Air Emergency Medical Response System Regulation

Air Emergency Medical Response System Regulation, M.R. 20/2006 The Emergency Medical Response and Stretcher Transportation Act , C.C.S.M. c. E83 Regulation 20/2006 Registered January 23, 2006 bilingual version (HTML) Table of Contents Section PART 1 INTRODUCTORY PROVISIONS 1 Definitions and interpretation PART 2 AIR MEDICAL RESPONSE SYSTEM 2 Air medical response system licence application 3 Issuance of licence 4 Expiry and renewal of licence 5 Agreement — medical director 6 Responsibility of medical director 7-8 Repealed 9 Transporting patients by air ambulance or other aircraft 10 Air medical response services — operations 11 Aircraft appropriate for patient's condition 12 Insurance requirements 13 Smoking prohibited 14 Notice of suspension or revocation of licence 15 Repealed 16 Transport reports 17 Aviation occurrences and other incidents 18 Reports re other occurrences including critical incidents 18.1 Reports re aircraft used in accordance with subsection 9(2) 19 Other reports 20 Form and timing for filing reports PART 3 PERSONNEL 21 Repealed 22 Qualifications: air ambulance pilots — captains and first officers 23 Qualifications — aeromedical attendant 24 Annual requirements 25-28 Repealed Schedule A Air Ambulance Specifications B Repealed C Repealed PART 1 INTRODUCTORY PROVISIONS Definitions and interpretation 1(1) The following definitions apply in this regulation. "Act" means The Emergency Medical Response and Stretcher Transportation Act . («  Loi  ») "aeromedical attendant" means a person responsible for the assessment and care of a patient during all phases of aeromedical transport. (« infirmier d'ambulance aérienne ») "air ambulance" means an ambulance that is an aircraft. (« ambulance aérienne ») "air ambulance pilot" means a person who has the qualifications set out in Part 3 to pilot an air ambulance while it is being used to provide air medical response services. (« pilote d'ambulance aérienne ») "air medical response services" means the transport of a patient by air ambulance, or by other aircraft in accordance with subsection 9(2), and in relation to the patient transported, includes (a) assessment of acuity; (b) pre-flight stabilization; (c) in-transport medical care; and (d) the orderly transfer of that care to the appropriate medical personnel following the transport. (« services aériens d'intervention médicale ») "air medical response system" means an emergency medical response system which provides air medical response services. (« entreprise aérienne d'intervention médicale ») "licence holder" means the holder of a licence to operate an air medical response system. (« titulaire de permis ») "low acuity air medical response services" means air transport for a patient who does not require critical or emergent care. (« services aériens d'intervention médicale de faible acuité ») "medical director" means a duly qualified medical practitioner licensed to practise in Manitoba who has entered into an agreement with a licence holder as described in section 5. (« directeur médical ») "specialized air medical response services" means transporting a patient who requires or may require critical or emergent care. (« services aériens d'intervention médicale spécialisés ») 1(2) For the purpose of this regulation, a patient requires (a) critical care if (i) one or more body systems of the patient are abnormal and rapidly deteriorating in association with an acute illness or injury, (ii) intense monitoring is required, or (iii) medical interventions are required to correct and stabilize the patient's condition; and (b) emergent care if, despite the patient's vital signs being within normal parameters and there being no immediate threat to life or function, the patient (i) suffers from acute illness or injury which could result in deterioration and instability in his or her condition, or (ii) requires intensive monitoring with the potential need for acute intervention. M.R. 170/2009 ; 141/2018 ; 112/2020 ; 94/2022 PART 2 AIR MEDICAL RESPONSE SYSTEM Applications and Renewal of Licences Air medical response system licence application 2(1) A certified and licensed Transport Canada air carrier that operates in accordance with (a) all applicable regulations, standards and orders; and (b) its Transport Canada approved company operations manual; may, in the form and manner specified by the minister, apply to the minister to become a licence holder. 2(2) An application must include (a) a copy of a valid air operator's certificate issued by Transport Canada; (b) a copy of the Transport Canada approved company operations manual; (c) if the applicant is incorporated under The Corporations Act , the names and addresses of the directors and officers of the corporation; (d) if the applicant is other than a corporation, the name and address of the owner, or if the applicant is a partnership, the names and addresses of all general partners in the partnership; (e) the municipal address and the mailing address of all the premises from which the applicant proposes to operate the air medical response system; (f) evidence that the applicant has obtained liability insurance, as specified in section 12; (g) a proposed aeromedical policy and procedure manual; and (h) any other information or documentation that the minister considers necessary to determine the ability of the person to operate the air medical response system. 