College of Paramedics of Manitoba General Regulation

College of Paramedics of Manitoba General Regulation, M.R. 104/2020 The Regulated Health Professions Act , C.C.S.M. c. R117 Regulation 104/2020 Registered October 30, 2020 bilingual version (HTML) Table of Contents Section PART 1 GENERAL PROVISIONS 1.1 Regulatory scheme 1.2 Definitions 1.3 Competent to practise PART 2 MEMBERSHIP 2.1 Overview 2.2 Register of regulated members 2.3 Register information 2.4 What information is available to the public? 2.5 Labour mobility 2.6 Application contents 2.7 Registration requirements for full membership — critical care paramedic 2.8 Registration requirements for full membership — advanced care paramedic 2.9 Registration requirements for full membership — primary care paramedic 2.10 Registration requirements for full membership — emergency medical responder 2.11 Additional registration requirements for provisional membership 2.12 Additional registration requirements for temporary membership 2.13 Additional registration requirements for non-practising membership 2.14 Additional registration requirements for retired membership 2.15 Membership period — provisional 2.16 Membership period — temporary 2.17 Contents of conversion application 2.18 Converting to non-practising class when no certificate of practice 2.19 Obligation to submit change in information PART 3 PRACTICE 3.1 Overview 3.2 Requirements for issuing certificate of practice 3.3 Primary care paramedic (intermediate care) 3.4 Expiry of certificate 3.5 Surrender of certificate 3.6 Renewal requirements 3.7 Conditions on certificate of practice 3.8 Checks to be provided every five years 3.9 Additional information 3.10 Practice — protocols and procedures 3.11 Titles and abbreviations 3.12 Insurance 3.13 Labour mobility PART 4 RESERVED ACTS 4.1 Overview 4.2 Definition 4.3 Performing reserved acts 4.4 Temporary class 4.5 Supervising students 4.6 Training to perform reserved acts 4.7 Supervision requirements 4.8 Delegating a reserved act 4.9 Accepting a delegation PART 5 STANDARDS OF PRACTICE 5.1 Practice obligations 5.2 Patient-centred practice 5.3 Collaborative care 5.4 Patient's record 5.5 Practice environment 5.6 Equipment 5.7 Practice directions PART 6 CONTINUING COMPETENCY 6.1 Overview 6.2 Requirement to comply 6.3 Annual requirement 6.4 Records 6.5 Practice audit 6.6 Powers of registrar 6.7 Progress reporting 6.8 Complaint if registrar aware of misconduct 6.9 Registrar to report annually PART 7 HEALTH PROFESSION CORPORATIONS 7.1 Overview 7.2 Restricted to critical care, advanced care and primary care paramedics 7.3 Health profession corporation permit 7.4 Additional contents of record 7.5 Name of health profession corporation 7.6 Error on record 7.7 Name removed from record PART 8 MISCELLANEOUS 8.1 Professional misconduct fines 8.2 Coming into force Schedule PART 1 GENERAL PROVISIONS Regulatory scheme 1.1 Persons who practise paramedicine are regulated under The Regulated Health Professions Act , this regulation, the Practice of Paramedicine Regulation , Manitoba Regulation 71/2018, and the College of Paramedics of Manitoba's by-laws and practice directions. Definitions 1.2 The following definitions apply in this regulation. "Act" means The Regulated Health Professions Act . («  Loi  ») "additional training" means a course, program of study, training or other structured process that meets approved criteria and the purpose of which is to provide a member with the competency to perform a reserved act. (« formation complémentaire ») "adult abuse registry check" means an adult abuse registry check under The Adult Abuse Registry Act . (« relevé concernant les mauvais traitements infligés aux adultes ») "advanced care paramedic" means an individual entered on the subregister of advanced care paramedics. (« travailleur paramédical en soins avancés ») "approved" means approved by the council, except when the approval is indicated to be given by the registrar. (« approuvé ») "child abuse registry check" means a child abuse registry check under The Child and Family Services Act . (« relevé concernant les mauvais traitements infligés aux enfants ») "college" means the College of Paramedics of Manitoba. (« Ordre ») "continuing competency program" means the continuing competency program described in Part 6. (« programme de formation continue ») "council" means the council of the college. (« conseil ») "criminal record check" means a record, including a vulnerable sector search, obtained from a law enforcement agency about a person stating (a) whether the person has any conviction or outstanding charge awaiting court disposition under any federal, provincial or territorial enactment; and (b) the details of any conviction or charge. (« relevé des antécédents judiciaires ») "critical care paramedic" means an individual entered on the subregister of critical care paramedics. (« travailleur paramédical en soins critiques ») "emergency medical responder" means an individual entered on the subregister of emergency medical responders. (« répondant médical d'urgence ») "full member" means a member who is registered in the full membership class. (« membre régulier ») "member" means a person who is registered as a regulated member of the college. (« membre ») "non-practising member" means a member who is registered in the non-practising membership class. (« membre non-praticien ») "practice of paramedicine" means the practice of paramedicine as that term is described in the Practice of Paramedicine Regulation . (« exercice de la profession de travailleur paramédical ») "primary care paramedic" means an individual entered on the subregister of primary care paramedics. (« travailleur paramédical en soins primaires ») "provisional member" means a member who is registered in the provisional membership class. (« membre provisoire ») "retired member" means a member who is registered in the retired membership class. (« membre retraité ») "satisfactory" means satisfactory to the registrar. (« satisfaisant ») "Schedule" means a Schedule to this regulation. (« annexe ») "temporary member" means a member who is registered in the temporary membership class. (« membre temporaire ») Competent to practise 1.3 For the purpose of this regulation, a member is considered competent to engage in the practice of paramedicine if the member has the requisite knowledge, skill and judgment to perform the act or service. PART 2 MEMBERSHIP Overview 2.1 This Part deals with membership in the College of Paramedics of Manitoba. It supplements Part 4 of the Act. Subregisters and membership classes are established and described. The registration requirements for each class are set out in this Part. The registration requirements for each class are in addition to the requirements set out in the Act. In most circumstances, a person's membership in one subregister or class may be changed to membership in another subregister or class. REGISTERS AND MEMBERSHIP CLASSES Register of regulated members 2.2(1) The register of regulated members consists of the following subregisters and membership classes: Subregister Membership class Critical care paramedic Full Provisional Temporary Non-practising Retired Advanced care paramedic Full Provisional Temporary Non-practising Retired Primary care paramedic Full Provisional Temporary Non-practising Retired Emergency medical responder Full Provisional Temporary Non-practising Retired 2.2(2) The description of each class is as follows: Membership class Description Full A member who is eligible to be issued a certificate of practice. Provisional A member who is eligible to be issued a certificate of practice, in extenuating circumstances, before satisfying