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Director may direct in his notice of cancellation.

^. Any order made by the Director after hearing, as provided herein,
denying or cancelling any license may be reviewed by application
for writ of review (certiorari) commended In the district court
of the county In which the licensed premises is located, within
ten (10) days from the date of notice in writing of the Director's
order of denial or cancelling such license has been served upon him.

5. Whenever the department shall furnish evidence to the county
attorney of any county in this state, the county attorney shall
prosecute any person, persons, firm or corporation violating any
provisions of this act, or any rules or regulations effective under
this act.



SECTION n. AMBULANCES AND AMBULANCE EQUIPMENT



PART A. AMBULANCES

Vehicles . Effect I ve Apr 1 1 1, 1972, all new vehicles purchased,
whether as a replacement or in the creation of a new ambulance
service, must conform to current specifications as set forth below.

(1) The ambulance vehicle should have space for a driver,
attendant and two litter patients^ The patients should be so
positioned in the vehicle that at least one can be given life-
support in transit. The vehicle should be able to carry
equipment and medical supplies for safeguarding personnel

and patients under hazardous conditions, and for maximum
emergency medical care, both outside the vehicle and in
transit. The emergency vehicle should be designed to provide
maximum safety and comfort for the patient.

(2) Minimum space between the head of the litter and the bulkhead
of the vehicle should be at least 25 inches, including a seat
for an attendant so positioned that he can provide respira-
tory care and resuscitation.

(3) Minimum space at the foot of the litter should be 15 inches
to accomodate traction splints and an attendant.

(4) Minimum space between litters should be 25 inches so that an
attendant can move between litters, and kneel to perform



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Legislation Appendix/170

external cardiac compression and other medical functions.

(5) While a height of 60 inches is preferable throughout the

interior of the emergency vehicle, the minima! height should
be at least Sk inches from floor to ceiling. This minimal
height provides approximately 39 inches from the top of the
litter to the ceiling, and allows the attendant enough room
to kneel beside the patient and to use maximal body weight
in performing cardiac compression.

PART B. AMBULANCE EQUIPMENT

!• General Equipment . All ambulances must carry the equipment described
in the Minimum Equipment List for Ambulances, 196? , as recommended
by the American College of Surgeons, or equipment which is equivalent.

2. American College of Surgeons Minimum Equipment List for Ambulances,
WT ; ~~ ~"

(1) Hinged half-ring lower extremity splint with webbing ankle
h i tch.

(2) Two or more padded boards hi feet long by 3 inches wide, and
two or more similar padded boards 3 feet long by 3 inches
wide, of material comparable to four-ply wood, for coaption
splinting of fracture of leg or thigh.

(3) Two or more padded 15-inch by 3-inch wood or cardboard splints
for fractures of the forearm.

\k) Short and long spine boards with accessories.

(5) Oxygen tanks and masks of assorted sizes.

(6) Hand-operated bag-mask resuscitation unit with adult-, child-
and infant-size masks, a unit which can be attached to oxygen
supply being preferred.

(7) Simple suction apparatus with catheter.

(8) Mouth-to-mouth, two-way resuscitation airways for adults and
chl Idren,

(9) Oropharyngeal airways.

(10) Mouth gags made of three tongue blades taped together and
padded.

(11) Universal dressing, approximately 10 inches by 36 inches,
packaged folded to 10 inches by 9 inches.

(12) Sterile gauze pads.

(13) One-, 2- and 3~inch adhesive tape on cylinder.



Legislation Appendix/171

(14) Six-inch by 5-yard soft roller-type bandages.

(15) Triangular bandages.

(16) Safety pins, large size.

(17) Shears for bandages,

(18) Several pi I lows.

3. Mobile Communications . Effective as of January 1, 1973, all ambu-
lance services must have two-way mobile communication equipment
capable of operating at least within the normal emergency service
area. On all new radio equipment secured after January 1, 1973, all
radio frequencies shall be compatible with the Montana Emergency
Medical Services Plan,

SECTION ill. PERSONNEL



PART A. LEVELS OF TRAINING

1. Persons to be Trained . All personnel operating an ambulance service,
including ambulance attendants and ambulance drivers must be trained.

2. Training Requirements . Effective April 1, 1972, all ambulance
personnel must be trained, and hold current certification at the
level of Advanced American Red Cross First Aid or its equivalent.

