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LCB File No. R182-01 PROPOSED REGULATION OF THE HEALTH DIVISION OF THE DEPARTMENT OF ADMINISTRATION CHAPTER 450B EMERGENCY MEDICAL SERVICES GENERAL PROVISIONS 450B.010........... Definitions 450B.013........... "Advanced emergency care" defined 450B.015........... "Agency's vehicle" defined 450B.040........... "Air attendant" defined 450B.050........... "Applicant" defined 450B.055........... "Attendant" defined 450B.061........... "Basic emergency care" defined 450B.070........... "Certificate" defined 450B.090........... "Driver" defined 450B.100........... "Emergency" defined 450B.103........... "Emergency call" defined 450B.105........... "Emergency care" defined 450B.115........... "First responder" defined 450B.125........... "Health division" defined 450B.140........... "Health officer" defined 450B.143........... "Industrial operator" defined 450B.147........... "Instructor" defined 450B.148........... "Intermediate emergency care" defined 450B.150........... "License" defined 450B.160........... "Licensee" defined 450B.170........... "Local authority" defined 450B.175........... "Municipal operator" defined 450B.177........... "National standard course" defined 450B.180........... "Patient" defined 450B.205........... "Physician" defined 450B.210........... "Pilot" defined 450B.215........... "Registered nurse" defined 450B.219........... "Report of emergency care" defined 450B.230........... "Service" defined 450B.240........... "State" defined 450B.245........... "State radio system for emergency medical services" defined 450B.253........... "Transfer" defined 450B.255........... "Transport" defined 450B.260........... "Unit" defined 450B.280........... "Volunteer service" defined --1-Agency Draft of Proposed Regulation R182-01 450B.295........... Variances by local authorities 450B.297........... Standards for licensing, certification, applicants for training and programs of training 450B.300........... Severability EMERGENCY CARE Licensing and Certification 450B.310........... Licensing of attendants required 450B.320........... Licensing of attendants: Qualifications 450B.330........... Licensing of attendants: Application; renewal 450B.340........... Attendant Trainee License [Provisional license] 450B.350........... License: Terms; renewal; responsibility of service or fire-fighting agency 450B.355........... Certification of first responders 450B.360........... Certification of emergency medical technicians: Qualifications; exception; contents of application; verification of completion of national standard course 450B.363........... Certification of emergency medical technician trained in another state 450B.364........... Certification of emergency medical technicians: Issuance of certificate 450B.366........... Expiration and renewal of certificate as first responder or emergency medical technician 450B.374........... Late renewal of certificate as emergency medical technician or first responder 450B.3745......... Training and certification of intermediate emergency medical technician 450B.375........... Late renewal of certificate as intermediate emergency medical technician 450B.378........... Certification of intermediate emergency medical technician trained in another state [450B.379.......... Reissuance of expired certificate of emergency medical technician or intermediate emergency medical technician] 450B.380........... Certificate as intermediate emergency medical technician: Expiration; examination of holder for retention of skills; renewal Authorized Activities 450B.383........... Emergency medical technician: Authorized practices 450B.384........... Emergency medical technician: Practice beyond scope of certificate prohibited; exception 450B.385........... Intermediate emergency medical technician: Authorized practices 450B.390........... Performance of special procedures: Venipuncture, management of airways, administration of medication and performance of intraosseous infusion ADVANCED EMERGENCY CARE 450B.400........... Certification: Qualifications 450B.410........... Certification: Person trained in another state 450B.420........... Certification: Expiration; examination for retention of skills; renewal 450B.425........... Certification: Late renewal [450B.427.......... Certification: Reissuance of expired certificate] [450B.430.......... Certification: Suspension and revocation] 450B.440........... Initial training 450B.443........... Training to maintain certification; reexamination 450B.447........... Authorized activities; oral orders --2-Agency Draft of Proposed Regulation R182-01 450B.450........... Rendering of care by hospital, service or fire-fighting agency; staffing of ambulance, air ambulance or agency's vehicle 450B.455........... Notations on reports of emergency care CONTROLLED SUBSTANCES AND DANGEROUS DRUGS 450B.461........... Restrictions on authority to administer 450B.465........... Storage and security 450B.471........... Administration: Reporting requirements; discarding of unused portion of unit dose 450B.475........... Supplying of controlled substances; handling, use and maintenance of controlled substances and dangerous drugs 450B.481........... Controlled substances: Record of usage; inventory AMBULANCE SERVICES AND FIRE-FIGHTING AGENCIES 450B.505........... Permit required; appointment, powers and duties of medical director 450B.510........... Permits: Application; renewal 450B.515........... Ambulance permits: Fee 450B.520........... Permits: Denial of application 450B.523........... Endorsement for operation at intermediate or advanced level 450B.526........... Application for endorsement 450B.529........... Endorsement: Investigation of applicant; issuance or rejection; limitation on time for obtainment 450B.532........... Renewal of endorsement 450B.535........... Endorsement for operation of individual ambulances or vehicles at specified levels of emergency care 450B.540........... Display, alteration, transferability of permit 450B.550........... Ambulance: Design 450B.560........... Ambulance, [air ambulance,] agency's vehicle or vehicle of a fire-fighting agency [used to transport or transfer patients]: Equipment required 450B.562........... Air ambulance: Compliance with certain Federal Aviation Rules; required certification of aircraft 450B.564........... Air ambulance: Surveillance review for safety and compliance 450B.566........... Air ambulance: Landing site for helicopters 450B.568........... Air ambulance: Restriction on transfer of patients 450B.570........... Air ambulance: Design and equipment 450B.574........... Agency's vehicle: Required personnel 450B.575........... Ambulance, [air ambulance] or agency's vehicle: Requirements for basic, intermediate and advanced care 450B.578........... Ambulance, air ambulance or agency's vehicle: Communication with and agreement by hospital 450B.580........... Ambulance, air ambulance or agency's vehicle: Standards and procedures for operation 450B.590........... Operation of ambulance by unlicensed person 450B.600........... Air ambulance: Endorsement, equipment and operation of aircraft; staff 450B.611........... Base stations, protocols and procedures 450B.620........... Reports required --3-Agency Draft of Proposed Regulation R182-01 450B.630........... Records concerning transportation and transfer of patients 450B.640........... Inspections 450B.645........... Reports of emergency care DISCIPLINARY ACTION 450B.650........... New periodic examination or investigation by health division 450B.655........... Unprofessional conduct 450B.660........... Grounds for disciplinary action; suspension or revocation 450B.680........... Notification of other licensing authorities of disciplinary action 450B.690........... Reinstatement of permit, endorsement, certificate or license 450B.695........... Revoked, terminated or suspended certificate not eligible for reissuance MISCELLANEOUS PROVISIONS 450B.700........... Fees 450B.705........... Restrictions on licenses 450B.710........... Notice to applicant of rejection of permit, endorsement or license 450B.715........... Renewal