H-1209 _______________________________________________
SUBSTITUTE HOUSE BILL NO. 237
_______________________________________________
State of Washington 50th Legislature 1987 Regular Session
By House Committee on Health Care (originally sponsored by Representatives Cantwell, Brooks, Braddock, Ballard, Scott, P. King, Kremen and Unsoeld; by request of Department of Social and Health Services)
Read first time 1/28/87 and passed to Committe on Rules.
AN ACT Relating to emergency medical services; amending RCW 18.73.010, 18.73.030, 18.73.050, 18.73.060, 18.73.070, 18.73.073, 18.73.085, 18.73.130, 18.73.140, 18.73.170, 18.73.180, and 18.73.190; adding new sections to chapter 18.73 RCW; and repealing RCW 18.73.077, 18.73.080, 18.73.090, 18.73.100, 18.73.110, 18.73.160, and 18.73.205.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1. Section 1, chapter 208, Laws of 1973 1st ex. sess. and RCW 18.73.010 are each amended to read as follows:
The
legislature finds that a state-wide program of emergency medical care is
necessary to promote the health, safety, and welfare of the citizens of this
state. The intent of the legislature is that the secretary of the department
of social and health services develop and implement a ((program)) system
to promote immediate prehospital treatment for victims of motor vehicle
accidents, suspected coronary illnesses, and other acute illness or trauma.
The legislature further recognizes that emergency medical care and transportation methods are constantly changing and conditions in the various regions of the state vary markedly. The legislature, therefore, seeks to establish a flexible method of implementation and regulation to meet those conditions.
Sec. 2. Section 3, chapter 208, Laws of 1973 1st ex. sess. as last amended by section 5, chapter 112, Laws of 1983 and RCW 18.73.030 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 social and health services.
(2) "Department" means the department of social and health services.
(3) "Committee" means the emergency medical services 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)
"((First)) Aid vehicle" means a vehicle used to carry
((first)) 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 18.73.110
as now or hereafter amended)) section 7 of this 1987 act.
(7) "Ambulance operator" means a person who owns one or more ambulances and operates them as a private business.
(8) "Ambulance director" means a person who is a director of a service which operates one or more ambulances provided by a volunteer organization or governmental agency.
(9)
"((First)) Aid vehicle operator" means a person who
owns one or more ((first)) aid vehicles and operates them as a private
business.
(10)
"((First)) Aid director" means a person who is a
director of a service which operates one or more ((first)) aid vehicles
provided by a volunteer organization or governmental agency.
(11)
"Emergency medical care" or "emergency medical service"
means such medical treatment and care which may be rendered ((to persons
injured, sick, or incapacitated in order to reduce the risk of loss of life or
aggravation of illness or injury, including care rendered)) at the scene
of a medical emergency and while transporting a patient ((from)) in
an ambulance ((or other vehicle)) to an appropriate ((location within
a hospital or other)) medical facility.
(12)
"Communications system" means a radio ((or)) 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 system.
(13) "Emergency medical services region" means a region established by the secretary of the department of social and health services pursuant to RCW 18.73.060, as now or hereafter amended.
(14)
"Patient care ((guidelines)) protocols" means ((the))
written guidelines adopted by ((local or regional emergency medical services
councils)) the emergency medical services medical program director
which direct the care of the emergency patient. These guidelines shall be
based upon the assessment of the patient's medical needs and ((his))
geographic location, and shall address which medical care vehicles will be
dispatched to the scene, what treatment will be provided for serious
conditions, which hospital will first receive the patient, and which hospitals
are appropriate for transfer if necessary.
(15) "Emergency
medical services medical program director" means a person who is an
approved medical program director ((under)) as defined by RCW
18.71.205(4).
(16) "Council" means the local or regional emergency medical services advisory council.
(17) "Basic life support" means emergency medical treatment services.
(18)
"Advanced life support" means emergency medical services
requiring advanced ((emergency)) medical treatment skills((, i.e.,
intravenous technicians, airway technicians, and paramedics)) as defined
by chapter 18.71 RCW.
(19) "System service area" means an emergency medical service area that develops because of trade, patient catchment, market, or other factors and may include county or multicounty boundaries.
(20)
"First responder" means a person who is authorized by the secretary
to render emergency medical care ((pursuant to RCW 18.73.205)) as
defined by section 7 of this 1987 act.
Sec. 3. Section 5, chapter 208, Laws of 1973 1st ex. sess. as amended by section 3, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.050 are each amended to read as follows:
The committee shall:
(1) Advise the secretary regarding emergency medical care needs throughout the state.
(2) Review regional emergency medical services plans and recommend changes to the secretary before adoption of the plans.
(3) Review all administrative rules proposed for adoption by the secretary under this chapter or under RCW 18.71.205. The secretary shall submit all such rules to the committee in writing. The committee shall, within forty-five days of receiving the proposed rules, advise the secretary of its recommendations. If the committee fails to notify the secretary within forty-five days of receipt of a proposed rule it shall be deemed to be approved by the committee.
