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General Assembly Substitute Bill No. 1005
January Session, 2019
AN ACT CONCERNING TH E DEPARTMENT OF PUBL IC HEALTH'S
RECOMMENDATIONS REGA RDING REVISIONS TO EMERGEN CY
MEDICAL SERVICES DEF INITIONS, CERTIFICATION AND
CONTINUING EDUCATION REQUIREMENTS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-175 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective July 1, 2019): 2
As used in this chapter, unless the context otherwise requires: 3
(1) "Emergency medical service system" means a system which 4
provides for the arrangement of personnel, facilities and equipment for 5
the efficient, effective and coordinated delivery of health care services 6
under emergency conditions; 7
(2) "Patient" means an injured or ill person or a person with a 8
physical disability requiring assistance and transportation; 9
(3) "Ambulance" means a motor vehicle specifically designed to 10
carry patients; 11
(4) "Ambulance service" means an organization which transports 12
patients; 13
(5) "Emergency medical technician" means a person who is certified 14 Substitute Bill No. 1005
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pursuant to chapter 384d; 15
(6) "Ambulance driver" means a person whose primary function is 16
driving an ambulance; 17
(7) "Emergency medical services instructor" means a person who is 18
certified pursuant to chapter 384d; 19
(8) "Communications facility" means any facility housing the 20
personnel and equipment for handling the emergency communications 21
needs of a particular geographic area; 22
(9) "Life saving equipment" means equipment used by emergency 23
medical personnel for the stabilization and treatment of patients; 24
(10) "Emergency medical service organization" means any 25
corporation or organization whether public, private or voluntary that 26
[offers transportation or treatment services to patients primarily] has 27
been certified or licensed by the Department of Public Health to offer 28
services as part of the emergency medical services system, which 29
services include, but are not limited to, treatment of patients (A) under 30
emergency conditions, sudden illness or injury, or (B) during 31
transportation by an authorized emergency medical services vehicle; 32
(11) "Invalid coach" means a vehicle used exclusively for the 33
transportation of nonambulatory patients, who are not confined to 34
stretchers, to or from either a medical facility or the patient's home in 35
nonemergency situations or utilized in emergency situations as a 36
backup vehicle when insufficient emergency vehicles exist; 37
(12) "Rescue service" means any organization, whether for-profit or 38
nonprofit, whose primary purpose is to search for persons who have 39
become lost or to render emergency service to persons who are in 40
dangerous or perilous circumstances; 41
[(13) "Provider" means any person, corporation or organization, 42
whether profit or nonprofit, whose primary purpose is to deliver 43 Substitute Bill No. 1005
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medical care or services, including such related medical care services 44
as ambulance transportation;] 45
[(14)] (13) "Commissioner" means the Commissioner of Public 46
Health; 47
[(15)] (14) "Paramedic" means a person licensed pursuant to chapter 48
384d; 49
[(16)] (15) "Commercial ambulance service" means an ambulance 50
service which primarily operates for profit; 51
[(17)] (16) "Licensed ambulance service" means a commercial 52
ambulance service or a volunteer or municipal ambulance service 53
issued a license by the commissioner; 54
[(18)] (17) "Certified ambulance service" means a municipal, 55
volunteer or nonprofit ambulance service issued a certificate by the 56
commissioner; 57
[(19)] (18) "Automatic external defibrillator" means a device that: (A) 58
Is used to administer an electric shock through the chest wall to the 59
heart; (B) contains internal decision -making electronics, 60
microcomputers or special software that allows it to interpret 61
physiologic signals, make medical diagnosis and, if necessary, apply 62
therapy; (C) guides the user through the process of using the device by 63
audible or visual prompts; and (D) does not require the user to employ 64
any discretion or judgment in its use; 65
[(20)] (19) "Mutual aid call" means a call for emergency medical 66
services that, pursuant to the terms of a written agreement, is 67
responded to by a secondary or alternate emergency medical [services 68
provider] service organization if the primary or designated emergency 69
medical [services provider] service organization is unable to respond 70
because such primary or designated [provider] emergency medical 71
service organization is responding to another call for emergency 72
medical services or the ambulance or nontransport emergency vehicle 73 Substitute Bill No. 1005
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operated by such primary or designated [provider] emergency medical 74
service organization is out of service. For purposes of this subdivision, 75
"nontransport emergency vehicle" means a vehicle used by emergency 76
medical technicians or paramedics in responding to emergency calls 77
that is not used to carry patients; 78
[(21)] (20) "Municipality" means the legislative body of a 79
municipality or the board of selectmen in the case of a municipality in 80
which the legislative body is a town meeting; 81
[(22)] (21) "Primary service area" means a specific geographic area to 82
which one designated emergency medical [services provider] service 83
organization is assigned for each category of emergency medical 84
response services; 85
[(23)] (22) "Primary service area responder" means an emergency 86
medical [services provider] service organization who is designated to 87
respond to a victim of sudden illness or injury in a primary service 88
area; 89
[(24)] (23) "Interfacility critical care transport" means the interfacility 90
transport of a patient between licensed health care institutions; 91
[(25)] (24) "Advanced emergency medical technician" means an 92
individual who is certified as an advanced emergency medical 93
technician pursuant to chapter 384d; 94
[(26)] (25) "Emergency medical responder" means an individual who 95
is certified pursuant to chapter 384d; 96
[(27)] (26) "Medical oversight" means the active surveillance by 97
physicians of the provision of emergency medical services sufficient 98
for the assessment of overall emergency medical service practice levels, 99
as defined by state-wide protocols; 100
[(28)] (27) "Office of Emergency Medical Services" means the office 101
established within the Department of Public Health pursuant to 102 Substitute Bill No. 1005
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section 19a-178, as amended by this act; 103
[(29)] (28) "Sponsor hospital" means a hospital that has agreed to 104
maintain staff for the provision of medical oversight, supervision and 105
direction to an emergency medical service organization and its 106
personnel and has been approved for such activity by the Department 107
of Public Health; 108
[(30)] (29) "Paramedic intercept service" means paramedic treatment 109
services provided by an entity that does not provide the ground 110
ambulance transport; [and] 111
[(31)] (30) "Authorized emergency medical services vehicle" means 112
an ambulance, invalid coach or advanced emergency technician-113
staffed intercept vehicle or a paramedic-staffed intercept vehicle 114
licensed or certified by the Department of Public Health for purposes 115
of providing emergency medical care to patients; and 116
(31) "Emergency medical services personnel" means an individual 117
certified to practice as an emergency medical responder, emergency 118
medical technician, advanced emergency medical technician, 119
emergency medical services instructor or an individual licensed as a 120
paramedic. 121
