THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY MELIO, FAIRCHILD, SOLOBAY, THOMAS, BELFANTI, BRENNAN, BROWN, CALTAGIRONE, CARROLL, CAUSER, COHEN, DeLUCA, FRANKEL, GRUCELA, HENNESSEY, HORNAMAN, W. KELLER, KIRKLAND, KOTIK, MANN, MUNDY, MURT, O'NEILL, PALLONE, PASHINSKI, READSHAW, SIPTROTH, K. SMITH, STABACK, WALKO, WATSON, WHITE, YOUNGBLOOD, GALLOWAY, LONGIETTI AND GEIST, FEBRUARY 18, 2009

AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES, MARCH 18, 2009   

AN ACT

Amending Titles 35 (Health and Safety) and 75 (Vehicles) of the

Pennsylvania Consolidated Statutes, regulating emergency

medical services systems; providing for licensure; conferring

powers and duties on the Department of Health; further

defining "emergency vehicle"; providing for penalties;

providing for Emergency Medical Services Operating Fund

distributions; and making a related repeal.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Title 35 of the Pennsylvania Consolidated

Statutes is amended by adding a chapter to read:

CHAPTER 72

EMERGENCY MEDICAL SERVICES SYSTEM

Subchapter

A.  Preliminary Provisions

B.  Program

C.  Miscellaneous Provisions

SUBCHAPTER A

PRELIMINARY PROVISIONS

Sec.

7201.  Short title of chapter.

7202.  Declaration of policy.

7203.  Definitions.

7204.  Emergency medical services system programs.

7205.  Duties of department.

7206.  Emergency medical services patient care reports.

7207.  Pennsylvania Trauma Systems Foundation.

7208.  State Advisory Board.

7209.  Regional emergency medical services councils.

§ 7201.  Short title of chapter.

This chapter shall be known and may be cited as the Emergency

Medical Services System Act.

§ 7202.  Declaration of policy.

The General Assembly finds and declares as follows:

(1)  Emergency medical services is an essential public

service and frequently the health care safety net for many

Commonwealth residents.

(2)  It is in the public interest to assure that there

are high quality and coordinated emergency and urgent medical

services readily available to the residents of this

Commonwealth to prevent premature death and reduce suffering

and disability which arise from severe illness and injury.

(3)  The public interest under paragraph (2) is best

achieved through a regulated and coordinated emergency

medical services system.

(4)  Transportation of both emergency and nonemergency

patients is an integral part of the health care delivery

system in this Commonwealth, and it is in the public interest

that the emergency medical services system serve all persons

in this Commonwealth who:

(i)  require medical care to address illness or

injury;

(ii)  need transportation to a hospital or other

health care facility to receive that care; and

(iii)  require medical assessment, monitoring,

assistance, treatment or observation during

transportation.

(5)  It serves the public interest if the emergency

medical services system is able to quickly adapt and evolve

to meet the needs of the residents of this Commonwealth for

emergency and urgent medical care and to reduce their illness

and injury risks.

(6)  It serves the public interest if the emergency

medical services system provides community-based health

promotion services that are integrated with the overall

health care system.

(7)  Emergency medical services should be acknowledged,

promoted and supported as an essential public service.

(8)  This chapter shall be liberally construed to

establish and maintain an effective and efficient emergency

medical services system which is accessible on a uniform

basis to residents of this Commonwealth and to visitors to

this Commonwealth.

(9)  Residents of this Commonwealth and visitors to this

Commonwealth should have prompt and unimpeded access to

urgent and emergency medical care throughout this

Commonwealth.

(10)  The Department of Health should continually assess

and, as needed, revise the functions of emergency medical

services agencies and providers and other components of the

emergency medical services system that it regulates under

this chapter, to:

(i)  improve the quality of emergency medical

services provided in this Commonwealth;

(ii)  have the emergency medical services system

adapt to changing needs of the residents of this

Commonwealth; and

(iii)  promote the recruitment and retention of

persons willing and qualified to serve as emergency

medical services providers in this Commonwealth.

(11)  The emergency medical services system should be

fully integrated with the overall health care system, and in

particular with the public health system, to identify, modify

and manage illness and injury and illness and injury risks.

§ 7203.  Definitions.

The following words and phrases when used in this chapter

shall have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Advanced emergency medical services."  Emergency medical

services exceeding the scope of practice of an emergency medical

technician.

"Advanced emergency medical technician."  An individual who

is certified by the Department of Health as an advanced

emergency medical technician.

"Advanced life support squad vehicle."  A vehicle which:

(1)  is maintained or operated to transport emergency

medical service providers above the advanced emergency

medical technician level, equipment and supplies to

rendezvous with the crew of an ambulance for the purpose of

providing advanced emergency medical services to patients;

and

(2)  is not used in the transportation of patients.

"ALS."  Advanced life support.

"Ambulance."  A ground, water or air vehicle which is

maintained or operated for the purpose of providing emergency

medical services to and transportation of patients.

