BILL REQ. #:  S-5183.1 

Read first time 03/01/10.   Referred to Committee on Ways & Means.

     AN ACT Relating to emergency medical technicians and paramedics; amending RCW 18.71.010, 18.73.030, 18.73.081, 43.70.110, and 43.70.250; reenacting and amending RCW 18.71.205; and providing an effective date.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 18.71.010 and 1994 sp.s. c 9 s 302 are each amended to read as follows:
     The following terms used in this chapter shall have the meanings set forth in this section unless the context clearly indicates otherwise:
     (1) "Commission" means the Washington state medical quality assurance commission.
     (2) "Secretary" means the secretary of health.
     (3) "Resident physician" means an individual who has graduated from a school of medicine which meets the requirements set forth in RCW 18.71.055 and is serving a period of postgraduate clinical medical training sponsored by a college or university in this state or by a hospital accredited by this state. For purposes of this chapter, the term shall include individuals designated as intern or medical fellow.
     (4) "Emergency medical care" or "emergency medical service" has the same meaning as in chapter 18.73 RCW.
     (5) "Compensation" has the same meaning as in RCW 18.73.030.

Sec. 2   RCW 18.71.205 and 1996 c 191 s 55 and 1996 c 178 s 6 are each reenacted and amended to read as follows:
     (1) The secretary of the department of health, in conjunction with the advice and assistance of the emergency medical services licensing and certification advisory committee as prescribed in RCW 18.73.050, and the commission, shall prescribe:
     (a) Practice parameters, training standards for, and levels of, physician trained emergency medical service intermediate life support technicians and paramedics;
     (b) Minimum standards and performance requirements for the certification and recertification of physician's trained emergency medical service intermediate life support technicians and paramedics; ((and))
     (c) Procedures for certification, recertification, and decertification of physician's trained emergency medical service intermediate life support technicians and paramedics; and
     (d) Appropriate fees under RCW 43.70.110 for those physician's trained emergency medical service intermediate life support technicians and paramedics who receive compensation.
     (2) Initial certification shall be for a period established by the secretary pursuant to RCW 43.70.250 and 43.70.280.
     (3) Recertification shall be granted upon proof of continuing satisfactory performance and education, and shall be for a period established by the secretary pursuant to RCW 43.70.250 and 43.70.280.
     (4) As used in chapters 18.71 and 18.73 RCW, "approved medical program director" means a person who:
     (a) Is licensed to practice medicine and surgery pursuant to chapter 18.71 RCW or osteopathic medicine and surgery pursuant to chapter 18.57 RCW; and
     (b) Is qualified and knowledgeable in the administration and management of emergency care and services; and
     (c) Is so certified by the department of health for a county, group of counties, or cities with populations over four hundred thousand in coordination with the recommendations of the local medical community and local emergency medical services and trauma care council.
     (5) The Uniform Disciplinary Act, chapter 18.130 RCW, governs uncertified practice, the issuance and denial of certificates, and the disciplining of certificate holders under this section. The secretary shall be the disciplining authority under this section. Disciplinary action shall be initiated against a person credentialed under this chapter in a manner consistent with the responsibilities and duties of the medical program director under whom such person is responsible.
     (6) Such activities of physician's trained emergency medical service intermediate life support technicians and paramedics shall be limited to actions taken under the express written or oral order of medical program directors and shall not be construed at any time to include free standing or nondirected actions, for actions not presenting an emergency or life-threatening condition.

