NRS 450B.160 Licensing of attendants and firefighters; regulations; certification of physicians, nurses and physician assistants serving as attendants.

NRS 450B.171 Relative of patient or other person may ride with attendants.

NRS 450B.180 Certification and authority of emergency medical technicians; maintenance of central registry of certificates issued; regulations. [Effective until the date of the repeal of the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

NRS 450B.180 Certification and authority of emergency medical technicians; maintenance of central registry of certificates issued; regulations. [Effective on the date of the repeal of the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

NRS 450B.183 Payment of child support: Statement by applicant for license or certificate; grounds for denial of license or certificate; duty of health authority. [Expires by limitation on the date of the repeal of the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

NRS 450B.185 Suspension of license or certificate for failure to pay child support or comply with certain subpoenas or warrants; reinstatement of license or certificate. [Expires by limitation on the date of the repeal of the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

NRS 450B.190 Provisional licensing of attendants.

BASIC EMERGENCY CARE

NRS 450B.1905 Requirements for training and certification.

INTERMEDIATE EMERGENCY CARE

NRS 450B.191 Requirements for training and certification.

NRS 450B.1915 Authorized activities.

ADVANCED EMERGENCY CARE

NRS 450B.195 Requirements for training and certification.

NRS 450B.197 Authorized activities.

PERMIT AUTHORIZING FIRE-FIGHTING AGENCY TO PROVIDE INTERMEDIATE OR ADVANCED MEDICAL CARE

NRS 450B.1985 Exclusive method of issuance; authority of district board of health in certain larger counties to issue; situations in which intermediate or advanced medical care may be provided.

AMBULANCES AND VEHICLES OF FIRE-FIGHTING AGENCIES

NRS 450B.200 Permit for operation; actions requiring opportunity for hearing; maintenance of central registry of permits issued; regulations.

NRS 450B.210 Provisional permit.

NRS 450B.220 Periodic inspections.

NRS 450B.230 Owner shall not allow operation without required equipment.

NRS 450B.235 Filing and maintenance of schedule of rates.

TREATMENT OF TRAUMA

NRS 450B.236 Approval required for operation of center for treatment of trauma.

NRS 450B.237 Establishment of program for treatment of trauma; regulations; proposal to designate hospital as trauma center; approval by Administrator of Health Division; standards; compliance.

NRS 450B.238 Regulations requiring hospital to record and maintain information.

NRS 450B.239 Health Division to cooperate with American College of Surgeons.

PROHIBITED ACTS

NRS 450B.240 Engaging in operation of services relating to ambulances without permit; provision of certain medical care by fire-fighting agency without permit.

NRS 450B.250 Service as attendant for ambulance without license; provision of certain medical care by firefighter without license.

NRS 450B.255 Representation as emergency medical technician without certificate.

NRS 450B.260 Operation of ambulance or fire-fighting vehicle used to provide medical care without licensed driver and attendant; exceptions.

NRS 450B.265 Offering advanced emergency care without permit; exception.

WITHHOLDING LIFE-SUSTAINING TREATMENT

NRS 450B.400 Definitions.

NRS 450B.405 “Attending physician” defined.

NRS 450B.410 “Do-not-resuscitate identification” defined.

NRS 450B.420 “Do-not-resuscitate order” defined.

NRS 450B.430 “Do-not-resuscitate protocol” defined.

NRS 450B.440 “Health care facility” defined.

NRS 450B.450 “Life-resuscitating treatment” defined.

NRS 450B.460 “Person who administers emergency medical services” defined.

NRS 450B.470 “Qualified patient” defined.

NRS 450B.475 “Terminal condition” defined.

NRS 450B.480 Applicability.

NRS 450B.490 Adoption of regulations; fee for do-not-resuscitate identification.

NRS 450B.500 Do-not-resuscitate identification: Contents.

NRS 450B.505 Do-not-resuscitate identification: Manufacture and issuance of bracelet or medallion.

NRS 450B.510 Written do-not-resuscitate orders: Issued only to qualified patients; physician authorized to apply for identification.

NRS 450B.520 Application for do-not-resuscitate identification: Form; requirements.

NRS 450B.525 Application for do-not-resuscitate identification on behalf of minor: Requirements; form; revocation by parent or legal guardian of authorization to withhold life-resuscitating treatment; minors of sufficient maturity.

NRS 450B.530 Revocation of authorization to withhold life-resuscitating treatment.

NRS 450B.540 Person not guilty of unprofessional conduct or subject to liability for withholding or providing life-resuscitating treatment under certain circumstances.

NRS 450B.550 Person who administers emergency medical services required to comply with do-not-resuscitate protocol; exception.

NRS 450B.560 Assumption that do-not-resuscitate identification is valid.

NRS 450B.570 Resulting death not suicide or homicide; life insurance or annuity not affected by possession of do-not-resuscitate identification or issuance of do-not-resuscitate order; prohibition or requirement of possession of do-not-resuscitate identification or issuance of do-not-resuscitate order not allowed in connection with health care.

NRS 450B.580 Unlawful acts; penalty.

NRS 450B.590 Limitations on effect of NRS 450B.400 to 450B.590, inclusive.

AUTOMATED EXTERNAL DEFIBRILLATORS

NRS 450B.600 Required to be placed in certain public buildings and locations; inspection and maintenance; training on operation and use.

MISCELLANEOUS PROVISIONS

NRS 450B.790 Hospital required to ensure that certain persons in need of emergency services are transferred to appropriate places in hospital within 30 minutes after arrival; regulations; civil or criminal liability.

NRS 450B.800 Fingerprints of applicant.

NRS 450B.810 Maintenance, inspection and compilation of information.

NRS 450B.820 Local requirements for franchise or permit are not superseded.

NRS 450B.830 Exemptions from chapter.

NRS 450B.840 Operation of ambulance or fire-fighting agency by county or city subject to provisions of chapter.

NRS 450B.850 Programs for training.

NRS 450B.860 Volunteer ambulance drivers and attendants: Discharge from employment; civil action; disclosure to employer.

PENALTIES

NRS 450B.900 Violations; penalty.

_________

GENERAL PROVISIONS

NRS 450B.015 Legislative declaration. The Legislature hereby declares that prompt and efficient emergency medical care and transportation is necessary for the health and safety of the people of Nevada, and that minimum standards for such care and all persons providing it must be established.

(Added to NRS by 1981, 1599; A 1993, 2828)

NRS 450B.020 Definitions. As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 450B.025 to 450B.110, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 1973, 1141; A 1985, 1693; 1987, 1043, 2207; 1993, 2118, 2828; 1995, 725; 1999, 1172)

NRS 450B.025 “Advanced emergency medical technician” defined. “Advanced emergency medical technician” means a person:

1. Trained in advanced emergency medical care in a training program approved by the board; and

2. Certified by the health officer as having satisfactorily completed the training program.

(Added to NRS by 1987, 2206; A 1993, 2828)

NRS 450B.030 “Air ambulance” defined. “Air ambulance” means an aircraft especially designed, constructed, modified or equipped to be used for the transportation of injured or sick persons. “Air ambulance” does not include any commercial aircraft carrying passengers on regularly scheduled flights.

(Added to NRS by 1973, 1141)

NRS 450B.040 “Ambulance” defined. “Ambulance” means a motor vehicle which is specially designed, constructed, equipped and staffed to provide basic, intermediate or advanced care for one or more:

1. Sick or injured persons; or

2. Persons whose medical condition may require special observation during transportation or transfer,

Ê including, without limitation, such a vehicle of a fire-fighting agency.