PART B. NUMBER OF PERSONNEL

1- Number Required . Effective April 1, 1972, there must be at least one
attendant In addition to the driver on every ambulance call.

SECTION !V. MAINTENANCE AND OPERATIONS



PART A. MAINTENANCE

1. Vehicle . Effective April 1, I972, it is required that reasonable
maintenance of all ambulance vehicles be maintained and that records
be kept to demonstrate such maintenance has been accomplished.

2. Sanitation . A level of sanitation, which is suitable for the trans-
portation of patients from the standpoint of health and safety, must
be maintained.



PART B. OPERATIONS

1. Records . Effective April 1, I972, in addition to the information

supplied for licensing, all ambulance services must keep trip reports
on each patient, and make available for inspection such reports.



(



Legislation Appendix/172

stating the name of attendants, type of emergency, response time,
type of injury and type of first aid administered on each emergency.

2. Access to Premises . All persons authorized by this act or by regu-
lations adopted under this act shall have free access at all
reasonable hours to any of the establishments licensed for the pur-
pose of determining compliance of this act.



SECTION V. REQUIREMENTS - STATE AND LOCAL ORDINANCES



PART A. ORDINANCES

1. State and Local Ordinances . All ambulances and ambulance services
must comply with all state and local laws concerning the operation
of ambulances and ambulance services.



SECTION VI . INSURANCE

PART A. INSURANCE

Insurance . Effective April 1, 1972, all ambulance services will be
properly covered by liability insurance with a minimum coverage
of not less than $100,000.00, $300,000.00, $25,000.00.



(



Leg is Sat ion Appendix/ 173



LAWS



CHAPTER 36 - COUNTY AND MUNICIPAL AMBULANCE SERVICE

Section 69-36OI . Establishment of service authorized-costs-petition.

69-3601. Establishment of service authorized-costs-petition. A
county, city or town, acting through its governing body, may establish
and maintain an ambulance service for such county, city or town. Any
county, city or town may contract with any county, city or town to
establish and maintain a joint ambulance service and to share the costs,
such costs to be apportioned according to the benefits to accrue, the pro-
portion to be paid by each to be fixed in advance by joint resolution by
the respective governing bodies, if the governing body has received a
petition signed by fifteen per centum (15^) of the electors registered to
vote in the county, city or town at the last preceding general election, or
in each of the counties, cities or towns wherein a joint ambulance service
is being established. In addition to all other levies authorized by law,
each county, city or town may levy an annual tax up to one (1) mill on the
dollar of the taxable value of all taxable property within the county, city
or town to defray the costs incurred in providing ambulance service.

History: En. Sec. 1, Ch. 238, L. I96I ; amd. Sec. 1, Ch. 162, L. 1967-

Amendments

The 1967 amendment ended the first sentence after "city or town";
substituted "Any county, city or town may contract with any county"
for "and it may also contract with another county" after "county or town"
to begin the second sentence; and substituted the passage beginning
"fifteen per centum (15%) of the electors" after "signed by" to the end
of this section for "fifty per centum (50%) of the taxpayers who are
listed on the last-completed assessment roll."

Effective Date

Section 2 of Ch. 162, Laws 1967 provided the act should be in effect
from and after its passage and approval. Approved February 27, 1967.



c



Legislation Append I x/ 1 Z'*



STATE OF MONTANA

OFFICE OF THE ATTORNEY GENERAL

HELENA 59601

December I'*, 1971



ROBERT L. WOODAHL
ATTORNEY GENERAL



Mrs. Gertrude Malone, R.N.
Executive Secretary
Montana Board of Nursing
601 North Davis Street
Helena, Montana 59601

Dear Mrs. Malone:

This is in reply to your inquiry as to the meaning of "administration
of medications" as defined in the Nurse Practice Act, Title 66, Chapter
12, Revised Codes of Montana, !9^7<

Section 66-1222, R.C.M. 1947, provides in part as follows:

"00. The practice of nursing embraces two classes of nursing
service and activity, defined, respectively, as follows:

"(1) The practice of professional nursing means the performance
for compensation of any act in the observation, care and counsel
of the ill, injured or infirm, or in the maintenance of health
or prevention of illness of others, or in the supervision and
teaching of other personnel, or the administration of medications
and treatments as prescribed by a person licensed in this state to
prescribe such medications and treatments; requiring substantial
specialized judgment and skill and based on knowledge and appli-
cation of the principles of biological, physical and social science.
The foregoing shall not be deemed to include acts of diagnosis
or prescription of therapeutic or corrective measures.

