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H0858.....................................................by WAYS AND MEANS EMERGENCY MEDICAL SERVICES - Amends existing law to provide definitions; to revise rulemaking authority; to create an Idaho Emergency Medical Services Physician Commission; to provide for the governance of the commission; to eliminate grandfather rights for ambulances; and to provide for supervision of the medical services provided by personnel affiliated with licensed ambulance or non-transport services. 03/29 House intro - 1st rdg - to printing 03/30 Rpt prt - to 2nd rdg Rls susp - PASSED - 64-2-4 AYES -- Anderson, Andrus, Barraclough, Barrett, Bastian, Bayer, Bedke, Bell, Bilbao, Black, Block, Boe, Bolz, Brackett, Bradford, Cannon, Chadderdon, Clark, Collins, Crow, Deal, Denney, Edmunson, Ellsworth, Eskridge, Field(18), Field(23), Garrett, Hart, Henbest, Henderson, Jaquet, Kemp, Lake, LeFavour, Loertscher, Martinez, Mathews, Miller, Mitchell, Moyle, Nielsen, Nonini, Pasley-Stuart, Pence, Raybould, Ring, Ringo, Roberts, Rusche, Rydalch, Sali, Sayler, Schaefer, Shepherd(2), Shepherd(8), Shirley, Skippen, Smith(30), Smith(24), Snodgrass, Stevenson, Trail, Wills NAYS -- McKague, Wood Absent and excused -- Harwood, McGeachin, Smylie, Mr. Speaker Floor Sponsor - Martinez Title apvd - to Senate 03/31 Senate intro - 1st rdg - to Health/Wel 04/03 Rpt out - rec d/p - to 2nd rdg Rls susp - PASSED - 32-0-3 AYES -- Andreason, Brandt, Broadsword, Bunderson, Burkett, Burtenshaw, Cameron, Coiner, Compton, Corder, Darrington, Davis, Goedde, Hill, Jorgenson, Kelly, Keough, Langhorst, Little, Lodge, Malepeai, Marley, McGee, McKenzie, Pearce, Richardson, Schroeder, Stegner, Stennett, Sweet, Werk, Williams NAYS -- None Absent and excused -- Fulcher, Gannon, Geddes Floor Sponsor - Werk Title apvd - to House 04/04 To enrol - Rpt enrol - Sp signed - Pres signed To Governor 04/10 Governor signed Session Law Chapter 421 Effective: 07/01/06
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]] Fifty-eighth Legislature Second Regular Session - 2006IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. 858 BY WAYS AND MEANS COMMITTEE 1 AN ACT 2 RELATING TO EMERGENCY MEDICAL SERVICES; AMENDING SECTION 56-1012, IDAHO CODE, 3 TO REVISE DEFINITIONS; AMENDING SECTION 56-1013, IDAHO CODE, TO PROVIDE 4 FOR CORRECT TERMINOLOGY AND TO MODIFY RULEMAKING AUTHORITY; AMENDING CHAP- 5 TER 10, TITLE 56, IDAHO CODE, BY THE ADDITION OF A NEW SECTION 56-1013A, 6 IDAHO CODE, TO CREATE AN IDAHO EMERGENCY MEDICAL SERVICES PHYSICIAN COM- 7 MISSION AND TO PROVIDE FOR THE GOVERNANCE OF THE COMMISSION; AMENDING SEC- 8 TION 56-1016, IDAHO CODE, TO ELIMINATE GRANDFATHER RIGHTS FOR AMBULANCES 9 AND TO PROVIDE FOR SUPERVISION OF THE MEDICAL SERVICES PROVIDED BY PERSON- 10 NEL AFFILIATED WITH LICENSED AMBULANCE OR NON-TRANSPORT SERVICE; AND 11 AMENDING SECTION 56-1017, IDAHO CODE, TO PROVIDE CORRECT TERMINOLOGY. 12 Be It Enacted by the Legislature of the State of Idaho: 13 SECTION 1. That Section 56-1012, Idaho Code, be, and the same is hereby 14 amended to read as follows: 15 56-1012. DEFINITIONS. As used in sections 56-1011 through 56-1018B, Idaho 16 Code: 17 (1) "Ambulance" means any privately or publicly owned ground vehicle, 18 nautical vessel, fixed wing aircraft or rotary wing aircraft used for, or 19 intended to be used for the transportation of sick or injured persons who may 20 need medical attention during transport. This may include dual or multipurpose 21 vehicles which otherwise comply with sections 56-1011 through 56-1018B, Idaho 22 Code, and specifications established by the board of health and welfare. 23 (2) "Board of Health and Welfare" means the Idaho board of health and 24 welfare. 25 (3)"Board of Medicine" means the Idaho board of medicine as provided in26chapter 18, title 54, Idaho Code.27(4)"Certified Personnel" means individuals who have completed training 28 and successfully passed examinations for training and skills proficiency in 29 one (1) or several levels as certified by the department of health and wel- 30 fare. These several levels of certified personnel shall include: 31 (a) FR -- "First Responder" (hereafter FR) means an individual certified 32 by the EMS bureau of the Idaho department of health and welfare as an FR 33 on the basis of successful completion of an FR course approved by the 34 board of health and welfare and subsequent required continuing training. 35 (b) EMT-B -- "Emergency Medical Technician-Basic" (hereafter EMT-B) means 36 an individual certified by the EMS bureau of the Idaho department of 37 health and welfare on the basis of successful completion of an EMT-B 38 course approved by the board of health and welfare and subsequent required 39 continuing training. 40 (c) "Ambulance Rating" means a certification issued by the EMS bureau of 41 the Idaho department of health and welfare to an EMT-B on the basis of 42 successful completion of supervised infield ambulance experience as 43 defined by the board of health and welfare. 