all conditions for full registration. Temporary A member who is eligible to be issued a certificate of practice for an authorized restricted purpose and a limited time period. Non-practising A member who is not currently engaged in the practice of paramedicine but who intends to become engaged in the practice of paramedicine at a later date. Retired A member who is not currently eligible for a certificate of practice and who does not intend to become engaged in the practice of paramedicine at a later date. Register information 2.3 A register must contain the information set out in subsection 28(1) or (2) of the Act, as the case may be. A register must also contain the following applicable information for each member: (a) the membership registration date; (b) in respect of the member's paramedic education, (i) the name of the institution the member attended, and (ii) the date the member completed the program of study; (c) whether the member holds a valid certificate of practice; (d) any cancellation of the member's certificate of practice in accordance with section 48 or 49 of the Act; (e) any censure accepted by the member in accordance with section 102 of the Act and a description of the circumstances that led to the acceptance of the censure; (f) any voluntary surrender of the member's certificate of practice accepted under section 102 of the Act and, if applicable, any direction given under section 105 of the Act to the member that they do one or more of the following to the satisfaction of a specified person or committee before the member's certificate may be reinstated: (i) take counselling or receive treatment, (ii) complete a specified course of studies, (iii) obtain supervised experience under a certificate of practice issued with conditions for that purpose; (g) any undertaking from or agreement with a member, including an undertaking accepted under section 102 of the Act, that provides for one or more of the following: (i) an assessment of the member's capacity or fitness to practice the regulated health profession, (ii) counselling or treatment of the member, (iii) monitoring or supervision of the member's practice, (iv) completion by the member of a specified course of studies by way of remedial training, (v) the placement of one or more conditions on the member's right to engage in the practice of paramedicine, which may include the conditions relating to reinstatement set out in section 106 of the Act; (h) any suspension of a member's registration or certificate of practice as permitted by section 110 or subsection 127(3) of the Act. What information is available to the public? 2.4 The following information must be made available to the public during normal business hours: (a) the information described in clauses 2.3(a) to (c); (b) the information about the cancellation described in clause 2.3(d), if the member has not had their certificate of practice reinstated or has not been issued a new certificate of practice; (c) the information described in clause 2.3(e), if the censure was accepted by the member in the current calendar year or the 10 previous calendar years; (d) the information about a voluntary surrender described in clause 2.3(f) (other than any directions), if the member has not had their certificate of practice reinstated or has not been issued a new certificate of practice; (e) the information described in subclause 2.3(g)⁠(v), if the undertaking or agreement is in effect; (f) the information described in clause 2.3(h) — not including information about the provision under which the member was suspended or reasons for the suspension — if the suspension is in effect. This information is in addition to the information that must be made available to the public as set out in subsections 28(3) and (4) of the Act. Labour mobility 2.5 For greater certainty, subsection 32(3) of the Act applies to this Part. REGISTRATION REQUIREMENTS Application contents 2.6 A person applying for registration who wishes to be registered as a member must submit the following to the registrar: 1. A signed application in the approved form. 2. The fees provided for in the college's by-laws. 3. Satisfactory proof of identity and current legal name. 4. Evidence of good standing in each jurisdiction in Canada or elsewhere in which the applicant is or has been registered or licensed to engage in the practice of paramedicine. 5. A satisfactory criminal record check, a satisfactory child abuse registry check and a satisfactory adult abuse registry check. 6. Evidence that the applicant meets the requirements for registration set out in (a) subsection 32(1) of the Act; (b) section 2.7, 2.8, 2.9 or 2.10, depending on the subregister for which the person is applying; and (c) section 2.11, 2.12, 2.13 or 2.14, depending on the membership class for which the person is applying. 7. Information as to whether (a) the applicant is the subject of a current investigation or proceeding relating to the applicant's suitability to practise a health profession in Canada or elsewhere; (b) the applicant is or has been the subject of a finding of conduct unbecoming, or professional misconduct or incompetence related to the practice of a health profession, in Canada or elsewhere; (c) the applicant is or has been the subject of a finding of professional negligence or malpractice in Canada or elsewhere; (d) the applicant has any current conditions, or had previous conditions, imposed on their ability to practise a health profession in Canada or elsewhere; (e) the applicant is or has been the subject of a denial of an application to practise a health profession in Canada or elsewhere; and (f) the applicant has a charge, conviction or a finding of guilt (including a conditional discharge, absolute discharge or suspended sentence) for any offence, including a criminal offence or an offence under any narcotic or controlled substances legislation, in any jurisdiction in Canada or elsewhere. 8. Any other information requested by the registrar, including information pertaining to the criminal record check, child abuse registry check or adult abuse registry check provided by the applicant. FULL MEMBERSHIP Registration requirements for full membership — critical care paramedic 2.7 For the purpose of clause 32(1)⁠(g) of the Act, an applicant for registration as a critical care paramedic in the full membership class must establish that (a) the applicant has successfully completed one of the following: (i) an approved critical care paramedic program in Manitoba, (ii) a critical care paramedic program in any other jurisdiction in Canada that the council considers to be comparable to a program in Manitoba, (iii) a program outside Canada that the council considers to be comparable to a critical care paramedic program in Manitoba; (b) the applicant meets the English fluency criteria established by the council; (c) the applicant does not have a physical or mental condition or disorder, including an addiction to alcohol or drugs, that may impair their ability to engage in the practice of paramedicine in a safe and effective manner and that makes it desirable in the public interest that they not engage in the practice of paramedicine; (d) the applicant's past and present conduct affords reasonable grounds for the belief that the applicant will engage in the practice of paramedicine competently, with decency, integrity and honesty and in accordance with the law; and (e) the applicant is legally entitled to work in Canada. Registration requirements for full membership — advanced care paramedic 2.8 For the purpose of clause 32(1)⁠(g) of the Act, an applicant for registration as an advanced care paramedic in the full membership