Sec. 4. Field emergency medical services
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Title XII of the Public Health Service Act ( 42 U.S.C. 300d et seq. ) is amended by adding at the end the following: In this part: The term ambulance diversion means the practice of hospitals denying access to an incoming ambulance and requesting that the ambulance proceed to another facility due to a stated lack of capacity at the initial facility, resulting in delayed access to definitive care. The term community paramedicine means a health care service provided by a field EMS agency for the provision of cost-effective health care assessment and prevention services to fill gaps in the local health care system.
The term emergency medical response means— medical care provided to patients with emergency medical conditions prior to or outside a medical facility; emergency medical dispatch, rapid response, and urgent or unscheduled patient assessment and intervention; emergency, critical care, and inter-facility and air medical transport; or telephone consultation to 911 callers as an alternative to ambulance dispatch, or other requests through a public safety answering point. The term emergency medical services means emergency medical care, trauma care, and related services provided to patients at any point in the continuum of health care services, including emergency medical dispatch and emergency medical care, trauma care, and related services provided in the field, during transport, or in a medical facility or other clinical setting.
The term FICEMS means the Federal Interagency Committee on Emergency Medical Services. The term field EMS means emergency medical response and mobile medical services provided prior to or outside a medical facility. The term field EMS agency means an organization providing field EMS, including— governmental (including fire-based agencies), nongovernmental (including hospital based or private agencies), and volunteer organizations; and organizations that provide field EMS by ground, air, or otherwise.
The term field EMS practitioner means an individual licensed and credentialed to provide emergency and mobile medical care to patients within the scope of such individual's practice. The term medical oversight means the supervision by a physician of the medical aspects of a field EMS system or agency and its practitioners, including prospective, concurrent, and respective components of field EMS and the education of field EMS practitioners. The term mobile integrated health care means a health care service that is undertaken collaboratively by a group of health care providers, including the local field EMS agency, in a community, for the provision of medical care to fill gaps in the local health care system.
The term mobile medical services means preventive medical assessment and care, chronic disease assessment and management support, post-discharge follow-up assessment and management support, and post-assessment patient transport, arranged transportation, or referral to other community health or social service resources. The term NEMSAC means the National Emergency Medical Services Advisory Council. The term NEMSIS means the National EMS Information System. The term NHTSA means the National Highway Traffic Safety Administration.
The term patient parking means the practice by hospitals of refusing to accept transfer of a patient's care from an ambulance crew until a regular emergency department bed is available, requiring the crew to continue to provide patient care on the ambulance stretcher rather than in a patient bed in the hospital, until hospital staff will accept the transfer of care, resulting in delayed access to definitive care for the patient and denied access to emergency care for the community served by the field EMS Agency.
The term readiness means the standby costs of preparedness to respond to a health care need, 24 hours a day, 7 days a week, 365 days a year. The term State EMS Office means an office designated by the State with primary responsibility for oversight of the State's emergency medical services system, such as responsibility for oversight of field EMS coordination, licensing or certifying field EMS practitioners, and emergency medical services system improvement. The Assistant Secretary for Preparedness and Response shall establish the Field EMS Preparedness Program to be administered by the Office of Emergency Medical Care for the purpose of improving field EMS agency all-hazards readiness and preparedness and public health emergencies and incidents.
To be eligible to receive a grant under this section, an eligible entity shall submit an application to the Assistant Secretary for Preparedness and Response in such form and manner, and containing such agreements, assurances, and information as such Assistant Secretary requires. The Assistant Secretary for Preparedness and Response shall ensure that grant application requirements are not unduly burdensome to smaller and volunteer field EMS agencies or other agencies with limited resources.