"Ambulance attendant."  An individual who is 16 years of age

or older and satisfies one of the following:

(1)  Possesses a certificate evidencing successful

completion of an advanced first aid course sponsored by the

American Red Cross and a current certificate evidencing

successful completion of a cardiopulmonary resuscitation

course acceptable to the Department of Health.

(2)  Possesses a current certificate evidencing

successful completion of a course determined by the

Department of Health to be equivalent to the requirements in

paragraph (1).

"Basic emergency medical services" or "basic EMS."  Emergency

medical services included within, but not exceeding, the scope

of practice of an emergency medical technician.

"Basic life support squad vehicle."  A vehicle which:

(1)  is maintained or operated to transport emergency

medical services providers, equipment and supplies to

rendezvous with the crew of an ambulance for the purpose of

providing emergency medical services at or below the advanced

emergency medical technician level to patients; and

(2)  is not used in the transportation of patients.

"BLS."  Basic life support.

"Board."  The State Advisory Board, which is the Board of

Directors of the Pennsylvania Emergency Health Services Council.

"Commonwealth emergency medical services medical director" or

"Commonwealth EMS medical director."  A physician who is

approved and employed by the Department of Health to advise and

formulate policy on matters pertaining to emergency medical

services.

"Department."  The Department of Health of the Commonwealth.

"Emergency."  A physiological or psychological illness or

injury of an individual, such that a prudent layperson who

possesses an average knowledge of health and medicine could

reasonably expect the absence of immediate emergency medical

services to result in:

(1)  placing the health of the individual or, with

respect to a pregnant woman, the health of the woman or her

unborn child, in serious jeopardy;

(2)  serious impairment of bodily functions; or

(3)  serious dysfunction of a bodily organ or part.

"Emergency medical responder" or "EMR."  An individual who is

certified by the Department of Health as an emergency medical

responder.

"Emergency medical services" or "EMS."  Any of the following:

(1)  The medical care, including medical assessment,

monitoring, treatment, transportation and observation, which

may be provided to a person in responding to an actual or

reported emergency to:

(i)  prevent or protect against loss of life or a

deterioration in physiological or psychological

condition; or

(ii)  address pain or morbidity associated with the

person's condition.

(2)  The transportation of an individual with medical

assessment, monitoring, treatment or observation of the

individual who, due to the individual's condition, requires

medical assessment, monitoring, treatment or observation

during the transport.

"Emergency medical services agency" or "EMS agency."  An

entity that engages in the business or service of providing

emergency medical services to patients within this Commonwealth

by operating any of the following:

(1)  An ambulance.

(2)  An advanced life support squad vehicle.

(3)  A basic life support squad vehicle.

(4)  A quick response service.

(5)  A special operations EMS service. This paragraph

includes, but is not limited to:

(i)  a tactical EMS service;

(ii)  a wilderness EMS service;

(iii)  a mass-gathering EMS service; and

(iv)  an urban search and rescue EMS service.

(6)  A vehicle or service which provides emergency

medical services outside of a health care facility, as

prescribed by the Department of Health by regulation.

"Emergency medical services agency medical director" or "EMS

agency medical director."  A physician who is employed by,

contracts with or volunteers with an emergency medical services

agency either directly or through an intermediary to:

(1)  evaluate the quality of patient care provided by the

emergency medical services providers utilized by the

emergency medical services agency; and

(2)  provide medical guidance and advice to the emergency

medical services agency.

"Emergency medical services provider" or "EMS provider."  Any

of the following:

(1)  An emergency medical responder.

(2)  An emergency medical technician.

(3)  An advanced emergency medical technician.

(4)  A paramedic.

(5)  A prehospital registered nurse.

(6)  A prehospital physician extender.

(7)  A prehospital emergency medical services physician.

(8)  An individual prescribed by regulation of the

Department of Health to provide specialized emergency medical

services.

"Emergency medical services system" or "EMS system."  The

arrangement of personnel, facilities and equipment to prevent

and manage emergencies in a geographic area.

"Emergency medical services vehicle operator" or "EMS vehicle

operator."  An individual certified by the Department of Health

to operate a ground emergency medical services vehicle.

"Emergency medical technician" or "EMT."  An individual who

is certified by the Department of Health as an emergency medical

technician.

"Facility."  A physical location at which an entity operates

a health care facility licensed under Federal or State law.

"Foundation."  The Pennsylvania Trauma Systems Foundation, a

nonprofit Pennsylvania corporation whose function is to accredit

trauma centers in this Commonwealth.

"Hospital."  An institution having an organized medical staff

that is primarily engaged in providing to inpatients, by or

under the supervision of physicians, diagnostic and therapeutic

services or rehabilitation services for the care or

rehabilitation of injured, disabled, pregnant, diseased, sick or

mentally ill persons. The term includes a facility for the

diagnosis and treatment of disorders within the scope of

specific medical specialties. The term does not include a

facility caring exclusively for the mentally ill.

