SENATE BILL NO. 521

June 08, 2021, Introduced by Senators BIZON, OUTMAN, VANDERWALL, POLEHANKI, BAYER, LASATA, BRINKS, GEISS, HERTEL, WOJNO, MACDONALD, CHANG and BULLOCK and referred to the Committee on Health Policy and Human Services.

"Public health code,"

by amending sections 20904, 20908, and 20910 (MCL 333.20904, 333.20908, and 333.20910), section 20904 as amended by 2000 PA 375, section 20908 as amended by 2004 PA 581, and section 20910 as amended by 2006 PA 582, and by adding section 20917b.

the people of the state of michigan enact:

Sec. 20904. (1) "Education program sponsor" means a person, other than an individual, that meets the standards of the department to conduct training at the following levels:

(a) Medical first responder.

(b) Emergency medical technician.

(d) Paramedic.

(e) Emergency medical services instructor-coordinator.

(2) "Emergency" means a condition or situation in which an individual declares a need for immediate medical attention for any individual, or where that need is declared by emergency medical services personnel or a public safety official.

(3) "Emergency medical services instructor-coordinator" means an individual licensed under this part to conduct and instruct emergency medical services education programs.

(4) "Emergency medical services" means the emergency medical services personnel, ambulances, nontransport prehospital life support vehicles, aircraft transport vehicles, medical first response vehicles, and equipment required for transport or treatment of an individual requiring medical first response life support, basic life support, limited advanced life support, or advanced life support.

(5) "Emergency medical services coordination committee" or "statewide emergency medical services coordination committee" means the state emergency medical services coordination committee created in section 20915.

(6) (5) "Emergency medical services personnel" means a medical first responder, emergency medical technician, emergency medical technician specialist, paramedic, or emergency medical services instructor-coordinator.

(7) (6) "Emergency medical services system" means a comprehensive and integrated arrangement of the personnel, facilities, equipment, services, communications, medical control, and organizations necessary to provide emergency medical services and trauma care within a particular geographic region.

(8) (7) "Emergency medical technician" means an individual who is licensed by the department to provide basic life support.

(9) (8) "Emergency medical technician specialist" means an individual who is licensed by the department to provide limited advanced life support.

(10) (9) "Emergency patient" means an individual with a physical or mental condition that manifests itself by acute symptoms of sufficient severity, including, but not limited to, pain such that a prudent layperson, possessing average knowledge of health and medicine, could reasonably expect to result in 1 or all of the following:

(a) Placing the health of the individual or, in the case of a pregnant woman, the health of the patient or the unborn child, or both, in serious jeopardy.

(b) Serious impairment of bodily function.

(11) (10) "Examination" means a written and practical evaluation approved or developed by the national registry National Registry of emergency medical technicians Emergency Medical Technicians or other organization with equivalent national recognition and expertise in emergency medical services personnel testing and approved by the department.

Sec. 20908. (1) "Nonemergency patient" means an individual who is transported by stretcher, isolette, cot, or litter but whose physical or mental condition is such that the individual may reasonably be suspected of not being in imminent danger of loss of life or of significant health impairment.

(2) "Nontransport prehospital life support operation" means a person licensed under this part to provide, for profit or otherwise, basic life support, limited advanced life support, or advanced life support at the scene of an emergency.

(3) "Nontransport prehospital life support vehicle" means a motor vehicle that is used to provide basic life support, limited advanced life support, or advanced life support, and is not intended to transport patients.

(4) "Ongoing education program sponsor" means an education program sponsor that provides continuing education for emergency medical services personnel.

(5) "Paramedic" means an individual licensed under this part to provide advanced life support.

(6) "Patient" means an emergency patient or a nonemergency patient.

(7) "Person" means a person that term as defined in section 1106 or a governmental entity other than an agency of the United States.

(8) "Professional standards review organization" means a committee established by a life support agency or a medical control authority for the purpose of improving the quality of medical care.

(9) "Protocol" means a patient care standard, standing orders, policy, or procedure for providing emergency medical services that is established by a medical control authority and approved by the department under section 20919.

