The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 466
INTRODUCER: Senator Torres
SUBJECT: Military Medics and Corpsmen of Florida Program
DATE: January 12, 2022
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Van
Winkle
Brown
HP
Pre-meeting
2. MS
3. AP
I. Summary:
SB 466 creates the Military Medics and Corpsman of Florida (MMACOF) program in the
Florida Department of Veterans’ Affairs (DVA), and requires the DVA, in collaboration with the
Department of Health (DOH), to establish and administer a program dedicated to offering
veterans career pathways to employment in health care if they meet certain requirements.
The bill requires the DVA to recruit and review the eligibility of veterans and to refer eligible
veterans to participating health care providers to gain employment, maintain medical skills,
address the shortage of health care professionals in this state, and work toward obtaining
appropriate health care registration, certification, or licensure. The program permits certain
veterans with clinical skills to practice medicine and nursing without a license while supervised
by health care practitioners.
The bill provides an effective date of July 1, 2022.
II. Present Situation:
Florida Department of Veterans’ Affairs (DVA)
The Legislature created the DVA to assist all former, present, and future members of the U.S.
Armed Forces and their dependents in preparing claims for and securing compensation,
hospitalization, career training, and other benefits or privileges to which they are, or may
become, entitled to under federal or state law by reason of their service in the U.S. Armed
Forces. All services rendered under the DVA must be without charge to the claimant.
1
More than
1
Section 292.05(1), F.S.
REVISED: BILL: SB 466 Page 2
1.5 million veterans currently live in Florida, making the state’s veteran population the third
largest nationally.
2
United States Armed Forced
The U.S. Armed Forces are made up of the six military branches: Air Force, Army, Coast
Guard,
3
Marine Corps, Navy and, most recently, the Space Force. There are three general
categories of military personnel: active duty (full-time soldiers and sailors); reserve & guard
forces (usually working in civilian jobs but can be called to full-time active duty); and veterans
and retirees (past members of the military). Additionally, there are the millions of family
members of military members, past and present. The President of the United States is the
commander in chief of the U.S. Armed Forces and is responsible for all final decisions. The
secretary of the U.S. Department of Defense (DOD) has control over the military and each
branch, except the Coast Guard, which is under the Department of Homeland Security (DHS).
With more than two million civilian and military employees, the U.S. DOD is the world's largest
employer.
4
Enlisted Members vs. Officers
Joining the U.S. Armed Forces as an enlisted member or an officer has a significant impact on
the type of experience and training a new recruit receives. All enlisted jobs require a high school
diploma, although, with certain exceptions, a passing General Education Development (GED)
test score is acceptable. While enlisted careers do include infantry roles, most jobs involve
hands-on training for mechanical, transportation, human service, or office fields that transfer
well to the civilian world.
Almost all officer positions require a four-year college degree or equivalent. Officers are the
managers of the military, acting in leadership roles that require planning, directing operations,
and making critical decisions. Officer positions also include careers that require advanced
degrees, such as law and medicine.
5
Enlisted Personnel
Each branch of the U.S. Armed Forces employs its own unique set of titles for its various
enlisted personnel, and all branches of the service utilize the same test to assign Advanced
Individualized Training (AIT) to new recruits, though different branches use different
2
Florida Department of Veterans’ Affairs, Our Veterans, available at http://floridavets.org/our-veterans/ (last visited Dec. 8,
2021).
3
The Coast Guard was originally part of the U.S. Department of Transportation (DOT), but after the terrorist attacks of
September 11, 2001, President George W. Bush established the Department of Homeland Security (DHS), and the Coast
Guard was transferred from civilian leadership to military leadership as part of DHS in 2003. United States Coast Guard,
Historian's Office—Timeline 1900s-2000s, available at https://www.history.uscg.mil/Complete-Time-Line/Time-Line-1900-
2000/ (last visited Jan. 9, 2022).
4
Military.com, What Are the Branches of the US Military? available at https://www.military.com/join-armed-forces/us-
military-branches-overview.html (last visited Dec. 8, 2021).
5
Today’s Military, Enlisted and Officer Paths, available at https://www.todaysmilitary.com/ways-to-serve/enlisted-officer-
paths (last visited Dec. 8, 2021). BILL: SB 466 Page 3
classification systems. The U.S. Army and Marines use the MOS Job Line Categories,
6
the Navy
and Coast Guard use job “Ratings” categories, though not the same ones,
7,8
and the Air Force
and Space Force both use MOS and Air Force Specialty Codes (AFSC).
For the sake of brevity, this analysis will use the U.S. Army, the country’s oldest military branch,
as the generic model for the basic discussion of the recruitment process in the U.S. Armed Forces
as it pertains to medics, hospital corpsmen, and medical technicians, generally, recognizing that
each service branch has its own unique nuances and requirements.
To become an enlisted soldier in the U.S. Army, a person must:
Be U.S. citizen or permanent resident with a valid Green Card (Permanent Resident Card);
Be between 17-35 years old;
Achieve a minimum score on the Armed Services Vocational Aptitude Battery (ASVAB)
exam;
Meet medical, moral, and physical requirements; and
Be a high school graduate or equivalent, in most cases.
Officers
Becoming an Army officer is different from enlisting as a soldier. Officers are responsible for
leading soldiers and planning missions. Training and initial requirements for accepting a
commission as an officer vary, but generally, to qualify a person must:
Be a college graduate by the time he or she is commissioned as an officer;
Be between 18 and 32 years old;
Meet medical, moral, and physical requirements; and
Be eligible for a secret security clearance.
If a person is qualified, there are four main paths to becoming an Army officer:
The Army Reserve Officers’ Training Corps (ROTC);
Direct commission;
Officer Candidate School (OCS); or
Attending the U.S. Military Academy.
9
Basic Training
No matter which branch of the U.S. Armed Forces a recruit choses, he or she will go to basic
training. Basic training, often called boot camp, prepares recruits for all elements of service:
6
See Operation Military Kids, Army, Army Combat Medic Specialist (MOS 68W): Career Details, available at
https://www.operationmilitarykids.org/army-combat-medic-specialist-mos-68w/ (last visited Jan. 7, 2022); Operation
Military Kids, Marines, Marine Corps MOS List And ASVAB Scores, available at
https://www.operationmilitarykids.org/marine-corps-mos-list-asvab-scores/ (last visited Jan. 9, 2022).
7
The Balancecareers.com, Careers, Navy Jobs, Navy Hospital Corpsman (HM) Enlisted Ratings available at
https://www.thebalancecareers.com/hospital-corpsman-3345823 (last visited Jan. 11, 2022).
8
The Balancecareers.com, U.S. Military Careers, Military Branches, Pros and Cons of Enlisting in the Coast Guard, available
at https://www.thebalancecareers.com/pros-cons-enlisting-in-coast-guard-4061204#toc-coast-guard-requirements (last visited
Jan. 11, 2022).
9
U.S. Army, Learn How to Join, Army Eligibility Requirements, available at https://www.goarmy.com/learn/understanding-
the-asvab.html (last visited Jan. 7, 2022). BILL: SB 466 Page 4
physical, mental, and emotional. It gives service members the basic tools necessary to perform
the roles that will be assigned for the duration of their tour. Each of the services has its own
training program, tailoring the curriculum to the specialized nature of its role in the Military. The
length of basic training varies from eight to 13 weeks, depending on the branch of the service.
Basic training includes daily cardio, weight training, pushups and sit-ups.
