reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.4 - Standing orders for neonatal resuscitation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following shall
				constitute standing orders for the resuscitation of neonatal patients:
1. As to the airway:
i. If meconium is present:
(1) If stable, suction the mouth, pharynx and nose
				with a bulb syringe or a large-bore catheter (12 or 14F) as soon as the head is
				delivered;
(2) If unstable, intubate the
				patient and extubate while applying suction at a vacuum pressure no greater than-100
				mmHg until little meconium is recovered or heart rate and/or respirations become
				severely depressed;
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.5 - Standing orders for pediatric endotracheal intubation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The standing orders
				in (b) below for endotrachael intubation are authorized in the event that a
				pediatric patient presents:
1. In respiratory
				arrest;
2. In respiratory failure with
				associated inadequate spontaneous ventilatory volume; and/or
3. Unconscious with absent protective gag
				reflex.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.6 - Standing orders for pediatric IV/IO therapy

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders for the initiation of pediatric IV therapy are authorized in those
				cases where an emergent or potentially emergent condition exists and current ALS
				treatment protocols require the initiation of IV therapy. In such cases, ALS
				crewmembers may establish IV access at keep vein open (KVO) rate, establish IV
				access with a saline port, or establish intraosseous infusion prior to contacting
				the medical command physician.
1. ALS crewmembers
				shall contact the medical command physician as soon as possible after the
				establishment of an IV/IO line. Contact with the medical command physician shall not
				be delayed by, or as a result of, unsuccessful IV/IO attempts in the
				field.
2. The time of the initiation of
				IV/IO therapy and the time of contact with the medical command physician shall be
				recorded on the patient care report.
3.
				The provider's medical director shall notify the Department as to the solution to be
				utilized for IV/IO therapy when established under this section.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.7 - Standing orders for pediatric cardiac arrest

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that a pediatric patient presents with
				ventricular fibrillation and/or pulseless ventricular tachycardia:
1. Determine pulselessness and begin
				CPR;
2. Secure the airway;
3. Hyperventilate with 100 percent
				oxygen;
4. Maintain normal body
				temperature;
5. Defibrillate at 2 J/kg
				or equivalent biphasic;
6. If no change
				in rhythm, defibrillate at 4 J/kg or equivalent biphasic;
7. If no change in rhythm, defibrillate at 4 J/kg
				or equivalent biphasic;
8. Establish
				IV/IO access with normal saline solution at a KVO rate;
9. Administer epinephrine:
i. 0.01 mg/kg (0.1 mL/kg) of a 1:10,000 solution
				via IV/IO; or
ii. 0.1 mg/kg (0.1 mL/kg)
				of a 1:1,000 solution via ET (diluted with normal saline to 5 ml);
10. If no change in rhythm,
				defibrillate at 4 J/kg or equivalent biphasic; and
11. Contact the medical command
				physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.8 - Standing orders for pediatric trauma

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event a pediatric patient presents with
				traumatic injuries:
1. Immobilize the spine if
				indicated;
2. Assess and secure the
				airway;
3. Administer 100 percent
				oxygen;
4. Control hemorrhage and
				bleeding;
5. Maintain normal body
				temperature;
6. Begin transport to the
				appropriate facility according to the pediatric trauma guidelines in Appendix
				E;
7. Establish IV/IO access with
				Ringer's Lactate solution at a KVO rate. If trauma is accompanied by burns,
				substitute normal saline for Ringers Lactate solution;
8. Administer a rapid fluid bolus of Lactated
				Ringers 20 ml/kg via IV/I or normal saline 20 ml/kg (if trauma is accompanied by
				burns); and
9. Contact the medical
				command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.9 - Standing orders for pediatric seizures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event a pediatric patient presents with active
				seizures:
1. Assess and secure the
				airway;
2. Administer 100 percent
				oxygen;
3. Maintain normal body
				temperature;
4. Obtain a rapid glucose
				test;
i. If blood glucose is greater than or equal
				to 60, contact the medical command physician;
ii. If blood glucose is less than 60:
(1) Establish IV/IO access with normal saline at a
				KVO rate.
(A) For patients less than one month of
				age, administer 0.5 g/kg of a 10 percent dextrose solution via IV/IO.
(B) For patients greater than or equal to one
				month of age, administer 0.5 g/kg of a 25 percent dextrose solution via
				IV/IO.
(C) If unable to establish an
				IV/IO, administer Glucagon 0.1 mg/kg (0.1 ml/kg) to a maximum of 1 mg via IM or SC
				routes (1mg=1ml=1 unit); and
5. Contact medical command.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.10 - Standing orders for pediatric allergic reaction and/or anaphylaxis