Sec. 2. Subdivisions (6) to (8), inclusive, of section 19a-177 of the 122
general statutes are repealed and the following is substituted in lieu 123
thereof (Effective July 1, 2019): 124
(6) Establish such minimum standards and adopt such regulations 125
in accordance with the provisions of chapter 54, as may be necessary to 126
develop the following components of an emergency medical service 127
system: (A) Communications, which shall include, but not be limited 128
to, equipment, radio frequencies and operational procedures; (B) 129
transportation services, which shall include, but not be limited to, 130
vehicle type, design, condition and maintenance, and operational 131
procedures; (C) training, which shall include, but not be limited to, 132
emergency medical [technicians] services personnel, communications 133 Substitute Bill No. 1005
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personnel, paraprofessionals associated with emergency medical 134
services, firefighters and state and local police; and (D) emergency 135
medical service facilities, which shall include, but not be limited to, 136
categorization of emergency departments as to their treatment 137
capabilities and ancillary services; 138
(7) Coordinate training of all emergency medical services personnel; 139
[related to emergency medical services;] 140
(8) (A) Develop an emergency medical services data collection 141
system. Each emergency medical service organization licensed or 142
certified pursuant to chapter 386d shall submit data to the 143
commissioner, on a quarterly basis, from each licensed ambulance 144
service, certified ambulance service or paramedic intercept service that 145
provides emergency medical services. Such submitted data shall 146
include, but not be limited to: (i) The total number of calls for 147
emergency medical services received by such licensed ambulance 148
service, certified ambulance service or paramedic intercept service 149
through the 9-1-1 system during the reporting period; (ii) each level of 150
emergency medical services, as defined in regulations adopted 151
pursuant to section 19a-179, required for each such call; (iii) the 152
response time for each licensed ambulance service, certified ambulance 153
service or paramedic intercept service during the reporting period; (iv) 154
the number of passed calls, cancelled calls and mutual aid calls, both 155
made and received, during the reporting period; and (v) for the 156
reporting period, the prehospital data for the nonscheduled transport 157
of patients required by regulations adopted pursuant to subdivision 158
(6) of this section. The data required under this subdivision may be 159
submitted in any [written or] electronic form selected by such licensed 160
ambulance service, certified ambulance service or paramedic intercept 161
service and approved by the commiss ioner, provided the 162
commissioner shall take into consideration the needs of such licensed 163
ambulance service, certified ambulance service or paramedic intercept 164
service in approving such [written or] electronic form. The 165
commissioner may conduct an audit of any such licensed ambulance 166 Substitute Bill No. 1005
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service, certified ambulance service or paramedic intercept service as 167
the commissioner deems necessary in order to verify the accuracy of 168
such reported data. 169
(B) On or before December 31, 2018, and annually thereafter, the 170
commissioner shall prepare a report to the Emergency Medical 171
Services Advisory Board, established pursuant to section 19a-178a, as 172
amended by this act, that shall include, but not be limited to, the 173
following data: (i) The total number of calls for emergency medical 174
services received during the reporting year by each licensed 175
ambulance service, certified ambulance service or paramedic intercept 176
service; (ii) the level of emergency medical services required for each 177
such call; (iii) the name of the [provider of] emergency medical service 178
organization that provided each such level of emergency medical 179
services furnished during the reporting year; (iv) the response time, by 180
time ranges or fractile response times, for each licensed ambulance 181
service, certified ambulance service or paramedic intercept service, 182
using a common definition of response time, as provided in 183
regulations adopted pursuant to section 19a-179; and (v) the number of 184
passed calls, cancelled calls and mutual aid calls during the reporting 185
year. The commissioner shall prepare such report in a format that 186
categorizes such data for each municipality in which the emergency 187
medical services were provided, with each such municipality grouped 188
according to urban, suburban and rural classifications. 189
(C) If any licensed ambulance service, certified ambulance service or 190
paramedic intercept service does not submit the data required under 191
subparagraph (A) of this subdivision for a period of six consecutive 192
months, or if the commissioner believes that such licensed ambulance 193
service, certified ambulance service or paramedic intercept service 194
knowingly or intentionally submitted incomplete or false data, the 195
commissioner shall issue a written order directing such licensed 196
ambulance service, certified ambulance service or paramedic intercept 197
service to comply with the provisions of subparagraph (A) of this 198
subdivision and submit all missing data or such corrected data as the 199 Substitute Bill No. 1005
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commissioner may require. If such licensed ambulance service, 200
certified ambulance service or paramedic intercept service fails to fully 201
comply with such order not later than three months from the date such 202
order is issued, the commissioner (i) shall conduct a hearing, in 203
accordance with chapter 54, at which such licensed ambulance service, 204
certified ambulance service or paramedic intercept service shall be 205
required to show cause why the primary service area assignment of 206
such licensed ambulance service, certified ambulance service or 207
paramedic intercept service should not be revoked, and (ii) may take 208
such disciplinary action under section 19a-17 as the commissioner 209
deems appropriate. 210
(D) The commissioner shall collect the data required by 211
subparagraph (A) of this subdivision, in the manner provided in said 212
subparagraph, from each emergency medical service organization 213
licensed or certified pursuant to this chapter. Any such emergency 214
medical service organization that fails to comply with the provisions of 215
this section shall be liable for a civil penalty not to exceed one hundred 216
dollars per day for each failure to report the required data regarding 217
emergency medical services provided to a patient, as determined by 218
the commissioner. The civil penalties set forth in this subparagraph 219
shall be assessed only after the department provides a written notice of 220
deficiency and the organization is afforded the opportunity to respond 221
to such notice. An organization shall have not more than fifteen 222
business days after the date of receiving such notice to provide a 223
written response to the department. The commissioner may adopt 224
regulations, in accordance with chapter 54, concerning the 225
development, implementation, monitoring and collection of 226
emergency medical service system data. All state agencies licensed or 227
certified as emergency medical service organizations shall be exempt 228
from the civil penalties set forth in this subparagraph; 229
(E) The commissioner shall, with the recommendation of the 230
Connecticut Emergency Medical Services Advisory Board established 231
pursuant to section 19a-178a, as amended by this act, adopt for use in 232 Substitute Bill No. 1005