class must establish that (a) the applicant has successfully completed one of the following: (i) an approved advanced care paramedic program in Manitoba, (ii) an advanced care paramedic program in any other jurisdiction in Canada that the council considers to be comparable to a program in Manitoba, (iii) a program outside Canada that the council considers to be comparable to an advanced care paramedic program in Manitoba; (b) the applicant has passed an approved examination within the period established by the council; (c) the applicant meets the English fluency criteria established by the council; (d) the applicant does not have a physical or mental condition or disorder, including an addiction to alcohol or drugs, that may impair their ability to engage in the practice of paramedicine in a safe and effective manner and that makes it desirable in the public interest that they not engage in the practice of paramedicine; (e) the applicant's past and present conduct affords reasonable grounds for the belief that the applicant will engage in the practice of paramedicine competently, with decency, integrity and honesty and in accordance with the law; and (f) the applicant is legally entitled to work in Canada. Registration requirements for full membership — primary care paramedic 2.9 For the purpose of clause 32(1)⁠(g) of the Act, an applicant for registration as a primary care paramedic in the full membership class must establish that (a) the applicant has successfully completed one of the following: (i) an approved primary care paramedic program in Manitoba, (ii) a primary care paramedic program in any other jurisdiction in Canada that the council considers to be comparable to a program in Manitoba, (iii) a program outside Canada that the council considers to be comparable to a primary care paramedic program in Manitoba; (b) the applicant has passed an approved examination within the period established by the council; (c) the applicant meets the English fluency criteria established by the council; (d) the applicant does not have a physical or mental condition or disorder, including an addiction to alcohol or drugs, that may impair their ability to engage in the practice of paramedicine in a safe and effective manner and that makes it desirable in the public interest that they not engage in the practice of paramedicine; (e) the applicant's past and present conduct affords reasonable grounds for the belief that the applicant will engage in the practice of paramedicine competently, with decency, integrity and honesty and in accordance with the law; and (f) the applicant is legally entitled to work in Canada. Registration requirements for full membership — emergency medical responder 2.10 For the purpose of clause 32(1)⁠(g) of the Act, an applicant for registration as an emergency medical responder in the full membership class must establish that (a) the applicant has successfully completed one of the following: (i) an approved emergency medical responder program in Manitoba, (ii) an emergency medical responder program in any other jurisdiction in Canada that the council considers to be comparable to a program in Manitoba, (iii) a program outside Canada that the council considers to be comparable to a emergency medical responder program in Manitoba; (b) the applicant has passed an approved examination within the period established by the council; (c) the applicant meets the English fluency criteria established by the council; (d) the applicant does not have a physical or mental condition or disorder, including an addiction to alcohol or drugs, that may impair their ability to engage in the practice of paramedicine in a safe and effective manner and that makes it desirable in the public interest that they not engage in the practice of paramedicine; (e) the applicant's past and present conduct affords reasonable grounds for the belief that the applicant will engage in the practice of paramedicine competently, with decency, integrity and honesty and in accordance with the law; and (f) the applicant is legally entitled to work in Canada. OTHER MEMBERSHIP CLASSES Additional registration requirements for provisional membership 2.11 An applicant for registration as a provisional member on any subregister must also establish that (a) the applicant (i) has requested and is waiting to obtain the evidence needed to satisfy the requirement in item 5 of section 2.6, or (ii) is scheduled to complete an approved paramedic examination or has written an approved paramedic examination but (A) the applicant has not yet received notice of the examination results, and (B) there are extenuating circumstances that have been approved by the council; and (b) except for the outstanding information set out in clause (a), the applicant meets all other requirements for registration under subsection 32(1) of the Act, section 2.6 and section 2.7, 2.8, 2.9 or 2.10, as the case may be. Additional registration requirements for temporary membership 2.12 An applicant for registration as a temporary member on any subregister must also (a) establish that the applicant is a full, practising paramedic or emergency medical responder in good standing in another jurisdiction in Canada or elsewhere; (b) establish that the applicant practised in that jurisdiction as a paramedic or emergency medical responder immediately before the application date; (c) give the registrar a signed declaration that the applicant will have direct patient contact only for one or more of the following purposes: (i) to engage in the practice of paramedicine for an approved purpose, (ii) to conduct a training course or clinical presentation related to the practice of paramedicine, (iii) to conduct or engage in a research program related to the practice of paramedicine, (iv) to demonstrate equipment or techniques to be used in clinical care related to the practice of paramedicine; and (d) establish that the applicant has met any other approved requirements for temporary membership. Additional registration requirements for non-practising membership 2.13 An applicant for registration as a non-practising member on any subregister must also (a) establish that the applicant is or has been on an extended leave from the practice of paramedicine due to a medical condition, a statutory leave or a leave authorized by their employer or the council; (b) establish that the applicant was registered as a full member in good standing immediately before applying for registration as a non-practising member; and (c) give the registrar a signed declaration that the applicant (i) does not intend, at the time of applying for membership, to engage in the practice of paramedicine in Manitoba as a non-practising member, but does intend to do so at a later date, and (ii) will participate in the continuing competency program. Additional registration requirements for retired membership 2.14 An applicant for registration as a retired member on any subregister must also (a) establish that the applicant was registered as a member in good standing immediately before applying for registration as a retired member; and (b) give the registrar a signed declaration that the applicant does not intend, at the time of applying for membership, to engage in the practice of paramedicine in Manitoba at a later date. MEMBERSHIP PERIOD Membership period — provisional 2.15(1) An applicant may be registered as a provisional member for the period established by the council. 