2 1 (d) "Advanced Emergency Medical Technician-Ambulance" (hereafter advanced 2 EMT-A) means a person who: 3 (i) Is certified by the EMS bureau of the Idaho department of 4 health and welfare on the basis of successful completion of EMT-A 5 training and in addition, has completedat least fifty (50) hours of6 advanced training in such techniques as intravenous fluid therapy, 7antishock trouser application,airway management, and subsequent 8 required continued training; and 9 (ii) Has received additional trainingbyunder the supervision of a 10 licensed physician: 11 (A) To administer drugs under written or oral authorization of 12 a licensed physician; and 13 (B) To perform such other acts under written or oral authoriza- 14 tion of a licensed physician as shall beauthorized by the board15of medicinedefined by the commission; and 16 (iii) Has been examined and certified as an advanced EMT-A by an 17 authorized representative of the department. 18 (e) "Emergency Medical Technician-Intermediate" (hereafter EMT-I) means a 19 person who: 20 (i) Has completed all the requirements for certification as an EMT- 21 I; and 22 (ii) Has successfully completed a course in patient care including 23 the required training under the supervision of a licensed physician 24 covering the scope of practice defined by theboard of medicinecom- 25 mission; and 26 (iii) Has been examined and certified as an EMT-I by an authorized 27 representative of the department. 28 (f) "Emergency Medical Technician-Paramedic" (hereafter EMT-P) means a 29 person who: 30 (i) Has completed all the requirements for certification as an EMT- 31 P; and 32 (ii) Has successfully completed a course in intensive patient care 33 including the required training under the supervision of a licensed 34 physician, including training in cardiac defibrillation, cardiac mon- 35 itoring, endotracheal intubation and drug administration; and 36 (iii) Has been examined and certified as an EMT-P by an authorized 37 representative of the department. 38 (4) "Commission" means the Idaho emergency medical services physician 39 commission. 40 (5) "Department" means the Idaho department of health and welfare. 41 (6) "Emergency Medical Services" means the services utilized in respond- 42 ing to a perceived individual need for immediate care in order to prevent loss 43 of life or aggravation of physiological or psychological illness or injury. 44 (7) "Non-Transport Service" means a service licensed by the department of 45 health and welfare, EMS bureau, operated with the intent to provide personnel 46 or equipment for medical stabilization at an emergency scene, but not intended 47 to be the service that will actually transport sick or injured persons. 48 (8) "Non-Transport Vehicle" means any vehicle licensed by the department 49 of health and welfare, EMS bureau, operated with the intent to provide person- 50 nel or equipment for medical stabilization at an emergency scene, but not 51 intended as the vehicle that will actually transport sick or injured persons. 52 (9) "Supervision" means the medical direction by a licensed physician of 53 activities provided by certified personnel affiliated with a licensed ambu- 54 lance or non-transport service, including, but not limited to: establishing 55 standing orders and protocols, reviewing performance of certified personnel, 3 1 providing instructions for patient care via radio or telephone, and other 2 oversight. 3 (10) "Transfer" means the transportation of a patient from one (1) medical 4 care facility to another. 5 SECTION 2. That Section 56-1013, Idaho Code, be, and the same is hereby 6 amended to read as follows: 7 56-1013. AUTHORIZED ACTIONS. Persons certified by the department shall be 8 authorized to perform such acts under written or oral authorization of a 9 licensed physician as shall be established by rules of theboard of medicine10 commission, including, but not limited to, administration of intravenous solu- 11 tions and drugs, cardiac defibrillation,antishock trouser application,airway 12 management, endotracheal intubation, and other patient care. 13 SECTION 3. That Chapter 10, Title 56, Idaho Code, be, and the same is 14 hereby amended by the addition thereto of a NEW SECTION, to be known and des- 15 ignated as Section 56-1013A, Idaho Code, and to read as follows: 16 56-1013A. IDAHO EMERGENCY MEDICAL SERVICES PHYSICIAN COMMISSION -- TERMS 17 AND OPERATION. (1) There is hereby created in the department of health and 18 welfare an Idaho emergency medical services physician commission for the pur- 19 pose of establishing standards for scope and practice and medical supervision 20 for certified personnel, ambulance services, and non-transport agencies 21 licensed by the department. Notwithstanding any other provision of law to the 22 contrary, the commission shall exercise its powers and duties in accordance 23 with the provisions of sections 56-1011 through 56-1018B, Idaho Code, relative 24 to scope of practice and medical supervision of certified personnel. 