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trauma data collection the most recent version of the National Trauma 233
Data Bank's National Trauma Data Standards and Data Dictionary and 234
nationally recognized guidelines for field triage of injured patients. 235
Sec. 3. Subsection (b) of section 19a-178a of the general statutes is 236
repealed and the following is substituted in lieu thereof (Effective July 237
1, 2019): 238
(b) The advisory board shall consist of members appointed in 239
accordance with the provisions of this subsection and shall include the 240
Commissioner of Public Health, the department's emergency medical 241
services medical director and the president of each of the regional 242
emergency medical services councils, or their designees. The Governor 243
shall appoint the following members: (1) One person from the 244
Connecticut Association of Directors of Health; (2) three persons from 245
the Connecticut College of Emergency Physicians; (3) one person from 246
the Connecticut Committee on Trauma of the American College of 247
Surgeons; (4) one person from the Connecticut Medical Advisory 248
Committee; (5) one person from the Emergency Nurses Association; (6) 249
one person from the Connecticut Association of Emergency Medical 250
Services Instructors; (7) one person from the Connecticut Hospital 251
Association; (8) two persons representing commercial ambulance 252
[providers] services; (9) one person from the Connecticut State 253
Firefighters Association; (10) one person from the Connecticut Fire 254
Chiefs Association; (11) one person from the Connecticut Police Chiefs 255
Association; (12) one person from the Connecticut State Police; and (13) 256
one person from the Connecticut Commission on Fire Prevention and 257
Control. An additional eighteen members shall be appointed as 258
follows: (A) Three by the president pro tempore of the Senate; (B) three 259
by the majority leader of the Senate; (C) four by the minority leader of 260
the Senate; (D) three by the speaker of the House of Representatives; 261
(E) two by the majority leader of the House of Representatives; and (F) 262
three by the minority leader of the House of Representatives. The 263
appointees shall include a person with experience in municipal 264
ambulance services; a person with experience in for-profit ambulance 265 Substitute Bill No. 1005
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services; three persons with experience in volunteer ambulance 266
services; a paramedic; an emergency medical technician; an advanced 267
emergency medical technician; three consumers and four persons from 268
state-wide organizations with interests in emergency medical services 269
as well as any other areas of expertise that may be deemed necessary 270
for the proper functioning of the advisory board. 271
Sec. 4. Subsection (a) of section 19a-180 of the general statutes is 272
repealed and the following is substituted in lieu thereof (Effective July 273
1, 2019): 274
(a) No person shall operate any ambulance service, paramedic 275
intercept service or rescue service without either a license or a 276
certificate issued by the commissioner. No person shall operate a 277
commercial ambulance service or commercial rescue service without a 278
license issued by the commissioner. A certificate shall be issued to any 279
volunteer or municipal ambulance service or any ambulance service or 280
paramedic intercept service that is operated and maintained by a state 281
agency and that shows proof satisfactory to the commissioner that it 282
meets the minimum standards of the commissioner in the areas of 283
training, equipment and personnel. No license or certificate shall be 284
issued to any volunteer, municipal or commercial ambulance service, 285
paramedic intercept service or rescue service or any ambulance service 286
or paramedic intercept service that is operated and maintained by a 287
state agency, unless it meets the requirements of subsection (e) of 288
section 14-100a. Applicants for a license shall use the forms prescribed 289
by the commissioner and shall submit such application to the 290
commissioner accompanied by an annual fee of two hundred dollars. 291
In considering requests for approval of permits for new or expanded 292
emergency medical services in any region, the commissioner shall 293
consult with the Office of Emergency Medical Services and the 294
emergency medical services council of such region and shall hold a 295
public hearing to determine the necessity for such services. Written 296
notice of such hearing shall be given to current [providers] emergency 297
medical service organizations in the geographic region where such 298 Substitute Bill No. 1005
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new or expanded services would be implemented, provided, any 299
volunteer ambulance service which elects not to levy charges for 300
services rendered under this chapter shall be exempt from the 301
provisions concerning requests for approval of permits for new or 302
expanded emergency medical services set forth in this subsection. A 303
primary service area responder that operates in the service area 304
identified in the application shall, upon request, be granted intervenor 305
status with opportunity for cross-examination. Each applicant for 306
licensure shall furnish proof of financial responsibility which the 307
commissioner deems sufficient to satisfy any claim. The commissioner 308
may adopt regulations, in accordance with the provisions of chapter 309
54, to establish satisfactory kinds of coverage and limits of insurance 310
for each applicant for either licensure or certification. Until such 311
regulations are adopted, the following shall be the required limits for 312
licensure: (1) For damages by reason of personal injury to, or the death 313
of, one person on account of any accident, at least five hundred 314
thousand dollars, and more than one person on account of any 315
accident, at least one million dollars, (2) for damage to property at least 316
fifty thousand dollars, and (3) for malpractice in the care of one 317
passenger at least two hundred fifty thousand dollars, and for more 318
than one passenger at least five hundred thousand dollars. In lieu of 319
the limits set forth in subdivisions (1) to (3), inclusive, of this 320
subsection, a single limit of liability shall be allowed as follows: (A) For 321
damages by reason of personal injury to, or death of, one or more 322
persons and damage to property, at least one million dollars; and (B) 323
for malpractice in the care of one or more passengers, at least five 324
hundred thousand dollars. A certificate of such proof shall be filed 325
with the commissioner. Upon determination by the commissioner that 326
an applicant is financially responsible, properly certified and otherwise 327
qualified to operate a commercial ambulance service, paramedic 328
intercept service or rescue service, the commissioner shall issue the 329
appropriate license effective for one year to such applicant. If the 330
commissioner determines that an applicant for either a certificate or 331
license is not so qualified, the commissioner shall notify such applicant 332
of the denial of the application with a statement of the reasons for such 333 Substitute Bill No. 1005
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denial. Such applicant shall have thirty days to request a hearing on 334
the denial of the application. 335
Sec. 5. Subsections (i) to (l), inclusive, of section 19a-180 of the 336
general statutes are repealed and the following is substituted in lieu 337
thereof (Effective July 1, 2019): 338
(i) The commissioner shall develop a short form application for 339
primary service area responders seeking to add an emergency vehicle 340
to their existing fleets pursuant to subsection (h) of this section. The 341
