Land Emergency Medical Response System Regulation

Land Emergency Medical Response System Regulation, M.R. 22/2006 The Emergency Medical Response and Stretcher Transportation Act , C.C.S.M. c. E83 Regulation 22/2006 Registered January 23, 2006 bilingual version (HTML) Table of Contents Section PART 1 INTRODUCTORY PROVISIONS 1 Definitions PART 2 LAND SYSTEM LICENCES 2 Licence required 3 Land system licence application 4 Expiry and renewal of licences 5 Pre-approval of alteration of location 6-7 Repealed 8 Medical director required 9-9.1 Repealed 10 Dispatch centre for licence holders 11 Medical oversight of dispatch centres 12 Agreement 13 Requirement for continuity of service 14 Agreements — continuity of service 14.1 Quality assurance program 15 Transporting patients by ambulance 16 Repealed 17 Specifications — vehicles 18 Infection control 19 Secure storage 20 Insurance requirements 21 Smoking prohibited 22 Patient care reports 23 Collision or fire reports 24 Reports re occurrences, including critical incidents 25 Other reports 26 Form and timing of reports 26.1 Repealed 27 Communications 28 Ambulance staffing 29 Dispatch centre staffing PART 3 PERSONNEL 30 When licence not required 30.1 Qualifications for first responders 31-35 Repealed PART 4 TRANSITIONAL AND COMING INTO FORCE 36-41 Repealed 42 Repeal 43 Coming into force Schedule A Repealed B Repealed PART 1 INTRODUCTORY PROVISIONS Definitions 1 The following definitions apply in this regulation. "Act" means The Emergency Medical Response and Stretcher Transportation Act . («  Loi  ») "call taker" means an individual employed in a dispatch centre who, as part of his or her employment, (a) interviews a caller to determine the caller's emergency medical needs; (b) determines the appropriate emergency medical response; (c) assigns priority for emergency medical response; and (d) if warranted, dispatches the appropriate emergency medical response vehicle, and provides assistance to its staff. (« préposé aux appels ») "dispatch centre" means a location where a call taker receives requests for land emergency medical response services from (a) a public safety answering point; (b) another emergency service provider; or (c) the public. (« centre de répartition ») "emergency medical responder" means an individual who (a) is registered as an emergency medical responder with the College of Paramedics of Manitoba; and (b) holds a valid certificate of practice issued by the College of Paramedics of Manitoba. (« répondant médical d'urgence ») "emergency medical response vehicle" includes an ambulance and a dedicated non-transporting emergency medical response vehicle. (« véhicule d'intervention médicale d'urgence ») "facility" has the meaning assigned by section 1 of The Health System Governance and Accountability Act. (« établissement ») "first responder" means an individual who meets the qualifications set out in section 30.1 and who is employed or engaged to provide land emergency medical response services by a fire department that is operated by a licence holder. (« premier intervenant ») "land emergency medical response services" means (a) conducting an assessment, outside a facility, of the medical condition of a patient; and (b) if the medical condition of the patient warrants, undertaking one or more of the following activities: (i) dispatching emergency medical response vehicles to the location of the patient, (ii) providing emergency medical treatment to the patient, (iii) referring the patient to the appropriate health care resources for continuing medical care, (iv) transporting the patient to a facility, providing in-transport medical care, and ensuring the orderly transfer of the patient's medical care to appropriate medical personnel at the facility. (« services terrestres d'intervention médicale d'urgence ») "land system" means a land emergency medical response system which provides land emergency medical response services. (« entreprise terrestre ») "licence holder" means the holder of a licence to operate a land system. (« titulaire de permis ») "medical director" means a physician who provides medical oversight to a licence holder under an agreement under subsection 8(1). (« directeur médical ») "non-transporting emergency medical response vehicle" means a motor vehicle that is designed to provide rapid primary intervention, advanced life support, or for supervisory or rescue purposes, but which is not designed or used to transport patients. (« véhicule d'intervention médicale d'urgence ne transportant pas de malade ») "paramedic" means an individual who (a) is registered as a primary care paramedic, an advanced care paramedic or a critical care paramedic with the College of Paramedics of Manitoba; and (b) holds a valid certificate of practice issued by the College of Paramedics of Manitoba. (« travailleur paramédical ») "public safety answering point" has the meaning assigned by section 1 of The Emergency 911 Public Safety Answering Point Act . (« centre téléphonique de sécurité publique ») M.R. 169/2015 ; 113/2020 ; 95/2022 ; 4/2025 PART 2 LAND SYSTEM LICENCES Licence required 2(1) No person other than a licence holder may (a) hold themselves out to the public as being available to provide land emergency medical response services upon request; (b) be dispatched to provide land emergency medical response services as a result of (i) an emergency 911 telephone call, or (ii) a telephone call made to any other emergency response telephone number listed in a telephone directory available to the public; or (c) subject to subsection (3), provide or agree to provide land emergency medical response services at a specific site or event. 