Issue 45 - 11-09-2023 | Kansas State Board of Emergency Medical Services | Permanent Administrative Regulations

Volume 42 - Issue 45 - November 9, 2023

State of Kansas

Board of Emergency Medical Services

Permanent Administrative Regulations

Article 1.—DEFINITIONS

109-1-1. Definitions. Each of the following terms, as used in the board’s regulations, shall have the meaning specified in this regulation:

(a) “AEMT” means advanced emergency medical technician.

(b) “Advanced life support” and “ALS” mean the statutorily authorized activities and interventions that may be performed by an advanced emergency medical technician or paramedic.

(c) “Air ambulance” means a fixed-wing or rotor-wing aircraft that is specially designed, constructed or modified, maintained, and equipped to provide air medical transportation and emergency care of patients.

(d) “Air medical director” means a physician as defined by K.S.A. 65-6112, and amendments thereto, who meets the following requirements:

(1) Is trained and experienced in care consistent with the air ambulance service’s mission statement; and

(2) is knowledgeable in altitude physiology and the complications that can arise due to air medical transport.

(e) “Air medical personnel” means the EMS providers listed on the EMS provider roster, health care personnel identified on the service health care personnel roster of the air ambulance service, specialty patient care providers specific to the mission, and the pilot or pilots necessary for the operation of the aircraft.

(f) “Airway maintenance,” as used in K.S.A. 65-6121 and amendments thereto and as applied to the authorized activities of an advanced emergency medical technician, means the use of any invasive oral equipment and procedures necessary to ensure the adequacy and quality of ventilation and oxygenation.

(g) “Attendant” means EMS provider.

(h) “Basic life support” and “BLS” mean the statutorily authorized activities and interventions that may be performed by an emergency medical responder or emergency medical technician.

(i) “CAPCE” means the commission on accreditation for pre-hospital continuing education.

(j) “Certified mechanic,” as used in K.A.R. 109-2-2, means an individual employed or contracted by the ambulance service, city or county, qualified to perform maintenance on licensed ambulances and inspect these vehicles and validate, by signature, that the vehicles meet both mechanical and safety considerations for use.

(k) “Class” means the period during which a group of students meets.

(l) “Coordination” means the submission of an application for approval of initial courses of instruction or continuing education courses and the oversight responsibility of those same courses and instructors once the courses are approved.

(m) “Course of instruction” means a body of prescribed EMS studies approved by the board.

(n) “Critical care transport” means the transport by an ambulance of a critically ill or injured patient who receives care commensurate with the care rendered by health care personnel as defined in this regulation or a paramedic with specialized training as approved by service protocols and the medical director.

(o) “Emergency” means a serious medical or traumatic situation or occurrence that demands immediate action.

(p) “Emergency call” means an immediate response by an ambulance service to a medical or trauma incident that happens unexpectedly.

(q) “Emergency care” means the services provided after the onset of a medical condition of sufficient severity that the absence of immediate medical attention could reasonably be expected to cause any of the following:

(1) Place the patient’s health in serious jeopardy;

(2) seriously impair bodily functions; or

(3) result in serious dysfunction of any bodily organ or part.

(r) “EMR” means emergency medical responder.

(s) “EMS” means emergency medical services.

(t) “EMS provider” means emergency medical service provider.

(u) “EMT” means emergency medical technician.

(v) “Ground ambulance” means a ground-based vehicle that is specially designed and equipped for emergency medical care and transport of sick and injured persons and meets the requirements in K.A.R. 109-2-8.

(w) “Health care personnel” and “health care provider,” as used in the board’s regulations, means a physician, physician assistant, licensed professional nurse, advanced practice registered nurse, or respiratory therapist.

(x) “Incompetence,” as applied to EMS providers and as used in K.S.A. 65-6133 and amendments thereto, means a demonstrated lack of ability, knowledge, or fitness to perform patient care according to applicable medical protocols or as defined by the authorized activities of the EMS provider’s level of certification.

(y) “Incompetence,” as applied to an operator and as used in K.S.A. 65-6132 and amendments thereto, means either of the following:

(1) The operator’s inability or failure to provide the level of service required for the type of permit held; or

(2) the failure of the operator or an agent or employee of the operator to comply with a statute or regulation pertaining to the operation of a licensed ambulance service.

