NOTICES
Required Ground and Air Ambulance Equipment and Supplies
[33 Pa.B. 4852] Under 28 Pa. Code §§ 1005.10(c) and 1007.7(c) (relating to licensure and general operating standards; and licensure and general operating requirements), the following equipment and supplies shall be carried and readily available in working order for use on basic and advanced life support (ALS) ambulances, which also includes air (rotorcraft) ambulances.
A. Ground Ambulance Requirements
Ground Ambulances: Basic Life Support/ALS Mobile Care Unit /ALS Squad Unit The ambulance must:
1. Meet the requirements of current Federal Specifications KKK 1822 in effect at the time of its manufacture regarding design type, floor plan, general configuration and exterior markings. (Does not apply to an ALS squad unit.)
2. Meet the Vehicle Code requirements, especially 67 Pa. Code Chapter 173 (relating to flashing or revolving lights on emergency and authorized vehicles), which includes:
a. Having red flashing or revolving exterior emergency lighting visible 360 degrees around the vehicle.
b. Flashing headlamp system.
c. No more than one flashing or revolving white or clear light.
d. A light bar assembly that may contain no more than two flashing or revolving white or clear lights.
e. Two amber lights other than the turn signal indicators.
3. Have the following emblems and markings:
a. The word ''AMBULANCE,'' mirror imaged, shall be block, blue, die cut style letters, not less than 4" high, centered above the grill. The placement of the word ''AMBULANCE'' on the curved surface of the hood or on a flat plastic type bugs screen is permitted.
b. The word ''AMBULANCE'' shall be in block, blue, die cut style letters of not less than 6" in height centered, with a white border, alongside or under the ''Star of Life'' on each side and rear of the vehicle.
c. A ''Star of Life'' not less than 3", blue, die cut style, with a white border located both to the right and left of the word ''AMBULANCE.''
d. A ''Star of Life'' not less than 16", blue, die cut style, with a white border on the right and left side panels.
e. A ''Star of Life'' not less than 12", blue, die cut style, with a white border on each rear door.
f. A ''Star of Life'' not less than 32", blue, die cut style (may be without the white Staff of Aesculapius) on the ambulance rooftop.
Note: An ALS squad unit is required to have only 3" size ''Stars of Life'' and no other markings or emblems, but it must have the required number, that is, 6.
4. The name of the ambulance service or its fictitious name in letters at least 3" in size on both the right and left exterior sides of the vehicle. Service name must be the dominant lettering.
5. Be equipped with an audible warning device that is electronically operated.
6. Have overhead interior lighting that illuminates the entire top surface of the patient litter, stair well lighting and courtesy lights that must illuminate the ambulance's controls. (Does not apply to an ALS squad unit.)
7. Have a dual battery system. (Does not apply to an ALS squad unit.)
8. Have one fully charged fire extinguisher rated at least 2 A: 10 B: C easily accessible from the outside of the vehicle. The fire extinguisher must be intact with safety seal, inspected within the previous 12 calendar months and the appropriate and completed inspection tag attached.
9. Have a power supply to generate sufficient current to operate all accessories without excessive demand on the generating system.
10. Have a floor that is flat, reasonably unencumbered, free of equipment in the walk through areas, nonskid and well maintained. (Does not apply to an ALS squad unit.)
11. Have minimum interior dimensions of 60" from floor to ceiling. (Does not apply to an ALS squad unit.)
12. Have an installed patient partition to separate the patient area from the driver area. (Does not apply to an ALS squad unit.)
13. Have storage cabinets with sliding doors or with latches to ensure against opening during vehicle movement. (Does not apply to an ALS squad unit.) Bulky items such as portable radios and AEDs must be secured to prevent them from becoming projectiles. Equipment on an ALS squad unit must be in cabinets or secured down with straps.
14. Have two IV hangers mounted flush with the ceiling. (Does not apply to an ALS squad unit.)
15. Have a litter for transporting a patient and at least three patient restraint straps in good operating condition secured to the litter. (Does not apply to an ALS squad unit.)
16. Have doors that function properly with door seals that are in good condition; that is, not cracked, broken or missing pieces.
17. Have a ''No Smoking'' sign in both the driver and the patient compartment. On an ALS squad unit, only one sign in the driver's compartment is required.
