The goal of the Bureau of Emergency Medical Services (EMS) is to ensure the delivery of a high level of emergency medical care to all citizens and visitors of the State of Florida. The Bureau of EMS requires that the equipment of prehospital ...

 

DEPARTMENT OF HEALTH
Division of Environmental Health

RULE NO: RULE TITLE
64E-2.002: Basic Life Support Service License - Ground
64E-2.003: Advanced Life Support Service License - Ground
64E-2.004: Medical Direction
64E-2.005: Air Ambulances
64E-2.006: Neonatal Interfacility Transfers
64E-2.007: Vehicle Permits
64E-2.012: Drivers
64E-2.034: Inspections
64E-2.036: Training Programs
PURPOSE AND EFFECT: The goal of the Bureau of Emergency Medical Services (EMS) is to ensure the delivery of a high level of emergency medical care to all citizens and visitors of the State of Florida. The Bureau of EMS requires that the equipment of prehospital providers to be up-to-date, functional, and available. Currently, the Florida Administrative Code (F.A.C.) lists not only the required medications, supplies and equipment to be carried in each vehicle, but also the quantity. To ensure proper equipment status, the Bureau of EMS conducts inspections of EMS service providers in accordance with Chapter 401, F.S. Deficiencies are documented and either corrected during the initial inspection visit or by the follow-up inspection.
The Medical Care Committee of the EMS Advisory Council has recommended that the Bureau of EMS eliminate the detailed and quantitative medication and supplies lists. In place of quantities, the recommendation is to focus on carrying the items necessary to accomplish the mission of EMS, tailoring the needs or each community, as identified by the Medical Director of each EMS provider; thus, allowing flexibility based on service population, EMS personnel, acute care facility availability, geographical variability, and research and development capabilities.
SUMMARY: The purpose of this rule change is to update forms, renumber the medical equipment and supplies tables, remove outdated equipment, and add equipment that will improve the quality of care and outcomes of adult and pediatric patients. This change will require all permitted ground and air transport vehicles, available for call, to maintain at least one of each item indicated on the equipment lists. This will allow the local service’s medical director to increase the quantity required in order to best serve their community, and shift the inspections process to a Quality Assurance/Quality Improvement process to identify the needs of the community and the patient. Medical Director involvement will also be enhanced, as the process will require periodic review and updating of medical protocols to improve outcomes. To aide with the Medical Director’s increased involvement, he/she will be required to attend additional training sessions to enhance skills that pertain to prehospital care.
EMS transport safety will also be enhanced by requiring all licensed providers, applying for an initial air ambulance aircraft permit, to submit a valid airworthiness certificate issued by the Federal Aviation Administration for each permitted aircraft.
SUMMARY OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 381.0011, 383.19, 395.405, 401.121, 401.25, 401.251, 401.265, 401.27, 401.2715 401.272, 401.31, 401.35, 499.05 FS.
LAW IMPLEMENTED: 381.001, 381.0011, 381.0205, 381.025, 383.15, 395.401, 395.4015, 395.402, 395.4025, 395.403, 395.404, 395.4045, 395.405, 401.23, 401.24, 401.25, 401.251, 401.252, 401.26, 401.265, 401.27, 401.2715, 401.281, 401.2915, 401.30, 401.31, 401.321, 401.34, 401.35, 401.41, 401.411, 401.414, 401.421, 499.005 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Lisa Walker, Government Analyst, Division of Emergency Medical Operations, 4052 Bald Cypress Way, Bin C-18, Tallahassee, Florida 32399-1738, [phone], ext. 2733, Email [e-mail]; or FAX [phone]

THE FULL TEXT OF THE PROPOSED RULE IS:

64E-2.002 Basic Life Support Service License – Ground.

(1) To obtain a license or renewal each applicant shall submit an application to the department on DH Form 631, October 05 May 98, Ground Ambulance Service Provider License Application.  This form is incorporated by reference and is available from the department.

(2) through (3) No change.

(4) Every provider, except those exempted in paragraph 64E-2.006(1)(a), F.A.C.,  shall ensure that each EMS vehicle permitted by the department, when available for call, shall be equipped and maintained as approved by the medical director of the service in the vehicle minimum equipment list. The vehicle minimum equipment list shall include, at a minimum, one each of the items listed in Table III and shall be provided to the department upon request.