(z) “Interoperable” means that one system has the ability to communicate or work with another.

(aa) “Lab assistant” means an individual who is assisting a primary instructor in the instruction and evaluation of students in classroom laboratory training sessions.

(bb) “Long-term provider approval” means that the sponsoring organization has been approved by the executive director to provide any continuing education program as prescribed in K.A.R. 109-5-3.

(cc) “Out of service,” as used in K.A.R. 109-2-5, means that a licensed ambulance is not immediately available for use for patient care or transport.

(dd) “Primary instructor” means the person who is listed by the sponsoring organization as the individual responsible for the competent delivery of cognitive, psychomotor, and affective objectives of an approved initial course of instruction or continuing education program and who is the person primarily responsible for evaluating student performance and developing student competency.

(ee) “Prior-approved continuing education” means material submitted by a sponsoring organization, to the board, that is reviewed and subsequently approved by the executive director, in accordance with criteria established by regulations, and that is assigned a course identification number.

(ff) “Program manager” means an individual who has been appointed, employed, or designated by a sponsoring organization, as defined in K.S.A. 65-6112 and amendments thereto, to ensure that the sponsoring organization is in conformance with applicable regulations and to ensure that quality EMS education is provided by the sponsoring organization’s qualified instructors.

(gg) “Public call” means the request for an ambulance to respond to the scene of a medical emergency or accident by an individual or agency other than any of the following:

(1) A ground ambulance service;

(2) the Kansas highway patrol or any law enforcement officer who is at the scene of an accident or medical emergency;

(3) a physician, as defined by K.S.A. 65-6112 and amendments thereto, who is at the scene of an accident or medical emergency; or

(4) an EMS provider who has been dispatched to provide emergency first response and who is at the scene of an accident or medical emergency.

(hh) “Quality management plan” means a written plan developed by a sponsoring organization that describes all processes utilized by the sponsoring organization to ensure that the EMS education provided meets the requirements of the community’s EMS training needs assessment or meets the training needs of the intended audience. Each quality management plan shall, at a minimum, include a review and analysis by the medical director and program manager of each completed course and the instructor evaluations.

(ii) “Reinstatement” means the process by which a person may be issued a certificate at the same level of certification as that of an expired certificate.

(jj) “Retroactively approved continuing education” means credit issued to an EMS provider after attending a program workshop, conference, seminar, or other offering that is reviewed and subsequently approved by the executive director, in accordance with criteria established by the board.

(kk) “Service director” means an individual who has been appointed, employed, or designated by the operator of an ambulance service to handle daily operations and to ensure that the ambulance service is in conformance with local, state, and federal laws and ensure that quality patient care is provided by the ambulance service EMS providers.

(ll) “Service records” means the documents required to be maintained by state regulations and statutes pertaining to the operation and education within a licensed ambulance service.

(mm) “Single-program provider approval” means that the sponsoring organization has been granted approval to offer a specific continuing education program.

(nn) “Sufficient application” means that the information requested on the application form is provided in full, any applicable fee has been paid, all information required by statute or regulation has been submitted to the board, and no additional information is required to complete the processing of the application.

(oo) “Teach” means instruct or coordinate training, or both.

(pp) “Unprofessional conduct,” as applied to EMS providers and as used in K.S.A. 65-6133 and amendments thereto, means conduct that violates those standards of professional behavior that through professional experience have become established by the consensus of the expert opinion of the members of the EMS profession as reasonably necessary for the protection of the public. This term shall include any of the following:

(1) Failing to take appropriate action to safeguard the patient;

(2) performing acts beyond the activities authorized for the level at which the individual is certified;

(3) falsifying a patient’s or an ambulance service’s records;

(4) verbally, sexually, or physically abusing a patient;

(5) violating statutes or regulations concerning the confidentiality of medical records or patient information obtained in the course of professional work;

(6) diverting drugs or any property belonging to a patient or an agency;

(7) making a false or misleading statement on an application for certification renewal or any agency record;

(8) engaging in any fraudulent or dishonest act that is related to the qualifications, functions, or duties of an EMS provider; or