(Added to NRS by 1973, 1141; A 1985, 1726, 2117; 2001, 998)

NRS 450B.050 “Attendant” defined. “Attendant” means a person responsible for the care of a sick or injured person in an ambulance or air ambulance, and includes the driver of an ambulance but not the pilot of an air ambulance.

(Added to NRS by 1973, 1141)

NRS 450B.060 “Board” defined. “Board” means:

1. In a county whose population is less than 400,000, the State Board of Health.

2. In a county whose population is 400,000 or more, the district board of health.

(Added to NRS by 1973, 1141; A 1993, 2828; 1995, 2547; 2005, 2471)

NRS 450B.061 “Committee” defined. “Committee” means the Committee on Emergency Medical Services.

(Added to NRS by 1999, 1170)

NRS 450B.063 “Emergency medical dispatcher” defined. “Emergency medical dispatcher” means a person who:

1. Has completed a training program in emergency medical dispatching which has been approved by the board; and

2. Has been certified as having satisfactorily completed such a training program by an entity approved by the board to provide such training.

(Added to NRS by 1993, 2117)

NRS 450B.065 “Emergency medical technician” defined. “Emergency medical technician” means a person:

1. Trained in basic emergency medical care in a training program approved by the board; and

2. Certified by the health officer as having satisfactorily completed the training program.

(Added to NRS by 1987, 2206; A 1993, 2828)

NRS 450B.070 “Emergency medical technician certificate” defined. Emergency medical technician certificate” means the certificate issued by the health authority acknowledging successful completion of an approved course for an emergency medical technician at the level identified on the certificate.

(Added to NRS by 1973, 1141; A 1987, 2207; 1993, 2828)

NRS 450B.071 “Firefighter” defined. “Firefighter” means a person who holds a license and is employed by or serving as a volunteer with a fire-fighting agency.

(Added to NRS by 1985, 1692; A 2005, 330)—(Substituted in revision for NRS 450B.073)

NRS 450B.072 “Fire-fighting agency” defined. “Fire-fighting agency” means a fire department or fire protection district of the State or a political subdivision which holds a permit issued pursuant to this chapter. The term does not include a person or governmental entity, other than a governmental entity to whom a permit is issued in accordance with the provisions of NRS 450B.1985, which provides transportation of sick or injured persons to a medical facility.

(Added to NRS by 1985, 1692; A 1987, 718; 2001, 998)

NRS 450B.073 “Fireman” defined. [Replaced in revision by NRS 450B.071.]

NRS 450B.077 “Health authority” defined. “Health authority” means:

1. In a county whose population is less than 400,000, the Health Division.

2. In a county whose population is 400,000 or more, the district board of health.

(Added to NRS by 1993, 2827; A 1995, 2547; 2005, 2471)

NRS 450B.080 “Health Division” defined. “Health Division” means the Health Division of the Department of Health and Human Services.

(Added to NRS by 1973, 1141; A 1973, 1406)

NRS 450B.082 “Health officer” defined. “Health officer” means:

1. In a county whose population is less than 400,000, the State Health Officer.

2. In a county whose population is 400,000 or more, the district health officer.

(Added to NRS by 1993, 2827; A 1995, 2547; 2005, 2471)

NRS 450B.085 “Intermediate emergency medical technician” defined. “Intermediate emergency medical technician” means a person:

1. Trained in intermediate emergency medical care in a training program approved by the board; and

2. Individually certified by the health officer as having satisfactorily completed the training program.

(Added to NRS by 1981, 277; A 1993, 2828)

NRS 450B.090 “License” defined. “License” means the license issued by the health authority under the provisions of this chapter to an attendant of an ambulance or an air ambulance or to a firefighter employed by or serving as a volunteer with a fire-fighting agency.

(Added to NRS by 1973, 1141; A 1985, 1693; 1993, 2828; 2005, 330)

NRS 450B.100 “Permit” defined. “Permit” means the permit issued by the health authority under the provisions of this chapter to:

1. A person, agency of the State or political subdivision to own or operate an ambulance or air ambulance in the State of Nevada; or

2. A fire-fighting agency to provide intermediate or advanced medical care to sick or injured persons:

(a) At the scene of an emergency; or

(b) At the scene of an emergency and while transporting those persons to a medical facility.

(Added to NRS by 1973, 1141; A 1985, 1693; 1993, 2829; 2001, 998)

NRS 450B.105 “Trauma” defined. “Trauma” means any acute injury which, according to standardized criteria for triage in the field, involves a significant risk of death or the precipitation of complications or disabilities.

(Added to NRS by 1987, 1042)

NRS 450B.110 “Volunteer attendant” defined. “Volunteer attendant” means a person who does not receive the majority of his annual employment income from employment as an attendant, and who is not employed by a commercial ambulance firm or corporation.

(Added to NRS by 1973, 1141)

NRS 450B.120 Regulations, standards and procedures of board. The board shall establish and promulgate such rules, regulations, standards and procedures as it determines are necessary to administer the provisions of this chapter.

(Added to NRS by 1973, 1141)

NRS 450B.130 Establishment of minimum standards and additional requirements.

1. The board shall adopt regulations establishing reasonable minimum standards for:

(a) Sanitation in ambulances and air ambulances;

(b) Medical and nonmedical equipment and supplies to be carried in ambulances and air ambulances and medical equipment and supplies to be carried in vehicles of a fire-fighting agency;

(d) Permits for operation of ambulances, air ambulances and vehicles of a fire-fighting agency;

(e) Records to be maintained by an operator of an ambulance or air ambulance or by a fire-fighting agency; and

(f) Treatment of patients who are critically ill or in urgent need of treatment.

2. The health officers of this state shall jointly adopt regulations to establish the minimum standards for the certification of emergency medical technicians. Upon adoption of the regulations, each health authority shall adopt the regulations for its jurisdiction. After each health authority adopts the regulations, the standards established constitute the minimum standards for certification of emergency medical technicians in this state. Any changes to the minimum standards must be adopted jointly by the health officers and by each health authority in the manner set forth in this subsection. Any changes in the minimum standards which are not adopted in the manner set forth in this subsection are void.

3. A health officer may adopt regulations that impose additional requirements for the certification of emergency medical technicians in his jurisdiction, but he must accept the certification of an emergency medical technician from the jurisdiction of another health officer as proof that the emergency medical technician has met the minimum requirements for certification.

(Added to NRS by 1973, 1142; A 1979, 69; 1981, 1553; 1985, 1693; 1993, 2829)

NRS 450B.140 Sources for standards and regulations; standards may differ for different categories.

1. In adopting regulations under NRS 450B.120 and 450B.130, the board may use standards and regulations proposed by:

(a) The Committee on Trauma of the American College of Surgeons;

(b) The United States Department of Transportation;

(d) The Bureau of Health Insurance of the Social Security Administration;

(e) The American Academy of Orthopaedic Surgeons;

(f) The National Academy of Sciences—National Research Council;

(g) The American Heart Association; and

(h) Regional, state and local emergency medical services committees and councils.

2. The board may establish different standards for commercial, volunteer, industrial and other categories of ambulances and fire-fighting agencies to reflect different circumstances and in the public interest.

(Added to NRS by 1973, 1142; A 1985, 1693; 1993, 2829)

NRS 450B.150 Administration and enforcement; inspections.

1. The health authority shall administer and enforce the provisions of this chapter.

2. The health authority and its authorized agents shall enter upon and inspect, in a reasonable manner and during reasonable business hours, the premises and vehicles of persons and governmental entities providing services regulated pursuant to the provisions of this chapter.

(Added to NRS by 1973, 1142; A 1985, 1694; 1987, 2207; 1989, 1505, 1928; 1993, 2830)

COMMITTEE ON EMERGENCY MEDICAL SERVICES

NRS 450B.151 Creation; membership; terms of members; alternate members; vacancies.