of certification of nonresident 450B.720........... Programs of training 450B.723........... Endorsement as instructor: Qualifications; authorized activities 450B.725........... Endorsement as instructor: Expiration; renewal 450B.730........... Report of traffic accident [450B.735.......... Portable masks and face shields used during cardiopulmonary resuscitation] TREATMENT OF TRAUMA Initial Procedures and Collection of Information 450B.760........... Definitions 450B.762........... Adoption of article by reference 450B.764........... Development of system for collection of information concerning treatment of trauma 450B.766........... Provision of information by person providing emergency medical care at scene of injury 450B.768........... Submission to health division of quarterly reports concerning patients treated by hospital; annual reports by health division 450B.770........... Procedures for initial identification and care of patients with traumas 450B.772........... Criteria for determining destination for transportation and treatment of patients with traumas 450B.774........... Procedure when patient refuses transportation to center for treatment of trauma Centers for Treatment of Trauma 450B.780........... Definitions 450B.782........... "Advanced Trauma Life Support" defined 450B.784........... "Burn center" defined 450B.786........... "Center for the treatment of trauma" defined 450B.788........... "Emergency department" defined 450B.790........... "Immediately available" defined 450B.792........... "Implementation" defined --4-Agency Draft of Proposed Regulation R182-01 450B.794........... "Injury severity score" defined 450B.796........... "Patient with a major trauma" defined 450B.798........... "Patient with trauma" defined 450B.799........... "Pediatric regional resource center for the treatment of trauma" defined 450B.800........... "Promptly available" defined 450B.802........... "Qualified specialist" defined 450B.804........... "Receiving hospital" defined 450B.806........... "Senior resident" defined 450B.808........... "Service area" defined 450B.810........... "System for providing treatment for trauma" defined 450B.812........... "Trauma team" defined 450B.814........... "Triage criteria" defined 450B.816........... Adoption of publications by reference 450B.818........... Development of process for accepting applications for designation or renewal of designation 450B.819........... Submission, contents and rejection of applications for designation or renewal of designation; requests for verification 450B.820........... Surveys for designation as centers; verification required 450B.8205......... Prerequisites to renewal of designation 450B.8215......... Disqualification of member of survey team for bias or prejudice 450B.824........... Notice of decision regarding application for designation or renewal of designation 450B.826........... Duration of designation and renewal of designation; provisional designation 450B.828........... Addition of centers to system of providing treatment for trauma 450B.830........... Discontinuance of designation by center; withdrawal of or refusal to renew designation 450B.832........... Fees for designation and renewal of designation; exception 450B.834........... Grounds for suspension or revocation of designation 450B.836........... Notice of intent to deny, suspend or revoke designation; summary suspension of designation; appeal of action 450B.838........... Level I center: Requirements for designation 450B.845........... Pediatric regional resource center: Requirements for designation 450B.852........... Level II center: Requirements for designation 450B.866........... Level III center: Requirements for designation 450B.871........... Level IV center: Requirements for designation 450B.875........... Establishment of programs to ensure quality of care WITHHOLDING LIFE-SUSTAINING TREATMENT 450B.950........... Do-not-resuscitate identification: Application to include statement regarding disclosure of decision 450B.955........... Do-not-resuscitate identification: Form; issuance to qualified patient upon submission of application and fee 450B.960........... Do-not-resuscitate identification: Procedures to be followed by persons who administer emergency medical services --5-Agency Draft of Proposed Regulation R182-01 EMERGENCY MEDICAL DISPATCHERS Certification of emergency medical dispatchers Certification of emergency medical dispatcher trained in another state Expiration and renewal of certificate as an emergency medical dispatcher Late renewal of certificate as an emergency medical dispatcher GENERAL PROVISIONS NAC 450B.010 Definitions. As used in this chapter, unless the context otherwise requires, the words and terms defined in: 1. NAC 450B.013 to 450B.280, inclusive; and 2. NRS 450B.025, 450B.030, 450B.040 and 450B.060 to 450B.110, inclusive, have the meanings ascribed to them in those sections. (Supplied in codification; A by Bd. of Health, 8-22-86; 11-12-87; 8-1-91) NAC 450B.013 "Advanced emergency care" defined. "Advanced emergency care" means care which includes, in addition to the activities of intermediate emergency care, advanced invasive procedures for cardiopulmonary emergencies, the administration of additional medications for acute and chronic medical conditions, the recognition of arrhythmia and therapeutic intervention under the supervision of a physician or a registered nurse supervised by a physician. (Added to NAC by Bd. of Health, eff. 8-1-91) NAC 450B.015 "Agency's vehicle" defined. "Agency's vehicle" means a vehicle operated by a service or fire-fighting agency under a permit issued pursuant to this chapter, which is staffed and equipped to respond to a medical emergency. (Added to NAC by Bd. of Health, eff. 8-22-86) NAC 450B.040 "Air attendant" defined. "Air attendant" means a qualified person licensed under this chapter whose primary responsibility is attending any patient or other person being transported in an air ambulance. [Bd. of Health, Ambulance Reg. § 1.002, eff. 12-3-73; renumbered as § 1.3, 2-28-80] NAC 450B.050 "Applicant" defined. "Applicant" means a person who applies for: 1. A permit, endorsement, license or certification; or 2. Training, under the applicable provisions of this chapter. [Bd. of Health, Ambulance Reg. § 1.004, eff. 12-3-73; renumbered as § 1.5, 2-28-80; + Life Support Reg. § 1.3, eff. 1-1-76]-(NAC A 10-14-82) NAC 450B.055 "Attendant" defined. "Attendant" means a person, including a fireman or a volunteer, who is licensed under the applicable provisions of this chapter to perform the duties of a driver, attendant or air attendant pursuant to this chapter. (Added to NAC by Bd. of Health, eff. 8-22-86) --6-Agency Draft of Proposed Regulation R182-01 NAC 450B.061 "Basic emergency care" defined. "Basic emergency care" means care which includes assessing life threatening and nonlife-threatening medical conditions, establishing and maintaining a patient's airway and ventilation, rendering cardiopulmonary resuscitation, controlling bleeding, treating shock and poisoning, dressing and bandaging wounds, splinting fractures, giving emergency obstetrical assistance and caring for newborn infants and executing appropriate rescue and extrication procedures. (Added to NAC by Bd. of Health, eff. 8-1-91) NAC 450B.070 "Certificate" defined. "Certificate" means the certificate issued by the health division under this chapter to a person certifying him to be qualified as a first responder, an emergency medical technician, an intermediate emergency medical technician, an advanced emergency medical technician or an instructor in a program of training in emergency medical services. [Bd. of Health, Life Support Reg. § 1.5, eff. 1-1-76; A 2-28-80]-(NAC A 10-14-82; 8-22-86; 11-12-87) NAC 450B.090 "Driver" defined. "Driver" means a qualified person, as determined by the department of motor vehicles, who is: 1. Responsible for the operation of an ambulance over the streets, roads and highways within the state; and 2. Possesses evidence of successful completion of a National Standard Emergency Vehicle Operations Course or its equivalent