Dr. J. E. Peavy Commissioner of Health Opinion No.M-609 Texas State Department of Health' Re: Validity of certain Austin, Texas 78756 rules andregulations of the StateHealth Dear Dr. Peavy: Department.

Pursuant to the provisions of Article 4590b, Vernon's Civil Statutes, certain rules and'regulations have been proposed for.adoption by the State Board of Health. These rules and regulations read as follows:

"Inaddition to items specifically set forth in S.B. 230 the following shall alsobe required prior to the issuing of any permit to operate an ambulance within the State of Texas. "A. ,Required:'Equipment-There will be on board,at all ,timesthe following items of equipment: "1. Hinged half-ring lower extremity splintwith web straps for ankle hitch "2. Twoor more ~paddedboards,I-l/2 feet in.length,-and-.3:inches wide and two **or** more similar padded.boards 3 feet in length and ,3"inches'uide;.ofmaterial~compareblee..to four-ply woodi.:forlcoaptation splinting-of' fracture'of leg-or+-thigh *~.:~,Twoormore padded 15 inch by 3 " inchwood or cardboard~splints for **fractures** of the forearm *4;' Shortiand long back boards with 2 inchwebbing.:.etrapsfor extrication **of** Victims with spine injuries

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Dr. J. E. Peavy, page 2 (M-609)

**“ 5.**  Oxygen tanks andmasks,of assorted sizes for administration of oxygen "6. Hand operated bag-mask resuscitation unit with adult, child and infant sizemasks (unitcapable **of** being attached tooxygen supply preferred) "7. Simple suction apparatus with catheter "8. Mouth-to-mouth, two-way resuscitation airways for adults (1)and children (1) "9. Oropharyngeal airways (3) "10. Mouth gags made of three tongue blades taped together and padded "11, Universal dressing, approximately 10 inches by 36 inches packaged folded to 10 inches by 9 inches "12. "13. cylinder "14. bandages "15., "16. -ii. "18. Sterile gauze pads One, 2 and 3 inch.,adhesivetape on
Six-inch by 5yard,soft roller type Triangular bandages Safety pins, large size Bandage shears Several pillows "This represents theminimal equipment list as prescribed by the American College ,of.SurgeonsCommittee on Trauma. "B. Ambulance Attendants -There shall at all times be two ambulance attendants on each ambulance while it ie in operation. All attendants will

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satisfactorily complete the Emergency Care Training Course for ambulance attendants which isoffered free of charge throughout the state by the Texas State Department of Health at such times as it is offered within their area. Ambulance attendant **means**an individual responsible for the operation of an ambulance and the care of the patients whether or not the.attendant also serves asa driver. "C. Non-Compliance - Following notification by a representative of the Texas State Department of Health, Disaster Health andMedical Services, of non-compliance with this act or the rules and regulations set forth to enforce it, the licensee shallwithin 14days: - "1..Notify the Texas State Department of Health,.Disaster Health and Medical Services, in writing that remedial measures have been taken to secure compliance: "2..~Forward.to;the Texas State Department of Health, DIMSwritten notice:of cause **for** not complying with thir,act and the rules and regulations prescribed for enforcing it, and request ahearing;

1. **3.** Cease;operations and.forward his ambulance permit(s) to the Texas State Department of Health, DHWS **by.**registered mail. "

,~1D.;~.:

Hearing iWhena hearing is requested it shall be held within 21,days from the date of request andwill:be held **at'** the Texas State Department of.Health inAustin, Texas. Within 10 days **after** conclusion of nuch hearing, awritten decision as to the statusof said ambulance permit shall be submitted to the licensee." **With** regard to the above.propoaed rules, you ask the following questionsr

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"(1) Since the above quoted Section 2prescribes minimum equipment tobe carried on these vehicles, may the Board of Health, by rules and regulations, expand the amount of equipment to be carried by the permittee's vehicle7 "(2) In the event that your answerto;' Question No. 1 is in the negative, thenmay the Board of Health, through thenrule-making authority granted in 459033,set theminimum contents of the first aid.kit prescribed by Section 2a of theAct? "(3) In the event that your answer to Question No. 1 is,,in*.the affirmative, are'permitteee in..violation~~~of,rulee and regulations promulgated by the~State Board **of** Health for. the purpose of carrying.out this Act subject to the penalty provided in Section 5of the Act? "(4) Are the,,existingregulations set.out inAttachment No. 1valid asbeing within the regulatory.powers granted the,Board **of** Health by theAct? "(5) If approved by the Board **of** Health, will the proposed regulationo'ae set out in Attachment No, 2be:valid as being within the regulatory powers granted the Board of Health by theAct?" Sections l~and.?..ofArticle 4590b, Vernon's Civil Statutes, provide:

