SB-1274, As Passed Senate, December 14, 2006

 

 

 

 

 

 

 

 

 

 

 

 

SUBSTITUTE FOR

 

SENATE BILL NO. 1274

 

(As amended December 14, 2006)

 

 

 

 

 

 

 

     [A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 17521, 20906, 20910, and 20919 (MCL 333.17521,

 

333.20906, 333.20910, and 333.20919), section 17521 as amended by 1993 PA

 

138, section 20906 as amended by 2004 PA 6, section 20910 as amended by

 

2004 PA 582, and section 20919 as amended by 2003 PA 233, and by adding

 

section 20911; and to repeal acts and parts of acts.]

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

  [Sec. 17521. (1) The Michigan board of osteopathic medicine and surgery is created in the department and shall consist of the following 9 11 voting members who shall meet the requirements of part 161: 5 7 physicians, 1 physician's assistant, and 3 public members.

     (2) The requirement of section 16135(d) that a board member shall have practiced that profession for 2 years immediately before appointment is waived until September 30, 1980 for members of the board who are licensed in a health profession subfield created by this part. The Michigan board of osteopathic medicine and surgery does not have the powers and duties vested in the task force by sections 17060 to 17084.]

     Sec. 20906. (1) "Life support agency" means an ambulance

 

operation, nontransport prehospital life support operation,

 

aircraft transport operation, or medical first response service.

 

     (2) "Life support vehicle" means an ambulance, nontransport

 

prehospital life support vehicle, aircraft transport vehicle, or

 

medical first response vehicle.


 

     (3)  (2)  "Limited advanced life support" means patient care

 

that may include any care an emergency medical technician

 

specialist is qualified to provide by emergency medical technician

 

specialist education that meets the educational requirements

 

established by the department under section 20912 or is authorized

 

to provide by the protocols established by the local medical

 

control authority under section 20919 for an emergency medical

 

technician specialist.

 

     (4)  (3)  "Local governmental unit" means a county, city,

 

village, charter township, or township.

 

     (5)  (4)  "Medical control" means supervising and coordinating

 

emergency medical services through a medical control authority, as

 

prescribed, adopted, and enforced through department-approved

 

protocols, within an emergency medical services system.

 

     (6)  (5)  "Medical control authority" means an organization

 

designated by the department under section 20910(1)(g) to provide

 

medical control.

 

     (7)  (6)  "Medical director" means a physician who is

 

appointed to that position by a medical control authority under

 

section 20918.

 

     (8)  (7)  "Medical first responder" means an individual who

 

has met the educational requirements of a department approved

 

medical first responder course and who is licensed to provide

 

medical first response life support as part of a medical first

 

response service or as a driver of an ambulance that provides basic

 

life support services only. Medical first responder does not

 

include a police officer solely because his or her police vehicle


 

is equipped with an automated external defibrillator.

 

     (9)  (8)  "Medical first response life support" means patient

 

care that may include any care a medical first responder is

 

qualified to provide by medical first responder education that

 

meets the educational requirements established by the department

 

under section 20912 or is authorized to provide by the protocols

 

established by the local medical control authority under section

 

20919 for a medical first responder.

 

     (10)  (9)  "Medical first response service" means a person

 

licensed by the department to respond under medical control to an

 

emergency scene with a medical first responder and equipment

 

required by the department before the arrival of an ambulance, and

 

includes a fire suppression agency only if it is dispatched for

 

medical first response life support. Medical first response service

 

does not include a law enforcement agency, as defined in section 8

 

of 1968 PA 319, MCL 28.258, unless the law enforcement agency holds

 

itself out as a medical first response service and the unit

 

responding was dispatched to provide medical first response life

 

support.

 

     (11)  (10)  "Medical first response vehicle" means a motor

 

vehicle staffed by at least 1 medical first responder and meeting

 

equipment requirements of the department. Medical first response

 

vehicle does not include a vehicle solely because it is staffed

 

with a medical first responder.

 

     Sec. 20910. (1) The department shall do all of the following:

 

     (a) Be responsible for the development, coordination, and

 

administration of a statewide emergency medical services system.