2.15(2) The registration of a provisional member is cancelled on the earliest occurrence of the following: (a) the specified membership period ends; (b) the member fails to pass the approved examination; (c) the member passes the approved examination and the registrar converts the member's membership class as provided for in subsection (3); (d) the member satisfactorily meets the requirement in item 5 of section 2.6 and the registrar converts the member's membership class as provided for in subsection (3); (e) the member fails to satisfactorily meet the requirement in item 5 of section 2.6. 2.15(3) The registrar may convert a provisional membership to a full membership after the member (a) satisfactorily meets the requirement in item 5 of section 2.6; or (b) passes the approved examination. Membership period — temporary 2.16(1) An applicant may be registered as a temporary member for a period of not more than six consecutive months. 2.16(2) The registrar may cancel a temporary member's registration (a) at the end of the six-month membership period; (b) before the six-month membership period ends if the registrar receives written notice from the member that the purpose or purposes for which the registration was granted have been fulfilled; or (c) when the member ceases to be registered as a full practising paramedic or emergency medical responder in good standing in another jurisdiction in Canada or elsewhere. CONVERTING MEMBERSHIP Contents of conversion application 2.17 To convert a registration to another subregister or class, an applicant must submit to the registrar the following: 1. A signed application in the approved form. 2. The fees provided for in the college's by-laws. 3. Satisfactory evidence that the applicant meets the requirements of the other subregister or class. Converting to non-practising class when no certificate of practice 2.18 If a member fails to renew or voluntarily surrenders their certificate of practice, the registrar may convert the member's registration to the applicable non-practising class. CONTINUING OBLIGATIONS Obligation to submit information if there has been a change 2.19 If there is a change in the information provided by a regulated member as set out in items 3 to 8 of section 2.6, the member's contact information or the member's employer, the member must promptly submit the new information to the registrar. PART 3 PRACTICE Overview 3.1 A certificate of registration does not entitle a member to engage in the practice of paramedicine. A member must also hold a certificate of practice. This Part supplements the requirements in the Act for a certificate of practice. This Part also deals with authorized titles and abbreviations and the requirement for professional liability insurance. Requirements for issuing certificate of practice 3.2(1) To engage in the practice of paramedicine, a member must submit an application in a satisfactory form to obtain a certificate of practice and must (a) meet the requirements set out in subsection 40(1) of the Act; (b) meet the requirements set out in subsection 32(1) of the Act and, depending on the applicant's membership class, the requirements for one of the following membership classes: (i) critical care paramedic (full) membership set out in section 2.7, (ii) advanced care paramedic (full) membership set out in section 2.8, (iii) primary care paramedic (full) membership set out in section 2.9, (iv) emergency medical responder (full) membership set out in section 2.10, (v) provisional membership set out in section 2.11, (vi) temporary membership set out in section 2.12; (c) establish that they do not have a physical or mental condition or disorder, including an addiction to alcohol or drugs, that may impair their ability to engage in the practice of paramedicine in a safe and effective manner and that makes it desirable in the public interest that they not engage in the practice of paramedicine; (d) establish that their past and present conduct affords reasonable grounds for the belief that the applicant will engage in the practice of paramedicine competently, with decency, integrity and honesty and in accordance with the law; and (e) establish that they have not been convicted of an offence that is relevant to their suitability to engage in the practice of paramedicine. 3.2(2) The registrar may request additional information from the applicant for the purpose of issuing the certificate of practice. Primary care paramedic (intermediate care) 3.3 To obtain the notation "(Intermediate Care)" on a primary care paramedic's certificate of practice, the member must establish that they have successfully completed any additional training required by the registrar. Expiry of certificate 3.4(1) Subject to subsection 46(3) of the Act, a certificate of practice is valid from the date it is issued or renewed until the expiry date specified on the certificate. 3.4(2) Despite subsection (1), a certificate of practice is no longer valid if the full, provisional or temporary member ceases to be registered as such a member. Surrender of certificate 3.5 When a member's certificate of practice is cancelled, the person must promptly surrender the certificate to the registrar. Renewal requirements 3.6(1) For the purpose of clause 46(1)⁠(c) of the Act, the requirements for renewal of a certificate of practice are as follows: (a) the member must meet the requirements set out in subsections 40(1) and 46(1) of the Act; (b) the member must meet the requirements set out in section 3.2 of this regulation; (c) the applicant must meet the continuing competency requirements under Part 6; (d) the member must provide any other information requested by the registrar. 3.6(2) If an applicant fails to meet the requirements of clause (1)⁠(b) or (c), the registrar may renew the applicant's certificate of practice if the council approves the renewal. Conditions on certificate of practice 3.7(1) For greater certainty, a certificate of practice is issued subject to any conditions imposed on the member's certificate of registration. 3.7(2) It is a condition of each temporary member's certificate of practice that they engage in the practice of paramedicine, including the performance of reserved acts, only as authorized by the registrar. Checks to be provided every five years 3.8 A member who holds a valid certificate of practice must provide the registrar with a satisfactory criminal record check, a satisfactory child abuse registry check and a satisfactory adult abuse registry check every five years after registration. Additional information 3.9(1) A member who holds a valid certificate of practice must promptly submit any change in the information provided to the registrar for the issuance of the certificate of practice. 3.9(2) If at any time the registrar receives information that causes the registrar to believe that a member may pose a risk to the public or may be unable to engage in the practice of paramedicine, the registrar may require the member to provide an additional satisfactory criminal record check, child abuse registry check or adult abuse registry check. 3.9(3) The registrar may request additional information respecting the criminal record check, child abuse registry check or adult abuse registry check provided by a member. Practice — protocols and procedures 3.10(1) Subject to subsection (2), in the course of engaging in the practice of paramedicine, a member must comply with the protocols and procedures established by the member's employer, if any. 3.10(2) A member is not required to comply with protocols and procedures unless (a) the member has been made aware of the protocol or procedure; and (b) the protocol or procedure is consistent with the Act or the college's regulations, by-laws, standards of practice, practice directions or code of ethics. Titles Titles and abbreviations 3.11(1) While engaged in the practice of paramedicine, a member who is registered as (a) a critical care paramedic is entitled to use the titles "Critical Care Paramedic" and "Paramedic" and the abbreviation "CCP"; (b) an advanced care paramedic is entitled to use the titles "Advanced Care Paramedic" and "Paramedic" and the abbreviation "ACP"; (c) a primary care paramedic is entitled to use the titles "Primary Care Paramedic" and "Paramedic" and the abbreviation "PCP"; (d) a primary care paramedic and who meets the requirements for a notation "(Intermediate Care)" set out in section 3.3 is entitled to use the titles "Primary Care Paramedic (Intermediate Care)" and "Paramedic" and the abbreviations "PCP (IC)" and "ICP"; or (e) an emergency medical responder is entitled to use the title "Emergency Medical Responder" and the abbreviation "EMR". 