Interpretation

1  (1)  In this regulation:

"Act" means the Health Emergency Act;

"active employment" means

(a) employment as an EMA, and

(b) available to perform pre-hospital emergency procedures;

"advanced EMA" means an EMA who has successfully completed training under an advanced medical procedures program described in Schedules F and G and has passed the required examinations;

"continuing medical education model" means the 5 year program of continuing medical education approved by the board for a category of EMA, consisting of 5 modules to be completed at the rate of 1 module per year;

"EMA" means an emergency medical assistant licensed in a category referred to in section 6;

"EMA FA" means an EMA who has successfully completed occupational first aid training or equivalent;

"EMA FR" means an EMA who has successfully completed level 1, 2 or 3 training under a first responder program;

"EMA 1" and "EMA 2" means an EMA who has successfully completed training under a level 1 and level 2 program respectively;

"EMA 3 (ALS)" means an EMA who has successfully completed training under an advanced life support program;

"EMA 3 (ITT)" means an EMA who has successfully completed training under an infant transport team program;

"licence" means registration as an EMA;

"rules" means the rules of the board;

"register" means the register of emergency medical assistants established and maintained under section 3;

"registrar" means the person appointed as registrar under section 2.

(2)  A reference to a licence is a reference to a valid and subsisting licence.

(3) and (4)  Repealed. [B.C. Reg. 125/2000, s. 1.]

[am. B.C. Regs. 125/2000, s. 1; 262/2001, ss. 1 and 2.]

 Registrar

2  The commission shall appoint a registrar who shall be the administrative officer responsible for the day-to-day management of the board, including the processing of applications for licences and the renewal, advancement and reinstatement of licences.

 Register

3  (1)  The board shall establish and maintain a permanent register of every EMA who has been granted a licence or temporary licence under the Act.

(2)  The registrar shall enter in the register the name and address of each EMA, his or her licence number, the licence expiry date, any other information the board deems essential for each EMA and, if the EMA is an employee of the commission, the employee number.

(3)  The information required under subsection (2) with respect to every newly registered EMA must be entered in the register at the time of acceptance of an application for registration.

(4)  An EMA shall notify the registrar, in writing, of any change of address or place of employment within 30 days after the change, and the registrar shall enter the change in the register.

(5)  If a licence has expired or is cancelled or suspended, the EMA shall, within 48 hours after expiration or after being notified of its cancellation or suspension, return the licence to the registrar.

(6)  The register must be kept at the office of the board and must be open to inspection by any person during normal business hours, subject to reasonable restrictions the board may impose.

 Forms

4  Every application for a licence or the renewal of a licence must be made to the registrar on a form approved by the board.

 Application for licence

5  (1)  A person not previously licensed in British Columbia who

(a) applies for a licence in the manner provided for by the rules,

(b) submits to the board

(i)  an application for a licence and an identification card, and

(ii)  2 pictures of the applicant, approximately 20 mm by 25 mm, and the negative from which the prints were made,

(c) has, for the category of licence sought,

(i)  the qualifications set out in Schedule A,

(ii)  the required training set out in Schedules B to G, and

(iii)  passed the required examinations approved by the board, and

(d) provides evidence, satisfactory to the board, that he or she is of good character and fit to work as an EMA,

is entitled to be licensed as an EMA in the category for which he or she is qualified.

(2)  The board shall

(a) return the application to the applicant if the board is of the opinion that the application is incomplete,

(b) reject the application if the board is of the opinion that the applicant has not complied with the requirements of subsection (1), or

(c) approve the application and issue a licence to the applicant if the board is of the opinion that the applicant has complied with the requirements of subsection (1).

(3)  If the board is of the opinion that the applicant should be licensed under the Act but the applicant is temporarily unable to comply with one or more requirements under subsection (1), the board may issue a temporary licence for one or more periods of 90 days.

 Out of Province applicants

5.1  (1)  In this section "in good standing" means, in relation to an emergency medical assistant or person of equivalent status not licensed in British Columbia, a person who

(a) is registered as an emergency medical assistant in another jurisdiction without any conditions, sanctions or restrictions imposed on that registration as a result of determinations made from a review of any patient care complaint,

(b) is not the subject of an investigation or pending hearing relating to any patient care complaint, and

(c) has not, for reasons of incompetence, incapacity or misconduct,

(i)  resigned,

(ii)  had conditions placed on his or her registration, or

(iii)  had his or her registration cancelled.

