5. In the principal Regulations, after regulation 9, insert —“Service crew of adult cardiac critical care service |
9A.—(1) Despite anything in regulation 9(2), this regulation applies to an emergency ambulance service licensee that is approved to provide an adult cardiac critical care service (called in this regulation the applicable EAS licensee).(2) An applicable EAS licensee that uses or intends to use extracorporeal membrane oxygenation on any emergency patient in the course of providing the adult cardiac critical care service must ensure that each service crew deployed to an emergency ambulance used to provide the adult cardiac critical care service includes the following members:(a) | a driver who satisfies the requirements in regulation 9(2)(a); | (b) | a crew leader who is an ambulance doctor and —(i) | is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of cardiothoracic surgery; or | (ii) | is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require the use of extracorporeal membrane oxygenation; |
| (c) | a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the adult cardiac critical care service as is acceptable to the Director‑General. |
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(3) An applicable EAS licensee that uses or intends to use an intra‑aortic balloon pump on any emergency patient in the course of providing the adult cardiac critical care service must ensure that each service crew deployed to an emergency ambulance used to provide the adult cardiac critical care service includes the following members:(a) | a driver who satisfies the requirements in regulation 9(2)(a); | (b) | a crew leader who is an ambulance doctor and —(i) | is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of cardiology or cardiothoracic surgery; or | (ii) | is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require the use of an intra‑aortic balloon pump; |
| (c) | a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the adult cardiac critical care service as is acceptable to the Director‑General. |
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(4) Where a crew leader mentioned in paragraph (2)(b) or (3)(b) is a conditionally registered medical practitioner, the applicable EAS licensee must additionally comply with regulation 9(2A) and (3A). |
(5) In this regulation, “applicable acute hospital service licensee” means either of the following:(a) | the acute hospital service licensee of the acute hospital to which an emergency patient is conveyed, unless sub‑paragraph (b) applies; | (b) | where an emergency patient is conveyed from an acute hospital to another acute hospital, the acute hospital service licensee of either acute hospital. |
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Service crew of adult general critical care service |
9B.—(1) Despite anything in regulation 9(2), this regulation applies to an emergency ambulance service licensee that is approved to provide an adult general critical care service (called in this regulation the applicable EAS licensee).(2) An applicable EAS licensee must ensure that each service crew deployed to an emergency ambulance used to provide the adult general critical care service includes the following members:(a) | a driver who satisfies the requirements in regulation 9(2)(a); | (b) | a crew leader who is an ambulance doctor and —(i) | is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of anaesthesiology, cardiology, cardiothoracic surgery, emergency medicine, general surgery or intensive care medicine; | (ii) | holds —(A) | one or more valid certifications in the provision of Fundamental Critical Care Support; or | (B) | one or more valid certifications equivalent to the certification specified in sub‑paragraph (A) as is acceptable to the Director‑General; |
| (iii) | has been trained by a medical practitioner registered under section 22 of the Medical Registration Act 1997 in any branch of medicine specified in sub‑paragraph (i); or | (iv) | is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require —(A) | the use of a chest tube or mechanical ventilator, as the case may be; or | (B) | the administration of any inotrope, sedative or paralytic by continuous intravenous infusion, |
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| (c) | a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the adult general critical care service as is acceptable to the Director‑General. |
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(3) Where a crew leader mentioned in paragraph (2)(b) is a conditionally registered medical practitioner, the applicable EAS licensee must additionally comply with regulation 9(2A) and (3A). |
(4) In paragraph (2)(b), “applicable acute hospital service licensee” means either of the following:(a) | the acute hospital service licensee of the acute hospital to which an emergency patient is conveyed, unless sub‑paragraph (b) applies; | (b) | where an emergency patient is conveyed from an acute hospital to another acute hospital, the acute hospital service licensee of either acute hospital. |
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Service crew of paediatric critical care service |
9C.—(1) Despite anything in regulation 9(2), this regulation applies to an emergency ambulance service licensee that is approved to provide a paediatric critical care service (called in this regulation the applicable EAS licensee).(2) An applicable EAS licensee must ensure that each service crew deployed to an emergency ambulance used to provide the paediatric critical care service includes the following members:(a) | a driver who satisfies the requirements in regulation 9(2)(a); | (b) | a crew leader who is a fully registered medical practitioner or conditionally registered medical practitioner and —(i) | holds a valid practising certificate under the Medical Registration Act 1997; | (ii) | holds one or more valid certifications certifying competency in the provision of Advanced Paediatric Life Support; and | (iii) | satisfies any of the requirements in paragraph (3); |
| (c) | a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the paediatric critical care service as is acceptable to the Director‑General. |
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(3) The requirements mentioned in paragraph (2)(b)(iii) are the following:(a) | the fully registered medical practitioner or conditionally registered medical practitioner mentioned in paragraph (2)(b) (called in this paragraph the applicable medical practitioner) is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of anaesthesiology, emergency medicine, neonatology or paediatric intensive care; | (b) | the applicable medical practitioner holds —(i) | one or more valid certifications in the provision of Paediatric Fundamental Critical Care Support; or | (ii) | one or more valid certifications equivalent to the certification specified in sub‑paragraph (i) as is acceptable to the Director‑General; |
| (c) | the applicable medical practitioner has been trained by a medical practitioner registered under section 22 of the Medical Registration Act 1997 in any branch of medicine specified in sub‑paragraph (a); | (d) | the applicable medical practitioner is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require —(i) | the use of extracorporeal membrane oxygenation, an intra‑aortic balloon pump, a chest tube or a mechanical ventilator, as the case may be; or | (ii) | the administration of any inotrope, sedative or paralytic by continuous intravenous infusion, |
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(4) Where a crew leader mentioned in paragraph (2)(b) is a conditionally registered medical practitioner, the applicable EAS licensee must additionally comply with regulation 9(2A) and (3A). |
(5) In paragraph (3), “applicable acute hospital service licensee” means either of the following:(a) | the acute hospital service licensee of the acute hospital to which an emergency patient is conveyed, unless sub‑paragraph (b) applies; | (b) | where an emergency patient is conveyed from an acute hospital to another acute hospital, the acute hospital service licensee of either acute hospital. |
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Service crew of isolation service |
9D.—(1) This regulation applies to an emergency ambulance service licensee that is approved to provide an isolation service (called in this regulation the applicable EAS licensee).(2) Despite anything in regulation 9(2), the applicable EAS licensee must ensure that each service crew deployed to an emergency ambulance used to provide the isolation service includes the following members:(a) | a driver who satisfies the requirements in regulation 9(2)(a); | (b) | a crew leader who satisfies the requirements in regulation 9(2)(b)(i); | (c) | a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the isolation service as is acceptable to the Director‑General. |
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(3) Where a crew leader mentioned in paragraph (2)(b) is a conditionally registered medical practitioner, the applicable EAS licensee must additionally comply with regulation 9(2A) and (3A). |
(4) Without affecting regulation 9(5), the applicable EAS licensee must ensure that —(a) | each service crew member (other than the driver) deployed to an emergency ambulance used to provide that service undergoes refresher training in the proper and safe handling and use of a portable medical isolation unit at least once a year; and | (b) | accurate and complete records of all refresher training mentioned in sub‑paragraph (a) are maintained.”. |
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