1.1                          A bill for an act 
  1.2             relating to health; defining and regulating first 
  1.3             responders; requiring permits and licenses; providing 
  1.4             penalties; amending Minnesota Statutes 1994, section 
  1.5             144.801, by adding subdivisions; proposing coding for 
  1.6             new law in Minnesota Statutes, chapter 144. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 1994, section 144.801, is 
  1.9   amended by adding a subdivision to read: 
  1.10     Subd. 11.  [FIRST RESPONDER.] "First responder" means an 
  1.11  individual who is registered by the commissioner as having 
  1.12  successfully completed the department of transportation first 
  1.13  responder course or its equivalent as approved by the 
  1.14  commissioner. 
  1.15     Sec. 2.  Minnesota Statutes 1994, section 144.801, is 
  1.16  amended by adding a subdivision to read: 
  1.17     Subd. 12.  [DESIGNATED FIRST RESPONDER.] "Designated first 
  1.18  responder" means a designated first responder dispatched by a 
  1.19  public safety answering point to the scene of an injury, 
  1.20  illness, or pregnancy in an out-of-hospital setting to provide 
  1.21  medical care before the arrival of a public safety answering 
  1.22  point dispatched licensed ambulance service. 
  1.23     Sec. 3.  Minnesota Statutes 1994, section 144.801, is 
  1.24  amended by adding a subdivision to read: 
  1.25     Subd. 13.  [ADVANCED PROCEDURES OR ADVANCED 
  1.26  SKILLS.] "Advanced procedures" or "advanced skills" means those 
  2.1   procedures or skills that require education and training beyond 
  2.2   that offered in the department of transportation first responder 
  2.3   course curriculum. 
  2.4      Sec. 4.  Minnesota Statutes 1994, section 144.801, is 
  2.5   amended by adding a subdivision to read: 
  2.6      Subd. 14.  [BASIC PROCEDURES OR BASIC SKILLS.] "Basic 
  2.7   procedures" or "basic skills" means those procedures or skills 
  2.8   that are consistent with the education and training offered by 
  2.9   the department of transportation first responder course 
  2.10  curriculum. 
  2.11     Sec. 5.  Minnesota Statutes 1994, section 144.801, is 
  2.12  amended by adding a subdivision to read: 
  2.13     Subd. 15.  [CERTIFICATION.] "Certification" means a 
  2.14  recognition given by a private entity or organization. 
  2.15     Sec. 6.  Minnesota Statutes 1994, section 144.801, is 
  2.16  amended by adding a subdivision to read: 
  2.17     Subd. 16.  [DEPARTMENT OF TRANSPORTATION 
  2.18  CURRICULUM.] "Department of transportation course curriculum" 
  2.19  means the nationally recognized emergency care course curriculum 
  2.20  developed by the United States Department of Transportation, 
  2.21  National Highway Traffic Safety Administration. 
  2.22     Sec. 7.  Minnesota Statutes 1994, section 144.801, is 
  2.23  amended by adding a subdivision to read: 
  2.24     Subd. 17.  [REGISTERED FIRST RESPONDER.] "Registered first 
  2.25  responder" means an individual who is registered by the 
  2.26  commissioner as having successfully completed the United States 
  2.27  Department of Transportation first responder course, or its 
  2.28  equivalent, and testing, approved by the commissioner, and who 
  2.29  is a member of an organized unit which is dispatched by a public 
  2.30  safety answering point, to the scene of an injury, illness, or 
  2.31  pregnancy to provide medical care in an out-of-hospital setting. 
  2.32     Sec. 8.  Minnesota Statutes 1994, section 144.801, is 
  2.33  amended by adding a subdivision to read: 
  2.34     Subd. 18.  [SUPERVISE.] "Supervise" means a stated person 
  2.35  who does the indicated activity in person or delegates the 
  2.36  activity to someone to act on the person's behalf.  The stated 
  3.1   person is responsible for content and process. 
  3.2      Sec. 9.  Minnesota Statutes 1994, section 144.801, is 
  3.3   amended by adding a subdivision to read: 
  3.4      Subd. 19.  [UNIT.] "Unit" means registered basic first 
  3.5   responders or registered advanced first responders identified on 
  3.6   a roster. 