 

     (b) Facilitate and promote programs of public information and

 

education concerning emergency medical services.

 

     (c) In case of actual disasters and disaster training drills

 

and exercises, provide emergency medical services resources

 

pursuant to applicable provisions of the Michigan emergency

 

preparedness plan, or as prescribed by the director of emergency

 

services pursuant to the emergency management act, 1976 PA 390, MCL

 

30.401 to 30.421.

 

     (d) Consistent with the rules of the federal communications

 

commission, plan, develop, coordinate, and administer a statewide

 

emergency medical services communications system.

 

     (e) Develop and maintain standards of emergency medical

 

services and personnel as follows:

 

     (i) License emergency medical services personnel in accordance

 

with this part.

 

     (ii) License ambulance operations, nontransport prehospital

 

life support operations, and medical first response services in

 

accordance with this part.

 

     (iii) At least annually, inspect or provide for the inspection

 

of each life support agency, except medical first response

 

services. As part of that inspection, the department shall conduct

 

random inspections of life support vehicles. If a life support

 

vehicle is determined by the department to be out of compliance,

 

the department shall give the life support agency 24 hours to bring

 

the life support vehicle into compliance. If the life support

 

vehicle is not brought into compliance in that time period, the

 

department shall order the life support vehicle taken out of


 

service until the life support agency demonstrates to the

 

department, in writing, that the life support vehicle has been

 

brought into compliance.

 

     (iv) Promulgate rules to establish the requirements for

 

licensure of life support agencies, vehicles, and individuals

 

licensed under this part to provide emergency medical services and

 

other rules necessary to implement this part. The department shall

 

submit all proposed rules and changes to the state emergency

 

medical services coordination committee and provide a reasonable

 

time for the committee's review and recommendations before

 

submitting the rules for public hearing under the administrative

 

procedures act of 1969.

 

     (f) Promulgate rules to establish and maintain standards for

 

and regulate the use of descriptive words, phrases, symbols, or

 

emblems that represent or denote that an ambulance operation,

 

nontransport prehospital life support operation, or medical first

 

response service is or may be provided. The department's authority

 

to regulate use of the descriptive devices includes use for the

 

purposes of advertising, promoting, or selling the services

 

rendered by an ambulance operation, nontransport prehospital life

 

support operation, or medical first response service, or by

 

emergency medical services personnel.

 

     (g) Designate a medical control authority as the medical

 

control for emergency medical services for a particular geographic

 

region as provided for under this part.

 

     (h) Develop and implement field studies involving the use of

 

skills, techniques, procedures, or equipment that are not included


 

as part of the standard education for medical first responders,

 

emergency medical technicians, emergency medical technician

 

specialists, or paramedics, if all of the following conditions are

 

met:

 

     (i) The state emergency medical services coordination committee

 

reviews the field study prior to implementation.

 

     (ii) The field study is conducted in an area for which a

 

medical control authority has been approved pursuant to subdivision

 

(g).

 

     (iii) The medical first responders, emergency medical

 

technicians, emergency medical technician specialists, and

 

paramedics participating in the field study receive training for

 

the new skill, technique, procedure, or equipment.

 

     (i) Collect data as necessary to assess the need for and

 

quality of emergency medical services throughout the state pursuant

 

to 1967 PA 270, MCL 331.531 to 331.533.

 

     (j) Develop, with the advice of the emergency medical services

 

coordination committee, an emergency medical services plan that

 

includes rural issues.

 

     (k) Develop recommendations for territorial boundaries of

 

medical control authorities that are designed to assure that there

 

exists reasonable emergency medical services capacity within the

 

boundaries for the estimated demand for emergency medical services.

 

     (l) Within 180 days after  July 12, 2004, in consultation with

 

the emergency medical services coordination committee, conduct a

 

study on the potential medical benefits, costs, and impact on life

 

support agencies if each ambulance is required to be equipped with


 

an automated external defibrillator and submit its recommendation

 

to the standing committees in the senate and the house of

 

representatives with jurisdiction over health policy issues.

