Current through Register Vol. 30, No. 38, September 20, 2024
A. An applicant or certificate holder shall
ensure that an air ambulance has:
1. A
climate control system to prevent temperature extremes that would adversely
affect patient care;
2. If a
fixed-wing air ambulance, pressurization capability;
3. Interior lighting that allows for patient
care and monitoring without interfering with the pilot's vision;
4. For each place where a patient may be
positioned, at least one electrical power outlet or other power source that is
capable of operating all electrically powered medical equipment without
compromising the operation of any electrical aircraft equipment;
5. A back-up source of electrical power or
batteries capable of operating all electrically powered life-support equipment
for at least one hour;
6. An entry
that allows for patient loading and unloading without rotating a patient and
stretcher more than 30 degrees about the longitudinal axis or 45 degrees about
the lateral axis and without compromising the operation of monitoring systems,
intravenous lines, or manual or mechanical ventilation;
7. A configuration that allows each medical
team member sufficient access to each patient to begin and maintain treatment
modalities, including complete access to the patient's head and upper body for
effective airway management;
8. A
configuration that allows for rapid exit of personnel and patients, without
obstruction from stretchers and medical equipment;
9. A configuration that protects the
aircraft's flight controls, throttles, and communications equipment from any
intentional or accidental interference from a patient or equipment and
supplies;
10. A padded interior or
an interior that is clear of objects or projections in the head strike
envelope;
11. An installed
self-activating emergency locator transmitter;
12. A voice communications system that:
a. Is capable of air-to-ground communication,
and
b. Allows the flight crew and
medical team members to communicate with each other during flight;
13. Interior patient compartment
wall and floor coverings that are:
a. Free of
cuts or tears,
b. Made from
non-absorbent material,
c. Capable of being
disinfected, and
d. Maintained in a
sanitary manner; and
14.
If a rotor-wing air ambulance, the following:
a. A searchlight that:
i. Has a range of motion of at least 90
degrees vertically and 180 degrees horizontally,
ii. Is capable of illuminating a landing
site, and
iii. Is located so that
the pilot can operate the searchlight without removing the pilot's hands from
the aircraft's flight controls;
b. Restraining devices that can be used to
prevent a patient from interfering with the pilot or the aircraft's flight
controls; and
c. A light to
illuminate the tail rotor.
B. An applicant or certificate holder shall
ensure that:
1. Except as provided in
subsections (D), (E), and (F), each air ambulance has the equipment and
supplies required in subsection (C) for each mission for which the air
ambulance is used; and
2. The
equipment and supplies on an air ambulance are secured, stored, and maintained
in a manner that prevents hazards to personnel and patients.
C. An applicant or certificate
holder shall ensure that an air ambulance used for an advanced life support
mission or critical care mission has the following equipment and supplies:
1. The following ventilation and airway
equipment and supplies:
a. Portable and fixed
suction apparatus, with wide-bore tubing, rigid pharyngeal curved suction tip,
tonsillar and flexible suction catheters, 5F-14F;
b. Portable and fixed oxygen equipment, with
variable flow regulators;
c. Oxygen
administration equipment, including: tubing; non-rebreathing masks (adult and
pediatric sizes); and nasal cannulas (adult and pediatric sizes);
d. Bag-valve mask, with hand-operated,
self-reexpanding bag (adult size), with oxygen reservoir/accumulator; mask
(adult, pediatric, infant, and neonate sizes); and valve;
e. Airways, oropharyngeal (adult, pediatric,
and infant sizes);
f. Laryngoscope
handle, adult and pediatric, with, if applicable, extra batteries and
bulbs;
g. Laryngoscope blades,
sizes 0, 1, and 2, straight; sizes 3 and 4, straight and curved;
h. Endotracheal tube cuff pressure
manometer;
i. Endotracheal tubes,
sizes 2.5-5.0 mm cuffed or uncuffed and 6.0-8.0 mm cuffed;
j. Stylettes for Endotracheal tubes, adult
and pediatric;
k. Airways, nasal
(adult, pediatric, and infant sizes), one each in French sizes 16 to
34;
l. One type of supraglottic
airway device, adult and pediatric;
m. 10 mL straight-tip syringes;
n. Small volume nebulizer or nebulizers and
aerosol masks, adult and pediatric;
o. Magill forceps, adult and
pediatric;
p. Nasogastric tubes,
sizes 5F and 8F, Salem sump sizes 14F and 18F;
q. End-tidal CO2 detectors,
quantitative;
r. Portable automatic
ventilator with positive end expiratory pressure; and
s. In-line viral/bacterial filter;
2. The following monitoring and
defibrillation equipment and supplies:
a.
Portable, battery-operated monitor/defibrillator, with:
i. Tape write-out/recorder,
ii. Defibrillator pads,
iii. Adult and pediatric paddles or
hands-free patches,
iv. ECG
leads,
v. Adult and pediatric chest
attachment electrodes, and
vi.
Capability to provide electrical discharge below 25 watt-seconds; and
b. Transcutaneous cardiac
pacemaker, either stand-alone unit or integrated into
monitor/defibrillator;
3. For rotor wing aircraft only, the
following immobilization devices and supplies:
a. Cervical collars, rigid, adjustable or in
an assortment of adult and pediatric sizes;
b. Head immobilization device, either firm
padding or another commercial device;
c. Lower extremity (femur) traction device,
including lower extremity, limb support slings, padded ankle hitch, padded
pelvic support, and traction strap; and
d. Upper and lower extremity immobilization
splints;
4. The
following bandages:
a. Burn pack, including
standard package, clean burn sheets;
b. Dressings, including:
i. Sterile multi-trauma dressings (various
large and small sizes);
ii.
