Title 30 — Subtitle 09. Commercial Ambulance Services

In this subtitle, the following terms have the meanings indicated.

Terms Defined.

Considerate and respectful care;

Information from the commercial ambulance service necessary in order to give informed consent for transport or treatment, or both;

The opportunity to refuse transport or treatment when the patient is apparently competent to do so;

Reasonable privacy concerning a patient's transportation and care;

Confidentiality of all communications and records relating to patient transportation and care except to the extent otherwise required by law;

Reasonable response to a request for services once the commercial ambulance service is engaged to provide service;

Service that is within reasonable limits of the scheduled pickup and delivery times;

Reasonable continuity of care once the commercial ambulance service is engaged to provide service;

An opportunity to examine and receive an explanation of the patient's bill;

An environment in the commercial ambulance free from recognized hazards and unreasonable annoyances including but not limited to:

Information that commercial ambulance services operating in Maryland are regulated by the Maryland Institute for Emergency Medical Services Systems.

There shall be a State Office of Commercial Ambulance Licensing and Regulation within MIEMSS which shall implement and enforce the provisions of this subtitle.

Unless otherwise specified, all communications to the Executive Director relating to this subtitle shall be addressed to Executive Director of MIEMSS, c/o State Office of Commercial Ambulance Licensing and Regulation, 653 West Pratt Street, Baltimore, Maryland 21201-1536.

Issued a license under Education Article, §13-515, Annotated Code of Maryland;

Exempt from this subtitle under Regulation .04 of this chapter; or

Issued a written waiver from SOCALR under Regulation .05 of this chapter.

The following vehicles are exempt from licensure under this subtitle:

If SOCALR believes that an ambulance operating in this State may be required to be licensed under this subtitle, SOCALR may conduct an investigation to determine whether the ambulance service or ambulance is required to be licensed.

The following services are exempt from licensure under this subtitle:

An out-of-State ambulance service seeking an exemption from a service license shall submit a completed application on the required form to SOCALR.

An exemption is not valid unless issued in writing by SOCALR for a specified period of time.

A commercial ambulance service granted an exemption from this subtitle shall reapply for the exemption 30 days before expiration of the exemption.

A service granted an exemption from this subtitle shall submit an annual report detailing the number of patients during the previous year who were transported:

When transporting patients from the scene of a public safety medical emergency, an exempt service shall transport the patient to the closest appropriate facility according to Maryland Medical Protocol for EMS Providers.

SOCALR may conduct an investigation to determine if an exemption should be revoked.

A service granted on exemption shall notify SOCALR of any disciplinary action taken against the service by the licensing authority in the state in which the service is licensed.

An exemption may be revoked if SOCALR finds the party to whom the exemption has been granted has:

The authority of a county or municipal corporation to regulate a commercial ambulance service with a base of operation located outside the county or municipal corporation that is licensed under this subtitle is preempted by Education Article, §13-515, Annotated Code of Maryland.

A county or municipal corporation is not preempted from regulating a commercial ambulance service with a base of operation located within its territorial boundaries, while the commercial ambulance service is operating within those territorial boundaries, so long as local legislation does not conflict with, frustrate, or diminish the intent of Education Article, §13-515, Annotated Code of Maryland, or this subtitle.

SOCALR shall:

The list shall contain the:

COMAR 30.01.04 governs responses to requests for public records of MIEMSS.

Own or operate at least one ambulance:

Have ground ambulances mechanically inspected under Regulation .05D(4) of this chapter;

Have all ambulances properly staffed and equipped;

Comply with all applicable statutes and regulations governing the operation of a commercial ambulance service and commercial ambulances;

Have proper insurance required by Regulation .06 of this chapter;

Have reliable communications as required in COMAR 30.09.10.03 and .04;

Submit the intended name of the service to SOCALR for approval;

Apply for a license under Regulation .03 of this chapter; and

Pay the required fees.

An applicant for a commercial ambulance service license shall submit a completed application to SOCALR on the required form.

A completed application shall contain:

The applicant shall submit with the application the applicable fees required in Regulation .07 of this chapter together with the documents required in this subtitle.

Before accepting any license for which it applied, the commercial ambulance service shall notify SOCALR of any changes to the information previously submitted on the application which occur before the license is granted, regarding:

To be eligible for a commercial ambulance license, an ambulance shall:

Additional Lettering for Ground Ambulances.