(9) failing to cooperate with the board and its agents in the investigation of complaints or possible violations of the EMS statutes or board regulations, including failing to furnish any documents or information legally requested by the board. EMS providers who fail to respond to requests for documents or requests for information within 30 days from the date of request shall have the burden of demonstrating that they have acted in a timely manner. (Authorized by K.S.A. 2022 Supp. 65-6110 and K.S.A. 2022 Supp. 65-6111; implementing K.S.A. 2022 Supp. 65-6110, K.S.A. 2022 Supp. 65-6111, K.S.A. 2022 Supp. 65-6129, K.S.A. 65-6132, and K.S.A. 2022 Supp. 65-6133; effective May 1, 1985; amended May 1, 1986; amended, T-88-12, May 18, 1987; amended, T-88-24, July 15, 1987; amended May 1, 1988; amended July 17, 1989; amended March 16, 1992; amended Jan. 31, 1994; amended Jan. 30, 1995; amended Jan. 31, 1997; amended Nov. 12, 1999; amended Jan. 27, 2012; amended March 15, 2013; amended April 29, 2016; amended Dec. 29, 2017; amended Dec. 31, 2021; amended Nov. 24, 2023.)

Article 5.—CONTINUING EDUCATION

109-5-1. Continuing education. (a) “Continuing education” shall mean a formally organized learning experience that has education as its explicit principal intent and is oriented towards the enhancement of emergency medical service (EMS), practice, values, skills, and knowledge.

(b) Continuing education credit shall be awarded in quarter-hour increments and shall not be issued for more than one hour of credit for a 60-minute period.

(1) Initial courses of instruction and prior-approved continuing education provided by a sponsoring organization;

(2) programs approved or accredited by the commission on accreditation for pre-hospital continuing education (CAPCE), which shall be presumptively accepted by the board unless the board determines that a particular program does not meet board requirements; and

(3) programs or courses approved by another state’s EMS regulatory or accrediting body, which shall be presumptively accepted by the board unless the board determines that a particular program does not meet board requirements.

(d) Any program not addressed in subsection (c) may be submitted for approval by the EMS provider as specified in K.A.R. 109-5-5.

(e) The amount of continuing education credit obtained in one calendar day shall not exceed 12 clock-hours.

(f) Each EMS provider shall keep documentation of completion of approved continuing education for at least three years and shall provide this documentation to the board upon request by the executive director.

(g) Documentation of completion of approved continuing education shall verify the following for each continuing education course completed:

(1) The name of the provider of the continuing education course;

(2) the name of the individual being issued the continuing education credit;

(3) the title of the continuing education course;

(4) the date or dates on which the course was conducted;

(5) the location where the course was conducted;

(6) the amount of continuing education credit issued to the individual; and

(7) the course identification number. (Authorized by K.S.A. 2022 Supp. 65-6110 and K.S.A. 2022 Supp. 65-6111; implementing K.S.A. 2022 Supp. 65-6129; effective, T-88-122, May 18, 1987; amended, T-88-24, July 15, 1987; amended May 1, 1988; amended July 17, 1989; amended Feb. 3, 1992; amended Aug. 16, 1993; amended Dec. 19, 1994; amended Nov. 1, 1996; amended Nov. 12, 1999; amended, T-109-8-8-00, Aug. 8, 2000; amended Nov. 13, 2000; amended Aug. 30, 2002; amended Sept. 10, 2010; amended, T-109-2-7-11, Feb. 7, 2011; amended June 3, 2011; amended Jan. 4, 2016; amended Dec. 29, 2017; amended March 1, 2019; amended Dec. 31, 2021; amended Nov. 24, 2023.)

109-5-1e. (Authorized by K.S.A. 2009 Supp. 65-6111, as amended by L. 2010, ch. 119, sec. 1; implementing K.S.A. 65-6129b; effective, T-109-2-7-11, Feb. 7, 2011; effective June 3, 2011; revoked Nov. 24, 2023.)

Article 6.—TEMPORARY CERTIFICATION

109-6-2. Renewal of EMS provider certificate. (a) Each EMS provider certificate shall expire on December 31 of the second complete calendar year following the date of issuance.

(b) An EMS provider may renew that person’s certificate for each biennial period upon submission of a sufficient application for renewal as specified in subsection (d).

