Regulations on the requirements for and organization of the municipal emergency services arrangement, ambulance service, medical emergency service etc. (emergency medicine Regulation)

Date-2015-03-20-231 Ministry health and Human Services Department published in 2015 booklet 2 entry into force 01.05.2015, 01.09.2015 last edited by-2015-11-06-1265 FOR Change-2005-03-18-252, FOR-2000-12-20-1556 applies to Norway Pursuant LAW-1999-07-02-61-section 2-1a, LAW-2011-06-24-30-section 3-1, LAW-2011-06-24-30-section 3-2, LAW-2011-06-24-30-section 11-1, LAW-2000-06-23-56-section 2-2, LAW-2000-06-23-56-section 6-2, LAW-1999-07-02-64-section 4, LAW-1999-07-02-64-section 39, LAW-2014-06-20-42-7, Announced at 20.03.2015. 14.20 short title emergency medicine regulation Chapter overview: Chapter 1 General provisions (sections 1-5) Chapter 2. Municipal emergency services arrangement (sections 6-9) Chapter 3. Ambulance service (§ § 10-11) Chapter 4. Medical emergency service (§ § 12-17) Chapter 5. Functional requirements for the communication technical equipment (§ § 18-19) Chapter 6. Requirements for storage of sound recordings (section 20) Chapter 7. The transitional arrangements. Entry into force (sections 21-22): the legal authority set forth by URkgl.res. 20. March 2015 with authorization in law 2. July 1999 No. 61 about the specialist and more (specialist health service Act) § 2-1a, law 24. June 2011 No. 30 in the municipal health and care services, and more (health and Human Services service law) § 3-1, section 3-2 and § 11-1, allowed 23. June 2000 Nr. 56 about health and social emergency (health emergency law) § 2-2 and § 6-2, law 2. July 1999 No. 64 on health personnel, etc. (helsepersonelloven) § 4 and § 39 and allowed 20. June 2014 Nr. 42 on the treatment of health information on the performance of health care (patient journal law) section 7. Promoted by the Ministry of health and care services.
Changes: modified by regulation 6 nov 2015 Nr. 1265. Chapter 1 General provisions section 1. Purpose the regulation should contribute to the population in need of immediate assistance receive proper and coordinated emergency medical services outside the hospital.
The regulation will also help ensure that equipment that is part of health and human services the service's communications preparedness work in a nationwide network and ensures the priority information flow both within and between medical institutions, to mobile devices and to affiliated agencies.

§ 2. Scope the regulation regulates the municipalities ' and the regional health enterprises ' emergency medical services outside the hospital. This includes municipal emergency services arrangement, ambulance service, medical emergency service and services provided by others by agreement with the municipality or regional health authority.

§ 3. Definitions a) with acute medicine is meant in this regulation medical diagnostics, counselling, treatment and/or monitoring by acute worsening of the disease or/damage, including acute mental illness and substance abuse problems and acute conditions after violence and abuse, where quick medical help can be crucial for the patient's health and life.

b) with emergency medical preparedness is meant in this regulation plans, equipment and personnel to ensure the population required emergency medical services.

c) with the municipal emergency services arrangement is meant in this regulation business that through 24 hours a day to consider requests for urgent help and make necessary follow-up.

d) with medical emergency service is meant in this regulation a nationwide communication, organisational and technical system for notification and handling of inquiries by the need for emergency medical help and communication within the health and Human Services service, where the municipalities ' emergency services numbers, national emergency services number (116 117) and medical emergency (113) are included.

e) with ambulance service is meant in this regulation car, boat and air ambulance service (ambulance helicopters and ambulance aircraft) which are included in the regional health enterprises ' emergency medical emergency outside of hospitals and where it during transport is in need of emergency medical treatment or monitoring.

f) With personnel in emergency medical preparedness will mean personnel by AMK and accident and emergency centres, personnel in the ambulance service, the personnel at the hospital departments with instant-help-function within somatikk, psychiatry and multidisciplinary specialized substance abuse treatment and health professionals in emergency medical preparedness in the municipality, including doctor in the guard.

g) With the communication technical equipment is meant in this regulation the technical equipment and software that are included in the health and human services the service's nationwide communications readiness.

h) with equipment for audio recording refers to a system for recording, playback and storage of oral communication between the caller and the AMK-and emergency services Central.