  3.7      Sec. 10.  [144.8045] [FIRST RESPONDER UNITS.] 
  3.8      Subdivision 1.  [UNITS.] To be registered as a basic first 
  3.9   responder unit, a group of first responders must:  
  3.10     (1) individually hold current registration cards as first 
  3.11  responders with the state of Minnesota; 
  3.12     (2) submit a roster and equipment list to the commissioner 
  3.13  biennially; and 
  3.14     (3) submit other documentation as required by the 
  3.15  commissioner. 
  3.16     Subd. 2.  [ADVANCED UNITS.] To be registered as an advanced 
  3.17  first responder unit, a group of first responders must: 
  3.18     (1) individually hold current registration cards as first 
  3.19  responders with the state of Minnesota; 
  3.20     (2) be trained to provide basic and advanced procedures 
  3.21  according to the unit's registration from the commissioner; 
  3.22     (3) have a unit medical director; 
  3.23     (4) biennially submit to the commissioner a roster, 
  3.24  equipment list, training records, protocols, documentation 
  3.25  indicating the name of the medical director, and any other 
  3.26  documentation required by the commissioner; 
  3.27     (5) complete and submit to the unit medical director a run 
  3.28  report, on a form approved by the unit medical director, with a 
  3.29  minimum data set required by the commissioner, for any call 
  3.30  involving the use of advanced equipment or procedures; 
  3.31     (6) submit to the commissioner a schedule of unit 
  3.32  availability to take calls and give advanced notice to a public 
  3.33  safety answering point of any schedule changes; 
  3.34     (7) provide only those procedures allowed under the unit's 
  3.35  registration from the commissioner and approved by the unit's 
  3.36  medical director.  The procedures may include antishock garment 
  4.1   inflation, advanced airway management, and automated 
  4.2   defibrillation; and 
  4.3      (8) cooperate with inspections of records and equipment by 
  4.4   the commissioner. 
  4.5      Subd. 3.  [RULES.] The commissioner may adopt rules to 
  4.6   implement sections 144.801 to 144.8097, including the following: 
  4.7      (1) identification of and requirements for individuals 
  4.8   seeking registration by the state as first responders; 
  4.9      (2) identification of and requirements for a basic first 
  4.10  responder unit that has appropriate personnel and equipment to 
  4.11  meet registration requirements of the commissioner that provides 
  4.12  a level of care to ensure that life-threatening situations and 
  4.13  potentially serious injuries can be recognized, patients will be 
  4.14  protected from additional hazards, and basic treatment to reduce 
  4.15  the seriousness of emergency situations will be administered at 
  4.16  the scene; and 
  4.17     (3) identification of and requirements for an advanced 
  4.18  first responder unit that has appropriate personnel and 
  4.19  equipment to meet registration requirements of the commissioner 
  4.20  that provides care equal to a basic first responder unit, and 
  4.21  advanced procedures limited to advanced airway management, 
  4.22  automated defibrillation, and antishock garment inflation. 
  4.23     Sec. 11.  [144.8046] [FIRST RESPONDER TRAINING.] 
  4.24     Subdivision 1.  [TRAINING.] To be registered as a first 
  4.25  responder in Minnesota, an individual must submit an application 
  4.26  provided by the commissioner, and: 
  4.27     (1) successfully complete a first responder course approved 
  4.28  by the commissioner that is consistent with the department of 
  4.29  transportation first responder course curriculum; successfully 
  4.30  complete a written test and a practical skills exam approved by 
  4.31  the commissioner; and apply for and be issued a current 
  4.32  Minnesota first responder registration card; 
  4.33     (2) be currently registered by the commissioner as an 
  4.34  emergency medical technician; 
  4.35     (3) if currently licensed or registered in Minnesota as a 
  4.36  registered nurse or physician assistant, successfully complete 
  5.1   first responder refresher written and practical tests, approved 
  5.2   by the commissioner; and apply for and be issued a current 
  5.3   Minnesota first responder registration card; or 
  5.4      (4) have current registration as an emergency medical 
  5.5   technician. 
