House Bill 821

AN ACT TO CREATE THE NONTRANSPORT EMERGENCY MEDICAL SERVICES ACT; TO ESTABLISH DEFINITIONS OF NONTRANSPORT EMERGENCY MEDICAL SERVICES AND PERSONNEL UNDER THIS ACT; TO ALLOW THE INSURANCE DEPARTMENT TO AUTHORIZE FIRST RESPONDERS UNDER THIS ACT; TO ESTABLISH DUTIES OF THE COMMISSIONER OF INSURANCE UNDER THIS ACT; TO AMEND SECTION 41-59-3, MISSISSIPPI CODE OF 1972, TO DEFINE NONTRANSPORT EMERGENCY MEDICAL SERVICES; TO AMEND SECTION 41-59-35, MISSISSIPPI CODE OF 1972, TO CONFORM; AND FOR RELATED PURPOSES.

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

SECTION 1. (1) "Nontransport emergency medical services" (NTEMS) means the provision of initial assessment and medical intervention with sick, wounded, or otherwise incapacitated persons, performed by a medically trained person or team of persons, prior to the availability of and intervention by an ambulance service. NTEMS are typically rendered at the location of first contact with a patient, and does not include transportation and care during transit to a medical facility, except in special transport circumstances where ambulance transport is not readily available. NTEMS shall be under the jurisdiction of the Commissioner of Insurance pursuant to Chapter 11 Title 45, Mississippi Code of 1972.

(2) "Department" means the Mississippi Insurance Department.

(3) "Commissioner" means the Mississippi Commissioner of Insurance, or his or her designated representative.

(4) "First responder" means a person who uses a limited amount of equipment to perform the initial assessment of and intervention with sick, wounded or otherwise incapacitated persons.

(5) "Medical first responder" means a person who uses a limited amount of equipment to perform the initial assessment of and intervention with sick, wounded or otherwise incapacitated persons who (a) is trained to assist other EMS personnel by successfully completing, and remaining current in refresher training in accordance with, an approved "First Responder: National Standard Curriculum" training program, as developed and promulgated by the United States Department of Transportation; (b) is nationally registered as a first responder by the National Registry of Emergency Medical Technicians; and (c) is certified as a medical first responder by the department.

(6) "Emergency response agency" means a fire department, state, county, municipal or other political subdivision of the State of Mississippi, which includes as part of its designated responsibility the making of emergency medical calls and emergency responses. An emergency response agency as defined herein shall include volunteer fire departments, and persons volunteering for such department shall be considered employees of the volunteer fire department in relation to the provisions of this act. An emergency response agency as defined herein shall not include any entity, or any persons employed thereby, which provides transport emergency medical services and is licensed under the Emergency Medical Services Act of 1974, Section 41-59-1 et seq.

(7) "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, psychiatric disturbances and/or symptoms of substance abuse, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

(8) "Emergency medical call" means a situation that is presumptively classified at the time of dispatch to have a high index of probability that an emergency medical condition or other situation exists that requires medical intervention as soon as possible to reduce the seriousness of the situation, or when the exact circumstances are unknown, but the nature of the request is suggestive of a true emergency where a patient may be at risk.

(9) "Emergency response" means responding immediately at the basic life support or advanced life support level of service to an emergency medical call. An immediate response is one in which the emergency response agency begins as quickly as possible to take the steps necessary to respond to the call.

(10) "Emergency mode" means an EMS vehicle operating with emergency lights and warning siren (or warning siren and air horn) while engaged in an emergency medical call.

(11) "Basic life support" (BLS) service means a nontransport EMS service that provides at a minimum an Emergency Medical Technician – Basic (EMT) as a component of the normal and customary response to emergency aid request. A BLS vehicle means a vehicle is equipped with the approved and required emergency medical supplies and equipment to support a BLS level of care as defined by the department. Standards of equipment and training are to be developed and monitored by the department in collaboration with the state EMS Medical Director at the Mississippi Department of Health-Bureau of EMS and nationally recognized standards.

(12) "Advanced life support (ALS) service" means a nontransport EMS service that provides at a minimum an Emergency Medical Technician-Advanced, approved nurse/medical provider that has completed the transition course set forth in this chapter or a paramedic as a component of the normal and customary response to an emergency aid request. An ALS vehicle means a vehicle is equipped with approved and required emergency medical supplies and equipment to support an ALS level of care as defined by the department. Standards of equipment and minimum standards are to be developed and monitored by the department in collaboration with the State EMS Medical Director at the Mississippi Department of Health-Bureau of EMS and nationally recognized standards.

(13) "Nontransport EMS vehicle" means a land, marine or airborne (manned and unmanned) vehicle that provides delivery of emergency medical personnel or equipment that is not designed to provide regulated transport of patients on marked modes of land travel but are allowed in the event of special transport circumstances.

