<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 30.09.14.04" title_num="30" subtitle_num="09" chapter_num="14" heading="Additional Staffing Requirements for Specialty Care Commercial Ambulance Services.">
  <paragraph num="A.">
    <text>An ambulance providing specialty care transport service shall be staffed as provided in this regulation.</text>
  </paragraph>
  <paragraph num="B.">
    <text>If the care required is within the scope of practice of Specialty Care Paramedic and the patient requires no more than one specialty care intervention, as defined in the Maryland Medical Protocols for Emergency Medical Services:</text>
    <paragraph num="(1)">
      <text>A driver who meets the requirements of COMAR 30.09.07.02A(4)(a); and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A Specialty Care Paramedic.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>If the care required is within the scope of practice of a Specialty Care Paramedic and the patient requires two or more specialty care interventions, as defined in the Maryland Medical Protocols for Emergency Medical Services:</text>
    <paragraph num="(1)">
      <text>A driver who meets the requirements of COMAR 30.09.07.02A(4)(a);</text>
    </paragraph>
    <paragraph num="(2)">
      <text>At least one individual who is:</text>
      <paragraph num="(a)">
        <text>A Specialty Care Paramedic; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A registered nurse with advanced training and certification in the care of specialty care patients and current knowledge of the EMS system as defined in Regulation .02G(3) of this chapter; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>At least one individual who:</text>
      <paragraph num="(a)">
        <text>Is one of the following:</text>
        <paragraph num="(i)">
          <text>A CRT initially licensed after July 1, 2001 or who has completed the CRT update program;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A paramedic; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>If the individual under §C(2) of this regulation is a Specialty Care Paramedic and one of the specialty care interventions involves ventilator management, a respiratory therapist; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Has successfully completed an orientation to specialty care transport.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>If the care required is outside the scope of practice of a Specialty Care Paramedic:</text>
    <paragraph num="(1)">
      <text>A driver who meets the requirements of COMAR 30.09.07.02A(4)(a); and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>At least two additional individuals who meet the following requirements:</text>
      <paragraph num="(a)">
        <text>One shall be at least:</text>
        <paragraph num="(i)">
          <text>A Specialty Care Paramedic; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A paramedic who has successfully completed an orientation to specialty care transport; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>One shall be a registered nurse, physician assistant, or physician with advanced training and certification in the care of specialty care patients and current knowledge of the EMS system as defined in Regulation .02G(3) of this chapter.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>If an SCT service is not able to provide a staffed and equipped SCT ambulance within a clinically reasonable time as determined by the referring physician, it may conduct the SCT transport if:</text>
    <paragraph num="(1)">
      <text>The sending facility provides health care personnel authorized by law to provide the level of care required by the patient during transport, which may include a nurse meeting the requirements of COMAR 10.27.09.04C(2);</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Required specialty equipment is available;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The ambulance used is licensed as at least an ALS ambulance;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Notice is made to SOCALR within 24 hours of the transport; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A report, reviewed and signed by the medical director, is submitted to SOCALR within 7 days of the transport, documenting the patient’s condition, the care rendered, crew configuration and efforts made by the referring physician, and the service to secure appropriate SCT resources.</text>
    </paragraph>
  </paragraph>
</regulation>