3.11(2) When using a title or abbreviation, (a) a provisional class member must also include the term "(Provisional Class)", or its equivalent in another language, immediately after the applicable title or abbreviation; (b) a temporary class member must also include the term "(Temporary Class)", or its equivalent in another language, immediately after the applicable title or abbreviation; (c) a non-practising member must also include the term "(Non-practising Class)", or its equivalent in another language, immediately after the applicable title or abbreviation; and (d) a retired member must also include the term "(Retired)", or its equivalent in another language, immediately after the applicable title or abbreviation. 3.11(3) No person other than a member may use any title or abbreviation listed in subsection (1), or a variation of any of those titles or abbreviations alone or in combination with other words, in a manner that states or implies that the person is a member of the college. 3.11(4) Only a regulated member who holds a valid certificate of practice is entitled to use the term "licensed" or a variation or abbreviation of it to describe the member's practice. Insurance 3.12(1) A member who holds a certificate of practice must (a) hold a policy of professional liability insurance of an approved type and providing coverage to the member to a minimum of $5 million for each occurrence or claim; and (b) promptly notify the registrar if they are no longer covered by the required liability insurance. 3.12(2) If the member is no longer covered by the required liability insurance, their certificate of practice is cancelled. At the time of notifying the registrar under clause (1)⁠(b), the member must also promptly surrender the certificate of practice to the registrar. Labour mobility 3.13 This Part is subject to the obligations of the college under subsection 3(1) of The Labour Mobility Act . PART 4 RESERVED ACTS Overview 4.1 Restrictions on performing certain reserved acts are set out in this Part. The restrictions are in addition to the restrictions set out in Part 2 of the Act. The reserved acts that form part of the scope of practice of paramedicine are set out in the Practice of Paramedicine Regulation . This Part also includes the rules for delegating and supervising the performance of reserved acts. Definition 4.2 In the Schedule, "standing order" means an instruction or authorization, including one in the form of a protocol, that is given to a member to perform a reserved act by a regulated health professional who is legally permitted and competent to give the order. Performing reserved acts 4.3(1) A member may perform a reserved act only if (a) the member is legally permitted and competent to perform the reserved act and it is safe and appropriate for the procedure being performed; and (b) it is appropriate to the member's practice setting. 4.3(2) A member may perform only those reserved acts as set out in the Table in the Schedule or delegated to the member in accordance with this Part, and only if the member has a valid certificate of practice and any additional training that is required. Temporary class 4.4 A member who is registered in the temporary class may perform the reserved acts set out in the Schedule (a) only if the member is authorized to do so by the registrar; and (b) only for the purpose for which the member is practising in Manitoba as set out in the declaration provided to the registrar in accordance with clause 2.12(c). SUPERVISION Supervising students 4.5 Subject to section 4.7, a member may supervise the performance of a reserved act by a person who is (a) registered in an approved paramedic education program; (b) training to become a member of another regulated health profession and is registered in an education program approved by that health professions college; or (c) a member completing additional training required to perform a reserved act. Training to perform reserved acts 4.6 For the purpose of completing additional training required to perform a reserved act, a member may perform that reserved act under the supervision of (a) another member who meets the requirements set out in section 4.7; or (b) a member of another regulated health profession who is authorized to perform the reserved act. Supervision requirements 4.7 A member who supervises the performance of a reserved act under section 4.5 or 4.6 or a member of another regulated health profession who supervises a member under section 4.6 must be (a) authorized and competent to perform the reserved act; (b) physically present while the reserved act is being performed; (c) available for consultation and to assist in performing the reserved act as required; and (d) able to observe, promptly intervene and stop or change the actions of the person being supervised without unduly interrupting the care of the person on whom the reserved act is being performed. DELEGATION Delegating a reserved act 4.8(1) A member may delegate the performance of a reserved act to another member who is a primary care paramedic or an advanced care paramedic only if the delegating member is (a) satisfied on reasonable grounds that the member accepting the delegation is legally permitted and competent to perform the reserved act being delegated; (b) satisfied on reasonable grounds that it is safe and appropriate for the member accepting the delegation to perform the reserved act; and (c) readily available for consultation while the member accepting the delegation performs the reserved act. 4.8(2) A delegation may be in writing or, in exigent circumstances, may be made verbally. 4.8(3) A written delegation must be recorded in the record of the patient to whom the delegation relates and must (a) name the person to whom the delegation is made; (b) name the patient to whom the delegation relates; (c) state the reason for the delegation; (d) state the duration of the delegation; (e) specify any conditions that the member who makes the delegation considers appropriate; and (f) be signed by the member making the delegation and indicate the abbreviation of the member's title. 