SECONDREGULARSESSION
HOUSEBILLNO.2381
101STGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVERODEN.
5094H.01I DANARADEMANMILLER,ChiefClerk
ANACT
Torepealsections190.100,190.134,650.320,and650.340,RSMo,andtoenactinlieu
thereofthreenewsectionsrelatingtoemergencymedicaldispatchers.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections190.100,190.134,650.320,and650.340,RSMo,arerepealed
2andthreenewsectionsenactedinlieuthereof,tobeknownassections190.100,650.320,and
3650.340,toreadasfollows:
190.100.Asusedinsections190.001to190.245,thefollowingwordsandterms
2mean:
3 (1)"Advancedemergencymedicaltechnician"or"AEMT",apersonwhohas
4successfullycompletedacourseofinstructionincertainaspectsofadvancedlifesupportcare
5asprescribedbythedepartmentandislicensedbythedepartmentinaccordancewithsections
6190.001to190.245andrulesandregulationsadoptedbythedepartmentpursuanttosections
7190.001to190.245;
8 (2)"Advancedlifesupport(ALS)",anadvancedlevelofcareasprovidedtotheadult
9andpediatricpatientsuchasdefinedbynationalcurricula,andanymodificationstothat
10curriculaspecifiedinrulesadoptedbythedepartmentpursuanttosections190.001to
11190.245;
12 (3)"Ambulance",anyprivatelyorpubliclyownedvehicleorcraftthatisspecially
13designed,constructedormodified,staffedorequippedfor,andisintendedorused,
14maintainedoroperatedforthetransportationofpersonswhoaresick,injured,woundedor
15otherwiseincapacitatedorhelpless,orwhorequirethepresenceofmedicalequipmentbeing
16usedonsuchindividuals,butthetermdoesnotincludeanymotorvehiclespeciallydesigned,
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17constructedorconvertedfortheregulartransportationofpersonswhoaredisabled,
18handicapped,normallyusingawheelchair,orotherwisenotacutelyill,oremergencyvehicles
19usedwithinairports;
20 (4)"Ambulanceservice",apersonorentitythatprovidesemergencyor
21nonemergencyambulancetransportationandservices,orboth,incompliancewithsections
22190.001to190.245,andtherulespromulgatedbythedepartmentpursuanttosections
23190.001to190.245;
24 (5)"Ambulanceservicearea",aspecificgeographicareainwhichanambulance
25servicehasbeenauthorizedtooperate;
26 (6)"Basiclifesupport(BLS)",abasiclevelofcare,asprovidedtotheadultand
27pediatricpatientasdefinedbynationalcurricula,andanymodificationstothatcurricula
28specifiedinrulesadoptedbythedepartmentpursuanttosections190.001to190.245;
29 (7)"Council",thestateadvisorycouncilonemergencymedicalservices;
30 (8)"Department",thedepartmentofhealthandseniorservices,stateofMissouri;
31 (9)"Director",thedirectorofthedepartmentofhealthandseniorservicesorthe
32director'sdulyauthorizedrepresentative;
33 (10)["Dispatchagency",anypersonororganizationthatreceivesrequestsfor
34emergencymedicalservicesfromthepublic,bytelephoneorothermeans,andisresponsible
35fordispatchingemergencymedicalservices;
36 (11)]"Emergency",thesuddenand,atthetime,unexpectedonsetofahealth
37conditionthatmanifestsitselfbysymptomsofsufficientseveritythatwouldleadaprudent
38layperson,possessinganaverageknowledgeofhealthandmedicine,tobelievethatthe
39absenceofimmediatemedicalcarecouldresultin:
40 (a)Placingtheperson'shealth,orwithrespecttoapregnantwoman,thehealthofthe
41womanorherunbornchild,insignificantjeopardy;
42 (b)Seriousimpairmenttoabodilyfunction;
43 (c)Seriousdysfunctionofanybodilyorganorpart;
44 (d)Inadequatelycontrolledpain;
45 [(12)] (11)"Emergencymedicaldispatcher",apersonwhoreceivesemergencycalls
46fromthepublicandhassuccessfullycompletedanemergencymedicaldispatchercourse[,
47meetingorexceedingthenationalcurriculumoftheUnitedStatesDepartmentof
48Transportationandanymodificationstosuchcurriculaspecifiedbythedepartment
49throughrulesadoptedpursuanttosections190.001to190.245] andanyongoingtraining
50requirementsundersection650.340;
51 [(13)] (12)"Emergencymedicalresponder",apersonwhohassuccessfullycompleted
52anemergencyfirstresponsecoursemeetingorexceedingthenationalcurriculumoftheU.S.