10
Armed Services Vocational Aptitude Battery (ASVAB)
As previously noted, all potential U.S. Armed Force members, during the recruiting process,
must take the ASVAB exam, which is administered while the recruit is at the Military Entrance
Processing Station (MEPS). The ASVAB exam is a multiple-choice exam that helps determine
the military careers for which an individual is best suited. There are two versions of the test:
The enlistment version, which is given at a MEPS
11
and is used for recruiting purposes only;
The student version, also known Career Exploration Program (CEP), used for career
exploration, which is given in high schools and community colleges, at job corps centers, and
at correctional facilities.
12
The ASVAB exam is a series of subtests to help the Army and Marines determine what MOS job
classification, what Rating in the Navy,
13,14,15
or what Air Force Specialty Code (AFSC) in the
Air Force and Space Force, an individual might be best qualified for. It is an aptitude test, not an
intelligence test. The ASVAB exam has two different scores and is divided into different
sections:
Arithmetic Reasoning (AR): Measures ability to solve basic arithmetic word problems;
Assembling Objects (AO): Measures ability with spatial relationships;
Auto & Shop Information (AS): Measures knowledge of automotive maintenance and repair,
as well as wood and metal shop practices;
10
Today’s Military, Boot Camp, available at https://www.todaysmilitary.com/joining-eligibility/boot-camp (last visited Dec.
8, 2021).
11
Today’s Military, Enlisting in the Military, available at https://www.todaysmilitary.com/joining-eligibility/enlisting-
military (last visited Dec. 8, 2021). The MEPS is a joint Service organization that determines an applicant's physical
qualifications, aptitude and moral standards as set by each branch of military service. There are MEPS locations all over the
country.
12
Operation Military Kids, Navy HM Hospital Corpsman: Everything You Wanted To Know (Dec. 19, 2019) available at
https://www.operationmilitarykids.org/navy-hospital-corpsman/#what-does-it-take-to-become-a-corpsman-in-the-navy (last
visited Dec. 8, 2021).
13
The Balancecareers.com, Military Branches, U.S. Navy, Navy Careers: What You Need to Know About Navy Enlisted
Ratings, (update Sept. 20, 2019) available at https://www.thebalancecareers.com/navy-enlisted-rating-job-descriptions-
3345844 (last visited Jan, 9, 2022). When it comes to Navy jobs, the sea service uses a different language than most
industries. You might hear references to Navy MOS, or Military Occupational Specialties, but the most common way to refer
to enlisted jobs is with the term "ratings."
14
The U. S. Marines do not have a dedicated medical corps, but use Navy corpsmen (HS) as their medical support personnel.
Corpsman train as soldiers as well as medical technicians, and serve alongside both Navy and Marine forces. They work in
medical settings in the field, in military hospitals and in medical clinics and ships. McQuerrey, Lisa, CHRON, What Is a
Corpsman in the Marines? (updated Jul. 1, 2018), available at https://work.chron.com/corpsman-marines-6677.html (last
visited Jan .9, 2022).
15
Unlike the Army, Navy and Air Force, the Coast Guard does not have a dedicated medical corps. However, a yeoman can
still pursue a career in health care with the Coast Guard, because the enlisted member’s AIT rating for the health services
technicians (HS), who is an enlisted Navy hospital corpsman (HM), who serve in a U. S. Coast Guard unit. Eliodoro Reinol,
Askinglot, updated Jan. 3, 2020, What is a corpsman in the Coast Guard? available at https://askinglot.com/what-is-a-
corpsman-in-the-coast-guard (last visited Jan. 9, 2022). BILL: SB 466 Page 5
Electronics Information (EI): Measures knowledge of electrical current, circuits, devices, and
electronic systems;
General Science (GS): Measures knowledge of life science, earth and space science, and
physical science;
Mathematics Knowledge (MK): Measures knowledge of mathematical concepts and
applications;
Mechanical Comprehension (MC): Measures knowledge of the principles of mechanical
devices, structural support, and properties of materials;
Paragraph Comprehension (PC): Measures ability to obtain information from written
material; and.
Word Knowledge (WK): Measures ability to understand the meaning of words through
synonyms.
The Armed Forces Qualification Test (AFQT) score includes arithmetic reasoning, mathematics
knowledge, word knowledge, and paragraph comprehensions, and is used to determine if an
individual is qualified at all to serve in any branch of the military. A recruit’s score on the
remaining aptitude subtests are used for job placement. All nine ASVAB subtests are scored as a
percentile in relation to how well the recruit did in comparison with all other recruits who took
the same ASVAB test.
16,17
The Army currently has the longest list of available MOS job line categories.
18
The Army offers
over 150 MOS specialties and uses the aforementioned subtest categories to create MOS job line
categories relevant to the type of jobs a recruit is best qualified for, as follows:
MOS Job Line Categories ASVAB Subtests Most Relevant to MOS
Clerical (CL) AR, MK, VE
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Combat (CO) AR, AS, CS, and MC
Electronics (EL) AR, EI, GS, and MK
Field Artillery (FA) AR, CS, MC, and MK
General Maintenance (GM) AS, EI, GS, and MK
General Technical (GT) AR and VE
Mechanical Maintenance (MM) AS, EI, and MC
Operators & Food (OF) AS, MC, and VE
Surveillance & Communications (SC) AR, AS, MC, and VE
Skilled Technical (ST) GS, MC, MK, and VE
16
Operation Military Kids, General Military Questions, ASVAB Scores and the Military Jobs that Qualify, available at
https://www.operationmilitarykids.org/asvab-scores-and-the-military-jobs-that-qualify/#army-asvab-scores (last visited Jan.
6, 2022).
17
U.S. Army, Learn How to Join, Understanding the ASVAB Test, available at
https://www.goarmy.com/learn/understanding-the-asvab.100-0-99-0-0-110-0-99-0-101.results.html (last visited Jan. 7, 2022).
18
. Operation Military Kids, General Military Questions, ASVAB Scores and the Military Jobs that Qualify, available at
https://www.operationmilitarykids.org/asvab-scores-and-the-military-jobs-that-qualify/#army-asvab-scores (last visited Jan.
6, 2022).
19
Id. VE, or Verbal Expression, is the sum of PC and WK. BILL: SB 466 Page 6
Military Health Care Education
After a recruit attends boot camp, Army AIT is mandatory. AIT teaches critical job skills needed
to serve the military in the recruit’s assigned MOS job line. This is where the technical training
begins at the Medical Education and Training Campus (METC) at Fort Sam Houston, Texas,
where medical personnel from all branches of the service learn and refine their skills. METC has
48 medical programs, 16,500 graduates a year, and is a state-of-the-art U.S. DOD health care
education campus that trains enlisted medical personnel. Training times vary depending upon a
recruit's progress and individual MOS, Rating, or AFSC career track.
20
Army Combat Medic Specialist (CMS)
A CMS, MOS 68W job, trains as a soldier responsible for providing emergency medical
treatment at the point of a soldiers’ wounding on the battlefield. Soldiers in this MOS line also
assist with limited primary care and health protection. They provide evacuation of patients from
a point of injury.
21
A CMS administers emergency medical care in humanitarian situations,
serves as a first responder and triages illnesses and injuries to save lives in many situations. A
CMS is also trained to train other soldiers in lifesaving and first responder courses.
22
Qualifications and Training
A CMS is an entry-level position that requires basic physical and medical evaluations. A soldier
desiring a career as a CMS must receive a minimum score of 101 on the ST and 107 on the GT
portions of the ASVAB test. After entry-level testing, a CMS candidate will attend AIT for 16
weeks which will include practice in patient care. After AIT, the CMS candidate must obtain
certification from the National Registry of Emergency Medical Technicians (EMT) to begin his
or her career as a CMS soldier in the U.S. Army.
