Sec. 30.09.14.07. Additional Equipment and Medication Requirements for Specialty Care Transport Ambulances

A. All specialized medical devices used during transport shall:

(1) If provided by the hospital, be maintained by the hospital; or

(2) If provided by the licensed commercial ambulance services be maintained as recommended by the manufacturer.

B. The licensed commercial service providing specialized medical devices used during transport shall maintain records documenting maintenance and repair services.

C. There shall be a means of communicating directly with the consulting specialty care physician and medical director.

D. All on-board medical devices shall be secured.

E. In addition to the equipment required in COMAR 30.09.10 and 30.09.11, the following shall be carried in a licensed ambulance when providing specialty care and shall be age and weight appropriate for the patient being transported:

(1) A means of blending oxygen and air to deliver varying concentrations of medical oxygen;

(2) One portable electric suction unit which:

(a) Meets the criteria in COMAR 30.09.10.06B; and

(b) Is adjustable down to 60 millimeters mercury (Hg);

(3) Intravascular Equipment and Supplies:

(a) Four infusion pumps or equivalent;

(b) Six intravenous (IV) pump tubing sets;

(c) Six extension sets;

(d) Eight stopcocks;

(e) Two blood infusion sets;

(f) Two intravenous (IV) filters;

(g) Eight total needles of assorted sizes ranging from 22 gauge to 18 gauge;

(h) When transporting adult patients:

(i) Two 1,000 cubic centimeter bags or equivalent of normal saline or Lactated Ringer's Solution;

(ii) Two 1,000 cubic centimeter bags or equivalent of maintenance intravenous solution; and

(iii) Twelve total syringes of assorted sizes ranging from 1 cubic centimeter to 60 cubic centimeters;

(i) When transporting pediatric patients:

(i) Two 250 cubic centimeter bags or equivalent of normal saline or Lactated Ringer's Solution;

(ii) Two 250 cubic centimeter bags or equivalent of maintenance intravenous solution; and

(iii) Twelve total syringes of assorted sizes ranging from 1 cubic centimeter to 2 cubic centimeters;

(4) Ventilation and airway maintenance equipment and supplies capable of at least the following:

(a) Oxygen concentrations between 21 and 100 percent;

(b) Peak pressures between 0 and 99;

(c) Adjustable inspiratory time;

(d) Selectable intermittent mandatory ventilation (IMV);

(e) Positive end expiratory pressure (PEEP) between 2-15 centimeters of water;

(f) Adjustable ventilatory rates between 0 and 60 breaths per minute;

(g) Adjustable tidal volume for adult patients between 200 milliliters and 1,000 milliliters or greater;

(h) Adjustable tidal volume for pediatric patients as low as 50 milliliters;

(i) Adjustable high and low pressure alarms; and

(j) Two ventilator circuits;

(5) Monitoring Equipment:

(a) One cardiac monitor which meets the criteria of COMAR 30.09.11.03B;

(b) Noninvasive blood pressure monitor;

(c) Invasive blood pressure monitor;

(d) End tidal carbon dioxide monitor with waveform display/recorder capable of providing quantitative reading; and

(e) Oxygen saturation monitor;

(6) Miscellaneous supplies and equipment:

(a) When transporting adult patients:

(i) One surgical and one needle crichthryotomy kit with transtracheal catheter ventilation system;

(ii) Replacement tracheostomy tubes, one of each size 6 and 8 millimeters;

(iii) One pleurevac;

(iv) One electronic thermometer; and

(v) Two surgical clamps capable of clamping up to a 40 french chest tube;

(b) When transporting pediatric patients:

(i) One surgical and one needle crichthryotomy kit with transtracheal catheter ventilation system;

(ii) Replacement tracheostomy tubes one each size 1, 2, 3, and 4 millimeters, and age-appropriate size during transport;

(iii) One pleurevac;

(iv) One electronic thermometer; and

(v) Two surgical clamps; and

(7) Medications including:

(a) All ALS medications listed in the Maryland Medical Protocols for Emergency Medical Service Providers; and

(b) Additional medications approved for use by the specialty care service medical director to meet the needs of the types of patients being transported.

F. A list of the additional medications used by the specialty care service shall be provided to SOCALR and shall be available on each ambulance when in use for a specialty care transport.

G. SOCALR shall be notified in writing of any changes to the list of additional medications used by the specialty care transport service, other than a temporary change resulting from a medication shortage, within 7 days of the change.

H. There shall be sufficient quantities of medications to care for one patient for the longer of:

(1) 1 hour; or

(2) Two times the estimated time of transport.

I. If the ambulance is also licensed as a neonatal ambulance under COMAR 30.09.12, the vehicle does not need to carry duplicates of required items.