No. 39550 (Amendment): Rule R426-4. Operations

(Amendment)

DAR File No.: 39550
Filed: 07/29/2015 09:26:31 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to include public comment from the previous revision, and directives from the EMS (emergency medical services) Rules Task Force.

Summary of the rule or change:

The rule incorporates public comment, removes redundant language, clarifies terms, uses standardized terms, and reflects best practice for the Emergency Medical Services Act (Title 26, Chapter 8a).

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 8a

Anticipated cost or savings to:

the state budget:

No anticipated change to the fiscal state budget. Amendments did include additional complaint requirements, but impacts will be absorbed as operational costs to the Department of Health.

local governments:

No anticipated change to the fiscal impact for local governments. Amendments did not change staffing requirements, required standards for operation, or related operational procedures.

small businesses:

No anticipated change to the fiscal impact for small businesses. Amendments did not change staffing requirements, required standards for operation, or related operational procedures.

persons other than small businesses, businesses, or local governmental entities:

No anticipated change to the fiscal impact for businesses. Amendments did not change staffing requirements, required standards for operation, or related operational procedures.

Compliance costs for affected persons:

Compliance costs for do not appear to be impacted by amendments. No items were added to increase costs.

Comments by the department head on the fiscal impact the rule may have on businesses:

This change has minimal fiscal impact on business in that it follows best practices which EMS providers currently observe.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Emergency Medical Services
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Guy Dansie at the above address, by phone at 801-273-6671, by FAX at 801-273-4165, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

09/14/2015

This rule may become effective on:

09/21/2015

Authorized by:

David Patton, Executive Director

RULE TEXT

R426. Health, Family Health and Preparedness, Emergency Medical Services.

R426-4. Operations.

R426-4-100. Authority and Purpose.

[(1) ]This rule is established under Title 26, Chapter 8a. It establishes standards for the operation of EMS providers licensed or designated under the provisions of the Emergency Medical Services System Act.

[(2) The purpose of this rule is to set forth air and ground ambulance policies, rules, and standards adopted by the Utah Emergency Medical Services Committee, which promotes and protects the health and safety of the people of this state.

(3) The definitions in Title 26, Chapter 8a are adopted and incorporated by reference into this rule.

]

R426-4-200. [Staffing]Ground Ambulance and QRV Staffing.

(1) While responding to a call, each [Quick response units]QRV shall be staffed by at least one [provider]individual certified at or above [their]the provider's designated level of service.

(2) While responding to a call, each [G]ground ambulance[or Paramedic services] shall be staffed[have the following] with the following minimum complement of certified personnel for the service level described:

(a) Basic Life Support ambulance : [services staffing shall be at least ]two [certified ]EMTs, AEMTs, [EMT-IA, ]or paramedics , or any combination thereof.

(b) AEMT ambulance : [services staffing shall be at least ]one [certified EMS Professional at the level of their service and one more certified provider at EMT level or higher]AEMT and one EMT, AEMT, or paramedic.

(c) EMT-IA ambulance : [services staffing shall be at least ]one [certified EMS Professional at the level of their service and one more certified provider at EMT level or higher]EMT-IA and one EMT, AEMT, or Paramedic.

(d) Paramedic ambulance[services]: [staffing shall be at least ]one paramedic and one EMT, AEMT, EMT-IA, or paramedic.

(e) Paramedic (non-transport): [services staffing shall be at least ]one paramedic.

(f) Paramedic inter-facility: [services staffing shall be ]one paramedic and [at least ]one EMT, AEMT, EMT-IA, or paramedic.

(g) Paramedic tactical: one paramedic.

(3) [Licensed]A paramedic ground ambulance or paramedic [services]provider shall deploy two paramedics to the scene of 911 calls for service requiring Advanced Life Support[ALS] response, unless otherwise determined by local selective medical dispatch system protocols.

[(4) Air ambulance services providing advanced life support must have at least one medical attendant who is a Paramedic, PA, RN, or MD/DO. This attendant shall be the primary medical attendant. The second medical attendant shall be a Paramedic, PA, Respiratory Therapist, RN, or MD/DO.

(5) Air ambulance services providing specialized life support must have at least one medical attendant who is an RN or MD. This attendant shall be the primary medical attendant. The second medical attendant shall be a Paramedic, PA, RT, RN, or MD/DO.

] [(6)](4) When providing care, responders not in a[n agency]Department approved uniform shall display their level of medical certification.

([7]5) Each [designated or licensed agency]provider shall maintain a personnel file for each certified individual. The personnel file must include records documenting the individual's qualifications, training, certification, immunizations, and continuing medical education.

([8]6) [A provider may only perform to the service level of the licensed or designated service, regardless of the certification level of the provider.]An individual may perform only to his certified service level, even if the provider is licensed or designated at a higher level.

 

R426-4-210. Air Ambulance Staffing.

(1) Air ambulance provider shall have at least one medical attendant who is a licensed PA, RN, or MD/DO. This attendant shall be the primary medical attendant. The second medical attendant shall be a Paramedic, PA, Respiratory Therapist, RN, or MD/DO.

(2) Air ambulance providers shall operate only within their accreditation standards designation.

(3) Air ambulance providers shall notify the Department if the air ambulance provider changes its specialty designation through its accrediting agency.

 

R426-4-300. Permits and Inspections.

[(1) The Department requires an annual inspection on all air and ground licensed vehicles, quick response designated vehicles, and emergency medical dispatch centers to assure compliance.

(a) Ambulance vehicles must meet Federal General Services Administration Specification for ground ambulances as of the date of manufacture and new vehicles must meet current state approved specifications for ground ambulances.

(b) All vehicles must pass an inspection of the equipment and vehicle supply requirements pursuant to R426-4-900 Ground Ambulance Vehicle Supply Requirements or R426-4-1000 Air Ambulance Supply Requirements.

(2) After successful completion of an inspection, the Department shall issue a permit for a period of one year from the date of issue and shall remain valid for that period, unless revoked or suspended by the Department.

(3) All air or ground ambulance, licensed and designated providers must annually obtain a permit from the Department to operate in Utah. The current permit decal shall be displayed in a visible location on the vehicle. Showing the permit expiration date and permit number issued by the Department prominent on a publicly visible place on the vehicle as evidence of compliance.

(4) Air Ambulance permit holder shall meet all Federal Aviation Regulations specific to the operations of the air medical service.

(5) The Department shall issue annual permits for vehicles used by licensees only if the new or replacement ambulance meets the requirements listed in R426-4-900.

(6) The Department may give consideration for a waiver from the requirements of R426-4-900 to communities with limited populations or unique problems for purchase and use of ambulance vehicles.

(7) Permits and decals are not transferable to other vehicles.

] (1) A ground ambulance, QRV or air ambulance provider shall only use vehicles for which the provider has obtained a permit from the Department.

(a) Ground ambulances must meet Federal General Services Administration Specification for ground ambulances as of the date of manufacture. New ground ambulance vehicles must meet current state approved specifications for ground ambulances.

(b) QRVs shall meet the Department requirements.

(2) A permit issued by the Department is valid for one year.

(3) The provider shall display the current permit location on vehicle in a location easily visible at ground level from outside of the vehicle.

(4) Permits and decals are not transferable to other vehicles.

(5) Each permit holder shall annually provide proof that every operator of an emergency vehicle has successfully completed an emergency vehicle operator's course approved by the Department for all emergency vehicle operators.

 

R426-4-310. Air Ambulance Shall Meet Federal Aviation Regulations.

Air Ambulance providers shall meet all Federal Aviation Regulations specific to their operations.

 

R426-4-400. [Vehicle Operations]Ground Ambulance and QRV Operations.