2(3) An application must be accompanied by an application fee of $3,000. Issuance of licence 3(1) A licence to operate an air medical response system may be issued if the minister (a) approves the proposed aeromedical policy and procedure manual submitted by the applicant; and (b) is satisfied that the applicant has satisfactorily demonstrated it can adequately operate the system. 3(2) During the term of its licence, the licence holder must amend or revise its aeromedical policy and procedure manual, as directed by the minister. Expiry and renewal of licence 4(1) Unless renewed, a licence issued under this Part expires on December 31 of the year in which it is issued, or such shorter period as the minister may determine. 4(2) To renew its licence, a licence holder must submit an application for renewal at least 90 days prior to the expiry date of the licence, and the application must (a) be in the form approved by the minister; (b) be accompanied with an application renewal fee of $1,000; and (c) include the information and documentation that the minister considers necessary to determine the ability of the licence holder to continue to operate the air medical response system. Medical Director Agreement — medical director 5 Before providing air medical response services, a licence holder must (a) enter into an agreement with a medical director in which the medical director agrees to perform the duties specified in section 6; and (b) file a copy of the agreement entered into under clause (a) with the minister. Responsibility of medical director 6 The medical director is responsible for (a) providing consultation to the licence holder and individuals employed or engaged by the licence holder on air medical response service issues; (b) ensuring that a medical quality assurance program is established and that the program is appropriate for the services provided; and (c) ensuring that all aeromedical attendants employed or engaged by the licence holder perform their patient care duties and functions in accordance with (i) the requirements of any Act of the Legislature under which the aeromedical attendant is licensed or otherwise authorized to provide health care, and the applicable regulations under that Act, and (ii) the code of ethics, standards of practice and practice directions established by the body that has responsibility under that Act to regulate the profession. M.R. 141/2018 ; 95/2019 ; 112/2020 7 and 8 [Repealed] M.R. 141/2018 ; 112/2020 Obligations of Licence Holder Transporting patients by air ambulance or other aircraft 9(1) Subject to subsections (2) and (3), in providing air medical response services, no aircraft other than an air ambulance may be used by a licence holder to transport a patient. 9(2) In providing air medical response services, a licence holder may use an aircraft other than an air ambulance to transport a patient if (a) the patient requires transport by air in order to preserve his or her life, limb or function; (b) the patient's location cannot be expeditiously accessed by an air ambulance; and (c) the patient is transported to (i) the nearest location expeditiously accessible by an air ambulance, for transfer of the patient to the air ambulance, or (ii) a community in which a hospital is located, whichever is closer or as required by the patient's condition. 9(3) Subclause 10(d)⁠(i), clauses 10(f) and (h) and section 11 apply with necessary changes to a licence holder in relation to an aircraft used in accordance with subsection (2). M.R. 170/2009 Air medical response services — operations 10 A licence holder must (a) ensure that the aeromedical policy and procedure manual is followed at all times when providing air medical response services; (b) not make any amendments to the aeromedical policy and procedure manual except with the prior approval of the minister; (c) ensure that every air ambulance used to provide air medical response services is staffed by at least one aeromedical attendant and two air ambulance pilots, one of whom is qualified to act as an air ambulance pilot — captain; (d) ensure that every air ambulance used to provide air medical response services (i) is airworthy and is maintained in a mechanically safe condition, (ii) is made available for inspection by a standards officer appointed by the minister and, where such an inspection has been done, it has been approved by the standards officer as conforming with Schedule A, and (iii) [repealed] M.R. 94/2022 , (iv) carries a copy of an aeromedical policy and procedure manual when providing air medical response services; (e) [repealed] M.R. 94/2022 ; (f) ensure that when an air ambulance is used to transport a patient with a known or suspected contagious disease, the air ambulance is not used (i) at the same time to transport another individual who does not have the same disease, or (ii) thereafter to transport any other patient without first being disinfected in accordance with