 

TABLE III

GROUND VEHICLE AND SERVICE STANDARDS

BLS MEDICAL EQUIPMENT AND SUPPLIES

 

1.  Bandaging, dressing, and taping supplies:
a.  Adhesive, silk, or plastic tape – assorted sizes.	Six rolls total.
b.  Sterile 4x4 inch gauze pads.	Six packs of 10 pads each, any size.
c.  Triangular bandages.	Six total.
d.  Roller gauze.	Six total.
e. ABD (minimum 5x9 inch) pads.	Six total.
2.  Bandage shears.	One.
3.  Patient restraints, wrist and ankle.	One set each.
4.  Blood pressure cuffs: infant, pediatric, and adult.	One each.
5.  Stethoscopes: pediatric and adult.	One each.
6.  Blankets.	Two.
7.  Sheets (not required for non-transport vehicle.)	Two.
8.  Pillows with waterproof covers and pillow cases or disposable single use pillows (not required for non-transport vehicle).	Two.
9.  Disposable blanket or patient rain cover.	One.
10. Long spine board and three straps or equivalent.	One.
11.  Short spine board and two straps or equivalent.	One.
12.  Adult and Pediatric cervical immobilization devices (CID), approved by the medical director of the service.  This approval must be in writing and made available by the provider for the department to review.	One each.
13.  Padding for lateral lower spine immobilization of pediatric patients or equivalent.	Two.
14. Portable oxygen tanks, "D" or "E" cylinders, with one regulator and gauge.  Each tank must have a minimum pressure of 1000 psi and liter flow at 15 liters per minute.	Two.
15. Transparent oxygen masks; adult, child and infant sizes, with tubing.	Two each.
16. Sets of pediatric and adult nasal cannulae with tubing.	Two.
17. Hand operated bag-valve mask resuscitators, adult and pediatric accumulator, including adult, child and infant transparent masks capable of use with supplemental oxygen.	One each.
18. Portable suction, electric or gas powered, with wide bore tubing and tips which meet the minimum standards as published by the GSA in KKK-A 1822EC specifications.	One.
19.  Extremity immobilization devices.  Pediatric and Adult.	Six assorted sizes.
20.  Lower extremity traction splint.  Pediatric and Adult.	One.
21.  Sterile obstetrical kit to include, at minimum, bulb syringe, sterile scissors or scalpel, and cord clamps or cord-ties.	One.
22.  Burn sheets.	Two.
23.  Flashlight with batteries.	One.
24.  Occlusive dressings.	Four.
25.  Oropharyngeal airways.  Pediatric and Adult.	Six assorted sizes.
26.  Installed oxygen with regulator gauge and wrench, minimum "M" size cylinder (minimum 500 PSI) with oxygen flowmeter to include a 15lpm setting., (not required for non-transport vehicles.)  (Other installed oxygen delivery systems, such as liquid oxygen, as allowed by medical director.  This approval must be in writing and available to the department for review).	One.
27. Gloves - suitable to provide barrier protection for biohazards.	Sufficient quantity, sizes, and material for all crew members.
28.  Face Masks -both surgical and respiratory protective.	Sufficient quantity, sizes, and material for all crew members.
29.  Rigid cervical collars as approved in writing by the medical director and available for review by the department.	Six, assorted pediatric and adult sizes.
30.  Nasopharyngeal airways, pediatric and adult French or mm equivalents.	One each of each size range:  infant (12, 14, 16, 18), pediatric (20, 22, 24) and adult (26, 28, 30).
31.  Approved biohazardous waste plastic bag or impervious container per chapter 64E-16, F.A.C.	One each.
32.  Safety goggles or equivalent meeting A.N.S.I. Z87.1 standard.	One per crew member.
33.  Bulb syringe separate from obstetrical kit.	One.
34.  Thermal absorbent reflective blanket.	One.
35.  Multitrauma dressings.	Two.
36.  Pediatric length based measurement device for equipment selection and drug dosage.

 

Specific Authority 381.0011, 395.405, 401.121, 401.25, 401.35 FS. Law Implemented 381.0011, 395.401, 395.4015, 395.402, 395.4025, 395.403, 395.404, 395.4045, 401.23, 401.24, 401.25, 401.252, 401.26, 401.27, 401.281, 401.30, 401.31, 401.321, 401.34, 401.35, 401.41, 401.411, 401.414, 401.421 FS. History-New 11-29-82, Amended 4-26-84, 3-11-85, Formerly 10D-66.49, Amended 4-12-88, 8-3-88,12-10-92, 10-2-94, 1-26-97. Formerly 10D-66.049.  Amended 8-4-98, 1-3-99, 11-19-01,_______.

 

64E-2.003 Advanced Life Support Service License - Ground.