(1) Each ground ambulance provider or QRV provider[Licensees] shall notify the Department of the permanent location of its ground ambulances and QRVs.[or where of the vehicles will be staged if using staging areas.] The ground ambulance provider or QRV provider[licensee] shall notify the Department in writing whenever it changes the permanent location for [each vehicle]any ground ambulance or QRV.

(2) [Vehicles shall be maintained]Each ground ambulance provider or QRV provider shall maintain each operational permitted vehicle on a premise suitable to make it available for immediate use, in good mechanical repair, properly equipped, and in a sanitary condition.

(3) Each ground ambulance provider or QRV provider shall [be maintained]maintain each operational vehicle in a clean condition with the interior being thoroughly cleaned after each use in accordance with OSHA standards and the [agency's]provider's exposure control plan.

(4) Each ground ambulance provider or QRV provider shall equip[be equipped] each operational vehicle with adult and child safety restraints. [and to]To the point practicable [when]and feasible , all occupants must be safely restrained during operation.

[(5) An air medical service ambulance shall comply with all state and federal requirements governing the specific vehicles utilized for air medical transport services.

(6) Each licensee is responsible for assuring that its vehicles are driven by only trained, experienced, and otherwise qualified personnel. The licensee must, at a minimum document that each of its drivers:

(a) Is at least 18 years of age;

(b) possesses a valid driver's license

(c) is trained in the safe operation of emergency vehicles, has completed an approved emergency vehicle operator's course;

(d) and possesses a valid cardiopulmonary resuscitation card.

(7) Personnel who do not hold a currently approved emergency medical technician certification are subject to:

(a) Application;

(b) Bureau of Criminal Investigations background check;

(c) and registration with the Department

(d) Upon successful completion of required items the Department shall issue a driver only registration card.

(8) The Department shall annually inspect licensees for verification of compliance with this section. Services that are unable to verify compliance are subject to disciplinary action Subsection 63G-3-201(5) and Section 26-23-6.

] (5) Each ground ambulance provider or QRV provider shall assure that each emergency vehicle operator who may drive the emergency vehicle:

(a) is at least 18 years of age;

(b) possesses a valid driver license;

(c) successfully passed the provider's criminal background check within the prior four years; and

(d) successfully completed a department approved emergency vehicle operator's course or refresher course within the past two years.

(6) The Department shall verify annually that providers are in compliance with this requirement.

 

[R426-4-500. Complaint Process.

(1) All complaints must be written and have complainant's contact information. Complaints will follow Department's Policy and will be investigated by the appropriate Department's staff.

(2) The Department will conduct an interview with the provider regarding the substance of the complaint and allow the provider a reasonable opportunity to respond to the allegations of the complaint.

(3) If the complaint is not deemed meritorious, the provider shall receive written notification from the Department that the complaint is unsubstantiated.

(4) A complaint deemed meritorious against the provider will require the Department to inform the provider in writing within 30 days;

(a) upon receipt of the written notification the provider will submit a corrective action plan within 45 days to the Department for approval. Extensions will be at the discretion of the Department;

(b) if the corrective action plan is determined to be inadequate by the Department, the Department will make recommendations for an agreeable corrective action plan; and

(c) for non-911 providers, the relevant political subdivision will be notified of the complaint and if applicable may issue a Request for Proposal according to 26-8a-405.4(3)(a)(ii)(B)(II).

 

]R426-4-[600]500 . Scene and Patient Management.

[(1) Upon arrival at the scene of a medical call injury or illness, the field EMS personnel shall establish radio or telephone contact with on-line medical control, as specified by agency protocol.

(2) If radio or telephone contact cannot be obtained, the field EMS personnel shall so indicate on the EMS report form and follow local written protocol;

(3) if there is a licensed physician at the scene who wishes to assist or provide on-scene medical direction to the field EMS personnel, the field EMS personnel may follow his/her instructions, but only until communications are established with on-line medical control. If the proposed treatment from the on-scene physician differs from existing EMS triage, treatment, and transport protocols and is contradictory to quality patient care, the field EMS personnel should revert to existing EMS triage, treatment, and transport protocols for the continued management of the patient.

] (1) Emergency medical service dispatch centers shall use a selective medical dispatch system to determine which EMS service provider will be notified for patient transport.

(2) When responding to a medical emergency call, EMS personnel shall follow protocols approved by the service provider's medical director, and act within their scope of practice.

(3) EMS personnel shall establish communication with on-line medical control as soon as reasonable.

(4) Paramedic tactical service may only function at the invitation of the local or state public safety authority. When called upon for assistance, the tactical paramedic shall immediately notify the local emergency medical service dispatch center to coordinate patient transportation.

[(a) If the physician at the scene wishes to continue directing the field EMS personnel's activities, the field EMS personnel shall so notify on-line medical control;

(b) the on-line medical control may:

(i) allow the on-scene physician to assume or continue medical control;

(ii) assume medical control, but allowing the physician at the scene to assist; or

(iii) assume medical control with no participation by the on-scene physician.

(c) If on-line medical control allows the on-scene physician to assume or continue medical control, the field EMS personnel shall repeat the on-scene physician's orders to the on-line medical control for evaluation and recording. If, in the judgment of the on-line medical control that is monitoring and evaluating the at-scene medical control, the care is inappropriate to the nature of the medical emergency, the on-line medical control may reassume medical control of the field EMS personnel at the scene.

(4) A paramedic tactical rescue may only function at the invitation of the local or state public safety authority. When called upon for assistance, it must immediately notify the local ground ambulance licensee to coordinate patient transportation.

]

R426-4-[700]600 . Pilot Projects.

(1) A person who proposes to undertake a research or study project which requires waiver of any rule must have a project director who is a physician licensed to practice medicine in Utah, and [must]shall submit a written proposal to the Department for presentation to the EMS Committee for recommendation.

(2) The proposal shall include the following:

(a) A project description that describes the:

(i) need for project;

(ii) project goal;

(iii) specific objectives;

(iv) approval by the [agency]provider off-line medical director;

(v) methodology for the project implementation;

(vi) geographical area involved by the proposed project;

(vii) specific rule or portion of rule to be waived;

(viii) proposed waiver language; and

(ix) evaluation methodology.

(b) A list of the EMS providers and hospitals participating in the project;

(c) a signed statement of endorsement from the participating hospital medical directors and administrators, the director of each participating paramedic and ambulance licensee, other project participants, and other parties who may be significantly affected.

(d) If the pilot project requires the use of additional skills, a description of the skills to be utilized by the field EMS personnel and provision for training and supervising the field EMS personnel who are to utilize these skills, including the names of the field EMS personnel.

(e) The name and signature of the project director attesting to his support and approval of the project proposal.

(3) If the pilot project involves human subjects' research, the applicant must also obtain Department Institutional Review Board approval.

(4) The Department or Committee, as appropriate, may require the applicant to meet additional conditions as it considers necessary or helpful to the success of the project, integrity of the EMS system, and safety to the public.

(5) The Department or Committee, as appropriate, may initially grant project approval for one year. The Department or Committee, as appropriate, may grant approval for continuation beyond the initial year based on the achievement and satisfactory progress as evidenced in written progress reports to be submitted to the Department at least 90 days prior to the end of the approved period. A pilot project may not exceed three years;

(6) the Department or Committee, as appropriate, may only waive a rule if:

(a) the applicant has met the requirements of this section;

(b) the waiver is not inconsistent with statutory requirements;

(c) there is not already another pilot project being conducted on the same subject; and

(d) it finds that the pilot project has the potential to improve pre-hospital medical care.

(7) Approval of a project allows the field EMS personnel listed in the proposal to exercise the specified skills of the participants in the project. The project director shall submit the names of field EMS personnel not initially approved to the Department.

