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ENGROSSED HOUSE AMENDME NT
TO
ENGROSSED SENATE BILL NO . 536 By: Rosino of the Senate
and
Hill of the House
An Act relating to emergency medical services;
amending 63 O.S. 2021, Section 1 -2503, as amended by
Section 1, Chapter 276 , O.S.L. 2022 (63 O.S. Supp.
2022, Section 1-2503), which relates to definition s
used in the Oklahoma Emergency Response Systems
Development Act; adding and modifying definitions;
repealing 63 O.S. 2021, Section 1-2503, as amended by
Section 1, Chapter 246 , O.S.L. 2016, which relates to
definitions used in the Oklahoma Emergency Resp onse
Systems Development Act; and providing an effec tive
date.
AMENDMENT NO. 1. Strike the title, enacting clause, and entire bill
and insert:
"An Act relating to emergency medical services;
amending 63 O.S. 2021, Section 1 -2503, as amended by
Section 1, Chapter 276, O.S.L. 2 022 (63 O.S. Supp.
2022, Section 1-2503), which relates to definitions
used in the Oklahoma Emergency Res ponse Systems
Development Act; adding and modifying definitions;
repealing 63 O.S. 2021, Section 1-2503, as amended by
Section 1, Chapter 246, O.S.L. 2016, which relates to
definitions used in the Oklahoma Emergency Response
Systems Development Act; and providing an effective
date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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SECTION 1. AMENDATORY 63 O.S. 2021, Section 1-2503, as
amended by Section 1, Chapter 276, O.S.L. 2022 (63 O.S. Supp. 2022,
Section 1-2503), is amended to read as follows:
Section 1-2503. As used in the Oklahoma Emergency Response
Systems Development Act:
1. “Ambulance” means any ground, air or water vehicle whi ch is
or should be approved by the State Commissioner of Health, designed
and equipped to transport a patient or patients an d to provide
appropriate on-scene and en route patient stabilization and care as
required. Vehicles used as am bulances shall meet s uch standards as
may be required by the Commissioner for approval, and shall display
evidence of such approval at all times;
2. “Ambulance authority” means any public trust or nonprofit
corporation established by the state or any unit of local government
or combination of units of government for the express purpose of
providing, directly o r by contract, emergency medical servi ces in a
specified area of the state;
3. “Ambulance patient” or “patient” means any person who is or
will be transported in a recli ning position to or from a health care
facility in an ambulance;
4. “Ambulance service” means any private firm or governmen tal
agency that owns or operates ambulances and which is or should shall
be licensed by the State D epartment of Health to provide levels of
medical care, including, but not limited to, comprehensive
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integrated medical c are in emergency and nonemergency sett ings under
the supervision of a physician based on certification standards
promulgated by the Commis sioner;
5. “Ambulance service district ” means any county, group of
counties or parts of counties formed together to p rovide, operate
and finance emergency medical services as provided by Section 9C of
Article X of the Oklahoma Constitution or Sections 120 1 through 1221
of Title 19 of the Oklahoma Statutes;
6. “Board” means the State Board of Health;
7. “Certified emergency medical responder” means an individual
certified by the Department to perform emergency medical services in
accordance with the Oklah oma Emergency Response Systems Development
Act and in accordance with the ru les and standards promulgated by
the Commissioner;
8. “Certified emergency medical response agency” means an
organization of any type certified by the Department to provide
emergency medical care and limited transport in an emergency vehicle
as defined in Section 1-103 of Title 47 of the Oklahoma Statutes. A
certified emergency medical response agency shall only provide
transport upon approval by the appropriate online medical con trol at
the time of transport. Certified emergency med ical response
agencies may utilize certified emergency medical responders or
licensed emergency m edical personnel; provided, however, that all
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personnel so utilized shall function under the direction o f and
consistent with guidelines for medical control;
9. “Classification” means an inclusive standardized
identification of stabilizing and definitive emergency services
provided by each hospital that treats emergency patients;
10. “CoAEMSP” means the Committee on Accreditation of
Educational Programs for th e Emergency Medical S ervices Professions;
11. “Commissioner” means the State Commissioner of Health;
12. “Community paramedic” means a licensed paramedic who meets
the requirements of Section 1-2505 of this title;
13. “Community paramedic ser vices” means services that inclu de
interventions intended to prevent unnecessary ambulance
transportation or hospital emergency department use, or are provided
as part of in-home inpatient or outpatient hospital services .
