Options for operating ground ambulances in Colorado without a state license: deploying for wildfires, major catastrophes, and other disasters

During normal operations, Colorado requires ground ambulance agencies to be licensed by the state if they are transporting patients who originate in Colorado. No license is required if an out-of-state ambulance is transporting a patient into Colorado. This document lists the options for out-of-state ambulances to legally provide services in Colorado during wildfires, major catastrophes, and other disasters. Note: This document does not address the licensing/certification of EMS providers (EMT, AEMT, EMT-I, Paramedic) because they are regulated separately - *see below for details*). 

Please reach out to the EMTS Branch if you have any questions by email cdphe_groundambulance@state.co.us or phone (303) 691-4932.

Requirements overview: Options for operating Ground Ambulances in Colorado without a state license

Requirements Description

1. Evacuation Vehicles

Subject to EMS Rules 6 CCR 1015-3, Chapter 4, 3.3.2

Out-of-state ambulance agencies working inside the controlled zone of a wildfire can operate without a Colorado license while under the direct supervision of the incident command onsite. These agencies are only allowed to transport within this zone, and shall hand off patients to an agency that holds a Colorado license at the border of the controlled zone to complete transport.

2. Ambulances during a major catastrophe or emergency

Subject to EMS Rules 6 CCR 1015-3, Chapter 4, 3.3.3

Out-of-state ambulance agencies may operate inside of Colorado without a license when the following conditions are met:

• There is a major catastrophe or emergency and there are not enough Colorado licensed agencies to provide proper coverage.
• Agencies should not self-dispatch to the incident; rather, they should wait to be requested by and work directly with the onsite incident command.
• State Statute: 25-3.5-314(2)(b), C.R.S. A vehicle rendering services as an ambulance during a major catastrophe or emergency when ambulances with authorizations to operate in the county or city and county in which the major catastrophe or emergency occurred or is occurring are insufficient to render the ambulance services required;

3. Become a licensed ambulance agency in Colorado

Start the process to become a licensed agency in Colorado. There are two separate paths:

• Complete a Provisional Ground Ambulance License Application in OATH
• Complete a Ground Ambulance Licensing Application in OATH
• Requirements include but are not limited to:

• Registration of a medical director who is a Colorado-licensed physician
• Electronic submission of ePCR within 48 hours that meets the NEMSIS 3.5 standards
• Submission of required policies as required
• Fingerprint-based background check of the Owner/Operator

4. Regional And Statewide Mutual Aid System (RSMAS): Colorado Mutual Aid System (CMAS)

• Colorado Mutual Aid System
• CMAS Quick Reference Guide
• Rules adopted by the Division of Fire Prevention and Control at 8 CCR 1507-38, pursuant to Section 24-33.5-1235, C.R.S.

5. Emergency Management Assistance Compact (EMAC)

• EMAC has been ratified by U.S. Congress (PL 104-321) and is law in all 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and the Northern Mariana Islands.
• Requires a governor's emergency disaster declaration to activate EMAC resource request process. Resources are deployed as requested in the EMAC Resource Support Agreement and as permitted by the EMAC legislation.
• Professionals licensed, certified, or permitted in an EMAC participating state can provide aid in another compact state when requested and fulfilling mission deployment orders during an emergency or coordinated training, as if licensed in the state receiving aid.
• When fulfilling an EMAC request, no additional documentation is required by the EMTS branch unless specified by the governor's declaration, executive order, or other executive action.
• Learn more about EMAC.

6. Governor’s Declaration or Executive Order

• The Governor can declare an emergency or give an Executive Order expanding the ability of EMS providers and/or agencies to practice in the state of Colorado.
• Certain licensing requirements may be waived by a Governor's Declaration, Executive Order, or other administrative actions. Information about any governor's declarations or executive orders will be made available at coems.info.

*EMS providers are required to be certified or licensed in Colorado or be certified or licensed in a state that participates in the EMS COMPACT.* Please see the Out-of-State EMS Providers Deployed for Wildfires & Disasters.

FAQs:

Q: My agency needs a letter of exemption for our federal contract. Can your office provide the letter?

A: Please reach out to the EMS Operations team at cdphe_groundambulance@state.co.us or call (303) 691-4932 to get started.

Q: Are my EMS providers certified/licensed in Colorado or the EMS Compact?

A: OATH public lookup for providers OR Is my state a part of the EMS Compact?

Q: Do my EMS providers need to be overseen by a licensed physician to practice as EMS providers?

A: Yes. See 6 CCR 1015-3, Chapter 2 for rules regarding medical direction by a Colorado licensed physician OR the EMS Compact administrative rules for provider privilege-to-practice.

Q: How does my owner/operator complete fingerprint background checks if there is not a vendor location near them?

A: Please contact one of the approved fingerprint vendors to discuss available options to send paper fingerprint cards. Paper fingerprint cards cannot be accepted by our office and will be returned to you and may delay application processing time.

Q: How can I find a licensed agency?

A: Ground Ambulance License status can be verified online in the OATH public lookup 

Q: What are the technology requirements to access OATH?

A: Online access is required to complete your application in OATH. Google Chrome is the recommended browser on a Windows or Mac platform. The application is also accessible in mobile format by most smartphone devices and tablets, where built in cameras can be used to capture and upload the required attachments.

Q: What do I do if I still have questions about getting my agency licensed in Colorado?

A: Please reach out to the EMS Operations team at cdphe_groundambulance@state.co.us or call (303) 691-4932.

Links: 

Colorado Department of Public Health and Environment, Emergency Medical and Trauma Services Branch: http://coems.info

Online Application Tracking Hub (OATH): https://colorado.emsbridge.com/licensure/public/colorado/portal#/login

Colorado EMS Rules 6 CCR 1015-3