(1) To obtain a license or renewal each applicant for an ALS license shall submit to the department DH Form 631, October 05 May 98, Ground Ambulance Service Provider License Application, which is incorporated by reference and available from the department.

(2) through (3) No change.

(4) In addition to the equipment and supplies listed in Table III, the medications and I.V. solutions and equipment listed in Table V are required on Each ALS permitted vehicle when available for call, shall be equipped and maintained as approved by the medical director of the service in the vehicle minimum equipment list.  The vehicle minimum equipment list shall include, at a minimum, one each of the items listed in Table III and II, and shall be provided to the department upon request, except those exempted in paragraph 64E-2.006(1)(a), F.A.C.  Substitutions are allowed with signed approval from the medical director and written notification to the department.

_____________________________________________________________________________________

TABLE II V

GROUND VEHICLE

ALS EQUIPMENT AND MEDICATIONS

MEDICATION	WT/VOL	QTY
1.  Atropine Sulfate.		2 mg. Total.
2.  Dextrose, 50 percent.	25 gm. per 50 ml.	Two.
3.  Epinephrine HCL.	1:1,000 1 mg./ml.	Two 1 mg/ml amps or one multi dose vial.
4.  Epinephrine HCL.	1:10,000 1 mg./10cc	Four.
5. Ventricular dysrhythmic.  Bolus maintenance infusion as appropriate. Lidocaine HCL.	100 mg. per 5 ml.	Two.
6.  Benzodiazepine sedative/anticonvulsant  Lidocaine HCL.  In any of the following combinations:
	2 gm. vials or pre-mixed syringes; or 1 gm. vials or pre-filled syringes; or pre-mixed solutions of 4 mg. per ml. in a 500 ml. bag.	4 gms. Total. Two.             Four.            Two.
7.  Naloxone (Narcan).	1 mg. /ml. 2 mg. amp.	4 mg.
8.  Nitroglycerin.	0.4 mg. spray pump.	1 pump sprayer.
9.  Diazepam.		20 mg. total.
10.  Inhalant beta adrenergic agent with nebulizer apparatus, as approved by the medical director.		2 doses.
I.V. Solutions Amount	Minimum Quantity	Minimum
1.  Lactated Ringers or Normal Saline.	4,000 ml.	In any combination.
EQUIPMENT	QTY.
(a)  Laryngoscope handle with batteries.	One.
(b)  Laryngoscope blades; adult, child and infants sizes.	One each.
(c)  Pediatric I.V. arm board or splint appropriate for I.V. stabilization.	One.
(d)  Disposable endotracheal tubes; adult, child and infant sizes.  2.5 mm - 5.0 mm uncuffed; 5.5 mm - 7.0 mm; 7.5 mm - 9.0 mm.	Six total. (2 each size range).
(e)  Endotracheal tube stylets pediatric and adult.	One each.
(f) Magill forceps, pediatric and adult sizes.	One each.
(g) Device for intratracheal meconium suctioning in newborns.	One.
(h) Tourniquets.	Three.
(i) I.V. cannulae 14 thru 24 gauge.	Ten total.
(j)  Micro drip sets.	Three.
(k)  Macro drip sets.	Three.
(l)  I.V. pressure infuser.	One.
(m) Needles 18 thru 25 gauge.	Six total.
(n)  Intraosseous needles 15 or 16 gauge and three way stop cocks for use with intraosseous needles.  As allowed by medical director.	Two each.
(o) Syringes, from 1 ml. to 20 ml.	Eight total, assorted sizes.
(p) D.C. battery powered portable monitor defibrillator with defibrillation and pacing capabilities, adult paddles (or hands-free pads) and pediatric paddles (or pediatric paddle adapter) ECG printout and spare battery.  The unit shall be capable of delivering pediatric defibrillation (energy below 25 watts/sec and appropriate equipment).	One.
(q)  Monitoring electrodes for adults and pediatrics.	Two sets each.
(r)  Pacing electrodes.  Pediatric and Adult., if monitor or defibrillator requires.	Two sets.
(s)  Oro/Nasogastric tubes.	One each of each size range, infant (8), and pediatric (12, 14, or 16).
(t)  Syringe appropriate for checking placement of oro/nasogastric tube.	One.
(s)(u)  Glucometer A method for rapidly determining blood glucose as approved by the medical director.
(t)(v)  Pediatric length based measurement device for equipment selection and drug dosage.	One.
(t)(w)  Approved sharps container per Chapter 64E-16, F.A.C.	One.
(v)(x)  Flexible suction catheters.	Assorted sizes, 1 each of each size range: infant (6-8 French), pediatric (10-12 French), and adult (14 French).
(w)  Electronic waveform capnography capable of real-time monitoring and printing record of the intubated patient (effective 01/01/2007).