(8) The Department or Committee, as appropriate, may rescind approval for the project at any time if:

(a) Those implementing the project fail to follow the protocols and conditions outlined for the project;

(b) it determines that the waiver is detrimental to public health; or

(c) it determines that the project's risks outweigh the benefits that have been achieved.

(9) The Department or Committee, as appropriate, shall allow the EMS provider involved in the study to appear before the Department or Committee, as appropriate, to explain and express its views before determining to rescind the waiver for the project.

(10) At least six months prior to the planned completion of the project, the medical director shall submit to the Department a report with the preliminary findings of the project and any recommendations for change in the project requirements.

 

R426-4-[800]700 . Confidentiality of Patient Information.

[Licensees, designees, and EMS certified individuals]Providers shall not disclose patient information except as necessary for patient care or as allowed by statute or rule.

 

R426-4-[ 900 ] 800 . [ Vehicle ] Ground Ambulance and QRV Supply Requirements.

(1) In accordance with the licensure or designation type and level, the ground ambulance or QRV shall carry on each [permitted ]vehicle the [minimum ]quantities of supplies, medications, and equipment as described in [this subsection]the Department inspection requirements.[Optional items are marked with an asterisk.

(a) For any medication used (whether required or optional) it is the responsibility of the Medical Director to provide the protocols, training, and quality assurance for each crew member.

(b) American Heart Association (AHA) regularly updates the guidelines for acute cardiac care. As a result, certain equipment or medications may be recommended by the most current AHA guidelines that are not included in this rule. Agency medical directors may authorize the use of these new medications or equipment in accordance with such revised AHA guidelines. Waivers for such medications/equipment will not be required, however agencies shall report to the Bureau the use of any AHA recommended medications/equipment not specifically mentioned in this rule.

(c) In times of drug shortages, the Department, in consultation with the State EMS Medical Director, may approve alternative medications as requested, or approve use of medications less than 6 months beyond their expiration date.] The vehicle requirements shall be approved by the State EMS Medical Director and the State EMS Committee.

(2) Medical directors for licensed or designated providers are responsible to provide protocols, training, and quality assurance for all medications used by certified individuals performing duties for their respective provider.

(3) If a licensed or designated provider desires to carry different equipment, supplies, or medication from the vehicle supply requirements, the provider shall submit a written request from the off-line medical director to the Department requesting the waiver. The request shall include:

(a) a detailed training outline;

(b) protocols;

(c) proficiency testing

(d) support documentation;

(e) local EMS Council or committee comments; and

(f) a detailed letter of justification.

(4) All non-disposable equipment shall be designed and constructed of materials that are durable and capable of withstanding repeated cleaning. The provider:

(a) shall clean the equipment after each use in accordance with OSHA standards;

(b) shall sanitize or sterilize equipment prior to reuse;

(c) shall not reuse equipment intended for single use;

(d) shall clean and change linens after each use; and

(e) shall store or secure all equipment in a readily accessible and safe manner to prevent its movement.

(5) The provider shall have all equipment tested, maintained, and calibrated according to the manufacturer's standards.

(6) The provider shall document all equipment inspections, testing, maintenance and calibrations. Testing or calibration conducted by an outside service shall be documented. Such inspections, testing and calibration shall be performed monthly. All testing documentation shall be maintained and available for Department review upon request.

(7) A provider required to carry any of the following equipment shall perform monthly inspections to ensure proper functionality:

(i) defibrillator, manual, or automatic;

(ii) autovent;

(iii) infusion pump;

(iv) glucometer;

(v) flow restricted, oxygen-powered ventilation devices;

(vi) suction equipment;

(vii) electronic Doppler device;

(viii) automatic blood pressure/pulse measuring device;

(ix) pulse oximeter; and,

(x) any other electronic, battery powered, or critical care device.

(8) The provider shall perform monthly inspections to ensure proper functionality of all equipment that require consumables: power supplies, electrical cables, pneumatic power lines, hydraulic power lines, or related connectors.

(9) Unless otherwise authorized by the State EMS Medical Director, a provider shall store all medications according to the manufacturers' recommendations:

(a) for temperature control and packaging requirements; and

(b) return to the supplier for replacement of any medication known or suspected to have been subjected to temperatures outside the recommended range.

(10) The Department shall maintain and publish requirements for ground ambulances and QRVs on the Department's website.

[(2) Equipment and Supplies:

(a) EMR Quick Response Unit

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Heavy duty shears

2 Universal sterile dressings, 9" x 5", 10" x 8", 8" x 9", or equivalent

12 Gauze pads, sterile, 4" x 4"

8 Bandages, self-adhering, soft roller type, 4" x 5 yards or equivalent

2 Rolls of tape

2 Triangular bandages

1 Box of gloves latex free or equivalent

1 Thermometer

1 Biohazard bag

1 Obstetrical kit (includes cord clamp, scissors, scalpel, bulb syringe, drapes, towels, gloves, feminine napkin, biohazard bags)

1 Printed pediatric reference material

1 Commercial tourniquet

Disinfecting agent for cleaning vehicle and equipment of body fluids in accordance with OSHA standards of bleach diluted between 1:10 and 1:100 with water or equivalent

Reflective safety vests one for each crew member OSHA approved

Preventive T.B. Transmission masks (N95 or N100) masks, one for each crew member

Protective eye wear (goggle or face shield), one for each crew member

Fire extinguisher, with current inspection sticker, of the dry chemical type with a rating of 2A10BC or halogen extinguisher of minimum weight 2.5 - 10 pounds

Airway Equipment and Supplies:

2 Bag valve mask ventilation units, one adult, one pediatric

1 Portable oxygen apparatus, capable of metered flow with adequate tubing*

2 02 masks, non-rebreather or partial non-rebreather, one adult and one pediatric*

1 Nasal cannula, adult*

Defibrillator Equipment and Supplies

1 Automated External Defibrillator (AED)

Additional Supplies:

1 Irrigation solution 500cc

2 Nerve Antidote Kits (Mark I Kits or DuoDote) for self or peer administration*

(b) EMT Quick Response Unit

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Heavy duty shears

2 Universal sterile dressings, 9" x 5", 10" x 8", 8" x 9", or equivalent

12 Gauze pads, sterile, 4" x 4"

8 Bandages, self-adhering, soft roller type, 4" x 5 yards or equivalent

2 Rolls of tape

4 Cervical collars, one adult, one child, one infant, plus one other size

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

1 Thermometer

2 Biohazard bags

1 Printed pediatric reference material

1 Obstetrical kit (includes cord clamp, scissors, scalpel, bulb syringe, drapes, towels, gloves, feminine napkin, Biohazard bags)

1 Commercial tourniquet

Disinfecting agent for cleaning vehicle and equipment of body fluids in accordance with OSHA standards of bleach diluted between 1:10 and 1:100 with water or equivalent

Reflective safety vests one for each crew member OSHA approved

Preventive T.B. Transmission masks (N95 or N100) masks, one for each crew member

Protective eye wear (goggle or face shield), one for each crew member

Fire extinguisher, with current inspection sticker, of the dry chemical type with a rating of 2A10BC or halogen extinguisher of minimum weight 2.5 - 10 pounds

Hemostatic Gauze or agent*

Glucose measuring device*

Transcutaneous carbon monoxide detector*

Head Immobilization Device*

Spine board (wood must be coated or sealed) *

Immobilization straps*

Multi-use splints*

Whole body vacuum splint*

Inflatable back raft*

Mucosal atomization device*

Airway Equipment and Supplies:

1 Portable or fixed suction, with wide bore tubing and rigid pharyngeal suction tip

1 Oxygen saturation monitor with adult and pediatric probes

2 Bag valve mask ventilation units, one adult, one pediatric, with adult, child, and infant size

1 Bulb syringe, separate from the OB kit

3 Oropharyngeal airways, with one adult, one child, and one infant size

3 Nasopharyngeal airways, one adult, one child, and one infant

1 Water based lubricant, one tube or equivalent

2 02 masks, non-rebreather or partial non-rebreather, one adult and one pediatric