approved by the health division. [Licensed as an attendant under NAC 450B.310 to 450B.350, inclusive.] [Bd. of Health, Ambulance Reg. § 1.007, eff. 12-3-73; A and renumbered as § 1.8, 2-28-80] NAC 450B.100 "Emergency" defined. "Emergency" means: 1. An unforeseen combination of circumstances or the resulting state that calls for immediate action; 2. An unlooked for or sudden occasion; 3. An accident; or 4. An urgent or pressing medical need. [Bd. of Health, Ambulance Reg. § 1.008, eff. 12-3-73; renumbered as § 1.9, 2-28-80; + Life Support Reg. § 1.7, eff. 1-1-76]-(NAC A 8-22-86) NAC 450B.103 "Emergency call" defined. "Emergency call" means any call requiring immediate action or response by an ambulance or an agency's vehicle. (Added to NAC by Bd. of Health, eff. 8-22-86) NAC 450B.105 "Emergency care" defined. "Emergency care" means basic, intermediate or advanced medical care given to a patient in an emergency and before he arrives at a hospital. (Added to NAC by Bd. of Health, eff. 10-14-82) NAC 450B.115 "First responder" defined. "First responder" means a person who has successfully completed the national standard course for first responders. (Added to NAC by Bd. of Health, eff. 8-22-86; A 11-12-87) --7-Agency Draft of Proposed Regulation R182-01 NAC 450B.125 "Health division" defined. (NRS 439.200, 450B.120) "Health division" means the health division of the department of human resources. (Added to NAC by Bd. of Health by R045-97, eff. 10-30-97) NAC 450B.140 "Health officer" defined. "Health officer" means the state health officer. [Bd of Health, Ambulance Reg. § 1.012 eff. 12-3-73; A and renumbered as §§ 1.14 & 1.14.1, 2-28-80; + Life Support Reg. § 1.11, eff. 1-1-76; A 2-28-80] NAC 450B.143 "Industrial operator" defined. "Industrial operator" means an operator of a service which is: 1. Provided for the benefit of the employees of an industry who become sick or are injured at the industrial site; and 2. Staffed by employees who are licensed attendants and perform emergency care primarily for the industry. (Added to NAC by Bd. of Health, eff. 10-14-82) NAC 450B.147 "Instructor" defined. "Instructor" means a person who has successfully completed a national standard course for instructors or its equivalent as approved by the health division. ["Instructor" means a person who has successfully completed the national standard course for instructors.] (Added to NAC by Bd. of Health, eff. 11-12-87) NAC 450B.148 "Intermediate emergency care" defined. "Intermediate emergency care" means care which includes, in addition to the activities of basic emergency care, invasive procedures and the administration of certain medications for acute life-threatening conditions under the supervision of a physician or a registered nurse supervised by a physician. (Added to NAC by Bd. of Health, eff. 8-1-91) NAC 450B.150 "License" defined. "License" means the license issued by, or on behalf of, the health division to a person certifying him as qualified to perform the duties of a driver, attendant, air attendant or volunteer pursuant to this chapter. [Bd. of Health, Ambulance Reg. § 1.013, eff. 12-3-73; A and renumbered as § 1.15, 2-28-80] NAC 450B.160 "Licensee" defined. "Licensee" means one who holds a license issued under this chapter. [Bd. of Health, Ambulance Reg. § 1.014, eff. 12-3-73; renumbered as § 1.16, 2-28-80] NAC 450B.170 "Local authority" defined. "Local authority" means a district health officer or other person charged with administering the duties of a health officer. [Bd. of Health, Life Support Reg. § 1.12, eff. 1-1-76] NAC 450B.175 "Municipal operator" defined. "Municipal operator" means an operator of a service which is: 1. Provided primarily as a public service by an agency of local government; and --8-Agency Draft of Proposed Regulation R182-01 2. Staffed by employees of the agency who are licensed attendants. Such a service may be a public service even if charges are imposed to offset the cost of operation. (Added to NAC by Bd. of Health, eff. 10-14-82) NAC 450B.177 "National standard course" defined. "National standard course" means a program of training in procedures and skills for emergency medical care as prepared and authorized by the National Highway Traffic Safety Administration of the United States Department of Transportation. (Added to NAC by Bd. of Health, eff. 8-22-86) NAC 450B.180 "Patient" defined. "Patient" means any person who is sick, injured, wounded, or otherwise incapacitated or helpless and who is carried in an ambulance or air ambulance or is cared for at the scene of an emergency by a licensed emergency medical technician at any level [attendant of a fire-fighting agency]. [Bd. of Health, Ambulance Reg. § 1.015, eff. 12-3-73; A and renumbered as § 1.17, 2-28-80; + Life Support Reg. § 1.13, eff. 1-1-76; A 2-28-80]-(NAC A 8-22-86) NAC 450B.205 "Physician" defined. "Physician" means a physician licensed pursuant to chapter 630 of NRS or an osteopathic physician licensed pursuant to chapter 633 of NRS. (Added to NAC by Bd. of Health, eff. 8-1-91) NAC 450B.210 "Pilot" defined. "Pilot" means the operator of an aircraft who is certified by the Federal Aviation Administration. [Bd. of Health, Ambulance Reg. § 1.019, eff. 12-3-73; renumbered as § 1.21, 2-28-80]-(NAC A 8-22-86) NAC 450B.215 "Registered nurse" defined. "Registered nurse" has the meaning ascribed to it in NRS 632.019. (Added to NAC by Bd. of Health, eff. 10-14-82) NAC 450B.219 "Report of emergency care" defined. "Report of emergency care" means the record of the care given to a person at the scene of an emergency and the transportation or transfer of any patient within Nevada or from Nevada to a location in another state. (Added to NAC by Bd. of Health, eff. 8-1-91) NAC 450B.230 "Service" defined. "Service" means an ambulance or air ambulance service, whether or not the service is conducted pursuant to a business license issued by a local government. [Bd. of Health, Ambulance Reg. § 1.021, eff. 12-3-73; A and renumbered as § 1.23, 2-28-80; + Life Support Reg. § 1.17, eff. 1-1-76; A 2-28-80]-(NAC A 10-14-82) NAC 450B.240 "State" defined. "State" includes all the incorporated and unincorporated areas within the geographic boundaries of the State of Nevada, except those areas under the jurisdiction of the United States Government. [Bd. of Health, Ambulance Reg. § 1.022, eff. 12-3-73; renumbered as § 1.24, 2-28-80; + Life Support Reg. § 1.18, eff. 1-1-76] --9-Agency Draft of Proposed Regulation R182-01 NAC 450B.245 "State radio system for emergency medical services" defined. "State radio system for emergency medical services" means the radio system of two-way vocal communications between ambulances or agency's vehicles and hospitals which operates throughout this state on the ultrahigh frequencies allocated for this purpose by the Federal Communications Commission. (Added to NAC by Bd. of Health, eff. 10-14-82; A 8-22-86) NAC 450B.253 "Transfer" defined. "Transfer" means the movement of a patient by ambulance or air ambulance from one medical facility to another medical facility. As used in this section, "medical facility" has the meaning ascribed to it in NRS 449.0151. (Added to NAC by Bd. of Health, eff. 8-22-86; A 5-18-92) NAC 450B.255 "Transport" defined. "Transport" means the movement of a patient by ambulance or air ambulance from the scene of an emergency to a medical facility [hospital]. (Added to NAC by Bd. of Health, eff. 8-22-86) NAC 450B.260 "Unit" defined. "Unit" means an ambulance, air ambulance or firefighting agency vehicle. ["Unit" means an ambulance or air ambulance.] [Bd. of Health, Ambulance Reg. § 1.024, eff. 12-3-73; A and renumbered as § 1.26, 2-28-80] NAC 450B.280 "Volunteer service" defined. (NRS 439.200, 450B.120) "Volunteer service" means a service approved by the health division for the operation of any ambulance or other motor vehicle for the purpose of transporting sick or injured persons or dead bodies without compensation other than reimbursements to defray the actual expenses of providing the service. A "volunteer service" may be wholly or partly subsidized and may be operated under the auspices of a governmental or