Title 202 | Chapter 007 | Regulation 560E
This emergency administrative regulation is being promulgated in order to meet an imminent threat to public health, safety, and welfare. Specifically, this emergency amendment is necessary to ensure adequate staffing of ambulances.
Senate Bill 150 (Regular Session 2020) (“SB 150”) granted the Kentucky Board of Emergency Medical Services (the “Board”) the authority to waive or modify certain statutes and regulations related to the EMS profession during the State of Emergency declared by the Governor in Executive Order 2020-215. See SB 150 § 1(13). On or about April 14, 2020, the Board filed an emergency waiver and modification of 202 KAR 7:560 with the Secretary of State. The waiver and modification waived (1) the requirement that paramedics staff at least 25% of Class I and Class IV Advanced Life Support (ALS) ambulances and (2) the requirement that ambulances be driven by emergency medical technicians (EMTs), providing instead that ambulances could be driven by “[a] driver certified in CPR and who has had an emergency vehicle operator’s course”. The Board’s modification and waiver of 202 KAR 7:560 was ratified and approved by the General Assembly until April 14, 2022. See House Joint Resolution 1 (Special Session 2021) § 4(29)(k); Senate Bill 25 (Regular Session 2022) § 4(27)(k).
On March 30, 2022, the Board filed emergency and ordinary amendments to 202 KAR 7:560 to allow emergency medical responders (EMRs) to drive ambulances instead of EMTs. (See Section 1, subsections (1)(a), (2)(a), (3)(a), (4)(a), (5)(a), (6)(a)(1), (7)(a)(1), and (8)(a). Section 1(17) is also stricken because under the March 30, 2022 amendments and these amendments, EMRs may be assigned to drive ambulances instead of EMTs and, therefore, Section 1(17) is no longer necessary.) The amendments also waived the requirement that paramedics staff at least 25% of Class I and Class IV ALS ambulances. Under the March 30, 2022 amendments and these amendments, Class I ALS agencies must instead have a paramedic on-duty at all times and all Class IV ALS ambulances must be staffed with either an Advanced EMT or a paramedic. Modifications to the paramedic staffing requirements are necessary because, due to staffing shortages, it is difficult for some agencies – particularly smaller ones – to ensure that they have enough paramedics on-duty to staff 25% of their ambulances.
At a duly called meeting of the Board on April 14, 2022, Judge/Executive Houston Wells, on behalf of the Kentucky County Judge/Executive Association, requested that the Board extend the provision in the Board’s modification and waiver of 202 KAR 7:560 that allowed individuals who are certified in CPR and have completed an emergency vehicle operator’s course to drive ambulances. This request was approved by the Board. At a duly called special meeting of the Board on April 21, 2022, the Board approved this emergency amendment and its companion ordinary amendment. This emergency amendment differs from the emergency amendment filed on March 30, 2022, in that it allows individuals who are certified in CPR and have completed an emergency vehicle operator’s course to drive ambulances until September 1, 2022, after which ambulance drivers must be certified EMRs (as required under the March 30, 2022 emergency amendment). The modifications to the paramedic minimum staffing requirements for Class I and Class IV ALS agencies remain unchanged from the March 30, 2022 amendments.
Emergency medical services across the Commonwealth continue to experience staffing shortages. Therefore, a temporary extension of ambulances services’ ability to assign drivers who are CPR-certified and have completed an emergency vehicle operator’s course is critical to ensuring that agencies can adequately staff ambulances. This extension is intended to allow time for additional personnel to become certified EMRs by September 1, 2022. Additionally, the removal of the requirement that paramedics staff at least 25% of Class I and Class IV ALS ambulances is necessary to ensure that such agencies can satisfy the minimum ambulance staffing requirements and utilize all available ambulances. However, Class I ALS agencies are required to have at least one (1) paramedic on-duty at all times and all Class IV ALS ambulances must be staffed with either an Advanced EMT or a paramedic.