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event a pediatric patient presents with an
				allergic reaction and/or anaphylaxis:
1. Assess
				and secure the airway;
2. Administer 100
				percent oxygen;
3. Maintain normal body
				temperature;
4. Administer Epinephrine
				0.01 mg/kg (0.01 ml/kg) of a 1:1,000 solution to a maximum of 0.5 mg via SC
				route;
5. If the patient is wheezing,
				administer albuterol 2.5 mg via nebulizer;
6. Establish IV access with normal saline solution
				at a KVO rate (if patient is severely unstable, establish intraosseous
				access);
7. If patient remains
				hemodynamically unstable, administer a rapid fluid bolus of normal saline solution
				at a dose of 20 ml/kg via IV/IO;
8. If
				no improvement, administer Diphenhydramine hydrochloride at a dose of 1 mg/kg (to a
				maximum dose of 50 mg) slowly via IV/IO; and
9. Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.11 - Standing orders for pediatric altered mental status

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that a pediatric patient presents with
				altered mental status:
1. Assess and secure the
				airway;
2. Administer 100 percent
				oxygen;
3. Maintain normal body
				temperature;
4. If evidence of trauma,
				refer to 8:41-8.8, Standing orders for pediatric
				trauma;
5. Establish IV access with
				normal saline solution at a KVO rate or, if patient is severely unstable, establish
				IO access;
6. Obtain a rapid glucose
				test. If blood glucose is less than 60:
i. For
				patients less than one month of age, administer 0.5 g/kg of a 10 percent dextrose
				solution via IV/IO;
ii. For patients
				greater than or one month of age, administer 0.5 g/kg of a 25 percent dextrose
				solution via IV/IO;
iii. If unable to
				establish an IV/IO, administer Glucagon 0.1 mg/kg (0.1 ml/kg) to a maximum of 1 mg
				via IM or SC routes (1mg=1ml=1 unit);
7. If no change in the patient's status,
				administer Naloxone 0.1 mg/kg, with a maximum dose of 2 mg via IV/IO/ET;
8. If there is a history of dehydration,
				administer a fluid bolus of normal saline at 20 ml/kg via IV/IO; and
9. Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.12 - Standing orders for pediatric asthma

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that a pediatric patient presents with
				asthma:
1. Assess and secure the airway;
2. Administer 100 percent oxygen;
3. Maintain normal body temperature;
4. Administer Albuterol 2.5 mg via
				nebulizer;
5. If patient condition
				becomes more unstable:
i. Administer epinephrine
				0.01 mg/kg (0.01 ml/kg) of a 1:1,000 solution to a maximum of 0.5 mg via SC
				route;
ii. Establish IV access of normal
				saline solution at a KVO rate; and
6. Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.13 - Standing orders for pediatric bradycardia

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that a pediatric patient presents with
				bradycardia:
1. Assess and secure the
				airway;
2. Administer 100 percent
				oxygen;
3. Maintain normal body
				temperature;
4. Perform chest
				compressions at a rate of 100 compressions per minute;
5. Establish IV/IO access with normal saline at a
				KVO rate;
6. Administer epinephrine:
i. 0.01 mg/kg (0.1 mL/kg) of a 1:10,000 solution
				via IV/IO; or
ii. 0.1 mg/kg (0.1 mL/kg)
				of a 1:1,000 solution via ET (diluted with normal saline to 5 ml); and
7. Contact the medical command
				physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.14 - Standing orders for pediatric burn management