23
A CMS is trained to perform necessary medical care in battlefield situations and has been trained
in specific skills to perform under physician supervision or protocols, as follows:
Take vital signs;
Ambulance operations and patient transport;
Emergency situation assessment (triage);
Injury identification and temporary resolution protocols to stabilize a patient for transport;
Insert IVs;
Apply a tourniquet;
Suture a wound;
Perform cardiopulmonary resuscitation (CPR);
Administer oxygen;
20
Medical Education and Training Campus, Welcome to the Medical Education & Training Campus (METC), available at
www.metc.mil (last visited Jan. 7, 2022).
21
Operation Military Kids, Army, Army Combat Medic Specialist (MOS 68W): Career Details, available at
https://www.operationmilitarykids.org/army-combat-medic-specialist-mos-68w/ (last visited Jan. 7, 2022).
22
U. S. Army, Careers & Jobs, Search Careers & Jobs, Career Match, Science Medicine, Intensive Care, Combat Medic
Specialist (68W), available at https://www.goarmy.com/careers-and-jobs/career-match/science-medicine/intensive-care/68w-
combat-medic-specialist.html (last visited Jan. 7, 2022).
23
Operation Military Kids, Army, Army Combat Medic Specialist (MOS 68W): Career Details, available at
https://www.operationmilitarykids.org/army-combat-medic-specialist-mos-68w/ (last visited Jan. 7, 2022). BILL: SB 466 Page 7
Take and prepare blood samples for laboratory analysis;
Administer injections, vaccines, and medications;
Manage a patient’s airway;
Stop hemorrhaging;
In a healthcare setting, a CMS is trained to:
o Assist a doctor or nurse;
o Prepare patients for surgery;
o Prepare equipment and supplies for surgery;
o Prepare and clean a room after a patient visit; and
o Keep health records and files up-to-date.
24
Navy and Marine
25
Hospital Corpsman (HM)
Only U.S. citizens can enlist to serve in the U.S. Navy to be a hospital corpsman (HM). Like
U.S. Army recruits, Navy recruits must complete the ASVAB exam at the MEPS, and basic
training.
Qualifications and Training
The minimum ASVAB exam scores associated with the Navy rating for HM jobs is 156; a
combination of the recruit’s VE (which is the combination of the WK and PC scores), plus the
MK and GS.
26
Upon completion of the initial seven to nine weeks of boot camp at Command Great Lakes,
Illinois, an HM recruit reports for AIT including Hospital Corpsman “A” School, which is 19
weeks at the METC, in San Antonio, Texas, for training on basic principles and techniques of
patient care and first aid procedures. Advanced technical training, or “C” school, is optional and
available to those who qualify after “A” School training is completed.
An HM assists in a wide range of departments and procedures, from dispensing vaccines and
analyzing lab samples to aiding in dental operations and assisting in emergency surgeries.
27
Currently, an HM graduates from an approved EMT course while attending his or her “A”
school, the initial job-specific training at METC, which meets the entry requirement for national
certification, but the Navy does not require sailors to test at that time.
28
24
Id.
25
The United States Marines actually use Navy corpsmen as their medical support professionals. Corpsman train as soldiers
as well as HMs, and serve alongside both Navy and Marine forces. McQuerrey, Lisa, CHRON, What Is a Corpsman in the
Marines? (updated Jul. 1, 2018), available at https://work.chron.com/corpsman-marines-6677.html (last visited Jan .8, 2022).
26
America’s Navy, Hospital Corpsman, available at https://www.navy.com/careers/hospital-corpsman (last visited Jan. 8,
2022); The Balancecareers.com, Military Branches, U.S. Navy, Navy Careers: What You Need to Know About Navy Enlisted
Ratings, (update Sept. 20, 2019) available at https://www.thebalancecareers.com/navy-enlisted-rating-job-descriptions-
3345844 (last visited Jan, 9, 2022).
27
Id.
28
Iorn-Set, Are Navy corpsman EMT certified? available at https://iron-set.com/us/what-rank-is-a-corpsman-in-the-
navy/#:~:text=Men%20and%20women%20between%2017%20and%2034%20years,must%20have%20a%20high%20school
%20diploma%2C%20at%20minimum (last visited Jan. 8, 2022). BILL: SB 466 Page 8
An HM assists health care professionals in providing medical care to Navy personnel and their
families. They function as clinical or specialty technicians, medical administrative personnel, and
health care providers at medical treatment facilities. Specifically, HMs may be called upon to:
Perform emergency medical treatment on SEALs, Seabees, Marines, and other military
personnel injured in the field, as well as on sailors aboard ships or aircraft;
Perform emergency dental treatment as well as construct dental crowns and bridges, process
dental X-rays, and operate X-ray equipment;
Serve as an operating room technician for general and specialized surgery;
Help administer a wide range of preventive care and medications, including immunizations
and intravenous fluids;
Conduct physical examinations and assist in the treatment of diseases and injuries;
Supervise sanitation and safety conditions in the workplace;
Maintain patient treatment records, conduct research and perform clinical tests;
Assist Navy physicians and nurses in a variety of medical fields, including, but not limited
to:
o Radiology;
o Physical therapy;
o Phlebotomy;
o Dental;
o Surgery;
o Family medicine;
o Pathology; and
o Women’s health.
29
The Navy and Marines utilize at least 38 Navy Enlisted Classifications (NEC) associated with
HM Ratings which include the following various types HMs:
Search and Rescue Medical Technician;
Submarine Force Independent Duty Corpsman;
Fleet Marine Force Reconnaissance Independent Duty Corpsman;
Field Medical Service Technician;
Aerospace Medical Technician;
Surface Force Independent Duty Corpsman; and
Fleet Marine Force Reconnaissance Corpsman.
Air Force and Space Force Aerospace Medical Service Technician (AMST)
The generic medic in the Air Force and Space Force is equivalent to a medic in the Army or a
corpsman in the Navy and has the job title Aerospace Medical Service Technician (AMST).
30
Potential Air Force and Space Force AMST recruits must also take the ASVAB exam and go
through the MEPS tests to assess the recruit’s physical and moral standards as set by the Air
29
America’s Navy, Hospital Corpsman, available at https://www.navy.com/careers/hospital-corpsman (last visited Jan. 8,
2022); Balancecareers.com, Military Branches, U.S. Navy, Navy Careers: What You Need to Know About Navy Enlisted
Ratings, (update Sept. 20, 2019) available at https://www.thebalancecareers.com/navy-enlisted-rating-job-descriptions-
3345844 (last visited Jan, 9, 2022).
30
Balancecareers.com, Air Force Enlisted Medical Careers, Aerospace Medical Service Technician, available at
https://www.thebalancecareers.com/air-force-enlisted-medical-careers-2356501 (last visited Jan. 9, 2022). BILL: SB 466 Page 9
Force and Space Force, the U.S. DOD, and federal law.
31
All Air Force and Space Force recruits
go for basic training at the Air Force BMT facility located at Lackland Air Force Base, San
Antonio, Texas.
32
Education and Training
The Air Force and Space Force categorize enlisted jobs using either the MOS or AFSC
categories. Both judge potential recruits in four areas: Administrative (A); Electronics (E);
General (G); and Mechanical (M). With the exception of the Coast Guard, the Air Force requires
the highest ASVAB exam scores for entry and requires candidates to have a minimum AFQT
test score of 36 with a high school diploma or a minimum AFQT test score of 50 with a GED.
