR 700.000: Implementation of M.G.L. c. 94C; (2) The familiarity and experience of the applicant in operating an EMS training program approved under .000, or in operating adult vocational training or higher educational programs; (3) The applicant’s ability to provide and sustain quality EMS training programs to serve the needs of students; (4) The ability of training institution administrators to operate the program in a manner sufficient to satisfy the requirements of .000 and/or 105 CMR 171.000: Massachusetts First Responder Training, as applicable; (5) Adequate financial resources of the applicant to provide training sufficient to meet the requirements of .000, as demonstrated by a current financial statement or current budget; (6) The adequacy of the training institution’s legal capacity to operate, as demonstrated by articles of incorporation and corporate bylaws; (7) The applicant’s history, if any, of any of the following: (a) Any willful or deliberate failure to provide training to a person for reasons of race, color, religion, sex, sexual orientation, age, national origin, ancestry or disability; (b) Any attempt to impede the work of a duly authorized representative of the Department or the lawful enforcement of any provisions of M.G.L. c. 111C or 105 CMR 170.000; (c) Conviction of a criminal offense, such as drug-related offenses, rape, assault or other violent crime against a person, or related to the provision of training subject to the Department’s approval; or (d) Any attempt to obtain accreditation or training program approval by fraud, misrepresentation, or the submission of false information.

(B) If the Department is unable to make a finding of responsibility and suitability on the basis of any of the factors listed above, the applicant will have the burden of persuasion to prove the applicant’s responsibility and suitability.

170.950: Duties and Responsibilities of Accredited Training Institutions

(A) Successfully prepare their students to achieve competency in the cognitive knowledge, psychomotor skills and professional behavior necessary to work effectively, upon Department certification, as EMTs at the level of their training.

(B) Conduct training programs in accordance with M.G.L. c. 111C, .000 and administrative requirements for the following: (1) Student performance outcome measures; (2) Academic and clinical staff; (3) Administrative staff; (4) Current initial training and continuing education standards including, but not limited to, incorporation of the Statewide Treatment Protocols; (5) Supervised clinical and field internships; (6) Ongoing student and instructor evaluation; (7) Classroom space, psychomotor skills training areas and equipment; (8) Timely submission of training program documentation to the Department; and (9) Maintenance of accurate and appropriate records for a minimum of seven years following course completion.

(D) Upon request, make available to agents of the Department all records relating to the provision of EMS training programs;

(E) Maintain an effective quality assurance/quality improvement system, which includes collection of data and adequate documentation to evaluate the program and assess its effectiveness in achieving educational goals and objectives;

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(F) Comply with applicable requirements pertaining to use and secure storage of controlled substances and instruments for administration of controlled substances, in accordance with requirements of the Department’s Drug Control Program, pursuant to 105 CMR 700.000: Implementation of M.G.L. c. 94C;

(G) Administer, in accordance with the Department’s administrative requirements, the Department-approved psychomotor examination meeting NREMT standards for NREMT and state certification for the training institution’s eligible students, and for eligible candidates as assigned by the Department; and

(H) Pay an accreditation fee in the amount of $1500 for the entire accreditation term upon application.

170.955: Grounds for Denial of Accreditation

(A) Grounds for denial of accreditation include, but are not limited to, the following: (1) Failure to meet the requirements for becoming accredited by the Department, in accordance with .946; (2) Failure to submit an application and fee in accordance with .946(C); (3) Failure to satisfy the Department as to any of the grounds for determining the responsibility and suitability of the applicant under .948; or (4) Fraud, deceit or knowing submission of inaccurate or incomplete data to the Department, either orally or in writing.

(B) Denial of accreditation may be appealed in accordance with .760.