1. The Committee on Emergency Medical Services, consisting of nine members appointed by the Governor, is hereby created.

2. Upon request of the Governor, employee associations that represent persons that provide emergency medical services, including, without limitation, physicians and nurses that provide emergency medical services, emergency medical technicians, ambulance attendants, firefighters, fire chiefs and employees of rural hospitals, shall submit to the Governor written nominations for appointments to the Committee.

3. After considering the nominations submitted pursuant to subsection 2, the Governor shall appoint to the Committee:

(a) One member who is a physician licensed pursuant to chapter 630 or 633 of NRS and who has experience providing emergency medical services;

(b) One member who is a registered nurse and who has experience providing emergency medical services;

(d) One member who is employed by a fire-fighting agency at which some of the firefighters are employed and some serve as volunteers;

(e) One member who is employed by an urban fire-fighting agency;

(f) One member who is employed by or serves as a volunteer with a medical facility that is located in a rural area and that provides emergency medical services;

(g) One member who is employed by an organization that provides emergency medical services in an air ambulance and whose duties are closely related to such emergency medical services;

(h) One member who is employed by a privately owned entity that provides emergency medical services; and

(i) One member who is employed by an operator of a service which is:

(1) Provided for the benefit of the employees of an industry who become sick or are injured at the industrial site; and

(2) Staffed by employees who are licensed attendants and perform emergency medical services primarily for the industry.

4. In addition to the members set forth in subsection 3, the following persons are ex officio members of the Committee:

(a) An employee of the Health Division, appointed by the Administrator of the Health Division, whose duties relate to administration and enforcement of the provisions of this chapter;

(b) The county health officer appointed pursuant to NRS 439.290 in each county whose population is 100,000 or more, or his designee; and

(c) A physician who is a member of a committee which consists of directors of trauma centers in this State and who is nominated by that committee.

5. The term of each member appointed by the Governor is 2 years, and such a member may not serve more than two consecutive terms.

6. The Governor shall not appoint to the Committee two persons who are employed by or volunteer with the same organization, except the Governor may appoint a person who is employed by or volunteers with the same organization of which a member who serves ex officio is an employee.

7. Each member of the Committee shall appoint an alternate to serve in his place if he is temporarily unable to perform the duties required of him pursuant to NRS 450B.151 to 450B.154, inclusive.

8. A position on the Committee that becomes vacant before the end of the term of the member must be filled in the manner prescribed by this section for the remainder of the term.

(Added to NRS by 1999, 1170; A 2005, 330)

NRS 450B.152 Chairman; meetings; rules for management; compensation of members.

1. The Committee shall elect a chairman from among its members. The term of the Chairman is 1 year.

2. The Committee shall meet at the call of the Chairman at least four times each year.

3. The Committee shall adopt rules for its own management.

4. A member of the Committee serves without compensation, except that, for each day or portion of a day during which he attends a meeting of the Committee or is otherwise engaged in the business of the Committee, a member of the Committee is entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally. The per diem allowance and travel expenses must be paid by the Health Division from money not allocated by specific statute for another use.

(Added to NRS by 1999, 1171)

NRS 450B.153 Duties. The Committee shall:

1. Review and advise the Health Division regarding the management and performance of emergency medical services in this State and regarding statewide emergency medical protocols;

2. Advise the Health Division on matters of policy relating to emergency care, including, without limitation, the qualifications of persons who provide emergency medical services;

3. Advise the board and Health Division with respect to the preparation and adoption of regulations regarding emergency care;

4. Review periodically the budget of the Health Division that relates to emergency medical services;

5. Encourage the training and education of emergency medical service personnel to improve the system of public safety in this State; and

6. Perform such other duties as may be required by law or regulation.

(Added to NRS by 1999, 1171)

NRS 450B.154 Administrative support. The Health Division shall provide administrative support and assistance to the Committee.

(Added to NRS by 1999, 1172)

EMERGENCY MEDICAL DISPATCHERS

NRS 450B.155 Training and certification.

1. An educational institution, public or private agency or other entity may provide a training program for emergency medical dispatchers and issue certificates of completion if the program meets the requirements set forth in the regulations of the board and is approved by the board.

2. The board shall adopt regulations:

(a) Prescribing the requirements for a program for training and certifying an emergency medical dispatcher;

(b) Prescribing the procedures for an educational institution, public or private agency or other entity to obtain the approval of the board to provide such a program; and

(Added to NRS by 1993, 2117)

AMBULANCE ATTENDANTS, EMERGENCY MEDICAL TECHNICIANS AND FIREFIGHTERS

NRS 450B.160 Licensing of attendants and firefighters; regulations; certification of physicians, nurses and physician assistants serving as attendants.

1. The health authority may issue licenses to attendants and to firefighters employed by or serving as volunteers with a fire-fighting agency.

2. Each license must be evidenced by a card issued to the holder of the license, is valid for a period not to exceed 2 years and is renewable.

3. An applicant for a license must file with the health authority:

(a) A current, valid certificate evidencing his successful completion of a program or course for training in emergency medical technology, if he is applying for a license as an attendant, or, if a volunteer attendant, at a level of skill determined by the board.

(b) A current valid certificate evidencing his successful completion of a program for training as an intermediate emergency medical technician or advanced emergency medical technician if he is applying for a license as a firefighter with a fire-fighting agency.

(1) His name and address;

(2) His employer’s name and address; and

(3) A description of his duties.

(d) Such other certificates for training and such other items as the board may specify.

4. The board shall adopt such regulations as it determines are necessary for the issuance, suspension, revocation and renewal of licenses.

5. Each operator of an ambulance or air ambulance and each fire-fighting agency shall annually file with the health authority a complete list of the licensed persons in its service.

6. Licensed physicians, registered nurses and licensed physician assistants may serve as attendants without being licensed under the provisions of this section. A registered nurse who performs advanced emergency care in an ambulance or air ambulance shall perform the care in accordance with the regulations of the State Board of Nursing. A licensed physician assistant who performs advanced emergency care in an ambulance or air ambulance shall perform the care in accordance with the regulations of the Board of Medical Examiners.

7. Each licensed physician, registered nurse and licensed physician assistant who serves as an attendant must have current certification of completion of training in:

(a) Advanced life-support procedures for patients who require cardiac care;

(b) Life-support procedures for pediatric patients who require cardiac care; or

(c) Life-support procedures for patients with trauma that are administered before the arrival of those patients at a hospital.

Ê The certification must be issued by the Board of Medical Examiners for a physician or licensed physician assistant or by the State Board of Nursing for a registered nurse.

8. The Board of Medical Examiners and the State Board of Nursing shall issue a certificate pursuant to subsection 7 if the licensed physician, licensed physician assistant or registered nurse attends:

(a) A course offered by a national organization which is nationally recognized for issuing such certification;

(b) Training conducted by the operator of an ambulance or air ambulance; or

Ê approved by the Board of Medical Examiners or the State Board of Nursing, whichever is issuing the certification. The Board of Medical Examiners and the State Board of Nursing may require certification of training in all three areas set forth in subsection 7 for a licensed physician, licensed physician assistant or registered nurse who primarily serves as an attendant in a county whose population is 400,000 or more.

(Added to NRS by 1973, 1142; A 1977, 962; 1979, 70; 1981, 278, 1554; 1985, 1694, 2118; 1987, 2207; 1993, 317, 2830; 1995, 725; 1997, 690; 2001, 782; 2005, 331)

NRS 450B.171 Relative of patient or other person may ride with attendants. Except as otherwise provided in this chapter, unlicensed relatives of a sick or injured patient and other persons may ride in an ambulance if there are two attendants in the ambulance, each of whom is licensed pursuant to this chapter or exempt from licensing pursuant to subsection 6 of NRS 450B.160.