An ordinary administrative regulation is not sufficient to address current EMS staffing shortages, which pose an imminent threat to public health, safety, and welfare. This emergency amendment is necessary to modify the minimum staffing requirements for ambulances to ensure that agencies can utilize their available ambulances. This emergency administrative regulation will be replaced by an ordinary administrative regulation. The ordinary administrative regulation is not identical to this emergency administrative regulation. EMS staffing shortages are expected to continue and, therefore, under the ordinary administrative regulation, agencies will continue to be permitted to assign EMRs as ambulance drivers and Class I and Class IV ALS agencies will not be required to staff at least 25% of their ambulances with paramedics.
202 KAR 7:560E.Ground vehicle staff.
Section 1.
Staffing Requirements.(1)
Each Class I agency BLS ambulance shall at minimum, be staffed by:(a)
Until September 1, 2022, a driver certified in CPR who has had an emergency vehicle operator's course. On and after September 1, 2022, a driver certified as an emergency medical responder (EMR); and(b)
An attendant certified as an emergency medical technician (EMT).(2)
Each Class I agency ALS ambulance shall at minimum be staffed by:(a)
Until September 1, 2022, a driver certified in CPR who has had an emergency vehicle operator's course. On and after September 1, 2022, a driver certified as an emergency medical responder (EMR); and(b)
An attendant certified as an Advanced EMT or licensed as a paramedic.1.
Each Class I ALS agency providing primary 911 emergency ambulance service shall ensure that there is a paramedic on-duty at all times.2.
To ensure compliance, each agency shall maintain its work schedules from the previous twelve (12) months until reviewed by board staff during its annual inspection.(3)
Each Class I agency operating an ALS ambulance providing a BLS level of care shall at minimum be staffed by:(a)
Until September 1, 2022, a driver certified in CPR who has had an emergency vehicle operator's course. On and after September 1, 2022, a driver certified as an emergency medical responder (EMR); and(b)
An attendant certified as an emergency medical technician (EMT).(4)
Each Class II agency shall at minimum be staffed by:(a)
Until September 1, 2022, a driver certified in CPR who has had an emergency vehicle operator's course. On and after September 1, 2022, a driver certified as an emergency medical responder (EMR); and(b)
An attendant certified as an emergency medical technician (EMT).(5)
A Class III Adult Critical Care ambulance agency shall at minimum be staffed by:(a)
Until September 1, 2022, a driver certified in CPR who has had an emergency vehicle operator's course. On and after September 1, 2022, a driver certified as an emergency medical responder (EMR);(b)
An attendant licensed as a paramedic; and(c)
One (1) licensed:1.
Registered nurse;2.
Advanced practice registered nurse;3.
Respiratory therapist;4.
Physician assistant;5.
Physician; or6.
Additional paramedic.(6)
(a)
Each Class III Pediatric Specialty Care Ambulance Agency shall at minimum be staffed by:1.
Until September 1, 2022, a driver certified in CPR who has had an emergency vehicle operator's course. On and after September 1, 2022, a driver certified as an emergency medical responder (EMR);2.
A primary attendant licensed as a registered nurse; and3.
One (1) additional attendant licensed as a:a.
Registered nurse;b.
Advanced practice registered nurse;c.
Respiratory therapist;d.
Physician assistant;e.
Physician; orf.
Paramedic.(b)
Any attendant hired after January 1, 2020 shall acquire and maintain within one (1) year of hire, a specialty certification in Pediatric Critical Care or Neonatal Critical Care acquired through successful completion of a validated examination administered by an independent entity not associated with a specific course or program of education.(7)
(a)
Each Class III Neonatal Specialty Care Ambulance Agency shall at minimum be staffed by:1.
Until September 1, 2022, a driver certified in CPR who has had an emergency vehicle operator's course. On and after September 1, 2022, a driver certified as an emergency medical responder (EMR);2.
A primary attendant licensed as a registered nurse; and3.
One (1) additional attendant licensed as:a.
