NOTICES

Required Ground and Air Ambulance Equipment and Supplies

[34 Pa.B. 6279]

   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 Pennsylvania 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° around the vehicle.

   b.  Having a flashing headlamp system.

   c.  Have no more than one flashing or revolving white or clear light or a light bar assembly that may contain no more than two flashing or revolving white or clear lights.

   d.  Have no more than two amber lights other than the turn signal indicators.

   3.  Have the following emblems and markings affixed to the vehicle exterior:

   a.  The word ''AMBULANCE,'' mirror imaged, shall be block, blue, die cut style letters, not less than 4 inches high, centered above the grill. The placement of the word ''AMBULANCE'' on the curved surface of the hood or on a flat plastic type bug screen is permitted.

   b.  The word ''AMBULANCE'' shall be in block, blue, die cut style letters of not less than 6 inches 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 inches, 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 inches, blue, die cut style, with a white border on the right and left side panels.

   e.  A ''Star of Life'' not less than 12 inches, blue, die cut style, with a white border on each rear door.

   f.  A ''Star of Life'' not less than 32 inches, 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 inches size ''Stars of Life'' and no other markings or emblems, but it must have the required number, that is six. These are two on the front, one on each side and two on the rear.

   4.  The name of the ambulance service or its registered 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 electronically operated audible warning device with a 110-watt speaker.

   6.  Have overhead interior lighting that illuminates the entire top surface of the patient litter, stairwell 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 by personnel, and mounted securely in an exterior compartment or mounted and easily accessible in the cab of the vehicle. The fire extinguisher must be intact with safety seal and have been inspected within the previous 12 calendar months, and have 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. All exterior and interior lighting and on-board equipment should be able to run at least five minutes without placing a demand on the engine.

   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 or have a cargo-type netting or other means to ensure against opening during vehicle movement. (Does not apply to an ALS squad unit.) Bulky items such as portable radios and AEDs, oxygen equipment and jump bags must be secured at all times during patient transport to prevent them from falling on patients or crew or becoming projectiles if the vehicle is involved in an accident. Equipment on an ALS squad unit must be in cabinets or secured at all times.

   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) (where 911 calls are answered) and hospitals in the ambulance services emergency service areas. A cellular phone may be used as a backup means of communication and not as the primary means of communication.

   21.  Have an installed, on-board 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 and be secured with at least three metal or nylon brackets while in the compartment.

   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 non-breakable humidifier.

   22.  Have an installed, on-board 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.

   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 pilot controllable search/spot/landing lights.

   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° 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.

   11.  Two-way radio communications for the pilot to be able to communicate with hospitals, PSAPs and ground ambulances in areas to which the air ambulance routinely provides service.

   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, securely mounted where it can be reached by the pilot or crewmembers. 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, on-board suctioning equipment that meets the same requirements as a transporting ground ambulance. (See requirements under Ground Ambulances.)

   15.  Have an on-board oxygen system with the following:

   a.  A cylinder with a capacity of 1,200 liters and at least 1,650 psi.

   b.  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.

   c.  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 sec.	X	X	X	X
2.  Suction catheters, pharyngeal: Rigid (2) Flexible:    6 and 8 (1 ea)    10 or 12 (2)    14 or 16 (2) Total of 6 (Must be sterile) Size is FR for each	X	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 permitted	X	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)   Humidifier bottle	X	X	X	X
10.  Adhesive Tape (4 rolls assorted) 1 roll must be hypoallergenic.	X	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) Multi-size          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 (450-700cc) (1) Must be capable of high concentration    oxygen delivery Adult and pediatric masks	X	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 foil for use on infants/newborns.	X	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 (3oz) (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, nontympanic	X	X	X	X
44.  Sharps Receptacle--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/Goggles (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)	X	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 8.0mm (2)       8.5 mm or 9.0 mm (2)         Must be sterile and individually          wrapped		X	X	X
52.  Endotrachael Tube Placement Validation Device (1) to verify correct placement--per regional protocol		X	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 (2cc 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 (per          regional protocols)         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 protocol		X	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 (1) Must be sterile.		X	X	X
63.  Cricothyrotomy set (surgical or needle)       Must be sterile.				X
64.  Phlebotomy Equipment (per regional protocols.		X	X
65.  Flutter valve (1)       Must be sterile.				X
66.  Epinephrine Auto-Injector (for authorized BLS services)      0.3mg/0.3ml of 1:1000 solution for    adult use (2)      0.15mg/0.3ml of 1:2000 solution for    pediatric use (2) (Not required for    licensure)	X
67.  Pulse Oximetry (for services with a medical director) (Not required for licensure)	X	X	X	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, 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 should 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. 04-2075. Filed for public inspection November 19, 2004, 9:00 a.m.]

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