application shall require an applicant to provide such information as 342
the commissioner deems necessary, including, but not limited to, (1) 343
the applicant's name and address, (2) the primary service area where 344
the additional vehicle is proposed to be used, (3) an explanation as to 345
why the additional vehicle is necessary and its proposed use, (4) proof 346
of insurance, (5) a list of the [providers] emergency medical service 347
organizations to whom notice was sent pursuant to subsection (h) of 348
this section and proof of such notification, and (6) total call volume, 349
response time and calls passed within the primary service area for the 350
one-year period preceding the date of the application. 351
(j) Notwithstanding the provisions of subsection (a) of this section, 352
any ambulance service or paramedic intercept service operated and 353
maintained by a state agency on or before October 1, 2014, that notifies 354
the Department of Public Health's Office of Emergency Medical 355
Services, in writing, not later than September 1, 2014, of such operation 356
and attests to the ambulance service or paramedic intercept service 357
being in compliance with all statutes and regulations concerning such 358
operation (1) shall be deemed certified by the Commissioner of Public 359
Health, or (2) shall be deemed licensed by the Commissioner of Public 360
Health if such ambulance service or paramedic intercept service levies 361
charges for emergency and nonemergency services. 362
(k) Notwithstanding the provisions of subsection (a) of this section, 363
any volunteer, hospital-based or municipal ambulance service that is 364
licensed or certified and a primary service area responder may apply 365 Substitute Bill No. 1005
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to the commissioner, on a short form application prescribed by the 366
commissioner, to change the address of a principal or branch location 367
or to add a branch location within its primary service area. Upon 368
making such application, the applicant shall notify in writing all other 369
primary service area responders in any municipality or abutting 370
municipality in which the applicant proposes to change principal or 371
branch locations. Unless a primary service area responder entitled to 372
receive notification of such application objects, in writing, to the 373
commissioner and requests a hearing on such application not later 374
than fifteen calendar days after receiving such notice, the application 375
shall be deemed approved thirty calendar days after filing. If any such 376
primary service area responder files an objection with the 377
commissioner within the fifteen-calendar-day time period and requests 378
a hearing, the applicant shall be required to demonstrate need to 379
change the address of a principal or branch location within its primary 380
service area at a public hearing as required under subsection (a) of this 381
section. 382
(l) (1) The commissioner shall develop a short form application 383
pursuant to subsection (k) of this section for primary service area 384
responders seeking to (A) change the address of a principal [or] 385
location or the branch location, [pursuant to subsection (k) of this 386
section.] or (B) to add a branch location. (2) The application shall 387
require an applicant to provide such information as the commissioner 388
deems necessary, including, but not limited to, [(1)] (A) the applicant's 389
name and address, [(2)] (B) the new address where the principal or 390
branch is to be located, [(3)] (C) an explanation as to why the principal 391
or branch location is being moved, (D) an explanation as to the need 392
for the addition of a branch location, and [(4)] (E) a list of the 393
[providers] emergency medical service organizations to whom notice 394
was sent pursuant to subsection (k) of this section and proof of such 395
notification. 396
Sec. 6. Subsections (a) and (b) of section 19a-180b of the general 397
statutes are repealed and the following is substituted in lieu thereof 398 Substitute Bill No. 1005
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(Effective July 1, 2019): 399
(a) For the purposes of this section, "supplemental first responder" 400
means an emergency medical [services provider] service organization 401
who holds a certificate of authorization by the Commissioner of Public 402
Health and responds to a victim of sudden illness or injury when 403
available and only when called upon, but does not offer transportation 404
to patients or operate an ambulance service or paramedic intercept 405
service, "emergency medical services personnel" means an individual 406
certified pursuant to chapter 384d to practice as an emergency medical 407
responder, emergency medical technician, advanced emergency 408
medical technician or emergency medical services instructor or an 409
individual licensed pursuant to chapter 384d as a paramedic, and 410
"patient", "ambulance service", ["provider"] "emergency medical 411
service organization", "paramedic intercept service" and "emergency 412
medical technician" have the same meanings as provided in section 413
19a-175, as amended by this act. 414
(b) Notwithstanding the provisions of subsection (a) of section 19a-415
180, as amended by this act, the Commissioner of Public Health may 416
issue a certificate of authorization for a supplemental first responder to 417
an emergency medical [services provider] service organization who 418
operates only in a municipality with a population of at least one 419
hundred five thousand, but not more than one hundred fifteen 420
thousand, as determined by the most recent population estimate by the 421
Department of Public Health. A certificate of authorization shall be 422
issued to an emergency medical [services provider] service 423
organization that shows proof satisfactory to the commissioner that 424
such emergency medical [services provider] service organization (1) 425
meets the minimum standards of the commissioner in the areas of 426
training, equipment and emergency medical services personnel, and 427
(2) maintains liability insurance in an amount not less than one million 428
dollars. Applications for such certificate of authorization shall be made 429
in the form and manner prescribed by the commissioner. Upon 430
determination by the commissioner that an applicant is qualified to be 431 Substitute Bill No. 1005
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a supplemental first responder, the commissioner shall issue a 432
certificate of authorization effective for two years to such applicant. 433
Such certificate of authorization shall be renewable biennially. If the 434
commissioner determines that an applicant for such license is not so 435
qualified, the commissioner shall provide such applicant with written 436
notice of the denial of the application with a statement of the reasons 437
for such denial. Such applicant shall have thirty days to request a 438
hearing concerning the denial of the application. Any hearing 439
conducted pursuant to this subsection shall be conducted in 440
accordance with the provisions of chapter 54. If the commissioner's 441
denial of a certificate of authorization is sustained after such hearing, 442
an applicant may make new application not less than one year after the 443
date on which such denial was sustained. 444
Sec. 7. Section 19a-180d of the general statutes is repealed and the 445
following is substituted in lieu thereof (Effective July 1, 2019): 446
[A provider] Emergency medical services personnel, as defined in 447
section 19a-175, as amended by this act, who holds the highest 448
classification of licensure or certification from the Department of 449
Public Health under this chapter and chapter 384d shall be responsible 450
for making decisions concerning patient care on the scene of an 451
emergency medical call. If two or more [providers] emergency medical 452