The Assistant Secretary for Preparedness and Response shall ensure that grant applications are consistent with national and relevant State preparedness plans and goals. Grants may be used by eligible entities to achieve the preparedness goals described under paragraphs (1), (3), (4), (5), (6), and
(8)of section 2802(b) with respect to all-hazards, including chemical, biological, radiological, or nuclear threats, including the purchase of equipment, training, and supplies. In carrying out this section, the Assistant Secretary for Preparedness and Response— shall establish a grantmaking process that includes— prioritization for the awarding of grants to eligible entities and consideration of the factors in reviewing grant applications by eligible entities, including— demonstrated financial need for funding; utilization of public and private partnerships; improving the availability of field EMS in underserved regions to enhance the capability for medical response to public health emergencies and incidents; unique needs of volunteer and rural field EMS agencies; distribution among a variety of geographic areas, including urban, suburban, and rural; distribution of funds among types of field EMS agencies, including governmental, nongovernmental, and volunteer agencies; implementation of regionalized systems of medical response to public health emergencies and incidents; and such other factors as the Assistant Secretary for Preparedness and Response determines necessary; a peer-reviewed process to recommend grant allocations in accordance with the prioritization established under subparagraph (A), except that final award determinations shall be made by the Assistant Secretary for Preparedness and Response; and the provision of grant awards to eligible entities on an annual basis, except that the Assistant Secretary for Preparedness and Response may reserve not more than 25 percent of the available appropriations for multiyear grants and no grant award may exceed a 2-year period; and shall consult with and take into consideration the recommendations of the FICEMS, NEMSAC, and relevant stakeholders. To be eligible to receive a grant under this section, an entity shall be a field EMS agency that— is licensed by or otherwise authorized in the State in which it operates; and has medical oversight and quality improvement programs, as determined by the Assistant Secretary for Preparedness and Response. As a condition on receipt of a grant under this section, the Assistant Secretary for Preparedness and Response shall require each grant recipient to adopt and implement (to the extent applicable) the guidelines promoted, developed, and disseminated under subparagraphs
(B)and
(C)of subsection (a)(1) of section 1293 with regard to medical oversight. The Assistant Secretary for Preparedness and Response shall submit an annual report on the Field EMS Preparedness Program under this section to Congress. To improve medical oversight of field EMS and ensure continuity and quality for such medical oversight, the Assistant Secretary for Preparedness and Response shall— promote high-quality and comprehensive medical oversight of— all medical care provided by field EMS practitioners; and the education and training of field EMS practitioners; promote the development, adoption, and utilization of national guidelines for the role of physicians who provide medical oversight for field EMS and other health care providers who support physicians in such role; support efforts of relevant physician stakeholders in developing and disseminating guidelines for use by field EMS medical directors and field EMS practitioners on a national basis; and convene a Field EMS Medical Oversight Advisory Committee, comprised of representatives of relevant physician stakeholders, to advise the Assistant Secretary for Preparedness and Response on ways and means to advance and support development and maintenance of quality medical oversight throughout the Nation's systems for field EMS. In carrying out subparagraphs
(B)and
(C)of paragraph (1), the Assistant Secretary for Preparedness and Response shall take into consideration— existing guidelines developed by national professional physician associations, States, and other relevant governmental or nongovernmental entities; the input of other relevant stakeholders, including health care providers who support physicians who provide medical oversight for field EMS; and the unique needs associated with medical oversight of provision of field EMS in rural areas or by volunteers. The guidelines promoted, developed, and disseminated under subparagraphs
(B)and
(C)of paragraph
(1)shall ensure high-quality training, credentialing, and direction in connection with medical oversight of field EMS at the State, regional, and local levels while providing sufficient flexibility to account for historical and legitimate differences in field EMS among States, regions, and localities. Field EMS agencies and practitioners shall be eligible to participate in the activities of patient safety organizations for the purpose of improving patient safety and the quality of health care delivery. Not later than 1 year after the date of the enactment of the Field EMS Modernization and Innovation Act , the Secretary, acting through the Assistant Secretary for Preparedness and Response, shall submit to Congress a report that— identifies gaps in the collection of data related to the provision of field EMS; and includes recommendations for improving the collection, reporting, and analysis of such data, and integration of such data with other health care data. The recommendations included in the report in accordance with paragraph (1)(B) shall— take into consideration the recommendations of FICEMS, NEMSAC, and relevant stakeholders; recommend methods for improving data collection, reporting, and analysis without unduly burdening reporting entities and without duplicating existing data sources (such as data collected by the National Trauma Data Bank); address the quality and availability of data, and linkages with existing patient registries, related to the provision of field EMS and utilization of field EMS with respect to a variety of illnesses and injuries (in both the everyday provision of field EMS and catastrophic or disaster