Part II. EMS Agency, EMS Vehicle and EMS Personnel Standards

Regulation	Compliance Statement
PART II. EMS AGENCY, EMS VEHICLE AND EMS PERSONNEL STANDARDS.

Article 1. EMS Agency Licensure and Requirements.

12 VAC 5-31-300. Requirement for EMS agency licensure and EMS certification. No person may establish, operate, maintain, advertise or represent themselves or any service or organization as an EMS agency or as EMS personnel without a valid license or certification, or in violation of the terms of a valid license or certification, issued by the Office of EMS.	Each EMS agency applicant must apply for and maintain a valid EMS agency license from OEMS.
12 VAC 5-31-310. Provision of EMS within Virginia. A person providing EMS to a patient received within Virginia and transported to a location within Virginia shall comply with these regulations.	Refer to the definition of "Person" in the definitions. All EMS care originating in & completed in Virginia requires a VA EMS agency license. Refer to 12 VAC5 -31-190.6 and 12VAC5-31-290.C.
12 VAC 5-31-320. General applicability of the regulations. These regulations have general application throughout Virginia for an EMS agency and an applicant for EMS agency licensure.	These regulations apply to all EMS agencies & those applying to be one.
12 VAC 5-31-330. Compliance with regulations. A. A person shall comply with these regulations. The Office of EMS will publish the Virginia EMS Compliance Manual, a document that describes and provides guidance to EMS agencies, vehicles and personnel on how to comply with these regulations.	Each person is responsible for reviewing & following these regulations. This compliance manual serves as a guidance document for all EMS personnel, agencies, vehicles.
B. An EMS agency, including its EMS vehicles and EMS personnel, shall comply with these regulations, the applicable regulations of other state agencies, the Code of Virginia and the United States Code.	All EMS agencies and personnel, or those attempting to provide EMS care must follow all applicable regulations. You are responsible for knowing the regulations.
12 VAC 5-31-340. EMS agency name. A person may not apply to conduct business under a name that is the same as or misleadingly similar to the name of a person licensed or registered by the Office of EMS.	OEMS will approve the agency name. No changes in name of agency shall occur without proper approval of OEMS to verify name change is not already in use or similar to another licensed EMS agency.
12 VAC 5-31-350. Ability to pay. In the case of an emergency illness or injury, an EMS agency may not refuse to provide required services including dispatch, response, rescue, life support, emergency transport and interfacility transport based on the inability of the patient to provide means of payment for services rendered by the agency. An EMS agency's decision to refer or refuse to provide service must be based upon the "prudent layperson" standard for determination of the existence of a medical emergency as defined under "emergency services" in § 38.2-4300 of the Code of Virginia.	EMS agencies may not refuse emergency treatment and/or emergency transportation based on the patient’s ability to pay for such services. Decisions not to transport cannot be based solely on the inability of a person to pay.
12 VAC 5-31-360. Public access. An EMS agency shall provide for a publicly listed telephone number to receive calls for service from the public.	The phone number for a Designated Emergency Response Agency (911) must be available through sources such as directory assistance, local 411, telephone directory or other similar means to disseminate the public access number. A "live" answering service is compliant. Specified and approved EMS agencies with unique, pre-defined services must provide a public phone number for use by their unique population.
1. The number must be answered in person on a 24-hour basis.	Answering machines, automated phone systems, phone tree systems, automated answering system electronic versions of the same do not comply with these regulations.
2. Exception: An EMS agency that does not respond to calls from the public but responds only to calls from a unique population shall provide for a telephone number known to the unique population it serves. The number must be answered during all periods when that population may require service and at all other times must direct callers to the nearest available EMS agency.	Specified and approved EMS agencies with unique, pre-defined services must provide a public phone number for use by their unique population. Example: An EMS agency based in an industrial plant.
12 VAC 5-31-370. Designated emergency response agency. An EMS agency that responds to medical emergencies for its primary service area shall be a designated emergency response agency.	Refer to the definition of a Designated Emergency Response Agency (DERA). Local governments and EMS Agencies must define a specific geographical map indicating boundaries of their primary service area with specific definitions. A DERA is an agency that responds to emergency calls for service such as 911 agencies or any agency that has the primary EMS response for a specific, defined area.
12 VAC 5-31-380. EMS agency availability. An EMS agency shall provide service within its primary service area on a 24-hour continuous basis.
12 VAC 5-31-390. Destination/trauma triage. An EMS agency shall participate in the regional Trauma Triage Plan established in accordance with § 32.1-111.3 of the Code of Virginia.	Refer to the Trauma Triage Plan for your Regional EMS Council. Each EMS agency must participate.
12 VAC 5-31-400. Nondiscrimination. An EMS agency may not discriminate due to a patient's race, gender, creed, color, national origin, location, medical condition or any other reason.	Discriminating against any patient is not permitted.
12 VAC 5-31-410. EMS agency licensure classifications. An EMS agency license may be issued for any combination of the following classifications of EMS services:	Agencies may be licensed as either non-transport or transport agencies. Transport agencies may have transport vehicles, non-transport vehicles, neonatal units and/or air units.
1. Nontransport first response. a. Basic life support. b. Advanced life support. 2. Ground ambulance. a. Basic life support. b. Advanced life support. 3. Neonatal ambulance. 4. Air ambulance.	An EMS Agency applicant interested in providing EMS services must apply for an agency license through the application process before advertising or beginning services. An EMS agency license (inspection) must be obtained prior to beginning services. Forms are available by contacting OEMS or via the web page. Background checks, information verification and any other informational checks may be conducted by OEMS prior to issuing a license.
12 VAC 5-31-420. Application for EMS agency license. A. An applicant for EMS agency licensure shall file a written application specified by the Office of EMS.
B. The Office of EMS may use whatever means of investigation necessary to verify any or all information contained in the application.	Background checks, information verification and any other means necessary may be used to determine suitability for licensure. See the Personnel Requirements section of these regulations for further information. Agency will provide OEMS a written list of owners, officers, directors or any other title given to leadership within the agency during the application or renewal process.
C. An ordinance or resolution from the governing body of each locality where the agency maintains an office, stations an EMS vehicle for response within a locality or is a Designated Emergency Response Agency as required by § 15.2-955 of the Code of Virginia confirming approval. This ordinance or resolution must specify the geographic boundaries of the agency's primary service area within the locality.	12VAC5-31-420.C. The local governing body approval via ordinance or resolution will be permitted if it is by the local governing official or forum appointed by the local governing official. Agencies will maintain a written copy of a resolution or ordinance defining their local government’s approval, which will indicate the primary service area for the applicant agency or renewing agency.
D. The Office of EMS will determine whether an applicant or licensee is qualified for licensure based upon the following: 1. An applicant or licensee must meet the personnel requirements of these regulations. 2. If the applicant is a company or corporation, as defined in § 12.1-1 of the Code of Virginia, it must clearly disclose the identity of its owners, officers and directors. 3. An applicant or licensee must provide information on any previous record of performance in the provision of emergency medical service or any other related licensure, registration, certification or endorsement within or outside Virginia.	Background checks, information verification and previous history of service/compliance may be verified by OEMS.