  5.6      Subd. 2.  [RENEWAL REQUIREMENTS.] A first responder may be 
  5.7   registered for a period of two years.  To renew registration, an 
  5.8   individual must complete a renewal application, and successfully 
  5.9   complete a first responder refresher training program and 
  5.10  testing requirements or meet the continuing education option and 
  5.11  testing requirements during the registration period.  
  5.12     (a) The first responder refresher training program must: 
  5.13     (1) include education and training necessary to 
  5.14  successfully complete testing and recertification in 
  5.15  cardiopulmonary resuscitation necessary to meet American Heart 
  5.16  Association standards, or their equivalent, as approved by the 
  5.17  commissioner; and 
  5.18     (2) be consistent with the knowledge and skills consistent 
  5.19  with the department of transportation first responder refresher 
  5.20  course curriculum. 
  5.21     (b) The testing requirements must include written and 
  5.22  practical skill exams that: 
  5.23     (1) are conducted under supervision of a medical director; 
  5.24     (2) are approved by the commissioner; and 
  5.25     (3) test knowledge and skill proficiency consistent with 
  5.26  the department of transportation first responder refresher 
  5.27  course curriculum, including:  patient assessment, airway 
  5.28  management, cardiopulmonary resuscitation, spinal management, 
  5.29  splinting and bandaging, scene safety, and use of personal 
  5.30  protective equipment. 
  5.31     The first responder refresher training program and testing 
  5.32  described in this section may be used for renewal for every 
  5.33  renewal cycle, or used alternately with the continuing education 
  5.34  option.  An individual may not use the continuing education 
  5.35  option described in paragraph (c) for consecutive renewal 
  5.36  periods.  The continuing education option courses and written 
  6.1   and practical skills exams must be approved by the commissioner. 
  6.2      (c) The continuing education option must: 
  6.3      (1) include 24 hours of in-service or formal classroom 
  6.4   training; 
  6.5      (2) include education and training necessary to 
  6.6   successfully complete testing and recertification in 
  6.7   cardiopulmonary resuscitation necessary to meet American Heart 
  6.8   Association standards; and 
  6.9      (3) be consistent with the knowledge and skills consistent 
  6.10  with the department of transportation first responder refresher 
  6.11  course curriculum. 
  6.12     Subd. 3.  [SKILL LEVEL.] (a) Registered first responders 
  6.13  serving as individuals, or staffing basic or advanced units may 
  6.14  perform basic skills consistent with the department of 
  6.15  transportation first responder curriculum including:  patient 
  6.16  assessment, airway management, cardiopulmonary resuscitation, 
  6.17  spinal management, scene safety, and use of personal protective 
  6.18  equipment.  
  6.19     (b) Advanced units must be able to perform advanced skills 
  6.20  approved by the unit medical director and required through 
  6.21  registration while on call.  Advanced first responder units must 
  6.22  have written protocols for advanced level procedures.  The unit 
  6.23  medical director must supervise unit member training and unit 
  6.24  quality assurance. 
  6.25     Persons who are registered first responders but who are not 
  6.26  members of a registered advanced unit may not perform or request 
  6.27  variances for advanced procedures. 
  6.28     Persons who are registered first responders and on the 
  6.29  roster of an advanced unit may: 
  6.30     (1) perform advanced procedures if they are appropriately 
  6.31  trained, approved by the unit's medical director to perform the 
  6.32  advanced procedure, and perform the advanced procedures as a 
  6.33  member of that unit; 
  6.34     (2) perform only those procedures approved by the unit's 
  6.35  medical director and the commissioner through the unit's 
  6.36  registration; 
  7.1      (3) provide continuity of advanced procedures during 
  7.2   transport of a patient, under the direction of the transporting 
  7.3   service's personnel and medical direction. 
  7.4      Advanced units must be able to perform while on call as an 
  7.5   advanced unit all of the following advanced skills: 
  7.6   defibrillation, antishock garment inflation, or advanced airway 
  7.7   placement. 