service organizations on such scene hold the same licensure or 453
certification classification, the [provider] emergency medical service 454
organization for the primary service area responder, as defined in said 455
section, shall be responsible for making such decisions. If all 456
[providers] emergency medicine services personnel on such scene are 457
emergency medical technicians or emergency medical responders, as 458
defined in said section, the emergency medical service organization 459
providing transportation services shall be responsible for making such 460
decisions. [A provider] An emergency medical service organization on 461
the scene of an emergency medical call who has undertaken decision-462
making responsibility for patient care shall transfer patient care to a 463
provider with a higher classification of licensure or certification upon 464 Substitute Bill No. 1005
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such provider's arrival on the scene. All [providers] emergency 465
medical services personnel with patient care responsibilities on the 466
scene shall ensure such transfer takes place in a timely and orderly 467
manner. For purposes of this section, the classification of licensure or 468
certification from highest to lowest is: Paramedic, advanced emergency 469
medical technician, emergency medical technician and emergency 470
medical responder. Nothing in this section shall be construed to limit 471
the authority of a fire chief or fire officer-in-charge under section 7-472
313e to control and direct emergency activities at the scene of an 473
emergency. 474
Sec. 8. Subsection (a) of section 19a-181b of the general statutes is 475
repealed and the following is substituted in lieu thereof (Effective July 476
1, 2019): 477
(a) Each municipality shall establish a local emergency medical 478
services plan. Such plan shall include the written agreements or 479
contracts developed between the municipality, its emergency medical 480
[services providers] service organizations and the public safety 481
answering point, as defined in section 28-25, that covers the 482
municipality. The plan shall also include, but not be limited to, the 483
following: 484
(1) The identification of levels of emergency medical services, 485
including, but not limited to: (A) The public safety answering point 486
responsible for receiving emergency calls and notifying and assigning 487
the appropriate [provider] emergency medical service organization to 488
a call for emergency medical services; (B) the emergency medical 489
[services provider] service organization that is notified for initial 490
response; (C) basic ambulance service; (D) advanced life support level; 491
and (E) mutual aid call arrangements; 492
(2) The name of the person or entity responsible for carrying out 493
each level of emergency medical services that the plan identifies; 494
(3) The establishment of performance standards, including, but not 495 Substitute Bill No. 1005
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limited to, standards for responding to a certain percentage of initial 496
response notifications, response times, quality assurance and service 497
area coverage patterns, for each segment of the municipality's 498
emergency medical services system; and 499
(4) Any subcontracts, written agreements or mutual aid call 500
agreements that emergency medical [services providers] service 501
organizations may have with other entities to provide services 502
identified in the plan. 503
Sec. 9. Subsection (b) of section 19a-182 of the general statutes is 504
repealed and the following is substituted in lieu thereof (Effective July 505
1, 2019): 506
(b) Each emergency medical services council shall develop and 507
revise every five years a plan for the delivery of emergency medical 508
services in its area, using a format established by the Office of 509
Emergency Medical Services. Each council shall submit an annual 510
update for each regional plan to the Office of Emergency Medical 511
Services detailing accomplishments made toward plan 512
implementation. Such plan shall include an evaluation of the current 513
effectiveness of emergency medical services and detail the needs for 514
the future, and shall contain specific goals for the delivery of 515
emergency medical services within their respective geographic areas, a 516
time frame for achievement of such goals, cost data for the 517
development of such goals, and performance standards for the 518
evaluation of such goals. Special emphasis in such plan shall be placed 519
upon coordinating the existing services into a comprehensive system. 520
Such plan shall contain provisions for, but shall not be limited to, the 521
following: (1) Clearly defined geographic regions to be serviced by 522
each [provider] emergency medical service organization including 523
cooperative arrangements with other [providers] organizations, 524
personnel and backup services; (2) an adequate number of trained 525
personnel for staffing of ambulances, communications facilities and 526
hospital emergency rooms, with emphasis on former military 527
personnel trained in allied health fields; (3) a communications system 528 Substitute Bill No. 1005
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that includes a central dispatch center, two-way radio communication 529
between the ambulance and the receiving hospital and a universal 530
emergency telephone number; and (4) a public education program that 531
stresses the need for adequate training in basic lifesaving techniques 532
and cardiopulmonary resuscitation. Such plan shall be submitted to 533
the Commissioner of Public Health no later than June thirtieth each 534
year the plan is due. 535
Sec. 10. Section 19a-183 of the general statutes is repealed and the 536
following is substituted in lieu thereof (Effective July 1, 2019): 537
There shall be established an emergency medical services council in 538
each region. A region shall be composed of the towns so designated by 539
the commissioner. Opportunity for membership shall be available to 540
all appropriate representatives of emergency medical services 541
including, but not limited to, one representative from each of the 542
following: (1) Local governments; (2) fire and law enforcement 543
officials; (3) medical and nursing professions, including mental health, 544
paraprofessional and other allied health professionals; (4) [providers 545
of] emergency medical service organizations that provide ambulance 546
services, at least one of which shall be a member of a volunteer 547
ambulance association; (5) institutions of higher education; (6) federal 548
agencies involved in the delivery of health care; and (7) consumers. All 549
emergency medical services councils [, including those in existence on 550
July 1, 1974,] shall submit to the commissioner information concerning 551
the organizational structure and council bylaws for the commissioner's 552
approval. Such bylaws shall include the process by which each council 553
shall elect a president. The commissioner shall foster the development 554
of emergency medical services councils in each region. 555
Sec. 11. Subsection (c) of section 20-206kk of the general statutes is 556
repealed and the following is substituted in lieu thereof (Effective July 557
1, 2019): 558
(c) No license as a paramedic or certificate as an emergency medical 559
responder, emergency medical technician, advanced emergency 560 Substitute Bill No. 1005
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medical technician or emergency medical services instructor shall be 561
required of (1) a person performing services within the scope of 562
practice for which he or she is licensed or certified by any agency of 563
this state, or (2) a student, intern or trainee pursuing a course of study 564
in emergency medical services in an accredited institution of education 565