4.8(4) A member who makes a verbal delegation must ensure that the information noted in clauses 4.8(3)⁠(a) through (e) is noted in the patient's record as soon as practicable after the delegation is made and the entry is signed by the member and indicates the abbreviation of the member's title. Accepting a delegation 4.9(1) Subject to subsection (2), a member, other than an emergency medical responder, may accept a delegation to perform a reserved act from another member or a regulated health professional who is not a member only if (a) the person who makes the delegation is (i) a member of the college or a member of a regulated health profession, (ii) legally permitted and competent to perform the reserved act being delegated, and (iii) readily available for consultation during the performance of the reserved act by the member accepting the delegation; and (b) the member who accepts the delegation (i) holds a valid certificate of practice, (ii) is competent to perform the reserved act, and (iii) is satisfied on reasonable grounds that it is safe and appropriate to perform the reserved act. 4.9(2) A member must not perform the following reserved acts: Reserved act 1: making a diagnosis and communicating it to an individual or their personal representative in circumstances in which it is reasonably foreseeable that the individual or representative will rely on the diagnosis to make a decision about the individual's health care. Reserved act 3(c): performing a procedure on tissue on or below the surface of the cornea. Reserved act 5(g): administering a substance using a hyperbaric chamber. Reserved act 6: prescribing a drug or vaccine. Reserved act 7: compounding a drug or vaccine. Reserved act 8: dispensing or selling a drug or vaccine. Reserved act 10: applying or ordering the application of (a) electricity for (i) aversive conditioning, (v) electrocoagulation, (vi) electroconvulsive shock therapy, (vii) electromyography, (viii) fulguration, and (ix) nerve conduction studies; (b) electromagnetism for magnetic resonance imaging; (c) other non-ionizing radiation for the purpose of cutting or destroying tissue or medical imagery; (d) X-rays or other ionizing radiation for diagnostic, imaging or therapeutic purposes, including computerized axial tomography, positron emission tomography and radiation therapy; and (e) any other use of a form of energy listed in clauses (b) to (e), if the use is specified by regulation. Reserved act 11: in relation to a therapeutic diet that is administered by enteral instillation or parenteral instillation, (a) selecting ingredients for the diet; or (b) compounding or administering the diet. Reserved act 12: casting a fracture of a bone. Reserved act 13: putting into the external ear canal, up to the eardrum, a substance that (a) is under pressure; or (b) subsequently solidifies. Reserved act 15: administering a high-velocity, low-amplitude thrust to move a joint of the spine within its anatomical range of motion. Reserved act 16: prescribing, dispensing or fitting a wearable hearing instrument. Reserved act 17: prescribing, dispensing or verifying a vision appliance. Reserved act 18: fitting a contact lens. Reserved act 19: prescribing, dispensing or fitting a dental appliance. Reserved act 20: performing a psycho-social intervention with an expectation of modifying a substantial disorder of thought, mood, perception, orientation or memory that grossly impairs judgment, behaviour, the capacity to recognize reality, or the ability to meet the ordinary demands of life. Reserved act 21: in relation to allergies, (a) performing challenge testing by any method; or (b) performing desensitizing treatment by any method. 4.9(3) For the purpose of this Part, a member is considered competent to perform a reserved act if the member has the requisite knowledge, skill and judgment to perform the act. 4.9(4) A delegation to perform a reserved act referred to in this Part may not be further delegated. PART 5 STANDARDS OF PRACTICE Practice obligations 5.1(1) A member may engage in the practice of paramedicine only if the member is legally permitted and competent to do so and only in a manner that is appropriate and safe. 5.1(2) A member must comply with the standards established in this Part and the standards established and published by the college entitled "Standards of Practice for the Paramedic Profession", as amended from time to time. Patient-centred practice 5.2 When engaging in the practice of paramedicine, a member must (a) perform an assessment to determine the needs and circumstances of the patient and provide care appropriate to those needs and circumstances; (b) perform an evaluation of the outcomes of the care and the modification or discontinuance of the care as required and as discussed with the patient or their representative; (c) refer the patient to another member or health care professional when appropriate; (d) support the patient in the management of their health care by providing information, resources and referrals to enable informed decision making by the patient or their representative; and (e) communicate with the patient or their representative in an effective and respectful manner, including (i) communicating about the patient's care in a timely manner, and (ii) communicating about the patient's conditions, the nature of the treatment and the treatment options, including the risks, benefits and efficacy of the options, to enable patients to make informed decisions. Collaborative care 5.3 A member must (a) work collaboratively and cooperatively with patients or their representative, families and other health care providers in providing for the health care of the patient and communicate effectively and appropriately with them; (b) ensure that they understand their role and the roles of the other health care providers; (c) explain to the patient or their representative the member's role and responsibilities; (d) comply with any collaborative care policies, protocols or procedures in place at the practice setting where the member and other health care providers are providing for the health care of the patient; (e) give the member's name, when requested, to the patient, their representative and any other person involved in the patient's health care; (f) treat other health care providers with respect; and (g) recognize the skill, knowledge, judgment and roles of others involved in the patient's care. Patient's record 5.4(1) A member must document, in a record specific to each patient, the care they provided to the patient. 5.4(2) A member must (a) sign and indicate the abbreviation of their title for entries on the record; (b) document the care provided by the member in the patient's record as the care is provided or as soon as practicable after the care is provided; (c) document the care provided by the member in the patient's record with enough detail for another member or health care professional to be sufficiently informed of that care; and (d) ensure the record is legible and accessible to maintain continuity of care. 5.4(3) When making a change to a patient record, a member must (a) ensure that the original entry remains identifiable and legible; (b) record the identity of the member making the change and the date of the change; and (c) document the change as soon as practicable after the reason for the change is identified. 5.4(4) A member must ensure that they comply with any other requirements relating to patient records under the Act, The Personal Health Information Act and any other enactment, by-law, standard of practice, code of ethics and practice direction with which a member must comply. Practice environment 5.5 While engaging in the practice of paramedicine, a member must demonstrate procedures that safeguard the hygiene and sanitation of the practice environment and the hygiene and sanitation of the equipment used in that care, so far as is reasonably practicable. Equipment 5.6(1) A member must ensure that equipment used in their practice of paramedicine is (a) fit for the purpose for which it is used; and (b) maintained in good repair and in sound operating condition. 