1.1                          A bill for an act 
  1.2             relating to health; requiring all ambulance services 
  1.3             to provide epinephrine treatment for allergic 
  1.4             reactions; modifying EMT training requirements; 
  1.5             amending Minnesota Statutes 2000, sections 144E.101, 
  1.6             subdivision 7, by adding a subdivision; 144E.28, 
  1.7             subdivision 7; Minnesota Statutes 2001 Supplement, 
  1.8             section 144E.101, subdivision 6. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 2001 Supplement, section 
  1.11  144E.101, subdivision 6, is amended to read: 
  1.12     Subd. 6.  [BASIC LIFE SUPPORT.] (a) Except as provided in 
  1.13  paragraph (e), a basic life support ambulance shall be staffed 
  1.14  by at least two ambulance service personnel, at least one of 
  1.15  which must be an EMT, who provide a level of care so as to 
  1.16  ensure that: 
  1.17     (1) life-threatening situations and potentially serious 
  1.18  injuries are recognized; 
  1.19     (2) patients are protected from additional hazards; 
  1.20     (3) basic treatment to reduce the seriousness of emergency 
  1.21  situations is administered; and 
  1.22     (4) patients are transported to an appropriate medical 
  1.23  facility for treatment. 
  1.24     (b) A basic life support service shall provide basic airway 
  1.25  management and administration of premeasured subcutaneous 
  1.26  epinephrine to treat an anaphylaxis allergic reaction according 
  1.27  to subdivision 14.  
  2.1      (c) By January 1, 2001, a basic life support service shall 
  2.2   provide automatic defibrillation, as provided in section 
  2.3   144E.103, subdivision 1, paragraph (b).  
  2.4      (d) A basic life support service licensee's medical 
  2.5   director may authorize the ambulance service personnel to carry 
  2.6   and to use medical antishock trousers and to perform intravenous 
  2.7   infusion if the ambulance service personnel have been properly 
  2.8   trained. 
  2.9      (e) Upon application from an ambulance service that 
  2.10  includes evidence demonstrating hardship, the board may grant a 
  2.11  temporary variance from the staff requirements in paragraph (a) 
  2.12  and may authorize a basic life support ambulance to be staffed 
  2.13  by one EMT and one first responder.  The variance shall apply to 
  2.14  basic life support ambulances operated by the ambulance service 
  2.15  for up to one year from the date of the variance's issuance.  
  2.16  When a variance expires, an ambulance service may apply for a 
  2.17  new variance under this paragraph.  For purposes of this 
  2.18  paragraph, "ambulance service" means either an ambulance service 
  2.19  whose primary service area is located outside the metropolitan 
  2.20  counties listed in section 473.121, subdivision 4, and outside 
  2.21  the cities of Duluth, Mankato, Moorhead, Rochester, and St. 
  2.22  Cloud; or an ambulance service based in a community with a 
  2.23  population of less than 1,000. 
  2.24     Sec. 2.  Minnesota Statutes 2000, section 144E.101, 
  2.25  subdivision 7, is amended to read: 
  2.26     Subd. 7.  [ADVANCED LIFE SUPPORT.] (a) An advanced life 
  2.27  support ambulance shall be staffed by at least: 
  2.28     (1) one EMT and one EMT-P; 
  2.29     (2) one EMT and one registered nurse who is an EMT, is 
  2.30  currently practicing nursing, and has passed a paramedic 
  2.31  practical skills test approved by the board and administered by 
  2.32  a training program; or 
  2.33     (3) one EMT and one physician assistant who is an EMT, is 
  2.34  currently practicing as a physician assistant, and has passed a 
  2.35  paramedic practical skills test approved by the board and 
  2.36  administered by a training program. 
  3.1      (b) An advanced life support service shall provide basic 
  3.2   life support, as specified under subdivision 6, paragraph (a), 
  3.3   advanced airway management, manual defibrillation, and 
  3.4   administration of intravenous fluids and pharmaceuticals, 
  3.5   including premeasured subcutaneous epinephrine to treat an 
  3.6   anaphylaxis allergic reaction according to subdivision 14. 
  3.7      (c) In addition to providing advanced life support, an 
  3.8   advanced life support service may staff additional ambulances to 
  3.9   provide basic life support according to subdivision 6.  When 
  3.10  routinely staffed and equipped as a basic life support service 
  3.11  according to subdivision 6 and section 144E.103, subdivision 1, 
  3.12  the vehicle shall not be marked as advanced life support.  
  3.13     (d) An ambulance service providing advanced life support 
  3.14  shall have a written agreement with its medical director to 
  3.15  ensure medical control for patient care 24 hours a day, seven 
  3.16  days a week.  The terms of the agreement shall include a written 
  3.17  policy on the administration of medical control for the 
  3.18  service.  The policy shall address the following issues:  
  3.19     (i) two-way communication for physician direction of 
  3.20  ambulance service personnel; 
  3.21     (ii) patient triage, treatment, and transport; 
  3.22     (iii) use of standing orders; and 
  3.23     (iv) the means by which medical control will be provided 24 
  3.24  hours a day. 
  3.25     The agreement shall be signed by the licensee's medical 
  3.26  director and the licensee or the licensee's designee and 
  3.27  maintained in the files of the licensee. 