"Medical command facility."  A distinct unit which contains

the necessary equipment and personnel for providing medical

command to and control over emergency medical services

providers.

"Medical command order."  An order issued by a medical

command physician to an emergency medical services provider who

is functioning on behalf of an emergency medical services

agency.

"Medical command physician."  A physician certified by the

Department of Health to give medical command orders to emergency

medical services providers.

"Medical monitoring."  Performing continuous or periodic

observations of an individual's condition or continuation of an

ordered treatment plan for an individual to prevent pain,

suffering or the exacerbation of a preexisting condition.

"Medical observation."  Performing continuous or periodic

observations of an individual's stable condition to determine

whether there is a change in that condition.

"Paramedic."  An individual who is certified by the

Department of Health as a paramedic.

"Patient."  An individual for whom an emergency medical

services provider is:

(1)  providing emergency medical services on behalf of an

EMS agency; or

(2)  required to provide emergency medical services on

behalf of an EMS agency because the individual's condition

requires or may require medical observation, monitoring,

assessment or treatment for an illness, disease, injury or

other disability.

"Peer review."  The evaluation by health care providers of

the quality and efficiency of services ordered or performed by

emergency medical services providers and physicians who direct

or supervise EMS providers under this chapter and the

regulations of the Department of Health.

"Physician."  A person who has a currently registered license

to practice medicine or osteopathic medicine in this

Commonwealth.

"Prehospital emergency medical services physician" or

"prehospital EMS physician."  A physician who is certified by

the Department of Health as a prehospital emergency medical

services physician.

"Prehospital physician extender" or "PHPE."  A physician

assistant who is certified by the Department of Health as a

prehospital physician extender.

"Prehospital registered nurse" or "PHRN."  A registered nurse

who is certified by the Department of Health as a prehospital

registered nurse.

"Quick response service" or "QRS."  An operation in which

emergency medical services providers of an EMS agency:

(1)  respond to an actual, reported or perceived

emergency; and

(2)  provide emergency medical services to patients

pending the arrival of an ambulance.

"Regional emergency medical services council" or "regional

EMS council."  A nonprofit incorporated entity or appropriate

equivalent that is assigned by the Department of Health to:

(1)  plan, develop, maintain, expand and improve

emergency medical services systems within a specific

geographic area of this Commonwealth; and

(2)  coordinate those systems into a regional emergency

medical services system.

"Regional emergency medical services medical director" or

"regional EMS medical director."  The medical director of a

regional emergency medical services council.

"Review organization."  A committee which engages in peer

review as authorized by the regulations of the Department of

Health.

"Rural area."  An area outside urbanized areas as defined by

the United States Bureau of the Census.

"Special care unit."  An appropriately equipped area of a

hospital where provisions have been made for a concentration of

physicians, nurses and others who have special skills and

experiences to provide medical care for critically ill patients.

"Trauma center."  A facility accredited as a trauma center by

the Pennsylvania Trauma Systems Foundation.

§ 7204.  Emergency medical services system programs.

(a)  Planning and coordination.--The department shall plan,

guide and coordinate programs on the following matters to

promote effective and efficient operation of Statewide and

regional EMS systems:

(1)  The number and distribution of EMS providers and

other persons integral to an EMS system, such as medical

command physicians and EMS agency medical directors, with

appropriate training and experience.

(2)  Reasonably accessible training for EMS providers and

other persons integral to an EMS system, including clinical

training and continuing education programs coordinated with

other programs providing similar, complementary and

supplemental training and education.

(3)  The joining of personnel, facilities and equipment

coordinated through a communication system to ensure that EMS

requests will be handled by communications facilities that:

(i)  utilize emergency medical telecommunications

screening to determine the appropriate emergency agency

response;

(ii)  are accessible to the general public through a

common telephone number and, where feasible, through the

universal emergency telephone number 911; and

(iii)  will have direct communications with

appropriate personnel facilities and equipment resources.

(4)  The number and distribution of ambulances and other

EMS vehicles in which:

(i)  ambulances and other vehicles meet appropriate

criteria relating to location, design, performance and

equipment; and

(ii)  operators and other personnel staffing vehicles

meet appropriate training and experience requirements.

(5)  The number and accessibility of facilities that:

(i)  are collectively capable of providing EMS on a

continuous basis;

(ii)  have appropriate specialty capabilities;

(iii)  meet appropriate standards relating to

capacity, location, personnel and equipment; and

(iv)  are coordinated with other health care

facilities and resource centers.

(6)  Access and transportation to trauma centers and

specialty care receiving facilities.

(7)  Transfer of patients between facilities or to

programs offering necessary follow-up care and

rehabilitation.

(8)  Utilization of appropriate personnel, facilities and

equipment of each entity providing EMS.

(9)  Regional EMS councils that provide persons residing

in an EMS region, and who have no professional or financial

interest in the provision of health care, with an adequate

opportunity to participate in the making of policy for the

regional EMS system.

(10)  The provision of EMS to all persons requiring those

services.