 

Specific Authority 381.0011, 395.405, 401.121, 401.265, 401.35 FS. Law Implemented 381.0011, 381.025, 395.401, 395.4015, 395.402, 395.4025, 395.403, 395.404, 395.4045, 395.405, 401.23, 401.24, 401.25, 401.26, 401.265, 401.27, 401.281, 401.30, 401.31, 401.321, 401.34, 401.35, 401.41, 401.411, 401.414, 401.421 FS. History-New 11-29-82, Amended 4-26-84, 3-11-85, Formerly 10D-66.50, Amended 4-12-88, 8-3-88, 8-7-89, 12-10-92, 11-30-93, 1-26-97. Formerly 10D-66.050.  Amended 8-4-98, 1-3-99, 7-14-99, 2-20-00, 9-3-00, 4-15-01, 11-19-01, 6-3-02,________.

 

64E-2.004 Medical Direction.

(1) Through (3)(b) No change.

(c) A medical director shall be board certified and active in be from a broad-based clinical medical specialty such as emergency medicine, internal medicine, anesthesiology, or other surgical specialty with demonstrated experience in prehospital care and hold an ACLS certificate or equivalent as determined in Chapter 64E-2.032, F.A.C. of successful course completion or be board certified in emergency medicine.  Prehospital care experience shall be documented by the provider.

(d) Through (4)(f) No change.

(g) Assume direct responsibility for: the use by an EMT of an automatic or semi-automatic defibrillator; the performance of esophageal airway patency techniques including airway adjuncts, not to include endotracheal intubation, by an EMT; and on routine interfacility transports, the monitoring and maintenance of non-medicated I.V.s by an EMT. The medical director shall ensure that the EMT is trained to perform these procedures; shall establish written protocols for the performance of these procedures; and shall provide written evidence to the department documenting compliance with provisions of this paragraph.

(h) Through (i) No change.

(j) Participate as a crew member on an EMS vehicle for a minimum of 10 hours per year and complete a minimum of 10 hours per year of continuing medical education related to prehospital care or teaching or a combination of both.  Participate in direct contact time with EMS field level providers for a minimum of 10 hours per year.  Notwithstanding the number of EMS providers served by the medical director, direct contact time shall be a minimum of 10 hours per year per medical director, not per provider.  Further, (s)he shall complete a minimum of 10 hours per year of continuing medical education related to prehospital care or teaching or a combination of both.

(k)              If he is a medical director of a training program:

1.  Be responsible for the instruction of the Department of Transportation (DOT) approved training program for EMTs and paramedics.

2.  Have substantial knowledge of the qualifications, training, protocols, and quality assurance programs for the training facility.

3.  Maintain current instructor level training in Aadvanced Ccardiac Llife Ssupport (ACLS), or equivalent, or Aadvanced Ttrauma Llife Ssupport (ATLS), maintain provider level training in Internationalbasic Ttrauma Llife Ssupport (IBTLS) or Pprehospital Ttrauma Llife Ssupport (PHTLS); andor Aadvanced Ppediatric Llife Ssupport (APLS), Pediatric Advanced Life Support (PALS) or Pediatric Education for Prehospital Professionals (PEPP).

4.  Act as a liaison between training centers, local EMS providers and hospitals.

5.  Participate in state and local quality assurance and data collections programs.

6.  The EMS training center shall by contract, require such medical director to be available 4 hours per month for classroom teaching or review of student performance, and participate in direct contact time with EMS field level providers for a minimum of 10 hours per year.  Notwithstanding the number of training centers or EMS providers served by the medical director, direct contact time shall be a minimum of 10 hours per year per medical director, not per training center.  Further, (s)he shall complete a minimum of 10 hours per year of continuing medical education related to prehospital care or teaching or a combination of both.

for a minimum of 10 hours per year, and complete a minimum of 10 hours per year of continuing medical education related to prehospital care or teaching or a combination of both.

7.  Through (5) No change.

 

Specific Authority 381.0011, 395.405, 401.265, 401.272, 401.35, 499.05 FS. Law Implemented 401.23, 401.24, 401.25, 401.26, 401.265, 401.27, 401.281, 401.2915, 401.30, 401.34, 401.35, 401.41, 401.411, 499.005 FS. History-New 8-7-89, Amended 6-6-90, 12-10-92, 3-19-95, 1-26-97. Formerly 10D-66.0505.  Amended 08-04-98, 01-03-99, 02-20-00, 4-15-01, 11-19-01, 06-09-05,    __________.