(14) "First responder service" means a nontransport EMS service that provides at a minimum a trained first responder as a component of the normal and customary response to an emergency aid request. A first responder vehicle means a vehicle that is equipped with approved and required emergency medical supplies and equipment to support a first responder level of care as implemented by the department. Standards of equipment and minimum standards are to be developed and monitored by the department in collaboration with the State EMS Medical Director at the Mississippi Department of Health-Bureau of EMS and nationally recognized standards.

(15) "Medical director" means a physician licensed in this state with EMS experience or board certification who is accountable for the care delivered by first responders. The medical director will develop an online medical control program, develop nontransport EMS medical protocols, implement a statewide data collection and charting system, and provide oversight for a quality management system.

(16) "Special transport circumstances" means off-road, austere, marine, air and disaster transport of an injured or ill patient to a waiting licensed ambulance or helicopter. This includes special event venue transport and other related mass gathering events.

(17) "Special operations service" means a nontransport EMS service that provides at a minimum a paramedic as a component of the normal and customary response to an emergency aid request. A special operations vehicle means a vehicle that is equipped with approved and required emergency medical supplies and equipment to support a critical care level of service as implemented by the department. Standards of equipment and minimum standards are to be developed and monitored by the department in collaboration with the State EMS Medical Director at the Mississippi Department of Health-Bureau of EMS and nationally recognized standards. Special operations providers shall meet the qualifications of critical care paramedic as defined by the Mississippi State Department of Health. These providers will provide specialized medical care during rescues or responses based on their training.

SECTION 2. Any person employed by an emergency response agency may be authorized by the department to perform as an emergency medical technician for the provision of care in a nontransport EMS setting pursuant to the procedures and protocols as established by the Commissioner. Nontransport emergency medical personnel are included within the coverage, authority and provisions of the Emergency Medical Services Personnel Licensure Interstate Compact as prescribed in Section 41-59-101.

SECTION 3. (1) The commissioner shall develop a standard medical control system, development and adoption of nontransport EMS medical protocols, and other related nontransport EMS activities. Coordination between the department, the Mississippi State Department of Health and the Bureau of Emergency Medical Services shall be accomplished through the respective medical directors of each entity.

(2) The commissioner is authorized to promulgate and enforce such rules, regulations and minimum standards as needed to carry out the provisions of this chapter.

(3) The department, acting as the lead agency, will develop a coordinated statewide system of nontransport EMS services for emergency response agencies that includes a quality management system, charting platform and data reporting system.

(4) The department may contract with a third-party vendor in order to serve as medical director, develop a standard medical control system, and establish and implement the protocols and quality management system as referenced in subsection (1) of this section.

SECTION 4. Section 41-59-3, Mississippi Code of 1972, is amended as follows:

41-59-3. As used in this chapter, unless the context otherwise requires, the term:

(a) "Ambulance" means any privately or publicly owned land or air vehicle that is especially designed, constructed, modified or equipped to be used, maintained and operated upon the streets, highways or airways of this state to assist persons who are sick, injured, wounded, or otherwise incapacitated or helpless;

(b) "Permit" means an authorization issued for an ambulance vehicle and/or a special use EMS vehicle as meeting the standards adopted under this chapter;

(c) "License" means an authorization to any person, firm, corporation, or governmental division or agency to provide ambulance services in the State of Mississippi;

(d) "Emergency medical technician" means an individual who possesses a valid emergency medical technician's certificate issued under the provisions of this chapter or who has a privilege to practice under the Emergency Medical Services Personnel Licensure Interstate Compact;

(e) "Certificate" means official acknowledgment that an individual has successfully completed (i) the recommended basic emergency medical technician training course referred to in this chapter which entitles that individual to perform the functions and duties of an emergency medical technician, or (ii) the recommended medical first responder training course referred to in this chapter which entitles that individual to perform the functions and duties of a medical first responder;

(f) "Board" means the State Board of Health;

(g) "Department" means the State Department of Health, Division of Emergency Medical Services;

(h) "Executive officer" means the Executive Officer of the State Board of Health, or his designated representative;

(i) "First responder" means a person who uses a limited amount of equipment to perform the initial assessment of and intervention with sick, wounded or otherwise incapacitated persons;

(j) "Medical first responder" means a person who uses a limited amount of equipment to perform the initial assessment of and intervention with sick, wounded or otherwise incapacitated persons who (i) is trained to assist other EMS personnel by successfully completing, and remaining current in refresher training in accordance with, an approved "First Responder: National Standard Curriculum" training program, as developed and promulgated by the United States Department of Transportation; (ii) is nationally registered as a first responder by the National Registry of Emergency Medical Technicians; and (iii) is certified as a medical first responder by the State Department of Health, Division of Emergency Medical Services;

(k) "Invalid vehicle" means any privately or publicly owned land or air vehicle that is maintained, operated and used only to transport persons routinely who are convalescent or otherwise nonambulatory and do not require the service of an emergency medical technician while in transit;

(l) "Special use EMS vehicle" means any privately or publicly owned land, water or air emergency vehicle used to support the provision of emergency medical services. These vehicles shall not be used routinely to transport patients;