'sh& 7Section.l;~~~d.persoa,-.,iirm:.or corporation operakec..or'cauee' tob?:operated,in thk, **Stater.of.~Texae,:.any~.eoergency.** arpbulance:, pu&~lio or private.,or imy:;othervehicle aomuon&y'.used **for** tbe.transportation:or **conveyance** of,the sick **or** injured.,without first securing a permit therefor~.fromthe State Board of Health as hereinafter provided. "Secw 2. 'Every ambulance, ,patrolautomobile..or.vehiclehereinafter .described,be**fore** permit.16 issued therefoc,,shall be

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equipped with and,when in service, carry as minimum equipment the following:
"(a) A first aid **kit;** "lb) Traction splints forkthe proper transportation.of fractures of the extremities." .Section 4authorizes the State Board of Health to adopt rules and regulations “for the,purpose of carrying out this Act" and states that it shall be the duty of the State Board of Health to issue apermit to applicants, and further provides: ".Anysuch permit may be subject **to** revocation.by the State,Board of Health upon the finding by:~apublic health officer of any political sub-division of this state.that said permittee has failed to comply,with the provisions df this Act or the rules and regulations of the State Board of Health; provided, however, that said permittee is:given notice and an opportunity'to'be heard;" Sectionsj,provides: "Sec. .5. Any'person violating any provision of this Act'shall, upon conviction ~~" thereof, be punished by a fine of not to exceed One Hundred ($lOO"OO) Dollars." If:'the.rules'.and':reg~latione 'adoptedby the State Board of ~ehl~h~~~~~s~~~~~~~~~e'~~rovisions of Article 4590b, Vernon's Cipil~,Stptutee," ") "'are~:~&ansietent with,,related'to, and an iihpleiae~tatio~fofiany'.of'th~'provisio~~'of,~Article 4590b. suchrules and,~regulations**are** valid. **Kee ’** **v.** Baber, 157 Tex. 387, 303 S.W.Zd 376 (1957).:.TexasState Board of Examinere~in..Optometry v. Carp, 412 S.W.Zd 307 (Tex.Sup. 1967).

Applying the above test to the rules and regulations submitted by.you, we note that the Legislature did not specify.the minimumrequirements for first aid kits, nor for traction splints "for the proper'transportation of fractures of the extremities,".rather it left such details to be implemented by reasonable~rules and regulations of the,,State Board of Health. It is further noted that the required

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equipment prescribed in the proposed rules constitutes the minimal equipment list as prescribed by the American College **of** Surgeons Committee on Trauma and therefore inour opinion properly implements Section 2ofArticle 4590b.

Your questions are therefore summarily answered. With reference to question Nos. 1, 4and 5,you are advised that the State Board **of** Health, **by** rules and regulations, may define what constitutes minimal equipment for aproper first aid kit and traction splints for the proper transportation.of fractures of the extremities. It is our opinion that the included rules and regulations are **reasonable** and constitute aproper exercise **of** the rula-meking Board since such rules are an‘implamentation of visions **of** Article **4590b.**

In'view of'.ouranswer toquestion.No. unnecersaty..to..anewer. question No. 2. **power** of the the pro1, it is

In **answer** to question No. 3,you are advised that if any person holding apermit tooperate an ambulance violates.such rules and regulations,the permit issued by the State Board.of Health may be revoked;.blyi$he State Board of Health upon adetermination by the.Boe& that raid permittee has failed-tooomply with the rules and regulations of the Board. Thereafter,'if such person operate8 an ambulance without avalid permit, such 

### personis subject to the penalties provided'in Section 5of Artiale 4590b. SUMMARY .The:Stats Soard,of liealfh.,aay.adopt8uch **reamonable:,ruka~hd~** regulations~~i&ating to ~ainillrrl;equigaunt"for,uPbul~~*;.ai q eon**sirtbnt.wi*,:** 

### ielated~: to;and:'.ur-.*lbsntation **of ’**  **SictioicZof** Artiola **459Ob,** ~e~On~'~~'C~vil, Statutas.~, ..

Preparedby .JohaItawes AssistantAttorney:General

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APPROVED: OPINION COMMITTEE Kerns Taylor, Chairman W. E.Allen, Acting Co-Chairman Ronald Luna Chat&es Parrett John Banks Kenneth Nordquist MJZADEF. GRIFFIN Staff Legal Assistant ALFRED WALKER Executive Assistant NOLA WHITE First Assistant

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