<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 30.09.11.04" title_num="30" subtitle_num="09" chapter_num="11" heading="Additional Requirements for Obstetrical Transports.">
  <paragraph num="A.">
    <text>An ALS-licensed ambulance may not transport an obstetrical patient from one hospital to another for a higher level of obstetrical care unless:</text>
    <paragraph num="(1)">
      <text>The admitting hospital:</text>
      <paragraph num="(a)">
        <text>Is a perinatal center;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Before designation of perinatal centers by the EMS Board, has a certificate of need issued by the Maryland Health Resources Planning Commission for its neonatal intensive care unit or approval from the Health Services Cost Review Commission for a neonatal intensive care cost center; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Before the EMS Board has completed the process of entering into an agreement with an out-of-State hospital to serve as an out-of-State perinatal referral center, possesses all government approvals required to operate a neonatal intensive care unit under the laws of the jurisdiction in which it is located including, if required, a certificate of need and all necessary licenses;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The additional equipment required under §B of this regulation is onboard; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>In addition to the staffing required under COMAR 30.09.07.02A(4), there is a registered nurse or physician experienced in the care of obstetrical patients onboard.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Equipment Requirements.</text>
    <paragraph num="(1)">
      <text>The additional equipment required under §B(2) of this regulation may be provided by the referring or admitting hospital and shall be onboard when transporting an obstetrical patient.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>In addition to the equipment required under COMAR 30.09.10 and this chapter, the following shall be onboard:</text>
      <paragraph num="(a)">
        <text>One doppler;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>One reflex hammer;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>One neonatal bag valve mask with manometer and newborn and premature infant size masks;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>One IV infusion pump; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The following medications:</text>
        <paragraph num="(i)">
          <text>Four vials oxytocin (10 units/milliliter);</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Two vials methergine (0.2 milligram/milliliter);</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Two vials 10 percent calcium gluconate (10 milliliters);</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Three vials terbutaline (1 milligram/milliliter); and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Eight vials 50 percent magnesium sulfate (10 milliliters).</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Additional Record Keeping Requirements.</text>
    <paragraph num="(1)">
      <text>In addition to the requirements in COMAR 30.09.08, the following information shall be documented on the patient report:</text>
      <paragraph num="(a)">
        <text>Name of the referring hospital;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Name of the referring physician;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Name of the receiving hospital;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Name of the receiving physician;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Names and license or certification level of the commercial ambulance driver and commercial ambulance personnel;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Time the request for transport was received by the commercial ambulance service;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Time en route to the referring hospital;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Time of arrival at the referring hospital;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Time of departure from the referring hospital;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Time of arrival at the admitting hospital;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Maternal gestational age;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Reason for transport; and</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Care provided during transport.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Patient care reports and EMS data shall be submitted in accordance with COMAR 30.03.04.04.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>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.</text>
  </paragraph>
</regulation>