public agency or an industrial or nonprofit corporation. [Bd. of Health, Ambulance Reg. § 1.026, eff. 12-3-73; A and renumbered as § 1.28, 2-2880]-(NAC A 10-14-82; R045-97, 10-30-97) NAC 450B.295 Variances by local authorities. A local authority may grant a variance to the provisions of this chapter pursuant to subsection 3 of NRS 439.200. (Added to NAC by Bd. of Health, eff. 8-22-86) NAC 450B.297 Standards for licensing, certification, applicants for training and programs of training. The standards adopted by the board for the qualifications for licensing and certification, the eligibility of applicants for training and the approval of programs of training are the sole standards applied in Nevada. (Added to NAC by Bd. of Health, eff. 8-22-86) NAC 450B.300 Severability. If any of the provisions of this chapter or any application thereof to any person, thing or circumstance is held invalid, it is intended that such invalidity not affect the remaining provisions, or their application, that can be given effect without the invalid provision or application. [Bd. of Health, Ambulance Reg. § 22.001, eff. 12-3-73; renumbered as § 24.1, 2-28-80; renumbered as § 25.1, 10-15-81; + Life Support Reg. § 13.1, eff. 1-1-76] --10-Agency Draft of Proposed Regulation R182-01 EMERGENCY CARE Licensing and Certification NAC 450B.310 Licensing of attendants required. Unless exempted by subsection 6 of NRS 450B.160 or NRS 450B.830, no person may act in the capacity of an attendant of a service or a fire-fighting agency, including a volunteer service or agency, unless he possesses a currently valid card evidencing that he holds a license issued by the health division and authorizing him to act in that capacity . [Bd. of Health, Ambulance Reg. § 13.001, eff. 12-3-73; renumbered as § 15.1, 2-28-80](NAC A 10-14-82; 8-22-86; 8-1-91) NAC 450B.320 Licensing of attendants: Qualifications. (NRS 439.200, 450B.120) 1. The health division may not issue a license to an applicant unless all the information required by NAC 450B.330 is contained in his application and the health division is satisfied that he meets the following criteria: (a) Is 18 years of age or older as of the date of the application. (b) If he is applying to become an attendant: (1) Holds a currently valid class 3 driver's license or its equivalent issued in this state; or (2) Is employed in Nevada, makes his residence in a contiguous state and is required by reason of his residence to maintain his driver's license issued by that state equivalent to a class 3 license in this state. (c) Is able to read, speak and understand the English language. (d) Has been found by a licensed physician within the 6 [12] months immediately preceding the date on which his application is submitted to be of sound physical and mental health and free of physical defects or diseases which might impair his ability to drive or attend an ambulance, air ambulance or agency's vehicle and that determination is verified by the physician on a form approved by the health division for that purpose. (e) [Notwithstanding the provisions of paragraph (f),] Has not been convicted of any felony or misdemeanor for committing an act, which, in the judgment of the health division, indicates that the applicant might not be able to function properly as a licensee [an attendant] or to care for patients for whom he would become responsible. [(f) Has not been convicted of a third or subsequent violation of the provisions of NRS 484.379 within the 7 years immediately preceding the date of his application.] (f) [(g)] Possesses a current, valid certificate evidencing his successful completion of a program of training with testing for competency in the [basic] procedures for emergency care which is equivalent to the national standard course for an emergency medical technician at any level. (g) Submit evidence of skill verification as approved by the health division. 2. In addition, an applicant for a license as an air attendant must: (a) Meet all the prerequisites for an attendant as listed in NAC 450B.310 to 450B.350, inclusive. (b) Possess the following: (1) A currently valid certificate as an intermediate emergency medical technician or as an advanced emergency medical technician which was issued pursuant to chapter 450B of NRS; or (2) A currently valid license as a registered nurse issued pursuant to chapter 632 of NRS. --11-Agency Draft of Proposed Regulation R182-01 (c) Provide to the health division documentation verifying successful completion of a course of training approved by the medical director of the service employing him. The course must include the following: (1) Special considerations in attending a patient in an air ambulance; (2) Aircraft safety and orientation; (3) Altitude physiology and principles of atmospheric physics; (4) Familiarization with systems for air-to-ground communications; (5) Familiarization with the system of emergency medical services in the service area; (6) Survival procedures in an air ambulance crash; (7) Response procedures to accidents involving hazardous materials; (8) Use of modalities for in-flight treatment; (9) Infection control; (10) Oxygen therapy in relation to altitude; (11) Patient assessment in the airborne environment; and (12) Vital sign determination in the airborne environment. 3. In addition to the qualifications listed in subsections 1 and 2, an advanced emergency medical technician or a registered nurse providing advanced life support care [in an air ambulance] must possess a currently valid certification of completion of a course in Advanced Cardiac Life Support issued by the American Heart Association or an equivalent approved by the health division. [Bd. of Health, Ambulance Reg. § 13.005 subsecs. (a)-(g) & (i), eff. 12-3-73; A and renumbered as §§ 15.5-15.5.7.7 & 15.5.9-15.5.9.4, eff. 2-28-80]-(NAC A 10-14-82; 8-22-86; 81-91; 5-18-92; R045-97, 10-30-97) NAC 450B.330 Licensing of attendants: Application; renewal. (NRS 439.200, 450B.120) 1. An application for a license must be made upon the form prepared and prescribed by the health division. The health division shall, within 30 days after receipt of an application, have an investigation made of the applicant and the information contained on his application. Upon completion of the investigation, the health division shall issue the license for which the application was made or notify the applicant in writing, in the manner prescribed in NAC 450B.710, that the application is rejected, setting forth the reasons for the rejection and his right to appeal to the health division in the manner prescribed in NAC 439.300 to 439.395, inclusive. 2. On an initial application for a license, the applicant must submit the following: (a) The applicant’s full name; (b) His current residence; (c) His date of birth; (d) His social security number; (e) The name and address of his present and if applicable, immediately previous EMS employer; (f) A description of the last two jobs ,if EMS related, he held immediately before the application is made; (g) A statement of whether the applicant, within the 5 years immediately preceding the date of the application, has been convicted of, or forfeited bail for, a traffic violation other than a parking violation and, if so, when, where and under what circumstances the violation occurred; --12-Agency Draft of Proposed Regulation R182-01 (h) A statement of whether the applicant has been convicted of a felony or a misdemeanor other than a traffic violation and, if so, when and where the conviction occurred and a description of the offense; (i) A description of the applicant's training and experience in the transportation and care of patients; (j) A statement of whether the applicant has previously been licensed as a driver, attendant, attendant-driver or air attendant in a service, fire-fighting agency or volunteer service or agency and, if so, where and by what authority that license was issued; (k) A statement of whether such a license has ever expired or been revoked or suspended and, if so, for what cause; (l) A statement indicating compliance with child support payment in accordance with NRS 450B.183; and (m) The