 

64E-2.005  Air Ambulances.

(1)              Each applicant for an air ambulance license shall pay the required fee as specified in Section 401.34(1)(j), F.S., and submit an application to the department on DH Form 1575, October 05 May 98, Air Ambulance Service License Application which is incorporated by reference and available from the department.  The air ambulance license shall automatically expire 2 years from the date of issuance.

(2)              Through (3) No Change.

(4)Each provider shall maintain in each paramedic’s employment file documentation of successful completion of an initial air crew member (ACM) education program that was conducted in accordance with the 1988 United States (U.S.) Department of Transportation (DOT) Air Medical Crew-Advanced National Standard Curriculum (NSC), which is incorporated by reference and is available for purchase from AAMS; 526 King Street 110 North Royal Street, Suite 415 307, Alexandria, VA  22314; 703-836-8732. 

Each provider shall ensure and shall document in its employee records that each EMT and paramedic which it employs holds a current certification from the department.

(5)              Through (6) No Change.

(7)              Every air ambulance maintained by an air ambulance provider shall meet the structural, equipment and supply requirements listed in Table III.

(8)              Each prehospital rotary wing air ambulance when available for call shall meet the structural requirements listed in Table III, and shall be equipped as approved by the medical director of the service in the aircraft minimum equipment list.  The aircraft minimum equipment list shall include, at a minimum, one each of the items listed in Table III and shall be provided to the department upon request.

_____________________________________________________________________________________________

TABLE III

AIR AMBULANCE

Structural, Equipment and Supply Requirements

 

ITEM		QTY.
Aircraft Requirements
1.  Entrance large enough to allow loading of a patient.
2.  Interior large enough for two medical crew members.
3.  Cabin illumination of 40 foot-candles at patient level.
4.  FAA approved stretcher system with 2 straps.
5.  Isolated aircraft cockpit to protect pilot from in-flight interference.
6.  Each aircraft shall be equipped with FAA approved communication equipment that operates on frequencies which allow licensed by the FCC. This equipment shall function so that the flight and medical crew to can communicate with ground and landing zone medical support exclusive of the air traffic control system.
7.  No smoking sign.
8.  External search light with a minimum of 400,000 candle power illumination at 200 feet separate from the aircraft landing lights, movable 90 degrees longitudinally, 180 degrees laterally and capable of being controlled from inside the aircraft (Helicopter only).
Medical Equipment Requirements
1.  Oxygen sufficient for duration of flight.
2.  Oxygen administration equipment.
3.  Oropharyngeal airways, sizes 0, 1, 2, 3, 4, 5, and 6. Pediatric and adult.		One each.
4.  Hand operated bag-valve mask resuscitators, adult and pediatric accumulator, including adult, child and infant transparent masks capable of use with supplemental oxygen.		One each.
5.  Equipment suitable to determine blood pressure of the adult and pediatric patient during flight.
6.  Approved sharps container per chapter 64E-16, F.A.C.		One.
7.  Approved biohazardous waste plastic bag or impervious container per chapter 64E-16, F.A.C.
8.  Portable suction unit with wide bore tubing and tips, electric or gas powered, which meets the minimum standards as published by the General Services Administration (GSA) in KKK-A-1822C specifications.
9.  Equipment suitable to determine blood pressure of the adult and pediatric patient during the flight.

