# Title 33 — State Department of Health

## Article 33-36 — Emergency Medical Services Personnel

## Chapter 33-36-01 — Emergency Medical Services Personnel Training, Testing, Certification, and Licensure

Services Personnel
Course Graduates [Repealed]
Courses [Repealed]
[Repealed]
### § 33-36-01-01. Definitions.

Words defined in North Dakota Century Code chapter 23-27 have the same meaning in this
chapter.
1. "Advanced emergency medical technician" means an individual certified by the national
registry as an advanced emergency medical technician. An advanced emergency medical
technician is eligible for licensure as an advanced emergency medical technician upon
completion of a license application and approval by the department.
2. "Cardiopulmonary resuscitation", initial and refresher, means the American heart association
health care provider standards or its equivalent which includes the following skills: adult
one-person and two-person cardiopulmonary resuscitation, adult obstructed airway, child
one-person and two-person cardiopulmonary resuscitation, child obstructed airway, infant
one-person and two-person cardiopulmonary resuscitation, infant obstructed airway, and
automated external defibrillator.
3. "Clinical and field internship preceptor" means a qualified individual designated by an
emergency medical services instructor or emergency medical services training institute to
supervise a student during clinical or field internship training.
4. "Department" means the department of health and human services.
5. "Emergency medical services instructor" means an individual who is licensed to conduct
emergency medical services courses, including continuing education courses.

6. "Emergency medical technician" means an individual certified by the national registry as an
emergency medical technician. An emergency medical technician is eligible for licensure as an
emergency medical technician upon completion of a license application and approval by the
department.
7. "Equivalent" means training of equal or greater value which accomplishes the same results.
8. "National registry" means the national registry of emergency medical technicians located in
Columbus, Ohio.
9. "On call" means that an individual is expected to be available for emergency response when
alerted by a method determined by the public safety answering point or dispatch center and
report after notification.
History: Effective April 1, 1992; amended effective August 1, 2003; January 1, 2006; January 1, 2008;
July 1, 2010; April 1, 2024.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
### § 33-36-01-02. Emergency medical services training courses.

The department acknowledges the following emergency medical services courses and personnel:
1. Courses leading to national registry certification:
a. Emergency medical responder;
b. Emergency medical technician;
c. Advanced emergency medical technician; and
d. Paramedic.
2. Courses requiring current department licensure that provide supplementary qualifications by
the department:
a. Emergency medical services instructor;
b. Community emergency medical technician;
c. Community advanced emergency medical technician; and
d. Community paramedic.
History: Effective April 1, 1992; amended effective October 1, 1992; August 1, 1994; August 1, 2003;
August 1, 2004; January 1, 2006; January 1, 2008; July 1, 2010; April 1, 2024.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
### § 33-36-01-03. Training, testing, certification, and licensure standards for emergency medical

services personnel.
The department shall authorize all courses leading to approval, certification, or licensure by the
department prior to the course being conducted in North Dakota contingent upon the course being
offered by a licensed emergency medical services training institute and on the following requirements:
1. Emergency medical responder:

