Sec. 30.09.07.03. Operational Requirements for Ambulances

A commercial ambulance service shall:

A. Only dispatch an ambulance if:

(1) The ambulance and crew can:

(a) Arrive at the scene within a reasonable response time;

(b) Provide appropriate transportation; and

(c) Provide appropriate medical care;

(2) The ambulance has available all of the following in adequate amounts to meet the needs of the patient being transported:

(a) Adequate supplies;

(b) Adequate equipment;

(c) All equipment assembled and ready for use, except items that are sterile;

(d) All portable oxygen cylinders which have a total of 210 liters at 1500 psi or more, excluding any cylinder with less than 500 psi;

(e) A cylinder attached to the portable oxygen administration device with more than 500 psi, and, if present, an onboard cylinder which has more than 300 psi;

(f) Sufficient oxygen available, after deducting for a safe residual pressure of 200 psi per cylinder, to meet the needs of the patient being transported based on the expected flow rate and the required duration of transport given the following formula and cylinder constants:

(GAUGE PRESSURE_{in psi} - SAFE RESIDUAL PRESSURE) X CYLINDER CONSTANT / FLOW RATE_{in liters/minute} = DURATION OF FLOW_{in minutes}

Where cylinder constants are for Size D = 0.16, Size E = 0.28, Size M = 1.56, Size G = 2.41, Size H = 3.14, and Size K = 3.14;

(g) Oxygen cylinders located in the patient compartment secured by a crash stable bracket that meets:

(i) For ground ambulances, the test requirements in Ambulance Manufacturers Division Oxygen Tank Retention Standard 003; or

(ii) For air ambulances, FAA requirements;

(h) Oxygen cylinders located in a compartment other than the patient compartment secured in a bracket appropriate for the cylinder that has:

(i) A positive locking latch, and

(ii) Both latch and hinges bolted to the door frame structure;

(i) Communication equipment required in COMAR 30.09.10.04C which:

(i) Is reliable, and

(ii) Can properly communicate with the ambulance services dispatch center from the time of dispatch until time call is completed;

(j) Communication equipment required in COMAR 30.09.10.04D which:

(i) Is reliable,

(ii) Can properly communicate with online medical control in Maryland, and

(iii) Meets the specifications set forth by the MIEMSS Emergency Medical Services Communications;

(k) A reliable means of communication from the point of dispatch until the patient reaches the final destination;

(3) The ambulance crew is adequately trained to safely:

(a) Operate an ambulance; and

(b) Use the equipment and supplies onboard;

B. Place medical supplies out of service as they expire and properly discard medical supplies which are expired;

C. Place malfunctioning medical equipment out of service until the equipment has been repaired or replaced;

D. Have an adequate number of AEDs to provide one AED on every:

(1) BLS licensed ambulance in service; and

(2) ALS licensed ambulance in service operating as a BLS ambulance;

E. For ground ambulances, have each ambulance inspected every 12 months by an inspection station licensed under Transportation Article, §23-103, Annotated Code of Maryland;

F. For ground ambulances, designate and maintain ambulances as emergency vehicles by equipping them with necessary:

(1) Lights;

(2) Sirens; and

(3) Special markings;

G. Under Transportation Article, §11-118, Annotated Code of Maryland, equip and operate only ambulances as emergency vehicles;

H. Always operate each ambulance with due regard for the public;

I. Only use emergency warning lights and audible warning devices when:

(1) En route to an emergency as a result of a call for assistance made directly to the commercial ambulance service; or

(2) Transporting a priority 1 patient;

J. Maintain in proper working order and good physical condition and, where applicable, meet all manufacturers recommendations for all:

(1) Equipment; and

(2) Ambulances;

K. Display the ambulance license, or a copy, in the patient compartment in a manner clearly visible to the patient;

L. Prohibit smoking or the carrying of lighted tobacco products on ambulances;

M. For ground ambulances, prohibit an ambulance to be driven, and may not allow any passengers or patients on board, until necessary repairs are completed and an inspection conducted if any of the following occur:

(1) An occupant complains of symptoms associated with or has been affected by carbon monoxide as a result of riding in the ambulance;

(2) Carbon monoxide levels at or above 9 parts per million are detected in the interior of the ambulance; or

(3) A mechanical condition is discovered that is reasonably likely to produce a carbon monoxide hazard to the occupants;

N. Assure occupants are safely transported in ambulances by:

(1) Requiring all occupants to wear safety restraints, except as necessary to attend to a patient;

(2) Requiring all patients to be secured to stretchers in accordance with the stretcher manufacturer's recommendation, except as may be necessary for treatment;

(3) For ground ambulances:

(a) Operating an ambulance only when the ambulance is equipped with devices that comply with federal motor vehicle safety standards (49 CFR Part 571) for:

(i) Restraints;

(ii) Anchors; and

(iii) Mechanisms; and

(b) Transport children younger than 4 years old, who are passengers and not patients, only in the front passenger compartment when:

(i) The child is secured in a child passenger restraint system which meets State and federal motor vehicle safety standards; and

(ii) The vehicle is not equipped with a passenger air bag;

O. Stow or adequately fasten all medical devices, supplies, or equipment to the satisfaction of SOCALR to prevent items from becoming projectiles that might cause injury in an abrupt stop or crash;

P. Assure that compartments used to carry heavier items, first aid kits, portable oxygen cylinders, suction units, intravenous pumps, ventilators, and monitors have positively locking latches:

(1) With both latch and hinge bolted to the door and frame structure; and

(2) That are designed to remain closed in an abrupt stop or crash, including rollovers; and

Q. Carry intravenous fluids, saline, sterile water, or other fluids only in bags or plastic bottles unless:

(1) A specific required fluid is only available in a glass container; and

(2) Protective measures are employed to protect occupants from broken glass in the event of breakage.