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that a pediatric patient presents with
				burns:
1. Stop the burning process;
2. If hazardous materials are suspected, take
				proper precautions and contact medical command physician for guidance on treatment
				protocols;
3. Immobilize the spine if
				indicated;
4. Assess and secure the
				airway;
5. Consider endotracheal
				intubation if indicated for airway burns and/or respiratory compromise;
6. Administer 100 percent oxygen;
7. Cover the burns with a dry dressing;
8. Maintain normal body temperature;
9. Begin transportation of patient to the
				appropriate facility;
10. If evidence of
				trauma, refer to
				8:41-8.8, Standing orders for pediatric
				trauma;
11. Establish IV access with
				normal saline at a KVO rate or, if patient is severely unstable, establish IO
				access; and
12. Contact the medical
				command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.15 - Standing orders for pediatric croup

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that a pediatric patient presents with
				croup:
1. Assess and secure the airway;
2. Administer 100 percent oxygen;
3. Maintain normal body temperature and position
				of comfort;
4. Mild to moderate distress
				(barking cough, inspiratory stridor):
i.
				Administer 3 cc normal saline via nebulizer with simple mask; and
ii. Contact the medical command
				physician;
5. Moderate to
				severe distress (stridor at rest, retractions, tripoding, accessory muscle use):
i. Administer epinephrine 3 mg (3 cc) 1:1,000
				solution via nebulizer;
ii. If no
				change, establish IV/IO access with normal saline at a KVO rate; and
iii. Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.16 - Standing orders for pediatric non-traumatic shock

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that a pediatric patient presents with
				non-traumatic shock:
1. Assess and secure the
				airway;
2. Administer 100 percent
				oxygen;
3. Maintain normal body
				temperature;
4. Establish IV/IO access
				with normal saline solution at a KVO rate;
5. Administer a rapid fluid bolus of normal saline
				at a dose of 20 mL/kg;
6. Obtain a rapid
				glucose test. If blood glucose is less than 60:
i.
				For patients less than one month of age, administer 0.5 g/kg of a 10 percent
				dextrose solution via IV/IO;
ii. For
				patients greater than one month of age, administer 0.5 g/kg of a 25 percent dextrose
				solution via IV/IO.
7. If
				unable to establish an IV/IO, administer Glucagon 0.1 mg/kg (0.1 ml/kg) to a maximum
				of 1 mg via IM or SC routes (1mg=1ml=1 unit);
8. If no change, administer a rapid fluid bolus of
				normal saline solution at a dose of 20 mL/kg; and
9. Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.17 - Standing orders for pediatric tachycardia

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that a pediatric patient presents with
				narrow complex tachycardia:
1. Assess and secure
				the airway;
2. Administer 100 percent
				oxygen;
3. Maintain normal body
				temperature;
4. If rhythm is sinus or
				supraventricular in nature, attempt vagal maneuvers;
5. If no change, establish IV/IO access with
				normal saline solution at a KVO rate;
6.
				Administer adenosine 0.1 mg/kg IV/IO (maximum dose of 6 mg);
7. If no change, administer adenosine 0.2 mg/kg
				IV/IO (maximum dose of 12 mg); and
8.
				Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.18 - Standing orders for sudden infant death syndrome