33
The Air Force and Space Force train their AMSTs at METC starting with the Aerospace Medical
Service Apprentice (AMSA) program, which provides the recruits with a basic knowledge,
through simulated and clinical training, of various aspects in emergency, nursing, and primary
care. Subjects include BLS, medical terminology, anatomy and physiology, EMT curriculum, as
well as various aspects of nursing and primary patient care. Outcome-based practice and safety
techniques are emphasized throughout the program. The program consists of lectures, group
activities, demonstrations, hands-on instruction, and clinical practice. Performance exercises,
written examinations, and clinical and practicum are used to assess accumulation and retention of
knowledge and skills. Lecture, demonstration, online materials, simulations, and laboratory
practice are utilized throughout the program.
The program provides graduates with technical skills and knowledge required to achieve entry-
level AMST task requirements and prepares the recruits for the required certification from the
National Registry of EMTs. AMST recruits must pass the national certification/examination to
serve as an AMST. The program prepares the recruit to perform inpatient and outpatient
operations in both traditional and non-traditional settings. The program is made up of the
following courses:
Anatomy & Physiology;
EMT;
Basic Nursing; and
Advanced Nursing.
34
Coast Guard Health Service Technician (HS)
The Coast Guard accepts fewer new recruits than the other branches of the military, and
qualifying requirements are strict. In addition to basic citizenship and physical fitness
31
U.S. Air Force available at https://www.airforce.com/how-to-join/process/enlisted (last visited Jan. 8, 2022).
32
U.S. Space Force, Space Force News, Space Force Enlists First Trainees, Sends to Bootcamp, available at
https://www.spaceforce.mil/News/Article/2387089/space-force-enlists-first-trainees-to-bootcamp (last visited Jan. 9, 2022).
The Air Force BMT is 8.5 weeks and the Space Force is 7.5 weeks.
33
Operation Military Kids, ASVAB Scores For Air Force Jobs: All 130+ For 2021, available at
https://www.operationmilitarykids.org/asvab-scores-for-air-force-jobs/ (last visited Jan. 9, 2022).
34
Medical Education and Training Campus, Joint Base San Antonio, Fort Sam Houston, Texas, 2021
Program Catalog, Rev. Jun. 30, 2021, available at https://www.metc.mil/Academics/Catalog/ (last visited Jan. 9, 2022). BILL: SB 466 Page 10
prerequisites, the Coast Guard sets academic standards at will.
35
The Coast Guard requires a
minimum AFQT score of 36 to even be considered, and a minimum ASVAB exam score of 154
to be considered for an HS job classification.
36
The Coast Guard has 20 enlisted jobs ratings
divided into four categories.
37
The HS falls under the Administrative and Scientific job
category.
38
Education and Training
An HS receives five months of intense training at the HS "A" school in Petaluma, California.
The training is performance based and provides lectures, laboratory demonstrations, practical
exercises, and clinical experiences in the areas of anatomy, medical administration, basic clinical
laboratory procedures, asepsis and sterilization technique, preventive medicine, nursing skills,
pharmacy clinical sick call, wound repair, clinical services, leadership and management. The
school also teaches classes about medical management information systems including; the
Composite Health Care System, Provider Graphic User Interface and Medical Readiness
Reporting System. Currently the school also includes a seven-week basic course in EMT
training.
39
The Coast Guard HS provides emergency health care services and daily medical care for Coast
Guard personnel and their families. HS tasks include assisting medical and dental officers
performing diagnostic testing, X-rays, lab tests, prescribing medications, administering
immunizations, and performing minor surgical procedures. An HS is normally assigned to a
large Coast Guard clinic, small sick bay ashore, or aboard a cutter.
40
35
Balancecareers.com, U.S. Military Careers, Military Branches, Pros and Cons of Enlisting in the Coast Guard, Coast
Guard Requirements, available a https://www.thebalancecareers.com/pros-cons-enlisting-in-coast-guard-4061204#toc-coast-
guard-requirements (last visited Jan. 9, 2022).
36
The Balancecareers.com, U.S. Military Careers, Military Branches, Pros and Cons of Enlisting in the Coast Guard, Coast
Guard Requirements, available at https://www.operationmilitarykids.org/asvab-scores-for-coast-guard-jobs/ (last visited Jan.
9, 2022).
37
Id. The Coast Guard only used four job classifications: Deck and Ordnance; Hull and Engineering; Aviation; and
Administrative and Scientific.
38
The Balancecareers.com, U.S. Military Careers, Military Branches, Pros and Cons of Enlisting in the Coast Guard, Coast
Guard Job Opportunities, available at https://www.operationmilitarykids.org/asvab-scores-for-coast-guard-jobs/ (last visited
Jan. 9, 2022). Deck and Ordnance includes Maritime Enforcement Specialists (ME), Boatswain's Mate (BM), Gunner’s Mate
(GM), Operations Specialist (OS), and Intelligence Specialist (IS); Hull and Engineering includes Damage Controlman (DC),
Electrician’s Mate (EM), Electronics Technician (ET), Information System Technician (IT), and Machinery Technician
(MK); Aviation includes Avionics Electrical Technician (AET), Aviation Maintenance Technician (AMT), and Aviation
Survival Technician (AST); and Administrative and Scientific includes Food Service Specialist (FS), Health Services
Technician (HS), Marine Science Technician (MST), Musician (MU), Public Affairs Specialist (PA), Storekeeper (SK), and
Yeoman (YN).
39
Gocoastguard.com, Active Duty Careers, Enlisted Opportunities, View Job Descriptions, Health Service Technician (HS),
Training Available:, available at https://www.gocoastguard.com/active-duty-careers/enlisted-opportunities/view-job-
descriptions/hs (last visited Jan. 9, 2022).
40
Gocoastguard.com, Active Duty Careers, Enlisted Opportunities, View Job Descriptions, Health Service Technician (HS),
Training Available:, available at https://www.gocoastguard.com/active-duty-careers/enlisted-opportunities/view-job-
descriptions/hs (last visited Jan. 9, 2022). BILL: SB 466 Page 11
Federal Tort Claims Act (FTCA)
The FTCA, dating back to 1946, allows private parties to recover restitution for certain torts
committed by employees or agents of the U.S. government, including military health care
providers. The FTCA gives people the ability to hold the U.S. government responsible for
wrongdoing committed by its employees or agents in the course of their employment. The statute
of limitation for FTCA cases is two years. To prove negligence, the injured party must file a
claim with the appropriate federal agency within two years of the injury or death. The Act also
provides authority for the federal government to defend against such claims.
FTCA cases can involve several areas of personal injury law. The Act applies when someone is
injured in one of the following ways:
Military Base Hospitals Medical Malpractice;
Veterans Affairs (VA) Malpractice;
Military Truck or Vehicular Wreck;
Medical Malpractice at a Federally Funded Clinic;
Premises Liability on Federal Property;
Vehicle Accident Involving Federal Employee; and
Personal Injury by Federal Employee.
41
When someone is injured by a federal employee or by federal property, the claimant must bring
his or her lawsuit under the FTCA. Under the FTCA, the laws of the state where the accident
occurred control damages limitations. For example, in Florida, personal injury or medical
malpractice damages arising out of the same incident or occurrence are capped at $200,000 per
occurrence, or $300,000 in the aggregate. Punitive damages are prohibited. This is effectively
providing personal injury and, if applicable, medical malpractice insurance to all federal health
care practitioners.
42
Florida’s Department of Health (DOH)
The Legislature created the DOH to protect and promote the health, safety and welfare of all
residents and visitors in the state.
43
The DOH is charged with the regulation of health
practitioners for the preservation of the health, safety, and welfare of the public. The Division of
Medical Quality Assurance (MQA) is responsible for the boards
44
and professions within the
DOH.