1 Nasal cannula, adult

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

Impedance threshold device*

Defibrillator Equipment and Supplies:

1 Automated external defibrillator (AED), per vehicle or response unit

Automated chest compression device*

Required Drugs:

1 Aspirin bottle Aspirin chewable 81 mg (minimum 8 tablets)

2 Epinephrine auto-injectors, one standard and one junior

1 Irrigation Solution 500cc

2 Oral Glucose tubes concentrated or equivalent

Activated Charcoal 25gm *

Acetaminophen elixir 160mg/5ml*

Ibuprofen (adult and pediatric)*

Naloxone (Intranasal use only)*

Nerve Antidote Kits (Mark I Kits or DuoDote)*

(c) AEMT Quick Response Unit

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Heavy duty shears

2 Universal sterile dressings, 9" x 5", 10" x 8", 8" x 9", or equivalent

12 Gauze pads, sterile, 4" x 4"

8 Bandages, self-adhering, soft roller type, 4" x 5 yards or equivalent

2 Rolls of tape

4 Cervical collars, one adult, one child, one infant, plus one other size

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

1 Glucose measuring device

1 Thermometer

2 Biohazard bags

1 Printed pediatric reference material

1 Obstetrical kit, includes cord clamp, scissors, scalpel, bulb syringe, drapes, towels, gloves, feminine napkin, Biohazard bags

1 Commercial tourniquet

2 Occlusive sterile dressings or equivalent

Disinfecting agent for cleaning vehicle and equipment of body fluids in accordance with OSHA standards of bleach diluted between 1:10 and 1:100 with water or equivalent

Reflective safety vests one for each crew member OSHA approved

Preventive T.B. Transmission masks (N95 or N100) masks one for each crew member

Protective eye wear (goggle or face shield) one for each crew member

Fire extinguisher, with current inspection sticker, of the dry chemical type with a rating of 2A10BC or halogen extinguisher of minimum weight 2.5 - 10 pounds

Hemostatic Gauze or agent*

Transcutaneous carbon monoxide detector*

Head Immobilization Device*

Spine board (wood must be coated or sealed)*

Immobilization straps*

Multi-use splints*

Whole body vacuum splint*

Inflatable back raft*

Airway Equipment and Supplies:

1 Portable or fixed suction, with wide bore tubing and rigid pharyngeal suction tip

1 Oxygen saturation monitor with adult and pediatric probes

2 Bag valve mask ventilation units, one adult, one pediatric, with adult, child, and infant sizes

1 Bulb syringe, separate from the OB kit

3 Oropharyngeal airways, with one adult, one child, and one infant size

3 Nasopharyngeal airways, one adult, one child, and one infant

2 O2 masks, non-rebreather or partial non-rebreather, one adult and one pediatric

1 Nasal cannula, adult

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

2 Small volume nebulizer container for aerosol solutions

2 Magill forceps, one adult, child/infant

1 Cath tip 60cc syringe* (for use with oro-nasogastric tube)

2 Supraglottic airway device (one adult and one pediatric (size)

CPAP device*

1 Water based lubricant, one tube or equivalent*

2 Oro-nasogastric tubes, one adult, and one pediatric*

End-tidal CO2 monitor*

Impedance threshold device*

Defibrillator Equipment and Supplies

1 Defibrillator with ECG display, or automated external defibrillator (AED), portable battery operated, per vehicle or response unit

2 Sets of adult electrode pads for defibrillation

1 12 lead ECG with transmission capability*

Automated chest compression device*

IV Supplies:

10 Alcohol or Iodine preps

2 IV start kits or equivalent

12 Over-the-needle catheters, two each, sizes 14g, 16g, 18g, 20g, 22g and 24g

2 Arm boards

5 IV tubings capable of micro and macro drip chambers, minimum 2 of each

8 Syringes, two each, 60cc, 10cc, 3cc, and 1cc

1 Sharps container

1 Safety razor

2 Saline lock

4 Normal Saline for injection/inhalation

1 Vacutainer holder*

4 Vacutainer tubes*

2 Intraosseous needles, one each 15 or 16, and 18 gauge or delivery device*

Mucosal atomization device*

Morgan lens for ocular irrigation*

Required Drugs:

2 Albuterol Sulfate 2.5mg premixed

1 Aspirin bottle chewable 81 mg (minimum 8 tablets)

2 Dextrose 50% 25gm preload

1 Epinephrine 1:1,000 1cc (1mg/1cc)

2 Epinephrine 1:10,000 1mg each*

1 Glucagon 2 mg

1 Irrigation solution 500cc

2 Naloxone HCL 2mg each

1 Nitroglycerine 0.4mg (tablets or spray)

2 Oral glucose concentrated tubes or equivalent 15g

2 Promethazine HCL 25mg each or ondansetron 8mg, or both*

Ringers Lactate or Normal Saline 4,000cc

may carry at least one benzodiazepine: midazolam, diazepam, or lorazepam*

may carry either Lidocaine or Amiodarone, or both*must carry at least one pain medication: nitrous, morphine, nalbuphine, fentanyl Acetaminophen elixir 160mg/5ml*

Activated Charcoal 25gm *

Amiodarone 300 mg IV*

Atropine Sulfate 1mg each*

Calcium Gluconate*

CyanoKit*

Diazepam*

Diphenhydramine 50 mg*

Fentanyl 200 mcg *

Ibuprofen* (adult and pediatric)

Ipratropium bromide*(nebulized)

Lidocaine (IV for cardiac use)*

Lorazepam*

Midazolam*

Morphine sulfate 10mg*

Nalbuphine 10 mg*

Nerve Agent Antidote kits* (Mark I Kits or DuoDote)

Nitrous oxide and required administration equipment*

Sodium bicarbonate 50 meq*

(d) EMT Ambulance

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Pillows, with vinyl cover or single use disposable pillows

2 Emesis basins, emesis bags, or large basins

1 Fire extinguisher, with current inspection sticker, of the dry chemical type with a rating of 2A10BC or halogen extinguisher of minimum weight 2.5 - 10 pounds

2 Head immobilization devices or equivalent

2 Lower extremity traction splints or equivalent, one adult and one pediatric

2 Non-traction extremity splints, one upper and one lower

2 Spine boards, one short and one long (wood must be coated or sealed)

1 Full body pediatric immobilization device

2 Heavy duty shears

2 Urinals, one male, one female, or two universal

1 Printed pediatric reference material

2 Blankets

2 Sheets

3 Towels

2 Universal sterile dressings, 9" x 5", 10" x 8", 8" x 9", or equivalent

12 Gauze pads, sterile, 4" x 4"

8 Bandages, self-adhering, soft roller type, 4" x 5 yards or equivalent

2 Rolls of tape

4 Cervical collars, one adult, one child, one infant, plus one other size

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

1 Obstetrical kit (includes cord clamp, scissors, scalpel, bulb syringe, drapes, towels, gloves, feminine napkin, biohazard bags)

2 Occlusive sterile dressings or equivalent

1 Thermometer

Water based lubricant, one tube or equivalent

2 Biohazard bags

Glucose measuring device

1 Commercial tourniquet

Car seat or equivalent approved by Federal Safety Standard

Reflective safety vests one for each crew member OSHA approved

Preventive T.B. transmission masks (N95 or N100) masks one for each crew member

Protective eye wear (goggles or face shields) one for each crew member

Full body substance isolation protection one for each crew member

Disinfecting agent for cleaning vehicle and equipment of body fluids in accordance with OSHA standards of bleach diluted between 1:10 and 1:100 with water or equivalent

