Del. Admin. Code tit. 16, Department of Health and Social Services, Division of Public Health, Emergency Medical Services (EMS), 4302, app A

Current through Register Vol. 28, No. 7, January 1, 2025

Appendix A - EDUCATIONAL REQUIREMENTS

Initial education preparation and requirements will be guided by each air medical ambulance service's mission statement, scope of care provided, levels of care providers, state requirements and medical direction.

I. ALS, RN, MD and SPECIALTY CARE PROVIDERS: Scheduled Crew

Prior to functioning as a provider in an air medical service, all ALS and Specialty care personnel must present documentation of having successfully completed an education program that validates minimum knowledge levels and skill competencies in the following identified areas:

A. Didactic Component that includes:

1. Advanced airway management

2. Altitude physiology; gas laws; stressors of flight

3. Anatomy, physiology and assessment of the adult, pediatric and neonatal patients

4. Oxygen therapy in the air medical environment

5. Mechanical ventilation and respiratory physiology for adults, pediatric and neonatal patients as appropriate to the mission statement and scope of care provided by the air medical service.

6. Respiratory emergencies

7. Recognition and management of cardiac emergencies including lethal dysrhythmias

8. Hemodynamic monitoring, pacemaker and automatic implantable cardiac defibrillator (AICD) management

9. Intra-aortic balloon pump, central lines, Swan Ganz and arterial catheters, left and right ventricular devices and extra corporeal membrane oxygenation (ECMO) when applicable

10. Environmental emergencies

11. High risk obstetric emergencies (bleeding, trauma, medical)

12. Neonatal emergencies (respiratory distress, cardiac, surgical)

13. Pediatric emergencies (medical, trauma)

14. Infection control practices and procedures

15. Metabolic/endocrine emergencies

16. Adult trauma and burns

17. Stress recognition and management

18. Toxicology

19. Pharmacology

20. Disaster and triage management**2

21. Survival training, if applicable

22. Hazardous materials scene recognition and response**2

23. Scene management/rescue/extrication**2

B. Clinical Component that includes experiences in providing:

1. Critical intensive care

2. Emergency care

3. Neonatal Intensive care

4. Obstetrics

5. Pediatric critical care

6. Prehospital care**2

7. Invasive procedures (or mannequin equivalent) for refreshing specific skills, i.e. endotracheal intubation

*1Refers to Inter hospital/inter facility providers only

** 2Refers to Prehospital providers only.

NOTE: Specialty Care Providers must have included in their educational programs, additional content material and skills specific for their specialty area.

C. Continuing Education

1. Documentation of each scheduled crew ALS, RN, MD or Specialty care provider completion of a minimum of 48 hours of air medical refresher/continuing education every two years must be kept on file by the air medical ambulance service and submitted to the Office biennially.

2. Continuing education/staff development programs, specific and appropriate to the mission statement and scope of care of the air medical ambulance service, must be provided.

3. Continuing education/staff development programs must include reviews and/or updates of the following areas:

a) Aviation-safety issues

b) Altitude physiology

c) Management of emergency/critical care adults, pediatric and neonatal patients (medical and trauma)

d) Obstetrical emergencies

e) Invasive procedures labs

f) Stress Management

g) Infection control

h) Hazardous materials scene recognition and response

i) Survival training, if applicable

j) Current certification must be maintained in the following areas:

(1) CPR (Cardio-pulmonary Resuscitation per guidelines of the American Heart Association)

(2) ACLS*3

(3) ATLS*3/Flight Nurse Advanced Trauma Course**/PHTLS*** (specific certification depends on level of care provider)

(4) PALS

(5) Neonatal Resuscitation Course (neonatal specialty care providers, only)

*3 Physicians must be either ABEM /ABOEM or ACLS & ATLS certified

**4 Nurses may elect to audit ATLS

***5 Paramedics may elect to be certified in Basic Trauma Life Support (BTLS)

4 DE Reg. 1827 (5/1/01)

5 DE Reg. 1727 (3/1/02)

II. Educational Requirements specific to the air medical in-flight environment for all air medical providers

A. Air medical patient transport considerations (assessment, treatment, preparation, handling, equipment)

1. Day and night flying protocols

2. EMS communications

3. EMS systems

4. General aircraft safety annually to include:

a) aircraft evacuation procedures

b) communications during an emergency situation and knowledge of emergency communication frequencies

c) in-flight and ground fire suppression procedures

d) in-flight emergency and emergency landing procedures (e.g., position, oxygen, securing equipment)

e) safety in and around aircraft including FAA rules and regulations pertinent to safety for air medical team members, patients, and lay individuals

f) specific capabilities, limitations and safety measures for each aircraft used

g) use of emergency locator transmitter (ELT)

5. Ground operations

III. Pilot Training Requirements

A. Initial training shall, at a minimum, consist of:

1. Training in specific type of aircraft as follows:

a) Less than 100 hours in aircraft type

(1) Factory school or equivalent (ground and flight)

(2) Twenty-five (25) hours as pilot in command in aircraft type prior to EMS missions

(3) Five (5) hours as pilot in command or at the controls prior to EMS missions

(4) Ten (10) hours as pilot in command or at the controls prior to EMS missions if transitioning from a single to a twin engine aircraft

b) Over 100 hours in aircraft type

(1) Part 135 check ride (for Part 135 certificate holders)

(2) Five (5) hours local area orientation

2. Minimum requirements for area orientation

a) Five (5) hours area orientation of which two hours must be at night as pilot in command or at the controls prior to EMS missions

b) Training hours in aircraft type and area orientation may be combined depending on the experience and background of the pilot

3. Terrain and weather considerations specific to the program's geographic area

4. Instrument Meteorological conditions (IMC) recovery procedures by reference to instruments

5. A structured orientation must be conducted for relief pilots which at a minimum must include: roles, responsibilities, and familiarization with the region served

6. Orientation to the hospital or health care system associated with the air medical service

7. Orientation to infection control, medical systems installed on the aircraft and patient loading and unloading procedures

8. Orientation to the EMS and public service agencies unique to the specific coverage area

B. Quality assurance and competency must be ensured through methodologies including monthly operational reviews, ensuring pilot proficiency in both standard and emergency procedures. Remediation must be implemented as deficiencies are identified.

C. Annual recurrent training will minimally include:

1. Factory or equivalent refresher course

2. FAR Part 135 training requirements

3. IMC recovery procedures

4. Flight by reference to instruments

Del. Admin. Code tit. 16, Department of Health and Social Services, Division of Public Health, Emergency Medical Services (EMS), 4302, app A

4 DE Reg. 1827 (5/1/01)