E. An applicant agency and all places of operation shall be subject to inspection by the Office of EMS for compliance with these regulations. The inspection may include any or all of the following:	Inspections may occur at any place of operation, at any time of the hours of operation listed for each agency. No prior notification is required by OEMS to conduct such inspections. Each agency shall ensure that all personnel are aware of this regulation. This includes all places where the records for such facilities are stored. (Billing records, PPCR storage, etc.)
1. All fixed places of operations, including all offices, stations, repair shops or training facilities.
2. All applicable records maintained by the applicant agency.	All records pertaining to the EMS operations must be maintained by the licensed agency, other designated agency, company/organization and produced as requested by the Office of EMS.
3. All EMS vehicles and required equipment used by the applicant agency.
12 VAC 5-31-430. Issuance of an EMS agency license. A. An EMS agency license may be issued by the Office of EMS provided the following conditions are met:	The agency must provide off site records (such as billing records kept at another facility) with 24 hours to OEMS. Other records maintained on site by the agency must be produced when requested immediately. All vehicles & equipment shall be available for inspection by OEMS. All licenses will be issued in writing by OEMS. Agencies may not sell, transfer, share, trade, will, gift or lease their license to any other organization. Licenses will be surrendered to OEMS when requested, when agency closes the business, during compliance matters when revocation occurs. Refer to 12VAC5-31-480.
1. All information contained in the application is complete and correct; and	Any missing information from the application may delay processing or denial of the application.
2. The applicant is determined by the Office of EMS to be eligible for licensure in accordance with these regulations.	The Office of EMS may conduct background checks, information verifications and any other means to verify information submitted.
B. The issuance of a license hereunder may not be construed to authorize any agency to operate any emergency medical services vehicle without a franchise or permit in any county or municipality which has enacted an ordinance pursuant to §32.1-111.14 of the Code of Virginia making it unlawful to do so.
C. An EMS agency license may include the following information: 1. The name and address of the EMS agency; 2. The expiration date of the license; 3. The types of services for which the EMS agency is licensed; and 4. Any special conditions that may apply.	If any special conditions exist, those conditions will be defined on the agency license.
D. An EMS agency license will be issued and remain valid with the following conditions: 1. An EMS agency license is valid for a period of no longer than two years from the last day of the month of issuance unless and until revoked or suspended by the Office of EMS.	Licenses will be issued in writing. All applicants and renewal applicants shall verify, every 2 years, prior to application, the localities ordinances and laws prior to the issuance of a license. All items contained within the application of the license must be complete & compliant with all regulations in order for issuance of the license. Licenses are valid for up to a two-year period, valid until the last day of the month issued unless suspended, revoked or voluntarily surrendered.
2. An EMS agency license is not transferable.	If an EMS Agency changes ownership or consolidates with another agency the EMS Agency license is void.
3. An EMS agency license issued by the Office of EMS remains the property of the Office of EMS and may not be altered or destroyed.
12 VAC 5-31-440. Display of EMS agency license. An EMS agency license is publicly displayed in the headquarters of the EMS agency and a copy displayed in each place of operations.	License must be displayed in a location where it can be viewed by the public. Each station or additional place of operations will also display a copy in a location for public viewing.
12 VAC 5-31-450. EMS agency licensure renewal. A. An EMS agency license renewal may be granted following an inspection as set forth in these regulations based on the following conditions:	Definition of renewal process includes a licensure packet, inspection schedule and inspection procedures available upon request from OEMS.
1. The renewal inspection results demonstrate that the EMS agency complies with these regulations.
2. There have been no documented violations of these regulations that preclude a renewal.
B. If the Office of EMS is unable to take action on a renewal application of a license before expiration, the license remains in full force and effect until the Office of EMS completes processing of a renewal application.
12 VAC 5-31-460. Denial of an EMS agency license. An application for a new EMS agency license or renewal of an EMS agency license may be denied by the Office of EMS if the applicant or agency does not comply with these regulations.	All regulations, Code of VA & all other applicable laws and regulations must be in compliance before a license will be issued.
12 VAC 5-31-470. Modification of an EMS agency license. A. Any change in the classifications of the EMS vehicles or medical equipment packages permitted to an EMS agency or in any of the conditions that may apply to the EMS agency requires the notification of the Office of EMS and the modification of the EMS agency license.	Notify OEMS in writing at least 15 calendar days before the modification will be needed. The modification of the license will be processed by the area Program Representative in a timely manner. Incomplete modification requests will not be processed.
B. The procedure for modification of a license is as follows: 1. The licensee shall request the modifications in writing on a form prescribed by the Office of EMS.	Form for Modification of a license may be requested from OEMS or downloaded from the web site. Modification requests must specify the changes desired.
2. The Office of EMS may use the full provisions of these regulations in processing a request as an application.	Background checks, information verification and suitability checks may be performed prior to any license modification. The modified license will replace the previous EMS license. § 12VAC5-31-1230 addresses staffing/ personnel requirements that may require licensure modifications.
3. Upon receiving a modified license, an EMS agency shall return the original license to the Office of EMS within 15 days and destroy all copies.
4. The issuance of a modified license hereunder may not be construed to authorize an EMS agency to provide emergency medical services or to operate an EMS vehicle without a franchise in any county or municipality that has enacted an ordinance requiring it.	All applicants for modification of a license must verify and demonstrate compliance with local ordinances and laws in that locality prior to the application for a modification. This also includes local government approval. This must be documented in writing by the applicant agency.
C. A request for modification of an EMS agency license may be denied by the Office of EMS if the applicant or agency does not comply with these regulations.
12 VAC 5-31-480. Termination of EMS agency licensure. A. An EMS agency terminating service shall surrender the EMS agency license to the Office of EMS.	Written documentation addressing each item listed will be submitted to OEMS verifying completion of the agency license termination process. Copy supplied to OEMS for documentation.
B. An EMS agency terminating service shall submit written notice to the Office of EMS at least 90 days in advance. Written notice of intent to terminate service must verify the following:
1. Notification of the applicable OMDs, regional EMS councils or local EMS resource agencies, PSAPs and governing bodies of each locality served.	Written notice must indicate how the OMD, Regional Council, PSAP & governing board were notified and when. Copies of these documents will be submitted to OEMS. Failure to do so will affect suitability for EMS agency licensure in the future.
2. Termination of all existing contracts for EMS services, Mutual Aid Agreements, or both.
3. Advertised notice of its intent to discontinue service has been published in a newspaper of general circulation in its service area.
C. Within 30 days following the termination of service, the EMS agency shall provide written verification to the Office of EMS of the following:
1. The return of its EMS agency license and all associated vehicle permits to the Office of EMS.
2. The removal of all signage or insignia that advertise the availability of EMS to include but not be limited to facility and roadway signs, vehicle markings and uniform items.
3. The return of all medication kits that are part of a local or regional medication exchange program or provision for the proper disposition of medications maintained under a Board of Pharmacy controlled substance registration.	Documented by a receipt of return of all medication equipment and related items. This shall be documented in writing.
