PA 15-223—sSB 999

Public Health Committee

AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS REGARDING EMERGENCY MEDICAL SERVICES

SUMMARY: This act makes various changes in the emergency medical services (EMS) laws, including emergency scene responsibilities, data reporting requirements, and credentialing. Among other things, the act:

1. establishes a hierarchy for determining which EMS provider is responsible for making patient care decisions at the scene of an emergency call, giving decision-making authority to the provider holding the highest classification of licensure or certification;

2. specifies that these provisions do not limit the authority of the fire officer-in-charge to control and direct emergency activities at the scene;

3. establishes a civil penalty of up to $100 per day for an EMS organization's failure to report data as required, in addition to existing penalties;

4. allows the Department of Public Health (DPH) commissioner to adopt regulations on the EMS data collection system; and

5. specifies certain exemptions from EMS provider certification, extending an existing exemption from paramedic licensure.

The act also makes many minor, technical, and conforming changes.

EFFECTIVE DATE: October 1, 2015

1 – PATIENT CARE DECISIONS AT EMERGENCY SCENES

The act establishes a hierarchy for determining which EMS provider is responsible for making patient care decisions at the scene of an emergency medical call. Under the act, the EMS provider holding the highest classification of DPH licensure or certification makes the decisions. The classification order, from highest to lowest, is (1) paramedic, (2) advanced emergency medical technician (AEMT), (3) emergency medical technician (EMT), and (4) emergency medical responder (EMR).

Under the act, if multiple providers hold the same licensure or certification, the provider for the primary service area responder makes the decisions. If all providers on the scene are EMTs or EMRs, the EMS organization providing transportation services makes the decisions.

The act requires the provider with decision-making responsibility to transfer patient care on the arrival of a provider with a higher licensure or certification. All providers must ensure that the transfer occurs in a timely and orderly manner.

The act specifies that these provisions do not limit the existing authority of the fire chief or fire officer-in-charge to control and direct emergency activities at the scene. By law, these officials have this authority when their fire department is responding to a fire, service call, or other emergency in their town (CGS 7-313e).

2 – EMS DATA REPORTING

Scope

By law, the DPH commissioner must develop an EMS data collection system. The act (1) eliminates her specific authority to expand the data collection to include, within available appropriations, clinical treatment and patient outcome data but (2) specifies that the law's list of reportable data is non-exclusive. Existing law requires EMS organizations to report on a quarterly basis the:

1. number of 9-1-1 calls received;

2. level of EMS required for each call;

3. response time;

4. number of passed, cancelled, and mutual aid calls (which, under the act includes calls both made and received); and

5. prehospital data for unscheduled patient transport.

Civil Penalty

Under the act, an EMS organization, other than one operated by a state agency, that fails to report as required is liable for a civil penalty of up to $100 per day. DPH can assess these penalties only after giving the organization written notice of the deficiency and an opportunity to respond. The organization must respond to the notice, in writing, within 15 business days.

Existing law requires the commissioner to issue a written order directing compliance if (1) an ambulance service or paramedic intercept service does not submit data for six consecutive months or (2) she believes the service knowingly or intentionally submitted incomplete or false data. If the service does not fully comply with the order within three months, the commissioner (1) must hold a hearing at which the service must show cause why its primary service area assignment should not be revoked and (2) may take several disciplinary actions (e. g. , license revocation or suspension, censure, or civil penalties).

Regulations

The act allows the commissioner to adopt regulations on the development, implementation, monitoring, and collection of EMS system data.

3-13 – EMS LICENSING AND CERTIFICATION

6 – Use of Title

The act specifically prohibits anyone not certified from using the titles of “emergency medical responder,” “emergency medical technician,” “advanced emergency medical technician,” or “emergency medical services instructor,” or using other words or abbreviations that may be confused with these certifications. (There is a similar provision in existing regulations, except for instructors. )

By law, these restrictions already apply to the use of “paramedic” or similar titles by someone not licensed as a paramedic.

6 – Exemptions

Under the act, certification as an EMR, EMT, AEMT, or EMS instructor is not required of:

1. any state-licensed or -certified person performing services within his or her scope of practice or

2. a student, intern, or trainee studying EMS at an accredited institution or DPH-approved program, as long as the activities otherwise requiring certification are supervised and part of a supervised course of study.

These exemptions already apply for paramedic licensure.

7, 8, & 10 – Certification and Recertification

The act specifically requires the DPH commissioner to issue a certification as an EMT, EMS instructor, EMR, or AEMT to an applicant who meets the certification requirements.

It requires AEMTs, EMRs, and EMS instructors to be recertified every three years. This already applies for EMTs.

The act allows, rather than requires, the commissioner to adopt regulations to (1) provide for statewide standardization of certification for each class of EMS personnel, (2) allow certification course work to be taken statewide, and (3) allow certified people to perform work within their scope of certification statewide.

8 – Applicants Certified in Other States

As is already the case with EMTs, EMRs, and paramedics, the act allows the DPH commissioner to issue an AEMT certification to an applicant who presents satisfactory evidence that he or she:

1. is currently certified in good standing in any New England state, New York, or New Jersey;

2. has completed an initial training program consistent with federal standards; and

3. has no pending disciplinary action or unresolved complaints.

As is already the case with EMRs, the act also allows the commissioner to issue an EMT or AEMT certificate to an applicant who presents satisfactory evidence that he or she:

1. is currently certified in good standing by a state with licensing requirements at least equal to Connecticut's,

2. completed (a) an initial DPH-approved training program with a written and practical examination or (b) a program outside the state that adheres to national education standards and includes an examination, and

3. has no pending disciplinary action or unresolved complaints against him or her.

9 – Disciplinary Action

The law lists several grounds on which DPH may discipline EMS personnel. For paramedics, these grounds previously included violations of the paramedicine laws or regulations. The act instead provides that DPH may discipline all EMS personnel for violations of licensure or certification provisions and regulations.

By law, other permissible grounds for discipline include (1) failure to conform to standards of the profession, (2) felony convictions, and (3) substance abuse.

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