Sec. 30.09.07.02. Operational Requirements for Commercial Ambulance Services

A. Staffing. A commercial ambulance service shall:

(1) Staff each ambulance with a minimum of two EMS providers;

(2) Require that EMS providers:

(a) Have a valid identification card issued by MIEMSS showing the provider is licensed or certified by the EMS Board in their possession while on duty; and

(b) Upon request of SOCALR, provide their certification or license for inspection;

(3) Assure that each BLS licensed ground ambulance is staffed with:

(a) A driver who is certified as emergency medical responder or higher and possesses and, while on duty, carries a valid motor vehicle license; and

(b) An individual in addition to the driver who is an emergency medical technician or higher, who is responsible for the patient until the patient is:

(i) Discharged in accordance with written physician orders; or

(ii) Delivered to a medical facility, nursing home, residence, or other home care system appropriate for the patient's condition;

(4) Assure that each ALS licensed ground ambulance is staffed with:

(a) A driver who is certified as an emergency medical responder or higher and possesses and, while on duty, carries a valid motor vehicle license; and

(b) An individual in addition to the driver who is a licensed CRT or higher, who is responsible for the patient until the patient is:

(i) Discharged in accordance with written physician orders; or

(ii) Delivered to a medical facility, nursing home, residence, or other home care system appropriate for the patient's condition;

(5) Assure that each air ambulance is staffed with a commercial ambulance crew and as required by CAMTS;

(6) Require that each nurse who is a regular crew member be familiar with the Maryland Protocols for EMS Providers;

(7) Require all employees to clearly display personal identification in readable text which includes the:

(a) Employee's last name; and

(b) Certification or license held by the individual;

(8) Require EMS providers to wear a certification or license insignia which is clearly displayed on the EMS providers' outermost garments;

(9) Require that employees display only valid certification or license identification or insignias; and

(10) Assure that EMS providers do not wear or display identification suggesting affiliation with any other service, organization, department, company, or agency.

B. Premises. A commercial ambulance service shall:

(1) Display its commercial ambulance service license, or a copy of it, at all locations of operation in a manner clearly visible to the public, at all times;

(2) Make readily available at all times for review by employees at the operating base and all satellite bases a current copy of:

(a) COMAR 30.01;

(b) COMAR 30.02;

(c) COMAR 30.03;

(d) COMAR 30.04;

(e) COMAR 30.09; and

(f) The documents incorporated by reference in this title;

(3) Maintain the premises identified on the application in a clean and orderly manner; and

(4) Upon request from SOCALR, allow the inspection of the areas in which are located the commercial ambulance service's:

(a) Primary place of business;

(b) Satellite offices; and

(c) Records.

C. Infection Control Standards.

(1) An ambulance service shall:

(a) Use freshly laundered linen or disposable sheets and pillowcases or their equivalent for each patient;

(b) Show evidence of sanitary laundering arrangements, acceptable to SOCALR, for reusable linen;

(c) Store medical supplies in a clean and sanitary manner;

(d) Clean all equipment used after each patient; including:

(i) Ambulance stretcher; and

(ii) Stretcher mattress;

(e) Clean the patient compartment surfaces in the ambulance at least daily, and use a disinfectant in accordance with 29 CFR §1910.1030:

(i) When surfaces become obviously contaminated;

(ii) After any spill of blood or other potentially infectious material; and

(iii) Routinely throughout the work shift if contamination might have occurred;

(f) Provide adequate hand-washing facilities with:

(i) Hot and cold running water;

(ii) Antiseptic soap; and

(iii) A sanitary method for hand drying;

(g) Require that each crew member wash their hands with an antiseptic agent before and after each patient contact;

(h) Dispose of equipment or supplies that are not reusable after use;

(i) Disinfect equipment or supplies intended to be clean but not sterile after each use or when they become soiled; and

(j) Sterilize equipment or supplies after each use or when sterility has been compromised.

(2) A commercial ambulance service may not transport a corpse unless:

(a) There is a compelling public interest for moving the body or body parts;

(b) Transport is not readily available by a funeral home; and

(c) An authorized representative of the Office of the Chief Medical Examiner requests transport.

(3) After the transport of a body in accordance with §C(2) of this regulation, a commercial ambulance service shall assure that the ambulance patient compartment is disinfected.

D. Training and Continuing Education Requirements. A commercial ambulance service shall:

(1) Provide an orientation to all new employees that includes a review of:

(a) COMAR 30.02;

(b) COMAR 30.09; and

(c) The documents incorporated by reference in Title 30;

(2) Before assigning duties and at least annually thereafter provide training at no cost to all employees which includes:

(a) Blood-borne pathogens in accordance with 29 CFR §1910.1030;

(b) Hazard Communication Plan in accordance with 29 CFR §1910.1200;

(c) FDA Medical Device Reporting in accordance with 21 CFR 803 et al.; and

(d) Other training required by the Maryland Occupational Safety and Health regulations;

(3) Provide for adequate training and continuing education opportunities to fulfill the minimum recertification or license renewal requirements for EMS providers; and

(4) Absorb the cost for providing training that will meet the recertification or relicensure requirements of EMS providers who worked for the commercial service an average of 20 hours per week for the previous 12 months.

E. Medical Direction Requirements. A commercial ambulance service shall:

(1) Retain one or more participating physicians who agree to:

(a) Assume physician responsibilities for the commercial ambulance service and its EMS providers; and

(b) Comply with all applicable sections of COMAR 30.03; and

(2) Provide an EMS skills review for the commercial ambulance service's EMS providers which meets their recertification and relicensing requirements.

F. Compliance with Statutes and Regulations. A commercial ambulance service shall:

(1) Comply with all applicable laws, including:

(a) COMAR 30.02;

(b) COMAR 30.03;

(c) COMAR 30.09; and

(d) The requirements contained in Maryland Medical Protocols for Emergency Medical Providers;

(2) Maintain uninterrupted and continuous insurance coverage as required in COMAR 30.09.04.06;

(3) Monitor the care provided by its EMS providers and ambulance drivers on an ongoing basis;

(4) Within 72 hours of occurrence, report any violations of:

(a) COMAR 30.02;

(b) COMAR 30.09; or

(c) The documents incorporated by reference in this title;

(5) Comply with all local, State, and federal laws and regulations including:

(a) Transportation Article, §11-101-27-109, Annotated Code of Maryland (relating to motor vehicle and emergency vehicle operations);

(b) COMAR 11.14 (relating to motor vehicle safety requirements);

(c) Maryland Department of Health regulations under COMAR Title 10;

(d) Maryland Occupational Safety and Health regulations under COMAR 09.12;

(e) 29 CFR §1910.1030 (relating to blood-borne pathogens);

(f) 29 CFR §1910.1200 (Hazard Communications/Employee Right to Know); and

(g) 21 CFR 803 et al. (FDA Medical Device Reporting Requirements).