4. The maintenance and secure storage of required agency records and prehospital patient care reports (PPCRs) for a minimum of five years from the date of termination of service.	A letter will be included to OEMS detailing where & how these records will be maintained, including contact information.
12 VAC 5-31-490. EMS agency insurance. A. An EMS agency shall have in effect and be able to furnish proof on demand of contracts for vehicular insurance as follows:
1. Insurance coverage for emergency vehicles shall meet or exceed the minimum requirements as set forth in §46.2-920 of the Code of Virginia.	See § 46.2-920 to this document for reference. (Attached)
2. Insurance coverage for nonemergency vehicles shall meet or exceed the minimum requirements as set forth in §46.2-472 of the Code of Virginia.	See § 46.2-472 to this document for reference. (Attached)
3. Insurance coverage for both classes of aircraft shall meet or exceed the minimum requirements as set forth in §5.1-88.2 of the Code of Virginia.	See § 5.1-88.2 to this document for reference. (Attached)
B. Nothing in this section prohibits an authorized governmental agency from participating in an authorized "self-insurance" program as long as the program provides for the minimum coverage levels specified in this section.	Self insured documents must be available for review & must contain the minimum coverage requirements in order to meet this regulation.
12 VAC 5-31-500. Place of operations. A. An EMS agency shall maintain a fixed physical location. Any change in the address of this location requires notification to the Office of EMS before relocation of the office space.	Directions to all EMS Agency facilities must be provided to OEMS upon request. Refer § 12VAC5-31-420.E.
B. Adequate, clean and enclosed storage space for linens, equipment and supplies shall be provided at each place of operation.
C. The following sanitation measures are required at each place of operation in accordance with standards established by the Centers for Disease Control and Prevention (CDC) and the Virginia occupational safety and health laws (Title 40.1-1 of the Code of Virginia):
1. All areas used for storage of equipment and supplies shall be kept neat, clean, and sanitary.
2. All soiled supplies and used disposable items shall be stored or disposed of in plastic bags, covered containers or compartments provided for this purpose. Regulated waste shall be stored in a red or orange bag or container clearly marked with a biohazard label.
12 VAC 5-31-510. Equipment and supplies. A. An EMS agency shall hold the permit to an EMS vehicle or have a written agreement for the access to and use of an EMS vehicle. An EMS agency that does not use an EMS vehicle shall maintain the required equipment and supplies for a nontransport response vehicle.	This requirement may be accomplished by written agreement with another agency.
B. Adequate stocks of supplies and linens shall be maintained as required for the classes of vehicles in service at each place of operations. An EMS agency shall maintain a supply of at least 75 triage tags of a design approved by the Office of EMS. These tags must be maintained in a location readily accessible by all agency personnel.	Cache of supplies and equipment must be maintained by the EMS agency. 75 Triage tags must be accessible by all agency personnel.
12 VAC 5-31-520. Storage and security of medications and related supplies. A. An area used for storage of medications and administration devices and a medication kit used on an EMS vehicle shall comply with requirements established by the Virginia Board of Pharmacy and the applicable drug manufacturer's recommendations for climate-controlled storage.	This section relates to medications and devices maintained at the agency location.
B. Medications and medication kits shall be maintained within their expiration date at all times.	All expired items will be removed from service at time of expiration. Medications found to be in violation will be directed to be exchanged and the exchanging facility will be required to be notified of the circumstances requiring exchange at the time of exchange.
C. Medications and medication kits shall be removed from vehicles and stored in a properly maintained and locked secure area when the vehicle is not in use unless the ambient temperature of the vehicle's interior medication storage compartment is maintained within the climate requirements specified in this section.	Refer to each drug’s storage temperature as defined and published. A thermometer may be used to verify appropriate temperatures are being maintained for drug storage.
D. An EMS agency shall notify the Office of EMS in writing of any diversion of (i.e., loss or theft) or tampering with any controlled substances, medication delivery devices or other regulated medical devices from an agency facility or vehicle. Notification shall be made within 15 days of the discovery of the occurrence.	Written documentation on the prescribed form, available from the web site, will be submitted to OEMS of any loss, theft or diversion of drugs and or regulated medical equipment. Regional Councils are also obligated to report the same when made aware.
E. An EMS agency shall protect EMS vehicle contents from climate extremes.
12 VAC 5-31-530. Preparation and maintenance of records and reports. An EMS agency is responsible for the preparation and maintenance of records that shall be available for inspection by the Office of EMS as follows:	Records may be inspected by OEMS at any time without prior knowledge in order to ensure compliance with these regulations. Each agency must ensure that all personnel employed by them understand this regulation and comply.
1. Records and reports shall be stored in a manner to ensure reasonable safety from water and fire damage and from unauthorized disclosure to persons other than those authorized by law.
2. EMS agency records shall be prepared and securely maintained at the principal place of operations or a secured storage facility for a period of not less than five years.	Secure record keeping (lock & key or similar device) must be demonstrated when requested by OEMS. Subject to inspection at any time for compliance with these regulations. Records will be in paper version. Electronic storage of patient care records are permitted under the following conditions: 1) the records are easily retrievable and producible for immediate paper copy, 2) there is a back-up run for the electronic storage of records on a regular basis, and 3) records are protected from unauthorized disclosure to persons and access to these records is password protected.
12 VAC 5-31-540. Personnel records. A. An EMS agency shall have a current personnel record for each individual affiliated with the EMS agency. Each file shall contain documentation of certification (copy of EMS certification, healthcare provider license or EVOC, or both), training and qualifications for the positions held.	Paper copies must be maintained in a single file for OEMS inspection. Copies of VIRGINIA EMS certification and a VIRGINIA health care provider license must be current at all times to be in compliance with these regulations. EVOC documentation must be included.
B. An EMS agency shall have a record for each individual affiliated with the EMS agency documenting the results of a criminal history background check conducted through the Central Criminal Records Exchange operated by the Virginia State Police no more than 60 days prior to the individual's affiliation with the EMS agency.	Notation in the file of completion of this process must be documented. To comply, the agency needs to supply documentation that a criminal history check was performed.
12 VAC 5-31-550. EMS vehicle records. An EMS agency shall have records for each vehicle currently in use to include maintenance reports demonstrating adherence to manufacturer's recommendations for preventive maintenance, valid vehicle registration, safety inspection, vehicle insurance coverage and any reportable motor vehicle collision as defined by the Motor Vehicle Code (Title 46.2 of the Code of Virginia).	Records must be available for inspection by OEMS during hours of operation for each EMS agency. All items listed in this regulation must be contained in each vehicle file.
12 VAC 5-31-560. Patient care records. A. An original prehospital patient care report (PPCR) shall specifically identify by name the personnel who meet the staffing requirements of the EMS vehicle.	Shall be legible & in ink. See attached § 32.1-116.1. PPDR reporting may be via electronic submission or via paper PPDR reporting forms. All forms and electronic programs are available from OEMS.