45
41
28 U.S.C. ss. 2671-2680, 2021; The United States Department of Justice, Federal Tort Claims Act Litigation Section,
available at https://www.justice.gov/civil/federal-tort-claims-act-litigation-section (last visited Jan. 10, 2022).
42
Section 768.28, F.S.
43
Sections 20.43 and 456.003, F.S.
44
Under s. 456.001(1), F.S., “board” is defined as any board, commission, or other statutorily created entity, to the extent
such entity is authorized to exercise regulatory or rulemaking functions within the DOH or, in some cases, within the MQA.
45
Section 20.43, F.S. BILL: SB 466 Page 12
Health Care Practitioner Regulation
The DOH, Division of MQA, provides health care practitioner regulation and support to health
care licensure boards and councils. Boards are responsible for approving or denying an
applicant’s license based upon:
The applicants qualifications specified in statute;
Reviewing and approving continuing education courses and practitioners;
Promulgating administrative rules authorized by statute;
Determining probable cause in cases resulting from complaints; and
Disciplining practitioners found to be in violation of applicable laws.
The Division of MQA licenses and regulates seven types of health care facilities and more than
200 license types in over 40 professions, while partnering with 22 boards and four councils.
46
Health Care Practitioner Scope of Practice
The scope of practice for a regulated health care profession includes those activities and
procedures that a person with a specified level of education, training, and competency is
authorized to perform under the laws and rules of the state in which the person practices. Scope
of practice can also incorporate conditions that may limit the exercise of authorized activities and
procedures.
47
Licensed health care practitioners in Florida may only perform that which is
authorized by the scope of practice for their profession. Individuals who perform functions
outside of their scope of practice are subject to discipline. Individuals who perform tasks that are
specific to a scope of practice identified in Florida Statutes without the required licensure may be
considered to be performing unlicensed activities in violation of law.
48
46
The Department of Health, Senate Bill 466, 2022 Agency Legislative Bill Analysis (Dec. 8, 2021)(on file with the Senate
Committee on Health Policy).
47
Federation of State Medical Boards, Assessing Scope of Practice in Health Care Delivery,(Apr., 2005) available at
https://www.fsmb.org/search-results/?s=relevance&n=10&q=definition+of+scope+of+practice (last visited Dec. 8, 2021).
The Federation of State Medical Boards is a national non-profit association whose members include all medical licensing and
disciplinary boards in the United States, and the U.S. territories. The Federation acts as a collective voice for 70 member
medical boards in promoting high standards for medical licensure and practice. The Guidelines recommend that State
regulators and legislators review the following factors when considering scope of practice initiatives in the interest of public
health and patient safety: (1) The existence of a verifiable need for the proposed scope of practice change; (2) Existing scopes
of practice and the effect of requested changes on public health and safety; (3) Formal education and training purported to
support scope of practice changes and the existence of a formal process for accreditation; (4) Existing or proposed regulatory
mechanisms such as licensure, certification and registration; (5) The advisability of allowing independent practice or
requiring collaboration or supervision; (6) The advisability of interaction and cooperation between affected regulatory boards
in evaluating issues that involve multiple practitioners, in investigating complaints, and in recommending appropriate
discipline; (7) The requirements for full and accurate disclosure by all health care practitioners as to their qualifications to
provide health care services; (8) The accountability and liability issues relating to scope of practice changes; (9) The details,
rationale, and ethics of any proposals to bypass licensing or regulatory requirements in allowing scope of practice changes,
the implications for other practitioners, and the effect on patient safety; and (10) The financial impact and incentives related
to and affecting the scope of practice changes.
48
Section 456.072, F.S. BILL: SB 466 Page 13
Practice of Medicine
Allopathic Medicine
A physician is a person who is licensed to practice medicine in Florida. Practicing medicine
includes the diagnosis, treatment, operation, or prescription for any human disease, pain, injury,
deformity, or other physical or mental condition.
49
Allopathic standards of practice and standards of care for particular practice settings include, but
are not limited to, education and training, equipment and supplies, medications including
anesthetics, assistance of and delegation to other personnel, transfer agreements, sterilization,
records, performance of complex or multiple procedures, informed consent, and policy and
procedure manuals.
50
Osteopathic Medicine
An osteopathic physician is a person who is licensed to practice osteopathic medicine Florida.
The practice of osteopathic medicine includes the diagnosis, treatment, operation, or prescription
for any human disease, pain, injury, deformity, or other physical or mental condition, which
practice is based in part upon educational standards and requirements that emphasize the
importance of the musculoskeletal structure and manipulative therapy in the maintenance and
restoration of health.
51
Practicing or offering to practice osteopathic medicine beyond the scope permitted by law,
includes accepting and performing professional responsibilities which the licensee knows or has
reason to know that he or she is not competent to perform. The standards of practice and
standards of care for particular practice settings include, but are not limited to, education and
training, equipment and supplies, medications including anesthetics, assistance of and delegation
to other personnel, transfer agreements, sterilization, records, performance of complex or
multiple procedures, informed consent, and policy and procedure manuals.
52
The Practice of Nursing
The scope of practice for nursing varies based on the type of education and nursing licensure
held by the health care practitioner.
The Advance Practitioner Registered Nurse (APRN)
The scope of practice for an APRN includes performing acts of nursing diagnosis and nursing
treatment for alterations of the health status. The APRN may also perform acts of medical
diagnosis and treatment, prescription, and operation as authorized by the supervising physician
or dentist. These tasks include, but are not limited to:
Initiate appropriate therapies for certain conditions.
Order diagnostic tests and physical and occupational therapy.
49
Section 458.305, F.S.
50
Section 458.311(1)(c), F.S.
51
Section 459.003, F.S.
52
Section 459.015(1)(z), F.S. BILL: SB 466 Page 14
Order any medication for administration to a patient in certain licensed health care facilities.
Within his or her specialty, an APRN may also:
o Manage selected medical problems.
o Order physical and occupational therapy.
o Initiate, monitor, or alter therapies for certain uncomplicated acute illnesses.
o Monitor and manage patients with stable chronic diseases.
o Establish behavioral problems and diagnosis and make treatment recommendations.
53
The Autonomous Advanced Practice Registered Nurse (AAPRN)
The AAPRN may engage in autonomous practice only in primary care, including family
medicine, general pediatrics, and general internal medicine, in a manner that meets the General
Standard of Practice. The general standard of practice shall be that standard of practice, care,
skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as
acceptable and appropriate by reasonably prudent similarly situated, educated, and licensed
APRNs.
54,55
Primary care practice includes physical and mental health promotion, assessment,
evaluation, disease prevention, health maintenance, counseling, patient education, diagnosis and
treatment of acute and chronic illnesses, inclusive of behavioral and mental health conditions.
56
The Registered Nurse (RN)
The RN may perform acts requiring substantial specialized knowledge, judgment, and nursing
skill based upon applied principles of psychological, biological, physical, and social sciences
which shall include, but not be limited to:
The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of
care;
Health teaching and counseling of the ill, injured, or infirm;
The promotion of wellness, maintenance of health, and prevention of illness of others;
The administration of medications and treatments as prescribed or authorized by a duly
licensed practitioner legally authorized to prescribe such medications and treatments; and
The supervision and teaching of other personnel in the theory and performance of other
nursing tasks.
57
The Licensed Practical Nurse (LPN)
An LPN may perform selected acts, including:
The administration of treatments and medications, in the care of the ill, injured, or infirm;
The promotion of wellness, maintenance of health, and prevention of illness of others under
the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a
licensed podiatric physician, or a licensed dentist; and
The teaching of general principles of health and wellness to the public and to students other
than nursing students.