appropriate fee as prescribed in NAC 450B.700 [On an initial application for a license, the applicant must submit the following information:] [(a) His place of residence for 5 years before he moved to his present address and length of time he has resided in this state;] [(b) His date of birth;] [(c) His height and weight;] [(d) The color of his eyes;] [(e) The color of his hair;] [(f) His social security number;] [(g) The name and address of his employer immediately preceding his current employment;] [(h) A description of the last two jobs he held immediately before the application is made;] [(i) A statement of whether the applicant, within the 3 years immediately preceding the date of the application, has been convicted of, or forfeited bail for, a traffic violation other than a parking violation and, if so, when, where and under what circumstances the violation occurred;] [(j) A statement of whether the applicant, within the 10 years immediately preceding the date of the application, has been convicted of a felony or a misdemeanor other than a traffic violation and, if so, when and where the conviction occurred and a description of the offense;] [(k) A description of the applicant's training and experience in the transportation and care of patients;] [(l) A statement of whether the applicant has previously been licensed as a driver, attendant, attendant-driver or air attendant in a service, fire-fighting agency or volunteer service or agency and, if so, where and by what authority that license was issued; and] [(m) A statement of whether such a license has ever expired or been revoked or suspended and, if so, for what cause.] 3. An applicant for initial licensure [a license] as an attendant must file with the health division, in addition to the items specified in subsection 2 ,a valid certificate designating him as an emergency medical technician, intermediate emergency medical technician or advanced emergency medical technician. 4. An application for renewal of a license must: (a) Be made on an abbreviated form of application prescribed by the health division; [and] (b) Include information relating to any conviction of the applicant for any felony or misdemeanor occurring since the submission of the application for the initial license; and[.] (c) The appropriate fee as prescribed in NAC 450B.700. 5. The health division shall not renew a license if: --13-Agency Draft of Proposed Regulation R182-01 (a) An applicant fails to comply with the provisions of subsection 4; or (b) In the judgment of the health division, the applicant is not able to function properly as an attendant or to provide care for patients for whom he would become responsible. [Bd. of Health, Ambulance Reg. §§ 13.002-13.004, eff. 12-3-73; A and renumbered as §§ 15.2-15.4, 2-28-80]-(NAC A 10-14-82; 8-22-86; 11-12-87; 8-1-91; R045-97, 10-30-97) NAC 450B.340 Attendant Trainee License [Provisional license]. (NRS 439.200, 450B.120) 1. Upon the request of a holder of a permit to operate a [volunteer] service, the health division may issue an attendant trainee [a provisional] license to an applicant who [has joined the volunteer service but] has not completed the required training for licensure. 2. Such a license may be valid only for the period necessary for the applicant to comply with the requirements prescribed in this chapter for a regular license as an attendant, but not more than 6 months. At the completion of the attendant trainee’s [provisional licensee's] training, the operator of the [volunteer] service must submit to the health division the information required in subsection 1 of NAC 450B.320 and NAC 450B.330. 3. A person who holds an attendant trainee [a provisional] license issued under this section may serve in a [volunteer service in a] training capacity when: [accompanied by two licensed attendants.] (a) accompanied by an attendant, licensed at or above the level of the trainee, while at the scene of an emergency; or (b) accompanied by two attendants, one of which is licensed at or above the level of the trainee, while transporting patients to a medical facility. [Bd. of Health, Ambulance Reg. § 13.005 subsec. (h), eff. 12-3-73; A and renumbered as §§ 15.5.8 & 15.5.8.1, 2-28-80; § 13.006 subsec. (h), eff. 12-3-73; A and renumbered as § 15.5.10, 228-80]-(NAC A 10-14-82; 8-1-91; R045-97, 10-30-97) NAC 450B.350 License: Terms; renewal; responsibility of service or fire-fighting agency. (NRS 439.200, 450B.120) 1. The license of an attendant is not asignable or transferable to any other person. 2. A license expires on the date of expiration appearing on it. The expiration of the license shall be concurrent with the expiration date on the emergency medical technician certificate. A license shall not be valid for more than two years. The health division may designate the same year of expiration for the licenses of all attendants in a particular service or fire-fighting agency upon written request of the service or fire-fighting agency. [2. A license expires on the date of expiration appearing on it. The date of expiration for licenses is July 1 and after the initial period of effectiveness, a license expires biennially] The health division shall designate the same year of expiration for the licenses of all attendants in a particular service or fire-fighting agency.] 3. An attendant must renew his license on or before its expiration date. 4. The health division shall renew an attendant's license if: (a) The health division is satisfied that, in addition to meeting the other requirements for a renewal, the applicant has complied with the requirements, limitations, terms and conditions applicable to obtaining an initial license; and --14-Agency Draft of Proposed Regulation R182-01 [(b) A physician determines that the applicant, within the preceding 12 months, is of sound physical and mental health, is free of physical defects or diseases and is able to drive or attend an ambulance, air ambulance or agency's vehicle and verifies such a determination in a written report submitted on a form approved by the health division.] 5. A service or fire-fighting agency shall ensure that each of its attendants holds a currently valid license. 6. No official entry made upon any license may be defaced, removed or obliterated. If any such defacement, removal or obliteration occurs on any portion of a license, it is void. [Bd. of Health, Ambulance Reg. §§ 13.007-13.010, eff. 12-3-73; A and renumbered as §§ 15.6-15.9, 2-28-80]-(NAC A 10-14-82; 8-22-86; 11-12-87; 8-1-91; R045-97, 10-30-97) NAC 450B.355 Certification of first responders. (NRS 439.200, 450B.120)j 1. To be certified as a first responder, an applicant must: (a) Be 16 years of age or older; (b) Have successfully completed the national standard course for first responders or an equivalent curriculum approved by the health division; (c) Have and maintain a current, valid American Heart Association Healthcare Provider CPR card or equivalent; (d) Submit the appropriate form and the fee prescribed in NAC 450B.700;and statement indicating compliance with child support payment in accordance with NRS 450B.183. [To be certified as a first responder, an applicant must be 18 years of age or older and have successfully completed the national standard course for first responders or an equivalent curriculum approved by the health division.] 2. The applicant shall submit verification to the health division, signed by the person responsible for conducting the training, that the applicant has successfully completed the course or curriculum. 3. Upon certification, a first responder may render services in rescue, first aid , [and] cardiopulmonary resuscitation, automatic and semi-automatic defibrillators. 4. An initial first responder certification shall be for a period not to exceed two years and shall expire on the date of expiration appearing on it. (Added to NAC by Bd. of Health, eff. 8-1-91; A by R045-97, 10-30-97) NAC 450B.360 Certification of emergency medical technicians: Qualifications; exception; contents of application; verification of completion of national standard course. 