Florida Regulations 64J-1.006: Neonatal Transports
(2) For any Neonatal transport, the Medical Director and the receiving neonatologist shall confirm that the level of care, staffing, and equipment is commensurate to the needs of the Neonate being transported.
(3) The Neonatal Ambulance shall have exterior wording or marking which identifies that the ambulance is only for Neonatal Transport. The wording shall be such that the public cannot mistake a neonatal vehicle as an ambulance for general patient care.
(4) Any EMS provider operating a Neonatal Ambulance shall have a Medical Director for all Neonatal Transports who meets the requirements of paragraphs 64J-1.004(1)-(4)(a)-(f), F.A.C., except as follows:
(a) The Medical Director shall be board certified and active in Neonatal-Perinatal Medicine, and shall demonstrate and have available for review by the department documentation of active participation on a national, regional or statewide physician group involved in Neonatal Transport;
(b) The Medical Director is not required to have prehospital care experience;
(c) All references to “”patients”” and “”BLS and ALS procedures”” shall be understood as referring to “”neonates”” and “”neonatal advanced life support procedures”” respectively;
(d) All references to “”paramedics”” and “”EMTs”” shall be understood as referring to persons staffing the Neonatal Transport as referenced in subsection (5), below; and
(e) The Medical Director shall participate in direct contact time with the transport staff while transporting a neonate for a minimum of 10 hours per year.
TABLE V
(Reference Section 64J-1.006, F.A.C.)
Neonatal Transports
ITEM
QTY.
1. Direct two-way communications with the designated neonatologist or attending physician and or receiving ICU.
2. A standby or backup power source other than the one contained in the isolette.
One
3. A source of electrical power sufficient to operate the isolette and ancillary electrically powered equipment.
One
4. A transport incubator with portable power supply, portable oxygen tanks or liquid oxygen, and a source of compressed air, including appropriate valves, meters, and fittings.
One
5. Portable heart rate monitor with visual or audible display and alarm system.
One per patient
6. Portable blood pressure monitor with assortment of cuff sizes suitable for infants.
One each
7. Battery powered mechanical I.V. pumps capable of delivering as low as 1 cc. increments for I.V. fluids.
Two
8. Battery or self-powered oxygen sensor and transcutaneous oxygen monitor or oxygen saturation monitor.
One
9. Oxygen delivery device and tubing capable of administering high concentrations of oxygen.
One
10. Temperature monitoring device.
One
11. Portable ventilator appropriate for neonatal patients.
One
12. Anesthesia and/or self-inflating bag with oxygen reservoir less than 750 ml and manometer (pressure gauge); premature, newborn and infant size clear masks.
13. Laryngoscope handle.
One
14. Blades.
Miller 00, Miller 0
15. Bulbs and batteries.
Two each
16. Endotracheal tubes.
2.0, 2.5, 3.0, 3.5, 4.0
17. Stylet.
Two each
18. Adapters.
Assortment of sizes
19. Oral Airways.
Assortment of sizes
20. Suction equipment with low suction capabilities of less than 80 mm of hg.
One
21. Sterile Gloves assorted sizes.
Sufficient quantity for all crew members
22. Suction catheters.
Size 5.0, 6.0, 8, & 10
Two each
23. Syringes sizes 1 cc. through 60 cc.
Assortment of sizes
24. Medication access device.
Two each
25. Vascular access devices 23-27 gauge.
Assortment of sizes
26. I.V. extension tubing.
Sufficient length to administer I.V
27. Securing device.
Assorted sizes
28. I.V. filters.
Two
29. Umbilical catheters.
Size 3.5 & 5
Two
30. Antiseptic solution.
Ten
31. Blood sugar device.
One
32. Lancets.
Five
33. Neonatal stethoscope.
One
34. Flashlight.
One
35. Gauze pads.
Assortment of sizes
36. No. 5 & No. 8 French feeding tubes.
One each
37. High intensity light capable of transillumination.
One
38. Approved biomedical waste plastic bag or impervious container and used sharps container per Fl. Admin. Code Chapter 64E-16
One each
39. Gloves – latex or other suitable materials.
Sufficient quantity for all crew members
40. Respiratory face masks.
Sufficient quantity for all crew members
41. Special procedure tray or instruments with capability for performing umbilical catheterization, venous cutdown and thoracostomy.