170.957: Grounds for Suspension, Revocation or Refusal to Renew Accreditation

(A) Grounds for suspension or revocation of accreditation include, but are not limited to, the following: (1) Documented record of failure of accredited training institution's students to achieve acceptable performance outcome measures, in accordance with .950 and administrative requirements of the Department; (2) Failure to meet the duties and responsibilities for accredited training institutions under .950; (3) With respect to accreditation at the paramedic level, failure to maintain current CAAHEP accreditation in good standing; (4) Failure to allow the Department or its agents to observe or evaluate programs, or to provide the Department upon its request, timely and appropriate documentation or information about the accredited training institution's EMS training program, as requested including, but not limited to, training program records, personnel, facilities, classes, clinical practice sessions and field internships; (5) Violation of a correction order; (6) Failure to submit an acceptable plan of correction as required under .710; (7) Failure to comply with a plan of correction; (8) Failure to pay a deficiency levied in accordance with .730; (9) Engaging in, or aiding, abetting, causing or permitting any act prohibited by M.G.L. c. 111C, .000 and administrative requirements of the Department; (10) Any actions that endanger the public health and safety; (11) Commission of gross misconduct including, but not limited to, committing an act of violence, a violation of professional boundaries with a patient, student, or candidate, or a drug-related offense; (12) Conviction of a criminal offense including, but not limited to, a drug-related offense, any crime that endangers the public health and safety, or any crime related to the provision of training subject to Department approval; or (13) Any attempt to maintain accreditation by fraud, misrepresentation or by omitting material facts or submitting false information to the Department, either orally or in writing.

(B) Suspension or revocation of accreditation may be appealed in accordance with .760.

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170.960: Approval of Training Programs by Nonaccredited Training Providers

(A) Each training program offered by a nonaccredited training provider must be individually approved by the Department. Nonaccredited training providers may provide only continuing education programs.

(B) Any nonaccredited training provider seeking training program approval shall submit a complete application on a form provided by the Department, to the Department or the appropriate Regional EMS Council(s), as an agent of the Department, in compliance with Department administrative requirements.

(C) Separate program approval is required for each offering of continuing education training program, even if the same training program was previously approved and/or offered. Blanket approval may be obtained for multiple offerings of the same training program in a single recertification year.

(D) Applicants denied approval may re-apply for approval, but not more than once in the 12 months following denial.

(E) Any publications or advertisements concerning the program shall accurately reflect the education and training being offered.

(F) Prior to receipt of Department approval for a training program pursuant to .960(A), no nonaccredited training provider shall: (1) Advertise such a training program as approved by the Department; (2) Accept applications from prospective students; or (3) Conduct any classes for such a training program.

170.964: Standards for Training Programs by Nonaccredited Training Providers

Nonaccredited training providers seeking Department approval for training programs, pursuant to .960, shall meet the following requirements:

(A) Training program subject matter must be relevant to the role and responsibilities of the EMT and conform to standards of practice in the Statewide Treatment Protocols.

(B) All training program instructors must have education and experience appropriate to the subject matter and to adult instruction. The nonaccredited training provider shall establish and maintain an effective quality assurance/quality improvement system for oversight and evaluation of instructors’ performance, in accordance with administrative requirements of the Department.

(C) All training programs shall be conducted in appropriate classroom space with appropriate educational aids and equipment, in accordance with administrative requirements of the Department. Nonaccredited training providers that offer training programs requiring practice of skills must also provide an appropriate laboratory setting and appropriate equipment for performing such skills, in accordance with the Department’s administrative requirements.

(D) Each training program presented for approval must contain appropriate objectives, content outline, teaching method and instructional media, and measurement/evaluation method, in accordance with administrative requirements of the Department.

(E) The training provided shall be consistent with the approved application.

(F) The nonaccredited training provider shall maintain original attendance rosters or other attendance documentation, in accordance with administrative requirements of the Department for each session of the training program, for seven years.

(G) The nonaccredited training provider shall make available to agents of the Department upon request all records relating to the provision of EMS training programs;

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(H) The nonaccredited training provider shall issue course completion documentation to those who have successfully completed the training program, in accordance with administrative requirements of the Department.