Hemostatic Gauze or agent*

Whole body vacuum splint*

Inflatable back raft*

Transcutaneous carbon monoxide detector*

Mucosal atomization device*

Airway Equipment and Supplies

1 Portable and fixed suction, with wide bore tubing and rigid pharyngeal suction tip

1 Oxygen saturation monitor with adult and pediatric probes

2 Bag valve mask ventilation units, one adult, one pediatric, with adult, child, and infant size

1 Bulb syringe, separate from the OB kit

3 Oropharyngeal airways, with one adult, one child, and one infant size

3 Nasopharyngeal airways, one adult, one child, and one infant

4 O2 masks, non-rebreather or partial non-rebreather, two adult and two pediatric

2 Nasal cannulas, adult

Portable oxygen apparatus, capable of metered flow with adequate tubing

1 Permanent large capacity oxygen delivery system

Impedance threshold device*

Automated transport ventilator*

Defibrillator Equipment and Supplies:

Automated external defibrillator (AED), per vehicle or response unit

Automated chest compression device*

Required Drugs

1 Aspirin bottle chewable 81 mg (minimum 8 tablets)

2 Epinephrine auto-injectors, one standard and one junior

1 Irrigation Solution 500cc

2 Oral Glucose tubes concentrated or equivalent

Activated Charcoal 25gm *

Acetaminophen elixir 160mg/5ml*

Ibuprofen (adult and pediatric)*

Naloxone (Intranasal use only)*

Nerve Antidote Kits (Mark I Kits or DuoDote)*

(e) AEMT Ambulance

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Pillows, with vinyl cover or single use disposable pillows

2 Emesis basins, emesis bags, or large basins

2 Head immobilization devices or equivalent

2 Lower extremity traction splints or equivalent, one adult and one pediatric

2 Non-traction extremity splints, one upper and one lower

2 Spine boards, one short and one long (Wood must be coated or sealed)

1 Full body pediatric immobilization device

2 Heavy duty shears

2 Urinals, one male, one female, or two universal

1 Printed pediatric reference material

2 Blankets

2 Sheets

3 Towels

2 Universal sterile dressings, 9" x 5", 10" x 8", 8" x 9", or equivalent

12 Gauze pads, sterile, 4" x 4"

8 Bandages, self-adhering, soft roller type, 4" x 5 yards or equivalent

2 Rolls of tape

4 Cervical collars, three adult and one pediatric or equivalent

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

1 Obstetrical kit (includes cord clamp, scissors, scalpel, bulb syringe, drapes, towels, gloves,

feminine napkins, biohazard bags)

2 Occlusive sterile dressings or equivalent

1 Thermometer

2 Biohazard bags

1 Glucose measuring device

1 Commercial tourniquet

1 Car seat or equivalent approved by Federal Safety Standard

Preventive T.B. transmission masks (N95 or N100) masks one for each crew member

Fire extinguisher, with current inspection sticker, of the dry chemical type with a rating of 2A10BC or halogen extinguisher of minimum weight 2.5 - 10 pounds

Protective eye wear (goggles or face shields) one for each crew member

Full body substance isolation protection one for each crew member

Reflective safety vests one for each crew member OSHA approved

Disinfecting agent for cleaning vehicle and equipment of body fluids in accordance with OSHA standards of bleach diluted between 1:10 and 1:100 with water or equivalent

Hemostatic Gauze or agent*

Whole body vacuum splint*

Inflatable back raft*

Transcutaneous carbon monoxide detector*

Airway Equipment and Supplies:

1 Portable and fixed suction, with wide bore tubing and rigid pharyngeal suction tip

1 Oxygen saturation monitor with adult and pediatric probes

2 Bag valve mask ventilation units, one adult, one pediatric, with adult, child, and infant size

1 Bulb syringe, separate from the OB kit

3 Oropharyngeal airways, with one adult, one child, and one infant size

3 Nasopharyngeal airways, one adult, one child, and one infant

4 O2 masks, non-rebreather or partial non-rebreather, two adult and two pediatric

2 Nasal cannulas, adult

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

1 Permanent large capacity oxygen delivery system

2 Small volume nebulizer container for aerosol solutions

2 Magill forceps, one adult, child/infant

1 Cath tip 60cc syringe* (for use with oro-nasogastric tube)

1 Water based lubricant, one tube or equivalent

2 Oro-nasogastric tubes, one adult, and one pediatric*

2 Supraglottic airway device (one adult and one pediatric size)

CPAP device*

Impedance threshold device*

End tidal CO2 Monitor*

Automated transport ventilator*

Morgan lens for ocular irrigation*

Defibrillator Equipment and Supplies:

1 Defibrillator with ECG display, or automated external defibrillator (AED), portable battery operated, per vehicle or response unit

2 Sets of adult electrode pads for defibrillation

1 12 lead ECG with transmission capability*

Automated chest compression device*

IV Supplies:

10 Alcohol or Iodine prep

2 V start kits or equivalent

12 Over-the-needle catheters, two each, sizes 14g, 16g, 18g, 20g, 22g and 24g

2 Arm boards

5 IV tubings capable of micro and macro drip chambers, minimum 2 of each

5 Extension tubings

8 Syringes, two each, 60cc, 10cc, 3cc, and 1cc

1 Three-way stopcock

1 Sharps container

1 Safety razor

2 Saline lock

4 Normal Saline for injection/inhalation

2 Intraosseous needles, one each, 15 or 16, and 18 gauge or delivery device*

1 Volutrol Pediatric IV chamber*

Mucosal atomization device*

Vacutainer holder*

Vacutainer tubes*

Required Drugs:

2 Albuterol Sulfate 2.5mg premixed

1 Aspirin bottle chewable 81 mg (minimum 8 tablets)

2 Dextrose 50% 25gm preload

1 Epinephrine 1:1,000 1cc (1mg/1cc)

2 Epinephrine 1:10,000 1mg each*

1 Glucagon 2 mg

1 Irrigation solution 500cc

2 Naloxone HCL 2mg each

1 Nitroglycerine 0.4mg (tablets or spray)

2 Oral glucose concentrated tubes or equivalent 15g

2 Promethazine HCL 25mg each or ondansetron 8mg, or both*

Ringers Lactate or Normal Saline 4,000cc

may carry at least one benzodiazepine: midazolam, diazepam, or lorazepam*

may carry either Lidocaine or Amiodarone, or both*

must carry at least one pain medication: nitrous, morphine, nalbuphine, fentanyl

Acetaminophen elixir 160mg/5ml*

Activated Charcoal 25gm *

Amiodarone 300 mg IV*

Atropine Sulfate 1mg each*

Calcium Gluconate*

CyanoKit*

Diazepam*

Diphenhydramine 50 mg*

Fentanyl 200 mcg *

Ibuprofen* (adult and pediatric)

Ipratropium bromide*(nebulized)

Lidocaine (IV for cardiac use)*

Lorazepam*

Midazolam*

Morphine sulfate 10mg*

Nalbuphine 10 mg*

Nerve Agent Antidote kits* (Mark I Kits or DuoDote)

Nitrous oxide and required administration equipment*

Sodium bicarbonate 50mEg each*

(f) Intermediate Advanced Ambulance

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

2 Pillows, with vinyl cover or single use disposable pillows

2 Emesis basins, emesis bags, or large basins

2 Head immobilization devices or equivalent

2 Lower extremity traction splints or equivalent, one adult and one pediatric

2 Non-traction extremity splints, one upper, one lower, or PASG pants

2 Spine boards, one short and one long (Wood must be coated or sealed)

1 Full body pediatric immobilization device

2 Heavy duty shears

2 Urinals, one male, one female, or two universal

1 Printed Pediatric Reference Material

2 Blankets

2 Sheets

3 Towels

1 Commercial Tourniquet

2 Universal sterile dressings, 9" x 5", 10" x 8", 8" x 9", or equivalent

12 Gauze pads, sterile, 4" x 4"

8 Bandages, self-adhering, soft roller type, 4" x 5 yards or equivalent

2 Rolls of tape

4 Cervical collars, three adult and one pediatric or equivalent

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

1 Obstetrical kit (includes cord clamp, scissors, scalpel, bulb syringe, drapes, towels, gloves, feminine napkins, biohazard bags)