B. The PPCR shall include the name and identification number of all EMS Personnel on the EMS vehicle and the signature of the Attendant-In Charge.	Attendant in charge must sign the PPCR. Signature must be legible. All other persons staffing the unit must be identified by name and identification number.
C. The required minimum data set shall be submitted on a schedule established by the Office of EMS as authorized in §32.1-116.1 of the Code of Virginia. This requirement for data collection and submission shall not apply to patient care rendered during local emergencies declared by the locality's government and states of emergency declared by the Governor. During such an incident, an approved triage tag shall be used to document patient care provided unless a standard patient care report is completed.
12 VAC 5-31-570. EMS Agency Status Report. A. An EMS agency must submit an "EMS Agency Status Report" to the Office of EMS within 30 days of a request or change in status of the following:	This information must be submitted to the Office of EMS via written correspondence within thirty (30) days of the change in any of the following listed members. If one person from any agency performs all of these functions, it shall be so noted by the agency. The Office will develop an electronic reporting mechanism allowing agencies to report required information on-line.
1. Chief executive officer. 2. Chief of operations. 3. Training officer 4. Designated infection control officer. 5. Other information as required.
B. The EMS agency shall provide the leadership position held, to include title, term of office, mailing address, home and work telephone numbers and other available electronic addresses for each individual.	This information must be submitted to the Office of EMS via written correspondence within thirty (30) days of the change in any of the following listed members. If one person from any agency performs all of these functions, it shall be so noted by the agency. The Office will develop an electronic reporting mechanism allowing agencies to report required information on-line.
12 VAC 5-31-580. Availability of these regulations. An EMS agency shall have readily available at each station a current copy of these regulations for reference use by its officers and personnel.	A paper or electronic version of these regulations shall be made available for all EMS personnel of each agency & shall not be restricted in use. All EMS personnel are responsible for knowledge of all applicable EMS regulations and laws. Posting of these regulations in each place of operation satisfies this requirement.
12 VAC 5-31-590. Operational Medical Director requirement. A. An EMS agency shall have a minimum of one operational medical director (OMD) who is a licensed physician holding endorsement as an EMS physician from the Office of EMS.	Refer to the OMD requirements section of these regulations for further guidance.
An EMS agency shall enter into a written agreement with an EMS physician to serve as OMD with the EMS agency. This agreement shall at a minimum specify the following responsibilities and authority:	Written documentation of this agreement must be provided to the Office during application or renewal of an EMS agency license.
1. This agreement must describe the process or procedure by which the OMD or EMS agency may discontinue the agreement with prior notification of the parties involved in accordance with these regulations.
2. This agreement must identify the specific responsibilities of each EMS physician if an EMS agency has multiple OMDs.	Each agency will maintain a copy of the OMD/agency agreement outlining the specific requirements as required by these regulations.
3. This agreement must specify that EMS agency personnel may only provide emergency medical care and participate in associated training programs while acting under the authority of the operational medical director's license and within the scope of the EMS agency license in accordance with these regulations.
4. This agreement must provide for EMS agency personnel to have direct access to the agency OMD in regards to discussion of issues relating to provision of patient care, application of patient care protocols or operation of EMS equipment used by the EMS agency.
5. This agreement must ensure that the adequate indemnification exists for: a. Medical malpractice; and b. Civil liability.
B. EMS agency and OMD conflict resolution. In the event of an unresolved conflict between an EMS agency and its OMD, the issues involved shall be brought before the regional EMS council or local EMS resource's medical direction committee (or approved equivalent) for review and resolution. When an EMS agency determines that the OMD presents an immediate significant risk to the public safety or health of citizens, the EMS agency shall attempt to resolve the issues in question. If an immediate risk remains unresolved, the EMS agency shall contact the Office of EMS for assistance.
C. Change of operational medical director.
1. An EMS agency choosing to secure the services of another OMD shall provide a minimum of 30 days advance written notice of intent to the current OMD and the Office of EMS.
2. An OMD choosing to resign shall provide the EMS agency and the Office of EMS with a minimum of 30 days written notice of such intent.
3. When extenuating circumstances require an immediate change of an EMS agency's OMD (e.g., death, critical illness, etc.), the Office of EMS shall be notified by the OMD within one business day so that a qualified replacement may be approved. In the event that the OMD is not capable of making this notification, the EMS agency shall be responsible for compliance with this requirement. Under these extenuating circumstances, the Office of EMS will make a determination whether the EMS agency will be allowed to continue its operations pending the approval of a permanent or temporary replacement OMD.
4. When temporary circumstances require a short-term change of an EMS agency's OMD for a period not expected to exceed one year (e.g., military commitment, unexpected clinical conflict, etc.), the Office of EMS shall be notified by the OMD within 15 days so that a qualified replacement may be approved.
5. The Office of EMS may delay implementation of a change in an EMS agency's OMD pending the completion of any investigation of an unresolved conflict or possible violation of these regulations or the Code of Virginia.
12 VAC 5-31-600. Quality management reporting. An EMS agency shall have an ongoing Quality Management (QM) Program designed to objectively, systematically and continuously monitor, assess and improve the quality and appropriateness of patient care provided by the agency. The QM Program shall be integrated and include activities related to patient care, communications, and all aspects of transport operations and equipment maintenance pertinent to the agency's mission. The agency shall maintain a QM report that documents quarterly PPCR reviews, supervised by the operational medical director.	The regional EMS council plan will satisfy this as long as the specified items listed in this regulation are verified and written report maintained by each agency.
12 VAC 5-31-610. Reserved.
12 VAC 5-31-620. Reserved.
12 VAC 5-31-630. Designated emergency response agency mutual aid.
A. A designated emergency response agency shall provide aid to all other designated emergency response agencies within the locality.	Such aid shall be defined by the local written plan. This plan must include radio communication details per § 12VAC5-31-760. Example: All DERAs in Amherst County must provide mutual aid to other Amherst County DERAs.
B. A designated emergency response agency shall maintain written mutual aid agreements with adjacent designated emergency response agencies in another locality with which it shares a common border. Mutual aid agreement(s) shall specify the types of assistance to be provided and any condition(s) or limitation(s) for providing this assistance.	Copies of written mutual aid agreements or memorandums of understanding addressing the EMS needs of the locality shall be written and available for inspection by OEMS. A DERA must have written mutual aid agreements with all other DERAs sharing a common response area/border.

Article 2. Emergency Medical Services Vehicle Permit.

12 VAC 5-31-640. EMS vehicle permit requirement.
A. A person may not operate or maintain any motor vehicle, vessel or craft as an EMS vehicle without a valid permit or in violation of the terms of a valid permit.	Any vehicle used to deliver emergency care must be permitted. See attached § 32.1-111.1
B. An EMS agency shall file written application for a permit on forms specified by the Office of EMS.	Only current forms in use by the Office will be accepted. Forms are available from the Office website or by contacting OEMS.
C. The Office of EMS may verify any or all information contained in the application before issuance.	Background checks, information verification and suitability may be verified prior to issuance of a permit.
D. The Office of EMS shall inspect the EMS vehicle for compliance with the vehicle requirements for the class in which a permit is sought.
