SECTION 310:641-3-23. Equipment for ground ambulance vehicles

(a)   The tampering, modification, or removal of the manufacturer's expiration date is prohibited.

(b)   Licensed ambulance services shall ensure that all recalled, outdated, misbranded, adulterated, deteriorated fluids, supplies, and medications are removed from ambulances immediately.

(c)   The medical control physician will authorize all equipment and medications placed on the units for patient care.

(1)   The authorized equipment will be detailed on a unit checklist described in the ambulance file section of this subchapter.

(2)   The medications authorized by the medical director will be detailed on the unit checklist described in the ambulance files section of this subchapter, to include the number, weight, and volume of the medication containers.

(3)   An electronic or paper copy of patient care protocols will be on each in-service ambulance.

(d)   Each ground ambulance service vehicle shall carry:

(1)   airway and breathing equipment and supplies, to include:

(A)   a pulse oximetry device with pediatric and adult capability.

(B)   a functioning portable suction apparatus with wide-bore tubing (1/4"), and rigid and soft suction catheters for adults, children, and infants, as detailed by agency protocols in addition tothe vehicle mounted suction unit.

(C)   One (1) bulb syringe, with saline drops, sterile, in addition to any bulb syringes in obstetric kits.

(D)   a minimum of two (2) each, single use adult, pediatric, and infant bag-valve mask resuscitators with an adult, child, and infant clear masks.

(E)   oropharyngeal airways set or a minimum of two (2) of each size for adult, child, and infant individually wrapped for sanitation purposes. Nasopharyngeal airways are optional.

(F)   a portable ventilator as directed by the agency medical director and approved protocols.

(G)   wall mounted oxygen set with variable flow regulators and adequate tubing.

(H)   portable oxygen cylinder and regulator with a spare oxygen cylinder appropriately secured.

(I)   a minimum of two (2) each adult, child, and infant sized oxygen masks.

(J)   a minimum of two (2) adult nasal cannulas.

(K)   a nebulizer; adult and pediatric, sizes per local protocols.

(2)   Bandaging materials to include:

(A)   two (2) burn sheets; clean, wrapped, and marked in a plastic bag.

(B)   fifty (50) sterile 4"x4" dressings.

(C)   six (6) sterile 6"x8" or 8"x10" dressings.

(D)   ten (10) roller bandages, 2" or larger, such as kerlix, kling, or equivalent.

(E)   four (4) rolls of tape (minimum of one (1) inch width).

(F)   four (4) sterile occlusive dressings, 3" x 8" or larger.

(G)   four (4) triangular bandages.

(H)   one (1) pair of bandage scissors must be on the ambulance or on the on-duty personnel.

(3)   Fracture immobilization devices, to include:

(A)   one (1) adult and one (1) pediatric traction splint or equivalent device capable of adult and pediatric application.

(B)   two (2) upper and two (2) lower extremity splints in adult and pediatric sizes.

(C)   short spine board or vest type immobilizer, including straps and accessories as described within agency protocols.

(D)   two (2)adult and one (1) pediatric size long spine board including straps and head immobilization devices(s), as described within the agency protocols.

(E)   two (2) rigid or adjustable extrication collars in large, medium, small adult sizes, and pediatric sizes for children ages 2 years or older, and one (1) infant collar, as described within the agency protocols. Collars shall not be foam or fiber filled.

(4)   Miscellaneous medical equipment, to include:

(A)   one (1) infant, one (1) child, two (2) adult, and one (1) extra-large blood pressure cuffs.

(B)   stethoscope, one (1) adult and one (1) pediatric size.

(C)   obstetrical kit, with towels, 4"x4" dressing, umbilical tape, bulb syringe, cord cutting device, clamps, sterile gloves, aluminum foil, and blanket.

(D)   universal communicable disease precaution equipment including gloves, mask, goggles, gown, and other universal precautions.

(E)   blood-glucose measurement equipment per medical direction.

(F)   CPAP per medical direction.

(G)   Semi-automatic advisory defibrillator (SAAD) with adult and pediatric capability.

(5)   Other mandatory equipment, to include:

(A)   Two (2) appropriately labeled or designated waste receptacles for:

(i)   waste that is contaminated by bodily fluids or potentially hazardous or infectious waste, and,

(ii)   waste that does not present a biological hazard, such as plastic and paper products that are not contaminated.

(B)   one (1) flexible, portable, soft stretcher for confined space and extrication as approved by medical direction.

(C)   two way radio communication equipment as detailed in this Chapter and through the Statewide Interoperability Governing Body utilizing VHF frequency 155.3400.

(D)   one (1) sturdy, lightweight, all-level cot for the primary patient and mounting cot fastener and/or anchorage assembly that is compliant with the vehicle manufacturing standards in place at the time of purchase.

(E)   at least three (3) strap type restraining devices (chest, hip, and knee), and compliant shoulder harness shall be provided per stretcher, cot, and litter (not less than two (2") inches wide, nylon,easily removable for cleaning, two (2) piece assembly with quick release buckles).