guidelines approved by the minister; (g) implement an infection control program as approved by the minister, and ensure that every air ambulance is equipped with the supplies necessary to follow the directions contained within that guideline; and (h) ensure that no person is permitted to perform the dual duties of air ambulance pilot and aeromedical attendant on an air ambulance transporting a patient, even if qualified in both positions. M.R. 100/2006 ; 141/2018 ; 112/2020 ; 94/2022 Aircraft appropriate for patient's condition 11 A licence holder must ensure that, as dictated by the patient's condition but subject to the safety of the air ambulance not being jeopardized, (a) the air ambulance used is capable of transporting the patient at the cabin altitude limits and within the time that is appropriate for the patient; and (b) the appropriate cabin altitude limit for the patient is adhered to by the flight crew. Insurance requirements 12 Except where the minister is satisfied that a licence holder is adequately self-insured, a licence holder must have insurance which insures every staff person involved in the provision of air medical response services in an amount of at least $5,000,000. M.R. 170/2009 Smoking prohibited 13 No individual may smoke or use an e-cigarette, as defined in The Smoking and Vapour Products Control Act , in an air ambulance. M.R. 112/2020 Notice of suspension or revocation of licence 14(1) The licence holder must advise the minister within eight hours of action by Transport Canada of the suspension or revocation of the operator's licence issued to the licence holder. 14(2) The licence holder must provide the minister a copy of each revision to the flight operations manual within one business day of each federally approved revision. 15 [Repealed] M.R. 94/2022 REPORTS Transport reports 16(1) A licence holder must ensure that a transport report in the form approved by the minister is completed by the aeromedical attendant immediately after the transportation of a patient in an air ambulance. 16(2) A licence holder must ensure that (a) a copy of the transport report is given to the minister upon request; and (b) the original transport report is retained by the licence holder for a period of seven years from the date of the transport, or for such longer period as is otherwise required by law. M.R. 141/2018 ; 112/2020 Aviation occurrences and other incidents 17 A licence holder must file with the minister a report of any of its air ambulances — regardless of category of aircraft — being involved in an aviation occurrence, as described in section 2 of the Transportation Safety Board Regulations , SOR/2014/37, made under the Canadian Transportation Accident Investigation and Safety Board Act (Canada), within seven days of the occurrence. M.R. 141/2018 Reports re other occurrences including critical incidents 18(1) The following definitions apply in this section. "critical incident" means a critical incident, as defined in section 53.1 of The Health System Governance and Accountability Act , that occurs in the course of providing air medical response services. (« incident critique ») "occurrence" means an event that occurs in the course of providing air medical response services that results in actual or potential harm or damage to, or loss of, any of the following: (a) life, limb or function; (b) property; and for certainty includes any event that results in a staff person, a medical or non-medical escort or a member of the public being injured and requiring medical care. (« événement ») 18(2) A licence holder must report, in or related to transporting any patient by air ambulance, (a) each occurrence, which is not otherwise a critical incident, to the minister; and (b) each critical incident in accordance with The Health System Governance and Accountability Act , where the licence holder has been prescribed as a health care organization for the purposes of Part 4.1 of that Act. M.R. 94/2022 Reports re aircraft used in accordance with subsection 9(2) 18.1(1) Within 24 hours after using an aircraft other than an air ambulance to transport a patient in accordance with subsection 9(2), a licence holder must report to the minister, by telephone or other means of electronic communication, providing such information as the minister may require. 18.1(2) In addition to the report required under subsection (1), the licence holder must give a written report to the minister within 30 days after the transport occurs, providing such information as the minister may require. M.R. 170/2009 Other reports 19 A licence holder must report any other information the minister requests from time to time. Form and timing for filing reports 20 A report required to be submitted to the minister under sections 16 to 19 must be filed in the time, form and manner specified by the minister. PART 3 PERSONNEL 21 [Repealed] M.R. 112/2020 Qualifications: air ambulance pilots — captains and first officers 22(1) A person may act as an air ambulance pilot without a licence issued under the Act if they (a) hold a valid and subsisting commercial pilot's licence; and (b) have completed, within the two years immediately preceding the person's employment or engagement as an air ambulance pilot, an aeromedical training course approved by the minister that included (i) the effect of flight on patients, and flying strategies to limit the effect, and (ii) Basic Cardiac Life Support Certification. 