§ 4. Interaction and collaboration between businesses that provide emergency medical services, the municipalities and the regional health authorities to ensure an appropriate and coordinated efforts in the various services in the emergency medical chain, and make sure that the contents of these services is coordinated with the other emergency services, rescue coordination centre and other authorities.
Businesses that provide emergency medical services to ensure that the personnel who perform the services get the necessary training and training in how to perform their own work tasks and training in interaction and collaboration between all the joints in the emergency medical chain.
All parts of the health and Human Services service that is part of the emergency medical emergency response, should be able to communicate internally and across established municipality and regional boundaries in a private, closed, uniform and nationwide communications networks.

§ 5. Agreement on assistance from people outside the service health and care services (acute helps) the municipalities and the regional health authorities can, as part of its emergency medical preparedness, enter into agreements for assistance from the emergency helpers. Such acute helpers can be members of non-governmental organizations or municipal fire departments. Such assistance can be in addition to, or in anticipation of, that personnel from the other emergency medical services can provide emergency medical help. People who will provide such assistance must have received the necessary training.

Chapter 2. Municipal emergency services arrangement section 6. The Council's responsibility for the municipal emergency services scheme the municipality should offer emergency services scheme that ensures the population's need for urgent help, and need to make sure that at least one doctor is available for emergency services 24 hours a day. Emergency medical service scheme shall, among other things a) assess, advise and guide by inquiries about instant help b) diagnose and treat acute medical conditions at medical consultations and sick visits and if necessary refer to other services in the community, including the general practitioner, and if applicable, specialist health service and c) provide help at accidents and other acute situations, among other things, come out immediately when it is needed.

section 7. Competence requirements for physician in Guard etc. A doctor can have emergency services alone, without qualified on call, when the terms of the letter a or the letter b is true: a) the doctor have approval as a specialist in general medicine and has conducted courses in violent offenders and handling.

b) Doctor have approval as a general practitioner under section 3 first paragraph, LITRA a, cf. section 8 or section 11 fourth paragraph, of the regulations 19. December 2005 Nr. 1653 about guided service for general practitioners, or section 10 of the regulations 8. October 2008 No. 1130 about authorization, license and approval for specialist health personnel with vocational qualifications from other EEA countries or from Switzerland. The doctor must have completed 40 legevakter, or have worked one year as a general practitioner in the municipal health and Human Services service. The doctor must also have completed courses in emergency medicine and violent offenders and handling.

The municipality is obliged to establish rear guard arrangements for doctors in the guard that does not meet the requirements of the first paragraph. Skills requirements in the first paragraph also applies to doctors as to have on call. Behind the Guard physician must be able to scramble when necessary.
If it is not possible for the municipality to provide physicians who meet the competency requirements, the County Governor may make exceptions from the requirements of the first paragraph. It can only be done except for the doctors who joins in the vikariater of up to two months ' duration, and that have completed at least one and a half years of supervised service after regulations 19. December 2005 Nr. 1653 about guided service for general practitioners section 4. It cannot be done except for the doctors to have on call.

section 8. Competence requirements for other health professionals health professionals that work together with the doctor in the guard, including operators of municipal emergency services centres, jf. section 13 letter f, shall have completed courses in emergency medicine and courses in violent offenders and handling.
The County Governor may after inquiry from the municipality make timed exception to the first paragraph, if it is temporarily not possible to provide enough health professionals that meets the requirements of the first paragraph.

§ 9. Requirements for equipment in municipal emergency services the municipality shall ensure that the emergency room is equipped so that health personnel in guard can carry out diagnostics and implement necessary medical treatment and monitoring in acute situations.
The municipality shall ensure that the emergency room is organized and equipped so that health professionals in the guard can come out immediately.

