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ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
air ambulance services
Purpose
Defines air ambulance and conforms statutes relating to the regulation of ambulances to include air ambulances.
Background
The Director of the Department of Health Services (DHS) is responsible for adopting rules and regulations governing ambulance operations, including medical equipment and supply requirements and staffing and safety standards. DHS also establishes certification standards for emergency medical care technicians and regulates emergency medical services in Arizona (A.R.S. § 36-2202).
The Medical Director of the Statewide Emergency Medical Services and Trauma System, the Emergency Medical Services Council and the Medical Direction Commission must recommend, to the Director of DHS: 1) statewide standardized training, certification and recertification standards for all classifications of emergency medical care technicians; 2) a standardized and validated testing procedure for all classifications of emergency medical care technicians; and 3) standards for ambulance service and medical transportation that give consideration to the differences between urban, rural and wilderness areas (A.R.S. § 36-2204).
An ambulance is any publicly or privately owned surface, water or air vehicle, including a helicopter, that contains a stretcher and necessary medical equipment and supplies as prescribed and that is especially designed and constructed or modified and equipped to be used, maintained or operated primarily to transport individuals who are sick, injured or wounded or who require medical monitoring or aid (A.R.S. § 36-2201).
A helicopter air ambulance operation is a flight, or sequence of flights, with a patient or medical personnel on board for the purpose of medical transportation by a person or entity with prescribed certification to conduct helicopter air ambulance operations. States may regulate staffing requirements, personnel qualifications, equipment requirements and the promulgation of standards for maintenance of sanitary conditions in helicopter air ambulances. However, any state law to regulate air ambulance safety, prices, routes or services is preempted by federal regulations, which further prescribe requirements relating to certification, instruments and operating procedures (14 C.F.R. § 135; USDOT).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Defines air ambulance as any publicly or privately owned aircraft with outlined certification that contains a stretcher and necessary medical equipment and supplies that is specifically designed and constructed or modified and equipped to be used, maintained or operated primarily to transport individuals who are sick, injured or wounded or who require medical monitoring or aid.
2. Defines air ambulance attendant to mean a:
a) paramedic whose primary responsibility is caring for patients in an air ambulance and who meets outlined medical control standards;
b) licensed respiratory therapist;
c) physician;
d) licensed professional nurse whose primary responsibility is caring for patients in an air ambulance; or
e) licensed nurse practitioner.
3. Modifies the definition of ambulance to remove an air vehicle, including a helicopter, and to specify that a qualified vehicle must be specifically, rather than especially, designed and constructed or modified and equipped to be used, maintained or operated primarily to transport individuals who are sick, injured or wounded or who require medical monitoring or aid.
4. Defines air ambulance service as a person or organization that owns and operates one or more air ambulances or that leases from an air carrier the use of one or more certificated air ambulances for the purpose of providing emergency medical services in air ambulances.
5. Requires the Director of DHS, in adopting standards, criteria and procedures for air ambulance certification, to require an air ambulance service providing interfacility transportation to staff each air ambulance transporting a patient with:
a) one air ambulance attendant who is a physician, licensed nurse or nurse practitioner; and
b) one air ambulance attendant who is a paramedic, licensed respiratory therapist or nurse.
6. Specifies that statutes relating to DHS investigations of ambulance operations and services apply to air ambulances and air ambulance services only to the extent that:
a) the complaint or proceedings relate to the emergency medical services provided by the air ambulance or air ambulance service; and
b) the investigation does not conflict with any federal law or regulation governing air carriers.
7. Removes the requirement that DHS rules for air ambulance services must establish response and operation time standards to assure public health and safety.
8. Makes technical and conforming changes.
9. Becomes effective on the general effective date.
House Action
HHS 1/22/26 DP 12-0-0-0
3rd Read 2/23/26 56-1-3
Prepared by Senate Research
March 2, 2026
MM/SDR/ci