SENATE BILL NO. 478
AS AMENDED BY SENATE AMENDMENTS NOS. 1 AND 2
AN ACT TO AMEND CHAPTER 79, TITLE 29, DELAWARE CODE, BY ESTABLISHING AN OFFICE OF EMERGENCY MEDICAL SERVICES WITHIN THE DIVISION OF PUBLIC HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, AND MAKING APPROPRIATION THEREFOR.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:
Section 1. Amend Chapter 79, Title 29, Delaware Code, by adding thereto a new Subchapter IV to read as follows:
"SUBCHAPTER IV. EMERGENCY MEDICAL SERVICES SYSTEMS
§7950. Statement of Purposes
The purposes of the Emergency Medical Services Systems legislation is to establish and/or identify specific roles and responsibilities in regard to emergency medical services in Delaware in order to reduce morbidity and mortality rates for the citizens of Delaware and to ensure quality of emergency care services within available resources, through the effective coordination of the Emergency Medical Services System.
As used in this Act:
'Advanced Life Support' (ALS) shall mean the advanced level of prehospital and interhospital emergency care that includes basic life support functions including cardiopulmonary resuscitation, plus cardiac monitoring, cardiac defibrillation, telemetered electrocardiography, administration of antiarrhythmic agents, intravenous therapy, administation of specific medications, drugs and solutions, use of adjunctive medical devices, trauma care, and other authorized techniques and procedures.
'Ambulance' shall mean any publicly or privately owned vehicle, as certified by the State Fire Prevention Commission, that is specifically designed, constructed or modified and equipped, and is intended to be used for and is maintained or operated for the transportation upon the streets and highways of this State for persons who are sick, injured, wounded or otherwise incapacitated or helpless.
'Ambulance Attendant' shall mean a person trained in emergency medical care procedures and currently certified by the Delaware State Fire Prevention Commission or its duly authorized agent in accordance with standards prescribed by the Commission. Such course shall be classified as basic life support and shall be the minimum acceptable level of training for certified emergency medical personnel.
'Basic Life Support' (BLS) shall mean the level of capability which provides prehospital, noninvasive emergency patient care designed to optimize the patient's chances of surviving an emergency situation.
'Consumer' shall mean a recipient or potential recipient of the services provided by an emergency medical services system, who receives no direct or indirect personal, financial, or professional benefit as a result of association with health care or emergency services other than that generally shared by the public at large, and who is not otherwise considered a 'provider' within the intent of this Act.
'Specialty Care Unit' shall mean sophisticated treatment facilities that provide advanced specialized definitive care for critically ill patients. The units shall be available for the diagnosis and care of specific patient problems including major trauma, burns, spinal cord injury, poisoning, acute cardiac, high-risk infant and behavioral emergencies.
'Disaster' shall mean a sudden unexpected event which disrupts normal community functions and/or quickly exhausts local facilities so as to require outside help.
'Emergency Medical Services Systems' (EMSS) shall mean a statewide system which provides for the utilization of available personnel, equipment, transportation and communication to ensure effective and coordinated delivery of medical care in emergency situations resulting from accidents, illness or natural disasters.
'Emergency Medical Technician' (EMT) shall mean a person trained, and currently certified by the State Fire Prevention Commission, in emergency medical care procedures through a course which meets the objectives of the national standard curriculum.
'Emergency Medical Technician - Cardiac' (EMT-C), also known as Cardiac Rescue Technician (CRT), shall mean a person who has successfully completed a course approved by the Board of Medical Practice or its duly authorized representative, which meets the objectives of the national standard curriculum.
'Emergency Medical Technician - Paramedic' (EMT-P) shall mean a person who has successfully completed a course approved by the Board of Medical Practice or its duly authorized representative, and who acts under the direct or radio control of a physician or physician surrogate.
'Health Planning Agencies' shall mean the federally designated health system agency and/or statewide health planning and development agency for Delaware.
'Medical Control' shall mean directions and advice normally provided from a centrally designated medical facility operating under medical supervision, supplying professional support through radio or telephonic communication for on-site and in-transit basic and advanced life support services given by field and satellite facility personnel.
'Mutual Aid Agreements' shall mean the establishment of appropriate arrangements with EMS Systems of other states for the provision of emergency medical services on a reciprocal basis.
'Provider' shall mean a person who, as an individual or member of a corporation or organization, whether profit-making or non-profit, on a regular basis gives or offers for sale any Supplies, equipment, professional or non-professional services, or is capable of giving or offering for sale supplies, equipment or services vital or incidental to the functions of an Emergency Medical Services System.
'Public Safety Personnel' shall mean law enforcement officers lifeguards, park rangers, firefighters, ambulance and rescue personnel, communications and dispatch specialists, and other public employees and emergency service providers charged with maintaining the public safety.
'Treatment Protocols' shall mean written uniform treatment and care plans for emergency and critical patients. The treatment plans for Advanced Life Support must be approved and signed by appropriate physicians and/or medical groups.
