11 Patient information
12 Patient transportation
13 Standards for attendants
14 Ambulances, equipment and supplies
15 Vehicle and equipment standards
16 Smoking in an ambulance
17 Disposal of medical waste
18 Notifiable diseases
19 Personal property
20 Repeal
21 Expiry
22 Coming into force
Schedule
Definitions
1 In this
Regulation,
(a) “Act” means the Ambulance Services Act;
(b) “approved facility” means
(i) an approved hospital as defined in the Hospitals
Act,
(ii) a nursing home as defined in the Nursing
Homes Act, or
(iii) any other facility approved by the Minister;
(c) “Emergency Medical Responder” means a person
registered as an Emergency Medical Responder under the Health Disciplines
Act;
(d) “Emergency Medical Technician‑Ambulance”
means a person registered as an Emergency Medical Technician‑Ambulance under
the Health Disciplines Act;
(e) “Emergency Medical Technologist‑Paramedic”
means a person registered as an Emergency Medical Technologist‑Paramedic
under the Health Disciplines Act;
(f) “licence” means a licence to provide
ambulance services under the Licensing Regulation;
(g) “registered nurse” means a registered nurse
as defined in the Nursing Profession Act;
(h) “registered nurse equivalent” means a
registered nurse equivalent (EMR), a registered nurse equivalent (EMT‑A)
and a registered nurse equivalent (EMT‑P) described in section 2;
(i) “Standards of Ambulance Equipment and
Supplies” means the Standards of Ambulance Equipment and Supplies
approved by the Minister and published by the Department of Health and
Wellness.
AR
45/99 s1;206/2001
Registered nurse equivalents
2(1) In this section,
“standards of competencies” means the standards of competencies for an
Emergency Medical Responder, an Emergency Medical Technician‑Ambulance
and an Emergency Medical Technologist‑Paramedic as determined by the
Alberta College of Paramedics.
(2) A person is
a “registered nurse equivalent (EMR)”, “registered nurse equivalent (EMT‑A)”
or “registered nurse equivalent (EMT‑P)” if the person is a registered
nurse who is determined by the Alberta College of Paramedics and the Alberta
Association of Registered Nurses to have met the relevant standards of
competencies.
AR
45/99 s2;221/2004
Higher qualifications permitted
3(1) Where this
Regulation requires or permits the use of an ambulance attendant who is an Emergency
Medical Responder or registered nurse equivalent (EMR), the requirement is also
met if an Emergency Medical Technician‑Ambulance or a registered nurse
equivalent (EMT‑A) or an Emergency Medical Technologist‑Paramedic
or a registered nurse equivalent (EMT‑P) is used.
(2) Where this Regulation requires the use of an ambulance
attendant who is an Emergency Medical Technician‑Ambulance or registered
nurse equivalent (EMT‑A), the requirement is also met if an Emergency
Medical Technologist‑Paramedic or a registered nurse equivalent (EMT‑P)
is used.
Emergency medical responder level
4 An ambulance
meets the requirements necessary to provide ambulance services at the emergency
medical responder level if
(a) it is staffed with at least 2 ambulance
attendants who are Emergency Medical Responders or registered nurse equivalents
(EMR), and
(b) it is equipped with the equipment and
supplies specified for that level in the Standards of Ambulance Equipment
and Supplies.
Basic life support level
5 An ambulance meets
the requirements necessary to provide ambulance services at the basic life
support level if
(a) it is staffed with at least 2 ambulance
attendants, one of whom is an Emergency Medical Technician‑Ambulance or
registered nurse equivalent (EMT‑A), and one of whom is an Emergency
Medical Responder or registered nurse equivalent (EMR), and
(b) it is equipped with the equipment and
supplies specified for that level in the Standards of Ambulance Equipment
and Supplies.
Advanced life support level
6 An ambulance
meets the requirements necessary to provide ambulance services at the advanced
life support level if
(a) it is staffed with at least 2 ambulance
attendants, one of whom is an Emergency Medical Technologist‑Paramedic or
registered nurse equivalent (EMT‑P), and one of whom is an Emergency
Medical Technician‑Ambulance or registered nurse equivalent (EMT‑A),
and
(b) it is equipped with the equipment and
supplies specified for that level in the Standards of Ambulance Equipment
and Supplies.
Levels of ambulance services
7 An operator must
ensure that an ambulance used by the operator to provide a level of ambulance
services meets the requirements of this Regulation for that level of ambulance
services.
Requirements for ambulance attendants
8(1) No operator
may employ or engage a person as an ambulance attendant unless that person is
registered under the Emergency Medical Technicians Regulation (AR 48/93)
or is a registered nurse equivalent.