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that sudden infant death syndrome is
				suspected:
1. Form a general impression of the
				patient's condition;
2. Establish
				responsiveness;
3. Assess airway and
				breathing and confirm apnea;
4. Assess
				pulselessness and initiate cardiac monitoring;
5. If patient does not exhibit lividity and/or
				rigor, go to cardiac arrest guidelines found at
				8:41-8.7;
6. If patient exhibits lividity and/or rigor,
				contact medical command physician for pronouncement;
7. Provide supportive measures and New Jersey SIDS
				Center (800) 545-7437 telephone number for caregivers;
8. Obtain patient history; and
9. Reassess the environment, documenting:
i. Where was the patient located on
				arrival;
ii. Description of objects
				located near the child upon arrival; and
iii. Unusual environmental conditions (that is;
				high room temperature, abnormal odors, etc.).
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.1 - Scope and purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a) These rules shall
				apply to any acute care hospital that operates, or seeks to operate, a mobile
				intensive care program within the State of New Jersey. These rules serve to define
				the operational requirements of such a program, to provide for a uniform application
				of standards, and to specify the personnel, equipment, organization and other
				resources required to successfully operate the program.
(b) No acute care hospital shall operate a mobile
				intensive care program in any form or manner or utilize any vehicle as a MICU within
				the State of New Jersey until licensed by the Department. In addition, as provided
				for at 8:41-9.2(a), a license
				to operate a mobile intensive care program shall not be issued unless a certificate
				of need has first been granted in accordance with the requirements set forth at
				N.J.A.C. 8:33.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.2 - Certificate of need requirements and patient restrictions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An acute care
				hospital shall not be issued a license to operate a mobile intensive care program
				unless approval has first been granted by the Department's Certificate of Need
				Program. Following approval by the Certificate of Need Program, an acute care
				hospital desiring to operate a mobile intensive care program shall make application
				in accordance with the process for licensure set forth in this chapter.
1. Consistent with N.J.A.C. 8:33, a certificate of
				need shall not be required for the permanent addition of full-time or part-time
				MICUs to a mobile intensive care program's primary service area in excess of those
				MICUs authorized pursuant to the original certificate of need approval letter. In
				such instances, the mobile intensive care program need only apply for licensure of
				those vehicles, in accordance with the standards for licensure as set forth at
				8:41-2.1 and 2.2.
2. Consistent with N.J.A.C. 8:33, a certificate of
				need shall not be required to increase the hours of operation of an existing MICU or
				to increase the number of licensed vehicles. In the case of an increase in the hours
				of operation, the mobile intensive care program need only notify OEMS, in writing,
				of the new hours. In the case of an increase of the number of licensed vehicles, the
				provider shall first license any new vehicles in accordance with the procedures for
				licensure set forth at
				8:41-2.1 and 2.2.
3. Consistent with N.J.A.C. 8:33, a certificate of
				need shall not be required to decrease the hours of operation of an existing MICU or
				for the permanent removal of a MICU from service. However, in such instances, the
				mobile intensive care program shall first notify, and receive approval from,
				OEMS.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.3 - Director

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each mobile
				intensive care program shall have a director who shall be responsible for all
				activities of that program.
(b) The
				person who serves as the director shall be either an EMT-Paramedic or a registered
				nurse with at least one year of critical care experience or who has demonstrated by
				education or experience the ability to manage health care organizations.
(c) A representative of the mobile intensive care
				program shall notify the Department, in writing, of any change of director within 14
				calendar days after the change.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.4 - Medical director

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each mobile
				intensive care program shall have a medical director who shall be responsible for
				all medical matters that affect that program, its personnel and its
				vehicles.
(b) The qualifications
				necessary to serve as the medical director of a mobile intensive care program shall
				be as follows:
1. Physician status;
2. Possession of CPR and ACLS
				certifications;
3. Possession of PALS or
				APLS certification;
4. Successful
				completion of the Advanced Trauma Life Support course to the standards of the
				American College of Surgeons; and
5.
				Experience in the provision of emergency care.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.5 - Medical command physician

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The qualifications
				necessary to serve as the medical command physician of a mobile intensive care
				program shall be as follows:
1. Physician status,
				or status as a permit holder as defined at
				8:43G-16.2(f)  (a
				person authorized by the New Jersey State Board of Medical Examiners to engage in
				the practice of medicine in the second year of a graduate medical education program
				or beyond);
2. Possession of CPR and
				ACLS certifications, and either PALS or APLS certification; and
3. Receipt of instruction in the proper
				utilization of the base station and the provision of medical command to ALS
				crewmembers, including viewing of the Department's "Medical Command in New Jersey"
				videotape.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.6 - Medical command

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The provision of
				advanced life support care by ALS crewmembers staffing a MICU is deemed a delegated
				medical practice. The medical command physician provides the authority for the ALS
				crewmembers to act.
(b) The medical
				command physician shall provide medical command to ALS crewmembers in a timely
				fashion and without undue delay.
1. All orders
				shall be prefaced with the name of the physician ordering the treatment.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.7 - Medical treatment protocols