(d) Each application for renewal shall be deemed sufficient when all of the following conditions are met:

(1) The applicant provides in full the information requested and no additional information is required by the board to complete the processing of the application.

(2) The applicant submits a renewal fee in the applicable amount specified in K.A.R. 109-7-1.

(3) The applicant has completed the requirements in K.A.R. 109-5-1, K.A.R. 109-5-1a, K.A.R. 109-5-1b, K.A.R. 109-5-1c, and K.A.R. 109-5-1d that are applicable to the application being submitted.

(e) The date of receipt of the renewal application shall mean the electronic time stamp indicating when the renewal application is submitted in the license management system. (Authorized by K.S.A. 2022 Supp. 65-6111; implementing K.S.A. 2022 Supp. 65-6129; effective Nov. 1, 1996; amended Oct. 31, 1997; amended Nov. 12, 1999; amended, T-109-8-8-00, Aug. 8, 2000; amended Nov. 13, 2000; amended Feb. 12, 2010; amended Dec. 29, 2017; amended Dec. 31, 2021; amended Nov. 24, 2023.)

Article 7.—FEES

109-7-1. Schedule of fees. (a) EMS provider and ambulance service application fees shall be nonrefundable.

(b) Emergency medical responder fees:

(1) Application for certification fee $15.00
(2) certification renewal application fee if received before certificate expiration 20.00
(3) certification reinstatement application fee if received within 31 calendar days after certificate expiration 40.00
(4) certification reinstatement application fee if received on or after the 32nd calendar day after certificate expiration 80.00

(1) Application for certification fee 65.00
(2) certification renewal application fee if received before certificate expiration 50.00
(3) certification reinstatement application fee if received within 31 calendar days after certificate expiration 100.00
(4) certification reinstatement application fee if received on or after the 32nd calendar day after certificate expiration 200.00

(d) EMT and AEMT fees:

(1) Application for certification fee 50.00
(2) certification renewal application fee if received before certificate expiration 30.00
(3) certification reinstatement application fee if received within 31 calendar days after certificate expiration 60.00
(4) certification reinstatement application fee if received on or after the 32nd calendar day after certificate expiration 120.00

(e) Inactive certificate fees:

(1) Application for inactive certificate 10.00
(2) inactive certificate renewal fee 25.00
(3) application fee for reinstatement of inactive certificate 20.00

(f) Ambulance service fees:

(1) Service permit application fee 100.00
(2) service permit renewal fee if received on or before permit expiration 100.00
(3) service permit renewal fee if received after permit expiration 200.00
(4) vehicle license application fee 40.00
(5) Temporary license for an ambulance 10.00

(g) Each application for certification shall include payment of the prescribed application for certification fee to the board.

(h) Payment of fees may be made by either of the following:

(1) An individual using a personal, certified, or cashier’s check, a money order, a credit card, or a debit card; or

(2) an ambulance service, fire department, or municipality using warrants, payment vouchers, purchase orders, credit cards, or debit cards.

(i) Payment submitted to the board for application for certification fee, reinstatement fee, or renewal fee for more than one EMS provider shall not be accepted, unless the fee amount is correct. (Authorized by K.S.A. 2022 Supp. 65-6110, K.S.A. 2022 Supp. 65-6111, K.S.A. 2022 Supp. 65-6127, and K.S.A. 2022 Supp. 65-6129; implementing K.S.A. 2022 Supp. 65-6111, K.S.A. 2022 Supp. 65-6127, K.S.A. 65-6128, and K.S.A. 2022 Supp. 65-6129; effective July 1, 1990; amended Feb. 3, 1992; amended Nov. 1, 1996; amended, T-109-8-8-00, Aug. 8, 2000; amended Nov. 13, 2000; amended Oct. 31, 2003; amended March 9, 2012; amended April 29, 2016; amended Dec. 29, 2017; amended Dec. 31, 2021; amended Nov. 24, 2023.)

Article 8.—EXAMINATIONS

109-8-1. Examination. (a) The cognitive certification examination for emergency medical responders, emergency medical technicians, advanced emergency medical technicians, and paramedics shall be the national registry of emergency medical technicians’ cognitive examination.