Chapter 3. § 10 the ambulance service. The regional health enterprises ' responsibility for ambulance services the regional health enterprises ' responsibility for ambulance services include a) to bring the competent personnel and emergency medical equipment quickly forward to seriously ill or injured patients b) to perform the necessary research, priorities, treatment and monitoring, either alone or in conjunction with other parts of the service c) to bring the sick or injured patients with needs for monitoring and/or treatment to proper treatment place and between places of treatment d) to have preparedness to be able to meet the demand for ambulance services by greater accidents and emergencies within their own health region and across regional and national borders e) to have the necessary readiness following the service for pregnant women to the birthplace and f) to participate in simple search and rescue operations.


The regional health authorities have responsibility for that car, boat and air ambulance service in the necessary degree is coordinated nationally.

section 11. Staffing and level of medical competence in the ambulance service Ambulance cars providing ambulance services to be staffed by at least two people, of which at least one shall have the authority as an ambulance worker. Where there is only one ambulance worker, the other person must have authorization or license that health personnel and necessary ambulance professional expertise. Both people should have a driver's license for vehicle class and skills evidence for drivers of emergency vehicles.
Ambulance cars that perform tasks for this regulation to be staffed with the present guard. Exceptions can be made where there is a low number of acute missions per year and the ambulance can be staffed within the proper time after the notification.
Ambulance boats providing ambulance services to be in addition to the boat leads be staffed with at least one person with authorization as an ambulance worker.
Ambulance flights should be staffed by a nurse with the necessary expertise. Ambulance and rescue helicopters to be staffed with a doctor and rescuer with the necessary expertise.
When the ambulance service to transport patients in need of treatment or monitoring between different treatment sites in the health service, the ambulance service, in consultation with the rekvirerer transport, assess the need for additional personnel from the nature.
For vikariater of up to two months ' duration may be made the exception from the requirement in the first paragraph that both people on the ambulance car must have a driver's license for vehicle class and skills evidence for drivers of emergency vehicles, if it is not possible to provide personnel that meet these requirements.

Chapter 4. Medical emergency service section 12. The Council's responsibility for the emergency service the municipality is responsible for a) to establish a twenty-four hour telephone number with the required line capacity for linking to a national emergency services number b) to establish a fixed and publicly known 8-digit direct number to the doctor c) to establish and operate twenty-four hour emergency services Central d) to facilitate the safe operation of the national emergency services number, among other things, to provide alternative answers sites e) to have a system for tracking/positioning of the calls f) to have the communications preparedness and necessary communications equipment related to a private, closed, uniform and nationwide communications networks for health care providers in emergency medical preparedness in the municipality and g) to cooperate with the regional health authority to coordinate communication between the doctor, the municipal emergency services scheme, AMK-centres and other emergency medical services.

section 13. Requirements to the Organization and staffing of the emergency services centres accident and emergency centres (LV-centres) to be a) receive and manage enquiries about instant help within the emergency services district via a national emergency services number b) able to communicate directly and pass on or konferansekoble requests for emergency medical help to the AMK-Central, or immediate assistance to other emergency services Central c) provide medical professional advice and guidance, prioritize, register, implement and follow up inquiries about the need for urgent help , among other things, to pass on requests to the health and Human Services service in the municipality, a doctor in the guard, general practitioner, midwife, crisis team and other relevant authorities d) adapt the system for the reception of phone calls so that 80 percent of all inquiries can be answered normally within two minutes e) have equipment for audio recording of important traffic, including audio recordings for use for documentation and quality assurance of the business and f) staffed with personnel with relevant health professional education at the bachelor's level , required clinical practice and conducted additional training for work as an operator.

section 14. The regional health entity's responsibility for the emergency service regional health entity has responsibility for a) to establish and operate it at any time the current telephone number for medical emergencies in the health region b) to establish and operate centres AMK c) to have emergency communication and the necessary communications equipment for AMK-distribution centres, hospitals with emergency function, the ambulance service and other parts of the specialist health service that is part of the regional health entity's emergency medical preparedness d) to cooperate with the relevant parties to ensure the necessary coordination with the municipal emergency medical service scheme , emergency services centres, fire brigade, police, rescue coordination centre and other partners and e) to fix the AMK-central to have parent coordination responsibilities in the region.