18. Have operational heating, cooling and ventilation equipment.
19. Have a current vehicle inspection validation issued by the State where the vehicle is registered.
20. Have operational radio equipment for communication with a public safety answering point (PSAP) and hospitals in the ambulance service's emergency service areas. A cellular phone may be used as a backup means of communication.
21. Have an installed, onboard oxygen system with the following (does not apply to an ALS squad unit):
a. At least 122 cubic feet supply of oxygen in a cylinder that is secured to provide maximum safety for patients and personnel. The securing brackets must be mounted to the vehicle frame. Services may use a liquid oxygen system that provides the same volume.
b. The cylinder must have more than 500 psi (500 liters of oxygen) of pressure at all times.
c. The unit must be equipped with a reducing valve (from 2,000 psi to 50 psi line pressure).
d. The unit must be equipped with one flow meter with a range of 0--25 lpm delivery.
e. The unit must be equipped with a nonbreakable humidifier and, if attached, must not have water in it when not in use.
22. Have an installed, onboard suctioning system with the following components and/or capabilities (does not apply to an ALS squad unit):
a. It is fitted with a large bore, nonkinking tubing with a lumen of at least 7 mm.
b. It has power enough to provide within 4 seconds a vacuum of over 300 mm/Hg or 11.8 inches of water when the tube is clamped.
c. It is controllable for use on children and intubated patients. The vacuum gauge, when attached to the tubing, must be adjustable to the amount of vacuum to ensure that the unit can maintain vacuum levels without requiring continuous increase in control.
d. It is equipped with a lateral opening between the suction tube and the suction source.
e. The tubing must be able to reach airways of patients regardless of the patient's position in the ambulance and must be able to reach the head and foot of the litter.
23. Must show proof of current motor vehicle insurance.
B. Air (Rotorcraft) Ambulance Requirements The following will apply to all air ambulances. The air ambulance must have:
1. The name of the air ambulance service or its registered fictitious name prominently displayed on its exterior.
2. Exterior lighting that illuminates the tail rotor and includes a controllable searchlight able to rotate 180 degrees.
3. An ''Air Worthiness Certificate'' from the Federal Aviation Administration (FAA).
4. A patient litter capable of carrying one adult in the supine position and capable of being secured according to FAA requirements.
5. Have an FAA Form 337 with items no. 1 (which identifies the aircraft), no. 2 (which identifies the aircraft owner) and no. 7 (which shows that the aircraft is approved to ''return to service'') completed and signed by the appropriate FAA official.
6. Climate controls for maintaining an ambient cabin temperature of between 65--85 degrees during flight.
7. Sufficient interior lighting to allow for close observation of patients.
8. A pilot partition to prevent patient interference with flight controls.
9. A barrier or an FAA approved mechanism for securing a patient's chest, pelvis, legs, wrist and ankles.
10. A 110-volt electrical outlet for each patient transported and a backup power supply.
11. Two-way radio communications for the pilot to be able to communicate with hospitals, PSAPs and ground ambulances.
12. At least three headsets to allow for voice communication among the crew when the aircraft is operating and noise levels prevent normal conversation.
13. One fully charged fire extinguisher rated at least 5 B: C. The fire extinguisher must be intact with safety seal and have been inspected within the previous 12 calendar months and have the appropriate inspection tag attached.
14. Installed, onboard suctioning equipment that meets the same requirements as a transporting ground ambulance. (See requirements under Ground Ambulances.)
15. An onboard oxygen system with the following:
a. A cylinder with a capacity of 1,200 liters.
b. The cylinder must have at least 1,650 psi at time of inspection.
c. If a liquid oxygen system is used, manufacturer documentation must be provided that the system has at least a 1,200-liter capacity and that at least a 1-hour oxygen delivery capacity at 25 lpm per patient is available.
d. A flow meter with a range of 0--25 lpm delivery.
C. Required Equipment and Supplies Approved equipment and supplies shall be carried and readily available in working order for use on both ground and air ambulances. Some patients and crewmembers of an ambulance service may have allergies to latex. Latex free supplies are recommended, where possible. The following equipment and supplies must be carried on each ground and air ambulance, as indicated:
Ambulance Type Equipment/Supplies
BLS ALS Mobile Care ALS Squad Air 1. Rechargeable Portable Electric Suction Unit with wide-bore tubing. Must achieve 300 mm/Hg or 11.8" in 4 seconds.
