This chapter governs the operations of neonatal ambulance services and neonatal ambulances. 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: Retained two or more registered nurses who: Meet the requirements of the Board of Nursing under COMAR 10.27.09.04 to provide nursing care to neonates during interfacility transport; and Agree to assume responsibility for patient care during the transport process; Retained one or more physicians who are board certified or are active candidates for board certification in neonatology who: Possess current knowledge of the Maryland EMS System as required in COMAR 30.03.03.03B(4), as well as current knowledge of: The effects of transport on the neonate; and The operation of neonatal transport equipment and ambulance communications equipment; and Working with a neonatal or perinatal center, agree to: Serve as medical director for the neonatal service; Provide medical direction to the commercial ambulance service's personnel-related neonatal care; Provide training as required in neonatal care; and Participate in a quality assurance program; and If providing neonatal transport services in partnership with a hospital-based neonatal intensive care unit, a written MOU stating that all equipment and medications required to transport a neonate under this chapter will be readily available to the service. 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: Is a perinatal center; Is a neonatal center; 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 Maryland Health Resources Planning Commission for a neonatal intensive care unit; or 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. Neonates. Neonates being transferred to a neonatal intensive care unit (NICU) shall be transported by a neonatal licensed transport service, as described in Regulation .04 of this chapter. Neonates being transferred to any acute care setting other than a NICU shall be transported by either: A neonatal licensed transport service; or A specialty care transport (SCT) service with an RN who has age-appropriate competencies and equipment. Infants. Infants being transferred to any acute care setting shall be transported by: A neonatal licensed transport service; An SCT service with a staff who has age-appropriate competencies and equipment; or An ALS unit that includes staff with age-appropriate competencies and equipment, only after a neonatal licensed transport or SCT service has reviewed the case and referred it to the ALS service. Neonates or Infants being transported for convalescent care at a rehabilitation hospital or long-term facility shall be transported by: A neonatal licensed transport service; An SCT service with a staff who has age-appropriate competencies and equipment; or An ALS unit that includes staff with age-appropriate competencies and equipment, only after a neonatal licensed transport or SCT service has reviewed the case and referred it to the ALS service. 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: A driver who meets the requirements in COMAR 30.09.07.02A(4)(a); and At least two individuals, in addition to the driver: At least one of whom shall be a registered nurse or physician with advanced training in the care of neonates; and The second individual shall be a Maryland licensed health care provider, including a physician, registered nurse, respiratory therapist, nurse practitioner, physician assistant, paramedic, or CRT, who is medically qualified to care for the patient and has additional training needed to care for neonatal patients during interfacility transport including: Knowledge of the Maryland EMS System; The effects of transport on the neonate; and The operation of neonatal transport equipment and ambulance communications equipment. When more than one patient is transported simultaneously in the same ambulance: There shall be at least one registered nurse or physician with advanced training in the care of neonates present for each neonatal patient; and Each patient shall be secured in a separate patient restraint device appropriate for the patients age and weight. All personnel attending to neonatal patients shall: Prior to transporting neonatal patients, successfully complete: The Neonatal Resuscitation Program; and The S.T.A.B.L.E. Program; Maintain a current: Neonatal Resuscitation Program Provider Course Completion Card; and S.T.A.B.L.E. Program Completion Certificate; and If a physician: Maintain board certification in neonatology; Maintain board certification in pediatric critical care; or Be a licensed physician serving in the second or third year of a neonatology or pediatric critical care fellowship. In addition to the information required in COMAR 30.09.08, the following information shall be documented on the patient runsheet: Mother's name; Name of the referring hospital; Name of the referring physician; Name of the receiving hospital; Name of the receiving physician; Date of birth; Time of birth; Gestational age of the patient; Weight of the patient; Primary reason for transport; Names and license or certification level of the commercial ambulance driver and all personnel; Time the request for transport was received by the commercial ambulance service; Time the transport team departed from base; Time the transport team arrived at the referral hospital; Time the transport team departed from the referral hospital; Time the transport team arrived at the receiving hospital; and Care provided during the transport. 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 review by registered nurses and physicians of patient care provided during neonatal transport; A review by the program medical director of each specialty care transport: Requiring a change in the plan of care during transport; In which the patient’s condition worsened during transport; Requiring a change in destination during transport; or During which there was an unexpected outcome or event; Written documentation of reviews of neonatal transports which shall be available to SOCALR upon request; and A quality assurance process for call taking, call screening, and dispatch. 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 specialized medical devices used during transport shall: If provided by the hospital, be maintained by the hospital; or If provided by the licensed commercial ambulance service, be maintained as recommended by the manufacturer; and The licensed commercial service providing specialized medical devices used during transport shall maintain records documenting maintenance and repair services. All on-board medical devices shall be secured to the satisfaction of SOCALR. The following equipment shall be carried in a neonatal ambulance: All equipment listed in the current Neonatal equipment list approved by SOCALR; Any additional equipment required for the care of the patient as determined by consultation between the referring and receiving physicians; and Additional medications approved for use by the neonatal service medical director to meet the needs of the types of patients being transported. 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: 1 hour; or Two times the estimated time of transport. Education Article, §13-515, Annotated Code of Maryland Effective date: October 12, 1992 (19:20 Md. R. 1816) Chapter recodified from COMAR 14.22.12 to COMAR 30.09.12, August, 1997 Regulations .01—.08, Enforcement, repealed effective January 10, 2000 (26:27 Md. R. 2017) Regulations .01—.07, Neonatal Ambulance Service, adopted effective January 10, 2000 (26:27 Md. R. 2017) Chapter revised effective September 1, 2014 (41:17 Md. R. 972) Regulation .02 amended effective May 3, 2021 (48:9 Md. R. 361) Regulation .03 amended effective May 3, 2021 (48:9 Md. R. 361) Regulation .04A amended effective May 3, 2021 (48:9 Md. R. 361); October 16, 2023 (50:20 Md. R. 889) Regulation .04C amended effective October 16, 2023 (50:20 Md. R. 889) Regulation .05B amended effective May 3, 2021 (48:9 Md. R. 361) Regulation .06 amended effective May 3, 2021 (48:9 Md. R. 361)