(2) An operator must ensure
that a registered nurse equivalent operates under medical control as defined in
the Emergency Medical Technicians Regulation (AR 48/93).
Additional equipment
9 No operator may
permit equipment that is additional to the equipment required for the level of ambulance services specified
in the operator’s licence to be carried in the operator’s ambulances unless the
additional equipment is approved by the Registrar.
Patient care report
10(1) An operator
must ensure that
(a) an ambulance attendant who attends a patient
completes a patient care report in the form approved by the Minister
immediately after the transportation of the patient,
(b) if the patient is transported to an approved
facility, one copy of the patient care report is given for inclusion in the
patient’s medical chart to a person at that facility who has the authority to
receive patient information,
(c) if the patient is transported to the
patient’s home or a place other than an approved facility, the copy of the
patient care report intended for the facility is retained in the records of the
operator, and
(d) one copy of the patient care report is
forwarded to the Department of Health and Wellness at a place and within the
time specified by the Minister.
(2) An operator must store
patient care reports securely.
(3) An operator must retain
a copy of a patient care report for a period of 10 years from the date the
patient was transported.
(4) Despite
subsection (3), the contents of a patient care report may be microfilmed or
electronically stored, and the original report may be destroyed not less than
one year after the patient is transported.
AR
45/99 s10;206/2001;4/2004
Patient information
11 When an ambulance
is used to transfer a patient from one approved facility to another, the
sending facility must provide the ambulance attendant with
(a) the patient’s identity,
(b) a summary of the patient’s medical history
prior to the transfer, including information that is relevant to complications
that may arise during the transfer,
(c) any orders by the attending physician for
treatment of the patient during transportation,
(d) the reason for the transfer, and
(e) the name of the receiving physician, the
receiving facility and confirmation that the receiving facility has been
notified.
Patient transportation
12(1) A patient
must be transported in the patient compartment of the ambulance.
(2) A patient must be
secured with a safety device appropriate to the patient’s condition.
Standards for attendants
13(1) At least one
ambulance attendant must be present in the patient compartment of the ambulance
with the patient when the patient is being transported, unless a physician or a
registered nurse is present with the patient during that time.
(2) A person who
drives an ambulance must hold a Class 1, 2 or 4 operator’s licence under the Operator
Licensing and Vehicle Control Regulation (AR 320/2002).
AR
45/99 s13;221/2004
Ambulances, equipment and supplies
14(1) An operator
must ensure that each ambulance and all equipment and supplies used or to be
used by the operator in providing ambulance services are maintained in a clean,
sanitary condition, in good repair, in proper working order and in accordance
with the manufacturer’s instructions and standards.
(2) An operator must ensure
that equipment, supplies and medication used in providing ambulance services
are handled as follows:
(a) all sterile equipment and supplies, whether
disposable or reusable, are kept in sealed packaging;
(b) all sterile reusable equipment that has been
used in the provision of care to a patient is removed from the ambulance,
cleaned and re‑sterilized before being used again;
(c) all equipment, supplies and medications that
have a specified shelf life are, on or before the expiry date, removed from the
ambulance and
(i) disposed of in accordance with any waste
management guidelines and standards prescribed by the Minister, or
(ii) in the case of sterile reusable equipment,
cleaned, re‑sterilized and repackaged.
Vehicle and equipment standards
15(1) An operator
must ensure that all ambulances used to provide ambulance services meet the
standards specified in the Schedule.
(2) Despite subsection (1),
sections 5, 16 and 19(d)(i) of the Schedule do not apply to
(a) an ambulance that received its unit number
from the Registrar before March 1, 1999,
(b) an ambulance that was manufactured before
March 1, 1999, or
(c) an ambulance that was used to provide
ambulance services outside Alberta before March 1, 1999, that is brought into
Alberta on or after March 1, 1999 and that is approved by the Registrar.
Smoking in an ambulance
16 No person may
smoke in an ambulance at any time.
Disposal of medical waste
17 An operator must
ensure that all biomedical waste, including sharps containers, is disposed of
in accordance with any waste management guidelines and standards governing the
disposal of biomedical waste that are prescribed by the Minister.
Notifiable diseases
18 If a patient who
is known to have or who is suspected of having a notifiable disease under the Communicable
Diseases Regulation (AR 238/85) is transported in an ambulance, the
operator must ensure that
(a) notification is made to the local medical
officer of health in accordance with the Public Health Act and the Communicable
Diseases Regulation (AR 238/85),
(b) if any body fluids of the patient have
contaminated the ambulance, the ambulance is decontaminated in accordance with
the methods under the Communicable Diseases Regulation (AR 238/85)
and any directions of the local medical officer of health, and
(c) if the pathogen is airborne, the patient is
provided with a mask.