TABLE IVI

Prehospital Rotary Wing Air Ambulances

_____________________________________________________________________________________________

ITEM		QTY.
Aircraft Structural Requirements
1.  External search light with a minimum of 400,000 candle power illumination at 200 feet separate from the aircraft landing lights, movable 90 degrees longitudinally, 180 degrees laterally and capable of being controlled from inside the aircraft.
Equipment
1.  Laryngoscope handle with batteries.		One.
2.  Laryngoscope blades; adult, child and infant size.		One each.
3.  Pediatric I.V. arm board or splint appropriate for I.V. stabilization.		One.
4.  Disposable endotracheal tubes; adult, child and infant sizes. Those below 5.5 mm shall be uncuffed. 2.5 mm—5.0 mm uncuffed; 5.5 mm—7.0 mm; 7.5 mm—9.0 11.0 mm.		Six total.  (2 each size range).
5.  Endotracheal tube stylets pediatric and adult.		One each.
6.  Magill forceps, pediatric and adult sizes.		One.
7.  Device for intratracheal meconium suctioning in newborns.		One.
8.  Tourniquets.		Three.
9.  I.V. cannulae between 14 and 24 gauge.		Ten.
10. Macro drip sets.		Three.
11. Micro drip sets.		Three.
12. I.V. pressure infuser.		One.
13. Needles between 18 and 25 gauge.		Six.
14. Intraosseous needles 15 or 16 gauge and three way stop cocks for use with intraosseous needles.  As allowed by medical director.		Two each.
15. 1 ml. syringes.		Two.
16. 2 ½ ml. to 6 ml. syringes.		Six.
15.17. Assorted10 ml. to 20 ml. syringes.		Four.
18. Suitable equipment and supplies to allow for collection and temporary storage of two blood samples.
16.19.  D.C. battery powered portable monitor defibrillator with defibrillation and pacing capabilities, adult paddles (or hands-free pads) and pediatric paddles (or pediatric paddle adapter) ECG printout and spare battery.  The unit shall be capable of delivering pediatric defibrillation (energy below 25 watts/sec and appropriate equipment).		One.
17.20.  Monitoring electrodes for adults and pediatrics.		Two sets each.
21.  Oro/nasogastric tubes.  8 French feeding tube, and sizes 12, 14, and 16 French nasogastric tubes.		One each.
22.  Syringe appropriate for checking placement of oro/nasogastric tube.		One.
18.23.  GlucometerA method for rapidly determining blood glucose as approved by the medical director.
19.24.  Pediatric length based measurement device for equipment selection and drug dosage.		One.
20.25.  Flexible suction catheters assorted sizes 6, 8, 10, 12, and 14 French.		One each.
21.26.  Multitrauma dressings.		Two.
22.27.  ABD pads.		Six.
23.28.  Sterile gauze pads.		Twenty-five.
24.29.  Adhesive tape assorted sizes.		Assorted sizes.
25.30.  Bite sticks or blocks.		Two.
26.31.  Triangular bandages.		Eight.
25.32.  Patient restraints, wrist and ankle.		One set each.
26.33.  Soft roller bandages.		Ten.
27.34.  Bandage shears.		One.
35.  Disposable blanket or patient rain cover.		One.
36.  Long spine board and three straps or equivalent.		One.
37.  Short spine board and two straps or equivalent.		One.
38.  Extremity immobilization, any device that immobilizes the joint above and below the fracture, must include splints to immobilize all long bone fractures.		Two each of arm, leg, hand and wrist, foot and ankle.
28.39.  Sterile obstetrical kit to include, at minimum, bulb syringe, sterile scissors or scalpel, and cord clamps or cord ties.		One.
29.40.  Burn sheets.		Two.
30.41.  Flashlight with batteries., minimum two “D” cells.		One.
31.42.  Vaseline gauze.		Four.
32.43.  Gloves—latex or other suitable material.  For all crew members.		Sufficient quantity for all crew members.
33.44.  Face masks for all crew members.		Sufficient quantity for all crew members.
34.45.  Naso and oropharyngeal airways assorted sizes 12, 14, 16, 18, 20, 22, 24, 26,  28 and 30 French or mm equivalents.		One each.
35.46.  Safety goggles or equivalent meeting A.N.S.I. Z87.1 standard.		One per crew member.
36.47.  Bulb syringe separate from obstetrical kit.		One.
37.48.  Thermal, absorbent, reflective blanket.		One.
38.49.  Standing orders.
39. Electronic waveform capnography capable of real-time monitoring and printing record of the intubated patient (effective 01/01/2007).
MEDICATION	WT./VOL.	QTY.
1.  Atropine sulfate.		2 mg. Total.
2.  Dextrose 50 percent.	25 gm. per 50 ml.	2
3.  Epinephrine HCL.	1:1,000 1 mg./ml.	2. 1mg./ml. amps or one multi dose.
4.  Epinephrine HCL.	1:10,000 1 mg./10 ml.	4
5.  Ventricular dysrhythmic Bolus and maintenance infusion, as appropriate. Lidocaine HCL.	100 mg. per 5 ml.	2
6.  Lidocaine HCL. In any of the following combinations:	2 gm. vials or pre-filled syringes; or 1 gm. vials or pre-filled syringes; or pre-mixed solutions of 4 mg. per ml. in a 500 ml. bag.	4 gms. Total.
6.7.  Sodium Bicarbonate.	50 mEq. or 44.6. mEg.	2 amps.
7.8.  Naloxone (Narcan).	1 mg./ml. 2 mg. amp.	2 amps.
8.9.  Nitroglycerin tabs.	0.4 mg./tablet or 0.4 mg. spray pump.	1 bottle or 1 pump sprayer.
9.10.Benzodiazepine sedative/anticonvulsant. Diazepam or	5 mg./ml.
Lorazepam.	2 mg./ml.
10.11.  Inhalant beta adrenergic agent of choice with nebulizer apparatus, as approved by the medical director.		One.
I.V. Solutions	Minimum Amount	Minimum Quantity
a.  Dextrose 5 percent in Water (D5W).	2,000 ml.	In any combination.
1.b.  Lactated Ringers or Normal Saline.	4,000 ml.	In any combination.