58
53
Section 464.003, F.S.
54
Section 464.0123, F.S.
55
Fla. Admin Code R. 64B9-4.021 and 64B9-4.020, (2021)
56
Fla. Admin. Code R. 64B9-4.001(12), (2021).
57
Section 464.003(19), F.S.
58
Section 464.003(18), F.S. BILL: SB 466 Page 15
The Certified Nursing Assistant (CNA)
A CNA may provide care and assistance to persons with tasks related to the activities of daily
living. These tasks includes personal care, maintaining mobility, nutrition and hydration,
toileting and elimination, assistive devices, safety and cleanliness, data gathering, reporting
abnormal signs and symptoms, postmortem care, patient socialization and reality orientation,
end-of-life care, cardiopulmonary resuscitation and emergency care, residents’ or patients’
rights, documentation of nursing-assistant services. Other tasks may be performed upon
completion of training beyond the minimum qualifications for initial certification and upon
validation of competence in that skill by an RN.
59
Emergency Medical Services (EMS)
The Legislature created ch. 401, F.S., in 1973 with the intent to establish a statewide organized
and regulated system of regional EMS providers with two major objectives:
To develop a statewide system of emergency medical telecommunications to maximize the
use of existing radio channels to provide faster and more effective EMS to the general
population;
60
and
To protect and enhance the public health, safety, and welfare with the establishment a state
wide EMS plan to:
o Monitor the quality of patient care delivered by each licensed service;
o Certify EMS personnel;
o Create an EMS advisory council;
o Develop a comprehensive statewide injury-prevention program; and
o Development minimum standards for EMS providers, personnel, vehicles, services,
medical direction and inspections.
61
The Legislature further recognized that a major impediment to meeting its two legislative
objectives for s. 401, F.S., was the inability of governmental and private agencies to respond
cooperatively in order to finance a system of regional EMS. In response, the Legislature found it
in the public interest to foster the development of a statewide EMS provider system and created
the Florida Emergency Medical Services Grant Act.
62
This law authorizes the DOH to make
grants to local agencies, EMS organizations, and youth athletic organizations to provide EMS,
including emergency medical dispatch, and work with local EMS organizations to expand the
use of automated external defibrillator (AED) devices.
63
Emergency Medical Service Providers
Every person, firm, corporation, association, or governmental entity owning or acting as agent
for the owner of any business or service which furnishes, operates, conducts, maintains,
advertises, engages in, proposes to engage in, or professes to engage in the business or service of
providing prehospital or interfacility advanced life support (ALS) services or basic life support
59
Section 464.201(5), F.S.
60
Section 401.013, F.S.
61
Section 401.211, F.S.
62
See ss. 401.101 and 401.104, F.S.
63
Section 401.111, F.S. BILL: SB 466 Page 16
(BLS) transportation services must be licensed as a BLS service or an ALS service, or both,
before offering such service to the public.
64
The Emergency Medical Technician (EMT)
An EMT is certified by the DOH to perform BLS techniques.
65
The BLS techniques includes the
treatment of medical emergencies by a certified EMT qualified in the use of techniques of patient
assessment, cardiopulmonary resuscitation (CPR), splinting, obstetrical assistance, bandaging,
administration of oxygen, application of medical anti-shock trousers, administration of a
subcutaneous injection using a premeasured auto-injector of epinephrine for an anaphylactic
reaction, and other techniques described in the U.S. DOT, EMT Basic Training Course
Curriculum (EMT-BTCC).
66
The Paramedic
A certified paramedic may perform both BLS and ALS.
67
ALS includes the assessment or
treatment by a certified paramedic qualified in the use of techniques such as endotracheal
intubation, the administration of drugs or intravenous fluids, telemetry, cardiac monitoring,
cardiac defibrillation, and other techniques described in the EMT-Paramedic National Standard
Curriculum or the National EMS Education Standards, pursuant to DOH administrative rules.
68
Any member of the U.S. Armed Forces, on active duty, who at the time he or she became a
member, was in good standing with the DOH, and certified to practice as an EMT or paramedic
in Florida remains in good standing without registering, paying dues or fees, or performing any
other act, as long as he or she is an active duty member of the U.S. Armed Forces, and for a
period of six months after he or she is discharge from active duty.
69
Qualifications for Licensure
Protection of the public is incumbent upon the accurate determination that a health care
professional is qualified to practice the health care profession for which they are seeking
licensure. Florida statutes delineate the minimum qualifications for each license based on the
profession and the associated scope of practice. However, all professions have the same general
categories of requirements for licensure, including:
Minimum educational requirements. This requirement may also encompass an internship
program or residency training.
Successful examination completion. Most health care professions require the successful
completion of a national examination to demonstrate competency.
Criminal history evaluation. All applicants are required to disclose prior criminal history,
professions identified in s. 456.0135, F.S., require electronic fingerprint submission. Certain
criminal activity reflected in the history may preclude licensure.
64
Section 401.25(1), F.S.
65
Section 401.23(11), F.S.
66
Section 401.23(7), F.S.
67
Section 401.23(17), F.S.
68
Section 401.23(1), F,S.
69
Section 401.2715, F.S. BILL: SB 466 Page 17
Disciplinary history evaluation. Disciplinary history evaluation includes all prior licensure in
any profession in any jurisdiction. Certain types of discipline may preclude licensure.
Health history evaluation. Applicants are required to disclose health history, including
evidence of impairment. Boards evaluate the disclosure to determine if the applicant is safe
to practice prior to making a final licensure determination.
Allopathic Medical Licensure (MD)
Licensure by examination for an MD, includes the following minimum education and
examination qualifications, with noted alternative methods to meet requirements:
Graduate of a U.S. allopathic medical school recognized by the U.S. Department of
Education and completion of one year of approved residency training; or
Graduate of an international allopathic medical school and have a valid Educational
Commission for Foreign Medical Graduates certificate and completion of a two-year
approved residency in one specialty area; or
Graduate of an international medical school except the internship or social service
requirement, passed parts I and II of the National Board of Medical Examiners (NBME) or
Educational Commission for Foreign Medical Graduates (ECFMG) equivalent examination,
and completed an academic year of supervised clinical training and completed 2 year
approved residency in one specialty area.
Passed all parts of a national examination (NBME, U.S. Medical Licensing Examination, or
Federation Licensing Examination); or
Currently licensed in the United States or Canada, and has actively practiced pursuant to such
licensure for at least 10 years, has passed a state board or Licentiate of the Medical Council
of Canada (LMCC) examination, and passed the Special Purpose Examination (SPEX); or
Licensed on the basis of a state board examination prior to 1974 and is currently licensed in
at least three other jurisdictions in the United States or Canada and practiced pursuant to such
licensure for at least twenty years.
70
Osteopathic Medical Licensure (DO)
Licensure as a DO physician includes the following minimum education and examination
qualifications, with noted alternative methods to meet requirements:
Graduate of an osteopathic medical school approved by the American Osteopathic
Association (AOA) and completion of an approved internship or a residency (not less than 12
months) accredited by the American Osteopathic Association or the Accreditation Council
for Graduate Medical Education. This requirement may be waived for an applicant who
matriculated in a college of osteopathic medicine during or before 1948.
Passed all three parts of the National Board of Osteopathic Medical Examiners (NBOME)
exam within five years of application or licensure in another state, or a substantially similar
exam approved by the Board.