2(2) For the purpose of clause (1)⁠(b), "emergency 911 telephone call" means an emergency telephone call placed to a public safety answering point by means of dialling the telephone digits 911. 2(3) A person does not provide land emergency response services when providing basic first aid to participants or patrons at a specific site or event if no transporting of patients occurs. M.R. 113/2020 Land system licence application 3(1) An applicant may, in the form and manner specified by the minister, apply to the minister to become a licence holder. 3(2) An application must include the following: (a) if the applicant is incorporated under The Corporations Act , a copy of the names and addresses of the directors and officers of the corporation; (b) if the applicant is other than a corporation, the name and address of the owner, or if the applicant is a partnership, the names and addresses of all general partners in the partnership; (c) the municipal address and the mailing address of all the premises from which the applicant proposes to operate the land system; (d) evidence that the applicant has obtained liability insurance, as specified in section 20; (e) an operational plan for the land emergency medical response services to be provided and evidence of the response time standards the applicant will be able to meet; (e.1) evidence that all individuals providing land emergency medical response services or dispatch services who are employed or engaged by the licence holder have the qualifications set out in this regulation; (f) any other information or documentation that the minister considers necessary to determine the ability of the person to operate the land system. 3(3) A licence to operate a land system may be issued if the minister is satisfied that the applicant has satisfactorily demonstrated it can adequately operate the system. 3(4) The minister may issue a licence that authorizes the licence holder to operate a land system that does not include the transportation of patients. M.R. 113/2020 ; 4/2025 Expiry and renewal of licences 4(1) Unless renewed, a land system licence expires on December 31 of the year in which it is issued, or such shorter period as the minister may determine. 4(2) To renew its licence, a licence holder must submit an application for renewal, in the form approved by the minister, at least 90 days prior to the expiry date of the licence. M.R. 169/2015 ; 97/2019 Pre-approval of alteration of location 5 A licence holder may not discontinue the delivery of services from a premises specified under clause 3(2)⁠(c) without the prior approval of the minister. M.R. 4/2025 6 and 7 [Repealed] M.R. 169/2015 ; 97/2019 ; 113/2020 Medical director required 8(1) Before providing land emergency medical response services, a licence holder must enter into an agreement with a medical director in which the medical director agrees to provide medical oversight in accordance with this section and, in the case of a dispatch centre, in accordance with section 11. 8(2) A licence holder must file a copy of every agreement with the minister. 8(3) A medical director must, for each licensed service for which they provide medical oversight, (a) provide consultation, or arrange for consultation by another physician, to the licence holder and its employees on issues relating to land emergency medical response services; (b) ensure that a medical quality assurance program is established in accordance with section 14.1 and that the program is appropriate for the services provided; and (c) ensure that paramedics and emergency medical responders employed or engaged by the licence holder comply with the requirements of The Regulated Health Professions Act , the applicable regulations under that Act and the code of ethics, standards of practice and practice directions of the College of Paramedics of Manitoba. M.R. 169/2015 ; 97/2019 ; 113/2020 9 [Repealed] M.R. 169/2015 ; 97/2019 ; 113/2020 9.1 [Repealed] M.R. 169/2015 ; 113/2020 Dispatch centre for licence holders 10 Every licence holder must either (a) operate its own dispatch centre in accordance with standards approved by the minister; or (b) enter into an agreement with another licence holder who operates a dispatch centre and who is acceptable to the minister, and file a copy of that agreement with the minister. M.R. 169/2015 Medical oversight of dispatch centres 11 A medical director who provides medical oversight for a dispatch centre must (a) provide consultation to the operator of the dispatch centre and the call takers on issues related to dispatch standards; (b) ensure that a medical quality assurance program is established in accordance with section 14.1 and that the program is appropriate for the services provided; and (c) approve the protocols to be followed by the dispatch centre respecting medical triage. M.R. 169/2015 ; 97/2019 ; 113/2020 Agreement 12(1) A licence holder that is not the provincial health authority must not provide any land emergency medical response services unless the licence holder has first entered into a written agreement with the provincial health authority. 12(2) A copy of every agreement entered into under subsection (1) by a licence holder must be filed with the minister. 