1. [Except as otherwise provided in subsection 2,] To be certified as an emergency medical technician, an applicant must: (a) Submit an application to the health division on the form prepared and prescribed by the health division; [health authority which has jurisdiction where the applicant resides;] (b) Be 18 years of age or older on the date of the application; (c) Have successfully completed the national standard course for emergency medical technicians developed by the United States Department of Transportation and approved by the health division; (d) Be able to demonstrate proficiency in the oral and written expression of the English language; [and] (e) Submit evidence of skill verification as approved by the health division; --15-Agency Draft of Proposed Regulation R182-01 (f) [(e)] Pass a written examination prepared and administered by the health division or approved by the health division; (g) Have and maintain a current, valid American Heart Association Healthcare Provider CPR card or equivalent; (h) Submit the appropriate form and the fee prescribed in NAC 450B.700;and statement indicating compliance with child support payment in accordance with NRS 450B.183. [2. A health authority may issue a certificate as an emergency medical technician to a person who is at least 16 years of age but not more than 18 years of age if the health authority determines that the applicant is otherwise qualified for a certificate pursuant to this section.] [3. An application for a certificate as an emergency medical technician must include, without limitation:] [(a) The applicant's name, date of birth, gender, residential address, telephone number and social security number;] [(b) A statement whether the applicant has been issued a certificate as an emergency medical technician and, if so, the name and location of each agency which issued the certificate and the period during which the certificate was in effect;] [(c) A statement whether the applicant's certificate as an emergency medical technician has been revoked or suspended;] [(d) A statement whether the applicant has been denied a certificate as an emergency medical technician; and] [(e) A statement signed by the applicant that the information contained in the application is true.] 2. [4] The applicant must submit with his application verification that he has successfully completed the national standard course for emergency medical technicians developed by the United States Department of Transportation and approved by the health division. The verification must be signed by the physician of record who was responsible for the training. [Bd. of Health, Ambulance Reg. §§ 14.001 & 14.002, eff. 12-3-73; A and renumbered as §§ 16.2 & 16.3, 2-28-80]-(NAC A 8-22-86; 11-12-87; 8-1-91; 11-1-95) NAC 450B.363 Certification of emergency medical technician trained in another state. (NRS 439.200, 450B.120) 1. The health division may issue a certificate as an emergency medical technician to an applicant trained in another state if the following requirements are met: (a) The applicant: (1) Is currently a resident of Nevada; (2) Will be a resident of Nevada within 6 months after applying for certification; or (3) Is a resident of a state contiguous to Nevada and is employed by or an active volunteer with a service or fire-fighting agency in Nevada. (b) The applicant submits the appropriate form and the fee prescribed in NAC 450B.700. (c) The applicant: (1) Has successfully completed training in a course approved by the appropriate authority in the other state, which course was at least equivalent to the national standard course for emergency medical technicians, and holds a valid certificate as an emergency medical technician issued by an authorized agency in the other state; or (2) Holds a valid certificate as an emergency medical technician issued by the national registry for emergency medical technicians. --16-Agency Draft of Proposed Regulation R182-01 (d) The applicant's certification or registration in the other state has not been revoked, terminated or suspended pursuant to any disciplinary proceeding. (e) The health division receives verification of his certificate as an emergency medical technician from the issuing agency of the other state on a form provided by the health division. 2. The health division may require the applicant to: (a) Demonstrate his practical skills. (b) Pass a written examination administered by the health division. 3. An individual who has been issued a certification pursuant to this section will be subject to the renewal process in accordance with NAC 450B.366. Added to NAC by Bd. of Health, eff. 10-14-82; A 8-22-86; 8-1-91; R045-97, 10-30-97) NAC 450B.364 Certification of emergency medical technicians: Issuance of certificate. A health authority shall not issue a certificate as an emergency medical technician to an applicant who resides outside the jurisdiction of that health authority unless that health authority and the health authority which has jurisdiction where the applicant resides agree that the health authority which does not have jurisdiction may issue the certificate. (Added to NAC by Bd. of Health, eff. 11-1-95) NAC 450B.366 Expiration and renewal of certificate as first responder or emergency medical technician. (NRS 439.200, 450B.120) 1. A certificate as a first responder or an emergency medical technician expires on the date of expiration appearing on it, and after the initial period of effectiveness, a certificate expires biennially. The health division shall designate the date of expiration of each certificate. 2. Such a certificate is renewable if: (a) The health division [officer] determines that the holder of the certificate has, before the date of expiration, successfully completed: (1) A course in continuing training which is equivalent to the national standard refresher course for first responders or emergency medical technicians and is approved by the health division; or (2) Any other program of continuing education approved by the health division. Such a program may not be approved unless the attendance requirement for a: (I) First responder is at least 20 hours for certification renewal. (II) Emergency medical technician is at least 30 hours for certification renewal. (b) The holder submits, [within the 3 months immediately] before the date his certificate expires, an application evidencing that he has met the requirements as set forth in paragraph (a). 3. An individual who has been issued a Nevada certification through reciprocity will not be allowed to renew their certification through reciprocity and will be subject to the renewal process in accordance with this section. (Added to NAC by Bd. of Health, eff. 10-14-82; A 8-22-86; 8-1-91; R045-97, 10-30-97) NAC 450B.374 Late renewal of certificate as emergency medical technician or first responder. (NRS 439.200, 450B.120) 1. If an emergency medical technician or first responder is unable to attend an approved course for continuing training required for renewal of his certificate, or otherwise comply with the requirements for renewal, within the prescribed period, he shall [may] submit a written request for a late renewal on a form provided by the health division. --17-Agency Draft of Proposed Regulation R182-01 2. To be granted a late renewal of his certificate, the applicant must: (a) Successfully meet all of the requirements for renewal; (b) Submit verification that he has met such requirements; and (c) For an emergency medical technician, pass a written [and practical] examination administered [as approved] by the health division. (d) Submit evidence of skill verification as approved by the health division. 3. The applicant for late renewal of a certificate must pay the fee required by NAC 450B.700. 