Emergency Medical Services

Requires DOH to integrate emergency aeromedical services into
statewide emergency medical services.  Establishes emergency
aeromedical information system and quality improvement committee.
Creates emergency medical services special fund.  (SD2)

THE SENATE                              S.B. NO.           S.D. 2
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  Section 321-222, Hawaii Revised Statutes, is
 2 amended by adding a new definition to be appropriately inserted
 3 and to read as follows:  
 4      ""Emergency aeromedical services" means a secondary response
 5 system which provides immediate critical care and transport by
 6 fixed-wing or roto wing aircraft of a patient to a facility that
 7 provides specialized medical care."
 8      SECTION 2.  Section 321-224, Hawaii Revised Statutes, is
 9 amended to read as follows:
10      "321-224  Department of health, functions, duties.  In
11 addition to other functions and duties assigned under this part
12 the department shall:
13      (1)  Regulate ambulances and ambulance services;
14      (2)  Establish emergency medical services throughout the
15           State, which shall include emergency aeromedical
16           services and which shall meet the requirements of this
17           part, subject to section 321-228;
18      (3)  Consult and coordinate with the University of Hawaii,
19           or any other accredited community college, college, or

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                                     S.B. NO.           S.D. 2

 1           university, or any professional organization that
 2           provides emergency medical services training, regarding
 3           the training for basic life support personnel and
 4           advanced life support personnel, as provided in section
 5           321-229;
 6      (4)  Collect and evaluate data for the continued evaluation
 7           of the state system subject to section 321-230;
 8      (5)  Coordinate emergency medical resources and the
 9           allocation of the state system's services and
10           facilities in the event of mass casualties, natural
11           disasters, national emergencies, and other emergencies,
12           ensuring linkage to local, state, and national disaster
13           plans, and participation in exercises to test these
14           plans;
15      (6)  Establish, administer, and maintain a communication
16           system for the state system;
17      (7)  Assist each county in the development of a "911"
18           emergency telephone system;
19      (8)  Secure technical assistance and other assistance and
20           consultation necessary for the implementation of this
21           part, subject to section 321-230;
22      (9)  Implement public information and education programs to
23           inform the public of the state system and its use, and

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                                     S.B. NO.           S.D. 2

 1           disseminate other emergency medical information,
 2           including appropriate methods of medical self-help and
 3           first-aid, and the availability of first-aid training
 4           programs in the State;
 5     (10)  Establish standards and provide training for
 6           dispatchers in the state system, and maintain a program
 7           of quality assurance for dispatch equipment and
 8           operations;
 9     (11)  Establish a program that will enable emergency service
10           personnel to provide early defibrillation;
11     (12)  Establish within the department the emergency medical
12           service system for children;
13     (13)  Consult with the advisory committee on matters relating
14           to the implementation of this part; and
15     (14)  Establish and maintain standards for emergency medical
16           services course instructor qualifications and
17           requirements for emergency medical services training
18           facilities."
19      SECTION 3.  Section 321-228, Hawaii Revised Statutes, is
20 amended to read as follows:
21      "321-228  Emergency medical services; counties.  The
22 department of health shall determine, in consultation with the
23 advisory committee under section 321-225, the levels of emergency

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                                     S.B. NO.           S.D. 2

 1 medical services which shall be implemented in each county.  The
 2 department of health may contract to provide emergency medical
 3 services including emergency aeromedical services or any
 4 necessary component of a county emergency services system in
 5 conformance with the state system.  In the event any county shall
 6 apply to the department to operate emergency medical ambulance
 7 services within the respective county, the department of health
 8 may contract with the county for the provision of such services.
 9 The department shall operate emergency medical ambulance services
10 or contract with a private agency in those counties which do not
11 apply to it under this section.  Any county or private agency
12 contracting to provide emergency medical ambulance services under
13 this section shall be required by the department to implement
14 such services in a manner and at a level consistent with the
15 levels determined under this section."
16      SECTION 4.  Section 321-230, Hawaii Revised Statutes, is
17 amended to read as follows:
18      "321-230  Technical assistance, data collection,
19 evaluation.  (a)  The department of health may contract for
20 technical assistance and consultation, including but not limited
21 to categorization, data collection, and evaluation appropriate to
22 the needs of the state system.  The collection and analysis of
23 statewide emergency medical services data, including pediatrics,