The applicant shall submit a diagram of the markings intended to be displayed on the ambulance including:

The applicant shall submit an application as required under Regulation .05 of this chapter.

The applicant shall pay the required fees.

An applicant for a commercial ambulance license shall submit a completed application to SOCALR on the required form.

A completed application shall contain:

The applicant shall pay the required fees.

The applicant shall submit with the application the following documents for each ground ambulance to be licensed:

The applicant shall submit with the application the following documents for each air ambulance the service intends to operate in Maryland:

Before the license is granted, the commercial ambulance service shall notify SOCALR of any changes to the information in the application which occur after the application is submitted.

A commercial ambulance service or a commercial ambulance may not be licensed or operated in Maryland unless the commercial ambulance service maintains continuous insurance, issued by an insurer authorized by the Maryland Insurance Commissioner to write these policies in Maryland, of the following types and amounts:

The general liability insurance coverage required by §A(1) of this regulation shall provide for payment of damages as a result of:

The financial responsibility requirements for commercial motor vehicle liability coverage shall conform to all applicable laws including:

The financial responsibility requirements for workers' compensation insurance shall comply with Labor and Employment Article, Title 9, Annotated Code of Maryland.

A commercial ambulance service shall provide SOCALR, as a condition of licensure or continued licensure, a certificate of insurance that:

A certificate of insurance for motor vehicle insurance required under §E of this regulation shall identify all vehicles covered by the manufacturer's vehicle identification number (VIN).

In addition to the notification requirements required by Insurance Article, §27-605, Annotated Code of Maryland, and this subtitle, a commercial ambulance service shall furnish to SOCALR, within 7 calendar days of receipt, copies of notification from an insurer of any of the following relating to insurance required by this chapter:

If the insurance coverage provided by an insurance company or a self-insurance fund is not adequate for the purposes required, MIEMSS may not issue a license.

Commercial Ambulance License Fees.

Miscellaneous Service Fees.

The licensing fee for adding a commercial ambulance vehicle during the fiscal year is:

SOCALR shall make noninflationary adjustments to the fees listed in §§A and B of this regulation by means of the regulatory promulgation process which affords interested parties the opportunity to make both oral and written comments to SOCALR before the adoption of a new fee schedule. The fees established in §§A and B of this regulation may be adjusted by SOCALR, from time to time, notwithstanding the inflationary adjustment in §E of this regulation, in order to provide funds sufficient to cover the actual direct and indirect costs of maintaining the licensing program in accordance with Education Article, §13-515, Annotated Code of Maryland, and this subtitle.

SOCALR may make inflationary adjustments to the fees listed in §§A and B of this regulation before the beginning of each fiscal year by applying the percent change in the consumer price index for the most recent complete calendar year to the annual licensing fee for the fiscal year ending rounded to the nearest $5 increment. This inflationary adjustment may be made by SOCALR without any additional consultation or amendment to the regulations. If the consumer price index ceases to be published, a comparable statistic on the purchasing power of the consumer dollar shall be adopted. If the base year (1982/84 = 100) or other base year used in computing the consumer price index is changed, the figures used in making the computation below shall be changed accordingly. The following formula shall be used in determining the annual inflationary adjustment to the fees:

SOCALR may set semiannual licensing fees that are adjusted to cover the additional costs incurred for semiannual rather than annual processing of licenses and decals. The semiannual licensing fee shall be one half of the annual licensing fee plus 6 percent of the halved annual fee, the sum of which is rounded to the nearest $5 increment.

Additional Fees.

When the fee schedule is adjusted, SOCALR shall provide a copy of the new fee schedule to all commercial ambulance services that:

All applicable fees listed in the fee schedule currently in effect shall be submitted to SOCALR with each application.

A license fee may not be refunded, in whole or in part, to any commercial ambulance service whose service or vehicle license is suspended or revoked.

SOCALR may waive any equipment requirements under COMAR 30.09 for any commercial ambulance service which is licensed by Maryland or applying for a license, which demonstrates to the satisfaction of SOCALR that the equipment offered by the commercial ambulance service is equivalent to or superior to the equipment required by this subtitle.

Waiver of Personnel Requirements.

A commercial ambulance service seeking a waiver under this regulation shall apply in writing to SOCALR.

A waiver is not valid unless issued in writing by SOCALR for a specific period of time.

A commercial ambulance service granted a waiver under this subtitle shall reapply for the waiver 30 days before expiration of the waiver.

