# COMAR Title 30 — Maryland Institute for Emergency Medical Services Systems (MIEMSS)

## Subtitle 09 — Commercial Ambulance Services

### Chapter 10 — Standard Commercial Ambulance Equipment

#### Regulation .09 Standard Ambulance Ventilation and Airway Maintenance Equipment.

*COMAR 30.09.10.09*

Each ambulance shall carry the following standard airway maintenance and ventilation equipment:

A. Oxygen which meets the following criteria:

  (1) For ground ambulances:

    (a) Optional onboard cylinders for BLS ambulances have a capacity of at least 3,000 liters;

    (b) Portable cylinders have a capacity of at least 400 liters;

    (c) The following number of cylinders, if on-board oxygen is present, unless more are needed for a particular patient based on COMAR 30.09.07.03A(2)(g):

      (i) One E size,

      (ii) One jumbo D size, or

      (iii) Two D size;

    (d) The following number of cylinders, if on-board oxygen is not present, unless more are needed for a particular patient based on COMAR 30.09.07.03A(2)(g):

      (i) Two E size,

      (ii) Two jumbo D size, or

      (iii) Three D size;

  (2) For air ambulances:

    (a) An on-board oxygen system that meets the CAMTS standards, which provide that:

      (i) Oxygen is installed according to FAA regulations;

      (ii) Medical transport personnel can determine if oxygen is on by in-line pressure gauges mounted in the patient care area;

      (iii) Each gas outlet is clearly marked for identification;

      (iv) Oxygen flow can be stopped at or near the oxygen source from inside the aircraft;

      (v) The indicators for quantity of oxygen remaining and measurement of liter flow are accessible to medical transport personnel while enroute; and

      (vi) Oxygen flow meters and outlets must be padded, flush mounted, or so located to prevent injury to medical transport personnel; and

    (b) A minimum of one portable oxygen cylinder that has a capacity of at least 400 liters;

  (3) All cylinders are properly color coded for U.S.P. grade, medical oxygen;

  (4) The system is free of:

    (a) Grease,

    (b) Oil, or

    (c) Other flammable organic material; and

  (5) All cylinders have passed hydrostatic testing during the past:

    (a) 5 years, or

    (b) 10 years, if approved by the inspector based on the condition of the cylinder;

B. Regulators which:

  (1) Have a reducing valve limiting line pressure to 50  10 psi;

  (2) Have a pressure gauge, with a range of 0 to 2,500 psi, to indicate the pressure of oxygen remaining in the cylinder;

  (3) Are capable of delivering at least 0 to 15 liters/minute flow in calibrated increments;

  (4) Are accurate to within 1 liter/minute when at a setting equal to or less than 5 liters/minute;

  (5) Are accurate to within 1.5 liters/minute when at a setting between 6 and 10 liters/minute; and

  (6) Are accurate to within 2 liters/minute when at a setting equal to or greater than 11 liters/minute;

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

D. If present, positive pressure demand valves which provide:

  (1) 100 percent oxygen;

  (2) An instantaneous flow rate not greater than 40 liters/minute;

  (3) An inspiratory pressure relief valve that opens at 60-centimeter water pressure; and

  (4) A 15/22-millimeter fitting;

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

  (1) Four non-rebreather;

  (2) Two venturi;

  (3) Six nasal cannula;

  (4) Disposable, single use design; and

  (5) Transparent;

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

  (1) Two non-rebreather;

  (2) Two nasal cannula;

  (3) Disposable, single use design; and

  (4) Transparent;

G. Two sets of oxygen connecting tubing;

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

  (1) Oxygen inlet;

  (2) Reservoir tube;

  (3) Transparent face mask; and

  (4) Selectable pop off valve or no pop off valve;

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

  (1) Oxygen inlet;

  (2) Reservoir tube;

  (3) One transparent neonatal face mask; and

  (4) One transparent pediatric or child face mask;

J. One pocket mask with one-way valve; and

K. One set of oropharyngeal airways in the following sizes:

  (1) Adult;

  (2) Child; and

  (3) Infant.