  7.8      A medical director of an advanced first responder unit must 
  7.9   provide written protocols for the advanced procedures approved 
  7.10  of through the unit's registration.  Advanced procedures must be 
  7.11  used under the direct or standing orders of the unit's medical 
  7.12  director.  The unit medical director must supervise training of 
  7.13  unit members and the quality assurance program of the unit. 
  7.14     Subd. 4.  [REQUIRED EQUIPMENT FOR BASIC FIRST RESPONDER 
  7.15  UNIT.] A registered first responder basic unit: 
  7.16     (a) must have the following equipment available when 
  7.17  responding to a call: 
  7.18     (1) bandaging supplies:  triangular bandages, dressings and 
  7.19  gauze pads, adhesive tape, multitrauma dressing, roller-type 
  7.20  bandages, occlusive dressings, eye protector (paper cup or 
  7.21  cone), and emergency medical technician scissors; 
  7.22     (2) infection control equipment:  gloves (latex or vinyl 
  7.23  and heavy duty such as leather), face mask, eye protection (such 
  7.24  as goggles or face shields), disinfectant for hand washing such 
  7.25  as towelettes, gown, and containers for disposable equipment; 
  7.26     (3) additional equipment:  blankets, flashlight, and an 
  7.27  area map. 
  7.28     (b) may carry the following equipment:  adult blood 
  7.29  pressure cuff, splint set, sterile water or saline, pillow, OB 
  7.30  kit, oxygen delivery equipment, and suction equipment. 
  7.31     (c) must maintain equipment according to manufacturers' 
  7.32  recommended maintenance schedule or an improved schedule based 
  7.33  upon actual equipment usage, and must keep maintenance schedules 
  7.34  in files. 
  7.35     (d) must require that: 
  7.36     (1) items used for storage of equipment are kept clean so 
  8.1   as to be free from dirt, grease, and contaminants; 
  8.2      (2) single-service equipment is wrapped, stored, and 
  8.3   handled so as to prevent contamination and to ensure proper 
  8.4   disposal after use; 
  8.5      (3) reusable equipment is cleaned and disinfected after 
  8.6   each use so as to be free from dirt, grease, and contaminants; 
  8.7      (4) equipment, soiled or otherwise not free from 
  8.8   contaminants, is kept in plastic bags, or securely covered 
  8.9   containers until disposed of or prepared for reuse; and 
  8.10     (5) equipment and supplies are properly stored and secured 
  8.11  in vehicles or storage containers or both so as to protect 
  8.12  equipment from damage, and patient or first responder from 
  8.13  injury or inconvenience. 
  8.14     Subd. 5.  [REQUIRED EQUIPMENT FOR ADVANCED FIRST RESPONDER 
  8.15  UNIT.] A registered first responder advanced unit must: 
  8.16     (a) have the following equipment available when responding 
  8.17  to a call: 
  8.18     (1) all the required and optional equipment listed for a 
  8.19  basic unit; 
  8.20     (2) equipment necessary to perform advanced procedures for 
  8.21  which the unit is registered to perform; and 
  8.22     (3) an automated defibrillator if the unit is registered by 
  8.23  the commissioner to provide defibrillation. 
  8.24     (b) maintain equipment according to manufacturers' 
  8.25  recommended maintenance schedule or an improved schedule based 
  8.26  upon actual equipment usage. 
  8.27     (c) require that: 
  8.28     (1) items used for storage of equipment are kept clean so 
  8.29  as to be free from dirt, grease, and contaminants; 
  8.30     (2) single-service equipment is wrapped, stored, and 
  8.31  handled so as to prevent contamination and to ensure proper 
  8.32  disposal after use; 
  8.33     (3) reusable equipment is cleaned and disinfected after 
  8.34  each use so as to be free from dirt, grease, and contaminants; 
  8.35     (4) equipment, soiled or otherwise not free from 
  8.36  contaminants, is kept in plastic bags, or securely covered 
  9.1   containers until disposed of or prepared for reuse; and 
  9.2      (5) equipment and supplies are properly stored and secured 
  9.3   in vehicles or storage containers or both so as to protect 
  9.4   equipment from damage, and patient or first responder from 
  9.5   injury or inconvenience. 