An advanced practice registered nurse;b.
A respiratory therapist;c.
A physician assistant;d.
A physician;e.
A registered nurse; orf.
Paramedic.(b)
Any attendant hired after January 1, 2020 shall acquire and maintain within one (1) year of hire, a specialty certification in Pediatric Critical Care or Neonatal Critical Care acquired through successful completion of a validated examination administered by an independent entity not associated with a specific course or program of education.(8)
Each Class IV agency operating a BLS ambulance shall at minimum be staffed by:(a)
Until September 1, 2022, a driver certified in CPR who has had an emergency vehicle operator's course. On and after September 1, 2022, a driver certified as an emergency medical responder (EMR); and(b)
An attendant certified as an emergency medical technician (EMT).(9)
Each Class IV service operating an ALS ambulance shall at minimum be staffed by:(a)
A driver certified as an emergency medical technician (EMT); and(b)
An attendant certified as an Advanced EMT or licensed as a paramedic.To ensure compliance, each agency shall maintain its work schedules from the previous twelve (12) months until reviewed by board staff during its annual inspection.(10)
Each Class VI BLS medical first response agency shall at minimum be staffed by a certified:(a)
Emergency medical responder (EMR); or(b)
Emergency medical technician (EMT).(11)
Each Class VI ALS medical first response agency shall at minimum be minimally staffed by:(a)
A certified Advanced EMT; or(b)
A licensed paramedic.(12)
Each Class VIII BLS agency shall be minimally staffed by a certified:(a)
Emergency medical responder (EMR); or(b)
Emergency medical technician (EMT).(13)
Each Class VIII ALS agency shall be minimally staffed by:(a)
A certified Advanced EMT; or(b)
A licensed paramedic.(14)
Each Class I ALS, Class III ACC, Class IV ALS, and Class VI ALS agency shall have a licensed paramedic on duty at all times.(15)
At all times, the attendant shall monitor the patient and remain with the patient in the patient compartment.(16)
This administrative regulation shall not prevent an agency from utilizing staff other than those required by this administrative regulation in:(a)
Disasters;(b)
Mass casualty incidents; or(c)
Extraordinary scene conditions that would impair the safety of the patient or personnel operating at the scene.(17)
Alternative staff shall not operate a licensed vehicle unless the:(a)
Agency administrator so directs; and(b)
Vehicle is out of service and not subject to an emergency response.Section 2.
Motor Vehicle Operator Requirements.(1)
Each person operating a vehicle shall:(a)
Be at least eighteen (18) years of age;(b)
Hold a valid driver's license in any state or territory of the United States; and(c)
Complete at least four (4) hours of driver training and education every two (2) years.(2)
The driver training and education shall consist of a:(a)
Review of driving a vehicle under emergency conditions;(b)
Review of KRS 189.910 through 189.950 regarding operation of emergency vehicles;(c)
Demonstration by the student of forward and back-up driving maneuvers in a controlled situation, such as in an obstacle course designed specifically for this purpose; and(d)
Review of defensive driving techniques and procedures with hands-on experience or exposure by visual aids or planned demonstrations.Section 3.
Public Notice of Negative Action. The board office shall cause to be published, on the KBEMS Web site or similar publication of the board, or otherwise disseminate, the name of any licensed agency that is fined, placed on probationary status, placed on restricted status, suspended, or had a license revoked.This emergency administrative regulation is being promulgated in order to meet an imminent threat to public health, safety, and welfare. Specifically, this emergency amendment is necessary to ensure adequate staffing of ambulances.
