# Title 33 — State Department of Health

## Article 33-36 — Emergency Medical Services Personnel

## Chapter 33-36-04 — Scope of Practice for Emergency Medical Services Professionals

### § 33-36-04-01. Definitions.

Words defined in chapter 23-27 of the North Dakota Century Code have the same meaning in this
chapter. For purposes of this chapter:
1. "Advanced emergency medical technician" means a person that has fulfilled the training,
testing, certification, and licensure process for advanced emergency medical technician as
required in chapter 33-36-01.
2. "Emergency medical technician" means a person that has fulfilled the training, testing,
certification, and licensure process for emergency medical technician as required in chapter
33-36-01.
3. "Emergency medical technician-intermediate/85" means a person that has fulfilled the training,
testing, certification, and licensure process for emergency medical technician-intermediate/85
as required in chapter 33-36-01.
4. "Emergency medical technician-intermediate/99" means a person that has fulfilled the training,
testing, certification, and licensure process for emergency medical technician-intermediate/99
as required in chapter 33-36-01.
5. "Paramedic" means a person that has fulfilled the training, testing, certification, and licensure
process for paramedic as required in chapter 33-36-01.
6. "Primary care provider" means a qualified individual responsible for the care of the patient and
supervision of all ambulance personnel while on the ambulance run.
History: Effective January 1, 2008; amended effective July 1, 2010.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
### § 33-36-04-02. Scopes of practice.

Each level of emergency medical services professional has a scope of practice that includes the
scopes of practice of all subordinate emergency medical services professionals and the scopes of all
emergency medical services providers listed in chapter 33-36-03. The hierarchy of emergency medical
services professionals is listed sequentially in this section.
1. Emergency medical technician.
a. Scope. The emergency medical technician's core scope of practice includes basic,
noninvasive interventions to reduce the morbidity and mortality associated with acute
out-of-hospital medical and traumatic emergencies. Emergency care is based on
assessment findings. An emergency medical technician is not prepared to make
decisions independently regarding the appropriate disposition of patients. The
emergency medical technician may make destination decisions in collaboration with
medical oversight. The principal disposition of the patient encounter will result in the
direct delivery of the patient to an acute care facility. The primary differences between an
advanced first-aid ambulance attendant and emergency medical technician are the

educational and testing requirements required for licensure as an emergency medical
technician.
b. Curriculum. The educational requirements include successful completion of a
state-authorized emergency medical technician training program and continued
educational requirements as defined in chapter 33-36-01.
c. Scope enhancements. Emergency medical technicians may provide enhanced
treatments beyond the core scope if they have completed training as defined in section
d. Skills. Specific skills for the emergency medical technician are defined by the
department. Local medical directors may limit the specific skills that an emergency
medical technician may provide and they may not exceed those specific skills defined by
the department.
e. Occupational setting. Emergency medical technicians may participate in the emergency
medical services system as a sole responder in a quick response unit, as the primary
care provider of a basic life support air or ground ambulance service, or as part of the
crew of an advanced life support air or ground ambulance service. Emergency medical
technicians may also provide services to a private company or organization as part of a
response team that is not offered to the general public.
f. Medical oversight. An emergency medical technician provides medical care with
physician oversight. A physician credentials the emergency medical technician and
establishes patient care standards through protocol.
g. Supervision. An emergency medical technician may be the highest trained person on a
quick response unit and as the primary care provider may supervise other emergency
medical technicians, emergency medical responders, or drivers. As part of a basic life
support ambulance crew, an emergency medical technician may supervise subordinate
emergency medical services personnel. As part of an advanced life support ambulance
service, an emergency medical technician is supervised by a paramedic.
2. Emergency medical technician-intermediate/85.
a. Scope. The scope of practice of an emergency medical technician-intermediate/85
includes basic, limited advanced interventions to reduce the morbidity and mortality
associated with acute out-of-hospital medical and traumatic emergencies. Emergency
care is based on assessment findings. An emergency medical technician-intermediate/85
is not prepared to make decisions independently regarding the appropriate disposition of
patients. The emergency medical technician-intermediate/85 may make destination
decisions in collaboration with medical oversight. The principal disposition of the patient
encounter will result in the direct delivery of the patient to an acute care facility. The
primary differences between an emergency medical technician and emergency medical
technician-intermediate/85 are the basic, limited advanced interventions that an
emergency medical technician-intermediate/85 may provide.
b. Curriculum. The core educational requirements include successful completion of a
state-authorized emergency medical technician-intermediate/85 training program and
continued educational requirements as defined in chapter 33-36-01.
c. Scope enhancements. Emergency medical technicians-intermediate/85 may provide
enhanced treatments beyond the core scope if they have completed training as defined
in section 33-36-01-04 and have the authorization to perform those skills from their
medical director.