(2)  A person from another jurisdiction in Canada who

(a) is an emergency medical assistant in a jurisdiction outside of British Columbia or, in the opinion of the board, is the equivalent of an emergency medical assistant in that other jurisdiction,

(b) is in good standing in that other jurisdiction, and

(c) meets the requirements of section 5 (1) (a), (b) and (d)

may apply for a licence and is, subject to subsection (3), entitled to be licensed as an EMA in the category for which he or she is qualified.

(3)  If the applicant under subsection (2) originates from a jurisdiction in which, in the opinion of the board, the training or scope of practice, or both training and scope of practice, is not equivalent to that in British Columbia, the board may require the applicant to complete any upgrading courses, education or examinations that the board considers necessary to ensure that the applicant is competent to be an EMA.

[en. B.C. Reg. 246/2001.]

 Categories of licence

6  The board may only issue licences in categories EMA FR, EMA FA, EMA 1, EMA 2, EMA 3 (ALS) or EMA 3 (ITT), all as described in Schedule A.

 Term of licence

7  Except in the case of a temporary licence issued under section 5 (3),

(a) a licence in category EMA FA, EMA 1, EMA 2, EMA 3 (ALS) or EMA 3 (ITT) expires 5 years after the date it was issued by the Board, and

(b) a licence in category EMA FR expires 3 years after the date it was issued by the Board.

[en. B.C. Reg. 125/2000, s. 2.]

 Requirement respecting active employment

8  It is a condition of every licence that active employment in British Columbia must not be interrupted by any continuous period greater than 6 months in which an EMA is not available for active employment.

[am. B.C. Reg. 125/2000, s. 3.]

 Requirement to maintain qualifications for licence

9  It is a condition of every licence that an EMA must continuously maintain the qualifications required under Schedule A for the category of licence that has been issued to the EMA by the board.

 Resumption of active employment

10  (1)  If active employment in British Columbia has been interrupted for a continuous period greater than 6 months, the EMA shall not be permitted to resume active employment until he or she has complied with any or all of the following requirements as may be ordered by the board for the EMA's category of licence:

(a) for an EMA FR or EMA FA licence, the EMA must successfully complete written and practical tests evaluating basic skill and knowledge;

(b) for an EMA 1 licence, the EMA must

(i)  successfully complete an oral or written examination, or both an oral and written examination, and

(ii)  successfully complete 2 practical examinations;

(c) for an EMA 2 licence, the EMA must

(i)  attend a training course approved by the board,

(ii)  successfully complete 4 practical scenarios,

(iii)  give a proper demonstration of any endorsement skills held, and

(iv)  complete an on-car internship with preceptor for not less than 3 months if required by the board;

(d) for an EMA 3 (ALS) licence, the EMA must

(i)  complete the requirements under paragraph (c),

(ii)  perform in-hospital practice involving advanced emergency techniques, and

(iii)  complete a chart review by the local medical coordinator;

(e) for an EMA 3 (ITT) licence, the EMA must

(i)  complete the requirements under paragraph (c),

(ii)  perform in-hospital practice involving advanced emergency techniques, and

(iii)  satisfactorily complete ITT skills evaluated by the ITT program coordinator.

(2)  If, in the opinion of the board, the EMA fails to comply with the requirements ordered under subsection (1), the EMA shall not return to active employment.

[am. B.C. Reg. 125/2000, s. 5.]

 Renewal of licence

11  (1)  An EMA shall apply to the board to renew a licence in the manner provided by the rules.

(2)  No EMA shall be eligible to renew a licence under this section unless the EMA has complied with sections 23 and 24 during the term of his or her licence.

(3)  The board shall renew for a further 3 year period a licence in category EMA FR which expires under section 7 if the EMA successfully completes written, oral and practical examinations as may be required by the board.

(4)  The board shall renew for a further 5 year period a licence in the category of EMA FA or EMA 1 that expires under section 7 if

(a) the board is satisfied that the EMA has a valid occupational first aid certificate issued under the Workers Compensation Act, or

(b) the EMA has successfully completed the applicable continuing medical education model.

(5)  The board shall renew for a further 5 year period a licence in the category of EMA 2, EMA 3 (ALS) or EMA 3 (ITT) that expires under section 7 if the EMA has successfully completed the applicable continuing medical education model.

(6)  Despite subsections (4) and (5), the board may require that an EMA satisfy the board of the EMA's suitability and competence before renewing a licence referred to in those subsections and for that purpose may require that the EMA successfully complete written, oral or practical examinations specified by the board if

(a) the EMA's active employment as an EMA has been interrupted for a period of at least 6 months and the EMA has not met the requirements of section 10, or

(b) the board has reason to believe that the EMA is not maintaining safe or acceptable practices or competencies.

