HSFE70-17-R-0008_Attachment__1_-_Equipment_for_Ambulances_in_Federal_Responses.pdf

HSFE70-17-R-0008 Attachment 1

Attachment 1

EQUIPMENT FOR AMBULANCES IN FEDERAL RESPONSES

The following list represents recommendations for the equipment and supplies that will facilitate patient care activities in the out-of-hospital setting during Federal task orders. Unless otherwise regulated by applicable state law, all ambulances that deploy in response to activation shall be equipped in accordance with the items listed herein. This equipment is recommended by the National Association of EMS Physicians, the American Academy of Pediatrics, Emergency Medical Services for Children, Emergency Nurses Association, the American College of Emergency Physicians, and the American College of Surgeons Committee on Trauma3, with the modifications set forth herein. The equipment and supplies in this document pertain specifically to basic life support (BLS) and advanced life support (ALS) ground ambulances.

The contractor may choose to establish caches of reserve ambulances to be used exclusively for Federal EMS deployments. They may not be used for routine non-Federal events. Since they are not used for routine patient transport, they need not be licensed or permitted by the State EMS Authority in the state(s) where they are stored, and are not subject to the ambulance equipment minimum standards of the state(s). These reserve ambulances, when used for Federal deployment, will be stocked with the minimum equipment established herein. These vehicles will be marked with special placards identifying them as Federal EMS Ambulances. They may be deployed within the state(s) where the disaster has occurred or in adjacent states if needed.

Some ambulances responding to task orders pursuant to the FEMA contract may be from states that require additional equipment exceeding these minimum guidelines. Use of this additional equipment will be guided by authorized medical control having jurisdiction at the site. Under no circumstances will EMS responders be allowed to use equipment and perform skills that exceed their formal training and scope of practice.

Except for controlled substances, the Contractor shall be responsible for stocking and/or re-supplying the ambulances such that all of the equipment and supplies listed in the Joint Statement (as modified) are on board during patient care and transport.

The following list is divided into equipment for basic life support (BLS) and advanced life support (ALS) emergency ground ambulances. ALS ambulances must have all of the equipment on the required BLS list as well as equipment on the required ALS list.

This list represents a consensus of recommendations for equipment and supplies that will facilitate patient care in the out-of-hospital setting. All supplies, reagents, fluids and medications shall be stored under conditions specified by the manufacturer, and shall not have exceeded their shelf lives according to their expiration dates. Optional Equipment for Critical Care Transport also listed.

Medications specific to critical care transports to be provided by other sources.

3 Joint Policy Statement - Equipment for Ambulances. Prehospital Emergency Care; January/March 2014; Volume 18, Number 1. Official Journal of the National Association of EMS Physicians. ISSN 1090-3127.

BASIC LIFE SUPPORT (BLS) GROUND

AMBULANCE REQUIRED EQUIPMENT

A. Ventilation and Airway Equipment

1. Portable and fixed suction apparatus with a regulator, per federal specifications:

Wide-bore tubing, rigid pharyngeal curved suction tip; tonsil and flexible suction catheters, 6F–16F, are commercially available (have one between 6F and 10F and one between 12F and 16F)

2. Portable oxygen apparatus, capable of metered flow with adequate tubing

3. Portable and fixed oxygen supply equipment Variable flowmeter

4. Oxygen administration equipment Adequate-length tubing; transparent mask (adult and child sizes), both non-rebreathing and valveless; nasal cannulas (adult, child)

5. Bag-valve mask (manual resuscitator) Hand-operated, self-expanding bag; adult (>1000 mL) and child (450– 750 mL) sizes, with oxygen reservoir/accumulator, valve (clear, operable in cold weather), and mask (adult, child, infant, and neonate sizes)

6. Airways Nasopharyngeal (16F–34F; adult and child sizes) Oropharyngeal (sizes 0–5; adult, child, and infant sizes)

7. Pulse oximeter with pediatric and adult probes

8. Saline drops and bulb suction for infants

B. Monitoring and Defibrillation BLS ground ambulances should be equipped with an automated external defibrillator (AED) unless staffed by advanced life support personnel who are carrying a monitor/defibrillator. The AED should have pediatric capabilities, including child-sized pads and cables OR dose attenuator with adult pads.9