Sec. 3   RCW 18.73.030 and 2005 c 193 s 2 are each amended to read as follows:
     Unless a different meaning is plainly required by the context, the following words and phrases as used in this chapter shall have the meanings indicated.
     (1) "Secretary" means the secretary of the department of health.
     (2) "Department" means the department of health.
     (3) "Committee" means the emergency medical services licensing and certification advisory committee.
     (4) "Ambulance" means a ground or air vehicle designed and used to transport the ill and injured and to provide personnel, facilities, and equipment to treat patients before and during transportation.
     (5) "Aid vehicle" means a vehicle used to carry aid equipment and individuals trained in first aid or emergency medical procedure.
     (6) "Emergency medical technician" means a person who is authorized by the secretary to render emergency medical care pursuant to RCW 18.73.081.
     (7) "Ambulance service" means an organization that operates one or more ambulances.
     (8) "Aid service" means an organization that operates one or more aid vehicles.
     (9) "Emergency medical service" means medical treatment and care which may be rendered at the scene of any medical emergency or while transporting any patient in an ambulance to an appropriate medical facility, including ambulance transportation between medical facilities.
     (10) "Communications system" means a radio and landline network which provides rapid public access, coordinated central dispatching of services, and coordination of personnel, equipment, and facilities in an emergency medical services and trauma care system.
     (11) "Prehospital patient care protocols" means the written procedure adopted by the emergency medical services medical program director which direct the out-of-hospital emergency care of the emergency patient which includes the trauma care patient. These procedures shall be based upon the assessment of the patient's medical needs and what treatment will be provided for emergency conditions. The protocols shall meet or exceed statewide minimum standards developed by the department in rule as authorized in chapter 70.168 RCW.
     (12) "Patient care procedures" means written operating guidelines adopted by the regional emergency medical services and trauma care council, in consultation with the local emergency medical services and trauma care councils, emergency communication centers, and the emergency medical services medical program director, in accordance with statewide minimum standards. The patient care procedures shall identify the level of medical care personnel to be dispatched to an emergency scene, procedures for triage of patients, the level of trauma care facility to first receive the patient, and the name and location of other trauma care facilities to receive the patient should an interfacility transfer be necessary. Procedures on interfacility transfer of patients shall be consistent with the transfer procedures in chapter 70.170 RCW.
     (13) "Emergency medical services medical program director" means a person who is an approved medical program director as defined by RCW 18.71.205(4).
     (14) "Council" means the local or regional emergency medical services and trauma care council as authorized under chapter 70.168 RCW.
     (15) "Basic life support" means noninvasive emergency medical services requiring basic medical treatment skills as defined in chapter 18.73 RCW.
     (16) "Advanced life support" means invasive emergency medical services requiring advanced medical treatment skills as defined by chapter 18.71 RCW.
     (17) "First responder" means a person who is authorized by the secretary to render emergency medical care as defined by RCW 18.73.081.
     (18) "Stretcher" means a cart designed to serve as a litter for the transportation of a patient in a prone or supine position as is commonly used in the ambulance industry, such as wheeled stretchers, portable stretchers, stair chairs, solid backboards, scoop stretchers, basket stretchers, or flexible stretchers. The term does not include personal mobility aids that recline at an angle or remain at a flat position, that are owned or leased for a period of at least one week by the individual using the equipment or the individual's guardian or representative, such as wheelchairs, personal gurneys, or banana carts.
     (19) "Compensation" means regular payment for providing emergency medical care in the course of employment, but does not include nominal payments, reimbursement for expenses, or payments made to volunteer part-time and volunteer on-call personnel of fire departments, fire districts, ambulance districts, aid or ambulance services, or any emergency response organization.

Sec. 4   RCW 18.73.081 and 1993 c 254 s 1 are each amended to read as follows:
     In addition to other duties prescribed by law, the secretary shall:
     (1) Prescribe minimum requirements for:
     (a) Ambulance, air ambulance, and aid vehicles and equipment;
     (b) Ambulance and aid services; and
     (c) Minimum emergency communication equipment;
     (2) Adopt procedures for services that fail to perform in accordance with minimum requirements;
     (3) Prescribe minimum standards for first responder and emergency medical technician training including:
     (a) Adoption of curriculum and period of certification;
     (b) Procedures for certification, recertification, decertification, or modification of certificates;
     (c) Adoption of requirements for ongoing training and evaluation, as approved by the county medical program director, to include appropriate evaluation for individual knowledge and skills. The first responder, emergency medical technician, or emergency medical services provider agency may elect a program of continuing education and a written and practical examination instead of meeting the ongoing training and evaluation requirements;
     (d) Procedures for reciprocity with other states or national certifying agencies;
     (e) Review and approval or disapproval of training programs; ((and))
     (f) Adoption of standards for numbers and qualifications of instructional personnel required for first responder and emergency medical technician training programs; and
     (g) Adoption of appropriate fees under RCW 43.70.110 for those first responders and emergency medical technicians who receive compensation;
     (4) Prescribe minimum requirements for liability insurance to be carried by licensed services except that this requirement shall not apply to public bodies; and
     (5) Certify emergency medical program directors.