(7)  Despite subsections (4) and (5), the board may renew a license referred to in those subsections for a further 5 year period for an EMA who does not meet the requirements of those subsections if the board is satisfied with respect to the EMA's suitability and competence and for that purpose may require that the EMA successfully complete written, oral or practical examinations specified by the board.

[am. B.C. Reg. 262/2001, s. 3.]

 Reinstatement

12  The board may reinstate the licence of a former EMA if

(a) the board is of the opinion that reinstatement would not constitute a risk to patient health or safety, and

(b) the former EMA successfully completes training and written, oral and practical examinations as may be required by the board.

 Special reinstatement

12.1  (1)  The board may reinstate the licence of a former EMA for a period of up to 90 days if the board is satisfied that

(a) section 12 does not apply in the circumstances, and

(b) the reinstatement is in the public interest.

(2)  The board may act under subsection (1) on more than one occasion respecting a former EMA.

[en. B.C. Reg. 77/2001.]

 Examinations

13  (1)  An examination required by this regulation shall be prepared or approved by the board.

(2)  The board shall determine or approve the time and place for the holding of each examination.

(3)  An applicant for initial registration as an EMA, or an EMA who applies to renew a licence or to rescind the suspension of a licence for the purposes of active employment, must attend any examination that he or she has been requested by the board to attend.

(4)  The minimum passing grade for an examination is 60% for all licence categories.

(5)  If an EMA does not on the first attempt pass the examinations required for relicensing, the board may require that the EMA only provide pre-hospital emergency care at his or her level with proper supervision.

(6)  The board may extend the period of time referred to in sections 14 to 16 if, in the opinion of the board, extraordinary circumstances justify an extension and no risk to the patient health or safety would result from the extension.

(7)  If an applicant or an EMA, without consent of the board, fails to attend an examination that he or she has been requested by the board to attend, the applicant or EMA shall be deemed to have taken and failed that examination.

(8)  The board shall not unreasonably withhold its consent under subsection (7).

(9)  If an applicant or an EMA fails an examination, the board may require that the applicant or EMA participate in an upgrading program before being permitted to take any further examinations.

(10)  If an EMA fails an examination and the board is of the opinion that there could be risk to patient care, the board may either suspend the EMA's licence or attach terms and conditions to the EMA's licence.

 EMA FR, EMA FA and EMA 1 licence

14  (1)  An EMA who fails to achieve the minimum qualifications to resume active employment or renew or reinstate in respect of an EMA FR, EMA FA or EMA 1 licence shall be given 2 further opportunities to comply during the 60 day period immediately following the failure of a requirement or a longer time as may be approved by the board.

(2)  If the EMA fails to achieve the minimum qualifications after the third attempt, the board shall revoke the EMA's licence.

 EMA 2 licence

15  (1)  An EMA who fails to achieve the minimum qualifications to resume active employment or renew or reinstate in respect of an EMA 2 licence shall be given 2 further opportunities to comply during the 90 day period immediately following the failure of a requirement or a longer time as may be approved by the board.

(2)  For the purpose of subsection (1), employment of the EMA under an EMA 2 licence shall be restricted to a supervised environment until the minimum qualifications are met.

(3)  If the EMA fails to achieve the minimum qualifications after the third attempt, the board shall revoke the EMA's licence.

 EMA 3 (ALS) and EMA 3 (ITT) licence

16  (1)  An EMA who fails to achieve the minimum qualifications to resume active employment or renew or reinstate in respect of an EMA 3 (ALS) or EMA 3 (ITT) licence shall be given one further opportunity to comply during the 30 day period immediately following the failure of a requirement or a longer time as may be approved by the board.

(2)  If the EMA fails to achieve the minimum qualifications after the second attempt, the qualifications of the EMA shall be deemed reduced to that of an EMA 2 licence for a period not to exceed 90 days.

(3)  During the 90 day period under subsection (2), the EMA shall be given a third opportunity to achieve the minimum qualifications.

(4)  If the EMA fails to achieve the minimum qualifications after the third attempt, the board shall cancel the registration of the EMA 3 (ALS) or EMA 3 (ITT) licence and, subject to compliance with this Part, the EMA shall be registered as an EMA 2.

 State of Washington emergency medical assistants

16.1  (1)  The board may issue a licence collectively recognizing as emergency medical assistants all persons certified under chapter 18.71 and 18.73 of the Revised Code of Washington of Washington State, one of the United States of America, to provide the emergency health services described in this section.

(2)  The emergency health services to be authorized by a licence under subsection (1) are restricted to emergency health services that the persons referred to in subsection (1)

(a) are authorized to provide in the State of Washington,

(b) provide under the supervision and control required by the terms of their certification in the State of Washington, and

(c) provide in British Columbia while transporting patients from the United States of America to medical facilities in British Columbia or the United States of America.

