# Title 33 — State Department of Health

## Article 33-11 — Licensing of Emergency Medical Services

## Chapter 33-11-07 — Critical Care Air Ambulance License

### § 33-11-07-01. Training standards for care providers.

Both care providers shall be critical care providers as listed in subsection 3 of section
33-11-01.2-12.
History: Effective January 1, 2006; amended effective April 1, 2009; July 1, 2010; April 1, 2024.
General Authority: NDCC 23-27-04
Law Implemented: NDCC 23-27-04
### § 33-11-07-02. Minimum equipment requirements.

In addition to an aircraft as described in subsection 3 of section 33-11-04-01, the air ambulance
shall have the following, unless otherwise approved by the department:
1. Patient litter or stretcher for patient transport.
2. Spinal immobilization:
a. One pediatric-safe transport device.
b. One adult cervical collar.
c. One pediatric cervical collar.
3. Oxygen delivery:
a. An onboard oxygen system, with the following:
(1) Cylinders with a capacity of one thousand two hundred liters.
(2) The cylinders must have at least one thousand six hundred fifty pounds per square
inch [11376.35 kilopascals] at the time of inspection.
(3) A flow meter with a range of zero to twenty-five liters per minute delivery.
b. Two D size oxygen cylinders or one D size oxygen cylinder and an onboard system
capable of providing, at a minimum, an additional four hundred fifteen liters of oxygen.
c. Nonsparking wrench or tank opening device.
d. Gauge or flow meter not gravity dependent and can deliver between zero and twenty-five
liters per minute.
e. Three adult nasal cannulas.
f. Three pediatric nasal cannulas.
g. Three adult nonrebreather oxygen masks.
h. Three pediatric nonrebreather oxygen masks.

i. Three sets of oxygen supply tubing.
j. Noninvasive positive pressure ventilation device.
k. Nebulizer with tubing.
l. End-tidal carbon dioxide detectors with pediatric and adult capability.
m. Multifunction mechanical ventilator.
4. Suction:
a. Portable suction unit with wide-bore tubing that is capable of achieving a minimum of
three hundred millimeters of mercury vacuum within four seconds or less after clamping
the suction tube or an aircraft suction system meeting the same or similar performance
standards and a portable manual suction device.
b. One rigid tonsil tip suction catheter.
c. One flexible suction catheter between size six and ten french.
d. One flexible suction catheter between twelve and sixteen french.
5. Airway adjuncts:
a. One set of adult sizes nasopharyngeal airways.
b. One set of pediatric sizes nasopharyngeal airways.
c. One set of adult sizes oropharyngeal airways.
d. One set of child sizes oropharyngeal airways.
e. One set of infant sizes oropharyngeal airways.
f. Alternative airway devices such as a supraglottic airway as approved by local medical
direction.
g. Adult endotracheal airway equipment.
h. Pediatric endotracheal airway equipment.
i. One size zero straight laryngoscope blade.
j. One size one straight laryngoscope blade.
k. One size two straight laryngoscope blade.
l. One size three or four straight laryngoscope blade.
m. One size two curved laryngoscope blade.
n. One size three or four curved laryngoscope blade.
o. One adult stylette.
p. One pediatric stylette.
q. One pair of adult Magill forceps.

r. One pair of pediatric Magill forceps.
s. One adult laryngoscope handle with extra batteries.
t. One pediatric laryngoscope handle with extra batteries.
6. Bag valve masks:
a. One adult bag valve mask resuscitation unit with face mask.
b. One child bag valve mask resuscitation unit with face mask.
c. One infant bag valve mask resuscitation unit with face mask.
7. One pelvic stabilization device for splinting.
8. Environmental:
a. Four cold packs.
b. Four hot packs.
9. Bandaging and bleeding control:
a. Two sterile burn sheets or equivalent.
b. Three triangular bandages or commercial slings.
c. Two trauma dressings approximately ten by thirty-six inches [25.4 by 91.44 centimeters].
d. Twenty-five sterile gauze pads approximately four by four inches [10.16 by 10.16
centimeters].
e. Twelve soft roller self-adhering type bandages approximately five yards [4.57 meters]
long.
f. Two sterile occlusive dressings approximately three by nine inches [76.2 by 228.6
millimeters].
g. Two commercial tactical tourniquets.
10. Diagnostic:
a. Manual cardiac monitor defibrillator with transcutaneous pacing, waveform capnography,
and pediatric capabilities.
b. Monitor electrocardiogram paper rolls.
c. Monitor electrodes.
d. Adult defibrillator pads.
e. Pediatric defibrillator pads.
f. Adult blood pressure cuff.
g. Large adult blood pressure cuff.
h. Child blood pressure cuff.

