Dr. J. E. Peavy 

Commissioner of Health 

Opinion No. M-609 

Texas State Department of Health' Re: Validity of certain 

Austin, Texas 78756 rules and regulations 

of the State Health 

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: 

"In addition to items specifically set 

forth in S.B. 230 the following shall also be 

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 ,times the following items of equipment : 

"1. Hinged half-ring lower extremity 

splint with web straps for ankle hitch 

"2. Twoor more ~padded boards,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;.of material~compareblee..to 

four-ply woodi.:forlcoaptation splinting-of' 

fracture'of leg-or+-thigh 

*~.:~,Two or more padded 15 inch by 3 " 

inch wood or cardboard~splints for fractures 

of the forearm 

*4;' Shortiand long back boards with 2 

inch webbing.:.etraps for extrication of Victims 

with spine injuries 

-2905- 
, . 

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

“5. Oxygen tanks and masks,of assorted 

sizes for administration of oxygen 

"6. Hand operated bag-mask resuscitation 

unit with adult, child and infant size masks 

(unit capable of being attached to oxygen 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.,adhesive tape on 

Six-inch by 5 yard,soft roller type 

Triangular bandages 

Safety pins, large size 

Bandage shears 

Several pillows 

"This represents the minimal equipment list as 

prescribed by the American College ,of.Surgeons Committee 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 

-2906- 
Dr. J. E. Peavy, page 3 (M-609) 

satisfactorily complete the Emergency Care 

Training Course for ambulance attendants which 

is offered 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 as a driver. 

"C. Non-Compliance - Following notification 

by a representative of the Texas State Department of Health, Disaster Health and Medical 

Services, of non-compliance with this act or the 

rules and regulations set forth to enforce it, 

the licensee shall within 14 days: - 

"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, DIMS written notice:of cause for not 

complying with thir,act and the rules and 

regulations prescribed for enforcing it, and 

request a hearing; 

1. 3. Cease;operations and. forward his ambulance permit(s) to the Texas State Department 

of Health, DHWS by. registered mail. " 

,~ 1D. ;~.: Hearing i Whena hearing is requested 

it shall be held within 21,days from the date of 

request and will:be held at' the Texas State Department of.Health in Austin, Texas. Within 10 

days after conclusion of nuch hearing, a written 

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 

-2907- 
Dr. J. E. Peavy. page 4 (M-609) 

"(1) Since the above quoted Section 2 prescribes minimum equipment to be 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, then may the 

Board of Health, through then rule-making authority 

granted in 459033, set the minimum contents of the 

first aid.kit prescribed by Section 2a of the Act? 

"(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 5 of the 

Act? 

"(4) Are the,,existing regulations set.out 

in Attachment No. 1 valid asbeing within the 

regulatory.powers granted the,Board of Health by 

the Act? 

"(5) If approved by the Board of Health, 

will the proposed regulationo'ae set out in 

Attachment No, 2 be:valid as being within the 

regulatory powers granted the Board of Health 

by the Act?" 

Sections l~and.?..of Article 4590b, Vernon's Civil 

Statutes, provide: 

'sh& 

7Section.l;~~~d.persoa,-.,iirm:.or corporation 

operakec..or'cauee' to b?:operated, in thk, 

Stater.of.~Texae,:.any~.eoergency. arpbulance:, pu&~lio 

or private.,or imy:;other vehicle aomuon&y'.used 

for tbe.transportation:or conveyance of,the sick 

or injured., without first securing a permit 

therefor~.from the State Board of Health as 

hereinafter provided. 

"Secw 2. 'Every ambulance, ,patrol automobile..or.vehicle hereinafter .described, before permit.16 issued therefoc,, shall be 

-2908- 
Dr. J. E. Peavy, page 5 (M-609) 

equipped with and, when in service, carry as 

minimum equipment the following: 

" (a) A first aid kit; 

"lb) Traction splints fork the proper transportation.of fractures of the extremities." 

.Section 4 authorizes 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 a permit to applicants, and further 

provides: 

".Any such permit may be subject to revocation.by the State, Board of Health upon the 

finding by:~a public 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;" 

Sections j,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 'adopted by 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).:.Texas State 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 

-2909- 
Dr. J. E. Peavy, page 6 (M-609) 

equipment prescribed in the proposed rules constitutes the 

minimal equipment list as prescribed by the American College 

of Surgeons Committee on Trauma and therefore in our opinion 

properly implements Section 2 of Article 4590b. 

Your questions are therefore summarily answered. 

With reference to question Nos. 1, 4 and 5, you are advised 

that the State Board of Health, by rules and regulations, 

may define what constitutes minimal equipment for a proper 

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 a proper exercise of the rula-meking 

Board since such rules are an‘implamentation of 

visions of Article 4590b. 

In'view of'.our answer to question.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 a permit to operate 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 a determination 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 a valid permit, such person is subject to the penalties provided'in Section 5 of Artiale 4590b. 

SUMMARY 

.The: Stats Soard,of liealfh.,aay.adopt 8uch 

reamonable:,ruka~hd~ regulations~~i&ating to 

~ainillrrl;equigaunt"for,uPbul~~*;.ai q eonsirtbnt.wi*,: ielated~: to;and:'.ur-.*lbsntation 

of’ SictioicZof Artiola 459Ob, ~e~On~'~~'C~vil, 

Statutas.~, . . 

Preparedby .Joha Itawes 

Assistant Attorney: General 

-2910- 
Dr. J. E. PeaVy, page 7 (M-609) 

APPROVED: 

OPINION COMMITTEE 

Kerns Taylor, Chairman 

W. E. Allen, Acting Co-Chairman 

Ronald Luna 

Chat&es Parrett 

John Banks 

Kenneth Nordquist 

MJZADE F. GRIFFIN 

Staff Legal Assistant 

ALFRED WALKER 

Executive Assistant 

NOLA WHITE 

First Assistant 

-2911-