(F)   electronic or paper patient care reports.

(G)   two (2) fire extinguishers one (1) in the cab of the unit, and one (1) in the patient compartment of the vehicle. Each mounted in a manner that allows for quick release and is compliant with the ambulance manufactures standards. Each extinguisher is to be dry powder, ABC, and a minimum of five (5#) pounds.

(H)   two (2) operable flashlights.

(I)   all ambulance equipment and supplies shall be maintained in accordance with the sanitation requirements in this subchapter. Additionally, sterility shall be maintained on all sterile packaged items.

(J)   digital or strip type thermometer and single use probes.

(K)   six (6) instant cold packs.

(L)   one (1) length/weight based drug dose chart or tape.

(M)   a minimum of two (2) DOT approved reflective vests.

(N)   one (1) pair of binoculars.

(O)   a current copy of the emergency response guide, electronic or paper format.

(P)   As approved by local medical direction, a child restraint system or equipment for transporting pediatric patients.

(e)   Intermediate equipment, in addition to the basic equipment, intermediate licensed service ambulance vehicles shall carry:

(1)   intravenous administration equipment in a sufficient quantity to treat multiple patients requiring this level of care, including intravenous catheters 14 to 24 gauge, six (6) each.

(2)   interosseous needles, two (2) each for adult and pediatric patients, and associated administration equipment if approved by local medical control.

(3)   appropriate quantities of sterile fluid as approved by local medical control.

(4)   adequate advanced airway equipment per medical control;

(A)   endotracheal tubes, two (2) sets of cuffed 2.5 to 8.0, as permitted and approved by local medical control. Uncuffed endotracheal tubes are optional, based on medical director approval.

(B)   supraglottic airway devices to be used as a primary or secondary airway intervention, as approved by medical control.

(C)   Laryngoscope handle with extra batteries and bulbs with blade sizes and styles as approved by local medical control.

(5)   blood sampling equipment if approved by medical control.

(6)   one (1) Occupational Safety and Health Administration (OSHA) approved sharps container.

(7)   magill forceps one (1) pediatric and one (1) adult size, individually wrapped.

(8)   continuous waveform capnography required for use in endotracheal intubation and specific supraglottic airway devices.

(f)   Advanced Emergency Medical Technician equipment, in addition to the required equipment for the EMT and the Intermediate, will carry:

(1)   medication that is permitted within the AEMT scope of practice and as approved by the medical control physician;

(2)   equipment and supplies that are permitted within the AEMT scope of practice and approved by the medical control physician.

(g)   Paramedic equipment, in addition to the required EMT, Intermediate, and AEMT equipment, the Paramedic level ambulance will carry:

(1)   cardiac monitor/defibrillator with printout, and appropriate pads, paddles, leads and/or electrodes (adult and pediatric). Telemetry capability is optional.

(2)   medication with quantities to be carried on each ambulance as detailed in the formulary of agency approved protocols.

(3)   nasogastric tubes; two (2) each 8 french to 16 french, in accordance with medical control authorization.

(h)   All ambulance vehicles, regardless of licensure level or level of care provided, shall carry:

(1)   three (3) reflectors (triangular) or battery powered warning lights;

(2)   two (2) OSHA approved hard hats, with goggles or face shield;

(3)   two (2) pair of heavy work gloves; and

(4)   one (1) spring-loaded window punch or other tool that may be used to access a patient through a window.

(i)   All ambulance services shall have sufficient and appropriate rescue equipment to gain access to patients either on board the ambulance or provided through an extrication agreement with a rescue department or team.

(j)   All assessment and medical equipment utilized for patient care will be maintained in accordance with the manufacturer's guidelines. Documentation will be maintained at the agency showing that periodic tests, maintenance, and calibration are being conducted in accordance with the manufactures requirements. These types of equipment include, but are not limited to, suction devices, pulse oximetry, glucometers, capnography monitors, end-tidal co2 monitors, CPAP/BiPAP devices, ventilators, and blood pressure monitors.

[Source: Added at 8 Ok Reg 3143, eff 7-18-91 (emergency); Added at 9 Ok Reg 1495, eff 5-1-92; Amended at 17 Ok Reg 392, eff 11-1-99 (emergency); Amended at 17 Ok Reg 2948, eff 7-13-00; Amended at 19 Ok Reg 386, eff 11-19-01 (emergency); Amended at 19 Ok Reg 1053, eff 5-13-02; Amended at 19 Ok Reg 2087, eff 6-27-02; Amended at 20 Ok Reg 2368, eff 7-11-03; Amended at 21 Ok Reg 2755, eff 7-12-04; Amended at 22 Ok Reg 2418, eff 7-11-05; Amended at 23 Ok Reg 2386, eff 6-25-06; Amended at 25 Ok Reg 2443, eff 7-11-08; Amended at 33 Ok Reg 1529, eff 9-11-16]