A waiver may be summarily suspended if SOCALR finds the party to whom the waiver has been granted has:

Failure to comply with the terms of a waiver granted under this regulation may be grounds for further action under COMAR 30.09.09.02.

SOCALR shall issue a license to an applicant that:

Before issuing a license, SOCALR may verify information relating to an application by:

SOCALR may not issue a license to an applicant whose name is, in the judgement of SOCALR, confusingly similar to another person doing business in Maryland, or who otherwise has the right to use the name in Maryland.

A licensed commercial ambulance service shall produce its license upon demand of any person.

Unless revoked or surrendered, a commercial ambulance service license or ambulance license shall expire at midnight on the date indicated on the license.

A revoked or surrendered commercial ambulance service license or ambulance license shall expire immediately upon notification.

SOCALR shall affix a licensing decal to a commercial ground ambulance when it is licensed. The decal shall be displayed at all times on the outside of the back surface of the ambulance in a manner clearly visible to the public.

A licensing decal is not proof of a valid license.

Licenses and licensing decals issued by MIEMSS at all times remain the property of MIEMSS.

A licensee shall apply for a new license at least 14 calendar days before the current license expires.

To renew a license, the licensee shall apply to SOCALR under COMAR 30.09.03—30.09.05.

If a commercial ambulance license is not renewed, the ambulance owner shall contact SOCALR to have the ambulance licensing decals removed from its ambulances under Regulation .09 of this chapter.

The owner of a Maryland licensed commercial ambulance service wishing to merge with or acquire the assets or stock of another Maryland licensed commercial ambulance service may submit a letter of intent for the purpose of transferring the service and ambulance licenses to the successor service.

Information submitted to SOCALR relating to the possible transfer of vehicle licenses in a potential merger or acquisition are confidential until a license is issued to the successor, except as otherwise required by law.

If a successor service continues to do business in the name of and at the principal address of a merged or acquired service as it appears on the service license issued to the merged or acquired service and vehicles are not added at the time of merger or acquisition, the ground ambulance transfer fee is not imposed on the successor service in connection with the merger or acquisition.

If a successor service changes the name or principal address of a merged or acquired service or any other information appearing on a ground ambulance license, a transfer fee shall be paid for each ground ambulance which is relicensed.

The licensing fee required by COMAR 30.09.04.07 shall be paid for any additional ground ambulances licensed at the time of a merger or acquisition.

A prospective purchaser of the stock or assets of a commercial ambulance service, with the written permission of current ownership, may apply to SOCALR for a preliminary determination of the eligibility of the prospective purchaser for a commercial ambulance service license based on the eligibility criteria in COMAR 30.09.04.

There is a fee for preliminary review of a license application submitted by a prospective buyer.

Any information submitted to SOCALR relating to a potential acquisition of a commercial ambulance service is confidential until a license is issued to the successor, except as otherwise required by law.

If the purchaser changes the name or principal address of the acquired service or any information on a ground ambulance license, a vehicle license transfer fee shall apply for each vehicle to be relicensed.

The licensing fee required in COMAR 30.09.04.07 shall be paid for any additional ground ambulance licensed at the time of purchase.

A licensed commercial ambulance service may apply to SOCALR to transfer a commercial ground ambulance license from one of its ambulances to another if the transfer does not result in a net increase in the number of ground ambulances operated by the licensee.

Any net increase in the number of ground ambulances operated by the licensee is:

A commercial ambulance service shall contact SOCALR to have the ambulance licensing decals removed from its ambulances:

If a licensed commercial ambulance service is sold or ceases to operate, the service shall return the ambulance service license and all ground ambulance licenses to SOCALR within 14 calendar days of the sale or cessation of operation.

A commercial ambulance service shall contact SOCALR to have the ambulance's licensing decals removed:

A commercial ambulance service shall return to SOCALR a commercial ambulance license:

Commercial ambulance service advertisements shall contain:

The license designation number requirement under §A(2) of this regulation does not apply to the ambulance.

A commercial ambulance service that advertises 24-hour service shall:

All commercial ambulance service advertisements shall comply with applicable laws, including the Consumer Protection Act, Commercial Law Article, Title 13, Annotated Code of Maryland, which prohibits unfair or deceptive trade practices and false, misleading, or deceptive advertising.

Each commercial ambulance service proposal or contract for services shall contain the:

Each commercial ambulance service invoice for services shall contain the designation "Md.Comm.Amb.Lic.#" followed by the ambulance service license number issued by SOCALR.