53DepartmentofTransportationandanymodificationstosuchcurriculaspecifiedbythe
HB2381 2 54departmentthroughrulesadoptedundersections190.001to190.245andwhoprovides
55emergencymedicalcarethroughemploymentbyorinassociationwithanemergencymedical
56responseagency;
57 [(14)] (13)"Emergencymedicalresponseagency",anypersonthatregularlyprovides
58alevelofcarethatincludesfirstresponse,basiclifesupportoradvancedlifesupport,
59exclusiveofpatienttransportation;
60 [(15)] (14)"Emergencymedicalservicesforchildren(EMS-C)system",the
61arrangementofpersonnel,facilitiesandequipmentforeffectiveandcoordinateddeliveryof
62pediatricemergencymedicalservicesrequiredinpreventionandmanagementofincidents
63whichoccurasaresultofamedicalemergencyorofaninjuryevent,naturaldisasteror
64similarsituation;
65 [(16)] (15)"Emergencymedicalservices(EMS)system",thearrangementof
66personnel,facilitiesandequipmentfortheeffectiveandcoordinateddeliveryofemergency
67medicalservicesrequiredinpreventionandmanagementofincidentsoccurringasaresultof
68anillness,injury,naturaldisasterorsimilarsituation;
69 [(17)] (16)"Emergencymedicaltechnician",apersonlicensedinemergencymedical
70careinaccordancewithstandardsprescribedbysections190.001to190.245,andbyrules
71adoptedbythedepartmentpursuanttosections190.001to190.245;
72 [(18)] (17)"Emergencymedicaltechnician-basic"or"EMT-B",apersonwhohas
73successfullycompletedacourseofinstructioninbasiclifesupportasprescribedbythe
74departmentandislicensedbythedepartmentinaccordancewithstandardsprescribedby
75sections190.001to190.245andrulesadoptedbythedepartmentpursuanttosections190.001
76to190.245;
77 [(19)] (18)"Emergencymedicaltechnician-communityparamedic","community
78paramedic",or"EMT-CP",apersonwhoiscertifiedasanemergencymedicaltechnician-
79paramedicandiscertifiedbythedepartmentinaccordancewithstandardsprescribedin
80section190.098;
81 [(20)] (19)"Emergencymedicaltechnician-paramedic"or"EMT-P",apersonwho
82hassuccessfullycompletedacourseofinstructioninadvancedlifesupportcareasprescribed
83bythedepartmentandislicensedbythedepartmentinaccordancewithsections190.001to
84190.245andrulesadoptedbythedepartmentpursuanttosections190.001to190.245;
85 [(21)] (20)"Emergencyservices",healthcareitemsandservicesfurnishedor
86requiredtoscreenandstabilizeanemergencywhichmayinclude,butshallnotbelimitedto,
87healthcareservicesthatareprovidedinalicensedhospital'semergencyfacilitybyan
88appropriateproviderorbyanambulanceserviceoremergencymedicalresponseagency;
89 [(22)] (21)"Healthcarefacility",ahospital,nursinghome,physician'sofficeorother
90fixedlocationatwhichmedicalandhealthcareservicesareperformed;
HB2381 3 91 [(23)] (22)"Hospital",anestablishmentasdefinedinthehospitallicensinglaw,
92subsection2ofsection197.020,orahospitaloperatedbythestate;
93 [(24)] (23)"Medicalcontrol",supervisionprovidedbyorunderthedirectionof
94physicians,ortheirdesignatedregisterednurse,includingbothonlinemedicalcontrol,
95instructionsbyradio,telephone,orothermeansofdirectcommunications,andoffline