(Added to NRS by 1989, 286; A 1993, 318)

1. Any person desiring certification as an emergency medical technician must apply to the health authority using forms prescribed by the health authority.

2. The health authority, pursuant to regulations and procedures adopted by the board, shall make a determination of the applicant’s qualifications to be certified as an emergency medical technician, and shall issue a certificate as an emergency medical technician to each qualified applicant.

3. A certificate as an emergency medical technician is valid for a period not exceeding 2 years and may be renewed if the holder of the certificate complies with the provisions of this chapter and meets the qualifications set forth in the regulations and standards established by the board pursuant to this chapter. The regulations and standards established by the board must provide for the completion of a course of instruction, within 2 years after initial licensure, relating to the medical consequences of an act of terrorism that involves the use of a weapon of mass destruction. The course must provide at least 4 hours of instruction that includes instruction in the following subjects:

(a) An overview of acts of terrorism and weapons of mass destruction;

(b) Personal protective equipment required for acts of terrorism;

(c) Common symptoms and methods of treatment associated with exposure to, or injuries caused by, chemical, biological, radioactive and nuclear agents;

(d) Syndromic surveillance and reporting procedures for acts of terrorism that involve biological agents; and

(e) An overview of the information available on, and the use of, the Health Alert Network.

Ê The board may thereafter determine whether to establish regulations and standards requiring additional courses of instruction relating to the medical consequences of an act of terrorism that involves the use of a weapon of mass destruction.

4. The health authority may suspend or revoke the certificate of an emergency medical technician if it finds that the holder of the certificate no longer meets the prescribed qualifications. Unless the certificate is suspended by the district court pursuant to NRS 425.540, the holder of the certificate may appeal the suspension or revocation of his certificate pursuant to regulations adopted by the board.

5. The board shall determine the procedures and techniques which may be performed by an emergency medical technician.

6. A certificate issued pursuant to this section is valid throughout the State, whether issued by the Health Division or a district board of health.

7. The Health Division shall maintain a central registry of all certificates issued pursuant to this section, whether issued by the Health Division or a district board of health.

8. The board shall adopt such regulations as are necessary to carry out the provisions of this section.

9. As used in this section:

(a) “Act of terrorism” has the meaning ascribed to it in NRS 202.4415.

(b) “Biological agent” has the meaning ascribed to it in NRS 202.442.

(d) “Radioactive agent” has the meaning ascribed to it in NRS 202.4437.

(e) “Weapon of mass destruction” has the meaning ascribed to it in NRS 202.4445.

(Added to NRS by 1973, 1143; A 1977, 70; 1981, 279, 1555; 1991, 1916; 1993, 2831; 1995, 2548; 1997, 2056; 2003, 2953; 2005, 2471)

1. Any person desiring certification as an emergency medical technician must apply to the health authority using forms prescribed by the health authority.

3. A certificate as an emergency medical technician is valid for a period not exceeding 2 years and may be renewed if the holder of the certificate meets the qualifications set forth in the regulations and standards established by the board pursuant to this chapter. The regulations and standards established by the board must provide for the completion of a course of instruction, within 2 years after initial licensure, relating to the medical consequences of an act of terrorism that involves the use of a weapon of mass destruction. The course must provide at least 4 hours of instruction that includes instruction in the following subjects:

(a) An overview of acts of terrorism and weapons of mass destruction;

(b) Personal protective equipment required for acts of terrorism;

(c) Common symptoms and methods of treatment associated with exposure to, or injuries caused by, chemical, biological, radioactive and nuclear agents;

(d) Syndromic surveillance and reporting procedures for acts of terrorism that involve biological agents; and

(e) An overview of the information available on, and the use of, the Health Alert Network.

4. The health authority may suspend or revoke the certificate of an emergency medical technician if it finds that the holder of the certificate no longer meets the prescribed qualifications. The holder of the certificate may appeal the suspension or revocation of his certificate pursuant to regulations adopted by the board.

5. The board shall determine the procedures and techniques which may be performed by an emergency medical technician.

6. A certificate issued pursuant to this section is valid throughout the State, whether issued by the Health Division or a district board of health.

7. The Health Division shall maintain a central registry of all certificates issued pursuant to this section, whether issued by the Health Division or a district board of health.

8. The board shall adopt such regulations as are necessary to carry out the provisions of this section.

9. As used in this section:

(a) “Act of terrorism” has the meaning ascribed to it in NRS 202.4415.

(b) “Biological agent” has the meaning ascribed to it in NRS 202.442.

(d) “Radioactive agent” has the meaning ascribed to it in NRS 202.4437.

(e) “Weapon of mass destruction” has the meaning ascribed to it in NRS 202.4445.

(Added to NRS by 1973, 1143; A 1977, 70; 1981, 279, 1555; 1991, 1916; 1993, 2831; 1995, 2548; 1997, 2056; 2003, 2953; 2005, 2471, 2472, effective on the date of the repeal of the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings)

1. An applicant for the issuance or renewal of a license as an attendant or firefighter employed by a fire-fighting agency or an emergency medical technician certificate shall submit to the health authority the statement prescribed by the Division of Welfare and Supportive Services of the Department of Health and Human Services pursuant to NRS 425.520. The statement must be completed and signed by the applicant.

2. The health authority shall include the statement required pursuant to subsection 1 in:

(a) The application or any other forms that must be submitted for the issuance or renewal of the license or certificate; or

(b) A separate form prescribed by the health authority.

3. A license or certificate described in subsection 1 may not be issued or renewed by the health authority if the applicant:

(a) Fails to submit the statement required pursuant to subsection 1; or

(b) Indicates on the statement submitted pursuant to subsection 1 that he is subject to a court order for the support of a child and is not in compliance with the order or a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order.

4. If an applicant indicates on the statement submitted pursuant to subsection 1 that he is subject to a court order for the support of a child and is not in compliance with the order or a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order, the health authority shall advise the applicant to contact the district attorney or other public agency enforcing the order to determine the actions that the applicant may take to satisfy the arrearage.

(Added to NRS by 1997, 2055; A 2005, 332)

1. If the health authority receives a copy of a court order issued pursuant to NRS 425.540 that provides for the suspension of all professional, occupational and recreational licenses, certificates and permits issued to a person who is the holder of a license as an attendant or firefighter employed by a fire-fighting agency or an emergency medical technician certificate, the health authority shall deem the license or certificate issued to that person to be suspended at the end of the 30th day after the date on which the court order was issued unless the health authority receives a letter issued to the holder of the license or certificate by the district attorney or other public agency pursuant to NRS 425.550 stating that the holder of the license or certificate has complied with the subpoena or warrant or has satisfied the arrearage pursuant to NRS 425.560.

2. The health authority shall reinstate a license as an attendant or firefighter employed by a fire-fighting agency or an emergency medical technician certificate that has been suspended by a district court pursuant to NRS 425.540 if:

(a) The health authority receives a letter issued by the district attorney or other public agency pursuant to NRS 425.550 to the person whose license or certificate was suspended stating that the person whose license or certificate was suspended has complied with the subpoena or warrant or has satisfied the arrearage pursuant to NRS 425.560; and

(b) The person whose license or certificate was suspended pays any fees imposed by the health authority for the reinstatement of a suspended license or certificate.