d. Skills. Specific skills for the emergency medical technician-intermediate/85 are defined
by department policy. Local medical directors, or hospitals if working in the hospital
setting may limit the specific skills that an emergency medical technician-intermediate/85
may provide. They may not exceed those specific skills defined by department policy.
e. Occupational setting. Emergency medical technicians-intermediate/85 may participate in
the emergency medical services system as a sole responder in a quick response unit, as
the primary care provider of a basic life support air or ground ambulance service, or as
part of the crew of an advanced life support air or ground ambulance service. Emergency
medical technicians-intermediate/85 may work for a hospital in a nonemergency setting
or provide services to a private company or organization as part of a response team that
is not offered to the general public.
f. Medical oversight. An emergency medical technician-intermediate/85 working in a
prehospital setting provides medical care with physician oversight. In this circumstance a
physician credentials the emergency medical technician-intermediate/85 and establishes
patient care standards through protocol. An emergency medical
technician-intermediate/85 working in a hospital setting is credentialed by the hospital.
g. Supervision. An emergency medical technician-intermediate/85 may be the highest
trained person on a quick response unit and as the primary care provider may supervise
other emergency medical technicians-intermediate/85, emergency medical technicians,
first responders, or drivers. As part of a basic life support ambulance crew, an emergency
medical technician-intermediate/85 may supervise subordinate emergency medical
services personnel. As part of an advanced life support ambulance service an
emergency medical technician-intermediate/85 is supervised by a paramedic.
Emergency medical technicians-intermediate/85 working in a hospital setting are
supervised by nursing staff.
3. Advanced emergency medical technician.
a. Scope. The advanced emergency medical technician's scope of practice includes basic,
limited advanced interventions to reduce the morbidity and mortality associated with
acute out-of-hospital medical and traumatic emergencies. Emergency care is based on
assessment findings. An advanced emergency medical technician is not prepared to
make decisions independently regarding the appropriate disposition of patients. The
advanced emergency medical technician may make destination decisions in
collaboration with medical oversight. The principal disposition of the patient encounter will
result in the direct delivery of the patient to an acute care facility. The primary differences
between an emergency medical technician and advanced emergency medical technician
are the basic, limited advanced interventions that an advanced emergency medical
technician may provide.
b. Curriculum. The core educational requirements include successful completion of a
state-authorized advanced emergency medical technician training program and
continued educational requirements as defined in chapter 33-36-01.
c. Skills. Specific skills for the advanced emergency medical technician are defined by
department policy. Local medical directors, or hospitals if working in the hospital setting,
may limit the specific skills that an advanced emergency medical technician may provide.
They may not exceed those specific skills defined by department policy.
d. Occupational setting. Advanced emergency medical technicians may participate in the
emergency medical services system as a sole responder in a quick response unit, as the
primary care provider of a basic life support air or ground ambulance service, or as part
of the crew of an advanced life support air or ground ambulance service. Advanced