§7952. Delaware Emergency Medical Services Advisory Council (DEMSAC)
The Delaware Emergency Medical Services Advisory Council, henceforth referred to as DEMSAC, established according to Chapter 79, Subchapter 1, of Title 29, Delaware Code, to serve in an advisory capacity to the Division of Public Health of the Department of Health and Social Services, is continued. The Council will review recommendations and developments of the lead agency and provide comments or advice as necessary.
§7953. Organizational Structure
(a) The Office of Emergency Medical Services is hereby created. The office shall be responsible for ensuring the effective coordination and evaluation of the Emergency Medical Services System in Delaware which includes providing assistance and advice for activities related toward the planning, development, improvement and expansion of Emergency Medical Services.
(b) The Office of Emergency Medical Services shall be a State agency within the Division of Public Health, Department of Health and Social Services. The Office of Emergency Medical Services shall report directly to and be responsible to the Director of the Division of Public Health, which is consistent with the Health Plan for Delaware.
(c) As used in this legislation, the term 'Office' shall refer to the State Office of Emergency Medical Services. In the performance of the functions mandated by this legislation which relate to the planning and evaluation of the Emergency Medical Services System in Delaware, the Office of Emergency Medical Services shall coordinate with the Bureau of Health Planning and Resources Development for technical assistance In Emergency Medical Services planning activities. Specifically, the Bureau of Health Planning and Resources Development shall have the primary responsibility for all data analysis related to the Emergency Medical Services System. This coordination should minimize duplication of effort between the two agencies and allow for the effective use of available staff resources within the Department of Health and Social Services.
§7954. System Components
(a) Manpower: It shall be the responsibility of the Office to collect and analyze annually data pertaining to certified emergency medical services personnel in Delaware by levels of training in order to identify possible or potential shortages. Once EMS manpower shortages are identified, the Office shall notify the affected agencies and provide recommended courses of action to alleviate the problem or potential problem. In order to accomplish this task, the following agencies shall he required to provide a listing of the appropriate emergency medical services personnel by organization, level of training and county:
(1) Delaware State Fire Prevention Commission or its duly authorized representative;
(2) Wilmington Medical Center School for Emergency Medical Technicians;
(3) Delaware Committee on Trauma of the American College of Surgeons - Advanced Trauma Life Support;
(4) American Heart Association of Delaware - cardiopulmonary resusciation (CPR) training programs and Advanced Cardiac Life Support;
(5) American Red Cross, Delaware Chapter - CPR training and first-aid training;
(6) Delaware Chapter of the American College of Emergency Physicians;
(7) Delaware Chapter of the Emergency Department Nurses Association; and
(8) Any other organization not listed above that provides certified emergency medical training, including CPR.
(b) Training: All organizations providing emergency medical training programs, as listed under the Manpower section, shall provide to the Office copies of course curricula and schedules of the availability of training courses. The Office shall monitor EMS training levels to provide information on the availability of training programs for all levels of EMS personnel. In addition, the EMS Office shall keep abreast of all federal training standards to ensure that EMS training agencies in Delaware are aware of regional and national standards. In accordance with Title 16, Subsection 6711, Paragraph 3 of the Delaware Code, the State Fire Prevention Commission shall adopt regulations setting forth the qualifications required for the certification of Ambulance Attendants., Since Advanced Life Support ambulance personnel are 'physicians' assistants' as defined in the Delaware Code, Section 1703(e) (7), they must have been trained in programs approved by the Delaware State Board of Medical Practice.
(c) Communications: The Office shall: (1) Through the appropriate County dispatch center directors, monitor and evaluate the effectiveness of the statewide EMS Communications System; (2) Identify resources to improve or augment both the Communications System in Delaware and the training of Env ilea! dispatchers as needed; (3) Monitor and evaluate the effectiveness of emergency access numbers in terms of the impact on the EMS System.
(d) Transportation: In conjunction with appropriate EMS providers in Delaware, the Office shall monitor and evaluate emergency medical transportation services in Delaware to ensure that patients in the EMS System have access to effective and efficient transportation to appropriate treatment
Pursuant to Title 16, Subsection 6709 of the Delaware Code, all ambulances in Delaware shall he Inspected and certified by the Delaware State Fire Prevention Commission or a duly authorized representative thereof. The Delaware State Fire Prevention Commission or its duly authorized representative shall be required to provide to the Office on an annual basis a listing and location of certified ambulances.
(e) Facilities: The Office shall monitor the availability of the various levels of care of EMS facilities and services and shall have the authority to categorize all Delaware emergency receiving facilities and services in accordance with criteria established by the Joint Commission on Accreditation of Hospitals (JCAH) for hospital settings and other appropriate national professional organizations for non-hospital settings. This authority shall also include the responsibility of categorizing and designating by level of care when appropriate, specialty care facilities in accordance with the established criteria of the American Medical Association or other appropriate national professional organizations. In addition, the Office shall periodically re-evaluate the categorization or designation of emergency care facilities and specialty care services.
