SB-1274, As Passed House, 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.