a. Course. A course conducted in North Dakota must adhere to the national emergency
medical services education standards for emergency medical responders as published
by the United States department of transportation, national highway traffic safety
administration. Prior to student eligibility for certification by the national registry,
competency in the required knowledge and skills must be verified by a North Dakota
emergency medical services instructor or North Dakota licensed emergency medical
services training institute.
b. Course instructors. Course instructors must be approved by the licensed emergency
medical services training institute and be knowledgeable in course content, effective in
teaching their assigned subjects, and capable through academic preparation, training,
and experience to teach courses or topics to which they are assigned.
c. An emergency medical responder student may practice all the skills defined in the scope
of practice for emergency medical responder while in the classroom and during a clinical
or field internship while under direct supervision of an instructor or clinical and field
internship preceptor and if registered with the department as an emergency medical
responder student.
d. Initial certification. Individuals sixteen years of age and older who are certified as an
emergency medical responder by the national registry are eligible for certification by the
department. Upon completion and department approval of an application, eligible
applicants may be certified by the department for a two-year period until June thirtieth of
the second year.
e. Recertification. An individual that maintains certification from the national registry is
eligible for recertification. Upon completion and approval of an application, eligible
applicants may be recertified by the department for a two-year period until June thirtieth
of the second year.
f. Individuals certified as emergency medical responders as of January 1, 2024, and those
attending emergency medical responder courses approved before January 1, 2024, and
certified by June 30, 2024, will not be required to obtain national registry certification.
(1) Prior to student eligibility for initial certification by the department under the
conditions identified in this subdivision, competency in the required knowledge and
skills must be verified by a North Dakota emergency medical services instructor or
North Dakota licensed emergency medical services training institute.
(2) Prior to eligibility for recertification by the department under the conditions identified
in this subdivision, individuals must complete recertification requirements equivalent
to those required by the national registry.
2. Emergency medical technician:
a. Course. A course conducted in North Dakota must adhere to the national emergency
medical services education standards for emergency medical technicians as published
by the United States department of transportation, national highway traffic safety
administration. Prior to student eligibility for certification by the national registry,
competency in the required knowledge and skills must be verified by a North Dakota
emergency medical services instructor or North Dakota licensed emergency medical
services training institute.
b. Course instructors. Course instructors must be approved by the licensed emergency
medical services training institute and be knowledgeable in course content, effective in

teaching their assigned subjects, and capable through academic preparation, training,
and experience to teach courses or topics to which they are assigned.
c. An emergency medical technician student may practice all the skills defined in the scope
of practice for emergency medical technician while in the classroom and during a clinical
or field internship while under direct supervision of an instructor or the clinical and field
internship preceptor and if registered with the department as an emergency medical
technician student.
d. Emergency medical technician initial licensure. Individuals sixteen years of age and older
who are certified as emergency medical technicians by the national registry are eligible
for licensure. Upon completion and department approval of a license application, eligible
applicants may be licensed by the department. The applicant must be affiliated with a
North Dakota licensed emergency medical services operation or obtain medical direction
from a North Dakota licensed physician. Licensure will expire ninety days after the
national registry emergency medical technician expiration date.
e. Relicensure of emergency medical technicians. An individual that maintains certification
from the national registry as an emergency medical technician is eligible for relicensure.
Upon completion and approval of a license application, eligible applicants may be
relicensed by the department. The applicant must be affiliated with a North Dakota
licensed emergency medical services operation or obtain medical direction from a North
Dakota licensed physician. Licensure will expire ninety days after the national registry
expiration date.
3. Advanced emergency medical technician:
a. Student prerequisite. Students must be certified as an emergency medical technician by
the national registry or licensed as an emergency medical technician or its equivalent.
b. Course. The course must adhere to the national emergency medical services education
standards for advanced emergency medical technicians as published by the United
States department of transportation, national highway traffic safety administration. Prior
to student eligibility for certification by the national registry, competency in the required
knowledge and skills must be verified by a North Dakota emergency medical services
instructor or North Dakota licensed emergency medical services training institute.
c. An advanced emergency medical technician student may practice all the skills defined in
the scope of practice for advanced emergency medical technician while in the classroom
and during a clinical or field internship while under direct supervision of an instructor or
clinical and field internship preceptor and if registered with the department as an
advanced emergency medical technician student.
d. Advanced emergency medical technician initial licensure. An individual eighteen years of
age or older who is certified as an advanced emergency medical technician by the
national registry is eligible for licensure. Upon completion and department approval of a
license application, eligible applicants may be licensed by the department. The applicant
must be affiliated with a North Dakota licensed emergency medical services operation or
obtain medical direction from a North Dakota licensed physician. Licensure will expire
ninety days after the national registry advanced emergency medical technician expiration
date.
e. Relicensure of advanced emergency medical technician. An individual that maintains
certification from the national registry as an advanced emergency medical technician is
eligible for relicensure. Upon completion and approval of a license application, eligible
applicants may be relicensed by the department. The applicant must be affiliated with a

