CHAPTER 33-36-04 SCOPE OF PRACTICE FOR EMERGENCY MEDICAL .
CHAPTER 33-36-04SCOPE OF PRACTICE FOR EMERGENCY MEDICAL DefinitionsScopes of Practice33-36-04-01. Definitions.Words defined in chapter 23-27 of the North Dakota Century Code have the samemeaning in this chapter. For purposes of this chapter:1. “Advanced first aid ambulance attendant” means a person that has fulfilled thetraining, testing, and certification process for advanced first aid ambulanceattendant as required in chapter 33-36-01.12. "Advanced emergency medical technician" means a person that has fulfilled thetraining, testing, certification, and licensure process for advanced emergencymedical technician as required in chapter 33-36-01.3. “Community Paramedic” means a person that has fulfilled the training, testing,certification, and licensure process for community paramedic as required inchapter 33-36-01.24. "Emergency medical technician" means a person that has fulfilled the training,testing, certification, and licensure process for emergency medical technician asrequired in chapter 33-36-01.5. “Emergency medical responder” means a person that has fulfilled the training,testing, and certification process for emergency medical responder as required inchapter 33-36-01.3. "Emergency medical technician-intermediate/85" means a person that has fulfilledthe training, testing, certification, and licensure process for emergency medicaltechnician-intermediate/85 as required in chapter 33-36-01.46. "Emergency medical technician-intermediate/99" means a person that hasfulfilled the training, testing, certification, and licensure process for emergencymedical technician-intermediate/99 as required in chapter 33-36-01.57. "Paramedic" means a person that has fulfilled the training, testing, certification,and licensure process for paramedic as required in chapter 33- 36-01.68. "Primary care provider" means a qualified individual responsible for the care ofthe patient and supervision of all ambulance personnel while on the ambulancerun.History: Effective January 1, 2008; amended effective July 1, 2010.1
General Authority: NDCC 23-27-04.3Law Implemented: NDCC 23-27-04.333-36-04-02. Scopes of practice. Each level of emergency medical servicesprofessional has a scope of practice that includes the scopes of practice of all subordinateemergency medical services professionals and the scopes of all emergency medicalservices providers listed in chapter 33-36-03. The hierarchy of emergency medical servicesprofessionals is listed sequentially in this section.1. Emergency medical responder.a.Scope. The emergency medical responder core scope of practice includessimple, noninvasive skills focused on lifesaving interventions for criticalpatients based on assessment findings. The emergency medical responderrenders on scene emergency care while awaiting additional emergencymedical services response and may serve as part of the transporting crew,but not as the primary care provider. An emergency medical responder is notprepared to make decisions independently regarding the appropriatedisposition of patients. An emergency medical responder must function withan emergency medical technician or higher level personnel during thetransportation of patients. The emergency medical responder’s scopeincludes all of the skills included in the driver’s scope. A major differencebetween a driver and an emergency medical responder is the training andskills to provide immediate lifesaving interventions.b.Curriculum. The educational requirements include successful completion of astate-authorized emergency medical responder training program andcontinued educational requirements as defined in chapter 33-36-01.c.Skills. Specific skills for the emergency medical responder are defined by thedepartment. Local medical directors may limit the specific skills that anemergency medical responder may provide and they may not exceed thosespecific skills defined by the department.d.Occupational setting. Emergency medical responders may participate in theemergency medical services system as a sole responder in a quick responseunit or as part of the crew of a basic life support ambulance service but not asthe primary care provider. Emergency medical responders may also providepatient care within their specific skillset as an employee within a hospitalsetting, or to a private company or organization.e.Medical oversight. An emergency medical responder provides medical carewith physician oversight. A physician credentials the emergency medicalresponder and establishes patient care standards through protocol.f.Supervision. An emergency medical responder may be the highest trainedperson on a quick response unit and may supervise other emergency medicalresponders or drivers. As part of a basic life support ambulance crew, an2
