Missouri Senate

Senate Substitute

EMERGENCY SERVICES DISTRICTS (Section 99.848)

Under this act, any emergency services district or 911 center providing emergency or dispatch services shall be entitled to a reimbursement from a special allocation fund. An ambulance district board, fire protection board, a governing body operating a 911 center, or emergency services board shall set the reimbursement rate prior to the time an assessment is paid into the fund. If a redevelopment plan, area, or project is amended by ordinance or other means, the board shall have the right to recalculate the base year and the refund amount.

CERTAIN DEFINITIONS (Sections 135.090, 190.094, 190.100, 190.103, 190.105, 190.131, 190.196, 190.246, and 191.630)

This act changes the term "emergency medical technician-intermediate" to "advanced emergency medical technician".

Additionally, the term "first responder" is replaced by "emergency medical responder".

Finally, the definition of "medical control" is modified to include both online and offline medical control.

EMS MEDICAL DIRECTORS (Section 190.103)

This act requires the state EMS medical director to be elected by the members of the regional EMS medical director's advisory committee, to serve a four-year term, and to coordinate EMS services between the EMS regions, as well as to promote educational efforts for agency medical directors, represent Missouri EMS nationally, and incorporate the EMS system into Missouri's health care system.

EMS TRAINING (Sections 190.131 and 190.142)

This act modifies education, training, and accreditation requirements for emergency medical technicians and paramedics. Paramedic training programs shall be accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or hold a CAAHEP letter of review.

TREATMENT PROTOCOLS (Sections 190.103 and 190.147)

Emergency medical technicians and paramedics shall only perform medical procedures as directed by treatment protocols approved by the regional medical director or as authorized through direct communication with online medical control.

Emergency medical technician paramedics (EMT-Ps) who have completed certain training, received authorization, and whose ambulance service has adopted certain protocols may make a good faith determination that certain behavioral health patients must be placed in a temporary hold for transport to the nearest appropriate facility. Physical restraint of a patient shall be permitted only to provide for bystander, patient, or emergency personnel safety, as approved by local medical control, or in cooperation with on-scene law enforcement. All incidents involving patient restraint shall be reviewed by the ambulance service physician medical director.

This act also specifies that the EMT-Ps who have made such determinations shall no longer rely on the common law doctrine of implied consent and are not to be held civilly liable nor be considered to have waived certain specified defenses if employed by a government employer.

Any ambulance services adopting the authority and protocols under this act shall have a memorandum of understanding with local law enforcement agencies to achieve a collaborative and coordinated response to patients displaying a likelihood of serious harm to themselves or others or significant incapacitation by alcohol or drugs.

DISCIPLINARY INVESTIGATIONS (Section 190.165)

Under current law, licensed EMS providers who are the subjects of disciplinary investigations are instructed that they are not entitled to have holders of certain certificates, permits, or licenses present at an interview. This act removes this prohibition against holders of certain certificates, permits, or licenses. Additionally, the act provides that the Administrative Hearing Commission shall hear all relevant evidence on remediation activities of the licensee and shall make a recommendation to the Department of Health and Senior Services as to licensure disposition based on such evidence.

EMS RECORDS (Section 190.173)

This act provides that any information regarding the physical or mailing address, phone number, fax number, or email address of a licensed ambulance service or certified training entity shall not be considered confidential.

Nothing in this provision shall prohibit the Department of Health and Senior Services from releasing certain aggregate information in accordance with state law.

EMS PERSONNEL LICENSURE INTERSTATE COMPACT (Sections 190.142 and 190.900 to 190.939)

This act authorizes Missouri to become a member state of the "Recognition of EMS Personnel Licensure Interstate Compact" and to adopt the provisions of authorization as specified in the act. The purpose of the compact is to facilitate the exchange of information between member states regarding EMS personnel licensure, adverse actions, and significant investigatory information.

Applicants for initial licensure as an emergency medical technician submitted after the recognition of the compact shall submit to a background check as provided in the act.

A home state's license authorizes an individual to practice in a remote state under the privilege to practice if the home state meets certain requirements, as set forth in the act. In order to exercise the privilege to practice under the terms and provisions of the compact, an individual shall: 1) be at least 18 years of age; 2) possess a current unrestricted license in a member state as an emergency medical technician (EMT), advanced emergency medical technician (AEMT), paramedic, or state-recognized and licensed level with a scope of practice and authority between EMT and paramedic; and 3) practice under the supervision of a medical director.

If an individual's license in any home state is restricted, suspended, or revoked, the individual shall not be eligible to practice in a remote state until the individual's home state license is restored. Additionally, if an individual's privilege to practice in any remote state is restricted, suspended, or revoked, the individual shall not be eligible to practice in any remote state until the individual's privilege to practice is restored.

The circumstances under which an individual may practice in a remote state in the performance of emergency medical services are set forth in the act, in conjunction with any rules created by the Interstate Commission for EMS Personnel Practice.

If a member state's governor declares a state of emergency or disaster that activates the Emergency Management Assistance Compact (EMAC), the terms of EMAC shall prevail over the terms or provisions of the compact with respect to any individual practicing in a remote state in response to such declaration.

A home state shall have exclusive power to impose adverse action against an individual's license issued by the home state. A remote state may take adverse action on an individual's privilege to practice within the remote state.

The Interstate Commission for EMS Personnel Practice has powers as set forth in the act, including the collection of an annual assessment from member states. The commission shall meet at least one during each calendar year. The commission may hold closed meetings to discuss matters as specified in the act.

The commission shall prescribe bylaws and rules to carry out the purposes and exercise the powers of the compact. The powers and duties of the commission are set forth in the act.

Any member state may withdraw from the compact by enacting a statute repealing the same. A member state's withdrawal does not take effect until 6 months after enactment of the repealing statute.

These provisions are substantially similar to provisions in SB 931 (2018) and HB 1662 (2018), and similar to provisions in HB 1431 (2018), HCS/SS/SCS/SB 124 (2017), SCS/SB 418 (2017), HCS/HB 100 (2017), HCS/HB 1044 (2017), and HB 1616 (2016).

SARAH HASKINS