2006 Legislation
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HOUSE BILL NO. 858 – EMS Medical Services Comm

HOUSE BILL NO. 858

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Bill Status



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

Bill Text


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-eighth Legislature                   Second Regular Session - 2006
                                                                        
                                                                        
                              IN 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  in
 26    chapter 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 completed  at least fifty (50) hours of
  6             advanced  training  in  such techniques as intravenous fluid therapy,
  7             antishock trouser  application,  airway  management,  and  subsequent
  8             required continued training; and
  9             (ii)  Has  received additional training by under 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 be authorized by the board
 15                  of medicine defined 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 the board of medicine  com-
 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 the board  of  medicine
 10    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  56-1011
 53    through  56-1018B,  Idaho  Code,  are  accorded  "grandfather rights," and are
                                                                        
                                           5
                                                                        
  1    therefore exempt from the ambulance vehicle specifications established by  the
  2    board  of  health  and welfare,  whether or not such ambulances continue under
  3    the control of the same authority Supervision -- 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)  The  board of medicine commission 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 the board of medicine commission.
 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 / Fiscal Impact


                                
                                
                           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