 

Specific Authority 381.0011, 401.25, 401.251, 401.265, 401.35 FS. Law Implemented 381.0011, 395.405, 401.23, 401.24, 401.25, 401.251, 401.252, 401.26, 401.27, 401.30, 401.31, 401.321, 401.34, 401.35, 401.41, 401.411 401.414, 401.421 FS. History-New 11-29-82, Amended 4-26-84, 3-11-85, Formerly 10D-66.51, Amended 4-12-88, 8-3-88, 8-7-89, 12-10-92, 11-30-93, 10-2-94, 1-26-97. Formerly 10D-66.051.  Amended 1-3-99, 9-3-00, 4-15-01,________.

 

64E-2.006  Neonatal Interfacility Transfers.

(1)              Neonates requiring critical care interfacility transport to a Level II or Level III Neonatal Intensive Care Unit shall be transported in either a neonatal ambulance or a permitted ALS or BLS transport ambulance or aircraft.

(a)              A neonatal ambulance shall meet the requirements listed in Table VI, paragraphs 64E-2.006(1)(c) and (d) and subsections 64E-2.006(2) and (3), F.A.C., and shall be exempt from meeting the equipment and medical supplies listed in Rule 64E-2.002, Table III, F.A.C., and in Rule 64E-2.003, Table II V, F.A.C.

 

TABLE VI

(Reference section 64E-2.006)

Neonatal Interfacility Transfers

_____________________________________________________________________________________________

ITEM		QTY.
1. Through 45. No Change.
MEDICATION	WT/VOL	QTY.
1. Through 23. No Change.

 

Specific Authority 381.0011, 383.19, 395.405, 401.251(6), 401.35 FS. Law Implemented 381.001, 383.15, 395.405, 401.24, 401.25, 401.251, 401.252, 401.26, 401.265, 401.27, 401.30, 401.31, 401.35, 401.41, 401.411, 401.414, 401.421 FS. History-New 11-30-93, Amended 1-26-97. Formerly 10D-66.0525.  Amended 8-4-98, 9-3-00,________.

 

64E-2.007  Vehicle Permits.

(4)All licensed providers applying for an initial air ambulance aircraft permit after January 1, 2005, shall submit to the department a valid airworthiness certificate (unrestricted), issued by the Federal Aviation Administration, for each permitted aircraft, prior to issuance of the initial permit.  Aircraft replacements are subject to the initial application process.

 

Specific Authority 381.0011, 401.35 FS. Law Implemented 381.001, 381.0205, 401.23, 401.24, 401.25, 401.251, 401.26, 401.27, 401.30, 401.31, 401.34, 401.35, 401.41, 401.411, 401.414 FS. History-New 11-29-82, Amended 4-26-84, 3-11-85, Formerly 10D-66.53, Amended 4-12-88, 12-10-92, 11-30-93, 1-26-97. Formerly 10D-66.053.  Amended 01-03-99, ____________.

 

64E-2.012  Drivers.

(1)              Each ALS and BLS provider shall ensure that each driver who operates a permitted vehicle meets the qualifications as listed in Section 401.281, F.S.

(a) An ALS or BLS provider may consider current Florida EMT or Paramedic certification as the driver having met the oath requirement listed in Section 401.281 (b) and (c).

 

Specific Authority 401.35 FS. Law Implemented 401.27, 401.281, 401.35, 401.411 FS. History-New 11-29-82, Amended 4-26-84, 3-11-85, Formerly 10D-66.59, Amended 4-12-88, 12-10-92. Formerly 10D-66.059,________.