E. An EMS vehicle permit may be issued provided all of the following conditions are met:
1. All information contained in the application is complete and correct.
2. The applicant is an EMS agency.
3. The EMS vehicle is registered or permitted by the Department of Motor Vehicles or approved equivalent.
4. The inspection meets the minimum requirements as defined in these regulations.	All required items for inspection shall be on the vehicle at the time the permit is requested.
5. The issuance of an EMS vehicle permit does not authorize any person to operate an EMS vehicle without a franchise or permit in any county or municipality that has enacted an ordinance requiring one.
F. An EMS vehicle permit may include but is not be limited to the following information: 1. The name and address of the agency. 2. The expiration date of the permit. 3. The classification and type of the EMS vehicle. 4. The motor vehicle license plate number of the vehicle. 5. Any special conditions that may apply.
G. An EMS vehicle permit may be issued and remain valid with the following conditions: 1. An EMS vehicle permit remains the property of the Office of EMS and may not be altered or destroyed. 2. An EMS vehicle permit is valid only as long as the EMS agency license is valid. 3. An EMS vehicle permit is not transferable. 4. An EMS agency must equip an EMS vehicle in compliance with these regulations at all times unless the vehicle is permitted as "reserved." A designated emergency response Agency may be issued a "reserved" permit by the Office of EMS.	Permits are not transferable under any terms. Permits must be returned to the Office should the agency or vehicle no longer be in operation. 1. A “RESERVE EMS VEHICLE” permit may be issued to fleet vehicles of a licensed EMS agency intended to be used as a mechanical reserve. A mechanical reserve is intended to replace a front-line permitted vehicle when it goes out of service for repairs or routine maintenance. When the front-line vehicle is repaired or returned to service, the mechanical reserve vehicle shall go back into reserve status. 2. A vehicle permitted as a reserve must have the following capability: a. Communication (radio) capability as outlined in 12 VAC 5-31-760 3. Prior to placing a reserve vehicle in service and available to respond to EMS calls, all applicable sections as specified under 12 VAC 5-31 Part 2 of the EMS Regulations for EMS Agency, Vehicle and Personnel standards must be met.
12 VAC 5-31-650. Temporary EMS vehicle permit.
A. A temporary EMS vehicle permit may be issued for a permanent replacement or additional EMS vehicle pending inspection. A temporary EMS vehicle permit will not be issued for a vehicle requesting a "reserved" permit.
B. An EMS agency shall file written application for a temporary permit on forms specified by the Office of EMS. Submission of this application requires the EMS agency to attest that the vehicle complies with these regulations.	Requests for temporary permits will be made on the current form provided by OEMS. Forms are available on the web site or by contacting OEMS.
C. The Office of EMS may verify any or all information contained in the application before issuance.	Information verification and background checks may be verified before issuing any permits.
D. The procedure for issuance of a temporary EMS vehicle permit is as follows:
1. An EMS agency requesting a temporary permit shall submit a completed application for an EMS vehicle permit attesting that the vehicle complies with these regulations.
2. The Office of EMS may inspect an EMS vehicle issued a temporary permit at any time for compliance with these regulations and issuance of an EMS vehicle permit.	Inspection may occur at any time and may or may not be scheduled.
E. A temporary EMS vehicle permit may include but not be limited to the following information: 1. The name and address of the EMS agency. 2. The expiration date of the EMS vehicle permit. 3. The classification and type of the EMS vehicle. 4. The motor vehicle license plate number of the vehicle. 5. Any special conditions that may apply.
F. A temporary EMS vehicle permit will be issued and remain valid with the following conditions: 1. A temporary EMS vehicle permit is valid for 60 days from the end of the month issued. 2. A temporary EMS vehicle permit is not transferable. 3. A temporary EMS vehicle permit is not renewable. 4. A temporary EMS vehicle permit shall be affixed on the vehicle to be readily visible and in a location and manner specified by the Office of EMS. An EMS vehicle may not be operated without a properly displayed permit.
12 VAC 5-31-660. Denial of an EMS vehicle permit. A. An application for an EMS vehicle permit shall be denied by the Office of EMS if any conditions of these regulations fail to be met.
B. The Office of EMS will notify the applicant or licensee of the denial in writing in the event that a permit is denied.
12 VAC 5-31-670. Display of EMS vehicle permit.
A. An EMS vehicle permit shall be affixed on the EMS vehicle, readily visible, and in a location and manner specified by the Office of EMS.
B. An EMS vehicle may not be operated without a properly displayed EMS vehicle permit.
12 VAC 5-31-680. EMS vehicle advertising. An EMS vehicle may not be marked or lettered to indicate a level of care or type of service other than that for which it is permitted.
12 VAC 5-31-690. Renewal of an EMS vehicle permit. A. Renewal of an EMS vehicle permit may be granted following an inspection if the EMS agency and EMS vehicle comply with these regulations.
B. If the Office of EMS is unable to take action on renewal of an EMS vehicle permit before expiration, the permit will remain in effect until the Office of EMS completes processing of the renewal inspection.	If the Office is unable to inspect the vehicle before its permit expiration, the vehicle remains permitted until an inspection takes place.

Article 3. Emergency Medical Services Vehicle Classifications and Requirements.

12 VAC 5-31-700. EMS vehicle safety.
An EMS vehicle shall be maintained in good repair and safe operating condition and shall meet the same motor vehicle, vessel or aircraft safety requirements as apply to all vehicles, vessels or craft in Virginia:
1. Virginia motor vehicle safety inspection, FAA Airworthiness Permit or Coast Guard Safety Inspection or approved equivalent must be current.	Valid inspection sticker shall be displayed. Valid FAA airworthiness permit shall be displayed. Coast Guard Safety Inspection sticker shall be displayed. Other current & approved equivalent as defined by OEMS.
2. Exterior surfaces of the vehicle including windows, mirrors, warning devices and lights shall be kept clean of dirt and debris.	All windows and mirrors shall be intact and free from cracks or breaks. All warning devices shall be operable.
3. Ground vehicle operating weight shall be no more than the manufacturer's gross vehicle weight (GVW) minus 700 pounds (316 kg).	Gross vehicle weight restrictions can be found on the inside area of the driver’s door. This weight, minus 700 pounds, shall be verified if by an approved means of vehicle weights as defined by law. The vehicle must be weighed while fully equipped and fueled - no staff or patient. The Office of EMS may request a weight verification of the fully stocked and fueled vehicle before issuing a permit to any vehicle. An EMS agency must submit weight verification to the Office before issuance of a temporary permit.
4. Emergency operating privileges including the use of audible and visible emergency warning devices shall be exercised in compliance with the Code of Virginia and local motor vehicle ordinances.
5. Smoking is prohibited in an EMS transport vehicle at all times.	No smoking in any EMS transport vehicle at any time, including when not occupied by a patient
12 VAC 5-31-710. EMS vehicle occupant safety.
A. An occupant shall use mechanical restraints as required by the Code of Virginia.	The Office of EMS strongly recommends the use of seat belts at all times.