or within an emergency medical services program approved by the 566
commissioner, provided the activities that would otherwise require a 567
license or certificate as an emergency medical services [provider] 568
personnel are performed under supervision and constitute a part of a 569
supervised course of study. 570
Sec. 12. Section 20-206jj of the general statutes is repealed and the 571
following is substituted in lieu thereof (Effective July 1, 2019): 572
As used in this section and sections 20-206kk to 20-206oo, inclusive, 573
as amended by this act: 574
(1) "Advanced emergency medical technician" means an individual 575
who is certified as an advanced emergency medical technician by the 576
Department of Public Health; 577
(2) "Commissioner" means the Commissioner of Public Health; 578
(3) "Emergency medical services instructor" means a person who is 579
certified under the provisions of section 20-206ll or 20-206mm, as 580
amended by this act, by the Department of Public Health to teach 581
courses, the completion of which is required in order to become an 582
emergency medical technician; 583
(4) "Emergency medical responder" means an individual who is 584
certified to practice as an emergency medical responder under the 585
provisions of section 20-206ll or 20-206mm, as amended by this act; 586
(5) "Emergency medical services personnel" means an individual 587
certified to practice as an emergency medical responder, emergency 588
medical technician, advanced emergency medical technician, 589
emergency medical services instructor or an individual licensed as a 590 Substitute Bill No. 1005
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paramedic; 591
(6) "Emergency medical technician" means a person who is certified 592
to practice as an emergency medical technician under the provisions of 593
section 20-206ll or 20-206mm, as amended by this act; 594
(7) "National organization for emergency medical certification" 595
means a national organization approved by the Department of Public 596
Health and identified on the department's Internet web site, or such 597
national organization's successor organization, that tests and provides 598
certification to emergency medical responders, emergency medical 599
technicians, advanced medical technicians and paramedics; 600
(8) "Office of Emergency Medical Services" means the office 601
established within the Department of Public Health pursuant to 602
section 19a-178, as amended by this act; 603
[(8)] (9) "Paramedicine" means the carrying out of (A) all phases of 604
cardiopulmonary resuscitation and defibrillation, (B) the 605
administration of drugs and intravenous solutions under written or 606
oral authorization from a licensed physician or a licensed advanced 607
practice registered nurse, and (C) the administration of controlled 608
substances, as defined in section 21a-240, in accordance with written 609
protocols or standing orders of a licensed physician or a licensed 610
advanced practice registered nurse; [and] 611
[(9)] (10) "Paramedic" means a person licensed to practice as a 612
paramedic under the provisions of section 20-206ll; and 613
(11) "Continuing education platform Internet web site" means an 614
online database, approved by the Commissioner of Public Health, for 615
emergency medical services personnel to enter, track and reconcile the 616
hours and topics of continuing education completed by such 617
personnel. 618
Sec. 13. Section 20-206mm of the general statutes is repealed and the 619
following is substituted in lieu thereof (Effective July 1, 2019): 620 Substitute Bill No. 1005
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(a) Except as provided in subsections (b) and (c) of this section, an 621
applicant for a license as a paramedic shall submit evidence 622
satisfactory to the Commissioner of Public Health that the applicant 623
has successfully (1) completed a paramedic training program 624
approved by the commissioner, and (2) passed an examination 625
prescribed by the commissioner. 626
(b) An applicant for licensure by endorsement shall present 627
evidence satisfactory to the commissioner that the applicant (1) is 628
licensed or certified as a paramedic in another state or jurisdiction 629
whose requirements for practicing in such capacity are substantially 630
similar to or higher than those of this state and that the applicant has 631
no pending disciplinary action or unresolved complaint against him or 632
her, or (2) (A) is currently licensed or certified as a paramedic in good 633
standing in any New England state, New York or New Jersey, (B) has 634
completed an initial training program consistent with the National 635
Emergency Medical Services Education Standards, as promulgated by 636
the National Highway Traffic Safety Administration for the paramedic 637
scope of practice model conducted by an organization offering a 638
program that is recognized by the national emergency medical services 639
program accrediting organization, and (C) has no pending disciplinary 640
action or unresolved complaint against him or her. 641
(c) Any person who is certified as an emergency medical technician-642
paramedic by the Department of Public Health on October 1, 1997, 643
shall be deemed a licensed paramedic. Any person so deemed shall 644
renew his license pursuant to section 19a-88 for a fee of one hundred 645
[fifty] fifty-five dollars. 646
(d) [The commissioner may issue an emergency medical technician 647
certificate,] On or after January 1, 2020, each person seeking 648
certification as an emergency medical responder [certificate or 649
advanced emergency medical technician certificate to an applicant 650
who presents] shall apply to the department on forms prescribed by 651
the commissioner. Applicants for certification shall comply with the 652
following requirements: (1) For initial certification, an applicant shall 653 Substitute Bill No. 1005
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present evidence satisfactory to the commissioner that the applicant 654
[(1) is currently certified as an emergency medical technician, 655
emergency medical responder, or advanced emergency medical 656
technician in good standing in any New England state, New York or 657
New Jersey, (2)] (A) has completed an initial training program 658
consistent with the National Emergency Medical Services Education 659
Standards, as promulgated by the National Highway Traffic Safety 660
Administration for the [emergency medical technician,] emergency 661
medical responder curriculum, [or advanced emergency medical 662
technician, and (3) has no pending disciplinary action or unresolved 663
complaint against him or her] and (B) has passed the emergency 664
medical responder examination administered by the national 665
organization for emergency medical certification or an examination 666
approved by the department, (2) for renewal certification, an applicant 667
shall present evidence satisfactory to the commissioner that the 668
applicant (A) has successfully completed continuing education for an 669
emergency medical responder as required by the national organization 670
for emergency medical certification or as approved by the department, 671
or (B) presents a current certification as an emergency medical 672
responder from the national organization for emergency medical 673
certification, or (3) for certification by endorsement from another state, 674
an applicant shall present evidence satisfactory to the commissioner 675
that the applicant (A) is currently certified as an emergency medical 676
responder in good standing by a state that maintains certification or 677
licensing requirements that the commissioner determines are equal to 678
or greater than those in this state, or (B) holds a current certification as 679
an emergency medical responder from the national organization for 680
emergency medical certification. 681