Current through Register Vol. 56, No. 14, July 15, 2024
Each mobile intensive care program shall develop and maintain
				  written medical treatment protocols that cover most common medical emergencies for
				  patients of all ages. These protocols shall be kept at the base station, where they
				  shall be immediately accessible to all physicians. These protocols shall serve as a
				  guide to the physicians, but shall not be deemed to restrict the treatment ordered
				  in the best judgment of the physicians and within the scope of practice of the ALS
				  crewmembers. The protocols shall be reviewed and signed off by the medical director
				  at least once every 12 months.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.8 - Required crewmembers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When "in-service,"
				each MICU shall be staffed by at least two persons, as follows:
1. Two EMTs-Paramedic;
2. Two registered nurses who meet the requirements
				set forth at 8:41-9.9; or
3. One registered nurse who meets the requirements
				set forth at 8:41-9.9 and one EMT-Paramedic.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.9 - Mobile intensive care nurses

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No provider shall
				allow a registered nurse to serve on one of its MICUs in the capacity of an MICN
				unless that person:
1. Has completed at least one
				year of full-time nursing care performing advanced clinical skills in the critical
				care unit or emergency department of an acute care hospital;
2. Possesses EMT-Basic, CPR and ACLS
				certifications;
3. Possesses PALS or
				PEPP-Advanced certification or has successfully completed the Emergency Nurse
				Pediatric Course to the standards of the Emergency Nurses Association;
4. Possesses either PHTLS or ITLS
				certification;
5. Has successfully
				completed at least a MICU field internship consisting of at least 100 hours, has
				successfully intubated at least five patients and has demonstrated proficiency in
				pre-hospital ALS treatment to the satisfaction of the mobile intensive care
				program's medical director;
6. Is
				physically capable of performing the duties of a MICN; and
7. Is endorsed by the medical director of a mobile
				intensive care program.
i. The director shall
				forward a letter to OEMS verifying the endorsement to the Department as soon as
				practical after the endorsement has been issued. The letter shall include a
				statement attesting to the competency of the person to perform all skills required
				of EMTs-Paramedic and compliance with the requirements for EMT-Paramedic
				recertification set forth at
				8:41A-4.3.
ii. The director shall notify OEMS, in writing, in
				the event that the medical director revokes, cancels or otherwise rescinds
				endorsement. Notification shall be made to OEMS within 14 calendar days of the
				medical director's action.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.10 - Additional basic equipment and supplies: MICUs

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to the
				equipment and supplies required at
				8:41-3.4, when "in-service," each MICU
				shall be equipped with the following:
1. Equipment
				capable of producing a 12-lead electrocardiogram tracing;
2. Equipment to perform needle chest
				decompression;
3. Pediatric airway
				management materials including:
i. Airways,
				endotracheal tubes and stylets;
ii.
				Pediatric and infant sized laryngoscope blades;
iii. Pediatric and infant sized oxygen masks;
				and
iv. 1,000 mL and 450 mL sized
				bag-valve-mask devices;
4.
				Pediatric-sized electrodes for the monitor/defibrillator;
5. Pediatric-sized paddles or defibrillation pads
				for the monitor/defibrillator;
6.
				Pediatric and infant-sized IV catheters and/or winged infusion sets;
7. Pediatric Intraosseous infusion sets;
8. Pediatric and infant sized blood pressure
				cuffs;
9. Pediatric sized rigid cervical
				collars;
10. A pediatric height/weight
				medication and equipment guide ( for example, Broslow Tape);
11. At least two protective multi-use jackets that
				are both fire and tear resistant, as well as two sets of gloves, head and eye
				protection that, at a minimum, meet the requirements set forth at
				29 C.F.R.
				1910.132 et seq., incorporated herein by
				reference;
12. Nasogastric tubes and
				irrigation syringes;
13. A long spine
				board made of impervious, inflexible material, 72 inches long by 16 inches wide with
				associated strap holes and full-length three-quarter inch runners, or another
				configuration that protects the crewmembers' hands from injury during patient
				movement;
14. A set of
				binoculars;
15. At least 25 disaster
				tags (that is, Met Tags[R]);
16. At
				least four red "biohazard" type bags utilized for disposal of untreated regulated
				medical waste as defined at
				7:26-3A.5 and 3A.6. The "biohazard" bags
				shall meet the requirements set forth at
				7:26-3A.11 and shall only be utilized
				for untreated regulated medical waste materials and shall be disposed of after
				utilization in accordance with all applicable laws, rules and/or regulations;
				and
17. A current copy of the U.S.
				Department of Transportation (U.S.D.O.T.) Emergency Response Guidebook (obtainable
				from The National Highway Traffic Safety Administration, 400 7th Street S.W.,
				Washington, D.C., 20590 or by calling (888) 327-4236 or accessing their website at
http://www.nhtsa.dot.gov/people/injury/ems
).
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.11 - Optional equipment and supplies