Personal property
19(1) If, in the
course of providing ambulance services, an operator or ambulance attendant
accepts property of the patient for safekeeping, the operator or ambulance
attendant must take reasonable care to ensure its safekeeping.
(2) An ambulance attendant
must
(a) immediately at the end of an ambulance trip,
search the ambulance for any property lost or left by any passenger, and
(b) deliver any property found
(i) to the patient or passenger who lost or left
the property,
(ii) to the nearest police station or to the
approved facility to which the patient or passenger was taken, or
(iii) to a medical examiner or the medical
examiner’s representative if the patient died in the ambulance and the death
requires notification under the Fatality Inquiries Act.
Repeal
20 The Staff,
Vehicle and Equipment Regulation (AR 4/94) is repealed.
Expiry
21 For
the purpose of ensuring that this Regulation is reviewed for ongoing relevancy
and necessity, with the option that it may be repassed in its present or an
amended form following a review, this Regulation expires on April 30, 2007.
AR
45/99 s21;4/2004
Coming into force
22 This Regulation
comes into force on March 1, 1999.
Schedule
Minimum Vehicle Standards for Ambulances
1 In
this Schedule,
(a) “AMD Standard 00‑” means those
standards for testing the construction and safety of ambulances that are
published from time to time by the Ambulance Manufacturers Division of the
National Truck Equipment Association;
(b) “primary response unit” means the ambulance
that a licensed operator intends to use first in response to an emergency or
non‑emergency;
(c) “secondary response unit” means an ambulance
used by a licensed operator that is available to respond to a request for
assistance if all of the operator’s primary response units are deployed.
2 The
patient compartment of an ambulance must have the following:
(a) not less than 127 cm between the finished
floor and the ceiling;
(b) not less than 300 cm between the bulkhead
partition immediately behind the driver’s seat and the inside of the rear
doors;
(c) seating for at least one attendant, with at
least one rear‑facing seat located immediately in front of the forward
edge of the main cot;
(d) not less than 68 cm between the backrest of
the rear‑facing attendant’s seat and the forward edge of the main cot;
(e) not less than 25 cm between the rear edge of
the main cot and the inside of the rear doors;
(f) a clear aisle of not less than 25 cm in
width between the main cot and the squad bench;
(g) space and facilities for the placing,
securing and transporting of 2 patients in a recumbent position;
(h) readily accessible space for the storing and
securing of equipment and supplies appropriate to the required level of
service;
(i) interior surfaces that are in good repair,
easily cleaned and sanitized and free of sharp edges and projections;
(j) no fewer than 4 fluorescent, fibre optic or
dual‑intensity incandescent ceiling lights controlled by 2 separate
electrical circuits.
3 The
exterior of an ambulance must have the following:
(a) flashing or rotating emergency warning
lights that are visible from all directions, including
(i) a forward‑facing lightbar or strobe
heads mounted not less than 180 cm above the ground, wired to a separate,
dedicated electrical circuit and displaying not fewer than 2 red beams,
(ii) 2 identical, red warning lights mounted on
the front plane of the vehicle, below the lower edge of the windshield, not
less than 75 cm above the ground and not less than 45 cm apart when measured at
the centre line of each lamp,
(iii) one or more side‑facing, red warning
lights mounted on the left and right sides of the vehicle not less than 180 cm
above the ground,
(iv) not fewer than 2 identical, red warning
lights mounted on the rear plane of the vehicle, not less than 180 cm above the
ground and so that no fewer than 2 beams are fully visible directly behind the
vehicle when the rear doors are open, and
(v) one or more red warning lights mounted as
near as is practical to the front edge of each of the left and right front
fenders to serve as intersection warning devices;
(b) one or more floodlights mounted on the rear
plane of the vehicle not less than 180 cm above the ground and designed so as
to illuminate the area at the rear of the vehicle in an unobstructed manner
when the rear doors are open;
(c) one or more floodlights mounted on each side
of the vehicle not less than 180 cm above the ground, designed to adequately
light the general area on each side of the vehicle and controllable
individually from the driver’s switch console;
(d) the word “AMBULANCE” in reverse placed on
the front of the vehicle in legible, capitalized, reflective, blue letters that
are at least 10 cm in height and have a minimum stroke width of 1.5 cm;
(e) the word “AMBULANCE” placed on the rear of
the vehicle in legible, capitalized, reflective, blue letters that are at least
15 cm in height and have a minimum stroke width of 2.5 cm;
(f) a blue, reflective “Star of Life” symbol
with a diameter of at least 30 cm placed on each side of the vehicle;
(g) an ambulance unit number, as assigned by the
Registrar, placed on the upper rear corners of each side and on the rear of the
vehicle in legible, blue figures that are at least 10 cm in height and have a
minimum stroke width of 1.35 cm.