(Added to NRS by 1997, 2056; A 2005, 333)

NRS 450B.187 Application for license or certificate to include social security number. [Expires by limitation on the date of the repeal of the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.] An application for the issuance or renewal of a license as an attendant or firefighter employed by a fire-fighting agency or an emergency medical technician certificate must include the social security number of the applicant.

(Added to NRS by 1997, 2056; A 2005, 333)

NRS 450B.190 Provisional licensing of attendants.

1. The health authority may, at its discretion, issue a provisional license as an attendant to a person who does not meet the qualifications established pursuant to this chapter, if the health authority determines that such issuance will be in the public interest.

2. A provisional license as an attendant must not be made valid for more than 1 year from the date of issuance and is not renewable.

(Added to NRS by 1973, 1144; A 1987, 2208; 1993, 2832)

BASIC EMERGENCY CARE

NRS 450B.1905 Requirements for training and certification.

1. A program for training in the basic care of a patient in urgent need of medical care or observation must be:

(a) Supervised by a physician and approved by the health authority; or

(b) Presented by a national organization which is nationally recognized for providing such training and approved by the board.

2. Except as otherwise provided in subsections 3 and 4, training in basic care must include:

(a) Procedures to establish and maintain an open airway in a patient;

(b) Administration of oxygen, both manually and by a device which uses intermittent positive pressure;

(d) Treatment of shock;

(e) Control of bleeding;

(f) Treatment of wounds;

(g) Application of splints;

(h) Treatment for poisoning;

(i) Childbirth; and

(j) Rescue.

3. A program for training in the basic care of a patient may follow the curriculum prepared by the United States Department of Transportation as a national standard for emergency medical technicians.

4. The board may adopt regulations which prescribe other requirements for training in the basic care of a patient in urgent need of medical care or observation.

5. An owner of an ambulance shall not offer basic care of a patient in urgent need of medical care or observation unless the attendant has successfully completed a program of training in such care or is exempt, pursuant to subsection 6 of NRS 450B.160, from the requirement to obtain that training.

6. The board may by regulation prescribe additional requirements for receiving and maintaining certification in basic emergency care. The curriculum for training must be:

(a) At the level of advanced first aid; or

(b) At least equivalent to any curriculum prepared by the Department of Transportation as a national standard for emergency medical technicians.

(Added to NRS by 1985, 2117; A 1987, 2208; 1993, 318, 2832)

INTERMEDIATE EMERGENCY CARE

NRS 450B.191 Requirements for training and certification.

1. A program of training in intermediate emergency care of a patient in urgent need of medical care or observation must be conducted by a licensed physician and approved by the health authority.

2. A program of training for an intermediate emergency medical technician must include an approved curriculum in intravenous therapy and the management of a passage for air to the lungs. Only a certified emergency medical technician with experience as established by the board is eligible for this training.

3. In order to maintain his certification, each intermediate emergency medical technician must annually:

(a) Comply with the requirements established by the board for continuing medical education; and

(b) Demonstrate his skills as required by regulation of the board.

4. The board may by regulation prescribe the curriculum and other requirements for training and maintaining certification in intermediate emergency care. The curriculum must be at least equivalent to any curriculum prepared by the United States Department of Transportation as a national standard for intermediate emergency medical technicians.

5. A person shall not represent himself to be an intermediate emergency medical technician unless he has on file with the health authority a currently valid certificate demonstrating successful completion of the program of training required by this section.

6. Except as authorized by subsection 6 of NRS 450B.160, an attendant or firefighter shall not perform, and the owner, operator, director or chief officer of an ambulance or a fire-fighting agency must not offer, intermediate emergency care without fulfilling the requirements established by the board.

(Added to NRS by 1981, 277; A 1981, 1557; 1985, 1695; 1987, 2209; 1993, 319, 2833; 1995, 725; 2005, 333)

NRS 450B.1915 Authorized activities. An intermediate emergency medical technician may perform any procedure and administer any drug approved by regulation of the board.

(Added to NRS by 1981, 278; A 1987, 2210)

ADVANCED EMERGENCY CARE

NRS 450B.195 Requirements for training and certification.

1. Only a certified emergency medical technician who is a licensed attendant or a firefighter with experience as established by the board is eligible for training as an advanced emergency medical technician.

2. A program of training in advanced emergency care for advanced emergency medical technicians must be conducted by a licensed physician and approved by the health authority.

3. In order to maintain his certification, each advanced emergency medical technician must annually:

(a) Comply with the requirements established by the board for continuing medical education; and

(b) Demonstrate his skills as required by regulation of the board.

4. The board may by regulation prescribe the curriculum and other requirements for training and maintaining certification in advanced emergency care. The curriculum must be at least equivalent to any curriculum prepared by the United States Department of Transportation as a national standard for advanced emergency medical technicians.

5. A person shall not represent himself to be an advanced emergency medical technician unless he has on file with the health authority a currently valid certificate evidencing his successful completion of the program of training required by this section.

6. Except as authorized by subsection 6 of NRS 450B.160, an attendant or firefighter shall not perform, and the owner, operator, director or chief officer of an ambulance or a fire-fighting agency must not offer, advanced emergency care without fulfilling the requirements established by the board.

(Added to NRS by 1973, 610; A 1975, 38; 1979, 71; 1981, 1555; 1985, 1696; 1987, 2210; 1993, 319, 2833; 1995, 725; 2005, 334)

NRS 450B.197 Authorized activities. An attendant or a firefighter who is an advanced emergency medical technician may perform any procedure and administer any drug approved by regulation of the board.

(Added to NRS by 1973, 610; A 1975, 38; 1981, 1556; 1985, 1696; 1987, 2211; 2005, 334)

PERMIT AUTHORIZING FIRE-FIGHTING AGENCY TO PROVIDE INTERMEDIATE OR ADVANCED MEDICAL CARE

NRS 450B.1985 Exclusive method of issuance; authority of district board of health in certain larger counties to issue; situations in which intermediate or advanced medical care may be provided.

1. Except as otherwise provided in subsection 2, no permit may be issued pursuant to this chapter authorizing a fire-fighting agency to provide intermediate or advanced medical care to sick or injured persons while transporting those persons to a medical facility.

2. Except as otherwise provided in subsection 9 of NRS 450B.200, the district board of health in a county whose population is 400,000 or more may issue a permit pursuant to NRS 450B.200 or 450B.210 authorizing a fire-fighting agency to provide intermediate or advanced medical care to sick or injured persons at the scene of an emergency and while transporting those persons to a medical facility.

(Added to NRS by 2001, 998; A 2005, 2473)

AMBULANCES AND VEHICLES OF FIRE-FIGHTING AGENCIES

NRS 450B.200 Permit for operation; actions requiring opportunity for hearing; maintenance of central registry of permits issued; regulations.

1. The health authority may issue a permit for the operation of an ambulance, an air ambulance or a vehicle of a fire-fighting agency at the scene of an emergency.

2. Each permit must be evidenced by a card issued to the holder of the permit.

3. No permit may be issued unless the applicant is qualified pursuant to the regulations of the board.

4. An application for a permit must be made upon forms prescribed by the board and in accordance with procedures established by the board, and must contain the following:

(a) The name and address of the owner of the ambulance or air ambulance or of the fire-fighting agency;

(b) The name under which the applicant is doing business or proposes to do business, if applicable;

(c) A description of each ambulance, air ambulance or vehicle of a fire-fighting agency, including the make, year of manufacture and chassis number, and the color scheme, insigne, name, monogram or other distinguishing characteristics to be used to designate the applicant’s ambulance, air ambulance or vehicle;

(d) The location and description of the places from which the ambulance, air ambulance or fire-fighting agency intends to operate; and

(e) Such other information as the board deems reasonable and necessary to a fair determination of compliance with the provisions of this chapter.