170.970: Request for Subsequent Approval of Training Programs by Nonaccredited Training Providers

In addition to the provisions set forth in .960 through 170.964, when a nonaccredited training provider that had previously received Department approval for an EMT training program requests approval for a subsequent training program, the Department shall evaluate the request in the light of its conduct of past training programs. This includes, but is not limited to, consideration of the following:

(A) The nonaccredited training provider's history of compliance with .000 including, but not limited to, submission of complete and timely applications for approval, issuance of course completion documentation to those students who have successfully completed programs and other documentation as requested by the Department; and

(B) The nonaccredited training provider’s cooperation with inquiries and site visits by representatives of the Department.

170.976: Grounds for Denial, Suspension, or Revocation of Approval of Training Programs by Nonaccredited Providers

The following reasons constitute grounds for denial, suspension, or revocation of program approval:

(A) Failure, at any time, to allow the Department to inspect, observe, or evaluate a training program, including the training program’s personnel, facilities, classes, and practical skills sessions associated with such program;

(B) Use of training or administrative personnel not competent for the type of training offered;

(C) Failure to meet any of the requirements for approval and conduct of training programs as set forth in .960 through 170.970 and in administrative requirements of the Department;

(D) Conviction of a criminal offense related to the provision of training that requires Department approval;

(E) Failure to observe recognized professional standards in the course content and operation of the training program;

(F) Any attempt to obtain or maintain training program approval by fraud, misrepresentation or by omitting material facts or submitting false information to the Department, either orally or in writing;

(G) Failure to keep accurate and adequate records, in accordance with .964(F);

(H) Any actions that endanger the public health and safety;

(I) Commission of gross misconduct including, but not limited to, committing an act of violence, a violation of professional boundaries with a student, patient or candidate, or a drug- related offense;

(J) Failure to submit an application in accordance with the requirements of .000 or the Department's application procedures;

(K) Failure to offer training that is consistent with the approved application; or

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(L) Engaging in, or aiding, abetting, causing or permitting any act prohibited by M.G.L. c. 111C, .000 or administrative requirements of the Department.

170.977: Instructor/Coordinators: Duties and Requirements for Approval

The Department shall approve personnel as Instructor/Coordinators (I/Cs), who shall be the sole persons authorized to teach an initial training program at the EMT-basic and Advanced EMT levels. An applicant shall specifically seek, and the Department shall grant qualified persons approval, as Instructor/Coordinator, at the EMT-Basic or EMT-Basic and Advanced EMT level(s) of training

(A) The duties and responsibilities of an Instructor/Coordinator include, but are not limited to, the following, at the level at which they have been approved by the Department: (1) Planning, developing, instructing and coordinating the EMT-Basic and Advanced EMT classes in accordance with .810 and the administrative requirements of the Department; (2) Managing and ensuring quality of the delivery of EMT-Basic and Advanced EMT classes, whether delivered by personal lecture or practical demonstration, or by specialty and guest lecturers. Such quality assurance shall include, at a minimum, a system that incorporates collection of data and adequate documentation to evaluate the EMT-Basic and Advanced EMT classes and assess their effectiveness in achieving educational goals and objectives, in accordance with the administrative requirements of the Department; (3) Remaining current and knowledgeable with regard to all EMT-Basic and Advanced EMT procedures, equipment, initial training standards, the Statewide Treatment Protocols, .000 and M.G.L. c. 111C pertaining to the provision of prehospital care and the role and responsibilities of the EMT-Basic and Advanced EMT; and (4) Making available to agents of the Department upon request all records relating to the provision of EMS training.