96medicalcontrolthroughsupervisionbytreatmentprotocols,casereview,training,and
97standingordersfortreatment;
98 [(25)] (24)"Medicaldirection",medicalguidanceandsupervisionprovidedbya
99physiciantoanemergencyservicesprovideroremergencymedicalservicessystem;
100 [(26)] (25)"Medicaldirector",aphysicianlicensedpursuanttochapter334
101designatedbytheambulanceservice, dispatchagency,oremergencymedicalresponse
102agencyandwhomeetscriteriaspecifiedbythedepartmentbyrulespursuanttosections
103190.001to190.245;
104 [(27)] (26)"Memorandumofunderstanding",anagreementbetweenanemergency
105medicalresponseagencyordispatchagencyandanambulanceserviceorserviceswithin
106whoseterritorytheagencyoperates,inordertocoordinateemergencymedicalservices;
107 [(28)] (27)"Patient",anindividualwhoissick,injured,wounded,diseased,or
108otherwiseincapacitatedorhelpless,ordead,excludingdeceasedindividualsbeingtransported
109fromorbetweenprivateorpublicinstitutions,homesorcemeteries,andindividualsdeclared
110deadpriortothetimeanambulanceiscalledforassistance;
111 [(29)] (28)"Person",asusedinthesedefinitionsandelsewhereinsections190.001to
112190.245,anyindividual,firm,partnership,copartnership,jointventure,association,
113cooperativeorganization,corporation,municipalorprivate,andwhetherorganizedfor
114profitornot,state,county,politicalsubdivision,statedepartment,commission,board,bureau
115orfraternalorganization,estate,publictrust,businessorcommonlawtrust,receiver,assignee
116forthebenefitofcreditors,trusteeortrusteeinbankruptcy,oranyotherserviceuseror
117provider;
118 [(30)] (29)"Physician",apersonlicensedasaphysicianpursuanttochapter334;
119 [(31)] (30)"Politicalsubdivision",anymunicipality,city,county,citynotwithina
120county,ambulancedistrictorfireprotectiondistrictlocatedinthisstatewhichprovidesorhas
121authoritytoprovideambulanceservice;
122 [(32)] (31)"Professionalorganization",anyorganizedgrouporassociationwithan
123ongoinginterestregardingemergencymedicalservices.Suchgroupsandassociationscould
124includethoserepresentingvolunteers,labor,management,firefighters,EMT-B's,nurses,
125EMT-P's,physicians,communicationsspecialistsandinstructors.Organizationscouldalso
126representtheinterestsofgroundambulanceservices,airambulanceservices,fireservice
HB2381 4 127organizations,lawenforcement,hospitals,traumacenters,communicationcenters,pediatric
128services,laborunionsandpoisoncontrolservices;
129 [(33)] (32)"Proofoffinancialresponsibility",proofofabilitytorespondtodamages
130forliability,onaccountofaccidentsoccurringsubsequenttotheeffectivedateofsuchproof,
131arisingoutoftheownership,maintenanceoruseofamotorvehicleinthefinancialamount
132setinrulespromulgatedbythedepartment,butinnoeventlessthanthestatutoryminimum
133requiredformotorvehicles.Proofoffinancialresponsibilityshallbeusedasproofofself-
134insurance;
135 [(34)] (33)"Protocol",apredetermined,writtenmedicalcareguideline,whichmay
136includestandingorders;
137 [(35)] (34)"RegionalEMSadvisorycommittee",acommitteeformedwithinan
