GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2001
H	1
HOUSE BILL 453

 
 
Short Title:	Regulation of Emergency Medical Services-AB.	()	
Sponsors:	Representative Wright.	
Referred to:	Health.	
March 1, 2001

A BILL TO BE ENTITLED
AN ACT TO PROVIDE FOR THE REGULATION OF EMERGENCY MEDICAL SERVICES.

The General Assembly of North Carolina enacts:
SECTION 1.  Article 7 of Chapter 131E of the General Statutes reads as rewritten:
"Article 7.
"Regulation of  Emergency Medical Services.
"§ 131E‑155.  Definitions.
As used in this Article, unless otherwise specified:
(1)	"Ambulance" means any privately or publicly owned motor vehicle, aircraft, or vessel that is specially designed, constructed, or modified and equipped and is intended to be used for and is maintained or operated for the transportation of patients on the streets or highways, waterways or airways of this State .
(2)	Repealed by Session Laws 1997‑443, s. 11A.129C.
(3)	" EMS provider" means  a firm, corporation or association who engages or professes to engage in the business or service of providing out-of-hospital care for  patients .
(4)	"Commission" means the North Carolina Medical Care Commission.
(5)	"Emergency medical dispatcher" means an emergency telecommunicator who has completed an educational program approved by the Department and has been credentialed as an emergency medical dispatcher by the Department.
(6)	"Emergency medical services" means all services rendered in responding to improve the health and wellness of the community and to address the individual’s need for emergency medical care in order to prevent loss of life or further aggravation of physiological or psychological illness or injury.
(7)	"Emergency medical services-nurse practitioner" means a nurse who is licensed by the North Carolina Board of Nursing and approved to perform medical acts by the North Carolina Medical Board and the North Carolina Board of Nursing and approved by the Office of Emergency Medical Services to issue instructions to ALS professionals in accordance with protocols approved by the sponsor hospital and under the direction of the medical director.
(8)	"Emergency medical services-physician assistant" means a physician assistant who has been licensed by the North Carolina Medical Board and approved by the Office of Emergency Medical Services to issue instructions to ALS professionals in accordance with protocols approved by the sponsor hospital and under the direction of the medical director.
(9)	"Emergency medical technician" means an individual who has completed an educational program in emergency medical care approved by the Department and has been certified credentialed as an emergency medical technician by the Department.
(10)	"Emergency medical technician-defibrillation" means an individual who has completed an educational program in emergency medical care approved by the Department and has been credentialed as an emergency medical technician-defibrillation by the Department.
(11)	"Emergency medical technician-intermediate" means an individual who has completed an educational program in emergency medical care approved by the Department and has been credentialed as an emergency medical technician-intermediate by the Department.
(12)	"Emergency medical technician-paramedic" means an individual who has completed an educational program in emergency medical care approved by the Department and has been credentialed as an emergency medical technician-paramedic by the Department.
(13)	"Medical responder" means an individual who has completed an educational program in emergency medical care and first aid approved by the Department and has been credentialed as a medical responder by the Department.
(14)	"Mobile intensive care nurse" means an individual who has completed an educational program in emergency medical care approved by the Department and has been credentialed as a mobile intensive care nurse by the Department.
(15)	"Patient" means an individual who is sick, injured, wounded, or otherwise incapacitated or helpless such that the need for some medical assistance might be anticipated.
(16)	"Practical examination" means a test where an applicant for  credentialing as an emergency medical technician, medical responder, emergency medical technician-defibrillation, emergency medical technician-intermediate, or emergency medical technician-paramedic demonstrates the ability to perform specified emergency medical care skills.
"§ 131E‑155.1.   EMS Provider License required.
(a)	No firm, corporation, or association shall furnish, operate, conduct, maintain, advertise, or otherwise engage in or profess to be engaged in the business or service of  providing out-of-hospital treatment for patients or transporting patients upon the streets or highways, waterways, or airways in North Carolina unless a valid  EMS Provider License has been issued by the Department.
(b)	Before an EMS Provider License may be issued, the firm, corporation, or association seeking the license shall apply to the Department for this license. Application shall be made upon forms and according to procedures established by the Department. Prior to issuing an original or renewal  EMS Provider License, the Department shall determine that the applicant meets all requirements for this license as set forth in this Article and in the rules adopted under this Article.  EMS Provider Licenses shall be valid for a period specified by the Department, provided that the period shall be a minimum of four years unless action is taken under subsection (d) of this section.
(c)	The Commission shall adopt rules setting forth the qualifications required for obtaining or renewing an  EMS Provider License.