"(2) The practice of practical nursing means the performance for
compensation in the care of the ill, injured or infirm, of acts
selected by and performed under the direction of an R.N. , or a
person licensed in this state to prescribe such medications and
treatments; and not requiring the substantial specialized skill,
judgment and knowledge required in professional nursing."

Section 66-1243, R.C.M. 1947, provides in part as follows:

"It shall be a misdemeanor for any person including any corpora-
tion, association or individual to:



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Legislation Appendix/ 1 75

"(3) Practice professional nursing as defined by this act unless
duly licensed to do so under the provisions of this act;

"{k) Practice practical nursing as defined by this act unless
duly licensed to do so under the provisions of this act; ..."

In view of the above, it is my opinion that only professional nurses are
duly licensed to administer medications and treatments and that licensed
practical nurses are duly licensed to administer such medications and
treatments as may be delegated to the licensed practical nurse by the
professional nurse or by a person licensed to prescribe medications and
treatments as long as this delegated act does not require the specialized
skill, judgment, and knowledge required in professional nursing.

The primary definition of "administer" is to give. !t is a word in general

use with a common and accepted meaning; and, where a person is charged with

administering medicine, it is the same as charging him with giving medicine.
Chandler v. State, 105 P- 375, 3 Okl . Cr. 25^. "Administer" as used in a

statute proscribing the administering of poison with intent to kill means

more than to prescribe or furnish, it must include giving. People v. Geither,
343 P. 2d 799, 173 C.A=2d 662.

In view of the above, it is my opinion the words "administration of medica-
tions" as used in the above sections refer to the actual giving of a medica-
tion or a treatment to a patient. Such wording should not be interpreted to
include the delegation of the medication procedure or a specific treatment by
a professional nurse to a person not licensed to perform nursing function in
this state. (n my opinion, if such a non-licensed person performed such
services, he would be in violation of section 66-12^3. supra.

Very truly yours,

s/ Robert L, Woodahi
ROBERT L. WOODAHL
Attorney General

RLW:ds



Legislation Anoendix/lTfi

STATE OF MONTANA

OFFICE OF THE ATTORNEY GENERAL

HELENA 59601

July 19, 1972



ROBERT L. WOODAHL
ATTORNEY GENERAL



MrSo Gertrude Malone, R.N.

Executive Secretary

Montana State Board of Nursing

601 North DavfS

Helena, Montana 59601

Dear Mrs, Malone:

In response to your inquiry concerning who may or may not perform
venipunctures, I have just completed my study of your questions.
You first asked:

"In the event that the state board of nursing would
like to have an attorney general's opinion changed,
what is the proper procedure to accomplish this end?"

An attorney general's opinion is an interpretation of existing law.
GeneraHy, an opinion stands until the statutory provisions inter-
preted have been amended. I would suggest that if the result of
the opinion is to be changed, legislation be introduced to amend
the statutory provisions interpreted by the opinion.

Your next question relates to the applicability of 26, Opinions of
the Attorney General , 89, in relation to whether medical emergency
technicians are allowed to do venipuncture. There are no provisions
in the statutes in regard to medical emergency technicians. As you
know, subsections (I) and (2) of section 66-122, R.C.M. 19^7, define
the practice of professional nursing and practical nursing. As stated
in 26, Opinions of the Attorney General , 89, intervenous treatment
given by a professional nurse upon order of a doctor of medicine is
not practicing medicine, but rather in the purview of professional
nursing However, medical emergency technicians are not professional
nurses and ! find no authority under the above opinion, or the laws
of Montana, allowing medical emergency technicians to perform veni-
punctures.

I hope the above information answers your questions. If I may be of
further service to you, please let me know.

Very truly yours,

s/Robert L. Woodahl

ROBERT L. WOODAHL
Attorney General

RLW:sjb



Legislation Appendix/ 177

Provided here are the Revised Codes of Montana which relate to
emergency health care. Due to the length of the codes, only those of
special interest are provided in full text. The remainder are listed
by RCM title and code number.

RCM 2^-1280 Protective devices.

