Sec. 30.09.14.02. General

A. To be licensed as a specialty care transport commercial ambulance service, a commercial ambulance service shall comply with the requirements of this chapter in addition to the other requirements of this subtitle.

B. An applicant for a specialty care transport commercial ambulance service license shall submit an application to SOCALR on the required form.

C. A licensed specialty care transport commercial ambulance service shall retain one or more medical directors as required by COMAR 30.03.03.

D. In addition to the qualifications in COMAR 30.03.03, the medical director for a specialty care service shall:

(1) Have educational experience in the care of the types of critically ill patients the service is transporting;

(2) Be board-certified in an appropriate specialty;

(3) Be actively practicing within a hospital clinical setting; and

(4) Use the following consultants when appropriate:

(a) Designated specialty physicians; or

(b) The patient's receiving physician.

E. The medical director for a licensed specialty care transport ambulance service shall participate in the development and implementation of any patient care guidelines required for interfacility transport of critically ill patients, including those guidelines to be followed by nursing personnel.

F. A licensed specialty care ambulance service shall immediately advise SOCALR of any change in medical directors.

G. A licensed specialty care ambulance service shall retain one or more registered nurses or nurse practitioners who:

(1) Are licensed by the Maryland Board of Nursing;

(2) Have knowledge of content which includes, but is not limited to:

(a) The transport arena (including transport team membership and role responsibility);

(b) Regulations governing COMAR 10.27.09;

(c) Documentation;

(d) Coordination with other transport team members;

(e) Knowledge and skill set appropriate to the client to be transported;

(f) Review of safety standards specific to the transport environment;

(g) Relevant components of the MIEMSS Base Station Course;

(h) Review of the MIEMSS Interhospital Transfer Resource Manual;

(i) Risk/benefit ratio assessment and triage decision-making process;

(j) Age-appropriate advanced life saving procedures, complications associated with procedures, and complications associated with delay in intervening with any of the procedures;

(k) Respiratory monitoring including differentiation between upper and lower airway obstruction, covert and overt signs of respiratory failure, and airway management;

(l) Neurological and spinal cord emergences and monitoring;

(m) Cardiovascular and hemodynamic monitoring including dysrhythmia recognition and pertinent laboratory data and interpretation;

(n) Blood and blood product administration;

(o) Knowledge of MIEMSS Maryland Medical Protocols for EMS Providers appropriate to the client population transported;

(p) Age-appropriate care algorithms and protocols;

(q) The responsibilities and accountability of the registered nurse to serve as team leader in absence of the physician;

(r) Insuring a safe environment and operational issues related to transport, including rapid egress from a trauma incident;

(s) Transport safety, which includes, but is not limited to:

(i) Safety briefing related to the vehicle;

(ii) Protective clothing; and

(iii) Mission profile;

(3) Demonstrate knowledge of the EMS system by:

(a) Completing a MIEMSS-approved base station course; or

(b) Being a currently licensed EMS provider;

(4) Comply with the requirements of COMAR 10.27.09;

(5) Screen all requests for specialty care transport; and

(6) Determine, in collaboration with the referring physician and program medical director, and in accordance with Regulation .04 of this chapter, the appropriate transport team configuration required for the patient.

H. The licensed specialty care ambulance service shall credential any registered nurse retained by the service to ensure the registered nurse meets the requirements of §G of this regulation.

I. A licensed specialty care commercial ambulance service shall have a quality assurance program required by COMAR 30.03.04 which shall include:

(1) A review by registered nurses and physicians of patient care provided during specialty care transport;

(2) A review by the program medical director or designated specialty physician of each specialty care transport:

(a) Requiring a change in the plan of care during transport;

(b) Whose condition worsened during transport;

(c) In which there was a change of destination during transport; or

(d) In which there was an unexpected outcome or event;

(3) Written documentation of reviews of specialty care transports which shall be available to SOCALR upon request;

(4) Patient feedback on outcomes to the sending facility; and

(5) A quality assurance process for call taking, call screening, and dispatch.