(((3)))
(4) Assist the secretary, at the secretary's request, to fulfill any
duty or exercise any power under this chapter.
Sec. 4. Section 6, chapter 208, Laws of 1973 1st ex. sess. and RCW 18.73.060 are each amended to read as follows:
(1) The
secretary shall designate at least eight planning and service ((areas)) regions
so that all parts of the state are within such an area. These regional
designations are to be made on the basis of convenience and efficiency of
delivery of needed emergency medical services.
(2) The
secretary shall conduct a ((public hearing)) regional emergency
medical services advisory committee meeting in a major city of each
planning and service ((area)) region at least sixty days prior to
the formulation of a ((comprehensive)) plan for prehospital emergency
medical services. Such ((hearing)) meetings shall (a) afford an
opportunity for participation by those interested in the determination of the
need for, and the location of ambulances and first aid vehicles and (b) provide
a public forum that affords a full opportunity for presenting views on any
relevant aspect of prehospital emergency medical services.
Sec. 5. Section 7, chapter 208, Laws of 1973 1st ex. sess. as amended by section 5, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.070 are each amended to read as follows:
After
conducting a ((public hearing)) regional emergency medical services
advisory council meeting in one or more major cities in each emergency
medical service region, affording ((all)) interested persons an
opportunity to present their views on any relevant aspect of emergency
medicine, the secretary shall adopt a ((state-wide comprehensive)) regional
plan for the development and implementation of emergency medical care systems
((based upon the regional plans)). The ((hearings)) meetings
shall be held at least sixty days before adoption or revision of the plan.
Components of this plan shall include but not be limited to: Facilities,
vehicles, medical and communications equipment, personnel and training,
transportation, public information and education, patient care protocols,
and coordination of services.
The secretary, with the advice and assistance of the regional emergency medical services advisory council, shall encourage communities and medical care providers to implement the regional plan.
Sec. 6. Section 8, chapter 112, Laws of 1983 and RCW 18.73.073 are each amended to read as follows:
(1) A county or group of counties may create a local emergency medical services advisory council composed of persons representing health services providers, consumers, and local government agencies involved in the delivery of emergency medical services.
(2) Regional emergency medical services advisory councils shall be created by the department with representatives from the local emergency medical services councils within the region and whose representation is determined by the local councils.
(3) Power and duties of the councils are as follows:
(a) Local
emergency medical services advisory councils shall review ((and)),
evaluate, and provide recommendations to the department regarding the
provision of emergency medical services in the community/system service area,
and provide recommendations to the regional emergency medical services advisory
councils on ((standards and matters relating to)) the plan for
emergency medical services.
(b)
Regional emergency medical services advisory councils shall make
recommendations to the department on ((projects, programs, and legislation))
components of the regional plan needed to improve emergency medical
services ((in the state)) systems.
NEW SECTION. Sec. 7. A new section is added to chapter 18.73 RCW 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) Emergency medical communication systems;
(2) 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) Procedures for reciprocity with other states or national certifying agencies;
(d) Review and approval or disapproval of training programs; and
(e) Adoption of standards for numbers and qualifications of instructional personnel required for first responder and emergency medical technician training programs;
(3) Prescribe minimum standards for evaluating the effectiveness of emergency medical systems in the state;
(4) Adopt a format for submission of regional plans;
(5) Prescribe minimum requirements for liability insurance to be carried by licensed services except that this requirement shall not apply to public bodies; and
(6) Certify emergency medical program directors.
Sec. 8. Section 8, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.085 are each amended to read as follows:
(1) The
secretary, with the assistance of the ((regional)) state
emergency medical services ((councils)) advisory committee, shall
adopt a program for the disbursement of funds for the development of the
emergency medical ((care)) service system. Under the program,
the secretary shall disburse funds to each regional council, stipulating the
purpose for which the funds shall be expended. The regional council shall use
such funds to make available matching grants in an amount not to exceed fifty
percent of the cost of the proposal for which the grant is made. Grants shall
be made to any public or private nonprofit agency which, in the judgment of the
regional council, will best fulfill the purpose of the grant.
(2) Grants may be awarded for any of the following purposes:
(a)
Establishment and initial development of an emergency medical service ((program))
system;
(b)
Expansion and improvement of an emergency medical service ((program)) system;
(c)
Purchase of equipment for the operation of an emergency medical service ((program))
system; and
(d) Training and continuing education of emergency medical personnel.
(3) Any
emergency medical service ((program)) agency which receives a
grant shall stipulate that it will:
(a) Operate
in accordance with patient care ((guidelines)) protocols adopted
by the ((regional council)) medical program directors; and
(b) Provide, without prior inquiry as to ability to pay, emergency medical care to all patients requiring such care.
NEW SECTION. Sec. 9. A new section is added to chapter 18.73 RCW to read as follows:
The secretary may grant a variance from a provision of this chapter if no detriment to health and safety would result from the variance and compliance is expected to cause reduction or loss of existing emergency medical services. Variances may be granted for a period of no more than one year. A variance may be renewed by the secretary upon approval of the committee.
