Or. Admin. R. 333-255-0072 - Ground Ambulance Vehicle Equipment Requirements

(1) As used in this rule, "surgical mask" means a mask that covers the user's nose and mouth and provides a physical barrier to fluids and particulate materials. The mask meets certain fluid barrier protection standards and Class I or Class II flammability tests. Surgical masks are tested for biocompatibility and are considered personal protective equipment (PPE).

(2) A licensed ambulance service must ensure that appropriate equipment and all ancillary supplies necessary for the proper use of equipment is available in the ground ambulance vehicle, is in satisfactory working condition, is maintained in accordance with manufacturer requirements, and is stored in a sanitary and secure manner that protects the viability and safe operation of medications and equipment.

(3) Required equipment for a ground ambulance vehicle that is used by an ambulance service to provide basic life support includes but is not limited to:

(a) Installed medical oxygen cylinder with a capacity of at least 3,000 liters and having not less than 500 psi:

(A) The installed medical oxygen cylinder must be located in a vented compartment; and

(B) The compartment shall not be utilized for storage of any non-secured equipment. No combustible items shall be stored in the oxygen compartment;

(b) Oxygen pressure regulator:

(A) The oxygen must be delivered by a single-stage regulator which is set to at least 50 psi;

(B) The pressure regulator controls must be accessible from inside the patient compartment; and

(C) The pressure regulator or other display must be visible from inside the patient compartment;

(c) Oxygen flow meter, mounted - 2:

(A) The flow meter must be readable from the EMS provider seat and squad bench; and

(B) The flow meter must be adjustable over a minimum range of 0 to 15 liters per minute;

(d) Portable medical oxygen cylinder with a capacity of at least 300 liters and having not less than 500 psi:

(A) The oxygen must be delivered by a yoke regulator with a pressure gauge and non-gravity-dependent flow meter that is visible and accessible to the medical personnel; and

(B) The flow meter must be adjustable over a minimum range of 0 to 15 liters per minute;

(e) Spare portable oxygen cylinder that is full, tagged, sealed and securely mounted;

(f) Oxygen non-rebreather masks with tubing in sizes to fit infants to adults;

(g) Oxygen nasal cannula with tubing that is transparent and disposable in sizes to fit neonates to adults;

(h) Bag-valve-mask ventilation device reservoir and masks in sizes to fit neonates to adults. The device(s) must:

(A) Have a standard universal adapter;

(B) Be operable with or without an oxygen supply; and

(C) Be manually operated and self-refilling;

(i) Nebulizer, if reflected by standing orders;

(j) Continuous Oxygen Saturation Monitor in pediatric and adult sizes;

(k) End-tidal CO2 detection device;

(L) Oropharyngeal airways in sizes to fit neonates to adults;

(m) Supraglottic airways in sizes to fit neonates to adults;

(n) Nasopharyngeal airways in sizes to fit neonates to adults;

(o) Two suction apparatus that shall:

(A) Be electrically powered or battery powered with pressure regulator;

(B) If battery powered, have enough back-up batteries to maintain suction during routine transport;

(C) Have adequate supply of wide-bore tubing, commercial rigid oral and flexible pharyngeal and tracheal suction catheters in sizes to fit neonates to adults;

(D) Have collection canisters, either disposable or sealable liners, with adequate capacity;

(p) Cardiac monitoring equipment including, at a minimum, a portable battery operated automatic external defibrillator (AED) with pediatric capabilities, and with hands-free pediatric and adult or combination pads;

(q) A wheeled stretcher:

(A) Capable of securely fastening to the ambulance body;

(B) Having restraining devices for the legs, pelvis, torso and two over the shoulder straps;

(C) Containing a standard size foam mattress with a fluid resistant cover; and

(D) Capable of having the head of the stretcher tilted upwards to a 60-degree semi-sitting position;