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each MICU may be,
				but is not required to be, equipped with the following equipment and supplies:
1. An esophageal gastric tube airway, a laryngeal
				mask airway and other commercial airways of similar design or function;
2. A Doppler-type stethoscope;
3. A commercially available vest-type upper spinal
				immobilization device (for example, K.E.D.[R]);
4. Adult and pediatric-sized pneumatic anti-shock
				garments (PASG);
5. An automatic blood
				pressure manometer and one each adult, obese adult and pediatric size
				cuffs;
6. Doughnut magnets;
7. Blood tubes for laboratory specimens;
8. Phlebotomy equipment; and
9. Percutaneous needle cricothyrotomy equipment to
				permit transtracheal catheter ventilation if the MICU elects to perform rapid
				sequence induction (RSI).
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.12 - Oxygen administration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each MICU shall be
				equipped with a portable oxygen system in accordance with the standards for such
				equipment as set forth at
				8:41-3.6.
(b) In addition, each MICU shall be equipped at
				all times with at least one reserve oxygen cylinder with a capacity of at least 300
				liters.
(c) The MICU may, but need not,
				carry a portable positive pressure device. If carried, the positive pressure device
				shall meet all of the standards set forth at
				8:41-3.6(c).
(d) The portable oxygen system, reserve oxygen
				cylinder and any portable positive pressure oxygen powered resuscitators shall be
				stored in a crashworthy manner.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.13 - Automatic transport ventilators

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A MICU may, but need
				not, be equipped with a portable, automatic transport ventilator of the type
				approved by the FDA for pre-hospital utilization, which meets the minimum standards
				of the American Heart Association, as described in the Cardiac Life Support
				Guidelines, 1997 edition, published by the American Heart Association, incorporated
				herein by reference, as amended and supplemented. Copies may be obtained by writing
				to the American Heart Association, National Center, 7272 Greenville Avenue, Dallas,
				Texas 75231-4596.
(b) Automatic
				transport ventilators shall be capable of:
1.
				Giving an oxygen concentration between 21 and 100 percent;
2. Adjustable peak pressures;
3. Adjustable inspiratory and expiratory
				times;
4. Adjustable minute ventilatory
				rates;
5. Adjustable tidal volume;
				and
6. Adjustable high and low pressure
				alarms.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.14 - Aspirator/suction equipment

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each MICU shall be
				equipped with a portable aspirator.
1. The
				portable aspirator shall be powered by an integral battery and shall be capable of
				providing adequate suction to clear a patient's airway. The aspirator shall provide
				a flow rate of at least 25 liters per minute at the end of the suction tube and a
				vacuum pressure of at least 300 mmHg within four seconds and a maximum vacuum
				pressure of at least 400 mmHg for at least 20 minutes. MICUs that utilize aspirators
				that are powered by field replaceable batteries shall carry a sufficient supply of
				batteries to permit the device to operate continuously and, in accordance with
				Federal Specifications for Ambulances, KKK-A-1822, "Portable Suction Aspirator," to
				meet the flow and vacuum pressure requirements for at least 20 minutes.
2. The portable aspirator shall be equipped with
				an unbreakable collection bottle and at least three feet of transparent or
				translucent non-collapsible suction tubing with an interior bore of at least
				one-quarter inch. A three-eighths inch bore is recommended. There shall be at least
				one Yankauer-type suction instrument and at least eight suction catheters in not
				less than four assorted adult and pediatric sizes. At least one catheter shall be a
				size "8" and one shall be a size "18." An infant bulb syringe shall also be carried.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.15 - Patients triaged to BLS ambulances