Staffing. A commercial ambulance service shall:

Premises. A commercial ambulance service shall:

Infection Control Standards.

Training and Continuing Education Requirements. A commercial ambulance service shall:

Medical Direction Requirements. A commercial ambulance service shall:

Compliance with Statutes and Regulations. A commercial ambulance service shall:

Only dispatch an ambulance if:

Place medical supplies out of service as they expire and properly discard medical supplies which are expired;

Place malfunctioning medical equipment out of service until the equipment has been repaired or replaced;

Have an adequate number of AEDs to provide one AED on every:

For ground ambulances, have each ambulance inspected every 12 months by an inspection station licensed under Transportation Article, §23-103, Annotated Code of Maryland;

For ground ambulances, designate and maintain ambulances as emergency vehicles by equipping them with necessary:

Under Transportation Article, §11-118, Annotated Code of Maryland, equip and operate only ambulances as emergency vehicles;

Always operate each ambulance with due regard for the public;

Only use emergency warning lights and audible warning devices when:

Maintain in proper working order and good physical condition and, where applicable, meet all manufacturers recommendations for all:

Display the ambulance license, or a copy, in the patient compartment in a manner clearly visible to the patient;

Prohibit smoking or the carrying of lighted tobacco products on ambulances;

For ground ambulances, prohibit an ambulance to be driven, and may not allow any passengers or patients on board, until necessary repairs are completed and an inspection conducted if any of the following occur:

Assure occupants are safely transported in ambulances by:

Stow or adequately fasten all medical devices, supplies, or equipment to the satisfaction of SOCALR to prevent items from becoming projectiles that might cause injury in an abrupt stop or crash;

Assure that compartments used to carry heavier items, first aid kits, portable oxygen cylinders, suction units, intravenous pumps, ventilators, and monitors have positively locking latches:

Carry intravenous fluids, saline, sterile water, or other fluids only in bags or plastic bottles unless:

Unless requested to do so by a jurisdiction's communications center or unless standing by under contract with the organizer of an event, a commercial ambulance service may not respond to an emergency incident which:

If a commercial ambulance service and jurisdiction units respond to a call for assistance for the same patient or incident, the commercial ambulance service shall defer to the jurisdictional EMS operational unit unless the patient, or the patient's legal guardian, when competent to do so, expressly requests care or transport, or both, from the commercial ambulance service instead of the jurisdictional EMS operational unit.

If an uncommitted commercial ambulance crew chooses to render assistance or medical care at an emergency, such as those described under §A of this regulation and can do so without the crew members themselves becoming victims, and no jurisdictional EMS providers are immediately available, the following procedure applies:

A commercial ambulance service that requests a jurisdiction to assist them with manpower or equipment shall:

Voluntary Service during Disasters.

Maintain records in any permanent form including:

Organize all records in such a manner as to allow the commercial ambulance service to locate, within a reasonable time, a record, given:

Retain all records for not less than 5 years and in accordance with:

A commercial ambulance service shall maintain complete and accurate records regarding the care and transportation of each patient that the commercial ambulance service:

A record for each patient referred to in §A of this regulation shall contain the following information:

A commercial ambulance service shall use the standard Maryland Ambulance Information System runsheet and additional narrative supplied at cost by SOCALR.

A complete and current personnel list which includes:

Personnel lists which include each employee's:

Accurate and completed employee training records for:

Training records that document:

Accurate records of employee:

Complete dated inventory sheets daily to ensure each ambulance is:

Maintain a written policy detailing the procedures to be followed if a mechanical failure occurs with the ambulance when responding to or transporting a patient.

Upon reasonable request from SOCALR, submit within a reasonable time:

Notify SOCALR orally within 72 hours, and in writing within 5 calendar days, of all:

Submit every proposed change to ambulance markings for review and approval before making any changes to ambulance markings, including but not limited to:

Submit by the 15th of each month for the preceding month a complete and accurate MAIS report for each patient that the commercial ambulance service:

Submit a current personnel list quarterly, before the 15th of January, April, July, and October; and

Submit by the 15th of each month for the preceding month a summary report listing the number of calls for the month that were:

If a licensee or applicant violates Education Article, §13-515, Annotated Code of Maryland, or this subtitle, SOCALR may:

If a person granted a waiver of the requirements of Education Article, §13-515, Annotated Code of Maryland, by MIEMSS violates the provisions of this subtitle, MIEMSS may rescind the waiver.