If licensed in another state, have actively and continuously engaged in the practice of
osteopathic medicine for the period time after being initially licensed with interruption to
practice totaling no more than two years (or for a longer period of time if the Board
70
Section 458.311, F.S. BILL: SB 466 Page 18
determines that the interruption of the osteopathic physician’s practice has not adversely
affected the physician’s present ability and fitness to practice osteopathic medicine).
71
Advanced Practice Registered Nurse (APRN)
Licensure for an APRN, in accordance with s. 464.012, F.S., includes the following minimum
education qualifications, with noted alternative methods to meet requirements:
Applicants who graduated on or after October 1, 1998, must have completed requirements
for a master’s degree or post-master’s degree certification.
Certified Registered Nurse Anesthetist (CRNA) applicants who graduated on or after
October 1, 2001, must have completed requirements for a master’s degree program.
Applicants who graduated prior to the dates specified are exempt from this requirement.
After July 1, 2006, applicants for licensure as an APRN pursuant to s.464.012(1), F.S., shall
submit proof of national advanced practice certification from an approved nursing specialty
board.
Licensure for APRNs, in accordance with s. 464.012, F.S., includes the following minimum
education qualifications, with noted alternative methods to meet requirements:
Applicants who graduated on or after October 1, 1998, must have completed requirements
for a master’s degree or post-master’s degree certification;
Certified Registered Nurse Anesthetist applicants who graduated on or after October 1, 2001,
must have completed requirements for a master’s degree program;
Applicants who graduated prior to the dates specified are exempt from this requirement; and
After July 1, 2006, applicants for licensure as an APRN pursuant to s. 464.012(1), F.S., must
submit proof of national advanced practice certification from an approved nursing specialty
board.
Autonomous Advanced Practice Registered Nurse (AAPRN)
To register as an AAPRN, the requirements are as follows and can be found in s. 464.0123, F.S.:
Hold a clear, active, Florida APRN license;
Completed at least 3,000 clinical hours under the supervision of an allopathic or osteopathic
physician within the past five years. These hours may include clinical instructional hours.
72
Submit proof of three graduate-level semester hours (or the equivalent) in differential
diagnosis, and three graduate-level semester hours (or the equivalent)
73
in pharmacology,
completed within the last five years; and
Not have been subject to disciplinary action within the past five years;
Registered Nurse (RN) and Licensed Practical Nurse (LPN)
Licensure for an LPN and RN are in accordance with s. 464.003, F.S., and include the following
minimum education qualifications and exam requirements, with noted alternative methods to
meet requirements:
71
Section 458.311, F.S.
72
See s. 464.0123(1)(c), F.S. for complete requirements.
73
See Fla. Admin. Code R. 64B9-4.002(2), (2021).Three graduate-level semester hours are equivalent to forty-five (45)
Continuing Education credits offered by the entities set forth in Section 464.013(3)(b), F.S. BILL: SB 466 Page 19
Graduation from a Florida approved, or accredited LPN or RN nursing education program as
defined in s. 464.003, F.S.;
Graduation form an Accreditation Commission for Education in Nursing (ACEN) or
Commission on Collegiate Nursing Education (CCNE) accredited LPN or RN nursing
program that has been issued a National Council Licensure Examination (NCLEX) code by
the National Council of State Boards of Nursing (NCSBN);
Graduation from an LPN or RN nursing education program that is approved or recognized by
the jurisdiction in which it is based and that has been issued an NCLEX code by the NCBSN;
Graduation from a military nursing education program that has been issued an NCLEX code
by NCSBN;
Graduation from a generic Master of Science in Nursing (MSN) or higher program that has
been issued an NCLEX code by NCSBN;
Graduation from a non-NCSBN jurisdiction (e.g. Puerto Rico), or international nursing
education program that the Board of Nursing determines to be equivalent to an approved
program; or
There are specific qualifications related to Canadian Registered Nurses who took the
Canadian Nurses Association Testing Service (CNATS) Examination; or
Successful completion of courses in a registered nursing education program that are
equivalent to a practical nursing education program – Practical Nurse Examination based on
practical nursing Equivalency (PNEQ).
An LPN or RN may also qualify for licensure in Florida by meeting endorsement qualifications
(holding a valid license in another state and meeting other minimum qualifications) or by Nurse
Licensure Compact.
Certified Nursing Assistant (CNA)
Qualifications for a CNA are in accordance with s. 464.203, F.S., includes the following
minimum education qualifications and exam requirements, with noted alternative methods to
meet requirements:
Successful completion of an approved training program and achieved a minimum score on
the nursing assistant competency examination. The examination consists of a written portion
and skills-demonstration portion approved by the board and administered at a site and by
personnel approved by the DOH;
Achieve a minimum score, established by rule of the board, on the nursing assistant
competency examination, and has a high school diploma, or its equivalent; or is at least 18
years of age;
Completion of the curriculum developed under the Enterprise Florida Jobs and Education
Partnership Grant and achieved a minimum score on the nursing assistant competency
examination; or
CNAs may qualify for licensure by endorsement if they are currently certified in another
state or territory of the United States or District to of Columbia and successfully complete
criminal history and discipline history requirements.
BILL: SB 466 Page 20
Emergency Medical Technicians (EMT)
Qualifications for an EMT are in accordance with s. 401.27, F.S., and include the following
minimum requirements:
Out of state or military applicants trained in accordance with either the 1994 U.S. DOT
EMT-Basic National Standard Curriculum or the January 2009 U.S. DOT National EMS
Education Standards and currently hold a valid EMT certification from the National Registry
of Emergency Medical Technicians (NR-EMT);
Completion of an emergency medical technician training course equivalent to the most recent
emergency medical technician basic training course of the U.S. DOT, within one year after
course completion have passed an examination for an emergency medical technician, hold
either a current American Heart Association cardiopulmonary resuscitation course card or an
American Red Cross cardiopulmonary resuscitation course card or its equivalent.
To be eligible for an EMT certification in Florida, an applicant must:
Submit a completed application;
Submit proof to the Certification Unit of meeting the required professional education in one
of the following ways:
o Florida Trained – Successful completion of EMT course from a DOH approved program
within two years of passing the examination;
o Out-of-State Trained – Submit proof of current NR-EMT certification;
o Florida Paramedic Certification. A Florida certified paramedic may use his or her
paramedic certificate, provided that it is current and in good standing, to satisfy the
professional education requirements for certification as an EMT; or
o If the applicant was initially trained in Florida, received a Florida EMT certification, but
did not maintain the certification, the applicant may apply by Out of State Certification
and submit a copy of one of the following to the Certification Unit:
An American Red Cross CPR for Professional Rescuer card;
An American Heart Association BLS for the Healthcare Provider;
A CPR equivalent certification from an organization approved by the Bureau of EMS
pursuant to Florida Administrative Code Rule 64J-1.022.
74
Paramedic
To be eligible for a paramedic certification in Florida, an applicant must:
Submit a completed Application;
Possess a high school diploma or GED;
Submit proof to the Certification Unit of meeting the required professional education in one
of the following ways:
o Florida Trained - Successful completion of a paramedic course from an approved
program within two years of passing the examination. If the course was taken more than
two years before you passed the examination it will not be accepted;
o Out of State Certification – An applicant must submit proof of current NR-EMT
certification; or
74
Section 401.25, F.S.; Fla. Admin C. Rule 64J-1.008, (2021); Florida Department of Health, Licensing and Regulation,
EMT and Paramedics, Licensing, Emergency Medical Technicians, available at https://www.floridahealth.gov/licensing-and-
regulation/emt-paramedics/licensing/index.html (last visited Jan. 10. 2022). BILL: SB 466 Page 21
o Health Professional Licensure – A Florida licensed physician, physician assistant,
dentist, or registered nurse may apply for certification as a paramedic and subsequently
challenge the paramedic exam, provided he or she holds a Florida EMT certificate which
is current, in good standing, and has successfully completed an advance cardiac life
support course.