(3)  The other provisions of this regulation do not apply to persons covered by a licence under this section.

[en. B.C. Reg. 240/95.]

 Approved training programs

17  The training required for each category of licence or for any endorsement of a licence must be given by persons or organizations with whom or with which the commission has entered into an agreement or arrangement under the authority of section 5 (1) (c) of the Act.

 Qualifications for advanced training programs

18  An EMA who wishes to qualify as an EMA 3 (ALS) or EMA 3 (ITT) must

(a) possess relevant experience recognized by the commission,

(b) maintain a satisfactory work record,

(c) participate in an interview for the appropriate advanced medical course, and

(d) pass a written and oral entrance examination.

 Performance of advanced skills

19  The board may require an advanced EMA to pass an examination set by the board before performing any advanced medical procedures if the advanced EMA has not been in active practice in his or her category of training during the previous 3 months.

 Restrictions on a licence

20  The board may restrict the use of procedures under a category of licence if geographical or other considerations require limitations on that use.

 Endorsement of other skills

21  The board may endorse a licence to permit the use of skills in addition to those identified in Schedules B to G for that category of licence.

 Intravenous starts

22  (1)  Every EMA 2 who is qualified to perform unsupervised intravenous starts must successfully perform not less than 15 intravenous starts during each 12 month period commencing on April 1 in the year immediately following qualification.

(2)  If the EMA fails to comply with subsection (1), the board may restrict the use of procedures under the EMA 2 licence.

 Misconduct

23  No EMA shall behave in a manner that could reasonably be expected to have a detrimental effect on patient health or safety.

 Condition of licence

24  It is a term and condition of every licence that

(a) an EMA complies with the Act and this regulation,

(b) an EMA must not work in a licence category for which he or she is not licensed, and

(c) an EMA maintains the minimum number of calls in accordance with Board policy.

[am. B.C. Reg. 125/2000, s. 4.]

 EMA board member

25  For the purpose of section 6 of the Act, the EMA selected to sit on the board will be nominated by Local 873 of the Canadian Union of Public Employees.

(a) employment with

(i)  a police force,

(ii)  a fire department, or

(iii)  an agency approved by the commission,

(b) successfully completed the required level 1, 2 or 3 training, as determined by the employer, for an EMA FR licence as set out in Schedule B, and

(c) passed the required examinations.

(a) acquired and maintained

(i)  an occupational first aid certificate issued under the Workers Compensation Act, or

(ii)  first aid certification equivalent to that under subparagraph (i) determined by the board to be sufficient,

(b) employment

(i)  with the commission, or

(ii)  with a contractor who has a contract for service with the commission, and

(c) successfully completed the required training for an EMA FA licence as set out in Schedule C.

(a) acquired and maintained

(i)  an occupational first aid certificate issued under the Workers Compensation Act, or

(ii)  first aid certification equivalent to that under subparagraph (i) determined by the board to be sufficient,

(b) employment

(i)  with the commission, or

(ii)  with a contractor who has a contract for service with the commission,

(c) successfully completed the required training for an EMA 1 licence as set out in Schedule D, and

(d) passed the required examinations.

(a) a valid EMA 1 licence,

(b) employment

(i)  with the commission, or

(ii)  with a contractor who, on the day this regulation comes into force, has a valid and subsisting contract for service with the commission,

(c) completed at least 25 ambulance calls,

(d) successfully completed the required training for an EMA 2 licence as set out in Schedule E, and

(e) passed the required examinations.

(a) a valid EMA 2 licence,

(b) employment with the commission, and

(c) successfully completed the ALS training course or the ITT training course and passed the required examinations for a licence in one of the following categories:

(i)  for EMA 3 (ALS) as set out in Schedule F;

(ii)  for EMA 3 (ITT) as set out in Schedule G.

1 Length of training course: 4 to 32 hours depending on level of training.

2 Course content:

Level 1

(a) knowledge and demonstrated practical skill in initial patient assessment and basic patient management, until more qualified EMA help becomes available, including the following:

(i)  scene assessment including environment, hazards and mechanism of injury;

(ii)  primary survey;

(iii)  spine immobilization in position found;

(iv)  opening and maintaining an airway;

(v)  assessment of breathing adequacy and ventilation by mouth to pocket mask;

(b) knowledge of legislation related to pre-hospital care;

(c) knowledge and demonstrated practical skill in handling trauma including head and neck injuries, chest injuries, fractures and dislocations, until more qualified EMA help becomes available.

