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HOUSE BILL NO. 858
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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
04/10 Governor signed
Session Law Chapter 421
]]]] 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
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
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.
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
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,
1 providing instructions for patient care via radio or telephone, and other
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
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
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
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
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.
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.
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