Community paramedic services:
a. must be part of a care plan orde red by a primary
health care provider or h ospital provider in
consultation with the medical director of an ambulance
service. Such care plan must ensure that the services
provided by a community paramedic do not duplicate
services already provided to the patient, including
home health and waiver services, and
b. shall include health assessment, chronic disease
monitoring and education, medication compliance,
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immunizations and vaccinations, laboratory specimen
collection, hospital discharge follow -up care, and
minor medical procedures compliant wit h the community
paramedic’s scope of practice and approved by the
ambulance medical director;
14. “Council” means the Trauma and Emergency Response Advisory
Council created in Section 1 -103a.1 of this title;
13. 15. “Critical care paramedic” or “CCP” means a licensed
paramedic who has succ essfully completed critical care training and
testing requirements in accorda nce with the Oklahoma Emergency
Response Systems Development Act and in accordance with the rules
and standards promulgated by the Commissioner ;
14. 16. “Department” means the State Department of Health;
15. 17. “Emergency medical services sy stem” means a system
which provides for the organization and appropriate designation of
personnel, facilities and e quipment for the effective and
coordinated local, regional and statewide del ivery of health care
services primarily under emergency condition s;
16. 18. “Letter of review” means the official designation from
CoAEMSP to a paramedic program that is in the “becoming accredited”
process;
17. 19. “Licensed emergency medical personnel ” means an
emergency medical technician (EMT), an intermediate emergency
medical technician (IEMT) , an advanced emergency medical technician
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(AEMT), or a paramedic licensed by the D epartment to perform
emergency medical services in accordance with the Oklah oma Emergency
Response Systems Development Act and the rules and standards
promulgated by the Commissioner;
18. 20. “Licensure” means the licensing of emergency medical
care providers and ambulance services pursuant to rules and
standards promulgated by t he Commissioner at one or more of the
following levels:
a. basic life support,
b. intermediate life support,
c. paramedic life support,
d. advanced life support,
e. stretcher van, and
f. specialty care, which shall be us ed solely for
interhospital transpor t of patients requiring
specialized en route medical monitoring and advanced
life support which exceed the capabi lities of the
equipment and personnel provided by paramedic life
support.
Requirements for each level of ca re shall be established by the
Commissioner. Licensure at any level of care includes a license to
operate at any lower level, with the exception of licensure for
specialty care; provided, however, that the highest l evel of care
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offered by an ambulance ser vice shall be available twenty-four (24)
hours each day, three hundred sixty-five (365) days per year.