2 Occlusive sterile dressings or equivalent

1 Thermometer or equivalent

2 Biohazard bags

1 Glucose measuring device

Car seat or equivalent approved by Federal Safety Standard

Preventive T.B. transmission masks (N95 or N100) masks one for each crew member

Fire extinguisher, with current inspection sticker, of the dry chemical type with a rating of 2A10BC or halogen extinguisher of minimum weight 2.5 - 10 pounds

Protective eye wear (goggles or face shields) one for each crew member

Full body substance isolation protection one for each crew member

Reflective safety vests one for each crew member OSHA approved

Disinfecting agent for cleaning vehicle and equipment of body fluids in accordance with OSHA standards of bleach diluted between 1:10 and 1:100 with water or equivalent

Hemostatic Gauze or agent*

Whole body vacuum splint*

Inflatable back raft*

Transcutaneous carbon monoxide detector*

Airway Equipment and Supplies:

1 Portable or fixed suction, with wide bore tubing and rigid pharyngeal suction tip

2 Bag mask ventilation units, one adult, one pediatric, with adult, child, and infant size masks

1 Baby syringe, bulb type, separate from the OB kit

3 Oropharyngeal airways, with one adult, one child, and one infant size

3 Nasopharyngeal airways, one adult, one child, and one infant

2 Magill forceps, one adult and one child

4 Non-rebreather or partial non-rebreather oxygen masks, two adult and two pediatric

2 Nasal cannulas, adult

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

1 Oxygen saturation monitor

1 Permanent large capacity oxygen delivery system

2 Small volume nebulizer container for aerosol solutions

1 Laryngoscope with batteries curved and straight blades with bulbs and two extra batteries and two extra bulbs

1 Water based lubricant, one tube or equivalent

7 Endotracheal tubes, one each: cuffed 8, 7.5, 7, 6, uncuffed 5, 4, 3

2 Endotracheal tube stylets, one pediatric and one adult

1 Device for securing the endotracheal tube

2 Endotracheal tube confirmation device

2 Flexible sterile endotracheal suction catheters from 5-12 french

2 Oro-nasogastric tubes, one adult, and one pediatric

2 Supraglottic airway device (one adult and one pediatric size)

Video laryngoscope*

Bougie device*

CPAP device*

Impedance threshold device*

End tidal CO2 Monitor*

Automated transport ventilator*

Morgan lens for ocular irrigation*

Defibrillator Equipment and Supplies:

1 Portable cardiac monitor/defibrillator/pacer with adult and pediatric capabilities

2 Sets Electrodes or equivalent

2 Sets Combination type defibrillator pads pacing/cardioversion/defibrillator

1 12 lead ECG with transmission capability*

Automated chest compression device*

IV Supplies:

10 Alcohol or Iodine preps

2 IV start kits or equivalent

12 Over-the-needle catheters, two each, sizes 14g, 16g, 18g, 20g, 22g and 24g

2 Arm boards

5 IV tubings capable of micro and macro drip chambers, minimum 2 of each

8 Syringes, two each, 60cc, 10cc, 3cc, and 1cc

1 Cath tip 60cc syringe

1 Three-way stopcock

1 Sharps container

1 Safety razor

2 Saline lock

4 Normal Saline for injection/inhalation

2 Intraosseous needles, one each, 15 or 16, and 18 gauge or delivery device

1 Volutrol Pediatric IV chamber*

Mucosal atomization device*

Vacutainer holder*

Vacutainer tubes*

Required Drugs:

2 Albuterol Sulfate 2.5mg premixed

1 Aspirin bottle chewable 81 mg (minimum 8 tablets)

2 Atropine Sulfate 1mg

2 Dextrose 50% or Glucagon (must have 1 D50)

2 Diphenhydramine intravenous 50mg each

1 Epinephrine 1:1,000 15mg or equivalent

2 Epinephrine 1:10,000 1mg each

1 Irrigation solution 500cc

2 Morphine Sulfate 10mg

2 Naloxone HCL 2mg each

1 Nitroglycerine bottle 0.4mg (tablets or spray)

2 Oral glucose concentrated tubes or equivalent

2 Promethazine HCL 25mg each or ondansetron 8mg, or both

1 Ringers Lactate or Normal Saline 4,000cc

must carry at least one benzodiazepine: midazolam, diazepam, or lorazepam*

must carry either Lidocaine or Amiodarone, or both*

must carry at least one pain medication: nitrous, morphine, nalbuphine, fentanyl

Acetaminophen elixir 160mg/5ml*

Activated Charcoal 25gm*

Adenosine*

Amiodarone 300 mg IV*

Calcium Gluconate*

CyanoKit*

Diazepam*

Fentanyl 200 mcg*

Furosemide*

Ibuprofen* (adult or pediatric)

Ipratropium bromide*(nebulized)

Lidocaine (IV for cardiac use)*

Lorazapam*

Midazolam*

Nalbuphine 10 mg*

Nerve Agent Antidote kits (Mark I Kits or DuoDote)*

Nitrous oxide and required administration equipment*

(g) Paramedic Services (Rescue, Transfer and Ambulance Units)

2 Blood pressure cuffs, one adult, one pediatric

2 Stethoscopes, one adult and one pediatric or combination

1 Thermometer

1 Glucose measuring device

2 Head immobilization devices or equivalent

2 Lower extremity traction splints or equivalent, one adult and one pediatric

2 Non-traction extremity splints, one upper and one lower

2 Spine boards, one short and one long. Wooden boards must be coated or sealed

1 Full body pediatric immobilization device. (Paramedic rescue units excluded)

2 Heavy duty shears

2 Blankets

3 Towels

2 Universal sterile dressings, 9" x 5", 10" x 8", 8" x 9", or equivalent

12 Gauze pads, sterile, 4" x 4".

8 Bandages, self-adhering, soft roller type, 4" x 5 yards or equivalent

2 Rolls of tape

4 Cervical collars, three adult and one pediatric or equivalent

2 Triangular bandages

2 Boxes of gloves, one box non-sterile and one box latex free or equivalent

1 Obstetrical kits (includes cord clamp, scissors, scalpel, bulb syringe, drapes, towels, gloves, feminine napkins, biohazard bags)

2 Occlusive sterile dressings or equivalent

2 Emesis basins, emesis bags, or large basins

1 Printed pediatric reference material

2 Urinals, one male, one female, or two universal

2 Pillows with vinyl cover or single use disposable pillows (paramedic rescue units excluded)

2 Sheets (paramedic rescue units excluded)

1 Commercial Tourniquet

2 Biohazard bags

Car seat or equivalent approved by Federal Safety Standard - (paramedic rescue units excluded) change definition

Preventive T.B. transmission masks (N95 or N100) masks one for each crew member

Fire extinguisher, with current inspection sticker, of the dry chemical type with a rating of 2A10BC or halogen extinguisher of minimum weight 2.5 - 10 pounds

Protective eye wear (goggles or face shields) one for each crew member

Full body substance isolation protection one for each crew member

Reflective safety vests one for each crew member OSHA approved

Disinfecting agent for cleaning vehicle and equipment of body fluids in accordance with OSHA standards of bleach diluted between 1:10 and 1:100 with water or equivalent

