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

## Subtitle 09 — Commercial Ambulance Services

### Chapter 10 — Standard Commercial Ambulance Equipment

**Authority:** Education Article, §§13-508 and 13-515, Annotated Code of Maryland

**Administrative History:** Effective date: October 12, 1992 (19:20 Md. R. 1816)

**Administrative History:** Regulation .04 adopted as an emergency provision effective January 6, 1997 (24:2 Md. R. 114); emergency status expired July 6, 1997

**Administrative History:** Regulation .04 adopted permanently effective July 7, 1997 (24:10 Md. R. 711)

**Administrative History:** Chapter recodified from COMAR 14.22.10 to COMAR 30.09.10, August, 1997

**Administrative History:** Regulation .04A amended as an emergency provision effective July 1, 1998 (25:15 Md. R. 1189); amended permanently effective October 5, 1998 (25:20 Md. R. 1534)

**Administrative History:** Regulations .01—.04, ALS Service, repealed effective January 10, 2000 (26:27 Md. R. 2017)

**Administrative History:** Regulations .01—.13, Standard Commercial Ambulance Equipment, adopted effective January 10, 2000 (26:27 Md. R. 2017)

**Administrative History:** Regulation .02 amended effective October 15, 2004 (31:20 Md. R. 1486)

**Administrative History:** Regulation .04E amended effective October 15, 2004 (31:20 Md. R. 1486)

**Administrative History:** Regulation .05 amended effective October 15, 2004 (31:20 Md. R. 1486)

**Administrative History:** Regulation .09A, C amended effective October 15, 2004 (31:20 Md. R. 1486)

#### Regulation .01 Scope.

*COMAR 30.09.10.01*

This chapter governs standard commercial ambulance equipment.

#### Regulation .02 Standard Equipment.

*COMAR 30.09.10.02*

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

  (1) Commercial ambulance service is specifically excluded from a specific class of commercial ambulance service in a related chapter of this subtitle; or

  (2) Requirement is waived in writing by SOCALR for a specific commercial ambulance service or a specific commercial ambulance.

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

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

  (1) The transport time is greater than 30 minutes, and the patient is known to require supplies or medications that exceed the requirements in COMAR 30.09.10—13; or

  (2) The ambulance is on standby at an event where it can reasonably be expected that there will be more than one patient.

D. Waivers.

  (1) A commercial ambulance service may request in writing under the requirements of COMAR 30.09.04.08 that SOCALR waive a requirement to carry equipment which is not needed for the service provided.

  (2) The commercial ambulance service shall bear the burden of demonstrating to SOCALR's satisfaction that the equipment is not necessary.

#### Regulation .03 Standard Operating Base Equipment.

*COMAR 30.09.10.03*

Each operating base shall have:

A. The ability to reliably communicate with the public by telephone;

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

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

#### Regulation .04 Standard Ambulance Equipment and Supplies.

*COMAR 30.09.10.04*

Each ambulance shall carry the following equipment and supplies:

A. Two C cell or larger, portable hand-lights;

B. 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;

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

D. 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;

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

F. 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

G. One copy of the Maryland Medical Protocols for EMS Providers.

#### Regulation .05 Standard Ambulance Medical Supplies.

*COMAR 30.09.10.05*

Each ambulance shall carry the following standard medical supplies:

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

B. Three rolls of 2-inch hypoallergenic adhesive tape;

C. Three rolls of 1-inch hypoallergenic adhesive tape;

D. 12 cravats or triangular bandages;

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

F. Four chemical cold packs;

G. One box of assorted, plastic, bandage strips;

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

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

J. Two tongue depressors;

K. Two tubes of glucose supplement;

L. One 30 milliliter vial of ipecac or equivalent;

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

N. Adult 0.3 milligram epinephrine auto-injector;

O. Pediatric 0.15 milligram epinephrine auto-injector;

P. One penlight;

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

R. Two burn sheets;

S. Two emesis basins;

T. One pair of all purpose utility scissors;

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

V. One box of facial tissue or roll of toilet tissue;

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

  (1) Red,

  (2) Yellow,

  (3) Green, and

  (4) Black;

X. One sterile commercially packaged obstetrical (OB) kit containing:

  (1) One large towel or receiving blanket,

  (2) One pair of sterile gloves,

  (3) Two umbilical clamps or ties,

  (4) One bulb syringe, and

  (5) One pair of sterile scissors or scalpel;

Y. One bed pan;

Z. One urinal;

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

  (1) Red, or

  (2) Marked with the universal biohazard symbol conforming to 29 CFR §1910.145;

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

CC. One CPR board or equivalent.

#### Regulation .06 Standard Ambulance Suction Units.

*COMAR 30.09.10.06*

Each ambulance shall be equipped with one:

