64J-1.003. 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, 04/09, Ground Ambulance Service Provider License Application, which is incorporated by reference and available from the department, as defined by subsection 64J-1.001(9), F.A.C., or at http://www.fl-ems.com.

(2) Each ALS provider shall ensure and document in its employee records that each of its EMTs or paramedics hold a current certification from the department.

(3) Each ALS provider shall ensure that a current copy of all standing orders authorized by the medical director shall be available in each of the provider’s vehicles; for review by the department; to each of the provider’s paramedics; and supplied to each physician designated by the medical director to receive a copy.

(4) 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 Tables I and II, and shall be provided to the department upon request, except those exempted in paragraph 64J-1.006(1)(a), F.A.C. Substitutions are allowed with signed approval from the medical director and written notification to the department.

(5) The medical director may authorize an EMT instead of the paramedic or licensed physician to attend a BLS patient on an ALS permitted ambulance under the following conditions:

(a) The medical director determines what type of BLS patient may be attended by an EMT and develops standing orders for use by the EMT when attending the type of BLS patients identified. The onscene paramedic shall conduct the primary patient assessment to determine if the patient’s condition meets the criteria in the standing orders for BLS care. This survey shall be documented on the patient care record and shall identify the paramedic who conducted the survey.

(b) The patient care record for any patient care or transport shall clearly state whenever an EMT attends the patient.

(c) The provider shall maintain and have accessible for review by the department documentation of compliance with the above requirements.

(6) ALS Nontransport:

(a) Unless otherwise specifically exempted, each advanced life support nontransport vehicle, when personnel are providing advanced life support treatment or care, must be staffed with a certified paramedic or licensed physician.

(b) A permitted advanced life support nontransport vehicle may operate as a basic life support emergency vehicle when the vehicle is not staffed by a certified paramedic or licensed physician and only in lieu of placing the unit completely out of service. When such advanced life support nontransport vehicle is operating under this section, the vehicle must be staffed with at least one person who must be an emergency medical technician, and shall carry portable oxygen, airway adjuncts, supplies and equipment as determined by the medical director of the licensed service.

1. Each service provider having permitted vehicles operating pursuant to this section shall log changes in vehicle status.

2. Vehicles operating pursuant to this section shall not display markings indicating advanced life support (other than permit sticker) when responding as basic life support emergency vehicle.

(c) Unless otherwise specifically exempted, the following advanced life support non-transport vehicles when personnel are providing emergency treatment or care, must be staffed, at a minimum, with a certified paramedic or licensed physician:

1. Advanced life support vehicles that respond to requests to provide emergency treatment or care during special events or activities or in locations where access by permitted transport vehicles is restricted or limited.

2. Advanced life support vehicles that respond to requests to provide emergency treatment or care in vehicles that cannot accommodate two persons, due to design and construction of the vehicle.

3. Advanced life support vehicles under 13,000 pounds gross vehicle weight that respond to requests to provide emergency treatment or care and are met at the scene by other concurrently responding permitted vehicles. Examples include vehicles that respond to requests to provide emergency treatment or care within a gated or restricted community that is established pursuant to Chapter 190, F.S.; vehicles that respond to requests to provide emergency treatment or care which are owned or operated by counties or municipalities established pursuant to Chapter 125 or 166, F.S.; or vehicles that respond to requests to provide emergency treatment and care which are owned or operated by advanced life support services licensees. Vehicles staffed pursuant to this section shall operate in accordance with a certificate of public convenience and necessity.

4. Advanced life support non-transport vehicle over 13,000 pounds gross vehicle weight that respond to requests to provide emergency treatment or care. Vehicles staffed pursuant to this section shall operate in accordance with a certificate of public convenience and necessity.

(d) Vehicles staffed pursuant to paragraph 64J-1.003(6)(c), F.A.C., may respond to requests for medical assistance in accordance with Section 252.40, F.S.

(e) Nothing herein shall prohibit an on duty certified EMT or paramedic who arrives on scene from initiating emergency care and treatment at the level of their certification prior to the arrival of other responding vehicles.

(7) Advanced life support non-transport vehicles, staffed pursuant to paragraph 64J-1.003(6)(c), F.A.C., are not required to carry the equipment and supplies identified in Table I or II. Such vehicles when personnel are providing advanced life support treatment or care, or when responding to calls in an ALS capacity shall at a minimum carry portable oxygen, defibrillation equipment, airway management supplies and equipment, and medications and fluids authorized by the medical director of the licensed service.

TABLE II GROUND VEHICLE ALS EQUIPMENT AND MEDICATIONS
MEDICATION	WT/VOL
1. Atropine Sulfate.
2. Dextrose, 50 percent.
3. Epinephrine HCL.	1:1,000
4. Epinephrine HCL.	1:10,000
5. Ventricular dysrhythmic.
6. Benzodiazepine sedative/anticonvulsant.
7. Naloxone (Narcan).
8. Nitroglycerin.	0.4 mg.
9. Inhalant beta adrenergic
agent with nebulizer apparatus,
as approved by the medical
director.
I.V. SOLUTIONS
1. Lactated Ringers or Normal Saline.
EQUIPMENT
(a) Laryngoscope handle with batteries.
(b) Laryngoscope blades; adult, child and infant sizes.
(c) Pediatric I.V. arm board or splint appropriate for I.V. stabilization.
(d) 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 mm).
(e) Endotracheal tube stylets pediatric and adult.
(f) Magill forceps, pediatric and adult sizes.
(g) Device for intratracheal meconium suctioning in newborns.
(h) Tourniquets.
(i) I.V. cannulae 14 thru 24 gauge.
(j) Micro drip sets.
(k) Macro drip sets.
(l) I.V. pressure infuser.
(m) Needles 18 thru 25 gauge.
(n) Intraosseous needles and three way stop cocks.
(o) Syringes, from 1 ml. to 20 ml.
(p) D.C. battery powered portable monitor with defibrillation
and pacing capabilities, ECG printout and spare battery.
The unit shall be capable of delivering  pediatric defibrillation
(energy below 25 watts/sec and appropriate equipment).
(q) Monitoring electrodes for adults and pediatrics.
(r) Pacing electrodes. Pediatric and Adult.
(s) Glucometer.
(t) Approved sharps container per Chapter 64E-16, F.A.C.
(u) Flexible suction catheters.
(v) Electronic waveform capnography capable of
real-time monitoring and printing record of the intubated
patient (effective 01/01/2008).

Rulemaking 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, 12-18-06, Formerly 64E-2.003, Amended 9-2-09.