(e) [An emergency medical responder, emergency medical 682
technician, advanced emergency medical technician or emergency 683
medical services instructor shall be recertified every three years. For 684
the purpose of maintaining an acceptable level of proficiency, each 685
emergency medical technician who is recertified for a three-year 686
period shall complete thirty hours of refresher training approved by 687 Substitute Bill No. 1005
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the commissioner or meet such other requirements as may be 688
prescribed by the commissioner. The refresher training or other 689
requirements shall include, but not be limited to, training in 690
Alzheimer's disease and dementia symptoms and care.] On or after 691
January 1, 2020, each person seeking certification as an emergency 692
medical technician shall apply to the department on forms prescribed 693
by the commissioner. Applicants for certification shall comply with the 694
following requirements: (1) For initial certification, an applicant shall 695
present evidence satisfactory to the commissioner that the applicant 696
(A) has completed an initial training program consistent with the 697
National Emergency Medical Services Education Standards, as 698
promulgated by the National Highway Traffic Safety Administration 699
for the emergency medical technician curriculum, and (B) has passed 700
the emergency medical technician examination administered by the 701
national organization for emergency medical certification or an 702
examination approved by the department, (2) for renewal certification, 703
an applicant shall present evidence satisfactory to the commissioner 704
that the applicant (A) has successfully completed continuing education 705
for an emergency medical technician as required by the national 706
organization for emergency medical certification or as approved by the 707
department, or (B) presents a current certification as an emergency 708
medical technician from the national organization for emergency 709
medical certification, or (3) for certification by endorsement from 710
another state, an applicant shall present evidence satisfactory to the 711
commissioner that the applicant (A) is currently certified as an 712
emergency medical technician in good standing by a state that 713
maintains certification or licensing requirements that the commissioner 714
determines are equal to or greater than those in this state, or (B) holds 715
a current certification as an emergency medical technician from the 716
national organization for emergency medical certification. 717
(f) On or after January 1, 2020, each person seeking certification as 718
an advanced emergency medical technician shall apply to the 719
department on forms prescribed by the commissioner. Applicants for 720
certification shall comply with the following requirements: (1) For 721 Substitute Bill No. 1005
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initial certification, an applicant shall present evidence satisfactory to 722
the commissioner that the applicant (A) has completed an initial 723
training program consistent with the National Emergency Medical 724
Services Education Standards, as promulgated by the National 725
Highway Traffic Safety Administration for the advanced emergency 726
medical technician curriculum, and (B) has passed the advanced 727
emergency medical technician examination administered by the 728
national organization for emergency medical certification or an 729
examination approved by the department, (2) for renewal certification, 730
an applicant shall present evidence satisfactory to the commissioner 731
that the applicant (A) has successfully completed continuing education 732
for an advanced emergency medical technician as required by the 733
national organization for emergency medical certification or as 734
approved by the department, or (B) presents a current certification as 735
an advanced emergency medical technician from the national 736
organization for emergency medical certification, or (3) for certification 737
by endorsement from another state, an applicant shall present 738
evidence satisfactory to the commissioner that the applicant (A) is 739
currently certified as an advanced emergency medical technician in 740
good standing by a state that maintains certification or licensing 741
requirements that the commissioner determines are equal to or greater 742
than those in this state, or (B) holds a current certification as an 743
advanced emergency medical technician from the national 744
organization for emergency medical certification. 745
(g) On or after January 1, 2020, each person seeking certification as 746
an emergency medical services instructor shall apply to the 747
department on forms prescribed by the commissioner. Applicants for 748
certification shall comply with the following requirements: (1) For 749
initial certification, an applicant shall present evidence satisfactory to 750
the commissioner that the applicant (A) is currently certified by the 751
department as an emergency medical technician or advanced 752
emergency medical technician or licensed by the department as a 753
paramedic, (B) has completed a program of training as an emergency 754
medical instructor based on current national education standards 755 Substitute Bill No. 1005
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within the prior two years, (C) has completed twenty-five hours of 756
teaching activity under the supervision of a currently certified 757
emergency medical services instructor, (D) has completed written and 758
practical examinations as prescribed by the commissioner, (E) has no 759
pending disciplinary action or unresolved complaints against the 760
applicant, and (F) effective on a date prescribed by the commissioner, 761
presents documentation satisfactory to the commissioner that the 762
applicant is currently certified as an emergency medical technician, 763
advanced emergency medical technician or paramedic by the national 764
organization for emergency medical certification, or (2) for renewal 765
certification, an applicant shall present evidence satisfactory to the 766
commissioner that the applicant (A) has successfully completed 767
continuing education and teaching activity as required by the 768
department, (B) maintains current certification by the department as an 769
emergency medical technician, advanced emergency medical 770
technician or licensure by the department as a paramedic, and (C) 771
effective on a date as prescribed by the commissioner, presents 772
documentation satisfactory to the commissioner that the applicant is 773
currently certified as an emergency medical technician, advanced 774
emergency medical technician or paramedic by the national 775
organization for emergency medical certification. 776
(h) A certified emergency medical responder, emergency medical 777
technician, advanced emergency medical technician or emergency 778
medical services instructor shall document the completion of his or her 779
continuing educational requirements through the continuing 780
education platform Internet web site. 781
[(f)] (i) The commissioner may issue a temporary emergency 782
medical technician certificate to an applicant who presents evidence 783
satisfactory to the commissioner that (1) the applicant was certified by 784
the department as an emergency medical technician prior to becoming 785
licensed as a paramedic pursuant to section 20-206ll, or (2) the 786
applicant's certification as an emergency medical technician has 787
expired and the applicant's license as a paramedic has become void 788 Substitute Bill No. 1005
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pursuant to section 19a-88. Such temporary certificate shall be valid for 789
a period not to exceed one year and shall not be renewable. 790
[(g)] (j) An applicant who is issued a temporary emergency medical 791