(f) Specialty Care Units: The Office shall identify the categorization of the seven specialty care areas for EMS which are available to all patients (the specialty care areas are: trauma, burns, spinal cord, poisoning, acute cardiac, high-risk infant and behavorial emergencies). In addition, the Office shall coordinate the activities of the EMS System to ensure that all patients have access, within a reasonable time period depending on the nature of the illness, to specialty care services. In accordance with this activity, the Office shall have the authority to desigante or categorize specialty care units by level of care as specified in the section related to facilities.
(g) Public Safety Agencies: Based on the data obtained in the section related to Manpower, the Office shall monitor and evaluate the activities of public safety agencies to determine the number of trained first responders and to promote their participation, to the maximum level possible consistent with their capabilities, in emergency medical situations.
(h) Consumer Participation: All agencies and organizations involved in the EMS System in Delaware should seek reasonable consumer participation in planning, development and organizational activities.
(i) Access To Care: The Office shall monitor and evaluate activities of all EMS organizations to ensure that no person is denied emergency treatment or transportation services.
(j) Patient Transfer: The EMS System shall provide for transfer of patients to facilities and programs which offer such follow-up care and rehabilitation as is necessary to effect the maximum recovery of the patient.
The transfer of emergency patients from the emergency site to the emergency department, specialty care unit, and to follow-up care and rehabilitation centers arc all within the scope of a total EMS System.
(k) Coordinated Patient Record keeping: The Office shall collect and analyze available data from all providers of the EMS System. This data will be used by the Office in conjunction with the appropriate EMS providers, to evaluate the overall effectiveness of the system. It is necessary that the data be collected from each level of care, which includes the initial entry point through final discharge from the health care delivery system.
(l) Public Information and Education: The Office shall provide programs of public information and education designed to inform residents of Delaware and visitors to the State of the availability of, proper use of and access to emergency medical services. Included in these programs will be elements related to citizens involvement in the administration of prchospital care (first-aid, CPR, etc.) and information pertaining to the availability of training programs in Delaware. In addition, the Office shall monitor public EMS information and education programs of major importance offered by other EMS providers in Delaware.
(m) Review and Evaluation: In conjunction with the health planning agencies and the EMS providers in Delaware, the Office shall conduct and/or coordinate an on-going comprehensive evaluation of the effectiveness of the EMS System, in terms of the impact on the health status of the EMS patients in Delaware.
(n) Disaster Planning: The Office shall: (1) Upon request, participate in disaster planning with all organizations that provide emergency medical servcies to assist with coordination of disaster activities which impact the EMS System and, (2) Review all municipal, county and State disaster plans which utilize the Emergency Medical Services System. All organizations involved in planning disaster exercises which impact the EMS System should advise the Office of scheduled disaster exercises. In addition, the Office shall, upon request, participate in disaster exercises for the purpose of evaluation and improvement of the Emergency Medical Services System and make recommendations as needed to the appropriate- provider for the refinement of their disaster plans. All disaster planning activities of the Office shall be coordinated with the Division of Emergency Planning and Operations as authorized by Title 20, Chapter 31 of the Delaware Code, and the Department of Health and Social Services Disaster Coordinator.
(o) Mutual Aid Agreements: The Director of the Office in conjunction with the Division Director shall be authorized to develop and implement mutual aid agreements as may he necessary to ensure continuity of care. These agreements shall be coordinated through and approved by the appropriate EMS providers. These agreements may relate to reciprocity of services, and treatment, transfer and triage protocols to coordinate the provision of services, both within Delaware and across State lines as necessary.
§7955. General Provisions
(a) In order to monitor and evaluate the effectiveness of the EMS System, the Office must be notified of any proposed new service or major service modification within the Emergency Medical Services System in Delaware.
(b) Copies of applications for federal, state and county Emergency Medical Service grant funds shall be sent to the Office.
(c) All proposed legislation pertaining to the EMS System in Delaware shall be reviewed by DEMSAC-Tvith recommendations from the Office.
(d) The Office shall, with the consent of the Director of the Division of Public Health, be auithorized to make news releases pertaining to the Emergency Medical Services System as required in order to inform the public on issues pertinent to the health and well being of the citizens of Delaware.
(e) The Office shall be required to provide routine progress reports identifying the accomplishments and the problem areas within the System to DEMSAC at its regularly scheduled meetings. In addition, an annual summary report shall be sent to the Chairman of DEMSAC through the Division Director by August 15th of each year.
(f) The Office is authorized and empowered to apply for, accept and disburse grants, gifts and contributions from the government, individuals, foundations, corporations, and other organizations, agencies or institutions on behalf of the EMS System in Delaware.
(g) During the fiscal year ending June 30, 1983 the Department of Health and Social Services shall implement as many of the provisions of this Subchapter as possible within the constraints of its appropriation for said fiscal year. In its budget request for the fiscal year ending June 30, 1984 and subsequently, the Department shall include the funds necessary to carry out the provisions of this Subchapter.
Approved July 9, 1982.