Licensure shall be granted or renewed for such periods and under
such terms and conditions as may be promulgated by the Commissioner;
19. 21. “Medical control” means local, regional or sta tewide
medical direction and quality assurance of health care delivery in
an emergency medical service system. O nline medical control is the
medical direction given to licensed em ergency medical personnel,
certified emergency medical responders and stretc her van personnel
by a physician via radio or telephone. Off -line medical control is
the establishment and monit oring of all medical components of an
emergency medical service sys tem, which is to include stretcher van
service including, but not limited to , protocols, standing orders,
educational programs, and the quality and delivery of onli ne
control;
20. 22. “Medical director” means a physician, fully licensed
without restriction, who acts as a paid or volunteer medic al advisor
to a licensed ambulance s ervice and who monitors and directs the
care so provided. Such physicians shall meet such q ualifications
and requirements as may be promulgated by the Commissioner;
21. 23. “Region” or “emergency medical service region ” means
two or more municipalities, counties, ambulance districts or other
political subdivisions exercising joint control over one or more
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providers of emergency medical services and stretcher van service
through common ordinances, authorities, boards or other means;
22. 24. “Regional emergency medical services system” means a
network of organizations, individuals, facilities and equipme nt
which serves a region, subject to a unified set of regional rules
and standards which may exceed, but may not be in c ontravention of,
those required by the state, which is under the medical direction of
a single regional medical director, and which part icipates directly
in the delivery of the following services:
a. medical call-taking and emergency medical services
dispatching, emergency and routine includ ing priority
dispatching of first response agencies, stretcher van
and ambulances,
b. emergency medical responder services provided by
emergency medical response agencies,
c. ambulance services, both emergency, routine a nd
stretcher van including, but not limited to, the
transport of patients in accordance with transport
protocols approved by the regional medical dir ector,
and
d. directions given by physicians directly via radio or
telephone, or by written protocol, to em ergency
medical response agencies, s tretcher van or ambulance
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personnel at the scene of an emergency or while en
route to a hospital;
23. 25. “Regional medical director ” means a licensed physician,
who meets or exceeds the qualifications of a medical dire ctor as
defined by the Oklahoma Emer gency Response Systems Development Act,
chosen by an emergency medical service region to p rovide external
medical oversight, quality control and related services to that
region;
24. 26. “Registration” means the listing of an ambulance
service in a registr y maintained by the Department; provided,
however, registration shall not be deemed to be a li cense;
25. 27. “Stretcher van” means any ground vehicle which is or
should shall be approved by the State Commissioner of Health, which
is designed and equipped to transport individuals on a stretcher or
gurney type apparatus. Vehicles used as stretcher vans shall meet
such standards as may be required by the Commissioner for approval
and shall display evidence of licensure at all times. The
Commissioner shall not establish Federal Specification KKK-A-1822
ambulance standards for stretcher vans; provided, a stretc her van
shall meet Ambulance Manufacturers Division (AMD) Standards 004, 012
and 013, and shall pass corresponding safety tests. Stretcher van
services shall only be permitted and approved by the Commissioner in
emergency medical service regions, ambulanc e service districts, or
counties with populations in excess of five hundred thousa nd
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(500,000) people. Notwithstanding the provisions of this paragraph,
stretcher van transports may be made to and from any federal or
state veterans facility. Stretcher va ns may carry and provide
oxygen and may carry and utilize any equipment necessary for the
provision of oxygen;
26. 28. “Stretcher van passenger” means any person who is or
will be transported in a reclining position on a stretcher or
gurney, who is medically stable, nonemergent and does not require
any medical monitoring equipment or a ssistance during transport
except oxygen. Passengers must be authorized as qualified to be
transported by stretcher van. Passengers shall be authorized
through screening provid ed by a certified medical dispatching
protocol approved made available for review by the Department during
inspection. All patients being transported to or from any medically
licensed facility shall be screened before transport. Any patient
transported without screening shall be a violation of Commissioner
rule by the transporting company and subject to administra tive
procedures of the Department; and
27. 29. “Transport protocol” means the written instructions
governing decision-making at the scene of a medical emergency by
ambulance personnel regardi ng the selection of the hospital to which
the patient shall be t ransported. Transport protocols shall be
developed by the regional medical director for a regional emergency
medical services system or by the Department if no regional
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emergency medical serv ices system has been established. Such
transport protocols shal l adhere to, at a minimum, the following
guidelines:
a. nonemergency, routine transport shall be to the
facility of the patient ’s choice,
b. urgent or emergency transport not involving life -
threatening medical illness or injury shall b e to the
nearest facility, or, subject to transport
availability and system area coverage, to the facility
of the patient’s choice,
c. life-threatening medical illness or injury shall
require transport to the near est health care facility
appropriate to the needs of the patient as established
by regional or state guidelines, and
d. emergency ambulance transportation is not required
when a patient’s apparent clinical condition, as
defined by applicable medical treatm ent protocols,
does not warrant emergency a mbulance transport, a nd
nontransport of patients is authorized pursuant to
applicable medical treatment protocols established by
the regional medical director.