Obtaining, attempting to obtain, or maintaining a waiver by fraud or deceit;

Making a material omission or misrepresentation of fact on an application for a license or a waiver;

Making a material omission or misrepresentation of fact in response to an inquiry or investigation by SOCALR for the purposes of determining compliance or investigating a complaint;

Defacing, altering, removing, or obliterating any portion of or any official entry on a license, licensing decal, or waiver issued by SOCALR;

Interfering with SOCALR in the performance of its duties;

Failing to pay applicable licensing fees;

Failing to pay the cost of services and materials provided to the commercial ambulance service by MIEMSS;

Failing to comply with the requirements of a noncompliance notice or remedial action;

Receiving multiple noncompliance notices which in SOCALR's judgment are of sufficient quantity, severity, or frequency to require more severe action to ensure the health, safety, and welfare of those persons utilizing the services of a particular commercial ambulance service;

Violating Education Article, §13-515, Annotated Code of Maryland;

Violating this subtitle; or

Under the laws of the United States or of any state, conviction of any owner, Maryland based principal, or individual with substantial control over the finances, operations, or both of the service, for a felony or a misdemeanor that is directly related to the fitness and qualification of the applicant or licensee to provide commercial ambulance services.

A commercial ambulance service licensed by SOCALR shall:

Any person may file a complaint about a commercial ambulance service with SOCALR.

SOCALR may ask a commercial ambulance service to explain a complaint before SOCALR takes further action on it.

A complaint not covered by this subtitle may be referred by SOCALR to other appropriate parties for investigation and action.

A commercial ambulance service shall:

A commercial ambulance service may not retaliate against an employee because the employee:

SOCALR does not have jurisdiction over and may not take action on complaints that relate solely to billing matters.

SOCALR may inspect a commercial ambulance service or commercial ambulance and investigate compliance by a commercial ambulance crew member to:

SOCALR may inspect the following to verify eligibility or continued compliance with this subtitle:

SOCALR may conduct confidential conferences with staff or patients during any inspection or investigation.

Upon request by SOCALR, a commercial ambulance service, and its owners, management, employees, or agents, shall, at reasonable times and without delay, allow SOCALR to enter all premises designated on the application or used in the operation of a commercial ambulance service, and all commercial ambulances used by the commercial ambulance service, for the purpose of an inspection or investigation necessary to ensure compliance with this subtitle.

Inspections to evaluate eligibility of a commercial ambulance service or a commercial ambulance for a license shall be scheduled with the management of the commercial ambulance service at least 24 hours before the inspection unless otherwise mutually agreed.

Inspections to ensure continued compliance with this subtitle do not require advance notice.

Inspection Procedure. SOCALR shall:

SOCALR may inspect a commercial ambulance vehicle at any reasonable time, including whenever it is present at a health care facility or other place of medical care or when picking up, transporting, or discharging any patient.

Inspections shall be conducted without impeding patient care or unreasonably delaying patient transport unless, in the judgment of SOCALR, the patient care being rendered is detrimental or is reasonably likely to be detrimental to the patient's health, safety, or welfare.

No one may impede SOCALR in conducting lawful inspections necessary to evaluate compliance with this subtitle.

SOCALR may, with written permission from a commercial ambulance service's owner, which may include a hold harmless clause, ride on commercial ambulance service calls for the purpose of evaluating compliance with this subtitle.

SOCALR may conduct surveys of patients served by a commercial ambulance service to evaluate compliance with this subtitle.

SOCALR may take photographs or videos during an inspection or investigation under this subtitle.

After the initial investigation, SOCALR may dismiss a complaint or terminate an investigation if it finds the complaint or alleged violation to be:

If SOCALR finds that a commercial ambulance service, a commercial ambulance, or an individual to whom MIEMSS has issued a certification card or license is believed to have violated this subtitle or an order issued by SOCALR, SOCALR may issue a noncompliance notice.

Each noncompliance notice shall:

The noncompliance notice is the final agency action if a party does not timely request a hearing under Regulation .09 of this chapter to contest the noncompliance notice.

SOCALR may summarily suspend a license for prohibited conduct under this chapter if the public health, safety, or welfare imperatively requires the emergency action.

If a license is summarily suspended under §A of this regulation, SOCALR shall furnish, within 3 business days, to the licensee whose license is temporarily suspended:

The written notice under §B of this regulation shall be:

For a hearing on a summary suspension under Regulation .09 of this chapter, certain time periods shall be shortened, as specified in Regulation .09 of this chapter.