X X X X 2. Suction catheters, pharyngeal:
Rigid (2)
Flexible:
6 and 8 (1 each)
10 or 12 (2)
14 or 16 (2) total of 6
(Must be sterile) Size is FR for eachX X X X 3. Airways:
Nasopharyngeal (5 different sizes)
Oropharyngeal (6 different sizes)X X X X 4. Sphygmomanometer:
Child, Adult and Thigh (large)
(1 each) Interchangeable gauges
are permittedX X X X 5. Stethoscope (1) X X X X 6. Stethoscope Doppler (1) X 7. Penlight (1) X X X X 8. Portable Oxygen Unit (1):
Cylinder capacity of at least 300
liters/D Size/500 psi
Yoke
Cylinder with a minimum total
pressure of 500 psi
Nonsparking wrench/tank opening
device
Gauge/flow meter not gravity
dependent and can deliver 0--25
liter per minute
Full spare cylinder with a 300 liter
capacity
Cylinders must be secured in the vehicle.X X X X 9. Oxygen Delivery Devices:
Nasal Cannulae--adult/pediatric 1 each
High concentration mask capable
of providing 80% or greater
concentration adult, pediatric,
infant--1 each
Pocket mask with one way valve and
oxygen port (1)X X X X 10. Adhesive Tape (4 rolls assorted)
1 roll must be hypoallergenicX X X X 11. Dressings:
Multi Trauma (10"× 30") (4)
Occlusive (3" × 4") (4)
Sterile Gauze Pads (3" × 3") (25)
Soft self-adhering (6 rolls)X X X X 12. Bandage Shears (1) X X X X 13. Immobilization Devices:
Lateral cervical spine device (1)
Long spine board (1)
Short spine board (1)
Rigid/Semi rigid neck
immobilizer S, M, L, pediatric
(1 each) Multisize are
permitted and will suffice for the
S, M, L (3)X X X X
(Short board not required)14. Bag-Valve-Mask Devices:
Hand operated adult (1)
Hand operated pediatric (450--
700 cc) (1) must be capable of 100%
oxygen delivery
Adult and pediatric masksX X X X 15. Pediatric Equipment Sizing Tape/Chart X X X X 16. Straps--9` (5) (may substitute spider
straps or speed clips for 3 straps)X X X X 17. Folding Litter/Collapsible Device (1) X X 18. Splinting Devices:
Lower extremity mechanical
traction splint adult and pediatric (1
each or combination)
Padded board splints:
4.5`, 3`, 15"--(2 each)X X 19. Sterile Water/Normal Saline (2 liters) X X X X 20. Sterile Burn Sheet (4'×4') (2) X X X 21. Cold Packs, Chemical (4) X X X X 22. Heat Packs, Chemical (4) X X X X 23. Triangular Bandages (8) X X X 24. Sterile OB Kits (2) X X X X
(Only 1 required)25. Separate Bulb Syringe (1) Sterile X X X X 26. Sterile Thermal Blanket (Silver Swaddler)
(1) or 1 roll of sterile aluminum foilX X X X 27. Blankets (2)--cloth X X X X 28. Sheets (4) X X X 29. Pillowcases (2) X X 30. Pillow (1) X X 31. Towels (4) X X 32. Disposable Tissues (1 box) X X 33. Emesis Container (1) X X 34. Urinal (1) X X 35. Bed Pan (1) X X 36. Disposable Paper Drinking Cups (3 oz) (4) X X 37. State-approved Triage Tags (25) X X X 38. Hand-lights (6 volts) (2) X X X X 39. Hazard Warning Device (3) X X X 40. Emergency Jump Kit (1) X X X X 41. Survival Bag (1) X 42. Emergency Response Guidebook (1)
(current edition)X X X 43. Thermometer--electronic (digital) X X X X 44. Sharps Receptacle (1)--Secured X X X X 45. Instant Glucose (40% dextrose-d-glucose gel) 45 grams
X X X 46. Activated Charcoal--50 grams X X X 47. Access Equipment:
Large Screwdriver, Phillips and
slotted (1 each)
Pliers (1 each) (slip joint, lineman's
needle nose, arc joint and locking)
Hand-held Sledgehammer (3 lbs) (1)
Impact metal Cutting Tool (1)
Short pry-bar (1)--12"
Cold Chisel (7" × 3/4") (1)