5.6(2) A member is responsible for the proper decontamination, cleaning, disinfection and sterilization of multiple-use equipment before use or reuse. Practice directions 5.7 Nothing in this Part limits or restricts the council from issuing practice directions under section 85 of the Act to enhance, explain, add to or guide members with respect to the subject matters described in this regulation or any other matter relevant to the practice of paramedicine. PART 6 CONTINUING COMPETENCY Overview 6.1 Subsection 87(1) of the Act requires the council to establish a continuing competency program to maintain the competency of members and to enhance the practice of paramedicine. Requirement to comply 6.2(1) A member must participate in the continuing competency program as required by this Part. 6.2(2) Despite subsection (1), this Part does not apply to temporary members or retired members. Annual requirement 6.3 Each year, a member must (a) satisfactorily complete the activities required under the continuing competency program, that may include (i) activities that promote continuing competency in the provision of health care, (ii) activities that promote continuing quality improvement in the provision of healthcare, or (iii) any other approved activities; and (b) report on those activities at the time and in the form required by the registrar. Records 6.4 A member must maintain a record of each continuing competency activity completed within the current year and the previous three years. On request, the member must submit copies of the records to the registrar.

Practice audit 6.5 The registrar may require a member to undergo a practice audit in the following circumstances: (a) the member fails to complete the continuing competency activities as required; (b) the member fails to maintain the required records; (c) the member is randomly or specifically selected to undergo the audit. Powers of registrar 6.6 If a member fails to complete the continuing competency requirements or if practice issues are identified through a practice audit, the registrar may do one or more of the following: (a) impose any conditions that the registrar considers necessary or advisable on the member's certificate of practice; (b) require the member to successfully complete any examinations, tests, assessments, training or education that the registrar considers necessary to establish that the member is competent to engage in the practice of paramedicine; (c) direct the member to take any action the registrar considers necessary to address any issues identified in the audit. Progress reporting 6.7 The member must report to the registrar, in the time and manner specified by the registrar, about their progress with respect to any action directed under clause 6.6(b) or (c). Complaint if registrar aware of misconduct 6.8 If the registrar believes that the conduct of a member may constitute conduct about which a finding could be made in accordance with subsection 124(2) of the Act, the registrar may treat the matter as a complaint and refer it to the complaints investigation committee in accordance with subsection 90(3) of the Act. Registrar to report annually 6.9 The registrar must submit an annual report to the council that includes information about the continuing competency program and the participation of regulated members in the program and any other information that the council requests. PART 7 HEALTH PROFESSION CORPORATIONS Overview 7.1 Part 5 of the Act deals with health profession corporations. This Part supplements the requirements relating to permits, the record and the naming of health profession corporations. Restricted to critical care, advanced care and primary care paramedics 7.2 The only members who may establish health profession corporations are critical care paramedics, advanced care paramedics and primary care paramedics who are registered in the full membership class and hold a valid practising certificate. Health profession corporation permit 7.3 Subsection 60(1) of the Act sets out the requirements for the issuance of a health profession corporation permit. For the purpose of clause 60(1)⁠(i) of the Act, a corporation must file with the registrar (a) a copy of the articles of incorporation and any articles of amendment, continuance or amalgamation; (b) a current status certificate issued under The Corporations Act ; and (c) a copy of the most recent annual report filed under The Corporations Act . Additional contents of record 7.4 The record of health profession corporations must contain the information set out in subsection 73(3) of the Act. The record must also contain the following applicable information for each health profession corporation: (a) the corporation's address, telephone number, fax number and e-mail address; (b) the time period during which the corporation's permit is valid; (c) information about any suspension or cancellation of the corporation's permit or alternative action taken in accordance with section 66 of the Act, including any conditions placed on the permit. Name of health profession corporation 7.5 A health profession corporation's name must not refer to an individual who is not a member. Error on record 7.6 The registrar may correct any error or remove any entry made in error on the record of health profession corporations. Name removed from record 7.7 When a health profession corporation's permit is cancelled, the registrar must remove the corporation's name from the record of health profession corporations. PART 8 MISCELLANEOUS Professional misconduct fines 8.1 Column 3 of the table of professional misconduct fines in Schedule 1 of the Act is specified for the purpose of clause 127(1)⁠(b) of the Act. PART 9 Coming into force 9 This regulation comes into force on December 1, 2020, or the day it is registered under The Statutes and Regulations Act , whichever is later. SCHEDULE (Section 4.9) Reserved act Critical Care Paramedic Advanced Care Paramedic Primary Care Paramedic (Intermediate Care) Primary Care Paramedic Emergency Medical Responder 1: making a diagnosis that is appropriate to the member's practice of paramedicine and communicating it to an individual or their personal representative in circumstances in which it is reasonably foreseeable that the individual or representative will rely on the diagnosis to make a decision about the individual's health care X X X X 2: with additional training, receiving reports of screening or diagnostic tests for the purpose of assessing, diagnosing or resolving a health condition that is appropriate to the paramedic's practice and in accordance with the National Occupational Competency Profile for Paramedics X X X X 2: with additional training, receiving X-rays, but only for confirmation of device placement X X 3(a): performing a procedure on tissue below the dermis for the purpose of wound management and of management of an impaled object X X X X X 3(a): performing a procedure on tissue below the dermis for the purpose of any of the following: (i) removal of a foreign body, (ii) wound repair, (iii) venous blood sample acquisition, (iv) peripheral intravenous cannulation X X X X but only with additional training 3(a): performing a procedure on tissue below the dermis for the purpose of any of the following: (i) intraosseous device insertion, (ii) needle decompression for tension pneumothorax during cardiac arrest X X X but only with additional training 3(a): performing a procedure on tissue below the dermis for the purpose of needle decompression for tension pneumothorax X X 3(a): with additional training, performing a procedure on tissue below the dermis for the purpose of thoracostomy X X 3(a): performing a procedure on tissue below the dermis for the purpose of managing patients with an established indwelling arterial catheter X X but only with additional training 3(a): with additional training, performing a procedure on tissue below the dermis for the purpose of any of the following: (i) umbilical arterial cannulation, (ii) arterial blood sampling