North Dakota licensed emergency medical services operation or obtain medical direction
from a North Dakota licensed physician. Licensure will expire ninety days after the
national registry advanced emergency medical technician expiration date.
4. Paramedic:
a. Student prerequisite. Students must be certified at minimum as an emergency medical
technician or licensed at minimum as an emergency medical technician or its equivalent.
b. Course. The course must adhere to the national emergency medical services education
standards for paramedics as published by the United States department of
transportation, national highway traffic safety administration and be conducted by a
commission on accreditation of allied education programs accredited paramedic
education program.
c. A paramedic student may practice all the skills defined in the scope of practice for
paramedic while in the classroom and during a clinical or field internship while under
direct supervision of an instructor or clinical and field internship preceptor and if
registered with the department as a paramedic student.
d. Paramedic initial licensure. An individual eighteen years of age or older who is certified
as a paramedic by the national registry is eligible for licensure. Upon completion and
department approval of a licensed application, eligible applicants may be licensed by the
department. The applicant must be affiliated with a North Dakota licensed emergency
medical services operation or obtain medical direction from a North Dakota licensed
physician. Licensure will expire ninety days after the national registry paramedic
expiration date.
e. Relicensure of paramedic. An individual that maintains certification from the national
registry as a paramedic is eligible for relicensure. Upon completion and approval of a
license application, eligible applicants may be relicensed by the department. The
applicant must be affiliated with a North Dakota licensed emergency medical services
operation or obtain medical direction from a North Dakota licensed physician. Licensure
will expire ninety days after the national registry paramedic expiration date.
5. Emergency medical services instructor:
a. Student prerequisite. A candidate for certification as an emergency medical services
instructor must be at least eighteen years of age and licensed for at least two years as an
emergency medical technician, advanced emergency medical technician, or paramedic.
b. Course. The course must be approved by the department.
c. Initial certification. The department shall issue initial certification to individuals who have
successfully completed an approved course and meet the prerequisites. Individuals
possessing a bachelor's degree in education, a teacher's certification in education, a
master's degree or doctorate and meeting the student prerequisites are eligible for initial
certification upon application to the department. Emergency medical services instructor
certification is concurrent with emergency medical services licensure.
d. Recertification. The department may recertify as emergency medical services instructors
those individuals who maintain emergency medical services licensure and:
(1) Are employed or affiliated with a licensed emergency medical services training
institution and submit documentation of eight hours of adult instructional education
approved by the licensed emergency medical services training institute; and

(2) Instruct or coordinate a minimum of one authorized emergency medical responder,
emergency medical technician, advanced emergency medical technician, or
paramedic education program every two years.
6. Community emergency medical technician:
a. The department shall certify as a community emergency medical technician an individual
who meets the following qualifications:
(1) Has a current license as an emergency medical technician issued by the
department.
(2) Has two years of service as an emergency medical technician.
(3) Has successfully completed a community emergency medical technician education
program from a college or university that has been approved by the department or
accredited by a department approved accreditation organization. The education
program must include clinical experience that is provided under the supervision of a
physician, advanced practice registered nurse, physician assistant, or public health
nurse operating under the direct authority of a local unit of government.
b. A community emergency medical technician shall practice in accordance with protocols
and standards established by a medical director and provide services as directed by a
patient care plan developed by a patient's primary or specialty care physician, advanced
practice registered nurse, or physician assistant. In the absence of a primary or specialty
care provider, the patient care plan may be directed by the medical director.
c. A community emergency medical technician must be employed by a licensed ground
ambulance or licensed hospital.
d. In addition to the relicensure requirements in subdivision e of subsection 2, a community
emergency medical technician shall complete an additional twelve hours of continuing
education in clinical topics approved by the medical director.
e. No individual shall hold themself out as a community emergency medical technician or
provide the services of a community emergency medical technician unless such
individual is certified by the department.
7. Community advanced emergency medical technician:
a. The department shall certify as a community advanced emergency medical technician an
individual who meets the following qualifications:
(1) Has a current license as an advanced emergency medical technician issued by the
department.
(2) Has two years of service as an advanced emergency medical technician.
(3) Has successfully completed a community advanced emergency medical technician
education program from a college or university that has been approved by the
department or accredited by a department approved accreditation organization. The
education program must include clinical experience that is provided under the
supervision of a physician, advanced practice registered nurse, physician assistant,
or public health nurse operating under the direct authority of a local unit of
government.