(d)	The Department may deny, suspend, amend, or revoke an EMS Provider License in any case where the Department finds that there has been a substantial failure to comply with the provisions of this Article or the rules adopted under this Article. The Department's decision to deny, suspend, amend, or revoke an EMS Provider License may be appealed by the applicant or licensee pursuant to the provisions of Article 3 of Chapter 150B of the General Statutes, the Administrative Procedure Act.
(e)	Operating as an  EMS provider without a valid  EMS Provider License is a Class 3 misdemeanor. Each day's operation as an  EMS provider without a license is a separate offense.
"§ 131E‑156.  Permit required to operate ambulance.
(a)	No person, firm, corporation, or association, either as owner, agent, provider, or otherwise, shall furnish, operate, conduct, maintain, advertise, or otherwise engage in or profess to be engaged in the business or service of transporting patients upon the streets or highways, waterways or airways in North Carolina unless a valid permit from the Department has been issued for each ambulance used in the business or service.
(b)	Before a permit may be issued for a vehicle to be operated as an ambulance, the  EMS provider shall apply to the Department for an ambulance permit. Application shall be made upon forms and according to procedures established by the Department. Prior to issuing an original or renewal permit for an ambulance, the Department shall determine that the vehicle for which the permit is issued meets all requirements as to equipment, design, supplies and sanitation as set forth in this Article and in the rules of the Commission and that the  EMS provider has the credentialed personnel necessary to operate the ambulance in accordance with this Article. Permits issued for ambulances shall be valid for a period specified by the Department, not to exceed four years.
(c)	Duly authorized representatives of the Department may issue temporary permits for vehicles not meeting required standards for a period not to exceed 60 days, when it determines the public interest will be served.
(d)	When a permit has been issued for an ambulance as specified by this Article, the vehicle and records relating to the maintenance and operation of the vehicle shall be open to inspection by duly authorized representatives of the Department at all reasonable times.
"§ 131E‑157.  Standards for equipment; inspection of equipment and supplies required for ambulances.
(a)	The Commission shall adopt rules specifying equipment, sanitation, supply and design requirements for ambulances.
(b)	The Department shall inspect each ambulance for compliance with the requirements set forth by the Commission and this Article when it deems an inspection is necessary. The Department shall maintain a record of the inspection.
(c)	Upon a determination, based upon an inspection, that an ambulance fails to meet the requirements of this Article or rules adopted under this Article, the Department may suspend or revoke the permit for the ambulance concerned until these requirements are met.
"§ 131E‑158.  Credentialed personnel required.
(a)	Every ambulance when transporting a patient shall be occupied at a minimum by  all of the following:
(1)	At least one emergency medical technician who shall be responsible for the medical aspects of the mission prior to arrival at the medical facility, assuming no other individual with higher  credentials is available.
(2)	One medical responder who is responsible for the operation of the vehicle and rendering assistance to the emergency medical technician.
An ambulance owned and operated by a licensed health care facility that is used solely to transport sick or infirm patients with known nonemergency medical conditions between facilities or between a residence and a facility for scheduled medical appointments is exempt from the requirements of this subsection.
(b)	The Commission shall adopt rules setting forth exemptions to the requirements stated in (a) of this section applicable to situations where exemptions are considered by the Commission to be in the public interest.
"§ 131E‑159.  Credentialing Requirements.
(a)	An individual seeking credentials as an emergency medical technician, emergency medical technician-defibrillation, emergency medical technician-intermediate, emergency medical technician-paramedic, mobile intensive care nurse, emergency medical services-physician assistant, or emergency medical services-nurse practitioner medical responder shall apply to the Department using forms prescribed by that agency. The Department's representatives shall examine the applicant  by either written, practical, or written and practical examination. The Department shall issue  appropriate credentials to the applicant who meets all the requirements set forth in this Article and the rules adopted for this Article and who successfully completes the examinations required for  credentialing. Emergency medical technician, medical  responder, emergency medical dispatcher, emergency medical technician-defibrillation, emergency medical technician-intermediate, emergency medical technician-paramedic, mobile intensive care nurse, emergency medical 
services-physician assistant, and emergency medical services-nurse practitioner  credentials shall be valid for a period not to exceed four years and may be renewed if the holder meets the requirements set forth in the rules of the Commission. The Department is authorized to revoke or suspend  these credentials at any time it determines that the holder no longer meets the qualifications prescribed.