response), including— cardiac events such as chest pain, sudden cardiac arrest, and ST-segment elevation myocardial infarction; stroke; trauma; disaster and catastrophic incidents, such as incidents related to terrorism or natural or manmade disasters; and ambulance diversion and patient parking; include an analysis of the variety of services provided by field EMS agencies; and any recommendations that require statutory authorization from Congress. The Secretary, acting through the Office of the National Coordinator for Health Information Technology, shall implement such recommendations for data collection to the extent that such authority exists and does not require further statutory authorization from Congress. The Assistant Secretary for Preparedness and Response shall support— further development and refinement of measures to be utilized under the Ambulance Quality Incentive Program, as appropriate, including— quality measures to improve accountability for patient outcomes in field EMS; and performance measures to enhance the measurement of field EMS system performance; and a technical assistance center to provide assistance and education to field EMS agencies, physician medical directors, and practitioners to participate effectively in quality and performance improvement programs. Nothing in HIPAA privacy and security law (as defined in section 3009(a)(2)) shall be construed as prohibiting the exchange of information between field EMS practitioners treating an individual and personnel of a hospital to which the individual has been treated for the purposes of relating information on the medical history, treatment, care, and outcome of such individual (including any health care personnel safety issues, such as infectious disease). The Secretary shall establish guidelines for exchanges of information between field EMS practitioners treating an individual and personnel of a hospital to which the individual has been treated to protect the privacy of the individual while ensuring the ability of such field EMS practitioners and hospital personnel to communicate effectively to further the continuity and quality of medical care provided to such individual. Nothing in HIPAA privacy and security law (as defined in section 3009(a)(2)) shall be construed as prohibiting the exchange of non-individually identifiable data between the field EMS agency, a State, and the Federal Government, including the exchange of information by— a field EMS agency to the State EMS Office for the purpose of quality improvement and data collection by the State for submission to NEMSIS; or the State EMS Office to the National EMS Database maintained by Assistant Secretary for Preparedness and Response. For the purpose of promoting field EMS as a health profession and ensuring the availability, quality, and capability of field EMS educators, practitioners, managers, and medical directors, the Assistant Secretary for Preparedness and Response shall make grants to eligible entities for the development, availability, and dissemination of field EMS education programs and courses that improve the quality and capability of field EMS practitioners, educators, managers, and physician medical directors. In carrying out this section, the Assistant Secretary for Preparedness and Response shall take into consideration recommendations of FICEMS, NEMSAC, and relevant stakeholders. In this section, the term eligible entity means an educational organization, an educational institution, a professional association, or any other entity involved in and experienced with the education of field EMS practitioners, physician medical directors, field EMS managers and administrators, and field EMS educators. The Assistant Secretary for Preparedness and Response may award a grant to an eligible entity under paragraph
(1)only if the entity agrees to use the grant to— develop and implement education programs to— train field EMS instructors and promote the adoption and implementation of the education standards identified in the Emergency Medical Services Education Agenda for the Future: A Systems Approach , including any revisions thereto or successor standards; provide training for information system workers, such as information security, forensic analysts, data analysts, network engineers, and similar roles to work in support of field EMS data systems; or provide training and retraining programs that prepare displaced workers to enter a field EMS profession, including veterans and military EMS practitioners; develop and implement educational courses pertaining to— improving the provision of quality medical oversight of field EMS; expanding the knowledge and skills of field EMS practitioners, including those needed to provide community paramedicine and mobile integrated health care; undertaking field EMS educational and clinical research to develop investigators; tactical training for field EMS; or developing and expanding field EMS undergraduate and graduate programs; evaluate education and training courses and methodologies to identify optimal educational modalities for field EMS practitioners; enhance the opportunity for medical direction training and for promoting appropriate medical oversight of field emergency medical care; or carry out such other activities as the Assistant Secretary for Preparedness and Response determines appropriate. The Assistant Secretary for Preparedness and Response, in consultation with relevant stakeholders, and taking into consideration the recommendations of FICEMS and NEMSAC, shall establish a system of prioritization in awarding grants under this section to eligible entities. Grants under this section shall be for a period of 1 to 3 years. The Assistant Secretary for Preparedness and Response may not award a grant to an eligible entity under this section unless the entity submits an application to such Assistant Secretary in such form, in such manner, and containing such agreements, assurances, and information as the Assistant Secretary may require. The Assistant Secretary for Preparedness and Response shall ensure that the requirements for submitting an application under this section are not unduly burdensome. The Secretary, acting through the Assistant Secretary for Preparedness and Response, shall develop and implement