RCM 75"7003. School bus driver qualifications:

Any driver of a school bus shall be qualified to drive such
school bus by compliance with the following requirements:

(1) he is not less than twenty-one (21) years of age;

(2) he is of good moral character;

(3) he IS the holder of a chauffeur's license;

(4) he has filed with the district a satisfactory medical
examination report signed by a licensed physician of the State of
Montana on a blank provided by the superintendent of public
instruct ion ;

(5) he has completed a standard first-aid course and holds a
valid standard first-aid certificate from an authorized instructor.
The Issuance of such certificate shall be governed by rules and
regulations established by the superintendent of public instruction,
provided that such rules may suspend this requirement for a
reasonable period of time where there has been an inadequate
opportunity for securing the first-aid course and certificate;

(6) he has complied with any other qualifications established
by the board of education; and

(7) he has filed with the county superintendent a certificate
from the trustees of the district for which the school bus is to be
driven certifying compliance with the several driver qualifications
enumerated in this section.

RCM 92-612. Liability for treatment of malpractice in case of
hospital service=

Disasters



RCM 11-3266. Department of Public Safety - pol ice and fire depart-
ments .

RCM 11-^301. Definitions. An emergency shall be:

RCM 11-^304. Council's resolut ions - inclusion of facts of disaster.

RCM 11-4305. Estimation of expenses and levying of tax.

RCM 11-4306. Emergency tax surplus.

RCM 77-107. Governor may order and organize militia.

RCM 77-151. Claims against National Guard appropriations.

RCM 77-1302. Policy and purpose.

RCM 77-1303. Definitions (Civil Defense).



Legislation Append ix/1 78

RCM ll-\'},Vil . Duties of director.

RCM 77-1308. Mutual-aid arrangements.

RCM 77-1309. Local organization for Civil Defense.

RCM 77-1^01 . Short title.

RCM 77-l''t02. Governor authorized to join in the interstate civil
defense and disaster compact.

RCM 77-1403. Form of compact.

RCM 77-1506. Proclamation of emergency-governor's powers during
emergency.

RCM 77-1'tO't. Governor authorized to execute supplemented agreements.

RCM 77-1502, Legislative f indings - pol icy of state.

RCM 77-1503. Definition of terms (emergency).

RCM 77-1504. State emergency resource planning.

RCM 77-1505. Governor's powers and duties under act.
Commi ttee — compos i t ion ,

RCM 77-1507. Judicial inquiry as to emergency proclamation and
facts.

RCM 79-2501. Governor may authorize expenditure in case of
emergency or disaster.

Emergency Vehicles

RCM 31-118. Definitions . The following words and phrases when
used in this act shall, for the purpose of this act, have the meanings
respectively ascribed to them in sections 31"! 19 to 31-124.

RCM 31-119, Vehicle-motor vehicle-farm tractor-school bus ,
(b) Motor vehicle. Every vehicle which is self-propelled and every
vehicle which is propelled by electric power obtained from overhead
trolley wires, but not operated on rails.

RCM 31-120. Person-operator-chauffer-owner . (c) Chauffer.
Every person who is employed by another for the principal purpose of
of driving a motor vehicle and every person who drives a school bus
transporting school children or any motor vehicle when in use for the
transportation of persons or property for compensation, but shall not
include persons driving farm trucks or hauling farm products for
producers of said farm products.



Legislation Appendix/ 179

RCM 31-125, Operators and chaufferj must be licensed . (a) No
person, except those hereinafter expressly exempted, under section
31-125, shall drive any motor vehicle upon a highway in this state
unless such person has a valid Montana license as an operator or
chauffer under the provisions of this act.

RCM 31-127o What persons shall not be licensed . The board shall
not issue any license hereunder:

2. To any person, as a chauffer, employed by another for the
principal purpose of driving a motor vehicle when in use exclusively
for the transportation of property for compensation, who is under the age
of eighteen (18) years, nor any person, as a chauffer, who is employed
by another for the principal purpose of driving a motor vehicle
transporting passengers for hire or transporting school children, who
is under the age of twenty-one (21) years;



RCM 32-2102 Definitions authorized emergency vehicle

(e) Authorized Emergency Vehicle. Vehicles of the fire department, fire
patrol, police vehicles, and such ambulances and emergency vehicles of
municipal departments or public service corporations or of persons as
are designated or authorized by the board.