(11)  A standardized data collection system that covers

all phases of the EMS incident, including, but not limited

to, the dispatch report and contact, treatment and transport

of a patient in the EMS system.

(12)  Programs of public education, information and

prevention, integrated with public health education and

taking into account needs of visitors and residents,

concerning methods for accessing EMS and stressing

dissemination of information as to first aid and

cardiopulmonary resuscitation.

(13)  The provision of periodic comprehensive review and

evaluation of the extent and quality of the EMS provided in

each regional EMS system and reports to the department of

each review or evaluation.

(14)  Plans to assure that each regional EMS system will

be able to provide or secure EMS during mass casualty

situations, natural disasters and declared states of

emergency in accordance with Chapter 71 (relating to general

provisions) and the instructions of the Pennsylvania

Emergency Management Agency.

(15)  Appropriate intrastate and interstate arrangements

for the provision of EMS as needed.

(b)  Limitations.--This section is intended to identify EMS

objectives to be pursued and achieved by the department in its

role as lead agency for EMS. Nothing herein shall be construed

to confer regulatory powers upon the department beyond those

conferred elsewhere in this chapter.

§ 7205.  Duties of department.

(a)  Duty.--It shall be the duty of the department to assist

in the development of local EMS systems; plan, guide and

coordinate the development of regional EMS systems into a

unified Statewide system; and coordinate systems in this

Commonwealth with similar systems in neighboring states.

(b)  Authority.--The department shall be the lead agency for

EMS in this Commonwealth. The department is authorized to:

(1)  Coordinate a program for planning, developing,

maintaining, expanding, improving and upgrading EMS systems

in this Commonwealth.

(2)  Establish, by regulation, standards and criteria

governing the awarding and administration of contracts and

grants under this chapter for initiation, maintenance and

improvement of regional EMS systems.

(3)  Require collection and maintenance of patient data

and information in EMS patient care reports by EMS agencies.

(4)  Collect, as deemed necessary and appropriate, data

and information regarding patients who utilize emergency

departments without being admitted to the facility and

patients admitted through emergency departments, trauma

centers or directly to special care units, in a manner that

protects and maintains the confidential nature of patient

records. The data and information shall be reasonable in

detail and shall be collected pursuant to regulations issued

by the department. Data and information shall be limited to

that which may be used for specific planning, research and

quality improvement purposes and shall not be duplicative of

data and information already available to the department.

(5)  Prepare and revise a Statewide EMS system plan under

section 7211 (relating to comprehensive plan).

(6)  Define and approve training programs and accredit

educational institutions for EMS training of EMS providers.

(7)  Provide technical assistance to local governments,

EMS agencies and other entities for the purpose of assuring

effective planning and execution of EMS.

(8)  Administer contracts and grants authorized under

this chapter and other grants pertaining to EMS.

(9)  Establish standards for the licensing, registration

and operation of EMS agencies, and inspect EMS agencies for

compliance with this chapter and regulations adopted under

this chapter.

(10)  Maintain a quality improvement program for the

purpose of monitoring and improving the delivery of EMS.

(11)  Promulgate regulations to establish standards and

criteria for EMS systems.

(12)  Integrate all trauma centers accredited pursuant to

section 7207 (relating to Pennsylvania Trauma Systems

Foundation) into the Statewide EMS system.

(13)  Recommend to 911 and other EMS agency dispatchers

protocols with respect to the type and quantity of EMS

resources to dispatch to emergencies.

(14)  Investigate, based upon complaints and information

received, possible violations of this chapter and regulations

under this chapter and take disciplinary actions, seek

injunctions and refer matters for criminal prosecution.

(15)  Investigate complaints concerning delivery of

services by trauma centers and forward investigation results

to the appropriate accrediting entity with a recommendation

for action.

(16)  Enter into agreements with other states which may

include, as appropriate to effectuate the purposes of this

chapter, the acceptance of EMS resources of other states that

do not fully satisfy the requirements of this chapter or

regulations adopted under this chapter.

(c)  EMS protocols.--The department shall establish criteria

and protocols, including bypass protocols, for evaluation,

triage, treatment, transport, transfer and referral of patients

to ensure that they receive appropriate EMS and are transported

to the most appropriate facility. Regional EMS councils shall

not be eligible for contracts or grant funds or State EMS

Operating Fund disbursements unless they assist in ensuring

regional implementation of the criteria and protocols. Protocols

under this subsection are not subject to the rulemaking process.

§ 7206.  Emergency medical services patient care reports.

(a)  Preparation.--An EMS agency shall ensure that its

responding EMS providers complete an EMS patient care report for

each response made in which it encounters a patient or a person

who has been identified as a patient to the EMS agency, unless

the department by regulation exempts certain types of patient

contact from the reporting requirement. The department shall

employ an electronic EMS patient care reporting process that

shall solicit standardized data and patient information. The

department may require an EMS agency to complete a different

standardized report or different fields in a standardized report

based upon the type of resources the EMS agency uses in

responding. The department shall permit an EMS agency to file a

paper report for extraordinary reasons as determined by the

department on a case-by-case basis.