(B) Persons seeking Department approval as an Instructor/Coordinator shall submit an application on a form provided by the Department. The minimum requirements for approval by the Department as an Instructor/Coordinator are as follows: (1) Current certification as in good standing at or above the level of EMT training to be taught, with no record of past enforcement actions of the Department; (2) Current certification as an Instructor in Basic Life Support cardiopulmonary resuscitation; (3) A minimum of three years’ experience within the last ten years, working for an ambulance service as an EMT providing EMS care, at or above the level EMT training to be taught; (4) Successful completion of a Department-approved EMT instructor-training course that includes adult education, psychomotor skills and affective learning components, or Department-approved substantially equivalent training; (5) Successful completion of an orientation provided by the Department; and (6) Competency in teaching and knowledge of the subject matter as demonstrated by a favorable evaluation by the Department.

(C) The Department may issue a certificate of approval as an Instructor/Coordinator at the EMT-Basic or EMT-Basic and Advanced EMT levels to an applicant who has successfully met all requirements of .977 applicable to the level to be taught. The term of such approval shall run concurrently with the term of the applicant’s EMT certificate.

170.978: Renewal of Approval as an Instructor/Coordinator

The Department may renew approval of an Instructor/Coordinator. An Instructor/ Coordinator must apply for renewal of approval on a form provided by the Department, no later than 60 calendar days prior to the expiration of the current approval. A person with an expired approval as an Instructor/Coordinator may not teach initial training programs at the EMT-Basic or Advanced EMT level.

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170.978: continued

(A) To be eligible for renewal of approval, an Instructor/Coordinator must: (1) Continue to meet the requirements of .977 and administrative requirements of the Department with respect to Instructor/Coordinators; provided, that an Instructor/Coordinator approved prior to January 6, 2023, shall have five years to come into compliance with the requirement of .977(B)(3); (2) Submit documentation evidencing, at the level of Instructor/Coordinator being renewed: (a) having actively been teaching; and (b) being responsible for managing and ensuring the quality Department-accredited initial EMT training program or approved continuing education courses, in accordance with administrative requirements issued by the Department; and (3) Successfully complete Instructor/Coordinator training updates as required by the Department.

(B) The Department shall provide written confirmation of renewed approval as an Instructor/ Coordinator at the EMT-Basic or EMT-Basic and Advanced EMT levels to an applicant who documents completion of the requirements of .978 and against whom there are no past enforcement actions of the Department with respect to that applicant, either as an EMT or as an Instructor/Coordinator, precluding renewed approval.

170.979: Grounds for Denial, Suspension, and Revocation of Instructor/Coordinator Approval or Reapproval

Approval or reapproval as an Instructor/Coordinator may be denied, suspended, or revoked by the Department on any of the following grounds:

(A) Failure to meet the requirements of .977 or 170.978;

(B) Failure to conduct and/or administer Department-approved training in accordance with Department administrative requirements;

(C) Interfering with the examination and/or certification process so as to improperly influence or attempt to influence the outcome of the examination;

(D) Failure to provide evidence of documentation of the requirements of .977 to the Department upon request;

(E) Failure to exercise reasonable care, judgment, knowledge, or ability in the performance of duties as an EMT or as an Instructor/Coordinator when conducting any program regulated by the Department, or to perform those duties within the scope of his or her training and certification and/or approval;

(F) Gross misconduct in the exercise of duties as an Instructor/Coordinator, an EMT, a Chief Examiner or an Examiner including, but not limited to, committing an act of violence, a violation of professional boundaries with a student, patient or candidate, or a drug-related offense;

(G) Conviction of any criminal offense relating to the performance of duties as an Instructor/Coordinator, an EMT, a Chief Examiner or an Examiner including, but not limited to, any conviction for a drug related offense, or any crime that endangers the public health and safety, or is related to the provision of training subject to Department approval;

(H) Any condition or action that endangers the health or safety of the public; or

(I) Any violation of M.G.L. c. 111C or .000.

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170.1000: Severability

If any rule contained in .000 is found to be unconstitutional or invalid by a Court of competent jurisdiction, the validity of the remaining rules will not be so affected.

REGULATORY AUTHORITY

.000: M.G.L. c. 111C.

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