(r) Appropriately sized pediatric restraint system(s) that, at a minimum, covers a weight range of between 10 and 99 pounds. Only the manufacturer's recommendations for the weight or size of the patient should be considered when selecting the appropriate device for the specific pediatric patient being transported;

(s) Fracture immobilization equipment, including but not limited to:

(A) Traction splints capable of pediatric and adult application;

(B) Extremity splints in pediatric and adult sizes;

(C) Extrication collars in pediatric and adult sizes;

(D) Pelvic sling in pediatric, adult, and extra-large sizes;

(E) Scoop stretcher, folding or non-folding type with necessary restraining devices and sufficient supplies for spinal motion restriction;

(F) Short backboard or equivalent with necessary restraining devices with sufficient supplies for spinal motion restriction;

(G) Long backboard with necessary restraining devices with sufficient supplies for spinal motion restriction;

(H) Pediatric backboard with necessary restraining straps with sufficient supplies for spinal motion restriction;

(t) Miscellaneous equipment, including but not limited to:

(A) Bandages and dressings in assorted sizes;

(B) Wound packing material, including hemostatic dressings;

(C) Bandage shears;

(D) Occlusive dressing or equivalent;

(E) Adhesive (consider hypo-allergenic) tape in assorted sizes;

(F) Commercially manufactured arterial tourniquets - 2;

(G) Emesis containers;

(H) Stethoscope: pediatric and adult;

(I) Aneroid sphygmomanometer in pediatric, adult and bariatric sizes;

(J) Hypothermia thermometer;

(K) Disposable obstetrical kits - 2;

(L) Chemical heat and cold packs - 4 each;

(M) Urinals: female and male - 1 each;

(N) Bedpan;

(O) Commercially available soft restraints;

(P) Digital or mechanical means to test blood glucose level;

(Q) A quick reference guide or other evidence-based reference material, such as a length-based tape, that provides appropriate guidance for pediatric drug dosing and equipment sizing;

(R) Medications and fluids as authorized by the EMS medical director, appropriate to the level of care being provided;

(S) Linen supplies and replacements sufficient to cover wheeled stretchers;

(T) Commercially packaged or sterile burn sheets; and

(U) Irrigation solution;

(u) Personal protection equipment sufficient for crew and patient(s), including but not limited to:

(A) Non-latex disposable gloves;

(B) Surgical masks;

(C) HEPA or N95 mask in provider-appropriate sizes for each crew member;

(D) Protective eyewear;

(E) Disposable isolation gowns;

(F) Commercial antimicrobial hand cleanser;

(G) Surface cleaning disinfectant;

(H) Sharps container for the patient care compartment and a separate container for each kit that contains needles; and

(I) Infectious waste disposal bags;

(v) Security and rescue equipment, including but not limited to:

(A) Fire extinguisher, 5lb. (2A-10BC type) - mounted and readily accessible in either the driver's or patient compartment;

(B) Nonflammable roadside warning devices that are reflective or illuminated - 6;

(C) Portable reusable light source, such as a flashlight or headlamp - 2;

(D) Leather gloves for each crew member;

(E) American National Standards Institute (ANSI) Class 2 or 3 reflective vests or outerwear for each crew member; and

(F) Adequate extrication equipment for agencies that provide initial response without the response of other rescue apparatus or equipment;

(w) The U.S. Department of Transportation, 2016 "Emergency Response Guidebook, (A Guidebook for First Responders During the Initial Phase of a Dangerous Goods/Hazardous Materials Transportation Incident)";

(x) Triage tags - 25;

(y) Oregon Trauma System Identification Bracelets - 5;

(z) Supplies necessary to complete a patient care report as required by OAR 333-250-0310;

(aa) A copy of standing orders dated within one year and signed by the EMS medical director;

(bb) A universal "No Smoking" sign conspicuously displayed in the driver's and patient compartment; and

(cc) A universal "Fasten Seatbelt" sign conspicuously displayed in the driver's compartment.