(b)  Content.--The report shall contain information as

solicited on the form or other reporting process developed by

the department. The reporting process shall solicit essential

information in reasonable detail. The department may also use

the reporting process to collect data to enhance its ability to

carry out its responsibilities under sections 7204 (relating to

emergency medical services system programs) and 7205 (relating

to duties of department).

(c)  Patient medical record.--If a patient is transported to

a hospital or from a hospital to another health care facility,

information about the patient and EMS performed on the patient

that is solicited through the reporting process shall be

provided by the EMS agency to the hospital or other health care

facility and become part of the patient's medical record.

(d)  Reporting.--An EMS agency shall report to the department

or a regional EMS council, as determined by department

regulation, data that is solicited through the reporting

process.

(e)  Confidentiality.--

(1)  Patient information collected by an EMS agency shall

be confidential and shall not be released by the EMS agency

or a health care facility except as follows:

(i)  To the patient who is the subject of the report

or to a person who is authorized to exercise the rights

of the patient with respect to securing the report.

(ii)  Pursuant to an order of a court of competent

jurisdiction, including a subpoena when it constitutes a

court order, except that disclosure pursuant to a

subpoena shall not be permitted as to information in the

report that is of such nature that disclosure pursuant to

a subpoena is not otherwise authorized by law.

(iii)  To a health care provider to whom a patient's

medical record may be released under the law.

(iv)  For billing purposes.

(v)  For quality improvement activities.

(vi)  To the department or a regional EMS council for

the purpose of investigating possible violations of this

chapter or related regulations.

(vii)  To a government agency or its agent, as

authorized by the department, for the purpose of the

agency performing official government duties.

(2)  Notwithstanding the duty of confidentiality

applicable to department and regional EMS councils concerning

reports under paragraph (1), the report may be released for

specific research or EMS planning purposes approved by the

department, subject to department approval and supervision to

ensure that use of the report is strictly limited to the

purposes of the research.

(f)  Vendors.--A vendor may not sell or otherwise provide or

offer reporting forms or software marketed as appropriate for

use in making reports required under this section unless the

vendor submits the product to the department for review and

receives department approval. Thereafter, the vendor shall

submit any modification of the product to the department for

review and approval if the vendor intends to offer the modified

product for use in the EMS patient care reporting process. If

the department makes changes to the EMS patient care report, it

shall publish a notice of the changes in the Pennsylvania

Bulletin. The effective date for the changes shall be no fewer

than 60 days following publication. After publication of

changes, a vendor may not market a product as one appropriate

for use in making an EMS patient care report, any reporting

forms or software approved by the department prior to

publication of the changes, unless the vendor clearly discloses

that the forms or software were approved prior to publication of

the changes. The department may assess a vendor a $5,000 civil

penalty for each day a vendor violates the provisions of this

subsection.

§ 7207.  Pennsylvania Trauma Systems Foundation.

(a)  Trauma center accreditation.--The foundation shall

develop a private voluntary accreditation program to:

(1)  Establish standards for the operation of trauma

centers in this Commonwealth, adopting, at a minimum, current

guidelines for trauma centers defined by the American College

of Surgeons. Additionally, Level III trauma centers shall

meet accreditation criteria for Level III trauma centers

imposed by the act of March 24, 2004, (P.L.148, No.15), known

as the Pennsylvania Trauma Systems Stabilization Act. For the

purpose of reaccreditation, the standards shall require, at a

minimum, that each Level I trauma center establish that 600

severe and urgent injury cases have been treated per year and

each Level II trauma center establish that 350 severe and

urgent injury cases have been treated per year.

(2)  Evaluate a hospital making application to the

foundation to determine if the hospital meets the

foundation's standards. An evaluation shall include hospital

site visits by accreditation survey teams composed of

independent, qualified persons selected by the foundation.

(3)  Issue certificates of accreditation to hospitals

that meet the accreditation standards. Certificates of

accreditation shall be valid for a period not to exceed three

years. Certificates of accreditation may be revoked by the

foundation if it is determined that the trauma center no

longer meets accreditation standards as set forth in this

chapter.

(4)  Establish an appeal mechanism for reconsideration of

accreditation decisions.

(b)  Judicial review.--A person aggrieved by a determination

of the foundation under this section may file a petition for

review within 30 days in an appropriate court of common pleas.

(c)  Prohibition.--No hospital shall hold itself out as a

trauma center unless it has a current certificate of

accreditation issued under this section.

(d)  Board of directors.--The board of directors of the

foundation shall consist of the following voting members: five

representatives of State organizations representing physicians;

five representatives of State organizations representing

hospitals; three representatives of State organizations

representing registered professional nurses; two representatives

of other Statewide EMS organizations having expertise in the

delivery of trauma services; the chairman and minority chairman

of the Public Health and Welfare Committee of the Senate or

designees chosen from among the members of the committee; the

chairman and minority chairman of the Health and Human Services

Committee of the House of Representatives or designees chosen

from among the members of the committee; and the Secretary of

Health or a designee. The bylaws of the foundation shall

identify a method to select members to achieve professional and

geographic balance on the board of directors. Terms of office

shall be limited to three years.