C. Immobilization Devices

1. Cervical collars Rigid for children ages 2 years or older, infant, child, and adult sizes (small, medium, large, and other available sizes) OR pediatric and adult adjustable cervical collars

2. Head immobilization device (not sandbags) Firm padding or commercial device

3. Upper and lower extremity immobilization devices 9 AEDs were not required in original contract and not all states require them on BLS ambulances. BLS ambulances will be equipped with AEDs if their home-state EMS authority requires it or if the government provides them.

J oint-above and joint-below fracture (adult and child sizes), rigid support appropriate material (cardboard, metal, pneumatic, vacuum, wood, or plastic)

4. Impervious backboards (long, short, radiolucent preferred) and extrication device S hort e xtrica tion/immobilization device Long tra ns port (he a d-to-feet length) with at least 3 appropriate restraint straps (chin strap alone should not be used for head immobilization) and with padding for children and handholds for moving patients

D. Bandages/Hemorrhage Control

1. Commercially packaged or sterile burn sheets

2. Bandages Tria ngula r ba nda ge s

3. Dressings S te rile dre s s ings , including ga uze s ponge s of s uita ble s ize Abdomina l dre s s ing

4. Gauze rolls Va rious s ize s

5. Occlusive dressing or equivalent

6. Adhesive tape Va rious s ize s (including 1′′ a nd 2′′) hypoa lle rge nic

Va rious s ize s (including 1′′ a nd 2′′) a dhe s ive

7. Arterial tourniquet (commercial preferred)

E. Obstetrical

1. OB Kit (separate sterile kit) Towe ls , 4” × 4” dre s s ing, umbilica l tape, sterile scissors or other cutting utensil, bulb suction, clamps for cord, sterile gloves, blanket

2. Thermal absorbent blanket and head cover, aluminum foil roll, or appropriate heat-reflective material (enough to cover newborn)

F. Communication In disaster areas where the communications infrastructure is intact, the Contractor should have two-way communications to enable ambulances to communicate with medical control and dispatch. FEMA will provide communications devices (government furnished equipment) to vendor’s Incident Management Team (IMT) leaders and ambulances to communicate with Forward Operating Base (FOB).

G. Miscellaneous

1. Access to pediatric and adult patient care protocols

2. Sphygmomanometer (pediatric and adult regular size and large cuffs)

3. Adult stethoscope

4. Thermometer with low-temperature capability

5. Heavy bandage or paramedic scissors for cutting clothing, belts, and boots

6. Cold packs

7. Sterile saline solution for irrigation

8. Two functional flashlights

9. Blankets

10. Sheets (at least one change per cot)

11. Pillows

12. Towels

13. Triage tags

14. Emesis bags or basins

15. Urinal

16. Wheeled cot

17. Stair chair or carry chair

18. Patient care charts/forms or electronic capability

19. Lubricating jelly (water soluble)

H. Infection Control

1. Eye protection (full peripheral glasses or goggles, face shield)

2. Face protection (e.g., surgical masks per applicable local or state guidance)

3. Gloves, nonsterile

4. Fluid-resistant overalls or gowns

5. Waterless hand cleanser, commercial antimicrobial (towelette, spray, or liquid)

6. Disinfectant solution for cleaning equipment

7. Standard sharps containers, fixed and portable

8. Biohazard trash bags (color coded or with biohazard emblem to distinguish from other trash)

9. Respiratory protection (e.g., N95 or N100 mask—per applicable local or state guidance) *When applicable, latex-free equipment should be available

I. Injury Prevention

1. Availability of necessary age/size-appropriate restraint systems for all Passengers and patients transported in ground ambulances. For children, this should be according to the National Highway Traffic Administration's document: Safe Transport of Children in Emergency Ground Ambulances

