144E.101 Ambulance service requirements.
Subdivision 1. Personnel. (a) No publicly or privately owned ambulance service shall be operated in the state unless its ambulance service personnel are certified, appropriate to the type of ambulance service being provided, according to section 144E.28 or meet the staffing criteria specific to the type of ambulance service.
(b) An ambulance service shall have a medical director as provided under section 144E.265.
Subd. 2. Patient care. When a patient is being transported, at least one of the ambulance service personnel must be in the patient compartment. If advanced life support procedures are required, an EMT-P, a registered nurse qualified under section 144E.001, subdivision 3a, clause (2), item (i), or a physician assistant qualified under section 144E.001, subdivision 3a, clause (3), item (i), shall be in the patient compartment.
Subd. 3. Continual service. An ambulance service shall offer service 24 hours per day every day of the year, unless otherwise authorized under subdivisions 8 and 9.
Subd. 4. Denial of service prohibited. An ambulance service shall not deny prehospital care to a person needing emergency ambulance service because of inability to pay or because of the source of payment for services if the need develops within the licensee's primary service area or when responding to a mutual aid call. Transport for the patient may be limited to the closest appropriate emergency medical facility.
Subd. 5. Types of service. The board shall regulate the following types of ambulance service:
(1) basic life support;
(2) advanced life support;
(3) part-time advanced life support; and
(4) specialized life support.
Subd. 6. Basic life support. (a) Except as provided in paragraph (e), a basic life support ambulance shall be staffed by at least two ambulance service personnel, at least one of which must be an EMT, who provide a level of care so as to ensure that:
(1) life-threatening situations and potentially serious injuries are recognized;
(2) patients are protected from additional hazards;
(3) basic treatment to reduce the seriousness of emergency situations is administered; and
(4) patients are transported to an appropriate medical facility for treatment.
(b) A basic life support service shall provide basic airway management.
(c) By January 1, 2001, a basic life support service shall provide automatic defibrillation, as provided in section 144E.103, subdivision 1, paragraph (b).
(d) A basic life support service licensee's medical director may authorize the ambulance service personnel to carry and to use medical antishock trousers and to perform intravenous infusion if the ambulance service personnel have been properly trained.
(e) Upon application from an ambulance service that includes evidence demonstrating hardship, the board may grant a temporary variance from the staff requirements in paragraph (a) and may authorize a basic life support ambulance to be staffed by one EMT and one first responder. The variance shall apply to basic life support ambulances operated by the ambulance service for up to one year from the date of the variance's issuance. When a variance expires, an ambulance service may apply for a new variance under this paragraph. For purposes of this paragraph, "ambulance service" means either an ambulance service whose primary service area is located outside the metropolitan counties listed in section 473.121, subdivision 4, and outside the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud; or an ambulance service based in a community with a population of less than 1,000.
Subd. 7. Advanced life support. (a) An advanced life support ambulance shall be staffed by at least:
(1) one EMT and one EMT-P;
(2) one EMT and one registered nurse who is an EMT, is currently practicing nursing, and has passed a paramedic practical skills test approved by the board and administered by a training program; or
(3) one EMT and one physician assistant who is an EMT, is currently practicing as a physician assistant, and has passed a paramedic practical skills test approved by the board and administered by a training program.
(b) An advanced life support service shall provide basic life support, as specified under subdivision 6, paragraph (a), advanced airway management, manual defibrillation, and administration of intravenous fluids and pharmaceuticals.
(c) In addition to providing advanced life support, an advanced life support service may staff additional ambulances to provide basic life support according to subdivision 6. When routinely staffed and equipped as a basic life support service according to subdivision 6 and section 144E.103, subdivision 1, the vehicle shall not be marked as advanced life support.
(d) An ambulance service providing advanced life support shall have a written agreement with its medical director to ensure medical control for patient care 24 hours a day, seven days a week. The terms of the agreement shall include a written policy on the administration of medical control for the service. The policy shall address the following issues:
(i) two-way communication for physician direction of ambulance service personnel;
(ii) patient triage, treatment, and transport;
(iii) use of standing orders; and
(iv) the means by which medical control will be provided 24 hours a day.
The agreement shall be signed by the licensee's medical director and the licensee or the licensee's designee and maintained in the files of the licensee.
(e) When an ambulance service provides advanced life support, the authority of an EMT-P, Minnesota registered nurse-EMT, or Minnesota registered physician assistant-EMT to determine the delivery of patient care prevails over the authority of an EMT.
Subd. 8. Part-time advanced life support. (a) A part-time advanced life support service shall meet the staffing requirements under subdivision 7, paragraph (a); provide service as required under subdivision 7, paragraph (b), for less than 24 hours every day; and meet the equipment requirements specified in section 144E.103.
(b) A part-time advanced life support service shall have a written agreement with its medical director to ensure medical control for patient care during the time the service offers advanced life support. The terms of the agreement shall include a written policy on the administration of medical control for the service and address the issues specified in subdivision 7, paragraph (d).
Subd. 9. Specialized life support. A specialized ground life support service providing advanced life support shall be staffed by at least one EMT and one EMT-P, registered nurse, or physician assistant. A specialized life support service shall provide basic or advanced life support as designated by the board, and shall be restricted by the board to:
(1) operation less than 24 hours of every day;
(2) designated segments of the population;
(3) certain types of medical conditions; or
(4) air ambulance service that includes fixed-wing or rotor-wing.
Subd. 10. Driver. A driver of an ambulance must possess a current driver's license issued by any state and must have attended an emergency vehicle driving course approved by the licensee. The emergency vehicle driving course must include actual driving experience.
Subd. 11. Personnel roster and files. (a) An ambulance service shall maintain:
(1) at least two ambulance service personnel on a written on-call schedule;
(2) a current roster of its ambulance service personnel, including the name, address, and qualifications of its ambulance service personnel; and
(3) files documenting personnel qualifications.
(b) A licensee shall maintain in its files the name and address of its medical director and a written statement signed by the medical director indicating acceptance of the responsibilities specified in section 144E.265, subdivision 2.
Subd. 12. Mutual aid agreement. A licensee shall have a written agreement with at least one neighboring licensed ambulance service for coverage during times when the licensee's ambulances are not available for service in its primary service area. The agreement must specify the duties and responsibilities of the agreeing parties. A copy of each mutual aid agreement shall be maintained in the files of the licensee.
Subd. 13. Service outside primary service area. A licensee may provide its services outside of its primary service area only if requested by a transferring physician or ambulance service licensed to provide service in the primary service area when it can reasonably be expected that:
(1) the response is required by the immediate medical need of an individual; and
(2) the ambulance service licensed to provide service in the primary service area is unavailable for appropriate response.
Subd. 14. Trauma triage and transport guidelines. By July 1, 2009, a licensee shall have written age appropriate trauma triage and transport guidelines consistent with the criteria issued by the Trauma Advisory Council established under section 144.608 and approved by the board. The board may approve a licensee's requested deviations to the guidelines due to the availability of local or regional trauma resources if the changes are in the best interest of the patient's health.