(4) Required equipment for a ground ambulance vehicle that is used by an ambulance service to provide advanced life support must meet the equipment requirements specified in section (3) of this rule and include, but not limited to:

(a) Cardiac monitoring equipment:

(A) A portable battery powered manual monitor defibrillator capable of recording an ECG reading;

(B) ECG electrodes, pediatric and adult;

(C) Patient cables - 2; and

(D) ECG paper.

(b) Physiologic isotonic crystalloid solution or combinations thereof - 6 liters;

(c) Intravenous administration sets: microdrip and macrodrip;

(d) Vascular access devices:

(A) Over-the-needle catheters in assorted sizes 24-gauge through 14-gauge;

(B) Specifically designed needles or device with needles for intraosseous infusions;

(C) Latex-free venous tourniquets;

(D) Syringes of various sizes;

(E) Needles of various sizes including sizes suitable for intramuscular injections; and

(e) A commercially manufactured quick reference guide that provides appropriate guidance for pediatric drug dosing and equipment sizing.

(5) If an ambulance service is providing advanced life support and the ground ambulance vehicle is staffed with a Paramedic or ambulance-based clinician, the ground ambulance vehicle shall have all the equipment identified in section (4) of this rule and include, but not limited to:

(a) Nasogastric tubes in sizes to fit neonates to adults;

(b) Cardiac monitoring equipment which must be capable of transcutaneous cardiac pacing, 12 lead ECG, and may be a stand-alone unit or integrated in the monitor and defibrillator unit; and

(c) Advanced airway care equipment:

(A) Primary and secondary laryngoscope devices in sizes to fit neonates to adults including:

(i) Straight 0, 1, 2, and 3; and

(ii) Curved 2 and 3;

(B) Endotracheal tubes in sizes to fit neonates to adults including:

(i) Uncuffed 2.5 mm and 3.0 mm;

(ii) Cuffed or Uncuffed 3.5 mm, 4.0 mm, 4.5 mm, 5.0 mm, 5.5mm; and

(iii) Cuffed 6.0 mm. 6.5mm, 7.0 mm, 7.5mm and 8.0 mm;

(C) Magill Forceps - pediatric and adult;

(D) Intubation stylettes - pediatric and adult; and

(E) Chest decompression equipment including:

(i) 23g diameter maximum length 2cm needles;

(ii) 14g diameter maximum length 3.8cm needles; and

(iii) 14g or larger diameter minimum length 8.25cm needles or commercial chest decompression device.

(6) A ground ambulance vehicle shall have two-way radio communication equipment to provide reliable contact between the ambulance and central dispatch, the receiving hospital, and online medical direction.

(7) A licensed ambulance service must ensure that its ambulance vehicles comply with the following equipment requirements in this rule by no later than July 1, 2022:

(a) Subsections (3)(f), (g), (h), (L), (m), and (n);

(b) Paragraph (3)(o)(C);

(c) Paragraphs (3)(t)(B), (F), (K), (L), and (O);

(d) Paragraph (3)(u)(B);

(e) Paragraphs (3)(v)(B), (C) and (E);

(f) Subsection (5)(a); and

(g) Paragraphs (5)(c)(A), (B), and (E).

Notes

Or. Admin. R. 333-255-0072

OHD 5-2001, f. & cert. ef. 4-24-01; PH 2-2007, f. & cert. ef. 2-1-07; PH 12-2010, f. 6-30-10, cert. ef. 7-1-10; PH 1-2011, f. & cert. ef. 1-6-11; PH 1-2013, f. & cert. ef. 1-25-13; PH 230-2018, amend filed 06/13/2018, effective 6/15/2018; PH 62-2021, minor correction filed 10/05/2021, effective 10/5/2021; PH 87-2021, amend filed 12/09/2021, effective 1/1/2022

Statutory/Other Authority: ORS 682.017, 682.068

Statutes/Other Implemented: ORS 682.017 - 682.117, 682.991