5. The board shall establish a reasonable fee for annual permits.

6. All permits expire on July 1 following the date of issue, and are renewable annually thereafter upon payment of the fee required by subsection 5 at least 30 days before the expiration date.

7. The health authority shall:

(a) Revoke, suspend or refuse to renew any permit issued pursuant to this section for violation of any provision of this chapter or of any regulation adopted by the board; or

(b) Bring an action in any court for violation of this chapter or the regulations adopted pursuant to this chapter,

Ê only after the holder of a permit is afforded an opportunity for a public hearing pursuant to regulations adopted by the board.

8. The health authority may suspend a permit if the holder is using an ambulance, air ambulance or vehicle of a fire-fighting agency which does not meet the minimum requirements for equipment as established by the board pursuant to this chapter.

9. The issuance of a permit pursuant to this section or NRS 450B.210 does not authorize any person or governmental entity to provide those services or to operate any ambulance, air ambulance or vehicle of a fire-fighting agency not in conformity with any ordinance or regulation enacted by any county, municipality or special purpose district.

10. A permit issued pursuant to this section is valid throughout the State, whether issued by the Health Division or a district board of health. An ambulance, air ambulance or vehicle of a fire-fighting agency which has received a permit from the district board of health in a county whose population is 400,000 or more is not required to obtain a permit from the Health Division, even if the ambulance, air ambulance or vehicle of a fire-fighting agency has routine operations outside the county.

11. The Health Division shall maintain a central registry of all permits issued pursuant to this section, whether issued by the Health Division or a district board of health.

12. The board shall adopt such regulations as are necessary to carry out the provisions of this section.

(Added to NRS by 1973, 1144; A 1977, 71; 1981, 279; 1985, 1697; 1987, 2212; 1991, 1916; 1993, 2834; 1995, 2548; 2005, 2473)

NRS 450B.210 Provisional permit.

1. The board may issue provisional permits limited as to time, place and purpose, based on the need therefor. No provisional permit may be issued for a period of longer than 6 months. The board may establish a reasonable fee for such provisional permits.

2. Unless otherwise limited in the permit, a provisional permit issued pursuant to this section is valid for providing emergency services throughout the State, whether issued by the Health Division or a district board of health.

(Added to NRS by 1973, 1145; A 1991, 1917; 2005, 2474)

NRS 450B.220 Periodic inspections. Subsequent to issuance of any permit under NRS 450B.200 and 450B.210, the health authority shall cause to be inspected the ambulances, aircraft, vehicles, medical supplies, equipment, personnel, records, premises and operational procedures of a holder of a permit whenever that inspection is deemed necessary, but no less frequently than once each year. The periodic inspection required by this section is in addition to any other state or local inspections required for ambulances, aircraft or motor vehicles under statute or ordinances.

(Added to NRS by 1973, 1145; A 1985, 1699; 1993, 2835)

NRS 450B.230 Owner shall not allow operation without required equipment. The public or private owner of an ambulance or air ambulance or the fire-fighting agency who owns a vehicle used in providing emergency medical care shall not permit its operation and use without the equipment required by regulations and standards of the board.

(Added to NRS by 1973, 1145; A 1985, 1699)

NRS 450B.235 Filing and maintenance of schedule of rates.

1. Each public and private owner of an ambulance or air ambulance shall file his schedule of rates with the health authority. Any change in a schedule must be filed before the change becomes effective.

2. The health authority shall keep each schedule of rates or changes filed with it for at least 3 years after the schedule has been superseded or otherwise become ineffective.

(Added to NRS by 1979, 726; A 1993, 2835)

TREATMENT OF TRAUMA

NRS 450B.236 Approval required for operation of center for treatment of trauma. A person shall not operate a center for the treatment of trauma without first applying for and obtaining the written approval of the Administrator of the Health Division.

(Added to NRS by 1987, 1042)

NRS 450B.237 Establishment of program for treatment of trauma; regulations; proposal to designate hospital as trauma center; approval by Administrator of Health Division; standards; compliance.

1. The board shall establish a program for treating persons who require treatment for trauma and for transporting and admitting such persons to centers for the treatment of trauma. The program must provide for the development, operation and maintenance of a system of communication to be used in transporting such persons to the appropriate centers.

2. The State Board of Health shall adopt regulations which establish the standards for the designation of hospitals as centers for the treatment of trauma. The State Board of Health shall consider the standards adopted by the American College of Surgeons for a center for the treatment of trauma as a guide for such regulations. The Administrator of the Health Division shall not approve a proposal to designate a hospital as a center for the treatment of trauma unless the hospital meets the standards established pursuant to this subsection.

3. Each district board of health in a county whose population is 400,000 or more shall adopt regulations which establish the standards for the designation of hospitals in the county as centers for the treatment of trauma which are consistent with the regulations adopted by the State Board of Health pursuant to subsection 2. A district board of health shall not approve a proposal to designate a hospital as a center for the treatment of trauma unless the hospital meets the standards established pursuant to this subsection.

4. A proposal to designate a hospital located in a county whose population is 400,000 or more as a center for the treatment of trauma:

(a) Must be approved by the Administrator of the Health Division and by the district board of health of the county in which the hospital is located; and

(b) May not be approved unless the district board of health of the county in which the hospital is located has established and adopted a comprehensive trauma system plan concerning the treatment of trauma in the county, which includes, without limitation, consideration of the future trauma needs of the county, consideration of and plans for the development and designation of new centers for the treatment of trauma in the county based on the demographics of the county and the manner in which the county may most effectively provide trauma services to persons in the county.

5. Upon approval by the Administrator of the Health Division and, if the hospital is located in a county whose population is 400,000 or more, the district board of health of the county in which the hospital is located, of a proposal to designate a hospital as a center for the treatment of trauma, the Administrator of the Health Division shall issue written approval which designates the hospital as such a center. As a condition of continuing designation the hospital must comply with the following requirements:

(a) The hospital must admit any injured person who requires medical care.

(b) Any physician who provides treatment for trauma must be qualified to provide that treatment.

(Added to NRS by 1987, 1042; A 1993, 2835; 2005, 1349)

NRS 450B.238 Regulations requiring hospital to record and maintain information. The State Board of Health shall adopt regulations which require each hospital to record and maintain information concerning the treatment of trauma in the hospital. The Board shall consider the guidelines adopted by the American College of Surgeons which concern the information which must be recorded.

(Added to NRS by 1987, 1043; A 1993, 2836)

NRS 450B.239 Health Division to cooperate with American College of Surgeons. In addition to the education and training required by this chapter, the Health Division shall cooperate with the American College of Surgeons to provide training in the treatment of trauma.

(Added to NRS by 1987, 1043)

PROHIBITED ACTS

NRS 450B.240 Engaging in operation of services relating to ambulances without permit; provision of certain medical care by fire-fighting agency without permit.

1. A person or governmental entity shall not engage in the operation of any ambulance or air ambulance service in this state without a currently valid permit for that service issued by the health authority.

2. A fire-fighting agency shall not provide intermediate or advanced medical care to sick or injured persons at the scene of an emergency or while transporting those persons to a medical facility without a currently valid permit for that care issued by the health authority.

(Added to NRS by 1973, 1145; A 1985, 1699; 1993, 2836; 2001, 999)

NRS 450B.250 Service as attendant for ambulance without license; provision of certain medical care by firefighter without license. Except as otherwise provided in this chapter, a person shall not serve as an attendant on any ambulance or air ambulance and a firefighter shall not provide intermediate or advanced medical care to sick or injured persons at the scene of an emergency or while transporting those persons to a medical facility unless he holds a currently valid license issued by the health authority under the provisions of this chapter.