22(2) A person may act as an air ambulance pilot — captain without a licence issued under the Act if they (a) meet the requirements of subsection (1); (b) have a valid and subsisting Airline Transport Licence; (c) are endorsed for instrument flight; (d) have a valid pilot proficiency check on the type of aircraft to be flown; and (e) have a minimum of 500 hours' pilot-in-command experience. 22(3) A person may act as an air ambulance pilot — first officer without a licence issued under the Act if they (a) meet the requirements of subsection (1); (b) have successfully completed a pilot competency check under the Canadian Aviation Regulations , SOR/96-433; and (c) have a minimum of 500 hours' total flight time experience. M.R. 100/2006 ; 14/2020 ; 112/2020 Qualifications — aeromedical attendant 23 A person may act as an aeromedical attendant without a licence issued under the Act if the person has successfully completed an aeromedical specialist registry examination approved by the minister and the person is (a) a registered nurse who is registered with and holds a valid certificate of practice issued by the College of Registered Nurses of Manitoba under The Regulated Health Professions Act and has (i) graduated from a critical care course or an emergency nursing course approved by the minister, or (ii) completed at least two years of related nursing experience; (b) registered as a primary care paramedic, an advanced care paramedic or a critical care paramedic with and holds a valid certificate of practice issued by the College of Paramedics of Manitoba; or (c) is registered in good standing with The Manitoba Association of Registered Respiratory Therapists, except if the person is registered on the roster of associate members of the Association. M.R. 141/2018 ; 112/2020 Annual requirements 24 A licence holder must ensure that all aeromedical attendants and air ambulance pilots employed or engaged by the licence holder to provide air medical response services meet the requirements of section 22 or 23. M.R. 141/2018 ; 112/2020 25 to 28 [Repealed] M.R. 112/2020 SCHEDULE A AIR AMBULANCE SPECIFICATIONS Aircraft specifications 1 Aircraft used as air ambulances must be powered by a turbine engine, suitably equipped and certified for flight into instrument or, when applicable, known icing conditions. M.R. 14/2020 Cabin size requirements 2(1) The cabin of an air ambulance must be of sufficient size (a) to carry a minimum of one stretcher or one incubator in a loading/securement platform approved by the minister; (b) to provide clear access to, and view of, any part of the patient's body that may require the attention of an aeromedical attendant, which includes unobstructed space over the patient's chest in order to do CPR and other medical procedures; (c) to provide unobstructed space at the patient's head, adequate to perform emergency care without compromise to the security of the patient or crew members, and a clear aisle area at the attending side of a stretcher; and (d) to provide unobstructed egress at all required times. 2(2) The loading door of the aircraft must be of sufficient size to allow horizontal stretcher loading. 2(3) The aircraft must be equipped with a means of isolating the cabin from the cockpit. Seating and equipment 3 For each stretcher and incubator carried, the aircraft must have (a) a minimum of one adjacent attendant seat with seat belt; and (b) two suitable hooks or hanging devices, each capable of suspending two IV bags, above each stretcher and incubator, at the maximum possible height above the patient. Heating and cooling 4 Air ambulances must have a heated cabin, and must (a) be air-conditioned; or (b) in weather above 20°C, be equipped with a cabin fan to circulate the interior air. Lighting 5 Air ambulances must have adequate lighting, as approved by the minister, for patient observation at each patient location at all times. Cabin interior 6 The interior of the cabin must be composed of materials which are easily disinfected. Communication 7 For the purposes of communication, the aircraft must be equipped with (a) two-way air to ground communication equipment to allow transmission and reception of medical communication; and (b) alternate radio/telephone communication equipment. Electrical 8 Air ambulances must have a Transport Canada approved 110 volt electrical power source capable of supplying power for medical equipment while en route, and must also have (a) sufficient capacity to supply power, in the event of one alternator or generator failure, for all required aircraft equipment for flight plus all medical equipment; and (b) a backup portable battery-powered system that is separate from the aircraft power system and is capable of supplying power to required medical equipment for the duration of flight plus the time required to land at the alternate airport specified in the flight plan. SCHEDULES B AND C [Repealed] M.R. 141/2018 ; 94/2022