(b) Each emergency medical responder or emergency medical technician applicant shall be required to successfully complete the national registry of emergency medical technicians’ cognitive examination and shall be required to demonstrate competency in psychomotor skills as evaluated by the psychomotor skills examination prescribed by the board.

(e) Each advanced emergency medical technician or paramedic applicant shall successfully complete the national registry of emergency medical technicians’ cognitive examination and psychomotor skills evaluation.

(f) Any emergency medical responder or emergency medical technician applicant who is tested in psychomotor skills and who fails any psychomotor skill station may retest each failed station a maximum of three times.

(g) Each emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic shall successfully complete both the cognitive examination and the psychomotor skills examination no later than 24 months after the last date of that individual’s initial course of instruction. Each individual specified in this subsection shall be required to successfully complete both the cognitive examination and the psychomotor skills examination within a 12-month period.

(h) Any examination for certification may be modified by the board as a pilot project to evaluate proposed changes to the psychomotor skills examination. (Authorized by K.S.A. 2022 Supp. 65-6110 and 65-6111; implementing K.S.A. 2022 Supp. 65-6111, and K.S.A. 2022 Supp. 65-6129; effective, T-109-1-19-89, Jan. 19, 1989; effective July 17, 1989; amended Aug. 27, 1990; amended Feb. 3, 1992; amended Dec. 19, 1994; amended Jan. 5, 1996; amended Nov. 8, 1996; amended May 16, 1997; amended, T-109-2-7-11, Feb. 7, 2011; amended June 3, 2011; amended Jan. 4, 2016; amended Dec. 29, 2017; amended March 1, 2019; amended Nov. 24, 2023.)

Article 9.—INSTRUCTOR-COORDINATOR

109-9-1. (Authorized by K.S.A. 65-6110, K.S.A. 2010 Supp. 65-6111; implementing K.S.A. 65-6129b; effective, T-109-1-19-89, Jan. 19, 1989; effective July 17, 1989; amended Aug. 27, 1990; amended Feb. 3, 1992; amended Nov. 12, 1999; amended Nov. 9, 2001; amended Sept. 2, 2011; revoked Nov. 24, 2023.)

109-9-4. (Authorized by K.S.A. 2016 Supp. 65-6110 and 65-6111; implementing K.S.A. 2016 Supp. 65-6110, 65-6111, and 65-6129b; effective, T-109-1-19-89, Jan. 19, 1989; effective July 17, 1989; amended Feb. 3, 1992; amended Jan. 31, 1994; amended Nov. 12, 1999; amended Nov. 9, 2001; amended Sept. 2, 2011; amended Dec. 29, 2017; revoked Nov. 24, 2023.)

Article 10.—CURRICULA

109-10-1e. (Authorized by and implementing K.S.A. 2014 Supp. 65-6110 and 65-6111; effective, T-109-2-7-11, Feb. 7, 2011; effective June 3, 2011; amended May 1, 2015; revoked Nov. 24, 2023.)

109-10-4. Student transfers. (a) To transfer from one initial course of instruction to another initial course of instruction of the same certification level, the student shall provide the primary instructor of the course of instruction into which the student desires to transfer with:

(1) A signed and dated document which outlines reasons why the student was unable to complete the original course of instruction in which the student was enrolled; and

(2) a summary of the portion of the original course of instruction which the student successfully completed, signed by the primary instructor of the original course of instruction in which the student was enrolled.

(b) For a student to transfer into an initial course of instruction from another initial course of instruction the primary instructor shall submit to the board:

(1) Documentation from the primary instructor of the original course of instruction in which the student was enrolled, summarizing the portion of the original course of instruction in which the student was enrolled;

(2) a statement from the primary instructor of the course into which the student desires to transfer, certifying that the primary instructor will provide the remaining required material to the student and the student will be given a final evaluation of competencies of the required material of the total course; and

(3) a student form adding the student to the course.

(c) A student may transfer from one course of instruction to another if the student has been enrolled in the original course of instruction within the past 1 year and the primary instructor agrees to accept this student and the requirements of subsections (a) and (b) of this regulation are met. (Authorized by and implementing K.S.A. 2022 Supp. 65-6110; effective Jan. 31, 1994; amended Nov. 24, 2023.)