4. The health division shall deny an application for late renewal if more than 3 years have elapsed from the date of the expiration of the certificate. (Added to NAC by Bd. of Health, eff. 11-12-87; A 8-1-91; R045-97, 10-30-97) NAC 450B.3745 Training and certification of intermediate emergency medical technician. (NRS 439.200, 450B.120) To be trained and certified as an intermediate emergency medical technician, an applicant must: 1. Possess a currently valid certificate as an emergency medical technician; 2. Have successfully completed the national standard course for intermediate emergency medical technicians or an equivalent curriculum approved by the health division; 3. Submit verification signed by the physician of record who was responsible for the training that the applicant has successfully completed the course or curriculum; [and] 4. Submit evidence of skill verification as approved by the health division; and [4. Possess or have applied for a license as an attendant.] 5. Successfully pass a written examination administered or approved by the health division. 6. Have and maintain a current, valid American Heart Association Healthcare Provider CPR card or equivalent; (Added to NAC by Bd. of Health, eff. 11-12-87; A 8-1-91; R045-97, 10-30-97) NAC 450B.375 Late renewal of certificate as intermediate emergency medical technician. (NRS 439.200, 450B.120) 1. If an intermediate emergency medical technician is unable to renew his certificate when required, he must [may] submit a request for a late renewal on a form provided by the health division. 2. Upon approval for late renewal the applicant must submit evidence of: (a) Successfully meeting all of the requirements for renewal of a certificate as an emergency medical technician; (b) Provide evidence of skill verification as approved by the health division. (c) Successfully pass a written examination administered by the health division with a minimum score of 80%. (d) Payment of the required fee, required by NAC 450B.700. late renewal may be authorized for the remainder of the new period of certification. [2.If he holds a current license as an attendant issued by the health division, upon:] [(a) Demonstrating his proficiency in practical skills to the medical director of a service or fire-fighting agency;] [(b) Successfully meeting all of the requirements for renewal of a certificate as an emergency medical technician;] --18-Agency Draft of Proposed Regulation R182-01 [(c) Verifying that he is or will be employed by or an active volunteer with a service or firefighting agency that holds a current permit to operate at the level of intermediate emergency care; and] [(d) Payment of the required fee,] 3. The health division shall deny an application for late renewal if more than 3 years have elapsed from the date of the expiration of the certificate. (Added to NAC by Bd. of Health, eff. 8-22-86; A 8-1-91; R045-97, 10-30-97) NAC 450B.378 Certification of intermediate emergency medical technician trained in another state. (NRS 439.200, 450B.120) 1. The health division may issue a certificate as an intermediate emergency medical technician to a person trained in another state if the following requirements are met: (a) The applicant: (1) Is currently a resident of Nevada; (2) Will be a resident of Nevada within 6 months after applying for certification; or (3) Is a resident of a state contiguous to Nevada and is employed by or an active volunteer with a service or fire-fighting agency in Nevada that holds a current permit to operate at the level of intermediate emergency care. (b) The applicant submits the appropriate form and the fee prescribed in NAC 450B.700. (c) The applicant: (1) Has successfully completed training in a course which was at least equivalent to the national standard course for intermediate emergency medical technicians [the course approved in Nevada] and holds a valid certificate as an intermediate emergency medical technician or an advanced medical technician issued by an authorized agency in the other state; or (2) Holds a valid certificate as an intermediate emergency medical technician issued by the national registry for emergency medical technicians. (d) The applicant's certification or registration in the other state has not been revoked, terminated or suspended pursuant to any disciplinary proceeding. (e) The health division receives verification of his certificate as intermediate emergency medical technician or advanced emergency medical technician from the issuing agency of the other state on a form provided by the health division. (f) Has and maintain a current, valid American Heart Association Healthcare Provider CPR card or equivalent; 2. The health division may require the applicant to: (a) Provide evidence of skill verification by a qualified instructor. [(a) Demonstrate his practical skills to the medical advisory board or the medical director of a service or fire-fighting agency.] (b) Pass a written examination administered by the health division. (Added to NAC by Bd. of Health, eff. 8-22-86; A 8-1-91; R045-97, 10-30-97) [NAC 450B.379 Reissuance of expired certificate of emergency medical technician or intermediate emergency medical technician.] [1. A person who allows his certificate as an emergency medical technician or intermediate emergency medical technician to expire may have his certificate reissued if the following conditions are met:] --19-Agency Draft of Proposed Regulation R182-01 [(a) Within 12 months after the date of the expiration of the certificate, he notifies the health division in writing of his intent to go on inactive status. Upon receipt of the written notice, the health division shall release to him his personnel file to retain for resubmission at the time he applies for reissuance of his certificate.] [(b) At the time of the application for reissuance of his certificate, he successfully completes a written and practical examination, given by or approved by the health division, with a score of at least 80 percent. In the case of an intermediate emergency medical technician, in addition to the examination, he must also successfully demonstrate the authorized intermediate procedures, to a physician designated to evaluate the demonstration of the procedures, at a level of retention of the skills of at least 80 percent.] [(c) If he will be actively engaged as an attendant for an ambulance or air ambulance or an attendant assigned to the duty of medical rescue on an agency's vehicle, he holds or has applied for a current license as an attendant issued by the health division.] [(d) He provides a letter from the operator of a service, a fire-fighting agency holding a permit or the chief officer of a fire department, governmental agency or other organization recognized by the health division which responds to medical emergencies that he is an active employee or volunteer of the service, agency, department or other agency or organization.] [(e) He pays the required fee.] [(f) He successfully completes a probationary period on the job of not less than 3 and not more than 5 months and a written recommendation is received by the health division from the service, agency or organization for whom he works or serves as a volunteer that the certificate be reissued.] [2.An applicant who fails the examination or the demonstration of procedures with a score of 70 percent to 79 percent, inclusive, may retake the examination one time, or be provided another opportunity to demonstrate the procedures, no earlier than 30 days and no later than 90 days after the first examination or demonstration.] [(Added to NAC by Bd. of Health, eff. 8-22-86)] NAC 450B.380 Certificate as intermediate emergency medical technician: Expiration; examination of holder for retention of skills; renewal. (NRS 439.200, 450B.120) 1. A certificate as an intermediate emergency medical technician expires on the date of expiration appearing on it, and after the initial period of effectiveness, a certificate expires biennially. The health division shall designate the date of expiration of each certificate. 2. A certified intermediate emergency medical technician must undergo at least one skill verification [examination] by a qualified instructor or the medical director of the service or firefighting agency every 12 months to verify retention of his skills in order to maintain his certification. [The medical director may recommend revocation of certification at any time.] 3. In making the skill verification [examination] of an intermediate emergency medical technician, the medical director or qualified instructor shall determine whether the intermediate emergency medical technician retains his skills in: (a) Each technique for which certification has been issued; and (b) The administration of approved medications, and enter that determination on a form provided by the health division. [The medical director shall forward the form to the health division.] 