State of TN New Equipment Rules Effective July 1, 2015

Have you read the new rules on Emergency Medical Services Equipment and Supplies Specifications approved by the Tennessee State EMS Board? The rules went into effect on July 1, 2015. There are several notable changes that will make your daily inventory check a little different. Some are things many ambulances already carried. Some are things that will need to be ordered.

One of the biggest changes are the pediatric size endotracheal tubes. All endotracheal tubes are now required to have a cuff. The new rules state an ambulance must have two (2) of each size 2.5 – 8.5 cuffed endotracheal tubes. You can still carry the uncuffed tubes; but your ambulance must have 2 of the cuffed tubes to pass inspection.

Another change to the rules is the requirement to have a reflective vest for each crew member. The vest must meet or exceed ANSI/ISEA Class I, II, or III. This is something each truck should already have to meet OSHA requirements. But it is now on the state daily inventory check as well.

You also need to have the DOT Emergency Response Guide (ERG) Book. If you didn’t have this on your ambulance, you can call your local EMA director or TEMA to get one for free.

Now each ambulance has to have a pelvic immobilization device. This can be a commercial device like the Sam Pelvic Sling. Or you can make a pelvic splint with sheets and clips. You can also use the KED for a pelvic splint. But if you are claiming a sheet or the KED for a splint, the crew on duty must be able to show the consultant how to apply the pelvic splint. A commercial splint sounds good to me.

Speaking of splints the new rules now require 2 pediatric traction splints. The standard issue for legs is 2. So this makes sense. It is possible to have 2 mid-shaft femur fractures in one incident, on the same patient or multiple patients.
How many of us still carry 2 cervical collars (c-collars) in Tall, Medium, Short, No Neck, and pediatric sizes? Well with the advent of adjustable collars, the state rules say the ambulance has to only carry 2 adult and 2 pediatric if they are adjustable. This is nice for the smaller trucks. If you still ride around in a van, 12 collars stuffed in a bag is a very bulky.
Bag valve mask (BVM) devices have had a small change. Ambulances are now required to carry 2 neonatal size bags. These bags have a bag volume of 200-250 milliliters. The bag must have an oxygen reservoir and a neonatal mask. These are the super tiny size masks. Just as a reminder the child BVM is 450-750 milliliters. And the adult BVM is at least 1,000 milliliters. Both must have an oxygen reservoir. The child bag must carry a child and an infant mask. Of course, the adult bag carries an adult mask.
The oropharyngeal and nasopharyngeal airways have had some changes as well. For the oropharyngeal airways, the old rules said “5 sizes.” The new rules say one in each size 0, 1, 2, 3, 4, and 5. Check your OPAs. You may need to add a size. The nasopharyngeal airway sizes are also specified now. You have to have one of a 16 or 18 Fr, one of a 20 or 22 Fr, one in size 24 or 26 Fr, one in size 28 or 30 Fr, and one in size 32 or 34 Fr. That is a total of 5 different NPAs.
Continuous Positive Airway Pressure or CPAP is also a new requirement. This is quite manageable since they have the disposable CPAPs available. You can purchase a disposable CPAP system for $30-50. This is a great option if you don’t want to purchase one of the large reusable systems.
Pediatric size nasal cannulas have been added to the list of critical items required on an ambulance. You must have 2 of them to go with the 2 adult nasal cannulas.
Another new non-disposable item required by the state is a non-mercury thermometer. There are several types on the market. You can get a thermometer from $10-350. The price depends on the type chosen. Just make sure it is non-mercury.
A pillow has also been added to the list. The pillow must be 1 time use or have a fluid proof covering. The type found in hospitals have a fluid proof cover that is not removable and wipes off easily.
Cold packs are now a required item. Most ambulance services have been carrying cold packs. If you haven’t had them, you must add 2 to each ambulance.
If you read the rules closely in the personal protective equipment section, you will see that a roll of impermeable tape is required. With the recent Ebola scare in the United States, the PPE section was re-vamped to add full body protection with fluid-proof / impermeable covers or gowns and leggings and a roll of impermeable tape. The other items have always been required.
In the BLS medication section, Narcan or naloxone has been added. A BLS truck must have a minimum of 4 mg of Narcan or the therapeutic equivalent. And to go along with this requirement, the truck must have a mucosal atomizer device or MAD. AEMTs are now able to give Narcan intranasally. A MAD device is required to administer the Narcan intranasally.
The EMS regional consultants are looking more closely at the glucometers. It has to be CLIA approved for waived testing. Which simply means the glucometer has to be “for healthcare use” instead of “for personal use only.” It also means we must be testing our glucometer as per the manufacturer guidelines and be able to calibrate the glucometer.
The Bougie device with a coude tip is also required. Many services were already carrying these because they are a real tool to have for intubation. If you didn’t have them on your truck, they aren’t expensive. For the benefit, they are definitely worth the money.
A pressure infusion device has become a required item. The state rules do not specify the size of the device. However, it would be best to have a pressure infusion device that fit the size IV fluids on the truck. They commonly are available in 500 cc and 1,000cc size.
One of the biggest changes (and potentially most costly) is in the cardiac monitor section. The cardiac monitor must have 12 lead and transcutaneous cardiac pacemaker capabilities within 3 years of the effective date of these rules, July 1, 2015. Most services have monitors capable of performing 12 leads and pacing. However, the monitor also must be capable of transmitting the 12 leads within 3 years as well.
There are several new changes to the rules. Each service and the crews need to read and understand the new rules. It definitely affects how the state regional consultant will check the trucks. I recommend each EMS person who works on an ambulance be familiar with these rules. You are responsible for knowing and understanding the rules. If you have any questions, you can contact your regional consultant or the state office of EMS.
Here is a link to read the new rules in their entirety on the state’s website:
http://tn.gov/assets/entities/health/attachments/Ambulance_Equipment_Specifications_Effective_July_1_2015.pdf

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