Article 11.—COURSE APPROVALS

109-11-7. (Authorized by and implementing K.S.A. 2020 Supp. 65-6110 and K.S.A. 2020 Supp. 65-6111; effective, T-109-1-19-89, Jan. 19, 1989; effective July 17, 1989; amended Dec. 31, 2021; revoked Nov. 24, 2023.)

109-11-8. Successful completion of a course of instruction. (a) To successfully complete an initial course of instruction for EMS provider, each student shall meet the following requirements:

(1) Demonstrate application of a cognitive understanding of each EMS educational standard;

(2) demonstrate all practical skills to the satisfaction of the primary instructor;

(3) for an emergency medical technician (EMT), initial course of instruction, demonstrate successful completion of each of the following:

(A) One complete patient assessment; and

(B) one nebulized breathing treatment during clinical training or field internship training;

(4) for an advanced emergency medical technician (AEMT), initial course of instruction, demonstrate successful completion of the following:

(A) 20 venipunctures, of which at least ten shall be for the purpose of initiating intravenous infusions;

(B) five intraosseous infusions;

(D) ten ambulance calls while being directly supervised by an AEMT, a paramedic, a physician, an advanced practice registered nurse, or a professional nurse;

(E) ten intramuscular or subcutaneous injection procedures;

(F) ten completed patient charts or patient care reports, or both; and

(G) eight electrocardiogram applications and interpretations during clinical training and field internship training; and

(5) for a paramedic initial course of instruction, demonstrate each of the following:

(A) Successful completion of both clinical and field internship components; and

(B) confirmation of eligibility to be conferred, at a minimum, an associate degree in applied science by the postsecondary institution.

(b) The primary instructor shall provide written verification, within 15 days of the final class and at least seven days before the state examination for certification, that the primary instructor’s students have met the requirements of subsection (a). (Authorized by K.S.A. 2022 Supp. 65-6110; implementing K.S.A. 2022 Supp. 65-6111, K.S.A. 2022 Supp. 65-6129; effective, T-109-1-19-89, Jan. 19, 1989; effective July 17, 1989; amended Jan. 31, 1994; amended Dec. 31, 2021; amended Nov. 24, 2023.)

Article 16.—GRADUATED SANCTIONS

109-16-1. Graduated sanctions. (a) The following documents of the Kansas board of emergency medical services, dated April 10, 2013, are hereby adopted by reference:

(1) “Graduated sanctions for attendants”; and

(2) “graduated sanctions for operators.”

(b) For purposes of applying the tables of graduated sanctions for EMS providers and operators, the following sanction levels shall apply:

(1) “Sanction level 1” means that the local action taken by the operator of the ambulance service, or its designee, is approved and accepted by the board’s investigations committee.

(2) “Sanction level 2” means the modification of a certificate or permit by the imposition of conditions.

(3) “Sanction level 3” means the limitation of a certificate or permit.

(4) “Sanction level 4” means the suspension of a certificate or permit for less than three months.

(5) “Sanction level 5” means the suspension of a certificate or permit for three months or more.

(6) “Sanction level 6” means the revocation of a certificate or permit.

(c) When the investigations committee is determining the appropriate sanction level, the following mitigating and aggravating circumstances, if applicable, shall be taken into consideration:

(1) The number of violations involved in the current situation;

(2) the degree of harm inflicted or the potential harm that could have been inflicted;

(3) any previous violations or the absence of previous violations;

(4) the degree of cooperation with the board’s investigation;

(5) evidence that the violation was a minor or technical violation, or a serious or substantive violation;

(6) evidence that the conduct was intentional, knowing, or purposeful or was inadvertent or accidental;

(7) evidence that the conduct was the result of a dishonest, selfish, or criminal motive;

(8) evidence that the EMS provider or operator refused to acknowledge or was willing to acknowledge the wrongful nature of that person’s conduct;

(9) the length of experience as an EMS provider or operator; and

(10) evidence that any personal or emotional problems contributed to the conduct. (Authorized by K.S.A. 2022 Supp. 65-6110, 65-6111, and 65-6129; implementing K.S.A. 2022 Supp. 65-6129; effective Jan. 17, 2014; amended Nov. 24, 2023.)

Joseph House
Executive Director
Board of Emergency Medical Services

Doc. No. 051650

Scott Schwab
Kansas Secretary of State

Kansas Register