The summary suspension is the final action if a party does not timely request a hearing under Regulation .09 of this chapter to contest the summary suspension.

SOCALR may suspend or revoke a license for acts that violate this chapter.

SOCALR may require appropriate remedial action instead of suspension or revocation of a license. The requirements for the remedial action shall:

The action taken by SOCALR is the final agency action if a party does not timely request a hearing under Regulation .09 of this chapter to contest the action.

Upon the suspension or revocation of a commercial ambulance service license the commercial ambulance service shall immediately:

Upon the suspension or revocation of a commercial ambulance license, the commercial ambulance service shall immediately:

Initiation of a Hearing.

Hearing Procedures.

Final Decision.

Exceptions.

Judicial Review. Final contested case decisions of the Executive Director are subject to judicial review as provided by law. MIEMSS shall be a party to any review.

In addition to the civil remedies provided under this subtitle, a person who violates any provision of this subtitle may be prosecuted criminally for commission of a misdemeanor.

Upon conviction, a person found guilty of violating any provision of this subtitle is subject to a fine not exceeding $1,000 per violation.

All commercial ambulance services shall equip operating bases and ambulances as required by this chapter unless the:

Additional equipment requirements for ALS and neonatal ambulances are listed in COMAR 30.09.11 and 30.09.12.

Greater quantities of supplies and medications shall be added to the ambulance if:

Waivers.

The ability to reliably communicate with the public by telephone;

A two-way radio or radiotelephone that will properly communicate with its ambulance within the routine area of operation; and

An adequate amount of medical supplies to ensure stock is reasonably proportional to the size of the service and call volume.

Two C cell or larger, portable hand-lights;

One A-B-C rated fire extinguisher of at least 5 pound capacity, securely mounted in a location that is readily accessible to the crew;

One 40-channel UHF two-way radio, with the tone codes necessary to communicate with online medical control in Maryland;

One two-way radio or cellular telephone that will properly communicate between the ambulance and the ambulance service dispatch center which may be the same radio referenced in §C of this regulation;

For ground ambulances, three U.S. Department of Transportation approved reflective road hazard triangles;

No Smoking signs in both the patient and driver compartment mounted in a location that is clearly visible to vehicle occupants with letters at least 1 inch tall and 3/4 inch wide; and

One copy of the Maryland Medical Protocols for EMS Providers.

24 sterile gauze pads at least 3 inch by 3 inch;

Three rolls of 2-inch hypoallergenic adhesive tape;

Three rolls of 1-inch hypoallergenic adhesive tape;

12 cravats or triangular bandages;

12 rolls of 4-inch self-adjusting gauze bandages;

Four chemical cold packs;

One box of assorted, plastic, bandage strips;

Six clean individually wrapped sanitary napkins or other highly absorbent sterile dressing;

Five sterile trauma dressings, 5 inches by 9 inches minimum;

Two tongue depressors;

Two tubes of glucose supplement;

One 30 milliliter vial of ipecac or equivalent;

One 100 gram bottle of activated charcoal with or without sorbitol;

Adult 0.3 milligram epinephrine auto-injector;

Pediatric 0.15 milligram epinephrine auto-injector;

One penlight;

One piece of nonadherent material for occlusive dressing, 18 inches by 25 inches minimum (metal foil not acceptable);

Two burn sheets;

Two emesis basins;

One pair of all purpose utility scissors;

One container of disinfectant meeting the requirements of 29 CFR §1910.1030;

One box of facial tissue or roll of toilet tissue;

Six Maryland triage/treatment tags, with color-coded plastic ribbon in:

One sterile commercially packaged obstetrical (OB) kit containing:

One bed pan;

One urinal;

Four leak proof bags of at least 3 millimeter thick which are:

One receptacle to safely dispose of needles, glass, or other sharp material; and

One CPR board or equivalent.

Onboard suction unit which is:

Portable suction unit which is:

Each ambulance shall carry a portable kit containing the following medical supplies:

The portable kit shall be:

Oxygen which meets the following criteria:

Regulators which:

At least one flow smeter dedicated to the portable oxygen system that is not gravity dependent;

If present, positive pressure demand valves which provide:

Adult oxygen administration sets which are the following types and quantities:

Pediatric oxygen administration sets which are the following types and quantities:

Two sets of oxygen connecting tubing;

One hand operated, self-reinflating adult bag valve mask with:

One hand operated, self-reinflating, pediatric bag valve mask with:

One pocket mask with one-way valve; and

One set of oropharyngeal airways in the following sizes:

One ambulance stretcher that:

One folding stair chair capable of negotiating narrow hallways or stairways.