emergency medical technicians may work for a hospital in a nonemergency setting or
provide services to a private company or organization as part of a response team that is
not offered to the general public.
e. Medical oversight. An advanced emergency medical technician working in a prehospital
setting provides medical care with physician oversight. In this circumstance, a physician
credentials the advanced emergency medical technician and establishes patient care
standards through protocol. An advanced emergency medical technician working in a
hospital setting is credentialed by the hospital.
f. Supervision. An advanced emergency medical technician may be the highest trained
person on a quick response unit and as the primary care provider may supervise other
advanced emergency medical technicians, emergency medical technicians, first
responders, or drivers. As part of a basic life support ambulance crew, an advanced
emergency medical technician may supervise subordinate emergency medical services
personnel. As part of an advanced life support ambulance service an advanced
emergency medical technician is supervised by a paramedic. Emergency medical
technicians working in a hospital setting are supervised by nursing staff.
4. Emergency medical technician-intermediate/99.
a. Scope. The scope of practice of an emergency medical technician-intermediate/99
includes basic, limited advanced and pharmacological interventions to reduce the
morbidity and mortality associated with acute out-of-hospital medical and traumatic
emergencies. Emergency care is based on assessment findings. An emergency medical
technician-intermediate/99 is not prepared to make decisions independently regarding
the appropriate disposition of patients. The emergency medical
technician-intermediate/99 may make destination decisions in collaboration with medical
oversight. The principal disposition of the patient encounter will result in the direct
delivery of the patient to an acute care facility. The primary differences between an
emergency medical technician-intermediate/85 and emergency medical
technician-intermediate/99 are the limited pharmacological interventions that an
emergency medical technician-intermediate/99 may provide.
b. Curriculum. The core educational requirements include successful completion of a
state-authorized emergency medical technician-intermediate/99 training program and
continued educational requirements as defined in chapter 33-36-01.
c. Scope enhancements. Emergency medical technicians-intermediate/99 may provide
enhanced treatments beyond the core scope if they have completed training as defined
in section 33-36-01-04 and have the authorization to perform those skills from their
medical director.
d. Skills. Specific skills for the emergency medical technician-intermediate/99 are defined
by department policy. Local medical directors, or hospitals if working in the hospital
setting, may limit the specific skills that an emergency medical technician-intermediate/99
may provide. They may not exceed those specific skills defined by department policy.
e. Occupational setting. Emergency medical technicians-intermediate/99 may participate in
the emergency medical services system as a sole responder in a quick response unit, as
the primary care provider of a basic life support air or ground ambulance service, or as
part of the crew of an advanced life support air or ground ambulance service. Emergency
medical technicians-intermediate/99 may work for a hospital in a nonemergency setting
or provide services to a private company or organization as part of a response team that
is not offered to the general public.

f. Medical oversight. An emergency medical technician-intermediate/99 working in a
prehospital setting provides medical care with physician oversight. In this circumstance a
physician credentials the emergency medical technician-intermediate/99 and establishes
patient care standards through protocol. An emergency medical
technician-intermediate/99 working in a hospital setting is credentialed by the hospital.
g. Supervision. An emergency medical technician-intermediate '99 may be the highest
trained person on a quick response unit and as the primary care provider may supervise
other emergency medical technicians-intermediate/99, emergency medical
technicians-intermediate/85, emergency medical technicians, emergency medical
responders, or drivers. As part of a basic life support ambulance crew, an emergency
medical technician-intermediate/99 may supervise subordinate emergency medical
services personnel. As part of an advanced life support ambulance service an
emergency medical technician-intermediate/99 is supervised by a paramedic.
Emergency medical technicians-intermediate/99 working in a hospital setting are
supervised by nursing staff.
5. Paramedic.
a. Scope. The paramedic's scope of practice includes invasive and pharmacological
interventions to reduce the morbidity and mortality associated with acute out-of-hospital
medical and traumatic emergencies. Emergency care is based on an advanced
assessment and the formulation of a field impression. The paramedic may make
destination decisions in collaboration with medical oversight. The principal disposition of
the patient encounter will result in the direct delivery of the patient to an acute care
facility. The major difference between the paramedic and the emergency medical
technician-intermediate/99 is the ability to perform a broader range of advanced skills.
These skills carry a greater risk for the patient if improperly or inappropriately performed,
are more difficult to attain and maintain competency in, and require significant
background knowledge in basic and applied sciences.
b. Curriculum. The core educational requirements include successful completion of a
state-authorized paramedic training program and continued educational requirements as
defined in chapter 33-36-01.
c. Skills. Specific skills for the paramedic are defined by department policy. Local medical
directors, or hospitals if working in the hospital setting, may limit the specific skills that a
paramedic may provide and they may not exceed those specific skills defined by
department policy.
d. Occupational setting. Paramedics may participate in the emergency medical services
system as a sole responder in a quick response unit, as the primary care provider of a
basic life support air or ground ambulance service, as the primary care provider of an
advanced life support air or ground ambulance service, or as the primary care provider of
a critical care air ambulance service. Paramedics may work for a hospital in an
emergency or nonemergency setting or provide services to a private company or
organization as part of a response team that is not offered to the general public.
e. Medical oversight. A paramedic working in a prehospital setting provides medical care
with physician oversight. In this circumstance a physician credentials the paramedic and
establishes patient care standards through protocol. A paramedic employed by and
working in a hospital setting is credentialed by the hospital.
f. Supervision. A paramedic may supervise all subordinate levels of emergency medical
services personnel. Paramedics working in a hospital setting are supervised by the
hospital's nurse executive.

History: Effective January 1, 2008; amended effective July 1, 2010.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
