Del. Admin. Code tit. 16, Department of Health and Social Services, Division of Public Health, Emergency Medical Services (EMS), 4302, app B
Current through Register Vol. 28, No. 7, January 1, 2025
Appendix B - AIRCRAFT AND EQUIPMENTThe certificate holder must meet all Federal Aviation Regulations specific to the operations of the air medical ambulance service.
A. AIRCRAFT MEDICAL CONFIGURATION STANDARDS 1. Air medical personnel assure that all medical equipment is in working order through checklists.2. All equipment (including specialized equipment) and supplies must be secured according to FAR's.3. Personnel must be in seatbelts (and shoulder harnesses if installed) for all take-offs and landings according to FAA regulations.4. Patients are restrained with straps that must comply with FAA regulations.5. A policy must be in place to address refusal to transport patients who may be considered a threat to the safety of the flight and/or air medical personnel.6. Patients under 60 pounds (27 kg), excluding transport isolette patients, shall be provided with an appropriately sized restraining device (for patient's height and weight) which is further secured by a locking device.7. The pilot(s), flight controls, throttles (RW) and radios are physically protected from an intended or accidental interference by the patient, air medical personnel or equipment and supplies.8. A minimum of one stretcher shall be provided that can be carried to the patient: a) The stretcher and the means of securing it for flight must be consistent with FARs.b) The stretcher shall be large enough to carry the 95th percentile adult American patient, full length in the supine position (the 95th percentile adult American male is 6 ft. and 212 lbs.).c) The stretcher shall be sturdy and rigid enough that it can support cardiopulmonary resuscitation. If a backboard or equivalent device is required to achieve this, such device will be readily available.d) The head of the stretcher is capable of being elevated at least 30 degrees for patient care and comfort.9. Medical oxygen system - oxygen is installed according to FAA regulation and is capable of being shut off from inside the aircraft. Medical personnel can determine oxygen status using in-line pressure gauges mounted in the patient care area.10. Each gas outlet is clearly marked for identification.11. Supplemental lighting system will be installed in the aircraft for use in situations in which standard lighting is insufficient for patient care. a) A self-contained lighting system powered by a battery pack or a portable light with a battery source must be available.b) A means of protecting the cockpit from light in the patient care area shall be provided for night operations or use of red lighting (if not able to isolate the patient care area) to restrict light intensity.12. Electric power outlet (with a minimum of 750 voltage amperage capacity) is provided, 28 volt DC and/or 115 volt AC, with sufficient output to meet the requirements of the complete specialized equipment package without compromising the operation of any electrical aircraft equipment.13. No smoking signs are prominently displayed inside the cabin.14. The air medical personnel "head-strike envelope" is clear of all obstructions.B. ADDITIONAL OPERATIONAL POLICIES There shall be specific policies and procedures regarding aircraft operations and evidence of training in the following areas:
1. Written patient loading and unloading procedures.2. Specific policies concerning circumstances for hot loading or unloading if practiced.3. Refueling policies for normal and emergency situations: Refueling with the engine running, rotor turning, and/or passengers on board is not recommended. However, emergency situations of this type can arise. Specific and rigid procedures should be developed by the operator to handles these occurrences. Refueling policies will address: a) Refueling with engine(s) running or shut down.b) Refueling with air medical personnel or patient(s) on board.4. Specific policy to address the combative patient. Additional physical and/or chemical restraints should be available and used for combative patients who potentially endanger himself, the staff or the aircraft.C. MEDICAL MANAGEMENT and EQUIPMENT REQUIREMENTS 1. Airway Maintenance and Oxygen Delivery a) Objectives: (1) The ability to initiate and maintain an airway with adequate ventilatory support for both adult and pediatric patients must be present.(2) Adequate amounts of oxygen must be available for every mission.(3) Oxygen flow can be stopped at or near the oxygen source from within the aircraft.(4) A variety of oxygen delivery devices which are consistent with the scope of care must be present.(5) The following indicators must be available to personnel while in flight: (a) quantity of oxygen remaining in the onboard oxygen supply system.(b) measurement of oxygen liter flow(6) There must be a back-up source of oxygen (of sufficient quantity to get safely to the ground for replacement) in the event the main system fails.(7) Oxygen flow meters and outlets must be padded, flush mounted, or so located to prevent injury to personnel.b) Required Equipment: (1) Oral and nasopharyngeal airway adjuncts(2) Oxygen supplies, including PEEP valves, appropriate for age and potential needs of patients(3) Bag-Valve-Masks with oxygen reservoirs (assorted sizes appropriate to age of patients)(4) Suction equipment (installed and portable) with appropriate suction tubes (sizes and types)(5) Laryngoscope and tracheal intubation equipment(6) Chest decompression and cricothyroidotomy equipment(8) Capnography (wave form)(9) And all other equipment required to comply with the Delaware Standard Treatment Protocols.2. Intravenous Fluids a) Objectives: (1) Fluids and supplies must be readily available.(2) Hangers/hooks are available that secure the IV solutions in place.(3) All hooks are padded and/or flush mounted to prevent injury to personnel.(4) Glass IV containers are prohibited unless explicitly required by medication administration specifications.b) Equipment: A variety of IV solutions, tubing and catheters which potentially may be needed must be carried.
3. Medications a) Objectives: (1) Medications must be easily accessible.(2) Controlled substances are to be secured in a manner consistent with state laws.(3) Medications are stored in such a manner as to protect them from temperature extremes.b) Equipment and Supplies: (1) All services whose scope of service include ALS and specialty care missions will carry the drugs required to comply with current Delaware Standard Treatment Protocols.(2) Medications required by a specific specialty care mission must be carried on board during the mission.(3) Appropriate medication administration equipment must be present.4. Cardiac Monitoring, Defibrillation and External Pacing a) Objectives: (1) External cardiac pacing must be available.(2) Equipment must be secured and positioned so that displays are clearly visible and usable to the attending personnel.(3) The aircraft must allow for in-flight, 'effective' CPR. (a) 'Effective' is defined as CPR that produces a compression pulse.b) Equipment Required: (1) Cardiac monitor/Defibrillator and External Cardiac Pacemaker:(2) Pediatrics paddles must be present if appropriate to the scope of service.(3) Extra power sources are available for cardiac monitor, defibrillator and external cardiac pacemaker.(4) Automatic blood pressure device Del. Admin. Code tit. 16, Department of Health and Social Services, Division of Public Health, Emergency Medical Services (EMS), 4302, app B