One full spinal immobilization board for transportation or equivalent;

One half spinal immobilization device;

One orthopedic or clamshell stretcher or equivalent;

Three 9-foot straps with buckles;

Two long padded board splints approximately 54 inches by 3 inches;

Two medium padded board splints approximately 36 inches by 3 inches;

Two short padded board splints approximately 15 inches by 3 inches; and

Rigid extrication collars in the following adult sizes:

Equipment or supplies required to protect personnel during the performance of their duties shall be carried in each commercial ambulance vehicle licensed under this subtitle.

The quantities and specifications of the equipment and supplies required in this chapter shall meet at least the requirements set by the Maryland Occupational Safety and Health.

Each ambulance shall carry the following personal protective equipment supplies:

Two pillows covered with nonabsorbent material or disposable;

Four cloth or disposable pillow cases;

Four cloth or disposable sheets; and

Two blankets.

An ALS commercial ambulance service shall retain at least one licensed paramedic to function as an ALS coordinator who:

An ALS commercial ambulance service may provide BLS service with an ambulance licensed as either:

An ALS commercial ambulance service may not provide scheduled ALS service with a BLS-licensed commercial ambulance vehicle unless:

An onboard oxygen system that meets the requirements of COMAR 30.09.10.09;

Cardiac monitoring/defibrillating/transcutaneous pacing equipment including:

Medications including:

Intravenous equipment and supplies including:

Parenteral administration equipment including:

Blood specimen collection equipment including:

Ventilation and airway maintenance equipment including:

One direct current to alternating current inverter power supply capable of providing proper wattage to power equipment used on an ALS ambulance; and

Miscellaneous equipment and supplies as follows:

An ALS-licensed ambulance may not transport an obstetrical patient from one hospital to another for a higher level of obstetrical care unless:

Equipment Requirements.

Additional Record Keeping Requirements.

The additional requirements for obstetrical transports listed in §§A and B of this regulation may be waived when an ALS-licensed commercial ambulance is transporting an uncomplicated obstetrical patient from a hospital without an obstetrical service.

Licensed as a specialty care transport ambulance service; or

No more than ten times a year, if a licensed specialty care transport ambulance service is not available within a clinically reasonable time as determined by the referring physician:

A commercial ambulance service wishing to provide neonatal ambulance services shall comply with the requirements of this chapter in addition to the other applicable requirements of this subtitle.

An ambulance service transporting neonates shall obtain a neonatal commercial ambulance service license.

An applicant for a neonatal commercial ambulance service license shall submit an application to SOCALR on the required form.

A completed application form shall be accompanied by documentation which states to SOCALR’s satisfaction that the commercial ambulance service has:

A licensed neonatal commercial ambulance service shall immediately advise SOCALR of any change in the medical director named in §D(2) of this regulation.

A licensed neonatal commercial ambulance service may not transport a neonate from one hospital to another for a higher level of care unless the admitting hospital:

Neonates.

Infants. Infants being transferred to any acute care setting shall be transported by:

Neonates or Infants being transported for convalescent care at a rehabilitation hospital or long-term facility shall be transported by:

An applicant for a neonatal commercial ambulance license shall submit an application to SOCALR.

A licensed neonatal commercial ambulance service may only provide neonatal transport service with an ALS or SCT licensed commercial ambulance that meets all the requirements of this chapter.

A licensed neonatal commercial ambulance service shall ensure the patient is secured in a patient restraint device appropriate for the patient’s age and weight.

A licensed commercial ambulance, when providing neonatal service, shall be staffed by:

When more than one patient is transported simultaneously in the same ambulance:

All personnel attending to neonatal patients shall:

In addition to the information required in COMAR 30.09.08, the following information shall be documented on the patient runsheet:

A copy of the runsheet and all documentation of patient care during the transport shall be submitted in accordance with COMAR 30.09.08.06D.

A licensed neonatal commercial ambulance service shall have a quality assurance program required by COMAR 30.03.04 which shall include:

A licensed neonatal commercial ambulance service shall comply with COMAR 30.09.11.03 when transporting a neonate.

There shall be a written maintenance plan for all medical devices used on neonatal commercial ambulances approved by SOCALR, which shall provide that:

All on-board medical devices shall be secured to the satisfaction of SOCALR.