Abdominal pads, 10" x 12" or larger; and
iii. 4" x 4" gauze sponges;
c. Gauze rolls, sterile (4" or
larger);
d. Elastic bandages,
non-sterile (4" or larger);
e.
Occlusive dressing, sterile, 3" x 8" or larger; and
f. Adhesive or self-adhesive tape, including
various sizes (1" or larger) hypoallergenic and various sizes (1" or larger)
adhesive or self-adhesive;
5. The following obstetrical equipment and
supplies:
a. Separate sterile obstetrical kit,
including:
i. Towels,
ii. 4" x 4" dressing,
iii. Umbilical tape,
iv. Sterile scissors or other cutting
utensil,
v. Bulb suction,
vi. Clamps for cord,
vii. Sterile gloves,
viii. Blankets, and
ix. A head cover; and
b. An alternate portable patient heat source
or two heat packs;
6.
The following infection control equipment and supplies, including the
availability of latex-free:
a. Eye protection
(full peripheral glasses or goggles, face shield);
b. Masks, at least as protective as a
National Institute for Occupational Safety and Health-approved N-95 respirator,
which are fit-tested;
c. Gloves,
non-sterile;
d. Jumpsuits or
gowns;
e. Shoe covers;
f. Disinfectant hand wash, commercial
antimicrobial (towelette, spray, or liquid);
g. Disinfectant solution for cleaning
equipment;
h. Standard sharps
containers;
i. Disposable red trash
bags; and
j. Protective facemasks
or cloth face coverings for patients;
7. The following injury prevention equipment:
a. Appropriate restraints, such as seat belts
or, if applicable, child safety restraints, for patient, personnel, and family
members;
b. For rotor wing aircraft
only, safety vest or other garment with reflective material for each personnel
member;
c. Fire extinguisher,
either disposable with an indicator of a full charge or with a current
inspection tag;
d. Hazardous
material reference guide; and
e.
Hearing protection for patient and personnel;
8. The following vascular access equipment
and supplies:
a. Intravenous administration
equipment, with fluid in bags;
b.
Antiseptic solution (alcohol wipes and povidone-iodine wipes);
c. Intravenous pole or roof hook;
d. Intravenous catheters 14G-24G;
e. Intraosseous needles, adult and pediatric
sizes;
f. Venous
tourniquet;
g. One of each of the
following types of intravenous solution administration sets:
i. A set with blood tubing,
ii. A set capable of delivering 60 drops per
cc, and
iii. A set capable of
delivering 10 or 15 drops per cc;
h. Intravenous arm boards, adult and
pediatric;
i. IV pump or pumps
(minimum of 3 infusion lines); and
j. IV pressure bag;
9. The agents, specified in a table of agents
established according to A.R.S. §§
36-2204 and
available through the Department at
www.azdhs.gov/ems-regulatory-references,
that an administrative medical director has authorized for use, based on the
EMCT classification of the medical team; and
10. The following miscellaneous equipment and
supplies:
a. Sphygmomanometer (infant,
pediatric, and adult regular and large sizes);
b. Stethoscope;
c. Pediatric equipment sizing reference
guide;
d. Thermometer with low
temperature capability;
e. Heavy
bandage or paramedic scissors for cutting clothing, belts, and boots;
f. Cold packs;
g. Flashlight (1) with extra batteries or
recharger, as applicable;
h.
Blankets;
i. Sheets;
j. Disposable emesis bags or
basins;
k. For fixed wing aircraft
only, a disposable bedpan;
l. For
fixed wing aircraft only, a disposable urinal;
m. Properly secured patient transport
system;
n. Lubricating jelly (water
soluble);
o. Glucometer or blood
glucose measuring device with reagent strips;
p. Pulse oximeter with pediatric and adult
probes;
q. Automatic blood pressure
monitor; and
r. A commercially
available trauma arterial tourniquet.
D. An applicant or certificate holder shall
ensure that an air ambulance used for an interfacility maternal transport
mission has:
1. The equipment and supplies in
subsection (C); and
2. The
following:
a. A Doppler fetal heart
monitor;
b. Unless use is not
indicated for the patient as determined through on-line medical direction or
on-line medical guidance provided as described in
R9-25-708(A)(3),
an external fetal heart and tocographic monitor with printer
capability;
c. Tocolytic and
anti-hypertensive medications;
d.
Advanced emergency cardiac life support equipment and supplies; and
e. Neonatal resuscitation equipment and
supplies.
E.
An applicant or certificate holder shall ensure that an air ambulance used for
an interfacility neonatal transport mission has:
1. The equipment and supplies in subsection
(C); and
2. The following:
a. A transport incubator with:
i. Battery and inverter
capabilities,
ii. An infant safety
restraint system, and
iii. An
integrated neonatal-capable pressure ventilator with oxygen-air supply and
blender;
b. An invasive
automatic blood pressure monitor;
c. A neonatal monitor or monitors with heart
rate, respiratory rate, temperature, non-invasive blood pressure, and pulse
oximetry capabilities;
d.
Neonatal-specific drug concentrations and doses;
e. Thoracostomy supplies;
f. Neonatal resuscitation equipment and
supplies;
g. A neonatal size cuff
(size 2, 3, or 4) for use with an automatic blood pressure monitor;
and
h. A neonatal probe for use
with a pulse oximeter.