(10) "Statewide emergency medical services communications system" means a system that integrates each emergency medical services system with a centrally coordinated dispatch and resource coordination facility utilizing the universal emergency telephone number, 9-1-1, when that number is appropriate, or any other designated emergency telephone number, a statewide emergency medical 2-way radio communications network, and linkages with the statewide emergency preparedness communications system.

(11) "Statewide system of care for time-sensitive emergencies" means the system of care for stroke and STEMI described in section 20910.

(12) (11) "Statewide trauma care system" means a comprehensive and integrated arrangement of the emergency medical services personnel, facilities, equipment, services, communications, medical control authorities, and organizations necessary to provide trauma care to all patients within a particular geographic region. Beginning on the effective date of rules promulgated under section 20910(1)(m), the statewide trauma care system includes the statewide system of care for time-sensitive emergencies.

(13) "STEMI" means ST-elevation myocardial infarction.

(14) (12) "Volunteer" means an individual who provides services regulated under this part without expecting or receiving money, goods, or services in return for providing those services, except for reimbursement for expenses necessarily incurred in providing those services.

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, 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 emergency medical services 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.before the field study is implemented.

(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 331.533.331.534.

(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 ensure that there exists reasonable emergency medical services capacity within the boundaries for the estimated demand for emergency medical services.

(l) 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, 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 must not require a hospital to be designated as providing a certain level of trauma care. Upon On 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) Within 1 year after the stroke advisory subcommittee and STEMI advisory subcommittee are established under section 20917b, and in consultation with the stroke advisory subcommittee and STEMI advisory subcommittee, develop, implement, and promulgate rules for the implementation and operation of a statewide system of care for time-sensitive emergencies. The implementation and operation of the statewide system of care for time-sensitive emergencies, including the rules promulgated in accordance with this subdivision, are subject to review by the emergency medical services coordination committee and the subcommittees described in this subdivision. The rules promulgated under this subdivision must ensure that the statewide system of care for time-sensitive emergencies is integrated into the statewide trauma care system within the emergency medical services system and must include all of the following:

(i) The designation of facilities as stroke and STEMI facilities based on a verification that national certification or accreditation standards, as approved by the stroke advisory subcommittee and the STEMI advisory subcommittee, have been met.

(ii) A requirement that a hospital is not required to be designated as providing certain levels of care for stroke or STEMI.

(iii) The development and utilization of stroke and STEMI registries that utilize nationally recognized data platforms with confidentiality standards, as approved by the stroke advisory subcommittee and the STEMI advisory subcommittee.

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

(o) (n) 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. 20917b. (1) The stroke advisory subcommittee and the STEMI advisory subcommittee are established under the emergency medical services coordination committee to advise and assist the department on all matters concerning the development, implementation, and continuing operation of a statewide system of care for time-sensitive emergencies. Subject to subsections (2) and (3), as applicable, each subcommittee described in this section must consist of members appointed by the director within 1 year after the effective date of the amendatory act that added this section, and must include at least 1 individual who represents a rural county as that term is defined in section 20917a.

(2) The stroke advisory subcommittee must include all of the following:

(a) A neurologist.

(b) A stroke neurointerventionalist.

(d) A stroke data abstractor.

(e) An emergency medicine physician.

(f) A medical control authority medical director.

(g) A life support agency manager.

(h) An individual representing the Upper Peninsula.

(i) An individual representing a hospital designated as a level I or level II trauma center.

(j) An individual representing a hospital designated as a level III or level IV trauma center.

(3) The STEMI advisory subcommittee must include all of the following:

(a) A cardiologist.

(b) An interventional cardiologist.

(d) A STEMI data abstractor.

(e) An emergency medicine physician.

(f) A medical control authority medical director.

(g) A life support agency manager.

(h) An individual representing the Upper Peninsula.

(i) An individual representing a hospital designated as a level I or level II trauma center.

(j) An individual representing a hospital designated as a level III or level IV trauma center.

(4) The members appointed to a subcommittee described in this section serve for a term of 3 years. A member who is unable to complete his or her term must be replaced for the balance of the unexpired term.

(5) Each subcommittee described in this section shall annually select a member to serve as chairperson.

(6) Meetings of each subcommittee described in this section are subject to the open meetings act, 1976 PA 267, MCL 15.261 to 15.275. Four members constitute a quorum for the transaction of business of each subcommittee.