emergency medical responder is supervised by the primary care provider.Supervision in a hospital setting pursuant to NDCC 23-27-04.4.2. Advanced first-aid ambulance attendant.a. Scope. The advanced first-aid ambulance attendant’s scope of practice is equalto the emergency medical technician’s defined in section 33-36-04-02.1. Theadvanced first-aid ambulance attendant’s scope includes the skills in the firstresponder’s scope and the driver’s scope. The major difference between anadvanced first-aid ambulance attendant and first responder is the knowledge andskills necessary to provide medical transportation of emergency patients.b. Curriculum. The curriculum for advanced first-aid ambulance attendant is nolonger supported. Therefore, no new advanced first-aid ambulance attendantscan be trained. Continued educational requirements are defined in chapter 3336-01.c. Scope enhancements. Advanced first-aid ambulance attendants may provideenhanced treatments beyond the core scope if they have completed training asdefined in section 33-36-04.3 and have the authorization to perform those skillsfrom their medical director.d. Skills. Specific skills for the advanced first-aid ambulance attendant are definedby the department. Local medical directors may limit the specific skills that anadvanced first-aid ambulance attendant may provide and they may not exceedthose specific skills defined by the department.e. Occupational setting. Advanced first-aid ambulance attendants may participate inthe emergency medical services system as a sole responder in a quick responseunit or as a primary care provider on a basic life support ambulance service.Advanced first-aid ambulance attendants may also provide patient care withintheir specific skillset as an employee within a hospital setting, or to a privatecompany or organization.f. Medical oversight. An advanced first-aid ambulance attendant provides medicalcare within physician oversight. A physician credentials the advanced first-aidambulance attendant and establishes patient care standards through protocol.g. Supervision. An advanced first-aid ambulance attendant may be the primary careprovider on a quick response unit or basic life support ambulance and maysupervise other advanced first-aid ambulance attendants, first responders, ordrivers. Supervision in a hospital setting pursuant to NDCC 23-27-04.413. Emergency medical technician.a.Scope. The emergency medical technician’s core scope of practice includesbasic, noninvasive interventions to reduce the morbidity and mortalityassociated with acute out-of-hospital medical and traumatic emergencies.Emergency care is based on assessment findings. An emergency medical3
technician is not prepared to make decisions independently regarding theappropriate disposition of patients. The emergency medical technician maymake destination decisions in collaboration with medical oversight. Theprincipal disposition of the patient encounter will result in the direct delivery ofthe patient to an acute care facility. The primary differences between anadvanced first-aid ambulance attendant and emergency medical technicianare the educational and testing requirements required for licensure as anemergency medical technician.b.Curriculum. The educational requirements include successful completion of astate-authorized emergency medical technician training program andcontinued educational requirements as defined in chapter 33-36-01.c.Scope enhancements. Emergency medical technicians may provideenhanced treatments beyond the core scope if they have completed trainingas defined in section 33-36-01-03.3 33-36-01-04 and have authorization toperform those skills from their medical director.d.Skills. Specific skills for the emergency medical technician are defined by thedepartment. Local medical directors may limit the specific skills that anemergency medical technician may provide and they may not exceed thosespecific skills defined by the department.e.Occupational setting. Emergency medical technicians may participate in theemergency medical services system as a sole responder in a quick responseunit, as the primary care provider of a basic life support air or groundambulance service, or as part of the crew of an advanced life support air orground ambulance service. Emergency medical technicians may also providepatient care within their specific skillset as an employee within a hospitalsetting,or services to a private company or organization as part of a responseteam that is not offered to the general public.f.Medical oversight. An emergency medical technician provides medical carewith physician oversight. A physician credentials the emergency medicaltechnician and establishes patient care standards through protocol.g.Supervision. An emergency medical technician may be the highest trainedperson on a quick response unit and as the primary care provider maysupervise other emergency medical technicians, emergency medicalresponders, or drivers. As part of a basic life support ambulance crew, anemergency medical technician may supervise subordinate emergencymedical services personnel. As part of an advanced life support ambulanceservice, an emergency medical technician is supervised by a paramedic.Supervision within a hospital setting pursuant to NDCC 23-27-04.4.2.Emergency medical technician-intermediate/85.a.Scope. The scope of practice of an emergency medical technicianintermediate/85 includes basic, limited advanced interventions to reduce the4