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                                     S.B. NO.           S.D. 2

 1 trauma, cardiac, medical, and behavioral medical emergencies is
 2 for the purpose of improving the quality of services provided.
 3      For the purposes of this [section,] subsection,
 4 "categorization" means systematic identification of the readiness
 5 and capabilities of hospitals and their staffs to adequately,
 6 expeditiously, and efficiently receive and treat emergency
 7 patients.
 8      (b)  The department of health shall establish, administer,
 9 and maintain an aeromedical emergency medical services
10 information system designed to collect and analyze data to
11 measure the efficiency and effectiveness of each phase of an
12 aeromedical quality improvement program.
13      The aeromedical emergency medical services information
14 system shall serve the emergency health needs of the people of
15 the State by identifying system strengths and weaknesses, the
16 allocation of resources, and the development of aeromedical
17 service standards.  The department of health in the
18 implementation of this subsection shall plan, coordinate, and
19 provide assistance to all entities and agencies, public and
20 private, involved in the system.
21      The aeromedical emergency medical services information
22 system shall measure, but is not limited to, the following
23 factors:

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                                     S.B. NO.           S.D. 2

 1      (1)  Communication and dispatch, including:
 2           (A)  Time at initial medical facility for
 3                stabilization;
 4           (B)  Availability and flight time of fixed-wing
 5                emergency aeromedical services to the nearest
 6                airport;
 7           (C)  Availability and transport time by ground
 8                ambulance from hospital to airport;
 9           (D)  Flight time of fixed-wing aircraft to Honolulu
10                airport; and
11           (E)  Availability and transportation by ground
12                ambulance to the designated medical center;
13      (2)  Medical oversight by physicians; and
14      (3)  License and standards of emergency aeromedical
15           services.
16      (c)  The department of health shall establish an emergency
17 aeromedical services quality improvement committee to analyze
18 information collected from the aeromedical quality improvement
19 performance measures as established by the American College of
20 Surgeons, and to recommend system standards and resources to
21 improve the Hawaii emergency aeromedical services system.  The
22 director of health shall appoint members to the committee, as
23 follows:

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                                     S.B. NO.           S.D. 2

 1      (1)  One member from each county representing hospital
 2           physicians;
 3      (2)  One member representing a major trauma center;
 4      (3)  One member specializing in tertiary pediatrics;
 5      (4)  One member representing burn center physicians;
 6      (5)  One member representing aeromedical services; and
 7      (6)  One member representing ground ambulance services."
 8      SECTION 5.  Section 321-232, Hawaii Revised Statutes, is
 9 amended by amending subsection (a) to read as follows:
10      "(a)  The department of health shall establish reasonable
11 fees for services rendered to the public by the department of
12 health, any county, or private agency under this part; provided
13 that all such revenues which shall be collected by the department
14 of health and the respective counties shall be deposited into the
15 [state general fund,] emergency medical services special fund
16 established by section 321-   , except such amounts necessary to
17 provide for collection services for bad debt accounts.  Fees
18 required to be set by this section shall be established in
19 accordance with chapter 91."
20      SECTION 6.  Chapter 321, Hawaii Revised Statutes, is amended
21 by adding a new section to be appropriately designated and to
22 read as follows:
23      "321-     Emergency medical services special fund.  (a)

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                                     S.B. NO.           S.D. 2

 1 There is established in the state treasury the emergency medical
 2 services special fund into which shall be deposited:
 3      (1)  Appropriations made by the legislature to the fund; and
 4      (2)  Revenues from fees charged for emergency ambulance
 5           services as provided in this part.
 6      (b)  Moneys in the emergency medical services special fund
 7 shall be used to carry out the purposes of this part.
 8      (c)  All unexpended and unencumbered moneys remaining in the
 9 emergency medical services special fund at the close of each
10 fiscal year that are deemed by the director of finance, after
11 consultation with the director of health, to be in excess of the
12 moneys necessary to carry out the purposes of this part over the
13 next following fiscal year, shall lapse to the credit of the
14 state general fund."
15      SECTION 7.  Statutory material to be repealed is bracketed.
16 New statutory material is underscored.
17      SECTION 8.  This Act shall take effect upon its approval.