SECTION 2. REPEALER 63 O.S. 2021, Section 1-2503, as
amended by Section 1, Chapter 246, O.S. L. 2016, is hereby repealed.
SECTION 3. This act shall become effective November 1, 2023."
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Passed the House of Representatives the 20th day of April, 2023.
Presiding Officer of the House of
Representatives
Passed the Senate the ____ day of _______ ___, 2023.
Presiding Officer of the Senate
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ENGROSSED SENATE
BILL NO. 536 By: Rosino of the Senate
and
Hill of the House
An Act relating to emergency medical services;
amending 63 O.S. 2021, Section 1 -2503, as amended by
Section 1, Chapter 276, O.S.L. 2 022 (63 O.S. Supp.
2022, Section 1-2503), which relates to definitions
used in the Oklahoma Emergency Response Systems
Development Act; adding and modifying definitions;
repealing 63 O.S. 2021, Section 1-2503, as amended by
Section 1, Chapter 246, O.S.L. 2016, which relates to
definitions used in the Oklahoma Emergency Response
Systems Development Act; and providing an effec tive
date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 4. AMENDATORY 63 O.S. 2021, Section 1-2503, as
amended by Section 1, Chapter 276, O.S.L. 2022 (63 O.S. Supp. 2022,
Section 1-2503), is amended to read as follows:
Section 1-2503. As used in the Oklahoma Emergency Response
Systems Development Act:
1. “Ambulance” means any ground, air or water vehicle whi ch is
or should be approved by the State Commissioner of Health, designed
and equipped to transport a patient or patients and to provide
appropriate on-scene and en route patient s tabilization and care as
required. Vehicles used as am bulances shall meet s uch standards as
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may be required by the Commissioner for approval, and shall display
evidence of such approval at all times;
2. “Ambulance authority” means any public trust or non profit
corporation established by the state or any unit of local government
or combination of units of government for the express purpose of
providing, directly or by contract, emergency medical services in a
specified area of the state;
3. “Ambulance patient” or “patient” means any person who is or
will be transported in a recli ning position to or from a health care
facility in an ambulance;
4. “Ambulance service” means any private firm or governmental
agency which is or should be licensed by the State D epartment of
Health to provide levels of medical care , including but not lim ited
to comprehensive integrated medical care in emergency and
nonemergency settings under the supervision of a physician based on
certification standards promulgated by the Commis sioner;
5. “Ambulance service district ” means any county, group of
counties or parts of counties formed together to provide, operate
and finance emergency medical services as p rovided by Section 9C of
Article X of the Oklahoma Constitution or Sections 120 1 through 1221
of Title 19 of the Oklahoma Statutes;
6. “Board” means the State Board of Health;
7. “Certified emergency medical responder ” means an individual
certified by the Department to perform emergency medical services in
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accordance with the Oklah oma Emergency Response Systems Development
Act and in accordance with the ru les and standards promulgated by
the Commissioner;
8. “Certified emergency medical response agency ” means an
organization of any type certified by the Department to provide
emergency medical care and limited transport in an emergency vehicle
as defined in Section 1-103 of Title 47 of the Oklahoma Statutes. A
certified emergency medical response agency shall only provide
transport upon approval by the appropriate online medical con trol at
the time of transport. Certified emergency med ical response
agencies may utilize certified emergency medical responders or
licensed emergency m edical personnel; provided, however, that all
personnel so utilized shall function under the direction o f and
consistent with guidelines for medical control;
9. “Classification” means an inclusive standardized
identification of stabili zing and definitive emergency services
provided by each hospital that treats emergency patients;
10. “CoAEMSP” means the Committee on Accreditation of
Educational Programs for th e Emergency Medical S ervices Professions;
11. “Commissioner” means the State Commissioner of Health;
12. “Community paramedic” means a licensed para medic who meets
the requirements of Section 1-2505 of this title;
13. “Community paramedic ser vices” means services that inclu de
interventions intended to prevent unnecessary ambulance
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transportation or hospital emergency department use. Community
paramedic services:
a. must be part of a care plan orde red by a primary
health care provider or hospit al provider in
consultation with the medical director of an ambulance