2. Fire extinguisher

3. Department of Transportation Emergency Response Guide

4. Reflective safety wear for each crewmember (must meet American National Standard for High Visibility Public Safety Vests if working within the right of way of any federal-aid highway. Visit www.reflectivevest.com/federalhighwayruling.html for more information) J. Protocols Each ambulance should contain a printed copy of clinical and operational protocols that are used in their home jurisdiction. The authorized medical director at the disaster site will determine what protocols are to be used. If the approved protocols used for the disaster contain procedures for which the healthcare provider has not been trained and certified, s/he shall not perform any procedures that exceed their licensed scope of practice. Additional “just-in-time” training may be provided to certify EMS responders to perform these procedures if approved by the medical director.

Department of Homeland Security – Office of Health Affairs (DHS-OHA) BLS and ALS protocols may be used if approved by appropriate regulatory agencies.

K. Optional Medications for BLS Ground Ambulances These medications may be used if authorized by applicable medical control authorities and only if the BLS provider has been trained to administer them.

1. Albuterol

2. Epipen

3. Oral glucose

4. Nitroglycerine (sublingual tablet or paste)

5. Aspirin

L. Optional Equipment for BLS Ground Ambulances The equipment in this section is not mandated or required. Use should be based on local needs and resources.

1. Glucometer or blood glucose test strips (per state protocol and/or local medical control approval)

2. Infant oxygen mask

3. Infant self-inflating resuscitation bag

4. Airways

a. Nasopharyngeal (12F, 14F)

b. Oropharyngeal (size 00)

5. CPAP/BiPAP capability

6. Neonatal blood pressure cuff

7. Infant blood pressure cuff

8. Pediatric stethoscope

9. Infant cervical immobilization device

10. Pediatric backboard and extremity splints

11. Femur traction device (adult and child sizes)

12. Pelvic immobilization device

13. Elastic wraps

14. Ocular irrigation device

15. Hot packs

16. Warming blanket

17. Cooling device

18. Soft patient restraints

19. Folding stretcher

20. Bedpan

21. Topical hemostatic agent/bandage

22. Appropriate CBRNE PPE (chemical, biological, radiological, nuclear, explosive personal protective equipment), including respiratory and body protection; protective helmet/ jackets or coats/pants/boots

23. Applicable chemical antidote auto-injectors (at a minimum for crew members’ protection; additional for victim treatment based on local or regional protocol;

appropriate for adults and children)

ADVANCED LIFE SUPPORT (ALS) GROUND

AMBULANCE REQUIRED EQUIPMENT

For paramedic services, include all of the required equipment listed above, plus the following additional equipment and supplies. For advanced EMT services (and other non-paramedic advanced levels), include all of the equipment from the BLS list and selected equipment and supplies from the following list, based on scope of practice, local need, and consideration of out-of-hospital characteristics and budget.

A. Airway and Ventilation Equipment

1. Laryngoscope handle with extra batteries and bulbs

2. Laryngoscope blades, sizes:

a. 0–4, straight (Miller), and

b. 2–4, curved

3. Endotracheal tubes (if ALS service scope of practice includes tracheal intubation), sizes:

a. 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, and 5.5 mm cuffed and/or uncuffed, and

b. 6.0, 6.5, 7.0, 7.5, and 8.0 mm cuffed (1 each), other sizes optional

4. 10-mL non-Luer Lock syringes

5. Stylettes for endotracheal tubes, adult and pediatric

6. Magill forceps, adult and pediatric

7. End-tidal CO2 detection capability (adult and pediatric)

8. Rescue airway device, such as the ETDLA (esophageal–tracheal doublelumen airway), laryngeal tube, disposable supraglottic airway, or laryngeal mask airway (as approved by local medical direction if ALS service scope of practice includes tracheal intubation).

