# Title 33 — State Department of Health

## Article 33-36 — Emergency Medical Services Personnel

## Chapter 33-36-03 — Scope of Practice for Unlicensed Emergency Medical Services Personnel

### § 33-36-03-01. 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 first-aid ambulance attendant" means a person that has fulfilled the training,
testing, and certification process for advanced first-aid ambulance attendant as required in
chapter 33-36-01.
2. "Airway adjuncts" means oxygen and oxygen delivery equipment, oropharyngeal airways,
nasopharyngeal airways, bag-valve-mask ventilator, or any other mechanical ventilator or
respiratory care equipment.
3. "Cardiopulmonary resuscitation" means the American heart association health care provider
standards or its equivalent which includes the skills adult one-person and two-person
cardiopulmonary resuscitation, adult obstructed airway, child one-person and two-person
cardiopulmonary resuscitation, child obstructed airway, infant cardiopulmonary resuscitation,
infant obstructed airway, and automated external defibrillator.
4. "Driver" means a person that is registered with the department as an uncertified crew member
of a basic life support ambulance.
5. "Emergency medical responder" means a person that has fulfilled the training, testing, and
certification process for emergency medical responder 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
### § 33-36-03-02. Scopes of practice.

Each level of emergency medical services provider has a scope of practice that includes the
scopes of practice of all subordinate emergency medical services providers. The hierarchy of
emergency medical services providers is listed sequentially in this section.
1. Driver.
a. Scope. The driver's minimum scope of practice primarily focuses on driving the basic life
support ambulance and assisting the other emergency medical services personnel on the
ambulance crew with nonpatient care issues. The driver's maximum scope of practice is
limited to providing cardiopulmonary resuscitation without mechanical resuscitation
equipment or airway adjuncts but including the use of an automated external defibrillator
if the driver is certified in cardiopulmonary resuscitation. A major difference between the
layperson and the driver is the "duty to act" as part of an organized emergency medical
services response.

b. Curriculum. The driver must hold a valid operator's license under chapter 39-06 of the
North Dakota Century Code.
c. Occupational setting. Drivers may only participate in the emergency medical services
system as part of a crew of a basic life support ambulance service or quick response
unit. At no time may a driver respond without other higher level emergency medical
services personnel.
d. Medical oversight. Because transport is an important part of the patient care continuum,
a driver functions with physician oversight through protocol.
e. Supervision. A driver is supervised by the primary care provider.
2. Emergency medical responder.
a. Scope. The emergency medical responder core scope of practice includes simple,
noninvasive skills focused on lifesaving interventions for critical patients based on
assessment findings. The emergency medical responder renders onscene emergency
care while awaiting additional emergency medical services response and may serve as
part of the transporting crew, but not as the primary care provider. An emergency medical
responder is not prepared to make decisions independently regarding the appropriate
disposition of patients. An emergency medical responder must function with an
emergency medical technician or higher level personnel during the transportation of
patients. The emergency medical responder's scope includes all of the skills included in
the driver's scope. A major difference between a driver and an emergency medical
responder is the training and skills to provide immediate lifesaving interventions.
b. Curriculum. The educational requirements include successful completion of a
state-authorized emergency medical responder training program and continued
educational requirements as defined in chapter 33-36-01.
c. Scope enhancements. Emergency medical responders may provide enhanced
treatments beyond the core scope if they have successfully completed training as
defined in section 33-36-01-04 and have authorization to perform those skills from their
medical director.
d. Skills. Specific skills for the emergency medical responder are defined by the
department. Local medical directors may limit the specific skills that an emergency
medical responder may provide and they may not exceed those specific skills defined by
the department.
e. Occupational setting. Emergency medical responders may participate in the emergency
medical services system as a sole responder in a quick response unit or as part of the
crew of a basic life support ambulance service but not as the primary care provider.
Emergency medical responders may also provide services to a private company or
organization as part of a response team that is not offered to the public.
f. Medical oversight. An emergency medical responder provides medical care with
physician oversight. A physician credentials the emergency medical responder and
establishes patient care standards through protocol.
g. Supervision. An emergency medical responder may be the highest trained person on a
quick response unit and may supervise other emergency medical responders or drivers.
As part of a basic life support ambulance crew, an emergency medical responder is
supervised by the primary care provider.
3. Advanced first-aid ambulance attendant.

a. Scope. The advanced first-aid ambulance attendant's scope of practice is equal to the
emergency medical technician's as defined in section 33-36-04-02.1. The advanced
first-aid ambulance attendant's scope includes the skills in the first responder's scope
and the driver's scope. The major difference between an advanced first-aid ambulance
attendant and first responder is the knowledge and skills necessary to provide medical
transportation of emergency patients.
b. Curriculum. The curriculum for advanced first-aid ambulance attendant is no longer
supported. Therefore, no new advanced first-aid ambulance attendants can be trained.
Continued educational requirements are defined in chapter 33-36-01.
c. Scope enhancements. Advanced first-aid ambulance attendants may provide enhanced
treatments beyond the core scope if they have completed training as defined in section
director.
d. Skills. Specific skills for the advanced first-aid ambulance attendant are defined by the
department. Local medical directors may limit the specific skills that an advanced first-aid
ambulance attendant may provide and they may not exceed those specific skills defined
by the department.
e. Occupational setting. Advanced first-aid ambulance attendants may participate in the
emergency medical services system as a sole responder in a quick response unit or as a
primary care provider on a basic life support ambulance service. Advanced first-aid
ambulance attendants may also provide services to a private company or organization as
part of a response team that is not offered to the public.
f. Medical oversight. An advanced first-aid ambulance attendant provides medical care with
physician oversight. A physician credentials the advanced first-aid ambulance attendant
and establishes patient care standards through protocol.
g. Supervision. An advanced first-aid ambulance attendant may be the primary care
provider on a quick response unit or basic life support ambulance and may supervise
other advanced first-aid ambulance attendants, first responders, or drivers.
History: Effective January 1, 2008; amended effective July 1, 2010.
General Authority: NDCC 23-27-04.3
Law Implemented: NDCC 23-27-04.3
