.04 Additional Staffing Requirements for Specialty Care Commercial Ambulance Services.

A. An ambulance providing specialty care transport service shall be staffed as provided in this regulation.

B. If the care required is outside the scope of practice of a paramedic credentialed to provide specialty care transport under the Maryland Medical Protocols for EMS Providers:

(1) A driver who meets the requirements of COMAR 30.09.07.02A(4)(a); and

(2) At least two additional individuals who meet the following requirements:

(a) One shall be at least:

(i) At the level of a paramedic who has successfully completed a paramedic specialty care transport course approved by the EMS Board or equivalent as determined by MIEMSS, or holds current Critical Care Paramedic or Flight Paramedic certification through the International Board of Specialty Certification, and is credentialed by the specialty care transport service under COMAR 30.03.03.06; or

(ii) A paramedic who has successfully completed an orientation to specialty care transport; and

(b) One shall be a registered nurse, physician assistant, or physician with advanced training and certification in the care of specialty care patients and current knowledge of the EMS system as defined in Regulation .02G(3) of this chapter.

C. If the care required is within the scope of practice of a paramedic with specialty care transport training:

(1) A driver who meets the requirements of COMAR 30.09.07.02A(4)(a);

(2) At least one individual who is:

(a) A paramedic who has successfully completed a paramedic specialty care transport course approved by the EMS Board, or holds current Critical Care Paramedic or Flight Paramedic certification through the International Board of Specialty Certification, and is credentialed by the specialty services under COMAR 30.03.03.06; or

(b) A registered nurse with advanced training and certification in the care of specialty care patients and current knowledge of the EMS system as defined in Regulation .02G(3) of this chapter; and

(3) At least one individual who:

(a) Is one of the following:

(i) A CRT initially licensed after July 1, 2001 or who has completed the CRT update program; or

(ii) A paramedic; and

(b) Has successfully completed an orientation to specialty care transport.

D. If an SCT service is not able to provide a staffed and equipped SCT ambulance within a clinically reasonable time as determined by the referring physician, it may conduct the SCT transport if:

(1) The sending facility provides health care personnel authorized by law to provide the level of care required by the patient during transport, which may include a nurse meeting the requirements of COMAR 10.27.09.04C(2);

(2) Required specialty equipment is available;

(3) The ambulance used is licensed as at least an ALS ambulance;

(4) Notice is made to SOCALR within 24 hours of the transport; and

(5) A report, reviewed and signed by the medical director, is submitted to SOCALR within 7 days of the transport, documenting the patient’s condition, the care rendered, crew configuration and efforts made by the referring physician, and the service to secure appropriate SCT resources.