(Added to NRS by 1973, 1145; A 1985, 1699; 1993, 2836; 2001, 999; 2005, 334)

NRS 450B.255 Representation as emergency medical technician without certificate. A person shall not represent himself to be an emergency medical technician unless he has been issued a currently valid certificate as an emergency medical technician by the health authority.

(Added to NRS by 1979, 71; A 1993, 2836)

NRS 450B.260 Operation of ambulance or fire-fighting vehicle used to provide medical care without licensed driver and attendant; exceptions.

1. Except as otherwise provided in this section, the public or private owner of an ambulance or air ambulance or a fire-fighting agency which owns a vehicle used in providing medical care to sick or injured persons at the scene of an emergency or while transporting those persons to a medical facility shall not permit its operation and use by any person not licensed under this chapter.

2. An ambulance carrying a sick or injured patient must be occupied by a driver and an attendant, each of whom is licensed as an attendant pursuant to this chapter or exempt from licensing pursuant to subsection 6 of NRS 450B.160, except as otherwise provided in subsection 5 or in geographic areas which may be designated by the board and for which the board may prescribe lesser qualifications.

3. An air ambulance carrying a sick or injured patient must be occupied by a licensed attendant, or a person exempt from licensing pursuant to subsection 6 of NRS 450B.160, in addition to the pilot of the aircraft.

4. The pilot of an air ambulance is not required to have a license under this chapter.

5. A person who operates or uses a vehicle owned by a fire-fighting agency is not required to be licensed under this chapter, except that such a vehicle may not be used to provide intermediate or advanced medical care to sick or injured persons:

(a) At the scene of an emergency unless at least one person in the vehicle is licensed to provide the care; or

(b) While transporting those persons to a medical facility unless at least two persons in the vehicle are licensed to provide the care.

(Added to NRS by 1973, 1145; A 1985, 1699; 1993, 320; 2001, 999)

NRS 450B.265 Offering advanced emergency care without permit; exception.

1. Except as otherwise provided in subsection 2, a fire-fighting agency or an owner, operator, director or chief officer of an ambulance shall not represent, advertise or imply that it:

(a) Is authorized to provide advanced emergency care; or

(b) Uses the services of an advanced emergency medical technician,

Ê unless the service has a currently valid permit to provide advanced emergency care issued by the health authority.

2. Any service in a county whose population is less than 400,000, that holds a valid permit for the operation of an ambulance but is not authorized by the health authority to provide advanced emergency care may represent, for billing purposes, that its ambulance provided advanced emergency care if:

(a) A registered nurse employed by a hospital rendered advanced emergency care to a patient being transferred from the hospital by the ambulance; and

(b) The equipment deemed necessary by the health authority for the provision of advanced emergency care was on board the ambulance at the time the registered nurse rendered advanced emergency care.

3. A hospital that employs a registered nurse who renders the care described in subsection 2 is entitled to reasonable reimbursement for the services rendered by the nurse.

(Added to NRS by 1979, 71; A 1985, 1700; 1987, 2213; 1989, 286, 1936; 1993, 2836)

WITHHOLDING LIFE-SUSTAINING TREATMENT

NRS 450B.400 Definitions. As used in NRS 450B.400 to 450B.590, inclusive, unless the context otherwise requires, the words and terms defined in NRS 450B.405 to 450B.475, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 1997, 287; A 2001, 815)

NRS 450B.405 “Attending physician” defined. “Attending physician” has the meaning ascribed to it in NRS 449.550.

(Added to NRS by 2001, 814)

NRS 450B.410 “Do-not-resuscitate identification” defined. “Do-not-resuscitate identification” means:

1. A form of identification approved by the health authority, which signifies that:

(a) A person is a qualified patient who wishes not to be resuscitated in the event of cardiac or respiratory arrest; or

(b) The patient’s attending physician has:

(1) Issued a do-not-resuscitate order for the patient;

(2) Obtained the written approval of the patient concerning the order; and

(3) Documented the grounds for the order in the patient’s medical record.

2. The term also includes a valid do-not-resuscitate identification issued under the laws of another state.

(Added to NRS by 1997, 287)

NRS 450B.420 “Do-not-resuscitate order” defined. “Do-not-resuscitate order” means a written directive issued by a physician licensed in this state that emergency life-resuscitating treatment must not be administered to a qualified patient. The term also includes a valid do-not-resuscitate order issued under the laws of another state.

(Added to NRS by 1997, 288)

NRS 450B.430 “Do-not-resuscitate protocol” defined. “Do-not-resuscitate protocol” means the standardized procedure and guidelines established by the board for the withholding of emergency life-resuscitating treatment in compliance with a do-not-resuscitate order or a do-not-resuscitate identification.

(Added to NRS by 1997, 288; A 1999, 45)

NRS 450B.440 “Health care facility” defined. “Health care facility” has the meaning ascribed to it in NRS 449.800.

(Added to NRS by 1997, 288)

NRS 450B.450 “Life-resuscitating treatment” defined. “Life-resuscitating treatment” means cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation, including chest compressions, defibrillation, cardioversion, assisted ventilation, airway intubation or administration of cardiotonic drugs.

(Added to NRS by 1997, 288)

NRS 450B.460 “Person who administers emergency medical services” defined. “Person who administers emergency medical services” means a paid or volunteer firefighter, law enforcement officer, emergency medical technician, ambulance attendant or other person trained to provide emergency medical services.

(Added to NRS by 1997, 288)

NRS 450B.470 “Qualified patient” defined. “Qualified patient” means:

1. A patient 18 years of age or older who has been determined by his attending physician to be in a terminal condition and who:

(a) Has executed a declaration in accordance with the requirements of NRS 449.600; or

(b) Has been issued a do-not-resuscitate order pursuant to NRS 450B.510.

2. A patient who is less than 18 years of age and who:

(a) Has been determined by his attending physician to be in a terminal condition; and

(b) Has been issued a do-not-resuscitate order pursuant to NRS 450B.510.

(Added to NRS by 1997, 288; A 2001, 815)

NRS 450B.475 “Terminal condition” defined. “Terminal condition” has the meaning ascribed to it in NRS 449.590.

(Added to NRS by 2001, 814)

NRS 450B.480 Applicability. The provisions of NRS 450B.400 to 450B.590, inclusive, apply only to emergency medical services administered to a qualified patient:

1. Before he is admitted to a medical facility; or

2. While the qualified patient is being prepared to be transferred, or is being transferred, from one health care facility to another health care facility.

(Added to NRS by 1997, 288; A 2001, 816)

NRS 450B.490 Adoption of regulations; fee for do-not-resuscitate identification.

1. The board shall adopt regulations to carry out the provisions of NRS 450B.400 to 450B.590, inclusive. The regulations must establish:

(a) A do-not-resuscitate protocol; and

(b) The procedure to apply for a do-not-resuscitate identification.

2. The board may establish a fee for:

(a) A do-not-resuscitate identification to be collected by the health authority. The fee may not exceed the actual cost to the health authority of:

(1) Manufacturing or obtaining the identification from a manufacturer, including the cost of shipping and handling; and

(2) Engraving the identification.

(b) The issuance of a bracelet or medallion which indicates that a do-not-resuscitate identification has been issued to a qualified patient.

3. In the case of a district board of health, such regulations take effect immediately upon approval by the State Board of Health.