B. Equipment and supplies in the patient compartment shall be stored within a closed and latched compartment or fixed securely in place while not in use.	No equipment, supplies or other items shall be loose in the patient compartment while not in use. The clipboard and other items should be secure by straps or other means to prevent them from becoming "missiles". Securing equipment on the identified seating areas with a seat belt shall meet this requirement.
C. While the vehicle is in motion, equipment and supplies at or above the level of the patient's head while supine on the primary ambulance stretcher shall be secured in place to prevent movement.	All items at or above the level of the head of the patient while supine on the stretcher shall be secured to prevent all movement.
12 VAC 5-31-720. EMS vehicle sanitation. The following requirements for sanitary conditions and supplies apply to an EMS vehicle in accordance with standards established by the Centers for Disease Control and Prevention (CDC) and the Virginia Occupational Safety and Health Law:
1. The interior of an EMS vehicle, including storage areas, linens, equipment, and supplies shall be kept clean and sanitary.
2. Linen or disposable sheets and pillowcases or their equivalent used in the transport of patients shall be changed after each use.
3. Blankets, pillows and mattresses used in an EMS vehicle shall be intact and kept clean and in good repair.	No holes, rips or tears shall be found in these items.
4. A device inserted into the patient's nose or mouth that is single-use shall be disposed of after use. A reusable item shall be sterilized or high-level disinfected according to current CDC guidelines before reuse. If not individually wrapped, this item shall be stored in a separate closed container or bag.
5. A used sharp item shall be disposed of in a leak proof, puncture-resistant and appropriately marked biohazard container (needle-safe device/sharps box) that is securely mounted.	Sharps boxes in vehicles shall be mounted to prevent movement while the vehicle is in motion.
6. Following patient treatment/transport within the vehicle and before being occupied by another patient:
a. Contaminated surfaces shall be cleaned and disinfected using a method recommended by the Centers for Disease Control and Prevention.
b. All soiled supplies and used disposable items shall be stored or disposed of in plastic bags, covered containers or compartments provided for this purpose. Regulated waste shall be stored in a red or orange bag or container clearly marked with a biohazard label.	EMS agencies are responsible for proper disposal of biohazardous waste used at emergency scenes.
12 VAC 5-31-730. Reserved.
12 VAC 5-31-740. EMS vehicle inspection.
A. An EMS vehicle is subject to, and shall be available for, inspection by the Office of EMS or its designee, for compliance with these regulations. An inspection may be in addition to other federal, state or local inspections required for the EMS vehicle by law.
B. The Office of EMS may conduct an inspection at any time without prior notification.	Spot inspections of vehicles may occur without prior notice. Agencies should make all personnel aware of this regulation to prevent the possibility of enforcement action should agency personnel not comply.
12 VAC 5-31-750. EMS vehicle warning lights and devices.
An EMS vehicle shall have emergency warning lights and audible devices as approved by the Superintendent of Virginia State Police, Virginia Department of Game and Inland Fisheries or the Federal Aviation Administration (FAA) as applicable.
1. A Ground EMS vehicle shall have flashing or blinking lights installed to provide adequate visible warning from all four sides.	All warning lights and audible devices shall be operable.
2. A Ground EMS vehicle shall have flashing or blinking red or red and white lights installed on or above the front bumper and below the bottom of the windshield.	Two single red lights or two red/white lights with "split" lenses.
3. An EMS vehicle shall have an audible warning device installed to project sound forward from the front of the EMS vehicle.	The siren must project to the front of the vehicle.
12 VAC 5-31-760. EMS vehicle communications.
A. An EMS vehicle shall have fixed communications equipment that provides direct two-way voice communications capabilities between the EMS vehicle, other EMS vehicles of the same agency, and either the agency's base of operations (dispatch point) or a governmental public safety answering point (PSAP). This communication capability must be available within the agency's primary service area or within a 25-mile radius of its base of operations, whichever is greater. Service may be provided by private land mobile radio service (PMRS) or by commercial mobile radio service (CMRS), but shall have direct and immediate communications via push-to-talk technology.	Standard radio communication is required. Cellular telephones do not replace the requirement for radio communications as defined in these regulations. "Nextel-type" or similar service complies with this regulation. Portable or fixed radio is acceptable.
B. An ambulance transporting outside its primary service area shall have fixed or portable communications equipment that provides two-way voice communications capabilities between the EMS vehicle and either the agency's base of operations (dispatch point) or a governmental public safety answering point (PSAP) during the period of transport. Service may be provided by private mobile radio service (PMRS) or by commercial mobile radio service (CMRS). When operating outside the agency's primary service area or a 25-mile radius of its base of operations, the requirement for direct and immediate communications via push-to-talk technology does not apply. This requirement does not apply in areas where CMRS is not available.
C. An ambulance or an advanced life support-equipped, nontransport response vehicle shall have communications equipment that provides two-way voice communications capabilities between the EMS vehicle's attendant-in-charge and the receiving medical facilities to which it regularly transports or a designated central medical control on one or more of the following frequencies:
155.340 MHz (statewide HEAR); 155.400 MHz (Tidewater HEAR); 155.280 MHZ (Inter-Hospital HEAR); 462.950/467.950 (MED 9 or CALL 1); 462.975/467.975 (MED 10 or CALL 2); 462.950-463.19375/467.950-468.19375 (UHF MED CHANNELS 1-103); and 220 MHz, 700MHz, 800MHz, or 900MHz frequency and designated talkgroup or channel identified as part of an agency, jurisdictional, or regional communications plan for ambulance to hospital communications.
1. Patient care communications with medical facilities may not be conducted on the same frequencies or talkgroups as those used for dispatch and on-scene operations.
2. Before establishing direct push-to-talk communications with the receiving medical facility or central medical control, EMS vehicles may be required to dial an access code. Radios in ambulances or advanced life support-equipped, nontransport response vehicles must be programmed or equipped with encoding equipment necessary to activate tone-coded squelched radios at medical facilities to which they transport on a regular basis.
3. Nothing herein prohibits the use of CMRS for primary or secondary communications with medical facilities, provided that the requirements of this section are met.
D. Mutual aid interoperability. An EMS vehicle must have fixed communications equipment that provides direct two-way voice communications capabilities between the EMS vehicle and EMS vehicles of other EMS agencies within the jurisdiction and those EMS agencies with which it has mutual aid agreements. Service may be provided by private mobile radio service (PMRS) or by commercial mobile radio service (CMRS), but requires direct and immediate communications via push-to-talk technology. This requirement may be met by interoperability on a common radio frequency or talkgroup, or by fixed or interactive cross-patching under supervision of an agency dispatch center or governmental PSAP. The means of communications interoperability must be identified in any mutual aid agreements required by these regulations.