 

     (l)  (m)  Within 1 year after the statewide trauma care

 

advisory subcommittee is established under section 20917a and in

 

consultation with the statewide trauma care advisory subcommittee,

 

develop, implement, and promulgate rules for the implementation and

 

operation of a statewide trauma care system within the emergency

 

medical services system consistent with the document entitled

 

"Michigan Trauma Systems Plan" prepared by the Michigan trauma

 

coalition, dated November 2003. The implementation and operation of

 

the statewide trauma care system, including the rules promulgated

 

in accordance with this subdivision, are subject to review by the

 

emergency medical services coordination committee and the statewide

 

trauma care advisory subcommittee. The rules promulgated under this

 

subdivision shall not require a hospital to be designated as

 

providing a certain level of trauma care. Upon implementation of a

 

statewide trauma care system, the department shall review and

 

identify potential funding mechanisms and sources for the statewide

 

trauma care system.

 

     (m)  (n)  Promulgate other rules to implement this part.

 

     (n)  (o)  Perform other duties as set forth in this part.

 

     (2) The department may do all of the following:

 

     (a) In consultation with the emergency medical services

 

coordination committee, promulgate rules to require an ambulance

 

operation, nontransport prehospital life support operation, or

 

medical first response service to periodically submit designated


 

records and data for evaluation by the department.

 

     (b) Establish a grant program or contract with a public or

 

private agency, emergency medical services professional

 

association, or emergency medical services coalition to provide

 

training, public information, and assistance to medical control

 

authorities and emergency medical services systems or to conduct

 

other activities as specified in this part.

 

     Sec. 20911. Within 9 months after the effective date of this

 

section, each life support vehicle that is dispatched and

 

responding to provide medical first response life support, basic

 

life support, or limited advanced life support shall be equipped

 

with an automated external defibrillator. This section is repealed

 

effective December 31, 2009.

 

     Sec. 20919. (1) A local medical control authority shall

 

establish written protocols for the practice of life support

 

agencies and licensed emergency medical services personnel within

 

its region. The protocols shall be developed and adopted in

 

accordance with procedures established by the department and shall

 

include all of the following:

 

     (a) The acts, tasks, or functions that may be performed by

 

each type of emergency medical services personnel licensed under

 

this part.

 

     (b) Medical protocols to ensure the appropriate dispatching of

 

a life support agency based upon medical need and the capability of

 

the emergency medical services system.

 

     (c) Protocols for complying with the Michigan do-not-

 

resuscitate procedure act, 1996 PA 193, MCL 333.1051 to 333.1067.


 

     (d) Protocols defining the process, actions, and sanctions a

 

medical control authority may use in holding a life support agency

 

or personnel accountable.

 

     (e) Protocols to ensure that if the medical control authority

 

determines that an immediate threat to the public health, safety,

 

or welfare exists, appropriate action to remove medical control can

 

immediately be taken until the medical control authority has had

 

the opportunity to review the matter at a medical control authority

 

hearing. The protocols shall require that the hearing is held

 

within 3 business days after the medical control authority's

 

determination.

 

     (f) Protocols to ensure that if medical control has been

 

removed from a participant in an emergency medical services system,

 

the participant does not provide prehospital care until medical

 

control is reinstated, and that the medical control authority that

 

removed the medical control notifies the department within 1

 

business day of the removal.

 

     (g) Protocols that ensure a quality improvement program is in

 

place within a medical control authority and provides data

 

protection as provided in 1967 PA 270, MCL 331.531 to 331.533.

 

     (h) Protocols to ensure that an appropriate appeals process is

 

in place.

 

     (i) Within 1 year after  the effective date of the amendatory

 

act that added this subdivision  December 23, 2003, protocols to

 

ensure that each life support agency that provides basic life

 

support, limited advanced life support, or advanced life support is

 

equipped with epinephrine or epinephrine auto-injectors and that


 

each emergency services personnel authorized to provide those

 

services is properly trained to recognize an anaphylactic reaction,

 

to administer the epinephrine, and to dispose of the epinephrine

 

auto-injector or vial.

 

     (j) Within 6 months after the effective date of the amendatory

 

act that added this subdivision, protocols to ensure that each life

 

support vehicle that is dispatched and responding to provide

 

medical first response life support, basic life support, or limited

 

advanced life support is equipped with an automated external

 

defibrillator and that each emergency services personnel is

 

properly trained to utilize the automated external defibrillator.