Hemostatic Gauze or agent*

Whole body vacuum splint*

Inflatable back raft*

Transcutaneous carbon monoxide detector*

Airway Equipment and Supplies:

1 Portable and fixed suction, with wide bore tubing and rigid pharyngeal suction tip

1 Portable suction unit, with wide bore tubing and rigid pharyngeal suction tip - (paramedic rescue units only)

1 Oxygen saturation monitor with adult and pediatric probes

1 Bulb syringe separate from the OB kit

1 Laryngoscope with batteries curved and straight blades with bulbs and two extra batteries and two extra bulbs

Video laryngoscope*

Bougie device*

1Water based lubricant, one tube or equivalent

11 Endotracheal tubes, one each, uncuffed 3, 3.5 4, 4.5 and 5, cuffed 5.5, 6, 6.5, 7, 7.5, 8

2 Endotracheal tube stylets, one pediatric and one adult

1 Device for securing the endotracheal tube

2 Endotracheal tube confirmation devices

2 Flexible sterile endotracheal suction catheters from 5-12 french

3 Oropharyngeal airways, one adult, one child, and one infant size

3 Nasopharyngel airways, one adult, one child, and one infant size

2 Magill forceps, one child and one adult/infant

1 Portable oxygen apparatus, capable of metered flow with adequate tubing

2 Oro-nasogastric tubes, one adult, and one pediatric

4 O2 masks, non-rebreather or partial non-rebreather, two adult and two pediatric

2 Nasal cannulas, adult

2 Bag mask ventilation units, one adult, one pediatric, with adult, child, and infant size masks

2 Tongue blades

1 Meconium aspirator

1 Cricothyroidotomy kit

2 Small volume nebulizer container for aerosol solutions

1 Permanent large capacity oxygen delivery system (paramedic rescue units excluded)

2 Supraglottic airway device (one adult and one pediatric size)

CPAP Device*

Impedance Threshold Device*

End tidal CO2 Monitor*

Automated transport ventilator*

Morgan lens for ocular irrigation*

Portable Sonographic device*

Defibrillator Equipment and Supplies:

1 Portable cardiac monitor/defibrillator/pacer with adult and pediatric capabilities

2 Sets Electrodes or equivalent

2 Sets Combination type defibrillator pads pacing/cardioversion/defibrillator

1 12 lead ECG with transmission capability*

Automated chest compression device*

IV Supplies:

10 Alcohol or iodine preps

2 IV start kits or equivalent

12 Over-the-needle catheters, two each, sizes 14g, 16g, 18g, 20g, 22g, 24g

2 Intraosseous needles, one each, 15 or 16, and 18 gauge or delivery device

2 Arm boards

5 IV tubings capable of micro and macro drip chambers, minimum 2 of each

2 IV tubings with blood administration sets

1 Volutrol Pediatric IV chamber

8 Syringes, two each, 60cc, 10cc, 3cc, and 1cc

2 Saline lock

4 Normal Saline for injection/inhalation

1 Cath tipped syringe, 60cc

2 Three-way stopcocks

1 Sharps container

1 Safety razor

1 Cath tipped syringe, 30cc*

Vacutainer holder*

Vacutainer multiple sample luer adapters*

Vacutainer tubes*

Mucosal atomization device*

IV Infusion pumps*

Required Drugs:

2 Albuterol Sulfate 2.5mg pre-mixed

1 Aspirin bottle 81 mg chewable (minimum 8 tablets)

2 Atropine Sulfate 1mg

2 Dextrose 50% preload

2 Diphenhydramine intravenous 50mg each

2 Dopamine HCL 400mg each or 2 mics/ml Epinephrine drip (2cc Epinephrine 1:1,000 to 1000cc LR% or NS), or both

1 Epinephrine 1:1,000 15mg or equivalent

2 Epinephrine 1:10,000 1mg each

1 Glucagon 2 mg

1 Irrigation solution 500cc

4 Naloxone HCL 2mg each

1 Nitroglycerine bottle 0.4mg (tablets or spray)

2 Oral Glucose concentrated 15g tubes or equivalent

2 Promethazine HCL 25mg each or ondansetron 8mg, or both

Ringers Lactate or Normal Saline 4,000cc

2 Sodium Bicarbonate 50mEg each

must carry at least one benzodiazepine: midazolam, diazepam, or lorazepam*

must carry either Lidocaine or Amiodarone, or both*

must carry at least one pain medication: nitrous, morphine, nalbuphine, fentanyl,

hydromorphone, or meperidine

Acetaminophen 160mg/5ml*

1 Activated Charcoal 25gm *

Adenosine*

2 Amiodarone 300 mg IV*

Calcium Gluconate*

CyanoKit*

Diazepam*

Droperidol*

Fentanyl 200 mcg*

Furosemide*

Haloperidol*

Hydromorphone*

Ibuprofen* (adult or pediatric)

Ipratropium bromide* (nebulized)

2 Lidocaine* (IV for cardiac use)

Lorazapam*

Magnesium Sulfate*

Meperidine*

Midazolam*

2 Morphine Sulfate 10mg each*

Nalbuphine 10mg*

Nerve Agent Antidote kits*(Mark I Kits or DuoDote)

Nitrous oxide and required administration equipment*

Oxytocin*

Procainamide*

Vasopressin*

Vecuronium* (only for therapeutic hypothermia protocol)

(3) If a licensed or designated agency desires to carry different equipment, supplies, or medication from the vehicle supply requirements, it must submit a written request from the off-line medical director to the Department requesting the waiver. The request shall include:

(a) a detailed training outline;

(b) protocols;

(c) proficiency testing;

(d) support documentation;

(e) local EMS Council or committee comments; and

(f) a detailed letter of justification.

(4) All equipment, except disposable items, shall be so designed, constructed, and of such materials that under normal conditions and operations, it is durable and capable of withstanding repeated cleaning. The permittee agency:

(a) Shall clean the equipment after each use in accordance with OSHA standards;

(b) shall sanitize or sterilize equipment prior to reuse;

(c) may not reuse equipment intended for single use;

(d) shall clean and change linens after each use; and

(e) shall store or secure all equipment in a readily accessible and protected manner and in a manner to prevent its movement during a crash.

(5) The permittee agency shall have all tested, maintain all equipment, and calibrated in according to with the manufacturer's standards.

(a) The permittee agency shall document all equipment inspections, testing, and maintenance. and calibrations. Testing or calibration conducted by an outside service shall be documented and available for Department review.

(b) an permittee agency required to carry any of the following equipment shall perform monthly inspections to ensure its ability to function correctly:

(i) defibrillator, manual, or automatic;

(ii) autovent;

(iii) infusion pump;

(iv) glucometer;

(v) flow restricted, oxygen-powered ventilation devices;

(vi) suction equipment;

(vii) electronic Doppler device;

(viii) automatic blood pressure/pulse measuring device; and

(ix) pulse oximeter.

(x) any other electronic, battery powered, or critical care device.

(6) All pieces of required equipment that require consumables for the operation of the equipment; power supplies; electrical cables, pneumatic power lines, hydraulic power lines, or related connectors, the permittee shall perform monthly inspections to ensure their correct function.

(7) A ground ambulance licensee shall store all medications according to the manufacturers' recommendations.

(a) for temperature control and packaging requirements; and

(b) return to the supplier for replacement of any medication known or suspected to have been subjected to temperatures outside the recommended range.

 

R426-4-1000. Air Ambulance Supply Requirements.

(1) Air ambulance vehicle requirements are as follows:

(a) The air ambulance must have sufficient space to accommodate at least one patient on a stretcher;

(b) the air ambulance must have sufficient space to accommodate at least two medical attendant seas; and

(c) the patient stretcher shall be FAA-approved.