Sec. 5   RCW 43.70.110 and 2009 c 403 s 5 are each amended to read as follows:
     (1) Except as provided in subsection (2) of this section, the secretary shall charge fees to the licensee for obtaining a license. Physicians regulated pursuant to chapter 18.71 RCW who reside and practice in Washington and obtain or renew a retired active license are exempt from such fees. After June 30, 1995, municipal corporations providing emergency medical care and transportation services pursuant to chapter 18.73 RCW shall be exempt from such fees, provided that such other emergency services shall only be charged for their pro rata share of the cost of licensure and inspection, if appropriate. The secretary may waive the fees when, in the discretion of the secretary, the fees would not be in the best interest of public health and safety, or when the fees would be to the financial disadvantage of the state.
     (2) Certifications for physician's trained emergency medical service intermediate life support technicians and paramedics certified under chapter 18.71 RCW and for first responders and emergency medical technicians certified under chapter 18.73 RCW shall be determined according to the pro rata share of the cost of certification to the department, except that the following are exempt from fees under this section:
     (a) Certifications for first responders and emergency medical technicians certified under chapter 18.73 RCW who do not receive compensation as defined in RCW 18.73.030;
     (b) Certifications for physician's trained emergency medical service intermediate life support technicians and paramedics certified under chapter 18.71 RCW who do not receive compensation as defined in RCW 18.73.030; and
     (c) Licenses for aid or ambulance services and vehicles under chapter 18.73 RCW.
     (3) Except as provided in subsection (((3))) (4) of this section, fees charged shall be based on, but shall not exceed, the cost to the department for the licensure of the activity or class of activities and may include costs of necessary inspection.
     (((3))) (4) License fees shall include amounts in addition to the cost of licensure activities in the following circumstances:
     (a) For registered nurses and licensed practical nurses licensed under chapter 18.79 RCW, support of a central nursing resource center as provided in RCW 18.79.202, until June 30, 2013;
     (b) For all health care providers licensed under RCW 18.130.040, the cost of regulatory activities for retired volunteer medical worker licensees as provided in RCW 18.130.360; and
     (c) For physicians licensed under chapter 18.71 RCW, physician assistants licensed under chapter 18.71A RCW, osteopathic physicians licensed under chapter 18.57 RCW, osteopathic physicians' assistants licensed under chapter 18.57A RCW, naturopaths licensed under chapter 18.36A RCW, podiatrists licensed under chapter 18.22 RCW, chiropractors licensed under chapter 18.25 RCW, psychologists licensed under chapter 18.83 RCW, registered nurses licensed under chapter 18.79 RCW, optometrists licensed under chapter 18.53 RCW, mental health counselors licensed under chapter 18.225 RCW, massage therapists licensed under chapter 18.108 RCW, clinical social workers licensed under chapter 18.225 RCW, and acupuncturists licensed under chapter 18.06 RCW, the license fees shall include up to an additional twenty-five dollars to be transferred by the department to the University of Washington for the purposes of RCW 43.70.112.
     (((4))) (5) Department of health advisory committees may review fees established by the secretary for licenses and comment upon the appropriateness of the level of such fees.

Sec. 6   RCW 43.70.250 and 2006 c 72 s 4 are each amended to read as follows:
     It shall be the policy of the state of Washington that the cost of each professional, occupational, or business licensing program be fully borne by the members of that profession, occupation, or business, except as otherwise provided under RCW 43.70.110. The secretary shall from time to time establish the amount of all application fees, license fees, registration fees, examination fees, permit fees, renewal fees, and any other fee associated with licensing or regulation of professions, occupations, or businesses administered by the department. In fixing said fees, the secretary shall set the fees for each program at a sufficient level to defray the costs of administering that program and the cost of regulating licensed volunteer medical workers in accordance with RCW 18.130.360, except as provided in RCW 18.79.202 until June 30, 2013. All such fees shall be fixed by rule adopted by the secretary in accordance with the provisions of the administrative procedure act, chapter 34.05 RCW.

NEW SECTION.  Sec. 7   This act takes effect July 1, 2010.