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