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Patients with whom a
				crewmembers make physical or verbal contact shall be evaluated to determine the
				nature of their illness and/or injury. This exam shall be detailed enough to
				provide:
1. At least one complete set of vital
				signs;
2. Documentation of chief
				complaint, past history and medications;
3. A clinical picture of the patient's status;
				and
4. Sufficient information to provide
				a reasonably complete narrative of the patient's medical condition.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.16 - Transport restrictions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The transportation
				of critically ill or injured patients in need of ALS treatment shall occur in the
				dispatched BLS vehicle responding or on scene at the time.
(b) MICUs may be utilized to transport critically
				ill or injured patients only in the following limited circumstances:
1. In the event of a life-threatening
				emergency;
2. In the event that a BLS
				ambulance is not responding and is not expected to arrive at the scene;
3. Where all of the appropriate on-scene ALS
				treatments have been rendered, the patient is ready for immediate transport and no
				BLS ambulance is present on the scene or where an appropriate dispatch center has
				confirmed that no BLS ambulance is responding;
4. When its services are requested during the
				course of a mass casualty incident; or
5. When a mobile intensive care program has been
				granted the right, pursuant to the terms of its original certificate of need or a
				subsequent waiver granted in accordance with
				8:41-1.4, to utilize its vehicles as
				transport vehicles.
i. In those instances where a
				mobile intensive care program has been granted the right to utilize its vehicles to
				transport patients, those vehicles shall also meet and comply with all of the
				requirements set forth at N.J.A.C. 8:41-4,
				8:41-10.10 (SCTU "Neonatal patient
				equipment supplies"), 8:41-10.11 (SCTU "Optional equipment and supplies"),
				8:41-10.14 (SCTU "Aspirator/suction equipment") as it relates to installed
				aspirators, 8:40-6.5 (BLS ambulance "Basic equipment and supplies"), 8:40-6.8 (BLS
				ambulance "Patient transport devices"), 8:40-6.9 (BLS ambulance "Spine boards,
				orthopedic litter and splints"), 8:40-6.10 (BLS ambulance "Patient compartment
				requirements and dimensions"), 8:40-6.11 (BLS ambulance "Vehicle certification to
				Federal specifications") and 8:40-6.12 (BLS "Vehicle markings and emergency warning
				devices").
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.17 - Vehicle markings and emergency warning devices

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each MICU shall bear
				the following markings:
1. The name of the mobile
				intensive care hospital approved to operate the mobile intensive care program. In
				the event that the mobile intensive care program consists of more than one hospital,
				all participating hospitals named in the certificate of need shall be
				identified;
2. The trade name as it
				appears on the Department issued vehicle license shall be visible on the two
				exterior sides of the vehicle in a size not less than four inches high;
3. The vehicle recognition number shall be visible
				on the rear and the two exterior sides of the vehicle in a size not less than three
				inches high;
4. The words "Ambulance" or
				"Emergency Medical Services" shall be in mirror image, centered above the grill, on
				the front of the vehicle in a size not less than four inches high and on each side
				and on the rear of the vehicle body in a size not less than six inches high;
				and
5. The words "Paramedic(s),"
				"EMT-Paramedic(s)," "Mobile Intensive Care Unit," "MICU," "Emergency Medical
				Services," "ALS" and/or "Advanced Life Support" may be located anywhere on the
				vehicle.
i. If any wording associated with advance
				life support or mobile intensive care services is located anywhere on the vehicle,
				staffing of the vehicle shall be maintained at that level at all times.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.18 - Two-way communications