25 (2) The commission shall be composed of eleven (11) voting members 26 appointed by the governor upon assurance of equitable geographic and rural 27 representation. Six (6) members shall be physicians currently licensed in 28 Idaho and appointed as follows: one (1) member representing the Idaho board of 29 medicine as provided in chapter 18, title 54, Idaho Code, one (1) member rep- 30 resenting the Idaho medical association, one (1) member representing the emer- 31 gency medical services (EMS) bureau of the department, one (1) member repre- 32 senting the Idaho chapter of the American college of emergency physicians, one 33 (1) member representing the Idaho chapter of the American academy of pediat- 34 rics and one (1) member representing the Idaho chapter of the American college 35 of surgeons committee on trauma. Three (3) members shall be physicians cur- 36 rently licensed in Idaho and practicing as an EMS medical director represent- 37 ing the following associations: one (1) member representing the Idaho associa- 38 tion of counties, one (1) member representing the Idaho fire chiefs associa- 39 tion and one (1) member representing the Idaho hospital association. Two (2) 40 members shall be Idaho citizens representing the public interest. 41 (3) Except as provided in this subsection, members of the commission 42 shall be appointed for a term of three (3) years. The following four (4) mem- 43 bers shall be appointed to an initial term of two (2) years: the member repre- 44 senting the board of medicine, the member representing the Idaho chapter of 45 the American college of emergency physicians, the member representing the 46 Idaho chapter of the American college of surgeons committee on trauma and the 47 member representing the Idaho fire chiefs association. The remaining seven (7) 48 members shall be appointed for an initial term of three (3) years. Thereafter, 49 all terms shall be for a period of three (3) years. 50 (4) The commission shall elect a chair and such officers as it may deem 51 necessary and appropriate. The commission shall meet at least annually and at 4 1 the call of the chair. Members of the commission shall be compensated as pro- 2 vided in section 59-509(b), Idaho Code. 3 (5) Prior to the expiration of the regular term of a member of the com- 4 mission or upon the occurrence or declaration of a vacancy in the membership 5 of the commission, the department shall notify the represented entity of that 6 fact in writing and the represented entity shall, within sixty (60) days 7 thereafter, nominate at least three (3) persons to fill the vacancy in a man- 8 ner as shall be determined by the rules and bylaws of the represented entity 9 and shall forward the nominations to the governor, who shall appoint from 10 among the nominees a person to be a member of the commission to fill the 11 vacancy. Persons nominated for a seat held by a physician must be licensed by 12 the state of Idaho to practice medicine. 13 (6) Moneys collected pursuant to rules promulgated by the department for 14 initial and renewal EMS certifications are hereby continuously appropriated 15 and shall be utilized exclusively for the purposes set forth in this section 16 as determined by the commission. 17 (7) The commission shall prepare a budget on an annual basis indicating 18 that portion of the funds necessary for the continuous operation of the com- 19 mission to achieve the purposes of this section. 20 SECTION 4. That Section 56-1016, Idaho Code, be, and the same is hereby 21 amended to read as follows: 22 56-1016. AMBULANCE MINIMUM STANDARDS. Each ambulance service and non- 23 transport service shall be licensed by the department and shall meet the fol- 24 lowing standards: 25 (1) Ambulance vehicles -- Each new ambulance vehicle purchased after the 26 effective date of these standards shall conform to the ambulance vehicle spec- 27 ifications for that type established by the board of health and welfare. The 28 patient compartment of each ambulance vehicle shall be maintained in a clean 29 and sanitary condition. 30 (2) Ambulance equipment -- Each ambulance shall be equipped with the 31 patient care items deemed essential for that type of ambulance by the board of 32 health and welfare. 33 (3) Ambulance personnel -- There shall be at least two (2) ambulance crew 34 members on each patient transport, with the crew member delivering patient 35 care being, at a minimum, a state certified emergency medical technician 36 (EMT), except that with the patient's and the patient's physician's permis- 37 sion, an EMT attendant shall not be required on routine, nonemergency transfer 38 calls. 