E. Air ambulance interoperability. A nontransport EMS vehicle or ground ambulance must have fixed communications equipment that provides direct two-way voice communications capabilities between the EMS vehicle and air ambulances designated to serve its primary response area by the State Medevac Plan. An air ambulance must have fixed communications equipment that provides direct two-way voice communications capabilities between the air ambulance, other EMS vehicles in its primary response area, and public safety vehicles or personnel at landing zones on frequencies adopted in accordance with this section. Radio communications must be direct and immediate via push-to-talk technology. This requirement may be met by interoperability on a common radio frequency or talkgroup, or by fixed or interactive cross-patching under supervision of an agency dispatch center or governmental PSAP. The frequencies used for this purpose will be those set forth by an agreement among air ambulance providers and EMS agencies for a specific jurisdiction or region, and must be identified in agency, jurisdictional, or regional protocols for access and use of air ambulances. Any nontransport EMS vehicle or ground ambulance not participating in such an agreement must be capable of operating on VHF frequency 155.205 MHz (carrier squelch), which is designated as the Statewide EMS Mutual Aid Frequency. An air ambulance must be capable of operating on VHF frequency 155.205 MHz (carrier squelch) in addition to any other frequencies adopted for jurisdictional or regional interoperability.
F. FCC licensure. An EMS agency shall maintain appropriate FCC radio licensure for all radio equipment operated by the EMS agency. If the FCC radio license for any radio frequency utilized is held by another person, the EMS agency shall have written documentation on file of their assigned authority to operate on such frequencies.
G. In-vehicle communications. An ambulance shall have a means of voice communications (opening, intercom, or radio) between the patient compartment and operator's compartment.
12 VAC 5-31-770. Ground EMS vehicle markings.
A. The vehicle body of a nontransport response vehicle, a ground ambulance or a neonatal ambulance must be marked with a reflective horizontal band permanently affixed to the sides and rear of the vehicle body. This horizontal reflective band must be of a material approved for exterior use, a minimum of four inches continuous in height.
B. The Star of Life emblem may appear on an EMS vehicle that conforms to the appropriate U.S. Department of Transportation specifications for the type and class of vehicle concerned. If used on any ground ambulance or neonatal ambulance, the emblem (14-inch size minimum) must appear on both sides of the EMS vehicle.	Star of Life must be 14 inches size or larger.
C. The following must appear in permanently affixed lettering that is a minimum of three inches in height and of a color that contrasts with the surrounding vehicle background. Lettering must comply with the restrictions and specifications listed in these regulations.	Abbreviated names do not satisfy this requirement. Use of "FD", "RS" or "Dept." is acceptable.
1. Nontransport response vehicle. The name of the EMS agency that the vehicle is permitted to shall appear on both sides of the vehicle body in reflective lettering.	Permitted fire vehicles must display the name of the agency in 3" reflective lettering.
Exception: A designated emergency response agency must have the approval of the Office of EMS for a vehicle to display an alternate name.	The approval request must be submitted in writing requesting the change and the reason why. Approvals will be issued in writing by OEMS.
2. Ground ambulance:
a. The name of the EMS agency that the vehicle is permitted to must appear on both sides of the vehicle body in reflective lettering.	Abbreviated names do not satisfy this requirement. Use of "FD", "RS" or "Dept." is acceptable.
Exception: A designated emergency response agency must have the approval of the Office of EMS for a vehicle to display an alternate name.	The approval request must be submitted in writing requesting the change and the reason why. Approvals will be issued in writing by OEMS.
b. The word "AMBULANCE" in reverse on the vehicle hood or bug deflector.
c. The word "AMBULANCE" on or above rear doors.
3. Neonatal Ambulance:
a. The name of the EMS agency to which the vehicle is permitted must appear on both sides of the vehicle body in reflective lettering.	Abbreviated names do not satisfy this requirement. Use of "FD","RS" or "Dept." is acceptable.
b. "NEONATAL CARE UNIT" or other similar designation, approved by the Office of EMS, must appear on both sides of the vehicle body.
12 VAC 5-31-780. Air Ambulance markings.
A. On a primary air ambulance, the following must appear in permanently affixed lettering that is a minimum of three inches in height and of a color that contrasts with its surrounding background. Lettering must comply with the restrictions and specifications listed in these regulations.
1. The name of the EMS agency that the aircraft is permitted to must appear on both sides of the aircraft body. This lettering may appear as part of an organization logo or emblem as long as the agency name appears in letters of the required height.
Exception: A Designated Emergency Response Agency must have the approval of the Office of EMS for a vehicle to display an alternate name.	The approval request must be submitted in writing requesting the change and the reason why. Approvals will be issued in writing by OEMS.
2. Agency or FAA assigned unit/vehicle identification number must appear on both sides of the aircraft.	Abbreviated names do not satisfy this requirement. Use of "FD", "RS" or "Dept." is acceptable.
B. The Star of Life emblem may appear on an air ambulance. If used, the emblem (14-inch size minimum) shall appear on both sides, and/or front and rear of the air ambulance.
12 VAC 5-31-790. EMS vehicle letter restrictions and specifications.
A. The following specifications apply to an EMS vehicle: the EMS agency name must appear in lettering larger than any optional lettering on an EMS vehicle, other than "Ambulance," the unit identification number or any lettering on the roof. Optional lettering, logos or emblems may not appear on an EMS vehicle in a manner that interferes with the public's ability to readily identify the EMS agency to which the EMS vehicle is permitted.
1. Additional lettering, logos or emblems must not advertise or imply a specified patient care level (i.e., Advanced Life Support Unit) unless the EMS vehicle is so equipped at all times.	Advertising is acceptable as long as the size of the lettering used is not larger than the agency name and shall not interfere with the identification of the EMS vehicle. "ALS" must not be on vehicle unless that vehicle is equipped as ALS at all times.
2. The terms "Paramedic" or "Paramedical" may only be used when the EMS vehicle is both equipped and staffed by a state certified EMT-Paramedic at all times.	“Paramedic” and “Paramedical” may only be used on a vehicle if it is so equipped and staffed at all times of use. The use of other ALS personnel is not a substitute for this requirement.
B. A nontransport response vehicle with a primary purpose as a fire apparatus or law-enforcement vehicle is not required to comply with the specifications for vehicle marking and lettering, provided the vehicle is appropriately marked and lettered to identify it as an authorized emergency vehicle.	Fire department or other related staff vehicles must be marked as required by non-transport regulations in order to receive and maintain an EMS vehicle permit.
C. An unmarked vehicle operated by an EMS agency is not eligible for issuance of an EMS vehicle permit except a vehicle used and operated by law-enforcement personnel.
12 VAC 5-31-800. Nontransport response vehicle specifications.
A. A vehicle maintained and operated for response to the location of a medical emergency to provide immediate medical care at the basic or advanced life support level (excluding patient transport) shall be permitted as a nontransport response vehicle. A nontransport response vehicle may not be used for the transportation of patients except in the case of a major medical emergency. In such an event, the circumstances of the call shall be documented.	Vehicles must be maintained and permitted for response to calls for medical emergencies per these regulations. Mass casualty events/incidents may utilize non-transport vehicles if necessary but shall be so documented. Refer to §12VAC5-31-520.