  9.6      Subd. 6.  [PROVISION OF CARE.] (a) Personnel of a 
  9.7   registered first responder unit must provide only those patient 
  9.8   care procedures for which they are trained and approved to 
  9.9   provide by unit registration, and the unit medical director. 
  9.10     (b) Upon the arrival of a licensed ambulance service, 
  9.11  charge of patient care is transferred to the licensed ambulance 
  9.12  service and its medical director. 
  9.13     (c) Any registered first responder assisting in patient 
  9.14  care at the scene may accompany the patient during transport to 
  9.15  a health facility at the discretion of, and under the 
  9.16  supervision of, the ambulance service personnel and the 
  9.17  service's medical director.  This may include the continued 
  9.18  provision of advanced procedures, initiated at the scene, with 
  9.19  approval from the ambulance service's medical director. 
  9.20     Sec. 12.  [144.8047] [PROHIBITED ACTS; ENFORCEMENT; 
  9.21  PENALTY.] 
  9.22     Subdivision 1.  [PROHIBITED ACTS.] The commissioner may 
  9.23  reject an application for registration or may act under 
  9.24  subdivision 2 against a first responder for failure to comply 
  9.25  with sections 144.801 to 144.8097.  Failure to apply to the 
  9.26  commissioner for registration or supplying false or misleading 
  9.27  information on the application for registration is a ground for 
  9.28  action under subdivision 2.  
  9.29     Subd. 2.  [ENFORCEMENT ACTIONS.] When the commissioner 
  9.30  finds that a first responder has violated one or more provisions 
  9.31  of sections 144.801 to 144.8097, the commissioner may do one or 
  9.32  more of the following: 
  9.33     (1) deny or reject the application for registration; 
  9.34     (2) revoke the registration; 
  9.35     (3) suspend the registration; 
  9.36     (4) impose, for each violation, a civil penalty that 
 10.1   reimburses the department of health for costs of the 
 10.2   investigation and proceeding resulting in disciplinary action, 
 10.3   including the amount paid for services of the office of 
 10.4   administrative hearings, the amount paid for services of the 
 10.5   office of the attorney general, attorney fees, court reporters, 
 10.6   witnesses, reproduction of records, advisory council members' 
 10.7   per diem compensation, department staff time, and expenses 
 10.8   incurred by advisory council members and department staff; 
 10.9      (5) censure or reprimand the first responder; 
 10.10     (6) impose a civil penalty not to exceed $10,000 for each 
 10.11  separate violation; or 
 10.12     (7) any other action reasonably justified by the individual 
 10.13  case. 
 10.14     Subd. 3.  [PROCEDURES.] The commissioner shall establish, 
 10.15  in writing, internal operating procedures for receiving and 
 10.16  investigating complaints and imposing enforcement actions.  The 
 10.17  written internal operating procedures may include procedures for 
 10.18  sharing complaint information with government agencies in this 
 10.19  and other states.  Establishment of the operating procedures are 
 10.20  not subject to rulemaking procedures under chapter 14.  
 10.21  Procedures for sharing complaint information must be consistent 
 10.22  with the requirements for handling government data under chapter 
 10.23  13. 
 10.24     Subd. 4.  [DISCOVERY.] In all matters relating to the 
 10.25  lawful regulation activities under sections 144.801 to 144.8097, 
 10.26  the commissioner may issue subpoenas to require the attendance 
 10.27  and testimony of witnesses and production of books, records, 
 10.28  correspondence, and other information relevant to any matter 
 10.29  involved in the investigation.  The commissioner or the 
 10.30  commissioner's designee may administer oaths to witnesses or 
 10.31  take their affirmation.  A subpoena may be served upon any 
 10.32  person it names anywhere in the state by any person authorized 
 10.33  to serve subpoenas or other processes in civil actions of the 
 10.34  district courts.  If a person to whom a subpoena is issued does 
 10.35  not comply with the subpoena, the commissioner may apply to the 
 10.36  district court in any district and the court shall order the 
 11.1   person to comply with the subpoena.  Failure to obey the order 
 11.2   of the court may be punished by the court as contempt of court.  
 11.3   All information pertaining to individual medical records 
 11.4   obtained under this section is health data under section 13.38.