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each MICU shall
				maintain a primary and a separate and distinct secondary means of communications
				equipment that allows the crewmembers to:
1.
				Directly contact the regional dispatch center while in or away from the
				vehicle;
2. Directly contact any acute
				care hospital's Emergency Department via utilization of the HEAR system (155.340
				mHz);
3. Directly contact the MICUs that
				operate in the area immediately bordering that MICU's territory;
4. Directly contact the medical command physician
				while in or away from the MICU and to send telemetered electrocardiograms when
				requested;
5. Interface with appropriate
				disaster control agencies in accordance with local and county emergency
				plans;
6. Directly capable of
				transmitting and receiving on the EMS Statewide coordination on JEMS 3 with a
				frequency of 155.280 mHz; and
7.
				Directly capable of transmitting and receiving on the Spen 4 or JEMS 4 with a
				frequency of 153.785 mHz.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.19 - MICU dispatch

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each mobile
				intensive care program shall utilize a regional dispatch center for the dispatching
				of its MICUs. All proposed dispatch agreements shall be subject to approval by the
				Department. The provider shall notify the Department of any proposed change in the
				dispatch agreement and/or the choice of regional dispatch center at least 14
				calendar days prior to implementing any such changes.
(b) The Department shall not approve a mobile
				intensive care program's choice of regional dispatch center unless that center is
				capable of providing:
1. Coordinated dispatch
				activity among various MICUs, BLS ambulances and first responders;
2. Dispatching of MICUs that is in compliance with
				the service area designations as determined by the certificate of need;
3. Adequate two-way communications coverage to the
				MICUs that the regional dispatch center serves;
4. Other emergency services that may be required,
				including coordination of mass casualty incidents and disasters; and
5. Record retention, including a log of all
				requests received for service, times as recorded by the regional dispatch center,
				the MICU assigned to the request, requests not assigned to the primary MICU for that
				area due to the vehicle being unavailable, and voice recording, either digital or
				analog, of required frequencies as determined by the regional dispatch center and
				the Department.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.20 - Back-up vehicles

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each provider shall
				secure a sufficient number of vehicles in order to comply with the following
				schedule for adequate back-up vehicles. For the purposes of this section, a
				part-time vehicle shall constitute a full operational vehicle. For example, a mobile
				intensive care program operating a full-time vehicle and part-time vehicle has two
				approved vehicles, and would require one back-up vehicle.
Click
				  here to view image.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.21 - Hours of operations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each mobile
				intensive care program shall operate its MICUs so that coverage is maintained at
				least to the level required by the terms set forth in the program's original
				certificate of need. In the event that the mobile intensive care program is unable
				to meet this requirement and coverage is interrupted, the program shall:
1. Assure that the service area is covered by
				another approved mobile intensive care program to the level of service that would
				normally be provided when there is an interruption in service of greater than three
				hours; and
2. Notify OEMS by telephone
				on the next business day during regular business hours, followed by written
				confirmation, when there is an interruption in service of greater than three hours.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.22 - Temporary utilization of back-up MICUs

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A mobile intensive
				care program may temporarily place a back-up MICU "in-service" if public safety
				concerns necessitate additional coverage for a limited period of time. This shall
				include:
1. Events where a large number of people
				are expected to gather;
2. A temporary
				change in the accessibility of the service area (for example, bridge or road
				closures);
3. A mass casualty incident,
				natural and/or man-made disasters, inclement weather, an emergency situation, as a
				part of an organized emergency preparedness action or drill; and/or
4. Other situations that are not covered by this
				section, but which have been approved in advance by OEMS.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 9 - SPECIFIC MOBILE INTENSIVE CARE PROGRAM REQUIREMENTS › Section 8:41-9.23 - Specialty units

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A mobile intensive
				care program may utilize bicycle or tactical teams for the purpose of attending
				special events and/or special operations. All bicycle and/or tactical teams shall be
				associated with a dedicated MICU. For purposes of this chapter, a dedicated MICU
				means the vehicle to which the bicycle or tactical team crewmembers are assigned or
				associated shall be utilized for any calls so long as the bicycle or tactical team
				is "in-service."
(b) The director of the
				mobile intensive care program shall ensure that all bicycle or tactical team members
				are provided with appropriate safety equipment and supplies (that is, helmets,
				reflective outerwear, etc.).