A. Onboard suction unit which is:

  (1) Powered by a reliable source from:

    (a) The engine manifold, or

    (b) An electrically powered vacuum pump;

  (2) Capable of developing a:

    (a) Vacuum pressure equivalent to at least 300 mm Hg within 4 seconds of clamping, and

    (b) Free air flow of at least 20 liters/minute at the end of the collection tube;

  (3) Adjustable in suction force for use in children and intubated patients;

  (4) Equipped with wide bore tubing;

  (5) Equipped with one rigid pharyngeal suction tip; and

  (6) Equipped with two suction catheters with integral thumb controls in assorted sizes appropriate for the patients being transported including at least one size from among:

    (a) 6, 8, 10, or 12 French catheter, and

    (b) 14, 16, or 18 French catheter; and

B. Portable suction unit which is:

  (1) Capable of operating continuously under suction for at least 20 minutes while independent of alternating current;

  (2) Capable of developing:

    (a) A vacuum pressure equivalent to 300 mm Hg within 4 seconds of clamping, and

    (b) A free air flow of at least 20 liters/minute at the end of the suction tube;

  (3) Equipped with wide bore tubing;

  (4) Equipped with one rigid pharyngeal suction tip; and

  (5) Equipped with two suction catheters with integral thumb controls in sizes appropriate for the patients being transported including one size from among:

    (a) 6, 8, 10, or 12 French catheter, and

    (b) 14, 16, or 18 French catheter.

#### Regulation .07 Standard Ambulance Portable Medical Equipment.

*COMAR 30.09.10.07*

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

  (1) 12 sterile gauze pads at least 3 inches by 3 inches in size;

  (2) Two rolls of 2-inch hypoallergenic adhesive tape;

  (3) Eight cravats or triangular bandages;

  (4) One set of oropharyngeal airways in adult, child, and pediatric sizes;

  (5) One stethoscope;

  (6) One adult blood pressure cuff;

  (7) One pediatric blood pressure cuff;

  (8) One pair of all purpose utility scissors;

  (9) One penlight;

  (10) Six rolls of 4-inch self-adjusting gauze bandages;

  (11) Four sterile trauma dressings at least 5 inch by 9 inches in size;

  (12) One marking pen; and

  (13) 12 exam gloves which meet the requirements of 29 CFR §1910.1030.

B. The portable kit shall be:

  (1) Dust and moisture resistant;

  (2) Large enough to carry the required items; and

  (3) Organized so items are readily accessible.

#### Regulation .08 Standard Ambulance Defibrillation Equipment.

*COMAR 30.09.10.08*

Each in-service ambulance shall carry at least one automated external defibrillator.

#### 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.

#### Regulation .10 Standard Ambulance Patient-Carrying Devices.

*COMAR 30.09.10.10*

Each ambulance shall carry the following standard equipment for carrying patients:

A. One ambulance stretcher that:

  (1) Is adjustable in height,

  (2) Permits the elevation of the upper body,

  (3) Has a mattress covered with nonabsorbent material free from defects, such as rips and tears,

  (4) Has safety straps to secure the patient in accordance with the manufacturer's recommendations, and

  (5) Has a stretcher-mounted IV pole or equivalent; and

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

#### Regulation .11 Standard Ambulance Fracture Immobilization Equipment.

*COMAR 30.09.10.11*

Each ambulance shall carry the following fracture immobilization equipment:

A. One full spinal immobilization board for transportation or equivalent;

B. One half spinal immobilization device;

C. One orthopedic or clamshell stretcher or equivalent;

D. Three 9-foot straps with buckles;

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

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

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

H. Rigid extrication collars in the following adult sizes:

  (1) Two adjustable; or

  (2) One of each of the following:

    (a) Medium (regular),

    (b) Small (short), and

    (c) Extra small (no-neck or neckless).

#### Regulation .12 Standard Ambulance Personal Protective Equipment.

*COMAR 30.09.10.12*

A. 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.

B. 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.

C. Each ambulance shall carry the following personal protective equipment supplies:

  (1) Adequate quantities of exam gloves in:

    (a) Uni-size; or

    (b) All of the following:

      (i) Small,

      (ii) Medium, and

      (iii) Large;

  (2) Two pair non-absorbent gowns per crew member;

  (3) Two surgical masks per crew member;

  (4) One pair safety goggles per crew member;

  (5) One particulate (TB) mask per crewmember; and

  (6) At least 4 ounces of waterless hand cleaner.

#### Regulation .13 Standard Ambulance Linen Supplies.

*COMAR 30.09.10.13*

Each ambulance shall carry the following linen supplies:

A. Two pillows covered with nonabsorbent material or disposable;

B. Four cloth or disposable pillow cases;

C. Four cloth or disposable sheets; and

D. Two blankets.