64J-1.006. Neonatal Transports

(1) A Neonatal Ambulance shall meet the requirements listed in Table V, paragraphs 64J-1.006(1)(c) and (d) and subsections 64J-1.006(2) and (3), F.A.C., and shall be exempt from meeting the equipment and medical supply requirements listed in Rule 64J-1.002, F.A.C., Table I and in Rule 64J-1.003, F.A.C., Table II.

(2) For any Neonatal transport, the Medical Director and the receiving neonatologist shall confirm that the level of care, staffing, and equipment is commensurate to the needs of the Neonate being transported.

(3) The Neonatal Ambulance shall have exterior wording or marking which identifies that the ambulance is only for Neonatal Transport. The wording shall be such that the public cannot mistake a neonatal vehicle as an ambulance for general patient care.

(4) Any EMS provider operating a Neonatal Ambulance shall have a Medical Director for all Neonatal Transports who meets the requirements of paragraphs 64J-1.004(1)-(4)(a)-(f), F.A.C., except as follows:

(a) The Medical Director shall be board certified and active in Neonatal-Perinatal Medicine, and shall demonstrate and have available for review by the department documentation of active participation on a national, regional or statewide physician group involved in Neonatal Transport;

(b) The Medical Director is not required to have prehospital care experience;

(c) All references to “patients” and “BLS and ALS procedures” shall be understood as referring to “neonates” and “neonatal advanced life support procedures” respectively;

(d) All references to “paramedics” and “EMTs” shall be understood as referring to persons staffing the Neonatal Transport as referenced in subsection (5), below; and

(e) The Medical Director shall participate in direct contact time with the transport staff while transporting a neonate for a minimum of 10 hours per year.

TABLE V (Reference Section 64J-1.006, F.A.C.) Neonatal Transports
ITEM			QTY.
1. Direct two-way communications with the
designated neonatologist or attending
physician and or receiving ICU.
2. A standby or backup power source			One.
other than the one contained in
the isolette.
3. A source of electrical power			One.
sufficient to operate the isolette
and ancillary electrically powered
equipment.
4. A transport incubator with portable			One.
power supply, portable oxygen tanks
or liquid oxygen, and a source of
compressed air, including appropriate
valves, meters, and fittings.
5. Portable heart rate monitor with			One per patient.
visual or audible display and alarm
system.
6. Portable blood pressure monitor			One each.
with assortment of cuff sizes suitable
for infants.
7. Battery powered mechanical I.V. pumps			Two.
capable of delivering as low as 1 cc.
increments for I.V. fluids.
8. Battery or self-powered oxygen sensor			One.
and transcutaneous oxygen monitor or
oxygen saturation monitor.
9. Oxygen delivery device and tubing			One.
capable of administering high
concentrations of oxygen.
10. Temperature monitoring device.			One.
11. Portable ventilator appropriate			One.
for neonatal patients.
12. Anesthesia and/or self-inflating bag
with oxygen reservoir less than
750 ml and manometer (pressure gauge);
premature, newborn and infant size
clear masks.
13. Laryngoscope handle.			One.
14. Blades.			Miller 00, Miller 0.
15. Bulbs and batteries.			Two each.
16. Endotracheal tubes.			2.0, 2.5, 3.0, 3.5,
			4.0.
17. Stylet.			Two each.
18. Adapters.			Assortment of sizes.
19. Oral Airways.			Assortment of sizes.
20. Suction equipment with low suction			One.
capabilities of less than 80 mm of hg.
21. Sterile Gloves assorted sizes.			Sufficient quantity
for all crew
members.
22. Suction catheters.		Size 5.0, 6.0,	Two each.
		8, & 10.
23. Syringes sizes 1 cc. through 60 cc.			Assortment of sizes.
24. Medication access device.			Two each.
25. Vascular access devices 23-27 gauge.			Assortment of sizes.
26. I.V. extension tubing.			Sufficient length to
			administer I.V.
27. Securing device.			Assorted sizes.
28. I.V. filters.			Two.
29. Umbilical catheters.		Size 3.5 & 5.	Two.
30. Antiseptic solution.			Ten.
31. Blood sugar device.			One.
32. Lancets.			Five.
33. Neonatal stethoscope.			One.
34. Flashlight.			One.
35. Gauze pads.			Assortment of sizes.
36. No. 5 & No. 8 French feeding tubes.			One each.
37. High intensity light capable of			One.
transillumination.
38. Approved biomedical waste plastic			One each.
bag or impervious container and
used sharps container per Chapter
64E-16, F.A.C.
39. Gloves – latex or other suitable			Sufficient quantity
materials.			for all crew members.
40. Respiratory face masks.			Sufficient quantity
			for all crew members.
41. Special procedure tray or instruments			One.
with capability for performing
umbilical catheterization, venous
cutdown and thoracostomy.
42. Bulb syringe. (Additional to OB kit)			One.
43. Cord clamp.			One.
44. Chest tube evacuation device.			One.
45. Needle aspiration device or			Appropriate sizes
chest tubes.			for neonate.
MEDICATION		WT/VOL	QTY.
1. Atropine Sulfate.		1 mg./10 ml.	One.
2. Injectable Vitamin K.		1 mg./0.5 ml.	One.
3. Antibiotics, to be
determined by medical
director.
4. Calcium Gluconate.		10% - 10- ml.	One.
5. Digoxin ped.		0.1 mg./ml.	One.
6. Anticonvulsant as
required by medical
director.
7. Dextrose.		50% 50 cc.	One.
8. Dopamine or		Depends on	One.
dobutamine.		medication
9. Epinephrine.		1:10,000	One.
10. Eye prophylaxis.			One.
11. Furosemide (Lasix).		20 mg./2 ml.	One.
12. Heparin.			One.
13. Lidocaine.		1%/2 mg.	One.
14. Naloxone (Narcan).		1.0 mg./ml or	One.
		.4 mg./ml.
15. Paralyzing agent.			One.
16. Phenobarbital.			One.
17. Prostin VR.		500 mcg/ml.	One.
(available for
transport)
18. Sodium Bicarbonate.		4.2% soln.	One.
19. Sedative as			One.
determined by the
medical director.
20. Volume expander.			One.
21. I.V. fluid.		Bags of	One each.
		D5W and D10W
22. Injectable			One.
non-preservative
sterile water.
23. Injectable			One.
non-preservative normal saline.