12(3) A licence holder may not provide services inconsistent with the terms of an agreement entered into under subsection (1). M.R. 97/2019 ; 113/2020 ; 95/2022 Requirement for continuity of service 13(1) A licence holder must ensure emergency medical response services are available (a) continuously, 24 hours per day, 365 days per year; and (b) within a response time standard acceptable to the minister. 13(2) Subsection (1) does not apply if a licence holder's ambulance is unavailable as a result of transporting a patient, mechanical breakdown or unforeseen emergency. 13(3) Subsection (1) does not apply to a licence holder who holds a licence issued under subsection 3(4). M.R. 4/2025 Agreements — continuity of service 14(1) A licence holder must enter into an agreement with another licence holder who agrees to provide land emergency medical services in the event the licence holder is temporarily unable to do so. 14(2) An agreement under subsection (1) must be filed with and be acceptable to the minister. 14(3) In the event a licence holder is unable to provide service in accordance with section 13, the licence holder must (a) notify the minister; (b) notify the party with whom an agreement has been entered into under subsection (1) and implement the terms and conditions of the agreement; (c) notify the public of the unavailability of service in a manner directed by the minister; and (d) follow any additional steps required by the minister. 14(4) Subsection (1) does not apply to a licence holder who holds a licence issued under subsection 3(4). M.R. 4/2025 Quality assurance program 14.1 Every licence holder must establish an appropriate medical quality assurance program for the land emergency medical response services they provide. M.R. 169/2015 ; 113/2020 Transporting patients by ambulance 15 In providing land emergency medical response services, no vehicle other than an ambulance may be used by a licence holder to transport a patient. 16 [Repealed] M.R. 95/2022 Specifications — vehicles 17(1) In providing land emergency medical response services, a licence holder must not use, or permit the use of, an ambulance unless (a) [repealed] M.R. 95/2022 ; (b) it is maintained in a mechanically safe condition; and (c) before January 31 of each year, the licence holder files with the minister satisfactory evidence it has passed a safety inspection by an agent authorized by the Vehicle Standards and Inspections section of the Department of Transportation and Government Services to conduct inspections of ambulances. 17(2) [Repealed] M.R. 95/2022 17(3) Except for an ambulance, no vehicle used by a licence holder may bear the exterior marking: "AMBULANCE". M.R. 95/2022 Infection control 18 A licence holder must (a) establish and implement an infection control program in accordance with guidelines approved by the minister; and (b) ensure that, when an ambulance is used to transport a patient with a known or suspected contagious disease, it is not used (i) at the same time to transport another patient who does not have the same disease, or (ii) thereafter to transport any other patient without first being disinfected in accordance with guidelines approved by the minister. Secure storage 19 Medications and patient care equipment and supplies in the possession of a licence holder or for use by a paramedic, emergency medical responder or first responder that pose a threat to the public if improperly used must be stored in a secure manner (a) in the premises of the licence holder; or (b) in the emergency medical response vehicles operated by the licence holder. M.R. 113/2020 ; 4/2025 Insurance requirements 20 Except where the minister is satisfied that a licence holder is adequately self-insured, a licence holder must have (a) insurance which insures every emergency medical response vehicle in an amount of at least $2,000,000 in respect of liability arising from (i) bodily injury to or the death of any individual being transported in the vehicle, or (ii) loss or damage to property, including any special care equipment not normally carried in the emergency medical response vehicle that is being carried in the vehicle for a particular patient; and (b) commercial liability and errors and omissions insurance in an amount of at least $5,000,000 in respect of liability regarding the provision of land emergency medical response services. M.R. 113/2020 Smoking prohibited 21 No individual may smoke or use an e-cigarette in an emergency medical response vehicle at any time. M.R. 97/2019 Patient care reports 22(1) A licence holder must ensure that a patient care report is completed by the paramedic, emergency medical responder or first responder immediately after providing care or transportation of a patient. 22(2) A licence holder must ensure that (a) where the patient is transported to a facility, a copy of the patient care report is provided to an individual in that facility who has authority to receive such information; (b) a copy of the patient care report or excerpts from it are provided to the minister on the minister's request; and (c) the original of the patient care report is retained by the licence holder for a period of seven years from the date of the transport, or for such longer period as is otherwise required by law. M.R. 97/2019 ; 113/2020 ; 4/2025 Collision or fire reports 23(1) A licence holder must file a report with the minister in the event an emergency medical response vehicle is involved in a collision or fire (a) while carrying a patient; or (b) that, under The Highway Traffic Act , is required to be reported to a peace officer. 