b. A community advanced emergency medical technician shall practice in accordance with
protocols and standards established by a medical director and provide services as
directed by a patient care plan developed by a patient's primary or specialty care
physician, advanced practice registered nurse, or physician assistant. In the absence of
a primary or specialty care provider, the patient care plan may be directed by the medical
director.
c. A community advanced emergency medical technician must be employed by a licensed
ground ambulance or licensed hospital.
d. In addition to the relicensure requirements in subdivision e of subsection 3, a community
advanced emergency medical technician shall complete an additional twelve hours of
continuing education in clinical topics approved by the medical director.
e. No individual shall hold themself out as an community advanced emergency medical
technician or provide the services of an community advanced emergency medical
technician unless such individual is certified by the department.
8. Community paramedic:
a. The department shall certify as a community paramedic an individual who meets the
following qualifications:
(1) Has a current license as a paramedic issued by the department.
(2) Has two years of service as a paramedic.
(3) Has successfully completed a community paramedic education program from a
college or university that has been approved by the department or accredited by a
department approved accreditation organization. The education program must
include clinical experience that is provided under the supervision of a physician,
advanced practice registered nurse, physician assistant, or public health nurse
operating under the direct authority of a local unit of government.
b. A community paramedic shall practice in accordance with protocols and standards
established by a medical director and provide services as directed by a patient care plan
developed by a patient's primary or specialty care physician, advanced practice
registered nurse, or physician assistant. In the absence of a primary or specialty care
provider, the patient care plan may be directed by the medical director.
c. A community paramedic must be employed by a licensed ground ambulance or licensed
hospital.
d. In addition to the relicensure requirements in subdivision e of subsection 4, a community
paramedic shall complete an additional eighteen hours of continuing education in clinical
topics approved by the medical director.
e. No individual shall hold themself out as a community paramedic or provide the services
of a community paramedic unless such individual is certified by the department.
9. Emergency medical dispatch. An individual authorized to provide prearrival emergency
medical instructions for a public safety answering point shall satisfactorily complete an
emergency medical dispatch course of instruction approved by the department. A certificate
indicating satisfactory completion of the emergency medical dispatch course of instruction
must be submitted to the department by the public safety answering point prior to the
individual providing prearrival emergency medical instructions for a public safety answering
point.

History: Effective April 1, 1992; amended effective August 1, 1994; August 1, 2003; January 1, 2006;
January 1, 2008; July 1, 2010; April 1, 2024.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
### § 33-36-01-03.1. Limited temporary certification or licensure of emergency medical services

training course graduates.
Repealed effective April 1, 2024.
### § 33-36-01-03.2. Continuing education.

An entity or individual that offers continuing education shall follow the continuing education policy
as published in the department's emergency medical services instructor handbook.
History: Effective July 1, 2010; amended effective April 1, 2024.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
### § 33-36-01-04. Training, testing, and certification standards for certification scope

enhancement courses.
Repealed effective April 1, 2024.
### § 33-36-01-04.1. Training, testing, and certification standards for certification refresher

courses.
Repealed effective April 1, 2024.
### § 33-36-01-05. Denial, suspension, or revocation of certification or licensure.

The department may deny, suspend, or revoke the certification or licensure of an individual who:
1. Has misrepresented to others that the individual is a physician, nurse, or health care provider
other than the highest level for which they are certified or licensed.
2. Is incapable of properly performing the skills for which the individual has been certified or
licensed.
3. Performs a skill which exceeds those allowed by the individual's level of certification or
licensure.
4. Is under indictment for or has been convicted of a misdemeanor or felony which has a direct
bearing upon the individual's ability to serve the public in a capacity certified or licensed by
this chapter, or has been convicted of a crime that requires the individual to register as a sex
offender in any state. Individuals certified or licensed who are under indictment for or have
been convicted of a misdemeanor or felony or required to register as a sex offender in any
state must report the information to the department within two business days.
5. Has been found by a court of law to be mentally incompetent.
6. Failure to follow examination policies as a student, instructor, or course coordinator.
7. Diversion of drugs for personal or unauthorized use.
8. Performance of care in a manner inconsistent with acceptable standards or protocols.