4. To renew his certificate, an intermediate emergency medical technician must: --20-Agency Draft of Proposed Regulation R182-01 (a) Meet the requirements for renewal of his certificate as an emergency medical technician; (b) Before his certificate expires, submit an application evidencing that he has met the requirements of this section. (c) Submit payment of the required fee, required by NAC 450B.700 5. An individual who has been issued a Nevada certification through reciprocity will not be allowed to renew their certification through reciprocity and will be subject to the renewal process in accordance with this section. [(b) Be employed by a service or fire-fighting agency or active in a volunteer service or firefighting agency which holds an endorsement authorizing its operation at the level of intermediate or advanced emergency care; and] [(c)] Three months before his certificate expires, submit an application evidencing that he has met the requirements of this section. [Bd. of Health, Ambulance Reg. § 14.003 subsec. 4, eff. 6-6-76; A and renumbered as §§ 16.6.3-16.6.4.1, 2-28-80]-(NAC A 10-14-82; 8-22-86; 11-12-87; 8-1-91; R045-97, 10-30-97) Authorized Activities NAC 450B.383 Emergency medical technician: Authorized practices. (NRS 450B.120) 1. An emergency medical technician may: (a) Render services in rescue, first aid and cardiopulmonary resuscitation in accordance with national standard course for emergency medical technician - basic; (b) Use an automatic external defibrillator or a semiautomatic external defibrillator to defibrillate a patient. [(c) Apply a pneumatic antishock garment:] [(1) As an attendant for a service or fire-fighting agency; and] [(2) In accordance with procedures established by the medical director of the service or fire-fighting agency.] 2. As used in this section: (a) "Automatic external defibrillator" means a device that is capable of the automatic analysis of heart rhythm and that will charge and deliver an electrical countershock after electronically detecting the presence of ventricular fibrillation or rapid ventricular tachycardia. (b) "Semiautomatic external defibrillator" means a device that is capable of electronically detecting ventricular fibrillation and rapid ventricular tachycardia, but which requires a command by the operator to deliver an electrical countershock. 3. In addition, as a licensed attendant provide care for sick and injured persons at the scene of an emergency and during transport in accordance with State and local medical protocols as approved by the health division. (Added to NAC by Bd. of Health, eff. 8-1-91; A by R055-99, 9-27-99) NAC 450B.384 Emergency medical technician: Practice beyond scope of certificate prohibited; exception. The holder of a certificate issued pursuant to NAC 450B.360 shall not practice beyond the scope of his certificate unless authorized by the health authority which issued the certificate. (Added to NAC by Bd. of Health, eff. 11-1-95) --21-Agency Draft of Proposed Regulation R182-01 NAC 450B.385 Intermediate emergency medical technician: Authorized practices. An intermediate emergency medical technician may, in addition to the authorized activities of an emergency medical technician: 1. During training in a clinical setting, perform venipuncture and intra-osseous infusion, administer parenteral medications and perform esophageal or endotracheal intubation under the supervision of a physician or registered nurse supervised by a physician. 2. As a licensed attendant, Under the supervision of a physician or a registered nurse supervised by a physician, or under such prescribed conditions as set forth by the medical director pursuant to written protocols [standing orders] of the service or fire-fighting agency, and in accordance with State medical protocols, perform such procedures and administer such medications as are approved by the board of health [officer] and recommended by the medical director of the service or fire-fighting agency.[, which may include, but are not limited to:] [(a) Performing venipuncture and intra-osseous infusion for the administration of intravenous therapy and the maintenance of intravenous therapy initiated by other authorized persons;] [(b) Performing esophageal or endotracheal intubation; and]. [(c) Administering 50 percent dextrose, naloxone and intravenous solutions other than blood or blood products.] (Added to NAC by Bd. of Health, eff. 11-12-87; A 8-1-91) NAC 450B.390 Performance of special procedures: Venipuncture, management of airways, administration of medication and performance of intra-osseous infusion. (NRS 439.200, 450B.120) 1. The following are the circumstances and conditions under which the special procedures of venipuncture, management of airways, administration of medication and performance of intraosseous infusion must be documented by a licensed attendant who is an intermediate emergency medical technician: (a) Any oral order from the physician, or a registered nurse acting on the authority of a physician, authorizing the attendant to perform one of these procedures must originate from an emergency department of a hospital or any other site designated by the health division and must be recorded on magnetic tape or digital disc. (b) Each tape or digital disc recording of a physician's oral orders to an attendant concerning these procedures must be retained by the hospital, [or] the facility issuing the medical directions or the dispatch center for at least 90 days [5 years] after the recording is made. (c) The attendant shall enter the physician's oral order or circumstances under which the emergency medical technician performed pursuant to a written order or protocol on the report of emergency care. (d) The entry on the report of emergency care must be countersigned by the physician receiving the patient unless the intermediate emergency medical technician was performing pursuant to a written order or protocol. 2. The fluids, tubing and needles used for venipuncture, equipment for the management of airways and the other supplies and medications needed to support the special procedures performed by the authorized attendants must not be carried or stored in any vehicle other than an ambulance or agency's vehicle operated under a permit. The special procedures may be performed only when the attendant is functioning as part of the ambulance's team or as an attendant of a fire-fighting agency at the scene of an emergency. --22-Agency Draft of Proposed Regulation R182-01 3. A person may perform one of the special procedures only if he is: (a) A licensed attendant at the [and an] intermediate emergency medical technician level; [or a registered nurse who is actively employed by or a volunteer with a service or fire-fighting agency that holds a current permit to operate at the level of intermediate emergency care;] and (b) Authorized for the procedure by the medical director of the service or fire-fighting agency [or the medical advisory board of the service that provides intermediate emergency care]. 4. The health division shall suspend the license and certificate of any person who performs one of these procedures without proper authorization or not in accordance with this section. [Bd. of Health, Ambulance Reg. § 14.003 subsec. 3, eff. 6-6-76; A and renumbered as § 16.6.2, 2-28-80; §§ 16.6-16.6.1.4 & 16.7-16.9, eff. 2-28-80; § 14.003 subsec. 5, eff. 6-6-76; A and renumbered as § 16.10, 2-28-80]-(NAC A 10-14-82; 8-22-86; 8-1-91; R045-97, 10-30-97) ADVANCED EMERGENCY CARE NAC 450B.400 Certification: Qualifications. (NRS 439.200, 450B.120) To be certified as an advanced emergency medical technician, an applicant must: 1. Have successfully completed the national standard course for advanced emergency medical technicians or an equivalent curriculum approved by the