morbidity and mortality associated with acute out-of-hospital medical andtraumatic emergencies. Emergency care is based on assessment findings.An emergency medical technician-intermediate/85 is not prepared to makedecisions independently regarding the appropriate disposition of patients. Theemergency medical technician-intermediate/85 may make destinationdecisions in collaboration with medical oversight. The principal disposition ofthe patient encounter will result in the direct delivery of the patient to an acutecare facility. The primary differences between an emergency medicaltechnician and emergency medical technician-intermediate/85 are the basic,limited advanced interventions that an emergency medical technicianintermediate/85 may provide.b.Curriculum. The core educational requirements include successful completionof a state-authorized emergency medical technician- intermediate/85 trainingprogram and continued educational requirements as defined in chapter 3336-01.c.Scope enhancements. Emergency medical technicians-intermediate/85 mayprovide enhanced treatments beyond the core scope if they have completedtraining as defined in section 33-36-01-04 and have the authorization toperform those skills from their medical director.d.Skills. Specific skills for the emergency medical technician- intermediate/85are defined by department policy. Local medical directors, or hospitals ifworking in the hospital setting may limit the specific skills that an emergencymedical technician-intermediate/85 may provide. They may not exceed thosespecific skills defined by department policy.e.Occupational setting. Emergency medical technicians-intermediate/85 mayparticipate in the emergency medical services system as a sole responder ina quick response unit, as the primary care provider of a basic life support airor ground ambulance service, or as part of the crew of an advanced lifesupport air or ground ambulance service. Emergency medical techniciansintermediate/85 may work for a hospital in a nonemergency setting or provideservices to a private company or organization as part of a response team thatis not offered to the general public.f.Medical oversight. An emergency medical technician-intermediate/85 workingin a prehospital setting provides medical care with physician oversight. In thiscircumstance a physician credentials the emergency medical technicianintermediate/85 and establishes patient care standards through protocol. Anemergency medical technician- intermediate/85 working in a hospital settingis credentialed by the hospital.g.Supervision. An emergency medical technician-intermediate/85 may be thehighest trained person on a quick response unit and as the primary careprovider may supervise other emergency medical techniciansintermediate/85, emergency medical technicians, first responders, or drivers.5
As part of a basic life support ambulance crew, an emergency medicaltechnician-intermediate/85 may supervise subordinate emergency medicalservices personnel. As part of an advanced life support ambulance service anemergency medical technician- intermediate/85 is supervised by aparamedic. Emergency medical technicians-intermediate/85 working in ahospital setting are supervised by nursing staff.34. Advanced emergency medical technician.a. Scope. The advanced emergency medical technician’s scope of practiceincludes basic, limited advanced interventions to reduce the morbidity andmortality associated with acute out-of-hospital medical and traumaticemergencies. Emergency care is based on assessment findings. Anadvanced emergency medical technician is not prepared to make decisionsindependently regarding the appropriate disposition of patients. Theadvanced emergency medical technician may make destination decisionsin collaboration with medical oversight. The principal disposition of thepatient encounter will result in the direct delivery of the patient to an acutecare facility. The primary differences between an emergency medicaltechnician and advanced emergency medical technician are the basic,limited advanced interventions that an advanced emergency medicaltechnician may provide.b. Curriculum. The core educational requirements include successfulcompletion of a state-authorized advanced emergency medical techniciantraining program and continued educational requirements as defined inchapter 33-36-01.c. Skills. Specific skills for the advanced emergency medical technician aredefined by department policy. Local medical directors, or hospitals ifworking in the hospital setting, may limit the specific skills that an advancedemergency medical technician may provide. They may not exceed thosespecific skills defined by department policy.d. Occupational setting. Advanced emergency medical technicians mayparticipate in the emergency medical services system as a sole responderin a quick response unit, as the primary care provider of a basic life supportair or ground ambulance service, or as part of the crew of an advanced lifesupport air or ground ambulance service. Advanced emergency medicaltechnicians may provide patient care as an employee within their specificskillset as an employee within a hospital work for a hospital in anonemergency setting or provide services to a private company ororganization as part of a response team that is not offered to the generalpublic.e. Medical oversight. An advanced emergency medical technician working ina prehospital setting provides medical care with physician oversight. In thiscircumstance, a physician credentials the advanced emergency medicaltechnician and establishes patient care standards through protocol. An6