a cohesive national emergency medical services strategy to strengthen the development of field EMS and the full continuum of emergency medical care and systems at the Federal, State, and local levels to improve patient outcomes and access to high-quality care in the field and develop financing models that support the evolution of value-based emergency medical care. In establishing such a strategy, the Assistant Secretary for Preparedness and Response shall— solicit and consider the 2007 and subsequent recommendations of the Institute of Medicine, the National EMS Advisory Council, and relevant stakeholders; consult and collaborate with the Federal Interagency Committee on EMS to ensure consistency of such national emergency medical services strategy within the larger Federal strategy regarding national preparedness and response; address issues related to emergency medical services system development, including— the regionalization of field EMS, trauma, and emergency medical services, particularly for time sensitive conditions such as trauma, ST–Segment Elevation Myocardial Infarction, stroke, neonatal patients, and poisonings; the availability of field EMS and trauma care and emergency medical services throughout the Nation; the integration of emergency medical care from the perspective of patients across the emergency care continuum, and accountability for system performance; and financing of field EMS agencies, including appropriate medical oversight; promote the professional development of field EMS practitioners to deliver high-quality field EMS, including the adoption by States of the education standards identified in the National EMS Education Standards and any revisions thereto or successor standards, including the standardization of licensing of field EMS practitioners and standards of care in accordance with the National EMS Scope of Practice Model and based on best practices and evidence-based medicine, including by— identifying differences in the levels of care, scope of practice, and licensure requirements among the States; and encouraging States to adopt national minimum standards for such levels of care and licensure requirements; promote a culture of safety, including through— the establishment of field EMS patient and practitioner safety goals and the specific means to improve field EMS practitioner and patient safety to achieve such goals; and the adoption of uniform national ambulance vehicle safety and manufacturing standards; support the development of value-based reimbursement for new mobile resources and models of delivery that support the transformation of health care, including the full utilization of field EMS to deliver emergency medical response and mobile medical services including— community paramedicine for the provision of cost-effective health care assessment and prevention services; mobile integrated health care undertaken collaboratively by a group of providers in a community, including local field EMS agencies, to fill gaps in the local health care system; integrated injury prevention strategies or programs; and such other issues as the Secretary considers appropriate; incorporate into such strategy preparedness and response objectives identified in the National Health Security Strategy under section 2802 in order— to ensure the capability and capacity of the full spectrum of field EMS to respond to terrorist attacks, disasters, catastrophic events, and mass casualty events; and to coordinate with the Secretary of Homeland Security accordingly; promote research in emergency medical services and coordination across Federal agencies undertaking such research, taking into consideration the National EMS Research Agenda; complete the development of such strategy not later than 18 months after the date of enactment of the Field EMS Modernization and Innovation Act ; communicate such strategy to the relevant congressional committees of jurisdiction; implement such strategy, to the extent practicable, not later than 3 years after the date of enactment of the Field EMS Modernization and Innovation Act ; and update such strategy not less than every 3 years. Pursuant to paragraph 41 of Homeland Security Presidential Directive HSPD–21, dated October 18, 2007, the Secretary shall establish an Office of Emergency Medical Care under the direct authority of the Assistant Secretary for Preparedness and Response, to carry out all of the responsibilities described in such paragraph of such directive. The Assistant Secretary for Preparedness and Response, acting through the Office of Emergency Medical Care, shall administer the emergency medical services activities and programs under this part and the trauma programs under parts A through D and H and shall— promote and fund research in emergency medicine and trauma health care; promote regional partnerships and effective emergency medical systems in order to enhance appropriate triage, distribution, and care of routine community patients; promote local, regional, and State emergency medical systems preparedness for and response to public health events; address the full spectrum of issues that have an impact on care in emergency departments, including the entire continuum of patient care from prehospital to disposition from emergency or trauma care; and coordinate with existing executive departments and agencies that perform functions related to emergency medical systems in order to ensure unified strategy, policy, and implementation. All functions, personnel, assets, and liabilities of, and administrative actions applicable to, the Emergency Care Coordination Center, as in existence on the day before the date of the enactment of the Field EMS Modernization and Innovation Act , shall be transferred to the Office of Emergency Medical Care established under subsection (a). . Section 921(8)(A) of the Public Health Service Act ( 42 U.S.C. 299b–21(8)(A) ) is amended— in clause (i), by inserting field EMS agency (as defined in section 1291), after clinical laboratory, ; and in clause (ii), by inserting field EMS (as defined in section 1291) medical director, emergency medical technician, after pharmacist, .
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- 42 USC 299b–21(8)(A)
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