23(2) [Repealed] M.R. 169/2015 M.R. 169/2015 Reports re occurrences, including critical incidents 24(1) The following definitions apply in this section. "critical incident" means a critical incident, as defined in section 53.1 of The Health System Governance and Accountability Act , that occurs in the course of providing emergency medical response services. (« incident critique ») "occurrence" means an event that occurs in the course of providing emergency medical response services that results in actual or potential harm or damage to, or loss of, any of the following: (a) life, limb or function; (b) property; and for certainty includes any event that results in a staff person, a medical or non-medical escort or a member of the public being injured and requiring medical care. (« événement ») 24(2) A licence holder must report (a) each occurrence, which is not otherwise a critical incident, in accordance with this section; and (b) each critical incident in accordance with The Health System Governance and Accountability Act , where the licence holder (i) is the provincial health authority or a health corporation, or (ii) has been prescribed as a health care organization for the purposes of Part 4.1 of that Act. 24(3) A licence holder that is not the provincial health authority must report an occurrence to the provincial health authority in accordance with the policy approved by the provincial health authority. 24(4) The provincial health authority must report to the minister, in accordance with the policy approved by the minister, (a) each occurrence for which it is the licence holder; and (b) any other occurrence that it becomes aware of as a result of receiving information under subsection (3). M.R. 97/2019 ; 113/2020 ; 95/2022 ; 4/2025 Other reports 25 A licence holder must report any other information the minister may require from time to time. Form and timing of reports 26 A report required to be submitted to the minister under sections 22 to 25 must be filed in the time, form and manner specified by the minister. 26.1 [Repealed] M.R. 169/2015 ; 113/2020 Communications 27(1) Communication related to the provision of emergency medical response services must be conducted on a radio system or frequency specifically authorized by the minister. 27(2) No person may use a frequency authorized under subsection (1) for any other purpose except related to the provision of emergency medical response services. Ambulance staffing 28(1) The licence holder must ensure an ambulance used to provide services is staffed by at least two staff, who must be paramedics or emergency medical responders. 28(2) A licence holder must ensure a non-transporting emergency medical response vehicle owned and operated by the licence holder, or responding under an agreement with a licence holder, is staffed by at least one paramedic, emergency medical responder or first responder. 28(3) [Repealed] M.R. 4/2025 M.R. 169/2015 ; 97/2019 ; 113/2020 ; 4/2025 Dispatch centre staffing 29 An operator of a dispatch centre must ensure that every call taker (a) is a paramedic or emergency medical responder; and (b) has completed a call taking and dispatch education program approved by the minister. M.R. 113/2020 PART 3 PERSONNEL When licence not required 30(1) A licence holder may employ or engage a paramedic, an emergency medical responder or a first responder who is not licensed under the Act to provide land emergency medical response services and the individual so employed or engaged may provide the services in accordance with the Act and this regulation. 30(2) [Repealed] M.R. 169/2015 M.R. 169/2015 ; 113/2020 ; 4/2025 Qualifications for first responders 30.1 An individual may act as a first responder if the individual (a) is a minimum of 18 years of age; (b) has, within the 12 months immediately preceding the day on which the individual is employed or engaged as a first responder, successfully completed (i) an advanced level first aid course approved by the minister, and (ii) a basic cardiopulmonary resuscitation course approved by the minister; and (c) maintains a valid certification for advanced level first aid and basic cardiopulmonary resuscitation while employed or engaged as a first responder. M.R. 4/2025 31 [Repealed] M.R. 113/2020 32 and 32.1 [Repealed] M.R. 9/2014 ; 169/2015 ; 113/2020 33 and 34 [Repealed] M.R. 113/2020 35 [Repealed] M.R. 169/2015 ; 97/2019 ; 113/2020 PART 4 TRANSITIONAL AND COMING INTO FORCE 36 to 41 [Repealed] M.R. 113/2020 Repeal 42 The Ambulance Services and Licences Regulation , Manitoba Regulation 133/96, is repealed. Coming into force 43(1) Subject to subsections (2) and (3), this regulation comes into force on the day The Ambulance Services Amendment Act , S.M. 1996, c. 42, comes into force. 43(2) The following provisions come into force on January 1, 2007 or on the day The Ambulance Services Amendment Act , S.M. 1996, c. 42, comes into force, whichever is later: (a) in section 1, the definitions "call taker" and "dispatch centre"; (b) clause 6(1)⁠(b); (c) sections 10, 11 and 29. 43(3) The definition "critical incident" in subsection 24(1) and clause 24(2)⁠(b) come into force on the day Part 1 of The Regional Health Authorities Amendment and Manitoba Evidence Amendment Act , S.M. 2005, c. 24, comes into force. SCHEDULE A [Repealed] M.R. 9/2014 ; 169/2015 ; 113/2020 SCHEDULE B [Repealed] M.R. 9/2014 ; 97/2019 ; 95/2022