One
42. Bulb syringe. (Additional to OB kit)
One
43. Cord clamp.
One
44. Chest tube evacuation device.
One
45. Needle aspiration device or chest tubes.
Appropriate sizes for neonate
MEDICATION
WT/VOL
QTY.
1. Atropine Sulfate.
1 mg./10 ml
One
2. Injectable Vitamin K.
1 mg./0.5 ml
One
3. Antibiotics, to be determined by medical director.
4. Calcium Gluconate.
10% – 10- ml
One
5. Digoxin ped.
0.1 mg./ml
One
6. Anticonvulsant as required by medical director.
7. Dextrose.
50% 50 cc
One
8. Dopamine or dobutamine.
Depends on medication
One
9. Epinephrine.
1:10,000
One
10. Eye prophylaxis.
One
11. Furosemide (Lasix).
20 mg./2 ml
One
12. Heparin.
One
13. Lidocaine.
1%/2 mg
One
14. Naloxone (Narcan).
1.0 mg./ml or .4 mg./ml
One
15. Paralyzing agent.
One
16. Phenobarbital.
One
17. Prostin VR. (available for transport)
500 mcg/ml
One
18. Sodium Bicarbonate.
4.2% soln
One
19. Sedative as determined by the medical director.
One
20. Volume expander.
One
21. I.V. fluid.
Bags of D5W and D10W
One each
22. Injectable non-preservative sterile water.
One
23. Injectable non-preservative normal saline.
One
(5) Each Neonatal Transport shall be staffed with a minimum of two persons, excluding the driver or pilot. One person shall be a Registered Nurse (RN), the second person shall be either an RN, a respiratory therapist (RT), or a paramedic. Physicians may be substituted by the Medical Director for either of the two persons. The staffing for each Neonatal Transport shall be determined by the Medical Director The Medical Director shall confirm that the staffing for each Neonatal Transport is capable of performing neonatal advanced life support procedures, as referenced by the American Academy of Pediatrics in Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients, 3rd ed, 2007, which is incorporated by reference and available at http://www.aap.org.
(a) The Medical Director shall confirm the RN is licensed in accordance with Florida Statutes Chapter 464; has a minimum of 4,000 hours RN experience, which includes 2,000 hours of Level II or Level III Neonatal Intensive Care Unit (NICU) nursing experience; has an American Heart Association (AHA) Neonatal Resuscitation Program (NRP) Certification and has accompanied a minimum of six Neonatal Transports prior to staffing a Neonatal Transport as the only RN in attendance.
(b) The Medical Director shall confirm the RT is registered by the National Board of Respiratory Care with a minimum of 2,000 hours of Level II or Level III NICU experience or is certified as a RT with a minimum of 3,000 hours of Level II or Level III NICU experience. The Medical Director shall also confirm that the RT has:
1. An AHA NRP Certification; and,
2. Accompanied a minimum of six Neonatal Transports prior to staffing a transport as the only RT in attendance.
(c) The Medical Director shall confirm the paramedic is a Florida-licensed paramedic with a minimum of 5,000 hours experience and has an AHA NRP Certification.
(d) The Medical Director may make medical staff substitutions with individuals of comparable skills when the condition of the neonate warrants such substitution.
(6) Treatment protocols for the management of the neonate from the receiving neonatologist shall accompany each Neonatal Transport.
Rulemaking Authority 381.0011, 383.19, 395.405, 401.251(6), 401.35 FS. Law Implemented 381.001, 383.15, 395.405, 401.24, 401.25, 401.251, 401.252, 401.26, 401.265, 401.27, 401.30, 401.31, 401.35, 401.41, 401.411, 401.414, 401.421 FS. History-New 11-30-93, Amended 1-26-97, Formerly 10D-66.0525, Amended 8-4-98, 9-3-00, 12-18-06, Formerly 64E-2.006, Amended 2-16-10.