4 The
windows on the rear doors of an ambulance must allow at least 80% light
transmission when the rear doors are open and the emergency warning lights on
the back of the ambulance show through the windows.
5(1) In this
section, “H‑V axis” in respect of a light means the horizontal‑vertical
axis at the centre of the light.
(2) The flashing or
rotating emergency warning lights on the exterior of an ambulance must
(a) flash on and off at a rate of 75‑80
times per minute;
(b) have an illuminated viewing area of not less
than 129 cm2;
(c) project a beam spread of at least 5 degrees
up and down and at least 45 degrees left and right of the H‑V axis of the
light;
(d) during daytime operation, produce at least
(i) 1200 candela at the H‑V axis, and
(ii) 75 candela at all points 5 degrees up and
down and 45 degrees left and right of the H‑V axis;
(e) during nighttime operation, produce at least
30% of the intensities specified in clause (d);
(f) have been tested by the manufacturer of the
lights to determine effective intensities in accordance with the Illumination
Engineering Society’s Guide for Calculating the Effective Intensity of
Flashing Lights, and the manufacturer’s test documentation for the
applicable lights must be available to the Registrar on request.
6 The
driver’s cab of an ambulance must have the following:
(a) a central switch console that
(i) is positioned not more than 30 mm above the
upper edge of the dashboard,
(ii) contains control switches for all emergency
warning and accessory devices, and
(iii) is readily accessible to the driver and is
operable by the driver when seated in the driving position;
(b) controls for an audio warning device that
(i) is capable of automatically producing
continuous multiple tones at rates of between 10 and 250 cycles per minute and
within a frequency range of 500 to 2000 Hz, and
(ii) is capable of powering one or more, forward‑facing,
100‑watt siren speakers to provide a minimum output level of 123 dBA at 3
m;
(c) one or more flashing warning lights that are
activated whenever a door to the patient compartment or an exterior storage
compartment is open.
7 The
low voltage electrical system of an ambulance must have
(a) 2 or more 12‑volt batteries that are
wired to provide starting motor circuitry in a manner approved by the chassis
manufacturer,
(b) a battery disconnect device, a labelled
“Battery Disconnect” switch and an indicator light, clearly visible to the
driver, to indicate that the batteries are on,
(c) a generating system that has a cold, high
speed rating of not less than 165 amperes and an operational rating of not less
than 135 amperes at 14 volts with an underhood temperature of 93EC, and
(d) been tested by the final stage manufacturer
in accordance with “AMD Standard 005, Ambulance 12‑volt DC Electrical
Systems Test” to determine the generating system reserve when under full
electrical load.
8 A tag
must be permanently attached to the vehicle in an easily accessible location by
the final stage manufacturer certifying that the electrical system has been
tested in accordance with section 7(d) and that the total electrical load of
all electrical components does not exceed the ambulance’s generating capacity.
9 In
addition to the requirements of section 7, the electrical system of an
ambulance may include a battery isolator and a switching device to select the
batteries, either simultaneously or independently, if power for the ambulance
conversion is routed directly from the generating system, through the isolator,
to the load.
10 The
ambulance conversion and accessory electrical equipment wiring must be
(a) served by circuits distinct from the vehicle
chassis circuits and protected by circuit breakers,
(b) permanently colour coded and numbered or
marked along its length with easily read letters or numbers to identify
function,
(c) located in accessible, enclosed and
protected locations,
(d) routed in conduit or high temperature looms
rated at 149EC, and
(e) protected by grommets where it passes
through apertures on the body.
11 An
ambulance must not be operated in any situation if the manufacturer’s ratings
for gross axle weight or gross vehicle weight are exceeded.
12 All
modular ambulance bodies and altered (raised roof) van ambulances must be
certified by the final stage manufacturer as meeting “AMD Standard 001, Static
Load for Ambulance Body Structure Test”, and test documentation for the
applicable structure must be available to the Registrar on request.
13 Doors
to the patient compartment of an ambulance must be
(a) located on the right side and at the rear,
(b) equipped with handles so that they may be
opened from either the interior or exterior of the vehicle,
(c) designed to allow stretcher patients to be
easily loaded and unloaded through the rear doors, and
(d) designed and placed in such a manner that
patients on a primary wheeled cot or a secondary stretcher may be unloaded
through the right side door in the event that the rear doors are inoperable.