technician certificate pursuant to subsection [(f)] (i) of this section may, 792
prior to the expiration of such temporary certificate, apply to the 793
department for: (1) Renewal of such person's paramedic license, giving 794
such person's name in full, such person's residence and business 795
address and such other information as the department requests, 796
provided the application for license renewal is accompanied by 797
evidence satisfactory to the commissioner that the applicant was under 798
the medical oversight of a sponsor hospital, as those terms are defined 799
in section 19a-175, as amended by this act, on the date the applicant's 800
paramedic license became void for nonrenewal; or (2) recertification as 801
an emergency medical technician, provided the application for 802
recertification is accompanied by evidence satisfactory to the 803
commissioner that the applicant completed emergency medical 804
technician refresher training approved by the commissioner not later 805
than one year after issuance of the temporary emergency medical 806
technician certificate. The department shall recertify such person as an 807
emergency medical technician without the examination required for 808
initial certification specified in regulations adopted by the 809
commissioner pursuant to section 20-206oo. 810
[(h) The commissioner may issue an emergency medical responder, 811
emergency medical technician or advanced emergency medical 812
technician certificate to an applicant for certification by endorsement 813
who presents evidence satisfactory to the commissioner that the 814
applicant (1) is currently certified as an emergency medical responder, 815
emergency medical technician or advanced emergency medical 816
technician in good standing by a state that maintains licensing 817
requirements that the commissioner determines are equal to, or greater 818
than, those in this state, (2) has completed an initial department-819
approved emergency medical responder, emergency medical 820
technician or advanced emergency medical technician training 821 Substitute Bill No. 1005
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program that includes written and practical examinations at the 822
completion of the course, or a program outside the state that adheres 823
to national education standards for the emergency medical responder, 824
emergency medical technician or advanced emergen cy medical 825
technician scope of practice and that includes an examination, and (3) 826
has no pending disciplinary action or unresolved complaint against 827
him or her. 828
(i) The commissioner may issue an emergency medical service 829
instructor certificate to an applicant who presents (1) evidence 830
satisfactory to the commissioner that the applicant is currently certified 831
as an emergency medical technician in good standing, (2) 832
documentation satisfactory to the commissioner, with reference to 833
national education standards, regarding qualifications as an 834
emergency medical service instructor, (3) a letter of endorsement 835
signed by two instructors holding current emergency medical service 836
instructor certification, (4) documentation of having completed written 837
and practical examinations as prescribed by the commissioner, and (5) 838
evidence satisfactory to the commissioner that the applicant has no 839
pending disciplinary action or unresolved complaints against him or 840
her.] 841
[(j)] (k) Any person certified as an emergency medical responder, 842
emergency medical technician, advanced emergency medical 843
technician or emergency medical services instructor pursuant to this 844
chapter and the regulations adopted pursuant to section 20-206oo 845
whose certification has expired may apply to the Department of Public 846
Health for reinstatement of such certification as follows: (1) If such 847
certification is expired [one year] for a period of two years or less, 848
[from the date of the application for reinstatement,] such person shall 849
complete the requirements for recertification specified in regulations 850
adopted pursuant to section 20-206oo; or (2) [if such recertification 851
expired more than one year but less than three years from the date of 852
application for reinstatement, such person shall complete the training 853
required for recertification and the examination required for initial 854 Substitute Bill No. 1005
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certification specified in regulations adopted pursuant to section 20-855
206oo; or (3)] if such certification is expired [three or] for a period of 856
more than two years, [from the date of application for reinstatement,] 857
such person shall complete the requirements for initial certification set 858
forth in this section. Any certificate issued pursuant to this section 859
shall remain valid for ninety days after the expiration date of such 860
certificate and become void upon the expiration of such ninety-day 861
period. 862
[(k)] (l) The Commissioner of Public Health shall issue an 863
emergency medical technician certification to an applicant who is a 864
member of the armed forces or the National Guard or a veteran and 865
who (1) presents evidence satisfactory to the commissioner that such 866
applicant holds a current certification as a person entitled to perform 867
similar services under a different designation by the National Registry 868
of Emergency Medical Technicians, or (2) satisfies the regulations 869
promulgated pursuant to subdivision [(4)] (3) of subsection (a) of 870
section 19a-179. Such applicant shall be exempt from any written or 871
practical examination requirement for certification. 872
[(l)] (m) For the purposes of this section, "veteran" means any 873
person who was discharged or released under conditions other than 874
dishonorable from active service in the armed forces and "armed 875
forces" has the same meaning as provided in section 27-103. 876
Sec. 14. Section 20-195ff of the general statutes is repealed and the 877
following is substituted in lieu thereof (Effective July 1, 2019): 878
The Commissioner of Public Health may adopt regulations, in 879
accordance with the provisions of chapter 54, to further the purposes 880
of subdivision (18) of subsection (c) of section 19a-14, subsection (e) of 881
section 19a-88, subdivision [(15)] (14) of section 19a-175, as amended 882
by this act, subsection (b) of section 20-9, sections 20-195aa to 20-195ff, 883
inclusive, and sections 20-206jj to 20-206oo, inclusive, as amended by 884
this act. 885 Substitute Bill No. 1005
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Sec. 15. Subdivision (14) of section 20-9 of the general statutes is 886
repealed and the following is substituted in lieu thereof (Effective July 887
1, 2019): 888
(14) Any person rendering service as a physician assistant licensed 889
pursuant to section 20-12b, a registered nurse, a licensed practical 890
nurse or a paramedic, as defined in subdivision [(15)] (14) of section 891
19a-175, as amended by this act, acting within the scope of regulations 892
adopted pursuant to section 19a-179, if such service is rendered under 893
the supervision, control and responsibility of a licensed physician; 894
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2019 19a-175
Sec. 2 July 1, 2019 19a-177(6) to (8)
Sec. 3 July 1, 2019 19a-178a(b)
Sec. 4 July 1, 2019 19a-180(a)
Sec. 5 July 1, 2019 19a-180(i) to (l)
Sec. 6 July 1, 2019 19a-180b(a) and (b)
Sec. 7 July 1, 2019 19a-180d
Sec. 8 July 1, 2019 19a-181b(a)
Sec. 9 July 1, 2019 19a-182(b)
Sec. 10 July 1, 2019 19a-183
Sec. 11 July 1, 2019 20-206kk(c)
Sec. 12 July 1, 2019 20-206jj
Sec. 13 July 1, 2019 20-206mm
Sec. 14 July 1, 2019 20-195ff
Sec. 15 July 1, 2019 20-9(14)
Statement of Legislative Commissioners:
In Section 12(9), "and" was bracketed, and in Section 12(10), "; and" was
added for grammatical correctness.
PH Joint Favorable Subst. -LCO