(e)  Data collection.--The foundation shall compile and

maintain statistics on mortality and morbidity on multisystem

trauma victims. The data collection shall be coordinated and

performed in conjunction with State data collection activities.

§ 7208.  State Advisory Board.

(a)  Designation and composition.--The board shall be

composed of volunteer, professional and paraprofessional

organizations involved in EMS. The board shall be geographically

representative of the provider organizations that represent EMS

providers, firefighters, regional EMS councils, physicians,

hospital administrators and other health care providers

concerned with EMS. The board may be composed of up to 30

organizations. Each organization that is a member of the

Pennsylvania Emergency Health Services Council and is elected to

serve as a member on the board shall have one vote on the board.

(b)  Duties.--The duties of the board shall be to:

(1)  Elect officers.

(2)  Advise the department concerning manpower and

training, communications, EMS agencies, content of

regulations, standards and policies promulgated by the

department under this chapter and other subjects deemed

appropriate by the department.

(3)  Serve as the forum for discussion on the content of

the Statewide EMS system plan, or any proposed revisions

thereto, and advise the department as to the content of the

plan.

(c)  Open meetings.--Meetings of the board shall be held in

accordance with 65 Pa.C.S. Ch. 7 (relating to open meetings).

(d)  Terms.--A voting member of the board shall serve a

three-year term. A voting member shall not serve more than two

consecutive terms.

(e)  Quorum.--A simple majority of the voting members of the

board shall constitute a quorum for the transaction of business.

(f)  Compensation.--Members of the board shall serve without

compensation, except the Pennsylvania Emergency Health Services

Council, through its contract or grant with the department, may

pay necessary and reasonable expenses incurred by members of the

board while performing their official duties.

(g)  Contracts and grants.--The department shall contract

with or provide a grant to the board for performance of its work

under subsection (b). Contracts and grants between the

department and the board for the performance of work other than

under subsection (b) shall be subject to section 7212 (relating

to contracts and grants) where applicable.

§ 7209.  Regional emergency medical services councils.

(a)  Purpose.--Regional EMS councils shall assist the

department in carrying out the provisions of this chapter. Each

regional EMS council shall adhere to policy direction from the

department.

(b)  Organization.--For purposes of this chapter, the

organizational structure of a regional EMS council shall be

representative of the public, health professions and major

private and public voluntary agencies, organizations and

institutions concerned with providing EMS in the region and

shall be one of the following:

(1)  A unit of general local government, with an advisory

council, meeting requirements for representation.

(2)  A representative public entity administering a

compact or other area-wide arrangement or consortium.

(3)  Any other public or private nonprofit entity that

meets requirements for representation as determined by the

department.

(c)  Duties.--Each regional EMS council shall, if directed by

the department:

(1)  Assist the department in achieving the Statewide and

regional EMS system components and goals described under

section 7204 (relating to emergency medical services system

programs).

(2)  Assist the department in the collection and

maintenance of standardized data and information as provided

in section 7206 (relating to emergency medical services

patient care reports).

(3)  Prepare, annually review and revise, as needed, a

regional EMS system plan for the EMS region the department

has designated and for which the department has contracted or

provided a grant to it to serve.

(4)  Carry out, to the extent feasible, the Statewide and

regional EMS system plans.

(5)  Assure the reasonable availability of training and

continuing education programs for EMS providers.

(6)  Provide necessary and reasonable staff services and

appropriate and convenient office facilities that can serve

as the EMS region's location for the planning, maintenance

and coordinative and evaluative functions of the council.

(7)  Establish a mechanism to provide for input from

facilities and EMS agencies in the EMS region in decisions

that include, but are not limited to, membership on its

governing body.

(8)  Establish, subject to department approval, regional

EMS triage, treatment and transportation protocols consistent

with Statewide protocols adopted by the department. A

regional EMS council may also establish, subject to

department approval, additional triage, treatment and

transportation protocols. No regional protocol shall be

subject to the rulemaking process.

(9)  Advise public safety answering points and municipal

and county governments as to the EMS resources available for

dispatching and recommend dispatch criteria that may be

developed by the department or the council as approved by the

department.

(10)  Assist the department in achieving a unified

Statewide EMS system.

(11)  Designate a regional EMS medical director and

establish a medical advisory committee and a quality

improvement committee.

(12)  Develop a conflict of interest policy, subject to

department approval, and require its board or advisory

council members, officials and employees to agree to the

policy in writing.

(13)  Perform other duties assigned by the department to

assist the department in carrying out the requirements of

this chapter.

(d)  Regional EMS medical directors.--The department shall

consult with the regional EMS medical directors in developing

and adopting EMS protocols and may consult with them on any

matter involved in the department's administration of this

chapter.

SUBCHAPTER B

PROGRAM

Sec.