14 Patient
compartment doors on modular ambulances must have latching mechanisms that are
installed and certified by the final stage manufacturer as meeting “AMD
Standard 002, Body Door Retention Components Test”, and test documentation for
the installation must be available to the Registrar on request.
15 The
primary cot must be secured in the ambulance by a crash stable cot fastener
assembly that is installed and certified by the final stage manufacturer as
meeting “AMD Standard 004, Litter Retention System Test”, and test
documentation for the installation must be available to the Registrar on
request.
16(1) The patient
compartment must have an occupant restraint net that prevents an occupant of
any side‑facing seat on the curbside of the passenger compartment from
striking the bulkhead during the rapid deceleration of the ambulance.
(2) The restraint net must
be
(a) positioned between the bulkhead of the
passenger compartment and any side‑facing seat on the curbside of the
patient compartment,
(b) located no more than 10 cm from,
(i) if the side‑facing seat is a bench
seat, the part of the forward edge of the base of the seat that is closest to
the bulkhead, and
(ii) if the side‑facing seat is a captain’s
chair, the part of the seat’s cushion that is closest to the bulkhead,
(c) attached to at least 2 points, not less than
40 cm apart, on or near the ceiling and 2 points, not less than 30 cm apart, on
or near the floor using low‑profile, quick‑release fasteners that
allow the net to be easily removed,
(d) not less than 50 cm wide,
(e) constructed of cargo webbing that can be
easily cleaned or an equivalent material that can be easily cleaned, and
(f) designed, constructed, installed and tested
to withstand a load of not less than 13 300 Newtons.
17 All
cabinets in the patient compartment of an ambulance must be securely bolted or
welded to metal tapping plates or framing members that are welded to the body
of the ambulance.
18 The
patient compartment of an ambulance must be equipped with an environmental
control system that
(a) consists of heating, ventilation and air
conditioning components and is capable of maintaining the interior temperature
at 20EC when operated at outdoor temperatures between ‑35EC and +35EC,
(b) has controls that are easily accessible to
the attendant, and
(c) is independent of the driver’s cab
environment system.
19 An
ambulance must be equipped with the following:
(a) an alarm that sounds when the vehicle is in
reverse gear, but the alarm may be overridden by means of a switch on the
driver’s switch console;
(b) a seat belt for each seating position in the
vehicle;
(c) “NO SMOKING ‑ OXYGEN EQUIPPED” signs
conspicuously displayed in the driver’s cab and patient compartment;
(d) a piped medical oxygen system installed in
the patient compartment consisting of
(i) a medical oxygen cylinder of not less than a
2000‑litre capacity that is secured into a retaining device that has been
designed, constructed, secured in a manner and tested to show that it meets the
requirements of “AMD Standard 003, Oxygen Tank Retention System Test”,
(ii) a pressure‑reducing regulator complete
with a contents gauge and preset to 344.5 kilopascals,
(iii) non‑ferrous piping or low pressure
electrically conductive hose that is approved for medical oxygen,
(iv) not fewer than 2 self‑sealing wall
outlets, and
(v) a pressure compensated flow meter for each
wall outlet that is being used to administer oxygen to a patient;
(e) a fixed, electrically powered suction system
installed in the patient compartment consisting of
(i) a motor/pump assembly capable of providing
not less than 20 litres per minute air flow and of achieving not less than 300
mm Hg vacuum within 4 seconds after the suction tube is closed,
(ii) a transparent collection jar with a capacity
of not less than 1000 ml,
(iii) a vacuum control and shut‑off valve,
(iv) a vacuum indicator gauge, and
(v) 3 metres of transparent suction tubing;
(f) a puncture‑proof sharps container for
discarded needles and scalpels that is securely installed within the patient
compartment of the vehicle.
20(1) When an
ambulance that is a primary response unit is not in use, it must be stored
inside a heated building if the outdoor temperature is below 0EC.
(2) When any ambulance is
not in use, the interior temperature of the ambulance must be maintained above
10EC.
(3) If an interior heater
is used in an ambulance to maintain the interior temperature above 10EC, the interior heater
must
(a) be permanently installed in a protective
metal mounting box within a cabinet in the patient compartment,
(b) be equipped with a thermostat, and
(c) if powered by 120 volt AC, be permanently
and directly wired through a ground‑fault interrupt breaker to a
shoreline connection on the exterior of the ambulance and have an automatically
resetting high temperature cutout switch.