via radial artery or established arterial line access X 3(a): performing a procedure on tissue below the dermis for the purpose of any of the following: (i) monitoring an established pulmonary artery catheter and interpreting data, (ii) umbilical venous cannulation X 3(b): performing a procedure on tissue below the surface of the mucous membrane for the purpose of any of the following: (i) wound management, (ii) management of an impaled object X X X X X 3(b): performing a procedure on tissue below the surface of a mucous membrane for the purpose of any of the following: (i) needle (percutaneous) cricothyroidotomy, (ii) surgical cricothyroidotomy X X but only with additional training 3(d): performing a procedure on tissue below the surface of a tooth for the purpose of emergency tooth re-implantation X X X X but only with additional training 4(a): inserting or removing an instrument or device into the external ear canal X X X X X 4(b): inserting or removing an instrument or device beyond the point in the nasal passages where they normally narrow for the purpose of airway management X X X X X 4(b): inserting or removing an instrument or device beyond the point in the nasal passages where they normally narrow for the purpose of any of the following: (i) nasal tracheal intubation, (ii) insertion of a device for epistaxis, with additional training X X 4(c): removing a device beyond the pharynx for the purpose of any of the following: (i) orogastric tube (gravity drain) maintenance, (ii) nasogastric tube maintenance (gravity drain) X X X X X but only with additional training 4(c): inserting a blind insertion airway device beyond the pharynx X X X X 4(c): inserting or removing an instrument or a device beyond the pharynx for the purpose of any of the following: (i) maintenance of established internal esophageal probe, (ii) maintenance of established nasogastric tube (suction) X X X X but only with additional training 4(c): with additional training, inserting or removing an instrument or a device beyond the pharynx for the purpose of orogastric tube insertion and maintenance X X 4(c): inserting or removing an instrument or a device beyond the pharynx for the purpose of removing a supraglottic foreign body X X X X but only with additional training 4(c): inserting or removing an instrument or a device beyond the pharynx for the purpose of suctioning X X X but only with additional training 4(c): inserting or removing an instrument or a device beyond the pharynx for the purpose of any of the following: (i) nasogastric tube insertion, (ii) endotracheal intubation, (iii) forceps removal of tracheal foreign body X X 4(c): with additional training, inserting or removing an instrument or device, hand or finger beyond the pharynx for the purpose of endotracheal intubation with paralytics X 4(d): removing a device from beyond the opening of the urethra for the purpose of urinary catheter maintenance X X X X X but only with additional training 4(d): removing a urinary catheter X X X X 4(d): inserting a device beyond the opening of the urethra for the purpose of urinary catheterization X X 4(e): inserting or removing a hand or finger beyond the labia majora for obstetrical emergencies related to a prolapsed umbilical cord or for the purpose of airway management of the fetus during breech birth X X X X X 4(e): inserting or removing a hand or finger beyond the labia majora for obstetrical emergencies related to limb presentation X X X X but only with additional training X but only with additional training 4(e): inserting or removing a hand or finger beyond the labia majora for obstetrical emergencies related to uterine inversion X X X but only with additional training X but only with additional training 4(e): inserting or removing a hand or finger beyond the labia majora for obstetrical emergencies related to shoulder dystocia X X but only with additional training 4(e): with additional training, inserting or removing a hand or finger beyond the labia majora for obstetrical emergencies for the purpose of bimanual compression X X 4(f): inserting or removing an instrument or device beyond the anal verge for the purpose of continuous core temperature monitoring X X X but only with additional training X but only with additional training 4(g): inserting or removing an instrument or device into an artificial opening in the body for the purpose of any of the following: (i) positive pressure ventilation with a tracheostomy, (ii) suctioning a tracheostomy X X X X X but only with additional training 4(g): inserting or removing an instrument or device into an artificial opening into the body for the purpose of managing obstructed tracheostomy X X X X but only with additional training X but only with additional training 5(a): administering a substance by injection X X X X 5(a): administering a substance by injection for the purpose of tube maintenance X X X X X but only with additional training 5(b): administering a substance by inhalation X X X X 5(c): administering a substance by mechanical ventilation using a bag-valve mask X X X X X 5(c): administering a substance by mechanical ventilation for the purpose of continuous positive airway pressure X X X X but only with additional training 5(c): administering a substance by mechanical ventilation for the purpose of bi-level positive airway pressure X X but only with additional training 5(d): administering a substance for the purpose of eye irrigation X X X X X 5(d): administering a substance the purpose of wound irrigation X X X X X 5(d): administering a substance for the purpose of bladder irrigation X X X X but only with additional training 5(e): administering a substance by enteral instillation or parenteral instillation for the purpose of tubes maintenance X X X X X but only with additional training 5(f): administering blood products by transfusion, if there is an order specific to the patient from a regulated health professional who is legally permitted and competent to give the order X X but only with additional training 9: administering oxygen X X X X X 9: if there is a standing order and with additional training, administering a drug, except vaccines, by (i) auto-injector, (ii) inhalation, metered dose inhaler or nebulizer, (iii) buccal, oral or sublingual routes, (iv) intranasal route X X X X X 9: if there is a standing order and with additional training, administering a drug by any method, except vaccines, incidental to the practice of paramedicine X X X X 9: administering a vaccine by any method in accordance with provincial requirements if the vaccine is required as part of a communicable disease response or in a public health emergency X X X X 10(a): with additional training, applying point-of-care ultrasound to facilitate intravenous cannulation X X 10(a): with additional training, applying point-of-care ultrasound in approved circumstances X X 10(b)⁠(ii): applying or ordering the application of electricity for cardiac pacemaker therapy X X 10(b): applying electricity for any of the following: (iii) cardioversion, (x) transcutaneous cardiac pacing X X X but only with additional training 10(b)⁠(iv): applying electricity for automated or semi-automated defibrillation without rhythm interpretation X X X X X 10(b)⁠(iv): applying electricity for non-automated defibrillation X X X X but only with additional training 12: setting a fracture of a bone for the purpose of restoring perfusion, extrication or immobilization X X X X X 12: setting a dislocation of a joint in approved circumstances X X X but only with additional training 14: managing the delivery of a baby only where delivery is imminent while the patient is in the care of a paramedic X X X X X