9. Has attempted to obtain by fraud or deceit a certification or license or has submitted to the
department any information that is fraudulent, deceitful, or false.
10. Has had the individual's national registry or other health care certification or license
encumbered for any reason. Individuals certified or licensed as described in this chapter must
report any encumbrance of their national registry or other health care certification or licensure
to the department within two business days.
11. Has misrepresented to others that the individual is an employee, volunteer, or agent of an
ambulance service, quick response unit, or rescue squad to offer emergency medical
services.
12. Unprofessional conduct, which may give a negative impression of the emergency medical
services system to the public.
13. As an instructor has failed to have emergency medical services training authorized as required
or has not met required education standards.
14. Providing emergency medical or community emergency medical technician, community
advanced emergency medical technician, or community paramedic services without
authorization from a physician.
15. Has been found to be under the influence of alcohol or mind-altering drugs while on call, on
duty, or during an emergency medical or community emergency medical technician,
community advanced emergency medical technician, or community paramedic response or
interfacility transfer.
16. Failing to respond to an emergency while on call or on duty. The failure to respond must be
caused by the individual's willful disregard and not caused by a good-faith error or
circumstances beyond the individual's control as determined by the department.
History: Effective April 1, 1992; amended effective August 1, 2003; January 1, 2006; January 1, 2008;
July 1, 2010; April 1, 2024.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
### § 33-36-01-05.1. Criminal history background checks.

The department may perform criminal history background checks on any applicant requesting a
certification or license or an individual requesting to be listed on an ambulance service or quick
response unit's roster as a driver. A driver may be denied participation in any emergency medical
services operation based on the driver's criminal background history or any occurrence listed in section
33-36-01-05.
History: Effective January 1, 2008; amended effective April 1, 2024.
General Authority: NDCC 12-60-24, 23-27-04.3
Law Implemented: NDCC 12-60-24, 23-27-04.3
### § 33-36-01-06. Revocation process.

The department may revoke an individual's certification or license after making a diligent effort to:
1. Inform the individual by the department of the allegations.
2. Inform the individual of the department's investigation results.
3. Inform the individual of the department's intent to revoke and provide a notice of right to
request hearing.

4. Provide the individual opportunity to request a hearing and rebut the allegations.
History: Effective April 1, 1992; amended effective August 1, 2003; January 1, 2006.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
### § 33-36-01-07. Hearing.

A request for hearing must be received by the department no later than twenty days following the
individual's receipt of the allegations against the individual. If a hearing is requested, the department
will apply to the office of administrative hearings for appointment of a hearing officer. The department
will notify any complainants and the accused of the date set for the hearing. The hearing officer will
conduct the hearing and prepare recommended findings of fact and conclusions of law as well as a
recommended order for the department. The department shall notify the individual of its findings in
writing after receiving the attorney general's finding of fact, conclusion of law, and recommended order.
History: Effective April 1, 1992.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
### § 33-36-01-08. Waivers.

Based on each individual case, the department may waive any provisions of this chapter that may
result in unreasonable hardship upon the individual or the individual's emergency medical service
operation, provided such a waiver does not adversely affect the health and safety of patients. The
department may consider waivers for the following situations and conditions:
1. An individual had completed all the requirements for recertification or relicensure and a
good-faith effort was made by that individual to recertify with the national registry and by no
fault of the individual recertification was not granted.
2. An individual who was current in the individual's certification or license was called to active
duty in the United States armed forces and deployed to an area without the resources to
maintain the individual's certification or license resulting in a lapse of the individual's
certification or license.
3. Other reason as determined by the department.
4. A waiver may be granted for a specific period of time not to exceed one year and shall expire
on June thirtieth of each year.
History: Effective January 1, 2006; amended effective July 1, 2010; April 1, 2024.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