B. A nontransport response vehicle must be constructed to provide sufficient space for safe storage of required equipment and supplies specified in these regulations. A nontransport response vehicle used for the delivery of advanced life support must have a locking storage compartment or approved locking bracket for the security of medications and medication kits. When not in use, medications and medication kits must be kept locked in the required storage compartment or approved bracket at all times. The EMS agency shall maintain medications and medication kits as specified in these regulations. 1.Sedan/zone car must have an approved locking device attached within the passenger compartment or trunk, inaccessible by the public. 2. Utility vehicle/van must have an approved locking device attached within the vehicle interior, inaccessible by the public. 3. Rescue vehicle/fire apparatus must have an approved locking device attached within the vehicle interior or a locked compartment, inaccessible by the public.	The vehicle’s trunk lock alone does not meet the requirements of these regulations. If a locked compartment is utilized, it shall remain locked at all times, even if it is carrying other EMS equipment. Keys for the locking mechanisms may be kept on the vehicle key ring or in a cabinet not immediately visible to the public.
C. A nontransport response vehicle must have a motor vehicle safety inspection performed following completion of conversion and before applying for an EMS vehicle permit.	A valid inspection sticker shall be posted in each vehicle for use.
12 VAC 5-31-810. Ground ambulance specifications.
A. A vehicle maintained and operated for response to the location of a medical emergency to provide immediate medical care at the basic or advanced life support level and for the transportation of patients shall be permitted as a ground ambulance.
B. A ground ambulance must be commercially constructed and certified to comply with the current federal specification for the Star of Life ambulance (U.S. General Services Administration KKK-A-1822 standards) as of the date of vehicle construction, with exceptions as specified in these regulations.	Such medications shall be available and unrestricted from use while a patient is in the ambulance.
C. A ground ambulance must be constructed to provide sufficient space for the safe storage of all required equipment and supplies.
1. A ground ambulance must have a locking interior storage compartment or approved locking bracket used for the secure storage of medications and medication kits that is accessible from within the patient compartment. Medications and medication kits must be kept in a locked storage compartment or approved bracket at all times when not in use. The EMS agency must maintain medications and medication kits as specified in these regulations.	Medications shall remain in a locked interior compartment or approved equivalent when not in use. Keys for the locking mechanisms may be kept on the vehicle key ring or in a cabinet not immediately visible to the public.
2. Required equipment and supplies specified in these regulations, excluding those in 12 VAC 5-31-860 I, J and K, must be available for access and use from inside the patient compartment.	Such medications shall be available and unrestricted from use while a patient is in the ambulance.
12 VAC 5-31-820. Advanced Life Support Equipment Package.
A. An EMS agency licensed to operate nontransport response vehicles or ground ambulances with ALS personnel shall maintain a minimum of one vehicle equipped with an ALS equipment package of the highest category licensed. ALS equipment packages consist of the following categories:	An EMS Agency licensed for ALS must maintain, at a minimum, one ALS equipment package and the personnel to utilize the ALS equipment.
1. ALS – EMT-enhanced equipment package; and	Refer to equipment chart.
2. ALS – EMT-intermediate/EMT-paramedic equipment package.	Refer to equipment chart.
B. ALS equipment packages shall consist of the equipment and supplies as specified in these regulations.	Refer to equipment chart.
12 VAC 5-31-830. Neonatal ambulance specifications.
A. A vehicle maintained and operated exclusively for the transport of neonatal patients between medical facilities shall be permitted as a neonatal ambulance. A neonatal ambulance shall not be used for response to out-of-hospital medical emergencies.	A neonatal ambulance must only transport neonates. A neonatal ambulance must not respond to general emergencies a sit is not required to carry equipment and personnel to handle general emergencies.
B. A neonatal ambulance must be commercially constructed and certified to comply with the current U.S. General Services Administration KKK-A-1822 standards as of the date of vehicle construction.
C. A neonatal ambulance must be constructed to provide sufficient space for safe storage of required equipment and supplies specified in these regulations.
1. A neonatal ambulance must be equipped to transport two incubators using manufacturer-approved vehicle mounting devices.
2. A neonatal ambulance must have an installed auxiliary power unit that is capable of supplying a minimum of 1.5 Kw of 110 VAC electric power. The auxiliary power unit must operate independent of the vehicle with starter and power controls located in the patient compartment.
3. A neonatal ambulance must have a locking interior storage compartment or approved locking bracket used for the secure storage of medications and medication kits that is accessible from within the patient compartment. Medications and medication kits must be kept in a locked storage compartment or approved bracket at all times when not in use. The EMS agency must maintain medications and medication kits as specified in these regulations.	Medications shall remain in a locked interior compartment or approved equivalent when not in use. Keys for the locking mechanisms may be kept on the vehicle key ring or in a cabinet not immediately visible to the public.
4. Required equipment and supplies specified in these regulations must be available for access and use from inside the patient compartment.	Required equipment specified in the equipment chart must be available for use from inside the patient compartment.
12 VAC 5-31-840. Air ambulance specifications.
A. An aircraft maintained and operated for response to the location of a medical emergency to provide immediate medical care at the basic or advanced life support level and for the transportation of patients shall be permitted as an air ambulance.
B. An air ambulance must be commercially constructed and certified to comply with the current U.S. Federal Aviation Administration standards as of the date of aircraft construction. An air ambulance must be constructed to provide sufficient space for safe storage of required equipment and supplies specified in these regulations.
C. Required equipment and supplies specified in these regulations, excluding those in 12 VAC 5-31-860 I and J, must be available for access and use from inside the patient compartment. A rotary wing air ambulance must be equipped with a 180-degree controllable searchlight of at least 400,000 candle power.	Refer to equipment chart. Documentation that the searchlight satisfies this requirement must be demonstrated to the Office.
12 VAC 5-31-850. EMS vehicle equipment requirements. In addition to the items otherwise listed in this article, an EMS vehicle must be equipped with all of the items required for its vehicle classification and any ALS equipment package it carries as listed in 12 VAC 5-31-860.	Refer to equipment chart.
12 VAC 5-31-860. Required vehicle equipment.

Article 4. EMS Personnel Requirements and Standard of Conduct.

12 VAC 5-31-900. General requirements. EMS personnel shall meet and maintain compliance with the following general requirements:
1. Be a minimum of 16 years of age. (An EMS agency may have associated personnel who are less than 16 years of age. This person is not allowed to participate in any EMS response, or any training program or other activity that may involve exposure to a communicable disease, hazardous chemical or other risk of serious injury.)	Persons less than 16 years of age may not participate in any EMS response, training program or other high risk environment or at risk for serious injury.
2. Be clean and neat in appearance;	Clean means free of dirt.
3. Be proficient in reading, writing and speaking the English language in order to clearly communicate with a patient, family or bystander to determine a chief complaint, nature of illness, mechanism of injury and/or assess signs and symptoms.
4. Have no physical or mental impairment that would render him unable to perform all practical skills required for that level of training. Physical and mental performance skills include the ability of the individual to function and communicate independently to perform appropriate patient care, physical assessments and treatments without the need for an assistant.
12 VAC 5-31-910. Criminal or enforcement history. EMS personnel shall meet and maintain compliance with the following general requirements:	Failure to disclose such information may result in permanent revocation of EMS certification in