7211.  Comprehensive plan.

7212.  Contracts and grants.

7213.  Emergency medical services providers.

7214.  Emergency medical responders.

7215.  Emergency medical technicians.

7216.  Advanced emergency medical technicians.

7217.  Paramedics.

7218.  Prehospital registered nurses.

7219.  Prehospital physician extenders.

7220.  Prehospital emergency medical services physicians.

7221.  Certification sanctions.

7222.  Emergency medical services vehicle operators.

7223.  Suspension of certification.

7224.  Emergency medical services instructors.

7225.  Medical director of emergency medical services agency.

7226.  Medical command physicians and facility medical

directors.

7227.  Medical command facilities.

7228.  Receiving facilities.

7229.  Emergency medical services agencies.

7230.  Advanced life support ambulances.

7231.  Air ambulances.

7232.  Advanced life support squad vehicles.

7233.  Basic life support ambulances.

7234.  Basic life support squad vehicles.

7235.  Quick response services.

7236.  Special operations emergency medical services.

7237.  First aid and other safety services.

7238.  Other vehicles and services.

7239.  Stretcher and wheelchair vehicles.

7240.  Conditional temporary licenses.

7241.  Plans of correction.

7242.  Emergency medical services agency license sanctions.

§ 7211.  Comprehensive plan.

(a)  Preparation.--

(1)  The department, with the assistance of the board,

shall prepare a Statewide EMS system plan, which plan shall

include both short-range and long-range goals and objectives,

and shall make the plan available to the General Assembly and

all concerned agencies, entities and individuals.

(2)  A regional EMS system plan, upon approval of the

department, shall:

(i)  Become part of the Statewide EMS system plan.

(ii)  Include for the EMS region the same types of

information that subsection (b) requires for the

Statewide plan.

(b)  Contents.--At a minimum, the Statewide plan shall

contain:

(1)  An inventory of EMS resources available within this

Commonwealth.

(2)  An assessment of the effectiveness of the existing

EMS system and a determination of the need for changes to the

EMS system.

(3)  Performance measures for delivery of EMS to all

persons in this Commonwealth.

(4)  Methods to be used in achieving the stated

performance measures.

(5)  A schedule for achievement of the stated performance

measures.

(6)  A method for monitoring and evaluating whether the

stated performance measures are being achieved.

(7)  Estimated costs for achieving the stated performance

measures.

(c)  Revisions.--

(1)  The department shall collect and analyze EMS data

for the purpose of:

(i)  Revising the Statewide EMS system plan,

including determining the status of the Statewide EMS

system, the degree of compliance with the requirements of

this chapter and the effectiveness of EMS systems in

reducing morbidity and mortality associated with medical

emergencies.

(ii)  Planning future EMS system initiatives.

(2)  Persons regulated by the department under this

chapter and dispatchers of EMS agencies shall provide data,

without charge, as reasonably requested by the department and

regional EMS councils, to aid them in developing and revising

Statewide and regional EMS system plans and in conducting

investigations under this chapter as authorized by the

department.

(d)  Annual reports.--The department shall annually publish

comprehensive and specific reports of activity and plan

implementation.

(e)  Use of Statewide plan.--

(1)  The department shall use the Statewide plan for

contract and grant purposes as set forth in section 7212(a)

(relating to contracts and grants).

(2)  Nothing in the Statewide plan shall be construed to

vest the department with any regulatory authority.

§ 7212.  Contracts and grants.

(a)  General power.--The department may enter into contracts

or grants with entities to serve as regional EMS councils

responsible for the initiation, expansion, maintenance and

improvement of regional EMS systems that are in accordance with

the Statewide EMS system plan.

(b)  Limitation.--An entity with which the department enters

into a contract or grant under this section to serve as a

regional EMS council shall carry out the duties assigned by the

department under section 7209(c) (relating to regional emergency

medical services councils).

(c)  Purposes.--In contracting with or giving a grant to

regional EMS councils, the department may allocate Emergency

Medical Services Operating Fund moneys appropriated to the

department only for the following purposes:

(1)  Providing programs of public education, information,

health promotion and prevention regarding EMS.

(2)  Purchasing ambulances, other EMS vehicles, medical

equipment and rescue equipment.

(3)  Applying to costs associated with conducting

training and testing programs for EMS providers.

(4)  Applying to costs associated with inspections and

investigations conducted to assist the department to carry

out its regulatory authority under this chapter.

(5)  Purchasing communications equipment and services,

including alerting equipment, provided that the purchases are

in accordance with the Statewide EMS system plan.

(6)  Assisting with the merger of EMS agencies or

assisting an EMS agency to acquire another EMS agency, when

the department determines circumstances exist such that the

transaction and financial assistance are needed to serve the

public interest.

(7)  Applying to costs associated with the maintenance

and operation of regional EMS councils. Those costs may

include, but shall not be limited to, salaries, wages and

benefits of staff, travel, equipment and supplies, leasing of

office space, and other costs incidental to the conduct of

business which are deemed by the department to be necessary

and appropriate for carrying out the purposes of this

chapter.