Hacksaw w/2 extra blades (1)
Adjustable Wrench--10" (1)
Center Punch (1)
Gloves (leather) (2 pairs)
Hard Hat (2)X X X 48. Flight Helmet (1 per crewmember) X 49. Personal Protection Equipment:
Eye protection, clear, disposable (1
per crew member)
Face Mask, disposable (1 per crew
member)
Gown/coat (1 per crew member)
Surgical Caps/Foot Coverings
disposable (1 set per
crewmember)
Double Barrier gloves (1 set per
crew member)
Container (1 per vehicle) or
disposable red bags (3 per vehicle)
Infection Control PlanX X X X 50. Sponges, Alcohol, Prep (10) X X X 51. Endotracheal Tubes Sizes/Quantities:
2.5 mm or 3.0 mm (2 uncuffed)
3.5 mm or 4.0 mm (2 uncuffed)
4.5 mm or 5.0 mm (2)
5.5 mm or 6.0 mm (2)
6.5 mm or 7.0 mm (2)
7.5 mm or 8.0 mm (2)
8.5 mm or 9.0 mm (2)
Must be sterile and individually wrappedX X X 52. Endotrachael Tube Placement Validation
Device (1) to verify correct placement--
per regional protocolX X X 53. Laryngoscope handle with batteries and
spare batteries and bulbs and the
following blades:
Straight Curved
#1 (S) #3
#2 (M) #4
#3 (L)
(1 each of the blades)X X X 54. Meconium Aspirator (1) X X X 55. Lubrication (2 cc or larger tubes) sterile (2) water soluble X X X X 56. Forceps, Magill (adult/pediatric 1 each) X X X 57. IV Fluid Therapy Supplies:
Catheters (over the needle-IV):
14,16,18, 20, 22, (4 each) and
24 gauge (2), Total of 22
individually wrapped and sterile
Micro drops (50-60 drops/ml) (2)
Macro drops (10-20 drops/ml) (2)
IV Fluids--total 2250 milliliters:
such as 5% dextrose, 0.9% sodium
chloride, Lactated Ringers
Tourniquets for IV Use (2)
Intraosseus needles 14--18 gauge (2)X X X 58. Medication and Supplies:
Emergency Drugs--(per regional
protocols and within State rules and
regulations and within expiration date)
Hypodermic needles:
16-18 gauge (4)
20-22 gauge (4)
23-25 gauge (4)
Total of 12 and each must be
individually wrapped and sterile.
Syringes--per regional protocolX X X 59. Defibrillator/Monitor: (FDA approved)
(battery powered, monophasic or
biphasic, energy dose range capable of
treating adult and pediatric
patients, paper readout), ECG cables
with 3 lead capability and pediatric
and adult paddles with pacing
capabilities or separate stand-alone pacer
X X X 60. Defibrillator/Monitor Supplies:
Paddle pads (4) or electric gel (2
tubes), electrodes, ECG, adult and
pediatric sizes (6 each)
X X X 61. Automated External Defibrillator
(for authorized BLS services)
X 62. Stylette, Malleable--pediatric (2)/adult
Must be sterile.
X X X 63. Cricothyrotomy set (surgical or needle)
Must be sterile.
X 64. Phlebotomy Equipment X X 65. Flutter valve (1) Must be sterile. X All equipment must be clean and functional and no supply item may be carried beyond any expiration date assigned to it.
Persons with a disability who require an alternate format of this notice (for example, large print, audiotape or Braille) should contact Robert H. Gaumer, Department of Health, Emergency Medical Services Office, Room 1032, Health and Welfare Building, Harrisburg, PA 17120, (717) 787-8740. Persons with a speech or hearing impairment may telephone V/TT: (717) 783-6154 or use the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).
CALVIN B. JOHNSON, M.D., M.P.H.,
Secretary
[Pa.B. Doc. No. 03-1904. Filed for public inspection September 26, 2003, 9:00 a.m.]
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