 

64E-2.034  Inspections

(1)  Inspections of Emergency Services Providers shall be documented by the department. on DH Form 1579, June 99, Service Records and Facilities Inspection Form; DH Form 627, June 99, Basic Life Support Vehicle Inspection Form; DH Form 1039, June 99, Advanced Life Support Vehicle Inspection Form; DH Form 629, June 99, Air Ambulance Inspection Form;  DH Form 1267, March 2000, Neonatal vehicle inspections shall be documented on Neonatal Interfacility Vehicle Inspection Form; DH Form 1831, June 99, Inspection Corrective Action Statement; DH Form 1264, September 99, Personnel Records Inspection Form; DH Form 1265, June 99, Supplemental Inspection Form and DH Form 1266, June 99, Equipment Test Results Inspection Form.  This form is These forms are incorporated by reference and available from the department.

(2)  Completion of Inspection Forms:

(a)  Inspection Codes - Inspection Forms DH Form 1579, June 99; DH Form 627, June 99; DH Form 1039, June 99; and DH Form 629, June 99, DH Form 1267, March 2000, shall be completed by the department with the following codes:

1 -Item meets inspection criteria.

1A -Item corrected during inspection to meet inspection criteria.  This indicates that equipment or supplies were not present or not working properly or proper documentation of records or procedures were not available when initially inspected but prior to the completion of the inspection, the item out of compliance was corrected.

2 -Item not in compliance with inspection criteria.  A code "2" represents a deficiency that is not in compliance with statute or rule and was not corrected during the inspection.

(1)(b)  Violation categories - All equipment, medical supplies, records and procedures required by Florida Statutes and rules are placed in one of three violation categories:

Category 1 - life-saving equipment, medical supplies, drugs, records, or procedures;

Category 2 - intermediate support equipment, medical supplies, drugs, records or procedures;

Category 3 - minimal support equipment, medical supplies records or procedures.

These categories shall be used to determine corrective action time frames for deficiencies noted during inspections.  The violation categories for each required item are noted on the inspection documentationforms.

(2)(3)  Corrective Action:

(a)  Corrective Action Time Frames - Based on the violation category definitions listed above, the following corrective action time frames and administrative action guidelines shall apply:

Category 1 - any item in this category found deficient shall require action by the service provider within 24 hours of the inspection to replace or correct the deficiency noted to avoid administrative action by the department;

Category 2 - any item in this category found deficient shall require action by the service provider within 5 working days (Monday - Friday) of the inspection to replace or correct the deficiency noted to avoid administrative action by the department;

Category 3 - any item in this category found deficient shall require action by the service provider within 10 working days (Monday - Friday) of the inspection to avoid administrative action by the department.

(b)  Inspection Corrective Action statement - Upon completion of an inspection in which deficiencies were noted, the EMS provider shall be given DH Form 1831, October 05 June 99 Inspection Corrective Action Statement, which is incorporated by reference and available from the department.  This form documents the corrective action that must be taken by the EMS provider to correct the inspection deficiencies and the time frames within which the corrective action must be taken.  The completed DH form 1831, October 05 June 99, and documentation of the corrective action taken, must be received by the department within 14 working days (Monday - Friday) of the inspection.  Failure of the EMS provider to submit the corrective action statement or correct identified deficiencies within the required time frames is grounds for disciplinary action under Chapter 401, F.S.

(3)(4)  A copy of the inspection forms and Inspection Corrective Action Statement shall be maintained by the provider for a period of 3 years.

 

Specific Authority  401.31, 401.35 FS.  Law Implemented  401.31 FS. History New 2-20-00.  Amended 9-3-00,________.

 

64E-2.036  Training Programs.

(2)  To be approved as an EMT Training Program, an entity shall submit a completed DH Form 1698E, April 02 October 05, Application for Approval of an Emergency Medical Technician – Basic (EMT-B) Training Program, which is incorporated by reference and available from the department.

(3)  To be approved as a Paramedic Training Program, an entity shall submit a completed DH Form 1698P, April 02 October 05, Application for Approval of an Emergency Medical Technician-Paramedic (EMT-P) Training Program, which is incorporated by reference and available from the department.

(4)  If aAny changes of to the training program are made to the application on file as approved by the department, then these changes shall be submitted to the department for review of compliance within 30 days of the change.

 

Specific Authority  401.27, 401.2715 FS.  Law Implemented 401.27, 401.2715 FS. History-New 9-3-00.  Amended 4-15-01, 4-21-02, 11-3-02,________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Lisa Walker, Government Analyst
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Jennifer Bencie Fairburn, M.D., M.S.A., Division Director.
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: May 9, 2006
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: October 28, 2005 and February 24, 2006.
DO131564