39 (4) Ambulance dispatch -- Each ambulance service shall have a twenty-four 40 (24) hour dispatch arrangement and shall respond to calls on a twenty-four 41 (24) hour basis. 42 (5) Ambulance inspections and licensing -- The department of health and 43 welfare, EMS bureau, shall conduct inspections at least annually related to 44 ambulance service licensing or shall contract to have the inspections carried 45 out. Each ambulance and non-transport vehicle shall have a current state 46 license in order to operate. 47 (6) Ambulance minimum standards waiver -- The controlling authority pro- 48 viding ambulance services may petition the board of health and welfare for 49 waiver of the ambulance standards of sections 56-1011 through 56-1018B, Idaho 50 Code, if compliance with these standards would cause undue hardship on the 51 community being served, or would result in abandonment of ambulance services. 52 (7)All ambulances in service on the effective date of sections 56-101153through 56-1018B, Idaho Code, are accorded "grandfather rights," and are5 1therefore exempt from the ambulance vehicle specifications established by the2board of health and welfare, whether or not such ambulances continue under3the control of the same authoritySupervision -- A licensed physician shall 4 supervise the medical activities provided by certified personnel affiliated 5 with the licensed ambulance or non-transport service including, but not lim- 6 ited to: establishing standing orders and protocols, reviewing performance of 7 certified personnel, approving methods for certified personnel to receive 8 instructions for patient care via radio, telephone, or in person, and other 9 oversight as provided in the rules of the commission. 10 SECTION 5. That Section 56-1017, Idaho Code, be, and the same is hereby 11 amended to read as follows: 12 56-1017. RULES. (1) Theboard of medicinecommission is authorized and 13 directed to adopt appropriate rules defining the allowable scope of practice 14 and acts and duties which can be performed by persons certified by the depart- 15 ment and the required level of supervision by a licensed physician. 16 (2) The board of health and welfare is authorized and directed to adopt 17 appropriate rules and standards concerning the administration of sections 18 56-1011 through 56-1018B, Idaho Code, including criteria for training pro- 19 grams, certification of personnel, licensure of ambulances and non-transport 20 services, licensure of ambulance and non-transport vehicles, criteria for the 21 use of air medical services by certified EMS personnel at emergency scenes, 22 establishment of fees for training, inspections, and certifications, and 23 appropriate requirements for recertification of personnel and equipment. The 24 rules of the board of health and welfare must be consistent with the rules 25 adopted by theboard of medicinecommission. 26 (3) Additionally, the department shall develop guidelines, standards and 27 procedures for reducing exposure to pathogens from human blood, tissue or flu- 28 ids. Such guidelines, standards and procedures shall be made available to all 29 law enforcement personnel, all emergency medical services personnel, and such 30 other emergency personnel as request such information.
STATEMENT OF PURPOSE RS 16308 This legislation creates a commission to regulate the scope of practice and medical supervision standards for the 4,500 emergency medical technicians, paramedics, and other EMS personnel in Idaho. Since the legislature passed the first EMS Act in Idaho in 1972, setting the scope of practice and medical supervision standards has been the responsibility of the board of medicine. These issues have become increasingly complex and time-consuming yet essential to assure the safety of the public and patients who are in the care of ambulance services and other EMS providers. The commission creates a forum for physicians and consumer members to determine these standards, with each physician member representing a state organization or association that have a vested interest in the Idaho emergency medical services system. The outcome is a level of regulation that is equal to that which is in place today, improved through decision making by individuals who are subject matter experts in the discipline of out of hospital emergency medicine. FISCAL NOTE There is no impact on the State General Fund. The legislation would designate the use of certification fees currently paid by advanced level EMS personnel under Section 56-1017(2), Idaho Code, and IDAPA 16.02.03.501 and 16.02.02.510, rules governing emergency medical services to fund the commission. This designation assures budget availability regardless of administration or priority changes within the Department of Health and Welfare. These fees amount to approximately $16,500 every year. Contact Name: Representative Elmer Martinez Phone: (208) 332-1000 Dia Gainor, Health and Welfare - Bureau of EMS Phone: (208) 334-4000 STATEMENT OF PURPOSE/FISCAL NOTE H 858