(m) "Trauma care system" or "trauma system" means a formally organized arrangement of health care resources that has been designated by the department by which major trauma victims are triaged, transported to and treated at trauma care facilities;

(n) "Trauma care facility" or "trauma center" means a hospital located in the State of Mississippi or a Level I trauma care facility or center located in a state contiguous to the State of Mississippi that has been designated by the department to perform specified trauma care services within a trauma care system pursuant to standards adopted by the department;

(o) "Trauma registry" means a collection of data on patients who receive hospital care for certain types of injuries. Such data are primarily designed to ensure quality trauma care and outcomes in individual institutions and trauma systems, but have the secondary purpose of providing useful data for the surveillance of injury morbidity and mortality;

(p) "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, psychiatric disturbances and/or symptoms of substance abuse, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part;

(q) "Emergency medical call" means a situation that is presumptively classified at time of dispatch to have a high index of probability that an emergency medical condition or other situation exists that requires medical intervention as soon as possible to reduce the seriousness of the situation, or when the exact circumstances are unknown, but the nature of the request is suggestive of a true emergency where a patient may be at risk;

(r) "Emergency response" means responding immediately at the basic life support or advanced life support level of service to an emergency medical call. An immediate response is one in which the ambulance supplier begins as quickly as possible to take the steps necessary to respond to the call;

(s) "Emergency mode" means an ambulance or special use EMS vehicle operating with emergency lights and warning siren (or warning siren and air horn) while engaged in an emergency medical call.

(t) "Nontransport emergency medical services" (NTEMS) means the provision of initial assessment and medical intervention with sick, wounded or otherwise incapacitated persons, performed by a medically trained person or team of persons, prior to the availability of and intervention by an ambulance service. NTEMS are typically rendered at the location of first contact with a patient, and do not include transportation and care during transit to a medical facility, except in special circumstances where ambulance transport is not readily available. NTEMS shall be under the jurisdiction of the Commissioner of Insurance in accordance with Chapter 11 Title 45, Mississippi Code of 1972.

SECTION 5. Section 41-59-35, Mississippi Code of 1972, is amended as follows:

41-59-35. (1) An emergency medical technician certificate so issued shall be valid for a period not exceeding two (2) years from the date of issuance and may be renewed upon payment of a renewal fee to be fixed by the board, which shall be paid to the board, provided that the holder meets the qualifications set forth in this Chapter 59 and Chapter 60 and rules and regulations promulgated by the board. Any increase in the fee charged by the board under this subsection shall be in accordance with the provisions of Section 41-3-65.

(2) The board is authorized to suspend or revoke a certificate so issued at any time it is determined that the holder no longer meets the prescribed qualifications.

(3) It shall be unlawful for any person, corporation or association to, in any manner, represent himself, herself or itself as an Emergency Medical Technician-Basic, Emergency Medical Technician-Advanced, Emergency Medical Technician-Paramedic, Emergency Medical Technician-Paramedic Critical Care, or Emergency Medical Services Driver, or use in connection with his or its name the words or letters of EMT, emt, paramedic, critical care paramedic, or any other letters, words, abbreviations or insignia which would indicate or imply that he, she or it is an Emergency Medical Technician-Basic, Emergency Medical Technician-Advanced, Emergency Medical Technician-Paramedic, Emergency Medical Technician-Paramedic Critical Care, or Emergency Medical Services Driver, unless certified in accordance with Chapters 59 and 60 of this title and in accordance with the rules and regulations promulgated by the board; or a person authorized by the Insurance Department to perform as an emergency medical technician for the provision of care in a NTEMS setting in accordance with rules and regulations promulgated by the Commissioner of Insurance or a person who has a privilege to practice under the Emergency Medical Services Personnel Licensure Interstate Compact. It shall be unlawful to employ an uncertified Emergency Medical Technician-Basic, Emergency Medical Technician-Advanced, Emergency Medical Technician-Paramedic, or Emergency Medical Technician-Paramedic Critical Care to provide basic or advanced life-support services.

(4) An EMT, EMT-A, EMR, or Paramedic may transport a police dog injured in the line of duty to a veterinary clinic, hospital emergency department or similar facility if there are no persons requiring medical attention or transport at that time. For the purposes of this subsection, "police dog" means a dog owned or used by a law enforcement department or agency in the course of the department or agency's work, including a search and rescue dog, service dog, accelerant detection canine, or other dog that is in use by a county, municipal, or state law enforcement agency.

(5) Any Emergency Medical Technician-Basic, Emergency Medical Technician-Advanced, Emergency Medical Technician-Paramedic, Emergency Medical Technician-Paramedic Critical Care, or Emergency Medical Services Driver who violates or fails to comply with these statutes or the rules and regulations promulgated by the board under these statutes shall be subject, after due notice and hearing, to an administrative fine not to exceed One Thousand Dollars ($1,000.00).

SECTION 6. This act shall take effect and be in force from and after July 1, 2022.