service. Such care plan must ensure that the services
provided by a community paramedic do not duplicate
services already provided to the patient, including
home health and waiver servi ces, and
b. shall include health assessment, chronic disease
monitoring and education, medication compliance,
immunizations and vaccinations, laboratory specimen
collection, hospital discharge follow -up care, and
minor medical procedures compliant with the community
paramedic’s scope of practice and approved by the
ambulance medical director;
14. “Council” means the Trauma and Emergency Response Advisory
Council created in Section 1 -103a.1 of this title;
13. 15. “Critical care paramedic” or “CCP” means a licensed
paramedic who has succ essfully completed critical care trai ning and
testing requirements in accorda nce with the Oklahoma Emergency
Response Systems Development Act and in accordance with the rules
and standards promulgated by the Commissioner;
14. 16. “Department” means the State Department of Health;
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15. 17. “Emergency medical services sy stem” means a system
which provides for the organization and appropriate designation of
personnel, facilities and e quipment for the effective and
coordinated local, regio nal and statewide del ivery of health care
services primarily under emergency condition s;
16. 18. “Letter of review” means the official designation from
CoAEMSP to a paramedic program that is in the “becoming accredited”
process;
17. 19. “Licensed emergency medical personnel ” means an
emergency medical technician (EMT) , an intermediate emergency
medical technician (IEMT) , an advanced emergency medical technician
(AEMT), or a paramedic licensed by the D epartment to perform
emergency medical services in acco rdance with the Oklah oma Emergency
Response Systems Development Act and the rules and standards
promulgated by the Commissioner;
18. 20. “Licensure” means the licensing of emergency medical
care providers and ambulance services pursuant to rules and
standards promulgated by t he Commissioner at one or more of the
following levels:
a. basic life support,
b. intermediate life support,
c. paramedic life support,
d. advanced life support,
e. stretcher van, and
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f. specialty care, which shall be used solely for
interhospital transpor t of patients requiring
specialized en route medical monitoring and advanced
life support which exceed the capabi lities of the
equipment and personnel provided by paramedic life
support.
Requirements for each level of care shall be est ablished by the
Commissioner. Licensure at any level of care includes a license to
operate at any lower level, with the exception of licensure for
specialty care; provided, however, that the highest l evel of care
offered by an ambulance service shall be a vailable twenty-four (24)
hours each day, three hundred sixty -five (365) days per year.
Licensure shall be granted or renewed for such periods and under
such terms and conditions as may be promulgated by the Commissioner;
19. 21. “Medical control” means local, regional or sta tewide
medical direction and quality assurance of health care delivery in
an emergency medical service system. O nline medical control is the
medical direction given to licensed em ergency medical personnel,
certified emergency medical responders and stretc her van personnel
by a physician via radio or telephone. Off -line medical control is
the establishment and monit oring of all medical components of an
emergency medical service sys tem, which is to include stretcher van
service including, but not limited to , protocols, standing orders,
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educational programs, and the quality and delivery of onli ne
control;
20. 22. “Medical director” means a physician, fully licensed
without restriction, who acts as a paid or volunteer medical advisor
to a licensed ambulance s ervice and who monitors and directs the
care so provided. Such physicians shall meet such q ualifications
and requirements as may be promulgated by the Commissioner;
21. 23. “Region” or “emergency medical service region ” means
two or more municipalities, counties, ambulance districts or other
political subdivisions exercising joint control over one or more
providers of emergency medical services and stretcher van service
through common ordinances, authorities, boards or other means;
22. 24. “Regional emergency medical services system” means a
network of organizations, individuals, facilities and equipme nt
which serves a region, subject to a unified set of regional rules
and standards which may exceed, but may not be in contravention of ,
those required by the state, which is under the medical direction of
a single regional medical director, and which part icipates directly
in the delivery of the following services:
a. medical call-taking and emergency medical services
dispatching, emergen cy and routine includ ing priority