75
III. Effect of Proposed Changes:
SB 466 creates the MMACOF program within the DVA and requires the DVA, in collaboration
the DOH, to establish and administer the program to offer assistance to veterans, who have
achieved certain levels of practice skills in the last 12 months, clinical, leadership, and non-
clinical career pathways to employment in health care in Florida.
The bill requires the DVA, in collaboration with local, state, and federal government nonprofit
health care associations and state health care systems, to refer eligible veterans to participating
health care providers throughout the state in order for them to gain employment, maintain
medical skills, address the shortage of health care professionals, and work toward obtaining
appropriate health care registration, certification, or licensure.
The bill defines the term “medically trained veteran” as a person who has served within the
preceding 12 months as a medic in the U.S. Army, a medical technician in the U.S. Air Force, or
a hospital corpsman in the U.S. Navy or the U.S. Coast Guard, who was discharged or separated
from service under conditions other than dishonorable, and who has performed more than 50
percent of the required scope of specific health care practice skills established by the DVA, in
collaboration with the DOH, to participate in the MMACOF program.
The bill also defines a “participating health care provider” as:
A physician licensed under ch. 458, F.S.;
An osteopathic physician licensed under ch. 459, F.S.;
A professional corporation or partnership of a licensed physician or osteopathic physician;
A hospital;
A commercial enterprise having medical facilities for its employees which are supervised by
one or more licensed physicians or osteopathic physicians; or
A facility that offers medical services to the public and is supervised by one or more licensed
physicians or osteopathic physicians.
Under the bill “veteran” is defined the same as in s. 1.01(14), F.S., or a former member of the
Florida National Guard.
The bill requires the MMACOF program to consist of three components: the MMACOF
Qualified component; the No Veteran Left Behind component; and the Health Care Leadership
component.
75
Section 401.25, F.S.; Fla. Admin. C. Rule 64J-1.009, (2021); Florida Department of Health, Licensing and Regulation,
EMT and Paramedics, Licensing, Paramedic, available at https://www.floridahealth.gov/licensing-and-regulation/emt-
paramedics/licensing/index.html (last visited Jan. 10. 2022). BILL: SB 466 Page 22
Under the bill, the MMACOF Qualified component seeks to permit medically trained veterans,
who have performed more than 50 percent of the required scope of specific health care practice
skills established by the DVA, in collaboration with the DOH, within the preceding 12 months,
to continue practicing those skills in a civilian health care setting under specific conditions while
obtaining the appropriate health care registration, certification, or licensure. Specifically, and
notwithstanding any provision of law to the contrary, the medically trained veteran participating
in the MMACOF program may:
Perform activities that constitute the practice of medicine under the direct supervision of a
physician licensed under ch. 458, F.S., an osteopathic physician licensed under ch. 459, F.S.,
or the chief medical officer of a participating health care provider.
Perform activities that constitute the practice of nursing under the direct supervision of a
physician licensed under ch. 458, F.S., an osteopathic physician licensed under ch. 459, F.S.,
or the chief medical officer of a participating health care provider; except that the chief
medical officer of a participating health care provider may, in consultation with the chief
nursing officer of such participating health care provider, designate a registered nurse
licensed under ch. 464, F.S., or practicing with a multistate license, to supervise medically
trained veterans in the practice of nursing.
The activities performed by the medically trained veteran must reflect his or her level of training
and experience. The supervising physician or registered nurse, as applicable, shall retain
responsibility for the care of the patient.
The No Veteran Left Behind component requires the MMACOF program to provide assistance to
veterans who do not meet the definition of the “medically trained veteran” but who have served
in health care-related specialties, in résumé writing, mentorship, and obtaining employment with
participating health care providers.
The Health Care Leadership component requires the MMACOF program to assist veterans who,
in the course of their military service, have gained management experience or completed
advanced degrees, to find civilian health care leadership and management employment in a
variety of health care disciplines.
The bill provides an effect date of July 1, 2022.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None. BILL: SB 466 Page 23
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
The bill, in part, is designed to address the shortage of health care professionals in this
state, but the impact is indeterminate at this time.
C. Government Sector Impact:
According to the DOH, the MQA may experience a recurring increase in workload and
cost associated with the collaboration with the Florida DVA for the MMACOF program.
The bill does not specify the roles that the MQA will contribute; therefore, the fiscal
impact is indeterminate.
76
According to the Florida DVA, the bill will require additional full-time-equivalent
personnel to support the bill’s mission, which would include establishing a separate
bureau to handle recruitment, placement, and the determination eligibility of veterans for
the program.
77
VI. Technical Deficiencies:
None.
VII. Related Issues:
The bill defines eligible veterans to be “medically trained” as a medic in the U.S. Army, a
medical technician in the U. S. Air Force, or a hospital corpsman in the U.S. Navy or the U.S.
Coast Guard. The actual military titles for those individuals are the Army Combat Medic
Specialist (CMS), Navy Hospital Corpsman (HM), Air Force Aerospace Medical Service
Technician (AMST), and Coast Guard Health Service Technician (HS).
76
Florida Department of Health, 2022 Legislative Analysis of SB 466, dated October 21, 2021 (on file with the Senate
Committee on Health Policy).
77
Florida Department of Veterans Affairs, 2022 Legislative Analysis of SB 466, (on file with the Senate Committee on
Health Policy). BILL: SB 466 Page 24
The bill excludes from the program the U.S. Marine Corp, which uses Navy trained HMs who
are Marines, and the Space Force, which currently uses Aerospace Medical Service Technicians
(AMST) trained by the Air Force, even though they are in the Space Force.
The bill also provides that the activities performed by the medically trained veteran must reflect
his or her level of training and experience, but does not define, nor give the Florida DVA nor
DOH, the authority to define, what activities fall within the medically trained veteran’s level of
training and experience that constitute the practice of medicine or nursing, or what constitutes
direct supervision of these medically trained veterans under the bill.
The bill provides that, notwithstanding any provision of law to the contrary, a military trained
veteran participating in the MMACOF program may perform activities that constitute the
practice of medicine or the practice of nursing under the direct supervision of a physician.
However, Army Combat Medic Specialists (CMS), Navy and Marine Hospital Corpsman (HM),
Air Force and Space Force Aerospace Medical Service Technicians (AMST), and Coast Guard
Health Service Technician (HS) are all entry-level job classifications similar to EMTs and
paramedics, with some additional skills such as suturing, starting IVs, and drawing blood for
labs. They are, by definition, not trained, experienced, or qualified to practice medicine or
nursing, even under supervision. Allowing unlicensed individuals to practice medicine or
nursing, even under supervision, could potentially place patients at risk.
The bill also does not provide for any rule making authority to the DVA or the DOH to address
the following issues:
o Lack of licensing, certification, or registration of the medically trained veteran;
o Lack of adverse incidences reporting;
o Absence of professional liability insurance;
o Absence of legislative direction on how long the status of “medically qualified veteran”
may exist; how the status is renewed; and what, if any, continuing education, reporting or
other requirements are necessary to renew or maintain it; and
o Lack of provision for professional discipline of the supervising health care provider or
the medically trained veteran for violations of standards of practice, criminal conduct, the
federal Health Insurance Portability and Accountability Act, etc.
VIII. Statutes Affected:
This bill creates section 295.126 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None. BILL: SB 466 Page 25
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.