A registered nurse functioning in a specialty practice shall have additional education, training, and experience. Specialty practice does not include advanced practice nursing. Definitions. In this regulation, the following terms have the meanings indicated. Terms Defined. “Critically ill client” means a client who: Has developed or is at high risk for developing life threatening problems; Requires constant intensive multidisciplinary assessment and intervention to restore stability and prevent complications; and Needs restoration or maintenance of physiologic stability. “Interfacility specialty care transport” means the movement of a critically ill client by transport vehicle when the client’s level of care requires the care of a registered nurse during transport. On-Line Medical Direction. “On-line medical direction” means oversight and orders by licensed physicians at base stations to EMS providers or members of the transport team providing patient care at an Advanced Life Support (ALS) or Basic Life Support (BLS) level. “On-line medical direction” includes medical orders and oversight by a licensed practitioner at a specialty care unit at a hospital to a registered nurse during a specialty care transport, provided the licensed practitioner is permitted by the facility to provide these services and the services are within the scope of the individual’s license. Licensed Practitioner. “Licensed practitioner” means a dentist, physician, nurse practitioner, nurse anesthetist, or nurse midwife or any other individual permitted by law and the facility to provide care and services within the scope of the individual’s license. “Licensed practitioner” does not include a student in a graduate education program whose practice requires supervision and whose orders must be countersigned. “Specialty care transport” means transport for all ages of critically ill clients in accordance with the definitions under COMAR 30.09.01.02. Practice Specialty Care Transport. Education, Training, and Experience Requirements. Except for the provisions under §C(2) and (4) of this regulation, a registered nurse who provides interfacility specialty care transport shall meet the education, training, and experience requirements for staffing an interfacility specialty care transport mission in accordance with COMAR 30.09.14.02G(1)—(3). When a specialty care transport ambulance is not available within a clinically reasonable time, a registered nurse who has not completed a program of study in accordance with COMAR 30.09.14.02G(1)—(3) for the transport of patients by ambulance can provide interfacility specialty care, if: The registered nurse has education, training, and experience in the critical care area required by the mission as determined by the referring physician; The registered nurse is accompanied by an individual who is currently licensed as a Maryland ALS provider, in accordance with COMAR 30.02.02, to support the registered nurse with the transport; and On-line medical direction is available to the registered nurse. A registered nurse providing specialty care transport who does not have national certification for working with the client population to be transported shall have at least: 2 years of clinical nursing experience in critical or specialty care within the last 5 years; Age appropriate advanced life support training; and Nursing expertise in the specialty care area required by the client’s age and diagnosis. This regulation does not apply to, restrict, or limit: Other health care practitioners who are authorized to perform these duties under their respective laws; or A registered nurse providing care to a critically ill patient during a declared natural disaster or emergency. A registered nurse is prohibited from accepting a transport assignment that exceeds the nurse’s knowledge and expertise.