138emergencymedicalservices(EMS)regiontoadviseambulanceservices,thestateadvisory
139councilonEMSandthedepartment;
140 [(36)] (35)"Specialtycaretransportation",thetransportationofapatientrequiringthe
141servicesofanemergencymedicaltechnician-paramedicwhohasreceivedadditionaltraining
142beyondthetrainingprescribedbythedepartment.Specialtycaretransportationservicesshall
143bedefinedinwritingintheappropriatelocalprotocolsforgroundandairambulanceservices
144andapprovedbythelocalphysicianmedicaldirector.Theprotocolsshallbemaintainedby
145thelocalambulanceserviceandshalldefinetheadditionaltrainingrequiredoftheemergency
146medicaltechnician-paramedic;
147 [(37)] (36)"Stabilize",withrespecttoanemergency,theprovisionofsuchmedical
148treatmentasmaybenecessarytoattempttoassurewithinreasonablemedicalprobabilitythat
149nomaterialdeteriorationofanindividual'smedicalconditionislikelytoresultfromoroccur
150duringambulancetransportationunlessthelikelybenefitsofsuchtransportationoutweighthe
151risks;
152 [(38)] (37)"Stateadvisorycouncilonemergencymedicalservices",acommittee
153formedtoadvisethedepartmentonpolicyaffectingemergencymedicalservicethroughout
154thestate;
155 [(39)] (38)"StateEMSmedicaldirectorsadvisorycommittee",asubcommitteeofthe
156stateadvisorycouncilonemergencymedicalservicesformedtoadvisethestateadvisory
157councilonemergencymedicalservicesandthedepartmentonmedicalissues;
158 [(40)] (39)"STEMI"or"ST-elevationmyocardialinfarction",atypeofheartattackin
159whichimpairedbloodflowtothepatient'sheartmuscleisevidencedbyST-segmentelevation
160inelectrocardiogramanalysis,andasfurtherdefinedinrulespromulgatedbythedepartment
161undersections190.001to190.250;
HB2381 5 162 [(41)] (40)"STEMIcare",includeseducationandprevention,emergencytransport,
163triage,andacutecareandrehabilitativeservicesforSTEMIthatrequiresimmediatemedical
164orsurgicalinterventionortreatment;
165 [(42)] (41)"STEMIcenter",ahospitalthatiscurrentlydesignatedassuchbythe
166departmenttocareforpatientswithST-segmentelevationmyocardialinfarctions;
167 [(43)] (42)"Stroke",aconditionofimpairedbloodflowtoapatient'sbrainasdefined
168bythedepartment;
169 [(44)] (43)"Strokecare",includesemergencytransport,triage,andacuteintervention
170andotheracutecareservicesforstrokethatpotentiallyrequireimmediatemedicalorsurgical
171interventionortreatment,andmayincludeeducation,primaryprevention,acuteintervention,
172acuteandsubacutemanagement,preventionofcomplications,secondarystrokeprevention,
173andrehabilitativeservices;
174 [(45)] (44)"Strokecenter",ahospitalthatiscurrentlydesignatedassuchbythe
175department;
176 [(46)] (45)"Trauma",aninjurytohumantissuesandorgansresultingfromthe
177transferofenergyfromtheenvironment;
178 [(47)] (46)"Traumacare"includesinjuryprevention,triage,acutecareand
179rehabilitativeservicesformajorsinglesystemormultisysteminjuriesthatpotentiallyrequire
180immediatemedicalorsurgicalinterventionortreatment;
181 [(48)] (47)"Traumacenter",ahospitalthatiscurrentlydesignatedassuchbythe
182department.