(Added to NRS by 1997, 288; A 1999, 45; 2001, 816; 2005, 2475)

NRS 450B.500 Do-not-resuscitate identification: Contents. Each do-not-resuscitate identification issued by the health authority must include, without limitation:

1. An identification number that is unique to the qualified patient to whom the identification is issued;

2. The name and date of birth of the patient; and

3. The name of the attending physician of the patient.

(Added to NRS by 1997, 288)

NRS 450B.505 Do-not-resuscitate identification: Manufacture and issuance of bracelet or medallion. The board may enter into an agreement for the manufacture of a bracelet or medallion to be worn by a qualified patient which indicates that the qualified patient has been issued a do-not-resuscitate identification. Such a bracelet or medallion may be issued to a qualified patient in addition to, and not in lieu of, the do-not-resuscitate identification.

(Added to NRS by 2001, 814)

NRS 450B.510 Written do-not-resuscitate orders: Issued only to qualified patients; physician authorized to apply for identification.

1. A physician licensed in this state may issue a written do-not-resuscitate order only to a patient who has been determined to be in a terminal condition.

2. Except as otherwise provided in subsection 3, the order is effective only if the patient has agreed to its terms, in writing, while he is capable of making an informed decision.

3. If the patient is a minor, the order is effective only if:

(a) The parent or legal guardian of the minor has agreed to its terms, in writing; and

(b) The minor has agreed to its terms, in writing, while he is capable of making an informed decision if, in the opinion of the attending physician, the minor is of sufficient maturity to understand the nature and effect of withholding life-resuscitating treatment.

4. A physician who issues a do-not-resuscitate order may apply, on behalf of the patient, to the health authority for a do-not-resuscitate identification for that patient.

(Added to NRS by 1997, 289; A 2001, 816)

NRS 450B.520 Application for do-not-resuscitate identification: Form; requirements. Except as otherwise provided in NRS 450B.525:

1. A qualified patient may apply to the health authority for a do-not-resuscitate identification by submitting an application on a form provided by the health authority. To obtain a do-not-resuscitate identification, the patient must comply with the requirements prescribed by the board and sign a form which states that he has informed each member of his family within the first degree of consanguinity or affinity, whose whereabouts are known to him, or if no such members are living, his legal guardian, if any, or if he has no such members living and has no legal guardian, his caretaker, if any, of his decision to apply for an identification.

2. An application must include, without limitation:

(a) Certification by the patient’s attending physician that the patient suffers from a terminal condition;

(b) Certification by the patient’s attending physician that the patient is capable of making an informed decision or, when he was capable of making an informed decision:

(1) He executed:

(I) A written directive that life-resuscitating treatment be withheld under certain circumstances; or

(II) A durable power of attorney for health care decisions pursuant to NRS 449.800 to 449.860, inclusive; or

(2) He was issued a do-not-resuscitate order pursuant to NRS 450B.510;

(c) A statement that the patient does not wish that life-resuscitating treatment be undertaken in the event of a cardiac or respiratory arrest;

(d) The name, signature and telephone number of the patient’s attending physician; and

(e) The name and signature of the patient or the attorney-in-fact or agent who is authorized to make health care decisions on the patient’s behalf pursuant to a durable power of attorney for health care decisions.

(Added to NRS by 1997, 289; A 1999, 45; 2001, 817)

1. A parent or legal guardian of a minor may apply to the health authority for a do-not-resuscitate identification on behalf of the minor if the minor has been:

(a) Determined by his attending physician to be in a terminal condition; and

(b) Issued a do-not-resuscitate order pursuant to NRS 450B.510.

2. To obtain such a do-not-resuscitate identification, the parent or legal guardian must:

(a) Submit an application on a form provided by the health authority; and

(b) Comply with the requirements prescribed by the board.

3. An application submitted pursuant to subsection 2 must include, without limitation:

(a) Certification by the minor’s attending physician that the minor:

(1) Suffers from a terminal condition; and

(2) Has been issued a do-not-resuscitate order pursuant to NRS 450B.510;

(b) A statement that the parent or legal guardian of the minor does not wish that life-resuscitating treatment be undertaken in the event of a cardiac or respiratory arrest;

(d) The name, signature and telephone number of the minor’s attending physician; and

(e) The name, signature and telephone number of the minor’s parent or legal guardian.

4. The parent or legal guardian of the minor may revoke the authorization to withhold life-resuscitating treatment by removing or destroying or requesting the removal or destruction of the identification or otherwise indicating to a person that he wishes to have the identification removed or destroyed.

5. If, in the opinion of the attending physician, the minor is of sufficient maturity to understand the nature and effect of withholding life-resuscitating treatment:

(a) The do-not-resuscitate identification obtained pursuant to this section is not effective without the assent of the minor.

(b) The minor may revoke the authorization to withhold life-resuscitating treatment by removing or destroying or requesting the removal or destruction of the identification or otherwise indicating to a person that he wishes to have the identification removed or destroyed.

(Added to NRS by 2001, 815)

NRS 450B.530 Revocation of authorization to withhold life-resuscitating treatment. Except as otherwise provided in NRS 450B.525, a qualified patient who possesses a do-not-resuscitate identification may revoke his authorization to withhold life-resuscitating treatment by removing or destroying or requesting the removal or destruction of his identification or otherwise indicating to a person that he wishes to have his identification removed or destroyed.

(Added to NRS by 1997, 289; A 2001, 817)

NRS 450B.540 Person not guilty of unprofessional conduct or subject to liability for withholding or providing life-resuscitating treatment under certain circumstances.

1. A person is not guilty of unprofessional conduct or subject to civil or criminal liability if he:

(a) Is a physician who:

(1) Causes the withholding of life-resuscitating treatment from a qualified patient who possesses a do-not-resuscitate identification in accordance with the do-not-resuscitate protocol; or

(2) While the patient is being prepared to be transferred, or is being transferred, from one health care facility to another health care facility, carries out a do-not-resuscitate order that is documented in the medical record of a qualified patient, in accordance with the do-not-resuscitate protocol;

(b) Pursuant to the direction of or with the authorization of a physician, participates in:

(1) The withholding of life-resuscitating treatment from a qualified patient who possesses a do-not-resuscitate identification in accordance with the do-not-resuscitate protocol; or

(2) While the patient is being prepared to be transferred, or is being transferred, from one health care facility to another health care facility, carrying out a do-not-resuscitate order that is documented in the medical record of a qualified patient, in accordance with the do-not-resuscitate protocol; or

(1) Causes or participates in the withholding of life-resuscitating treatment from a qualified patient who possesses a do-not-resuscitate identification;

(2) Before a qualified patient is admitted to a medical facility, carries out a do-not-resuscitate order that has been issued in accordance with the do-not-resuscitate protocol; or

(3) While the patient is being prepared to be transferred, or is being transferred, from one health care facility to another health care facility, carries out a do-not-resuscitate order that is documented in the medical record of a qualified patient, in accordance with the do-not-resuscitate protocol.

2. A health care facility, ambulance service or fire-fighting agency that employs a person described in subsection 1 is not guilty of unprofessional conduct or subject to civil or criminal liability for the acts or omissions of the employee carried out in accordance with the provisions of subsection 1.

3. A physician, a person pursuant to the direction or authorization of a physician, a health care facility or a person administering emergency medical services who provides life-resuscitating treatment pursuant to:

(a) An oral or written request made by a qualified patient, or the parent or legal guardian of a qualified patient, who may revoke the authorization to withhold life-resuscitating treatment pursuant to NRS 450B.525 or 450B.530; or

(b) An observation that a qualified patient, or the parent or legal guardian of a qualified patient, has revoked or otherwise indicated that he wishes to revoke the authorization to withhold life-resuscitating treatment pursuant to

US Laws, Codes, Statutes & Cases

Chapter 450B — Emergency Medical Services

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