 

     (2) A protocol established under this section shall not

 

conflict with the Michigan do-not-resuscitate procedure act, 1996

 

PA 193, MCL 333.1051 to 333.1067.

 

     (3) The procedures established by the department for

 

development and adoption of written protocols under this section

 

shall comply with at least all of the following requirements:

 

     (a) At least 60 days before adoption of a protocol, the

 

medical control authority shall circulate a written draft of the

 

proposed protocol to all significantly affected persons within the

 

emergency medical services system served by the medical control

 

authority and submit the written draft to the department for

 

approval.

 

     (b) The department shall review a proposed protocol for

 

consistency with other protocols concerning similar subject matter

 

that have already been established in this state and shall consider

 

any written comments received from interested persons in its


 

review.

 

     (c) Within 60 days after receiving a written draft of a

 

proposed protocol from a medical control authority, the department

 

shall provide a written recommendation to the medical control

 

authority with any comments or suggested changes on the proposed

 

protocol. If the department does not respond within 60 days after

 

receiving the written draft, the proposed protocol shall be

 

considered to be approved by the department.

 

     (d) After department approval of a proposed protocol, the

 

medical control authority may formally adopt and implement the

 

protocol.

 

     (e) A medical control authority may establish an emergency

 

protocol necessary to preserve the health or safety of individuals

 

within its jurisdiction in response to a present medical emergency

 

or disaster without following the procedures established by the

 

department under this section for an ordinary protocol. An

 

emergency protocol established under this subdivision is effective

 

only for a limited time period and does not take permanent effect

 

unless it is approved according to this subsection.

 

     (4) A medical control authority shall provide an opportunity

 

for an affected participant in an emergency medical services system

 

to appeal a decision of the medical control authority. Following

 

appeal, the medical control authority may affirm, suspend, or

 

revoke its original decision. After appeals to the medical control

 

authority have been exhausted, the affected participant in an

 

emergency medical services system may appeal the medical control

 

authority's decision to the statewide emergency medical services


 

coordination committee. The statewide emergency medical services

 

coordination committee shall issue an opinion on whether the

 

actions or decisions of the medical control authority are in

 

accordance with the department-approved protocols of the medical

 

control authority and state law. If the statewide emergency medical

 

services coordination committee determines in its opinion that the

 

actions or decisions of the medical control authority are not in

 

accordance with the medical control authority's department-approved

 

protocols or with state law, the emergency medical services

 

coordination committee shall recommend that the department take any

 

enforcement action authorized under this code.

 

     (5) If adopted in protocols approved by the department, a

 

medical control authority may require life support agencies within

 

its region to meet reasonable additional standards for equipment

 

and personnel, other than medical first responders, that may be

 

more stringent than are otherwise required under this part. If a

 

medical control authority establishes additional standards for

 

equipment and personnel, the medical control authority and the

 

department shall consider the medical and economic impact on the

 

local community, the need for communities to do long-term planning,

 

and the availability of personnel. If either the medical control

 

authority or the department determines that negative medical or

 

economic impacts outweigh the benefits of those additional

 

standards as they affect public health, safety, and welfare,

 

protocols containing those additional standards shall not be

 

adopted.

 

     (6) If adopted in protocols approved by the department, a


 

local medical control authority may require medical first response

 

services and licensed medical first responders within its region to

 

meet additional standards for equipment and personnel to ensure

 

that each medical first response service is equipped with an

 

epinephrine auto-injector, and that each licensed medical first

 

responder is properly trained to recognize an anaphylactic reaction

 

and to administer and dispose of the epinephrine auto-injector, if

 

a life support agency that provides basic life support, limited

 

advanced life support, or advanced life support is not readily

 

available in that location.

 

     (7) If a decision of the medical control authority under

 

subsection (5) or (6) is appealed by an affected person, the

 

medical control authority shall make available, in writing, the

 

medical and economic information it considered in making its

 

decision. On appeal, the statewide emergency medical services

 

coordination committee shall review this information under

 

subsection (4) and shall issue its findings in writing.