(b)	The Commission shall adopt rules setting forth the qualifications required for  credentialing of medical responders, emergency medical technicians, emergency medical technician-defibrillation, emergency medical technician-intermediate, emergency medical technician-paramedic, emergency medical dispatcher, mobile intensive care nurse, emergency medical services-physician assistant, and emergency medical services-nurse practitioner. 
(c)	An individual currently  credentialed as an emergency medical technician, emergency medical technician-defibrillation, emergency medical technician-intermediate, and emergency medical technician-paramedic by the National Registry of Emergency Medical Technicians or by another state where the education/credentialing requirements have been approved for legal recognition by the Department of Health and Human Services, in accordance with rules promulgated by the Medical Care Commission, and who is either currently residing in North Carolina or affiliated with a permitted  EMS provider offering service within North Carolina, may be eligible for credentialing as an emergency medical technician without examination. This credentialing shall be valid for a period not to exceed the length of the emergency medical technician-defibrillation, emergency medical technician-intermediate, and emergency medical technician-paramedic applicant's original credentialing or four years, whichever is less.
(d)	An individual currently credentialed as an emergency medical dispatcher by a national credentialing agency, or by another state where the education/credentialing requirements have been approved for legal recognition by the Department of Health and Human Services, in accordance with rules issued by the Medical Care Commission, and who is either currently residing in North Carolina or affiliated with an emergency medical dispatcher program approved by the Department of Health and Human Services offering service within North Carolina, may be eligible for credentialing as an emergency medical dispatcher without examination. This credentialing shall be valid for a period not to exceed the length of the applicant's original credentialing or four years, whichever is less. 
(e)	Duly authorized representatives of the Department may issue temporary  credentials with or without examination upon finding that this action will be in the public interest. Temporary  credentials shall be valid for a period not exceeding 90 days.
"§ 131E‑160. Exemptions.
All of the following vehicles are exempt from the provisions of this Article:
(1)	Privately owned vehicles not  used in the business of  transporting patients.
(2)	A vehicle rendering service as an ambulance in case of a major catastrophe or emergency, when the permitted ambulances based in the locality of the catastrophe or emergency are insufficient to render the services required.
(3)	Any ambulance based outside this State, except that an ambulance which receives a patient within this State for transportation to a location within this State shall comply with the provisions of this Article.
(4)	Ambulances owned and operated by an agency of the United States government.
(5)	Vehicles owned and operated by rescue squads chartered by the State of North Carolina as nonprofit corporations or associations which are not regularly used to transport sick, injured, wounded or otherwise incapacitated or helpless persons except as a part of rescue operations.
"§ 131E‑161.  Violation declared misdemeanor.
It shall be the responsibility of the  EMS provider to ensure that the ambulance operation complies with the provisions of this Article and all rules adopted for this Article. Upon the violation of any part of this Article or any rule adopted under authority of this Article, the Department shall have the power to revoke or suspend the permits of all vehicles owned or operated by the violator. The operation of an ambulance without a valid permit or after a permit has been suspended or revoked or without  appropriate credentialed staffing as required by G.S. 131E‑158, shall constitute a Class 1 misdemeanor."
SECTION 2.  Article 7A of Chapter 131E reads as rewritten:
"Article 7A.
"Statewide Trauma System Act of 1993.
"§ 131E‑162.  Statewide trauma system.
The Department shall establish and maintain a program for the development of a statewide trauma system. The Department shall consolidate all State functions relating to trauma systems, both regulatory and developmental, under the auspices of this program.
The Commission shall adopt rules to carry out the purpose of this Article. These rules shall be adopted with the advice of the State Emergency Medical Services Advisory Council and shall include the operation of a statewide trauma registry, statewide educational requirements fundamental to the implementation of the trauma  system.  The rules adopted by the Commission shall establish guidelines for monitoring and evaluating the system including standards and criteria for the denial, suspension, voluntary withdrawal, or revocation of credentials for trauma center designation. The rules adopted by the Commission shall avoid duplication of reporting and minimize the cost to hospitals or other persons reporting under this act. The Office of Emergency Medical Services shall be the agency responsible for monitoring system development, ensuring compliance with rules, and overseeing system effectiveness.
With respect to collection of data and educational requirements regarding trauma, rules adopted by the Medical Care Commission shall limit the authority of the Department to hospitals and  Emergency Medical Services providers. Nothing in this Article shall be interpreted so as to grant the Department authority to require private physicians, schools, or universities, except those  participating in the trauma system, to provide information or data or to conduct educational programs regarding trauma.
"§§ 131E‑163, 131E‑164: Reserved for future codification purposes."
SECTION 3.  This act is effective when it becomes law.