650.320.Forthepurposesofsections650.320to650.340,thefollowingtermsmean:
2 (1)"Ambulanceservice",thesamemeaninggiventotheterminsection190.100;
3 (2)"Board",theMissouri911serviceboardestablishedinsection650.325;
4 [(2)](3)"Dispatchagency",anypersonororganizationthatreceivesrequests
5foremergencymedicalservicesfromthepublic,bytelephoneorothermeans,andis
6responsiblefordispatchingemergencymedicalservices;
7 (4)"Medicaldirector",thesamemeaninggiventotheterminsection190.100;
8 (5)"Memorandumofunderstanding",thesamemeaninggiventothetermin
9section190.100;
10 (6)"Publicsafetyansweringpoint",thelocationatwhich911callsareanswered;
11 [(3)](7)"Telecommunicator",anypersonemployedasanemergencytelephone
12worker,calltakerorpublicsafetydispatcherwhosedutiesincludereceiving,processingor
13transmittingpublicsafetyinformationreceivedthrougha911publicsafetyansweringpoint.
650.340.1.Theprovisionsofthissectionmaybecitedandshallbeknownasthe
2"911TrainingandStandardsAct".
HB2381 6 3 2.Initialtrainingrequirementsfortelecommunicatorswhoanswer911callsthat
4cometopublicsafetyansweringpointsshallbeasfollows:
5 (1)Policetelecommunicator,16hours;
6 (2)Firetelecommunicator,16hours;
7 (3)Emergencymedicalservicestelecommunicator,16hours;
8 (4)Jointcommunicationcentertelecommunicator,40hours.
9 3.Allpersonsemployedasatelecommunicatorinthisstateshallberequiredto
10completeongoingtrainingsolongassuchpersonengagesintheoccupationasa
11telecommunicator.Suchpersonsshallcompleteatleasttwenty-fourhoursofongoing
12trainingeverythreeyearsbysuchpersonsororganizationsasprovidedinsubsection6ofthis
13section.
14 4.AnypersonemployedasatelecommunicatoronAugust28,1999,shallnotbe
15requiredtocompletethetrainingrequirementasprovidedinsubsection2ofthissection.Any
16personhiredasatelecommunicatorafterAugust28,1999,shallcompletethetraining
17requirementsasprovidedinsubsection2ofthissectionwithintwelvemonthsofthedatesuch
18personisemployedasatelecommunicator.
19 5.Thetrainingrequirementsasprovidedinsubsection2ofthissectionshallbe
20waivedforanypersonwhofurnishesprooftothecommitteethatsuchpersonhascompleted
21traininginanotherstatewhichisatleastasstringentasthetrainingrequirementsof
22subsection2ofthissection.
23 6.Theboardshalldeterminebyadministrativerulethepersonsororganizations
24authorizedtoconductthetrainingasrequiredbysubsection2ofthissection.
25 7.[Thissectionshallnotapplytoanemergencymedicaldispatcheroragencyas
26definedinsection190.100,orapersontrainedbyanentityaccreditedorcertifiedunder
27section190.131,orapersonwhoprovidesprearrivalmedicalinstructionswhoworksforan
28agencywhichmeetstherequirementssetforthinsection190.134] Theboardshallbe
29responsiblefortheapprovaloftrainingcoursesforemergencymedicaldispatchers.
30Theboardshalldevelopnecessaryrulesandregulationsincollaborationwiththestate
31EMSmedicaldirectorsadvisorycommittee,asdescribedinsection190.103,whichmay
32providerecommendationsrelatingtothemedicalaspectsofprearrivalmedical
33instructions.
34 8.Adispatchagencyisrequiredtohaveamemorandumofunderstandingwith
35allambulanceservicesthatitdispatches.Ifadispatchagencyprovidesprearrival
36medicalinstructions,itisrequiredtohaveamedicaldirectorwhosedutiesincludethe
37maintenanceofstandardsandapprovalofprotocolsorguidelines.
[190.134.Adispatchagencyisrequiredtohaveamemorandumof
2 understandingwithallambulanceservicesthatitdispatches.Ifadispatch
HB2381 7 3 agencyprovidesprearrivalmedicalinstructions,itisrequiredtohavea
4 medicaldirector,whosedutiesincludethemaintenanceofstandardsand
5 protocolapproval.]
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HB2381 8