The following equipment shall be carried in a neonatal ambulance:

A list of the additional medications used by the neonatal service and approved by the neonatal service medical director shall be provided to SOCALR and approved by the State EMS Medical Director annually upon license renewal, and shall be available on each ambulance when in use for a neonatal transport.

SOCALR shall be notified in writing of any changes to the list of additional medications used by the neonatal transport service within 7 days of the change.

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

To be licensed as a commercial care air ambulance service, a commercial air ambulance service shall comply with the requirements of this chapter in addition to the other applicable requirements of this subtitle.

An applicant for a commercial air ambulance service license shall submit an application to SOCALR on the required form.

An applicant for a commercial air ambulance service license shall:

A licensed commercial air ambulance service shall notify SOCALR within 24 hours of any change in CAMTS accreditation status and the reason for the change.

A licensed commercial air ambulance service may provide ALS, critical care, or neonatal transport service, or any combination of these, if:

A licensed commercial air ambulance service may not provide services with an unlicensed air ambulance unless:

A licensed commercial air ambulance service that provides services with an unlicensed air ambulance shall notify SOCALR when the licensed air ambulance is returned to service.

A pilot who meets the requirements of licensure established by the Federal Aviation Administration 14 CFR Parts 61, 67, and 135; and

At least two additional individuals who meet or exceed the requirements for CAMTS accreditation at the level which the service is providing.

Each air ambulance shall carry sufficient equipment and supplies listed in COMAR 30.09.10—13 to assure:

A list of medical equipment and supplies will be provided to SOCALR with the licensing application.

All medical, communications, and associated equipment on-board:

Pilots of rotary wing air ambulances shall remain with the aircraft when the aircraft is occupying a hospital helipad with room for landing a single aircraft.

SYSCOM shall coordinate the landing sequence of multiple emergency medical services aircraft in consultation with the pilots-in-command based on patient priority.

Commercial air ambulance services shall:

To be licensed as a specialty care transport commercial ambulance service, a commercial ambulance service shall comply with the requirements of this chapter in addition to the other requirements of this subtitle.

An applicant for a specialty care transport commercial ambulance service license shall submit an application to SOCALR on the required form.

A licensed specialty care transport commercial ambulance service shall retain one or more medical directors as required by COMAR 30.03.03.

In addition to the qualifications in COMAR 30.03.03, the medical director for a specialty care service shall:

The medical director for a licensed specialty care transport ambulance service shall participate in the development and implementation of any patient care guidelines required for interfacility transport of critically ill patients, including those guidelines to be followed by nursing personnel.

A licensed specialty care ambulance service shall immediately advise SOCALR of any change in medical directors.

A licensed specialty care ambulance service shall retain one or more registered nurses or nurse practitioners who:

The licensed specialty care ambulance service shall credential any registered nurse retained by the service to ensure the registered nurse meets the requirements of §G of this regulation.

A licensed specialty care commercial ambulance service shall have a quality assurance program required by COMAR 30.03.04 which shall include:

The interior configuration of an ambulance used for specialty care transport shall:

A licensed specialty care transport ambulance service may provide specialty care transport using:

An ambulance providing specialty care transport service shall be staffed as provided in this regulation.

If the care required is within the scope of practice of Specialty Care Paramedic and the patient requires no more than one specialty care intervention, as defined in the Maryland Medical Protocols for Emergency Medical Services:

If the care required is within the scope of practice of a Specialty Care Paramedic and the patient requires two or more specialty care interventions, as defined in the Maryland Medical Protocols for Emergency Medical Services:

If the care required is outside the scope of practice of a Specialty Care Paramedic:

If an SCT service is not able to provide a staffed and equipped SCT ambulance within a clinically reasonable time as determined by the referring physician, it may conduct the SCT transport if:

The paramedic shall provide documentation to the licensed commercial ambulance service that they have successfully completed a specialty care transport course that meets the requirements of COMAR 30.04.03.

The medical director is responsible for credentialing the paramedic as required in COMAR 30.03.03.06.

The paramedic shall receive at least 36 hours of specialty care continuing education every 3 years.

Annual review of clinical competency in the skills required for the type that are transported; and

Proof of training on the use of the equipment necessary to care for and transport the patient, including those items in Regulation .04 of this chapter.

All specialized medical devices used during transport shall:

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

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

All on-board medical devices shall be secured.

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

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

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

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

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