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<regulation prefix="Regulation" num=".03" citation="COMAR 30.09.11.03" title_num="30" subtitle_num="09" chapter_num="11" heading="Additional Equipment Required for ALS Ambulances.">
  <text>In addition to the equipment required under COMAR 30.09.10, the following equipment and supplies shall be carried in commercial ambulances licensed to provide ALS service:</text>
  <paragraph num="A.">
    <text>An onboard oxygen system that meets the requirements of COMAR 30.09.10.09;</text>
  </paragraph>
  <paragraph num="B.">
    <text>Cardiac monitoring/defibrillating/transcutaneous pacing equipment including:</text>
    <paragraph num="(1)">
      <text>One monitor/defibrillator which has:</text>
      <paragraph num="(a)">
        <text>Direct current capability,</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Paper print out capability,</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Synchronized cardioversion and unsynchronized defibrillation,</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Two adult and one pediatric defibrillator pads,</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Defibrillator pads with quick look capability,</text>
      </paragraph>
      <paragraph num="(f)">
        <text>One set of EKG leads, and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Transcutaneous pacing; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Supplies related to EKG monitoring to include the following items:</text>
      <paragraph num="(a)">
        <text>18 ECG electrodes,</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Spare set of EKG leads or equivalent,</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Spare monitor/defibrillator batteries,</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Two spare EKG paper rolls,</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Two adult transcutaneous pacing pads,</text>
      </paragraph>
      <paragraph num="(f)">
        <text>One pediatric transcutaneous pacing pad, and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>One tube of electrode paste or two packages of electrolyte pads for use in defibrillation;</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Medications including:</text>
    <paragraph num="(1)">
      <text>All the medications listed in the Maryland Medical Protocols for Emergency Medical Services Providers in sufficient quantities to treat and care for each patient that they respond to and care for;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Sufficient quantities to provide:</text>
      <paragraph num="(a)">
        <text>At least the maximum dosage for one 100 kilogram patient for a period of 30 minutes, or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>An adequate quantity to treat and care for the patient if the transport time is expected to exceed 30 minutes;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Controlled substances which are stored in a controlled access system acceptable to SOCALR; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Two nebulizers for medication administration;</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Intravenous equipment and supplies including:</text>
    <paragraph num="(1)">
      <text>Two 16 gauge 1 1/4 to 1 1/2 inches long intravenous catheters with needles;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Two 18 gauge, 1 1/4 to 1 1/2 inches long intravenous catheters with needles;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Two 20 gauge, 1 1/4 to 1 1/2 inches long intravenous catheters with needles;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Two 22 gauge, 1 1/4 to 1 1/2 inches long intravenous catheters with needles;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Two 24 gauge, 1 1/4 to 1 1/2 inches long intravenous catheters with needles;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Two 10 or 20 drops/milliliter or equivalent intravenous administration sets;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Two 60 drops/milliliter or equivalent intravenous administration sets;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Two 1000 cubic centimeter bags or equivalent of Ringer's lactate intravenous solution;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Site preparation materials; and</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Roof-mounted hooks for hanging intravenous solutions;</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Parenteral administration equipment including:</text>
    <paragraph num="(1)">
      <text>Four 1 milliliter syringes with 25 gauge needles;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Four 3—5 milliliter syringes with 1-inch, 18—21 gauge needles for IM injection;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Four 10 milliliter syringes; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Four 18, 19, or 20 gauge needles;</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Blood specimen collection equipment including:</text>
    <paragraph num="(1)">
      <text>Two red top blood tubes;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Two purple top blood tubes; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Two vacutainer barrels;</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Ventilation and airway maintenance equipment including:</text>
    <paragraph num="(1)">
      <text>Laryngoscope equipment and supplies:</text>
      <paragraph num="(a)">
        <text>One of each size 0, 1, 2, 3, and 4 Miller laryngoscope blades,</text>
      </paragraph>
      <paragraph num="(b)">
        <text>One of each size 1, 2, 3, and 4 MacIntosh laryngoscope blades, and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>One each adult and pediatric laryngoscope handles;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Endotracheal tubes:</text>
      <paragraph num="(a)">
        <text>One of each size 6, 7, 8, and 9 millimeter cuffed, and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>One of each size 2.5, 3, 3.5, 4, and 5 millimeter uncuffed;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>One adult flexible stylette;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>One pediatric flexible stylette;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>One roll of 1-inch adhesive tape;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>One 10 milliliter syringe;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>One pair adult McGill forceps;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>One pair pediatric McGill forceps;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>One 4-ounce tube or four 3-gram packets of water soluble surgical lubricant;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>One spare laryngoscope bulb for both MacIntosh and Miller blades;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>One spare set of laryngoscope batteries for both adult and pediatric handles; and</text>
    </paragraph>
    <paragraph num="(12)">
      <text>One end title carbon dioxide (ETCO2) detector.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>One direct current to alternating current inverter power supply capable of providing proper wattage to power equipment used on an ALS ambulance; and</text>
  </paragraph>
  <paragraph num="I.">
    <text>Miscellaneous equipment and supplies as follows:</text>
    <paragraph num="(1)">
      <text>One glucometer;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>One pulse oximeter for each in-service ALS ambulance; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>One current, printed within last 2 years, copy of a drug reference.</text>
    </paragraph>
  </paragraph>
</regulation>