(8)  Applying to costs associated with collection and

analysis of data necessary to evaluate the effectiveness of

EMS systems in providing EMS and to administer quality

improvement programs.

(9)  Applying to costs associated with assisting EMS

agencies to recruit and retain EMS providers.

(d)  Restriction.--In contracting with or providing grants to

regional EMS councils, the department may not allocate Emergency

Medical Services Operating Fund moneys appropriated to the

department for the following purposes:

(1)  Acquisition, construction or rehabilitation of

facilities or buildings, except renovation as may be

necessary for the implementation or modification of EMS

communication systems.

(2)  Purchasing hospital equipment, other than

communications equipment for medical command and receiving

facilities, unless the equipment is used or intended to be

used in an equipment exchange program with EMS agencies.

(3)  Maintenance of ambulances, other EMS vehicles and

equipment.

(4)  Applying to costs deemed by the department as

inappropriate for carrying out the purposes of this chapter.

(5)  Applying to costs which are normally borne by

patients, except for extraordinary costs as determined by the

department.

(e)  Reports.--The recipient of a contract or grant under

this chapter shall make reports to the department as may be

required by the department.

(f)  Contract and grant prerequisites.--The department shall

not contract with or provide a grant to an entity for that

entity to serve as a regional EMS council unless:

(1)  The entity has submitted a contract or grant

application to the department in a form and format prescribed

by the department that is consistent with the Statewide and

regional EMS system plans.

(2)  The application addresses planning, maintenance and

improvement of the regional EMS system.

(3)  The entity demonstrates to the department's

satisfaction the qualifications and commitment to plan,

maintain and improve a regional EMS system, and that the

entity has the required organizational structure and

provisions for representation of appropriate entities.

(g)  Technical assistance.--The department shall provide

technical assistance, as appropriate, to regional EMS councils

and to such other eligible entities as necessary for the purpose

of their carrying out the provisions of contracts and grants

under this section, with special consideration for contractors

and grantees representing rural areas.

(h)  Payments.--Payments pursuant to a contract or grant

under this section may be made in advance or by way of

reimbursement and in installments and on conditions as the

department determines will most effectively carry out the

provisions of this chapter.

(i)  Other funds considered.--

(1)  In determining the amount of a contract or grant

under this section, the amount of funds available to the

contractor or grantee from non-State contributions and

Federal grant or contract programs pertaining to EMS shall be

taken into consideration.

(2)  For purposes of this subsection, "non-State

contributions" include the outlay of cash and in-kind

services to the contractor or grantee or toward the operation

of a regional EMS system by private, public or government

third parties, including the Federal Government.

(j)  Other contracts and grants.--The department may enter

into contracts and grants with organizations other than regional

EMS councils in order to assist the department in complying with

the provisions of this section and chapter.

(k)  Public disclosure.--

(1)  Subject to the provisions of paragraph (2),

finalized contracts and grants shall be deemed public records

subject to disclosure.

(2)  The department may not disclose information in

contracts or grants that could be used by persons to

undermine measures to combat, respond to or recover from

terrorist attacks.

(l)  Sole source contract or grant.--Upon expiration of a

contract or grant with an entity to carry out the duties of a

regional EMS council as set forth in subsection (c), the

department, without undertaking a competitive bidding process,

may enter into a new contract or grant with the same entity for

that entity to continue to serve as a regional EMS council and

perform the duties set forth in subsection (c), as determined by

the department, if that entity, in carrying out the prior

contract or grant, demonstrated its ability and commitment to

the department's satisfaction to plan, maintain and improve the

regional EMS system consistent with the terms of the prior

contract or grant.

§ 7213.  Emergency medical services providers.

(a)  Certification.--The department shall issue

certifications for the following types of EMS providers, which

shall be permanent, subject to disciplinary action pursuant to

section 7221 (relating to certification sanctions):

(1)  Emergency medical responder.

(2)  Emergency medical technician.

(3)  Advanced emergency medical technician.

(4)  Paramedic.

(5)  Prehospital registered nurse.

(6)  Prehospital physician extender.

(7)  Prehospital EMS physician.

(8)  Any other class of EMS provider the department

establishes by regulation.

(b)  Other emergency medical services providers.--The

department may establish, by regulation as the need arises,

classes of EMS providers to provide specialized EMS. The

regulations shall establish certification, practice,

disciplinary and other provider standards consistent with the

purposes of this chapter, and the statutory regulatory schemes

applicable to paramedics except as necessary to meet the special

EMS needs for which the class of EMS provider is created.

(c)  Application.--An applicant for EMS provider

certification shall complete an application for certification on

a form or through an electronic application process prescribed

by the department.

(d)  Education.--The department shall assist, encourage and

coordinate the education of EMS providers.

(1)  The department shall develop standards through

regulations for the accreditation, reaccreditation and

operation of educational institutes to provide the training

persons must successfully complete to be certified as EMS