(i) it must be installed using the FAA 337 form or a "Supplemental Type Certificate";

(ii) the stretcher shall be of sufficient length and width to support a patient in full supine position who is ranked as a 95th percentile American male that is 6 feet tall and weighing 212 pounds; and

(iii) The head of the stretcher shall be capable of being elevated at least 30 degrees.

(d) the air ambulance doors shall be large enough to allow a stretcher to be loaded without rotating it moe than 30 degrees about the longitudinal roll axis, or 45 degrees about the lateral pitch axis;

(e) the stretcher shall be positioned so as to allow the medical attendants a clear view and access to any part of the patient's body that may require medical attention. Seat-belted medical attendants must have access to the patient's head and upper body;

(f) the patient, stretcher, attendants, seats, and equipment shall be so arranged as to not block the pilot, medical attendants, or patients from easily exiting the air ambulance;

(g) the air ambulance shall have FAA- approved two point safety belts and security restraints adequate to stabilize and secure any patient, patient stretcher, medical attendants, pilots, or other individuals;

(h) the air ambulance shall have a temperature and ventilation system for the patient treatment area;

(i) the patient area shall have overhead or dome lighting of at least 40-foot candle at the patient level, to allow adequate patient care. During night operations the pilot's cockpit shall be protected from light originating from the patient care area;

(j) the air ambulance shall have a self-contained interior lighting system powered by a battery pack or portable light with a battery source;

(k) the pilots, flight controls, power levers, and radios shall be physically protected from any intended or accidental interference by patient, air medical personnel or equipment and supplies;

(l) the patient must be sufficiently isolated from the cockpit to minimize in-flight distractions and interference which would affect flight safety;

(m) the interior surfaces shall be of material easily cleaned, sanitized, and designed for patient safety. Protruding sharp edges and corners shall be padded;

(n) patients whose medical problems may be adversely affected by changes in altitude may only be transported in a pressurized air ambulance;

(o) the air medical service shall provide all medical attendants with sound ear protectors sufficient to reduce excessive noise pollution arising from the air ambulance during flight; and

(p) there shall be sufficient medical oxygen to assure adequate delivery of oxygen necessary to meet the patient medical needs and anticipated in-flight complications. The medical oxygen must:

(i) Be installed according to FAA regulation;

(ii) have an oxygen flow rate determined by in-line pressure gauges mounted in the patient care area with each outlet clearly identified and within reach of a seat-belted medical attendant;

(iii) allow the oxygen flow to be stopped at or near the oxygen source from inside the air ambulance;

(iv) have gauges that easily identify the quantity of medical oxygen available;

(v) be capable of delivering fifteen liters/minute at fifty psi;

(vi) have a portable oxygen bottle available for use during patient transfer to and from the air ambulance;

(vii) have a fixed back-up source of medical oxygen in the event of an oxygen system failure;

(viii) the oxygen flow meters shall be recessed, padded, or by other means mounted to prevent injury to patients or medical attendants; and

(ix) "No smoking" signs shall be prominently displayed inside the air ambulance.

(q) the air ambulance electric power must be provided through a power source capable to operate the medical equipment and a back-up source of electric power capable of operating all electrically powered medical equipment for one hour;

(r) the air ambulance must have at least two positive locking devices for intravenous containers padded, recessed, or mounted to prevent injury to air ambulance occupants;

(s) the containers shall be within reach of a seat-belted medical attendant;

(t) the air ambulance must be fitted with a metal hard lock container, fastened by hard point restraints to the air ambulance, or must have a locking cargo bay for all controlled substances left in an unattended;

(u) an air ambulance shall have properly maintained survival gear appropriate to the service area and number of occupants;

(v) an air ambulance shall have an equipment configuration that is installed according to FAA criteria and in such a way that the air medical personnel can provide patient care;

(w) the air ambulance shall be configured in such a way that the air medical personnel have access to the patient in order to begin and maintain basic and advanced life support care;

(x) the air ambulance shall have space necessary to allow patient airway maintenance and to provide adequate ventilatory support from the secured, seat-belted position of the medical personnel;

(y) be knowledgeable in the application, operation, care, and removal of all medical equipment used in the care of the patient.

(z) The air medical personnel shall have a knowledge of potential in-flight complications, which may arise from the use of the medical equipment and its in-flight capabilities and limitations; and

(2) have available during transport, a current copy of all written protocols authorized for use by the air medical service medical director. Patient care shall be governed by these authorized written protocols.

]

R426-4-[1100]900 . Air Ambulance Equipment Standards.

[(1) ]Air ambulance[s] providers must maintain minimum quantities of supplies and equipment for each air [medical]ambulance transport [as listed in the document R426 Appendix ]in accordance with its accreditation designation.[the air medical service's licensure level.] The air ambulance medical director shall oversee and determine the protocols and provide training to support the medications.[ Due to weight and safety concerns on specialized air transports, the air medical service medical director shall insure that the appropriate equipment is carried according to the needs of the patient to be transported. All medications shall be stored according to manufacturer recommendations.

(2) All medical equipment except disposable items, shall be designed, constructed, and made of materials that under normal conditions and operations are durable and capable of withstanding repeated cleaning.

(3) The equipment and medical supplies shall be maintained in working condition and within legal specifications.

(4) All non-disposable equipment shall be cleaned or sanitized after each air medical transport.

(5) Medical equipment shall be stored and readily accessible by air medical personnel.

(6) Before departing, the air medical personnel shall notify the pilot of any add-on equipment for weight and balance considerations.

(7) Physical or chemical restraints must be available and used for combative patients who could possibly hurt themselves or any other person in the air ambulance.]

 

R426-4-[1200]1000 . Air Ambulance Operational Standards.

(1) [The]An air ambulance pilot may refuse transport to any individual who the pilot considers to be a safety hazard to the air ambulance or any of its passengers.

(2) [Records made for each trip on forms or data format specified by the Department and a copy shall remain at the receiving facility for continuity of care.]Air ambulance providers shall provide a patient care record to the receiving hospital as soon as practical, but no longer than 24 hours after completion of the transport.

(3) [The air medical service must]Air ambulance providers shall maintain a personnel file [for personnel, ]which shall include [their]staff qualifications and training.

(4) All air [medical services]ambulance providers [must]shall have an operational manual or policy and procedures manual available for all air [medical]ambulance personnel.

(5) All air [medical]ambulance [service]provider records shall be available for inspection by representatives of the Department.

(6) A[ll a]ir ambulances shall be equipped to allow air [medical]ambulance [service]provider personnel to be able to:

(a) Communicate with hospital emergency medical departments, flight operations centers, air traffic control, [emergency medical services]ground ambulance providers, and law enforcement agencies[.];

(b) Communicate with other air ambulances while in flight[.];

([i]c) [The pilot must be able]Have the ability to override any radio or telephone transmission in the event of an emergency.

(7) The management of the air [medical]ambulance [service]provider shall be familiar with the federal regulations related to air [medical]ambulance [services]providers.

(8) Each air [medical]ambulance [service must]provider shall have a safety committee, with a designated safety officer. The committee shall meet at least quarterly to review safety issues and submit a written report to the air [medical]ambulance [service]provider's management and maintain a copy on file at the air [medical]ambulance [service]provider's office.

(9) A[ll a]ir [medical]ambulance [service]providers shall have a quality management team and a program implemented by this team to assess and improve the quality of patient care provided by the air [medical]ambulance [service]provider.

 

[R426-4-1300 . Penalties.

As required by Subsection 63G-3-201(5): Any person that violates any provision of this rule may be assessed a civil money penalty as provided in Section 26-23-6 and/or suspension or revocation of license(s).

 

]KEY: emergency medical services

Date of Enactment or Last Substantive Amendment: [October 18, 2013]2015

Authorizing, and Implemented or Interpreted Law: 26-8a

 

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