dispatching of first response agencies, stretcher van
and ambulances,
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b. emergency medical responder services provided by
emergency medical response agencies,
c. ambulance services, both emergency, routine and
stretcher van including, but not limited to, the
transport of patients in accordance with transport
protocols approved by the regional medical dir ector,
and
d. directions given by physicians directly via radio or
telephone, or by written protocol, to emergency
medical response agencies, s tretcher van or ambulance
personnel at the scene of an emergency or while en
route to a hospital;
23. 25. “Regional medical director ” means a licensed physician,
who meets or exceeds the qualifications of a medical director as
defined by the Oklahoma Emer gency Response Systems Development Act,
chosen by an emergency medical service region to p rovide external
medical oversight, quality control and related services to that
region;
24. 26. “Registration” means the listing of an ambulance
service in a registr y maintained by the Department; provided,
however, registration shall not be deemed to be a li cense;
25. 27. “Stretcher van” means any ground vehicle which is or
should be approved by the State Commissioner of Health, which is
designed and equipped to tra nsport individuals on a stretcher or
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gurney type apparatus. Vehicles used as stretcher vans shall meet
such standards as may be required by the Commissioner for approval
and shall display evidence of licensure at all times. The
Commissioner shall not est ablish Federal Specification KKK-A-1822
ambulance standards for stretcher vans; provided, a stretc her van
shall meet Ambulance Manufacturers Division (AMD) Standards 004, 012
and 013, and shall pass corresponding safety tests. Stretch er van
services shall only be permitted and approved by the Commissioner in
emergency medical service regions, ambulanc e service districts, or
counties with populations in excess of five hundred thousa nd
(500,000) people. Notwithstanding the provisions of this paragraph,
stretcher van transports may be made to and from any federal or
state veterans facility. Stretcher va ns may carry and provide
oxygen and may carry and utilize any equipment necessary for the
provision of oxygen;
26. 28. “Stretcher van passenger” means any person who is or
will be transported in a reclining position on a stretcher or
gurney, who is medically stable, nonemergent and does not require
any medical monitoring equipment or a ssistance during transport
except oxygen. Passengers m ust be authorized as qualified to be
transported by stretcher van. Passengers shall be authorized
through screening provid ed by a certified medical dispatching
protocol approved by the Department. Al l patients being transported
to or from any medically l icensed facility shal l be screened before
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transport. Any patient transported without screening shall be a
violation of Commissioner rule by the transporting company and
subject to administrative proce dures of the Department; and
27. 29. “Transport protocol” means the written instructions
governing decision-making at the scene of a medical emergency by
ambulance personnel regardi ng the selection of the hospital to which
the patient shall be transported . Transport protocols shall be
developed by the region al medical director f or a regional emergency
medical services system or by the Department if no regional
emergency medical serv ices system has been established. Such
transport protocols shall adhere t o, at a minimum, the following
guidelines:
a. nonemergency, routine transpor t shall be to the
facility of the patient ’s choice,
b. urgent or emergency transport not involving life -
threatening medical illness or injury shall b e to the
nearest facility, or, subject to transport
availability and system area cover age, to the facility
of the patient’s choice,
c. life-threatening medical illness or injury shall
require transport to the near est health care facility
appropriate to the needs of the patient as establ ished
by regional or state guidelines, and
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d. emergency ambulance transporta tion is not required
when a patient’s apparent clinical condition, as
defined by applicable medical treatm ent protocols,
does not warrant emergency a mbulance transport, and
nontransport of patients is authorized pursuant to
applicable medical treatment pro tocols established by
the regional medical director.
SECTION 5. REPEALER 63 O.S. 2021, Section 1-2503, as
amended by Section 1, Chapter 246, O.S. L. 2016, is hereby repealed.
SECTION 6. This act shall become effectiv e November 1, 2023.
Passed the Senate the 9th day of March, 2023.
Presiding Officer of the Senate
Passed the House of Representatives the ____ day of __________,
2023.
Presiding Officer of the House
of Representatives