  3.28     (e) When an ambulance service provides advanced life 
  3.29  support, the authority of an EMT-P, Minnesota registered 
  3.30  nurse-EMT, or Minnesota registered physician assistant-EMT to 
  3.31  determine the delivery of patient care prevails over the 
  3.32  authority of an EMT. 
  3.33     Sec. 3.  Minnesota Statutes 2000, section 144E.101, is 
  3.34  amended by adding a subdivision to read: 
  3.35     Subd. 14.  [EPINEPHRINE ADMINISTRATION.] Notwithstanding 
  3.36  any law regarding scope of practice or administration of drugs 
  4.1   to the contrary, ambulance service personnel trained according 
  4.2   to this subdivision may administer premeasured subcutaneous 
  4.3   epinephrine to treat an anaphylaxis allergic reaction.  An 
  4.4   ambulance service licensee's medical director shall ensure that: 
  4.5      (1) all ambulance service personnel who administer 
  4.6   epinephrine have satisfactorily completed board-approved 
  4.7   training in the administration of subcutaneous epinephrine to 
  4.8   treat an anaphylaxis allergic reaction; 
  4.9      (2) at least one ambulance service personnel who is trained 
  4.10  to administer epinephrine is on duty at all times; 
  4.11     (3) ambulance service personnel who administer epinephrine 
  4.12  receive, at least every two years, continuing education or 
  4.13  clinical training in the administration of subcutaneous 
  4.14  epinephrine to treat an anaphylaxis allergic reaction; and 
  4.15     (4) the ambulance service maintains standing orders for the 
  4.16  administration of subcutaneous epinephrine to treat an 
  4.17  anaphylaxis allergic reaction. 
  4.18     Sec. 4.  Minnesota Statutes 2000, section 144E.28, 
  4.19  subdivision 7, is amended to read: 
  4.20     Subd. 7.  [RENEWAL.] (a) Before the expiration date of 
  4.21  certification, an applicant for renewal of certification as an 
  4.22  EMT shall:  
  4.23     (1) successfully complete a course in cardiopulmonary 
  4.24  resuscitation that is approved by the board or the licensee's 
  4.25  medical director; and 
  4.26     (2) take the United States Department of Transportation EMT 
  4.27  refresher course and successfully pass the practical skills test 
  4.28  portion of the course, or successfully complete 48 hours of 
  4.29  continuing education in EMT programs that are consistent with 
  4.30  the United States Department of Transportation National Standard 
  4.31  Curriculum or its equivalent as approved by the board or as 
  4.32  approved by the licensee's medical director and pass a practical 
  4.33  skills test approved by the board and administered by a training 
  4.34  program approved by the board.  The cardiopulmonary 
  4.35  resuscitation course and practical skills test may be included 
  4.36  as part of the refresher course or continuing education renewal 
  5.1   requirements.  Twenty-four Twenty-eight of the 48 hours must 
  5.2   include at least four hours of instruction in each of the 
  5.3   following six seven categories: 
  5.4      (i) airway management and resuscitation procedures; 
  5.5      (ii) circulation, bleeding control, and shock; 
  5.6      (iii) human anatomy and physiology, patient assessment, and 
  5.7   medical emergencies; 
  5.8      (iv) injuries involving musculoskeletal, nervous, 
  5.9   digestive, and genito-urinary systems; 
  5.10     (v) environmental emergencies and rescue techniques; and 
  5.11     (vi) emergency childbirth and other special situations; and 
  5.12     (vii) administration of premeasured subcutaneous 
  5.13  epinephrine to treat an anaphylaxis allergic reaction. 
  5.14     (b) Before the expiration date of certification, an 
  5.15  applicant for renewal of certification as an EMT-I or EMT-P 
  5.16  shall:  
  5.17     (1) for an EMT-I, successfully complete a course in 
  5.18  cardiopulmonary resuscitation that is approved by the board or 
  5.19  the licensee's medical director and for an EMT-P, successfully 
  5.20  complete a course in advanced cardiac life support that is 
  5.21  approved by the board or the licensee's medical director; and 
  5.22     (2) successfully complete 48 hours of continuing education 
  5.23  in emergency medical training programs, appropriate to the level 
  5.24  of the applicant's EMT-I or EMT-P certification, that are 
  5.25  consistent with the United States Department of Transportation 
  5.26  National Standard Curriculum or its equivalent as approved by 
  5.27  the board or as approved by the licensee's medical director.  An 
  5.28  applicant may take the United States Department of 
  5.29  Transportation Emergency Medical Technician refresher course or 
  5.30  its equivalent without the written or practical test as approved 
  5.31  by the board, and as appropriate to the applicant's level of 
  5.32  certification, as part of the 48 hours of continuing education.  
  5.33  Each hour of the refresher course, the cardiopulmonary 
  5.34  resuscitation course, and the advanced cardiac life support 
  5.35  course counts toward the 48-hour continuing education 
  5.36  requirement.  At least four of the 48 hours must include 
  6.1   instruction in the administration of premeasured subcutaneous 
  6.2   epinephrine to treat an anaphylaxis allergic reaction. 
  6.3      (c) Certification shall be renewed every two years. 
  6.4      (d) If the applicant does not meet the renewal requirements 
  6.5   under this subdivision, the applicant's certification expires. 
  6.6      Sec. 5.  [EFFECTIVE DATE.] 
  6.7      Sections 1 to 4 are effective January 1, 2003.