i. Stethoscope.
j. Pulse oximeter.
k. Glucose measuring device.
l. Penlight.
m. Thermometer.
11. Medication delivery:
a. Four of each size and individually wrapped and sterile hypodermic needles size sixteen
to eighteen gauge, twenty to twenty-two gauge, twenty-three to twenty-five gauge, and
two hypodermic needles of assorted sizes, including at least one with a one milliliter
volume.
b. Intravenous therapy equipment, including venous restriction device, micro and macro
drip administration sets, catheters size sixteen gauge to twenty-four gauge, intraosseous
needles, tubing, solutions, and intravenous arm boards for both pediatric and adult
patients, as approved by local medical direction.
c. Two three and one-quarter inch [8.26 centimeters] over the needle catheter in ten,
twelve, or fourteen gauge.
d. Three intravenous infusion pumps or one multichannel unit capable of managing three
simultaneous infusions.
e. Two intravenous bag holders with straps.
12. Medications:
a. Alkanilizing agent.
b. Anxiolytic.
c. Anticholinergen parasympatholytic.
d. Anticonvulsants.
e. Antidysrhythmic/antiarrhythmic.
f. Antiemetic.
g. Antihistamine.
h. One small bottle of chewable aspirin.
i. Adrenergic intravenous or subcutaneous bronchodilator or sympathomimetic.
j. Adult and pediatric doses of epinephrine administered through an autoinjector or
intramuscular, if approved by medical director. If epinephrine is administered
intramuscular the air ambulance shall have syringes and needles for intramuscular
delivery.
k. Bronchodilator for nebulized delivery.
l. Dextrose containing solution.

m. Coronary vasodilator, antianginal.
n. Corticosteroid or glucocorticoid.
o. Opioid antagonist.
p. Analgesic.
q. Other medications may be carried as approved by the medical director.
13. Personal protective equipment:
a. Personal infection control kit, which includes the following:
(1) Eye protection, clear, and disposable for each crew member.
(2) Gown or coat for each crew member.
(3) Disposable surgical cap and foot coverings, for each crew member.
(4) Exam gloves for each crew member.
(5) Sharps containers and red bags per infectious control plan.
(6) N95 respirator for each crew member.
(7) Hand disinfectant for each crew member.
(8) Ten alcohol sponges.
14. Two liters of sterile water or normal saline.
15. Safety:
a. For rotor-wing aircraft, flight helmet with built-in communication for each crew member.
b. One survival bag.
c. One fully charged fire extinguisher rated at least 5 B:C securely mounted where it can be
reached by the pilot or crew members. The fire extinguisher must be intact with safety
seal, have been inspected within the previous twelve calendar months, and have the
appropriate inspection tag attached.
16. Communications:
a. Two-way radio communications for the pilot to be able to communicate with hospitals,
public safety answering points, and ground ambulances in areas to which the air
ambulance routinely provides service.
b. For fixed-wing aircraft, at least one headset per crew member with built-in
communication among the crew when the aircraft is operating and noise levels prevent
normal conversation.
17. Other:
a. Four assorted rolls of adhesive tape, with at least one hypoallergenic roll.
b. One bandage shears.

c. Pediatric length-based drug dosing and equipment sizing tape, most current version
available.
d. One sterile obstetrical kit.
e. One separate sterile bulb syringe.
f. One silver swaddler sterile thermal blanket or one roll of sterile aluminum foil for use on
infants and newborns.
g. Appropriate patient coverings capable of maintaining body temperature based on
anticipated weather conditions.
h. Two sterile water-soluble lubrication, two cubic centimeter or larger tubes.
i. Copy of most current version of agency protocols, as approved by medical director.
History: Effective January 1, 2006; amended effective April 1, 2024.
General Authority: NDCC 23-27-04
Law Implemented: NDCC 23-27-04
### § 33-11-07-03. Advertising restrictions.

No air ambulance service may advertise itself as a critical care air ambulance service unless it has
been issued a critical care air ambulance license by the department.
History: Effective January 1, 2006.
General Authority: NDCC 23-27-04
Law Implemented: NDCC 23-27-04