Sec. 10. Section 13, chapter 208, Laws of 1973 1st ex. sess. as last amended by section 13, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.130 are each amended to read as follows:
An
ambulance operator, ambulance director, ((first)) aid vehicle operator
or ((first)) aid director may not operate a service in the state of
Washington without holding a license for such operation, issued by the
secretary when such operation is consistent with the comprehensive plan
established pursuant to RCW 18.73.070, indicating the general area to be served
and the number of vehicles to be used, with the following exceptions:
(1) The United States government;
(2) Ambulance operators and ambulance directors providing service in other states when bringing patients into this state;
(3) Owners
of businesses in which ambulance or ((first)) aid vehicles are used
exclusively on company property but occasionally in emergencies may bring
patients to hospitals not on company property;
(4) Operators of vehicles pressed into service for transportation of patients in emergencies when licensed ambulances are not available or cannot meet overwhelming demand.
The license shall be valid for a period of three years and shall be renewed on request provided the holder has consistently complied with the regulations of the department and the department of licensing and provided also that the needs of the area served have been met satisfactorily. The license shall not be transferable.
Sec. 11. Section 14, chapter 208, Laws of 1973 1st ex. sess. as amended by section 14, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.140 are each amended to read as follows:
The
secretary shall ((approve the issuance of)) issue an ambulance or
aid vehicle license for each vehicle so designated. The license shall be
for a period of one year and may be reissued on expiration if the vehicle and
its ((operation)) equipment meet requirements in force at the
time of expiration of the license period. The license may be revoked if the
ambulance or aid vehicle is found to be operating in violation of the
regulations promulgated by the department or without required equipment. The
license shall be terminated automatically if the vehicle is sold or transferred
to the control of anyone not currently licensed as an ambulance or aid
vehicle operator or ((ambulance)) director. The ((ambulance))
license number shall be prominently displayed on each vehicle.
((Licensed
ambulances shall be inspected periodically by the secretary at the location of
the ambulance station. Inspection shall include adequacy and maintenance of
medical equipment and supplies and the mechanical condition of the vehicle
including its mechanical and electrical equipment.))
Sec. 12. Section 17, chapter 208, Laws of 1973 1st ex. sess. as amended by section 17, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.170 are each amended to read as follows:
The ((first))
aid vehicle shall be operated in accordance with standards promulgated by the
secretary, by at least one person holding a certificate recognized under RCW
18.73.120.
The ((first))
aid vehicle may be used for transportation of patients only when it is
impossible or impractical to obtain an ambulance or when a wait for arrival of
an ambulance would place the life of the patient in jeopardy. If so used, the
vehicle shall be under the command of a person holding a certificate recognized
pursuant to ((RCW 18.73.110)) section 7 of this 1987 act other
than the driver ((who shall be in attendance to the patient)).
NEW SECTION. Sec. 13. A new section is added to chapter 18.73 RCW to read as follows:
The secretary shall adopt a self-inspection program to assure compliance with minimum standards for vehicles and for medical equipment and personnel on all licensed vehicles. The self-inspection shall coincide with the vehicle licensing cycle and shall be recorded on forms provided by the department. The department may perform an on-site inspection of any licensed service or vehicles as needed.
Sec. 14. Section 18, chapter 208, Laws of 1973 1st ex. sess. as amended by section 18, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.180 are each amended to read as follows:
Other
vehicles not herein defined by this chapter shall not be used ((commercially
or by public services)) for transportation of patients who must be carried
on a stretcher ((and)) or who may require medical
attention en route, except that such transportation may be used when a disaster
creates a situation that cannot be served by licensed ambulances.
Sec. 15. Section 19, chapter 208, Laws of 1973 1st ex. sess. and RCW 18.73.190 are each amended to read as follows:
Any person
who ((shall)) violates any of the provisions of this chapter and
for which a penalty is not provided shall be deemed guilty of a misdemeanor and
upon conviction thereof, shall be fined in any sum not exceeding one hundred
dollars for each day of the violation, or may be imprisoned in the
county jail not exceeding six months.
NEW SECTION. Sec. 16. The following acts or parts of acts are each repealed:
(1) Section 7, chapter 112, Laws of 1983 and RCW 18.73.077;
(2) Section 8, chapter 208, Laws of 1973 1st ex. sess., section 6, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.080;
(3) Section 9, chapter 208, Laws of 1973 1st ex. sess., section 9, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.090;
(4) Section 10, chapter 208, Laws of 1973 1st ex. sess., section 10, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.100;
(5) Section 11, chapter 208, Laws of 1973 1st ex. sess., section 11, chapter 261, Laws of 1979 ex. sess., section 1, chapter 53, Laws of 1982 and RCW 18.73.110;
(6) Section 16, chapter 208, Laws of 1973 1st ex. sess., section 16, chapter 261, Laws of 1979 ex. sess. and RCW 18.73.160; and