RCM 32-2128. Authorized emergency vehicles. (a) The driver of
an authorized emergency vehicle, when responding to an emergency call
or when in the pursuit of an actual or suspected violator of the law
or when responding to but not returning from a fire alarm, may exercise
the privileges set forth in this section, but subject to the conditions
herein stated, (b) The driver of an authorized emergency vehicle may:

1. Park or stand, irrespective of the provisions of this act;

2. Proceed past a red or stop signal or stop sign, but only
after slowing down as may be necessary for safe operation;

3. Exceed the speed limits so long as he does not endanger life
or property;

h. Disregard regulations governing direction of movement or
turning in specified directions,
(c) The exemptions herein granted to an authorized emergency vehicle
shall apply only when such vehicle is making use of audible and visual
signals meeting the requirements of section 129 (32-21-132) of this
act, except that an authorized emergency vehicle operated as a police
vehicle need not be equipped with or display a red light visible from
in front of the vehicle. (d) The foregoing provisions shall not relieve
the driver of an authorized emergency vehicle from the duty to drive
with due regard for the safety of all persons, nor shall such pro-
visions protect the driver from the consequences of his reckless dis-
regard for the safety of others.

RCM 32-21-132. Audible and visual signals on vehicles ,
(a) Every authorized emergency vehicle shall, in addition to any other
equipment and distinctive markings required by this act, be equipped
with a siren, exhaust whistle or bell capable of giving an audible sig-
nal, (b) Every authorized emergency vehicle shall, in addition to any
other equipment and distinctive markings required by this act, be
equipped with signal lamps mounted as high and as widely spaced laterally
as practicable, displaying to the front two (2) alternately flashing
red lights located at the same level and to the rear two (2) alternately
flashing red lights located at the same level, and these lights shall



(i



Legislation Append ix/l80

have sufficient intensity to be visible at five hundred (500) feet in
normal suni Ight .

RCM 32-21-145. Horns and warning devices . (b) No vehicle shall
be equipped with nor shall any person use upon a vehicle any siren,
whistle, or bell, except as otherwise permitted In this section,
(d) Any authorized emergency vehicle may be equipped with a siren,
whistle, or bell, capable of emitting sound audible under normal con-
ditions from a distance of not less than five hundred (500) feet and of
a type approved by the board, but such siren shall not be used except
when such vehicle is operated In response to an emergency call or in
the immediate pursuit of an actual or suspected violator of the law.
In which said latter events the driver of such vehicle shall sound said
siren when reasonably necessary to warn pedestrians and other drivers
of the approach thereof «

RCM 32-2175o Operation of vehicles on approach of authorized
emergency vehicles. (a) Upon the immediate approach of an authorized
emergency vehicle making use of audible and visual signals meeting the
requirements of section 129 (32-25-132) of this act, or of a police
vehicle properly and lawfully making use of an audible signal only,
the driver of every other vehicle shall yield the right of way and shall
immediately drive to a position parallel to, and as close as possible to,
the right-hand edge or curb of the roadway clear of any intersection
and shall stop and remain in such position until the authorized emergency
vehicle has passed, except when otherwise directed by a police officer
or highway patrolman= (b) This section shail not operate to relieve
the driver of an authorized emergency vehicle from the duty to drive
with due regard for the safety of all persons using the highway.

Publ ic Access



RCM 9't"35"22l . 1 . Failure to relinquish party line telephone for
emergency call — penalty.

RCM 9'*"35"221 c2. Lack of knowledge as defense - emergency as de-
fense.

RCM 94~35"22K3. False pretext of emergency - penal ty .
Good Samaritan Act

RCM 17-4iOo Emergency care rendered at scene of accidents . Any
person licensed as a physician and surgeon under the laws of the state
of Montana, or any other person, who in good faith renders emergency
care or assistance, without compensation, at the scene of an emergency
or accident, shall not be liable for any civil damages for acts or
omissions other than damages occasioned by gross negligence or by
willful or wanton acts or omissions by such person in rendering such
emergency care.

Stopping at the Scene of a Vehicle Accident

RCM 94~35-269. ". . • Who knowingly falls to give assistance to
a person who he has injured shall be guilty of a misdemeanor."

Note: Persons are required to stop only If they have been involved in
the accident.



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I



Charts/181



ACCIDENTAL DEATH RATES: U.S. 6 MONTANA, I9AO-72
BY PUCE OF RESIDENCE



ALL ACCIDENTS



120 -



10 -



100 -



SOURCE

National Center for Health Statistics
Bureau of Records & Statistics

Montana rates for the years 1 969-72

Note: U.S. rates for the years
1969-72 are provisional



90



80 -


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