(5) Each Neonatal Transport shall be staffed with a minimum of two persons, excluding the driver or pilot. One person shall be a Registered Nurse (RN), the second person shall be either an RN, a respiratory therapist (RT), or a paramedic. Physicians may be substituted by the Medical Director for either of the two persons. The staffing for each Neonatal Transport shall be determined by the Medical Director The Medical Director shall confirm that the staffing for each Neonatal Transport is capable of performing neonatal advanced life support procedures, as referenced by the American Academy of Pediatrics in Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients, 3rd ed, 2007, which is incorporated by reference and available at http://www.aap.org.

(a) The Medical Director shall confirm the RN is licensed in accordance with Chapter 464, F.S.; has a minimum of 4,000 hours RN experience, which includes 2,000 hours of Level II or Level III Neonatal Intensive Care Unit (NICU) nursing experience; has an American Heart Association (AHA) Neonatal Resuscitation Program (NRP) Certification and has accompanied a minimum of six Neonatal Transports prior to staffing a Neonatal Transport as the only RN in attendance.

(b) The Medical Director shall confirm the RT is registered by the National Board of Respiratory Care with a minimum of 2,000 hours of Level II or Level III NICU experience or is certified as a RT with a minimum of 3,000 hours of Level II or Level III NICU experience. The Medical Director shall also confirm that the RT has:

1. An AHA NRP Certification; and

2. Accompanied a minimum of six Neonatal Transports prior to staffing a transport as the only RT in attendance.

(c) The Medical Director shall confirm the paramedic is a Florida-licensed paramedic with a minimum of 5,000 hours experience and has an AHA NRP Certification.

(d) The Medical Director may make medical staff substitutions with individuals of comparable skills when the condition of the neonate warrants such substitution.

(6) Treatment protocols for the management of the neonate from the receiving neonatologist shall accompany each Neonatal Transport.

Rulemaking 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, 12-18-06, Formerly 64E-2.006, Amended 2-16-10.