Senate Bill 150 (Regular Session 2020) (“SB 150”) granted the Kentucky Board of Emergency Medical Services (the “Board”) the authority to waive or modify certain statutes and regulations related to the EMS profession during the State of Emergency declared by the Governor in Executive Order 2020-215. See SB 150 § 1(13). On or about April 14, 2020, the Board filed an emergency waiver and modification of 202 KAR 7:560 with the Secretary of State. The waiver and modification waived (1) the requirement that paramedics staff at least 25% of Class I and Class IV Advanced Life Support (ALS) ambulances and (2) the requirement that ambulances be driven by emergency medical technicians (EMTs), providing instead that ambulances could be driven by “[a] driver certified in CPR and who has had an emergency vehicle operator’s course”. The Board’s modification and waiver of 202 KAR 7:560 was ratified and approved by the General Assembly until April 14, 2022. See House Joint Resolution 1 (Special Session 2021) § 4(29)(k); Senate Bill 25 (Regular Session 2022) § 4(27)(k).
On March 30, 2022, the Board filed emergency and ordinary amendments to 202 KAR 7:560 to allow emergency medical responders (EMRs) to drive ambulances instead of EMTs. (See Section 1, subsections (1)(a), (2)(a), (3)(a), (4)(a), (5)(a), (6)(a)(1), (7)(a)(1), and (8)(a). Section 1(17) is also stricken because under the March 30, 2022 amendments and these amendments, EMRs may be assigned to drive ambulances instead of EMTs and, therefore, Section 1(17) is no longer necessary.) The amendments also waived the requirement that paramedics staff at least 25% of Class I and Class IV ALS ambulances. Under the March 30, 2022 amendments and these amendments, Class I ALS agencies must instead have a paramedic on-duty at all times and all Class IV ALS ambulances must be staffed with either an Advanced EMT or a paramedic. Modifications to the paramedic staffing requirements are necessary because, due to staffing shortages, it is difficult for some agencies – particularly smaller ones – to ensure that they have enough paramedics on-duty to staff 25% of their ambulances.
At a duly called meeting of the Board on April 14, 2022, Judge/Executive Houston Wells, on behalf of the Kentucky County Judge/Executive Association, requested that the Board extend the provision in the Board’s modification and waiver of 202 KAR 7:560 that allowed individuals who are certified in CPR and have completed an emergency vehicle operator’s course to drive ambulances. This request was approved by the Board. At a duly called special meeting of the Board on April 21, 2022, the Board approved this emergency amendment and its companion ordinary amendment. This emergency amendment differs from the emergency amendment filed on March 30, 2022, in that it allows individuals who are certified in CPR and have completed an emergency vehicle operator’s course to drive ambulances until September 1, 2022, after which ambulance drivers must be certified EMRs (as required under the March 30, 2022 emergency amendment). The modifications to the paramedic minimum staffing requirements for Class I and Class IV ALS agencies remain unchanged from the March 30, 2022 amendments.
Emergency medical services across the Commonwealth continue to experience staffing shortages. Therefore, a temporary extension of ambulances services’ ability to assign drivers who are CPR-certified and have completed an emergency vehicle operator’s course is critical to ensuring that agencies can adequately staff ambulances. This extension is intended to allow time for additional personnel to become certified EMRs by September 1, 2022. Additionally, the removal of the requirement that paramedics staff at least 25% of Class I and Class IV ALS ambulances is necessary to ensure that such agencies can satisfy the minimum ambulance staffing requirements and utilize all available ambulances. However, Class I ALS agencies are required to have at least one (1) paramedic on-duty at all times and all Class IV ALS ambulances must be staffed with either an Advanced EMT or a paramedic.
An ordinary administrative regulation is not sufficient to address current EMS staffing shortages, which pose an imminent threat to public health, safety, and welfare. This emergency amendment is necessary to modify the minimum staffing requirements for ambulances to ensure that agencies can utilize their available ambulances. This emergency administrative regulation will be replaced by an ordinary administrative regulation. The ordinary administrative regulation is not identical to this emergency administrative regulation. EMS staffing shortages are expected to continue and, therefore, under the ordinary administrative regulation, agencies will continue to be permitted to assign EMRs as ambulance drivers and Class I and Class IV ALS agencies will not be required to staff at least 25% of their ambulances with paramedics.