Level 2

(a) all of the content requirements under Level 1;

(b) recognition and treatment of abdominal and burn injuries;

(c) knowledge and demonstrated practical skill in more advanced spine, airway and breathing management techniques, until more qualified EMA help becomes available.

Level 3

(a) all of the content requirements under Levels 1 and 2;

(b) knowledge and demonstrated practical skill in handling medical and environmental emergencies until more qualified EMA help becomes available.

1 Length of training course: approximately 70 hours

2 Course content:

(a) knowledge and practical skill in scene assessment as well as initial and secondary patient assessment and vital sign monitoring;

(b) knowledge of life support systems and practical skill in upper airway maintenance, artificial ventilation, use of oropharyngeal airway, use of manual self-inflating bag ventilators and administration of oxygen;

(c) knowledge and practical skill in cardiopulmonary resuscitation and assessment of circulation;

(d) knowledge and practical skill in basic wound care, immobilization of fractures, and basic management of epileptic, diabetic, cerebrovascular and cardiac disorders;

(e) knowledge and practical skill in patient extrication, handling and transport, management of potential cervical and other spine injuries, and lifting and moving techniques;

(f) knowledge of accurate reporting methods and documentation of patient information.

1 Length of training course: 80 hours.

2 Course content:

(a) safe lifting and specific types of lifts used in the ambulance service;

(b) use, care and maintenance of ambulance equipment;

(c) forms of technical communication within the ambulance service and approaches to interpersonal communications in an ambulance setting;

(d) theory of safe driving, regulations governing driving, and practical exposure to emergency driving conditions;

(e) knowledge of anatomy and physiology, such that knowledge of surface features will support patient assessment and treatment skills;

(f) assessment of the situation surrounding a call for service and the extent of a person's injury or medical condition and reporting this information clearly in accordance with standard medical guidelines;

(g) understanding and management of land, sea and air patient transport as appropriate to the EMA's scope of practice.

1 Length of training course: 240 hours.

2 Course content:

(a) anatomy, physiology, pathology and pharmacology, as they relate to injuries or medical conditions;

(b) knowledge of, and practical experience in, basic rescue and extrication of sick or injured patients;

(c) general study of, and practical experience in, ambulance work including care of the elderly, extended transfer, psychology of intervention (abusive or hostile individuals), care of the dead, infection control, medical-legal aspects of ambulance work and coordination with other emergency services;

(d) filing standardized reports, in a form fixed by the commission, with the receiving hospital and the commission;

(e) knowledge of, and practical experience in, the use of automatic external defibrillators;

(f) understanding and management of land, sea and air patient transport as appropriate to the EMA's scope of practice;

(g) a minimum of 10 hours of theoretical and practical training in a format determined by the board with respect to intravenous procedures including the following:

(i)  performing a critical examination of patients suffering from traumatic injuries and making a reasonable diagnosis;

(ii)  beginning an intravenous infusion;

(iii)  a minimum of 25 supervised intravenous starts in a hospital approved by the board for that purpose, and

(iv)  intravenously administering nutrient and electrolyte solutions as required by the clinical situation.

1 Length of training course: 56 weeks.

2 Course content:

(a) recognition and interpretation of cardiac dysrhythmias and understanding the principles of therapy for life threatening cardiac situations;

(b) recognition of various forms of acute respiratory failure and understanding the therapy for life threatening respiratory disorders;

(c) treating those situations outlined in paragraphs (a) and (b) by appropriate techniques including the administration of the appropriate drugs designated by the local medical coordinator;

(d) operation of a D.C. defibrillator under appropriate life threatening conditions;

(e) receiving directions on administering drugs from a medical practitioner;

(f) treatment of other life threatening disorders as directed by a medical practitioner with due attention to current medical standards and patient safety;

(g) understanding and management of land, sea and air patient transport as appropriate to the EMA's scope of practice.

1 Length of training course: 18 months.

2 Course content:

(a) recognition of normal and abnormal obstetrical, neonatal and pediatric care;

(b) collection of patient history and performance of a physical assessment on both normal and abnormal infants, children and high risk obstetrical patients;

(c) interpretation and effective communication of the information in paragraphs (a) and (b) to medical and nursing staff in the appropriate unit;

(d) sensitive and appropriate communication of the patient's problems to immediate family;

(e) initiation of stabilization or emergency treatment prior to and during transportation of an infant, child or high risk obstetrical patient both with and without the assistance or direction of other health care professionals;

(f) safe operation of all equipment required to support the patient being transported;

(g) understanding and management of land, sea and air patient transport as appropriate to the EMA's scope of practice.