B. Vascular Access

1. Isotonic crystalloid solutions

2. Antiseptic solution (alcohol wipes and povidone–iodine wipes preferred)

3. Intravenous fluid bag pole or roof hook

4. Intravenous catheters, 14G–24G

5. Intraosseous needles or devices appropriate for children and adults

6. Latex-free tourniquet

7. Syringes of various sizes

8. Needles, various sizes (including suitable sizes for intramuscular injections)

9. Intravenous administration sets (microdrip and macrodrip)

10. Intravenous arm boards, adult and pediatric

C. Cardiac

1. Portable, battery-operated cardiac monitor/defibrillator With tape write-out/recorder, defibrillator pads, quick-look paddles or electrode, or hands-free patches, electrocardiogram leads, adult and pediatric chest attachment electrodes, adult and pediatric paddles

2. Transcutaneous cardiac pacemaker Either stand-alone unit or integrated into monitor/defibrillator

D. Other Advanced Equipment

1. Nebulizer

2. Glucometer or blood glucose measuring device with reagent strips

3. Long large-bore needles or angiocatheters (should be at least 3.25” in length for needle chest decompression in large adults)

4. A length based pediatric dosing tape or appropriate reference material that converts length to estimated ideal body weight in kilograms for pediatric drug dosing and equipment sizing.

E. Optional Equipment for ALS Ground Ambulances The equipment in this section is not mandated or required. Use should be based on local needs and resources.

1. Respirator, volume-cycled, on/off operation, 100% oxygen, 40–50 psi pressure (child/infant capabilities)

2. Blood sample tubes, adult and pediatric

3. Automatic blood pressure device

4. Nasogastric tubes, pediatric feeding tube sizes 5F and 8F, sump tube sizes 8F–16F

5. Size 1 curved laryngoscope blade

6. Gum elastic bougies

7. Needle cricothyrotomy capability and/or cricothyrotomy capability (surgical cricothyrotomy can be performed in older children in whom the cricothyroid membrane is easily palpable, usually by puberty)

8. Rescue airway devices for children

9. Atomizers for administration of intranasal medications

F. Optional Equipment for ALS Ground Ambulances – Critical Care

1. Monitor/Defibrilator with pulse oximetry, temperature, heart rate, NIBP, AIBP, 12 lead ability, trending, and ETCO2

2. Portable ventilator, and oxygen to support

3. Portable IV Infusion Pump – 2 chamber

4. Pressure Infusion Bag

5. Suction

G. Medications Drug dosing in children should use processes minimizing the need for calculations, preferably a length-based system. In general, medications may include:

1. Cardiovascular medications, such as

a. Epinephrine 1:10,000

b. Atropine

c. Antidysrhythmics, for example

i. Adenosine (Adenocard)

ii. Amiodarone (Cordarone)

iii. Lidocaine Hydrochloride

d. Calcium channel blockers

e. Beta-blockers

f. Nitroglycerin tablets or spray

g. Aspirin

h. Vasopressor for infusion

2. Cardiopulmonary/respiratory medications, such as

a. Albuterol (or other inhaled beta agonist)

b. Ipratropium bromide

c. Epinephrine 1:1,000

d. Furosemide (Lasix)

3. 50% dextrose solution (and sterile diluent or 25% dextrose solution for pediatrics)

4. Analgesics, narcotic and nonnarcotic 10 (recommended, not required)

a. Morphine Sulfate Injection, 10 mg/ml, and

b. Fentanyl Injectable (Sublimaze), 0.05 mg/ml

5. Anticonvulsant medication5 (recommended, not required)

a. Diazepam (Valium)

b. Midazolam (Versed)

6. Sodium bicarbonate

7. Magnesium sulfate

8. Glucagon

9. Naloxone hydrochloride (Narcan)

10. Calcium chloride

11. Bacteriostatic water and sodium chloride for injection Paralytics and other pharmaceutical adjuncts shall NOT be supplied to facilitate endotracheal intubation.

Medications not listed above, specific to critical care transports, to be provided by other sources.

G. Interfacility Transport ALS and BLS prehospital care providers who transport patients between facilities may need additional equipment. Transfers may be done to a lower or higher level of care, depending on the specific need. Specialty transport teams, including pediatric and neonatal teams, may include other personnel such as respiratory therapists, nurses, and physicians. Training and equipment needs may be different depending on the skills needed during transport of these patients.