section 15. Requirements for AMK-AMK centres centres-a) shall deal with requests for emergency medical assistance b) answer 90 percent of requests from the public within 10 seconds c) give appropriate advice and guidance, prioritize, register, implement, coordinate and follow up the emergency medical mission d) immediately implement notification (triple alert) in need of at the same time efforts from several emergency services, States e) rescue coordination centre when required as well as notify the AMK-centres that are affected f) notify the municipal doctor about the need for urgent help in the municipality of g) as a rule, put the call to emergency services Central on predefined lines when the call comes to allmennmedisinske issues without the need for intervention from the specialist h) have the equipment necessary to coordinate and follow up the ambulance missions in) have a system to keep track of the emergency medical emergency response inside and outside the own responsibility j) have equipment for audio recording of important traffic, including audio recordings to use for documentation and quality assurance of the own business k) have a system for tracking/positioning of the calls l) staffed with a nurse or an ambulance worker who has completed additional training for work as an operator m) have available emergency medical doctor with expertise in 24 basis n) in addition to the Norwegian could communicate with the caller in English and have established emergency preparedness with interpreting for Saami language and appropriate foreign languages o) have readiness to meet the demand for capacity for larger accidents and emergencies, and p) have reserve solutions for AMK-sentralenes features by failure.

section 16. More on the hospitals with acute features hospital with acute features are part of the medical emergency service and to be able to a) manage and coordinate requests for urgent-help-admissions in hospital b) deal with, communicate directly, disclose and konferansekoble inquiries about emergency medical help to the AMK-centres and emergency services centres and c) put the personnel in emergency medical preparedness outside the hospital in contact with personnel in the hospital.

§ 17. Communication preparedness municipality and the regional health authority shall ensure that the personnel in emergency medical preparedness is immediately available in a private, closed, uniform and nationwide communications networks for health service, cf. § 4, and can communicate with each other and with other emergency services, States.

Chapter 5. Functional requirements for the communication technology section 18. The responsibility of the regional health authorities, health authorities and the municipalities are to ensure and be able to document that the communication technical equipment which are included in their communications preparedness, training in the use of the equipment, organization, use, operation and maintenance of the equipment at all times meets the requirements set forth by the Health Directorate.

§ 19. Technical organization, requirements specifications and communication protocols/interface and feature authentication to ensure that all parts of the health and Human Services service that is part of the emergency medical emergency response to be able to communicate in a proper and safe way in a nationwide network, cf. section 17, the Directorate for health fix necessary requirements to the technical organization, use and maintenance of the communication technical equipment, requirements specifications, communication protocols and interfaces for such equipment and the requirements for training in the use of the equipment.
If there is doubt about the communication technical equipment is in accordance with the requirements or specifications of communication protocols and interfaces, Health Affairs require that the equipment will be funksjonsgodkjennes. Health Directorate provides functional approval and can fix closer to the procedures for such approval.

Chapter 6. Requirements for storage of audio recording section 20. Storage of sound recordings and AMK emergency services sentralers audio recording is to be regarded as part of the patient's journal. The recording should be kept for three years after the recording date and then deleted. Audio recording to still not be deleted where the recording is used as part of the decision making in supervisory, complain or replacement issues, are included in other proceedings or the absorption of other causes have value as documentation. File the Regulation section 3-18 also applies.

Chapter 7. The transitional arrangements. Entry into force § 21. Transitional arrangements because requirements for medical expertise under section 7 the first paragraph shall be fulfilled within three years from the regulation to take effect.
Requirements for basic skills for personnel who man the emergency services centres under section 13 letter f should be met within 1. may 2018.
Requirements to the course for the doctor after section 7 first paragraph and to other health care under section 8 the first paragraph should be met within five years from the regulation to take effect.
Competence requirements for staffing in the ambulance cars under section 11 the first paragraph shall be fulfilled within three years from the regulation to take effect.
Requirements for the equipment for audio recording in the emergency services Office, as set out in section 13 letter e applies from the time of the introduction of the nødnett is finalized in all municipalities.

§ 22. Entry into force these regulations, with the exception of section 13 letter a, will take effect 1. may 2015.
The regulations section 13 letter a takes effect 1. September 2015.

From the same time repealed regulations 18. March 2005 Nr. 252 about requirements for emergency medical services outside hospitals and regulation 20. December 2000 No. 1556 on technical function requirements to the communication technical equipment which are included in the health and human services the service's communications readiness.