advanced emergency medical technician working in a hospital setting iscredentialed by the hospital.f. Supervision. An advanced emergency medical technician may be thehighest trained person on a quick response unit and as the primary careprovider may supervise other advanced emergency medical technicians,emergency medical technicians, first responders, or drivers. As part of abasic life support ambulance crew, an advanced emergency medicaltechnician may supervise subordinate emergency medical servicespersonnel. As part of an advanced life support ambulance service anadvanced emergency medical technician is supervised by a paramedic.Emergency medical technicians working in a hospital setting aresupervised by nursing staff.Supervision in a hospital setting pursuant toNDCC 23-27-04.445. Emergency medical technician-intermediate/99.a. Scope. The scope of practice of an emergency medical technicianintermediate/99 includes basic, limited advanced and pharmacologicalinterventions to reduce the morbidity and mortality associated with acuteout-of-hospital medical and traumatic emergencies. Emergency care isbased on assessment findings. An emergency medical technicianintermediate/99 is not prepared to make decisions independently regardingthe appropriate disposition of patients. The emergency medical technicianintermediate/99 may make destination decisions in collaboration withmedical oversight. The principal disposition of the patient encounter willresult in the direct delivery of the patient to an acute care facility. Theprimary differences between an emergency medical technicianintermediate/85 and emergency medical technician- intermediate/99 arethe limited pharmacological interventions that an emergency medicaltechnician-intermediate/99 may provide.b. Curriculum. The core educational requirements include successfulcompletion of a state-authorized emergency medical technicianintermediate/99 training program and continued educational requirementsas defined in chapter 33-36-01.c. Scope enhancements. Emergency medical technicians-intermediate/99may provide enhanced treatments beyond the core scope if they havecompleted training as defined in section 33-36-01-03.3 33-36-01-04 andhave the authorization to perform those skills from their medical director.d. Skills. Specific skills for the emergency medical technician-intermediate/99are defined by department policy. Local medical directors, or hospitals ifworking in the hospital setting, may limit the specific skills that anemergency medical technician-intermediate/99 may provide. They may notexceed those specific skills defined by department policy.7
e. Occupational setting. Emergency medical technicians-intermediate/99 mayparticipate in the emergency medical services system as a sole responderin a quick response unit, as the primary care provider of a basic life supportair or ground ambulance service, or as part of the crew of an advanced lifesupport air or ground ambulance service. Emergency medical techniciansintermediate/99 may provide patient care within their specific skillset as anemployee within a hospital work for a hospital in a nonemergency setting orprovide services to a private company or organization as part of aresponse team that is not offered to the general public.f. Medical oversight. An emergency medical technician-intermediate/99working in a prehospital setting provides medical care with physicianoversight. In this circumstance a physician credentials the emergencymedical technician-intermediate/99 and establishes patient care standardsthrough protocol. An emergency medical technician-intermediate/99working in a hospital setting is credentialed by the hospital.g. Supervision. An emergency medical technician-intermediate ’99 may bethe highest trained person on a quick response unit and as the primarycare provider may supervise other emergency medical techniciansintermediate/99, emergency medical technicians-intermediate/85,emergency medical technicians, emergency medical responders, ordrivers. As part of a ba
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 .
Part One: Heir of Ash Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26 Chapter 27 Chapter 28 Chapter 29 Chapter 30 .
TO KILL A MOCKINGBIRD. Contents Dedication Epigraph Part One Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Part Two Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18. Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26
DEDICATION PART ONE Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 PART TWO Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 .
Chapter 5 Project Scope Management Chapter 5 Project Scope Management 5.1 Plan Scope Management 5.1 Colect Requirements 5.2 Collect Requirements 5.2 Define Scope 5.3 Define Scope 5.3 Create WBS 5.4 Create WBS 5.4 Verify Scope 5.5 Validate Scope 5.5 Control Scope 5.6 Control Scope PMBOK 5th Edition
About the husband’s secret. Dedication Epigraph Pandora Monday Chapter One Chapter Two Chapter Three Chapter Four Chapter Five Tuesday Chapter Six Chapter Seven. Chapter Eight Chapter Nine Chapter Ten Chapter Eleven Chapter Twelve Chapter Thirteen Chapter Fourteen Chapter Fifteen Chapter Sixteen Chapter Seventeen Chapter Eighteen
18.4 35 18.5 35 I Solutions to Applying the Concepts Questions II Answers to End-of-chapter Conceptual Questions Chapter 1 37 Chapter 2 38 Chapter 3 39 Chapter 4 40 Chapter 5 43 Chapter 6 45 Chapter 7 46 Chapter 8 47 Chapter 9 50 Chapter 10 52 Chapter 11 55 Chapter 12 56 Chapter 13 57 Chapter 14 61 Chapter 15 62 Chapter 16 63 Chapter 17 65 .
HUNTER. Special thanks to Kate Cary. Contents Cover Title Page Prologue Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter
Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 . Within was a room as familiar to her as her home back in Oparium. A large desk was situated i
