Report Title:

Emergency Medical Services Integration; Emergency Medical Services Enhancement for Neighbor Islands and Rural Areas

Description:

Requires DOH to integrate emergency aeromedical services into statewide emergency medical services. Appropriates funds for: aeromedical services for Maui county, emergency medical services at the Waianae Coast Comprehensive Health Center, and advance life support ambulance services for parts of Maui and Hawaii. Requires matching county funds. (SD1)

HOUSE OF REPRESENTATIVES

H.B. NO.

1182

TWENTY-SECOND LEGISLATURE, 2003

H.D. 2

STATE OF HAWAII

S.D. 1


 

A BILL FOR AN ACT

 

RELATING TO EMERGENCY MEDICAL SERVICES.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

PART I

SECTION 1. Section 321-222, Hawaii Revised Statutes, is amended by adding a new definition to be appropriately inserted and to read as follows:

""Emergency aeromedical services" means a secondary response system which provides immediate critical care and transport by rotary-wing aircraft of a patient to a facility that provides specialized medical care."

SECTION 2. Section 321-224, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) In addition to other functions and duties assigned under this part, the department shall:

(1) Regulate ambulances and ambulance services;

(2) Establish emergency medical services throughout the State, including emergency aeromedical services, which shall meet the requirements of this part, subject to section 321-228;

(3) Review and approve the curricula and syllabi of training courses offered to emergency medical services personnel who provide basic, intermediate, and advanced life support, consult and coordinate with the University of Hawaii, or any other accredited community college, college, or university, or any professional organization that provides emergency medical services training, regarding the training for basic, intermediate, and advanced life support personnel, as provided in section 321-229;

(4) Collect and evaluate data for the continued evaluation of the state system, subject to section 321-230;

(5) Coordinate emergency medical resources and the allocation of the state system's services and facilities in the event of mass casualties, natural disasters, national emergencies, and other emergencies, ensuring linkage to local, state, and national disaster plans, and participation in exercises to test these plans;

(6) Establish, administer, and maintain a communication system for the state system;

(7) Assist each county in the development of a "911" emergency telephone system;

(8) Secure technical assistance and other assistance and consultation necessary for the implementation of this part, subject to section 321-230;

(9) Implement public information and education programs to inform the public of the state system and its use, and disseminate other emergency medical information, including appropriate methods of medical self-help and first-aid, and the availability of first-aid training programs in the State;

(10) Establish standards and provide training for dispatchers in the state system, and maintain a program of quality assurance for dispatch equipment and operations;

(11) Establish a program that will enable emergency service personnel to provide early defibrillation;

(12) Establish within the department the emergency medical service system for children;

(13) Consult with the advisory committee on matters relating to the implementation of this part; and

(14) Establish and maintain standards for emergency medical services course instructor qualifications and requirements for emergency medical services training facilities."

SECTION 3. Section 321-228, Hawaii Revised Statutes, is amended to read as follows:

"321-228 Emergency medical services; counties. The department [of health] shall determine, in consultation with the advisory committee under section 321-225, the levels of emergency medical services, which shall be implemented in each county. The department [of health] may contract to provide emergency medical services, including emergency aeromedical services, or any necessary component of a county emergency services system in conformance with the state system. In the event any county shall apply to the department to operate emergency medical ambulance services within the respective county, the department [of health] may contract with the county for the provision of [such] those services. The department shall operate emergency medical ambulance services or contract with a private agency in those counties which do not apply to it under this section. Any county or private agency contracting to provide emergency medical ambulance services under this section shall be required by the department to implement [such] those services in a manner and at a level consistent with the levels determined under this section."

SECTION 4. Section 321-230, Hawaii Revised Statutes, is amended to read as follows:

"321-230 Technical assistance, data collection, evaluation. (a) The department [of health] may contract for technical assistance and consultation, including but not limited to categorization, data collection, and evaluation appropriate to the needs of the state system. The collection and analysis of statewide emergency medical services data, including pediatrics, trauma, cardiac, medical, and behavioral medical emergencies is for the purpose of improving the quality of services provided.

The department [of health] may implement and maintain a trauma registry for the collection of information concerning the treatment of critical trauma patients at state designated trauma centers and carry out a system for the management of that information. The system may provide for the recording of information concerning treatment received before and after a trauma patient's admission to a hospital or medical center. All state designated trauma centers shall submit to the department of health periodic reports of each patient treated for trauma in the state system in such manner as the department shall specify.

For the purposes of this [section,] subsection, "categorization" means systematic identification of the readiness and capabilities of hospitals and their staffs to adequately, expeditiously, and efficiently receive and treat emergency patients.

(b) The department shall establish, administer, and maintain an aeromedical emergency medical services system designed to collect and analyze data to measure the efficiency and effectiveness of each phase of an emergency aeromedical program.

The aeromedical emergency medical services system shall serve the emergency health needs of the people of the State by identifying system strengths and weaknesses, the allocation of resources, and the development of aeromedical service standards. The department, in the implementation of this subsection, shall plan, coordinate, and provide assistance to all entities and agencies, public and private, involved in the system.

(c) The department shall use an emergency aeromedical services quality improvement committee comprised of representatives of trauma, emergency, and tertiary care physicians and providers to analyze information collected from the aeromedical quality improvement performance measures as established by the American College of Surgeons, and to recommend system standards and resources to maintain and improve the Hawaii emergency aeromedical services system."

PART II

SECTION 5. The legislature finds that Hawaii, an island state, is dependent upon the aeromedical transportation of patients from neighbor island medical facilities who require specialized care at tertiary hospitals in Honolulu. The rural nature of neighbor island communities also requires long ground transport times to medical facilities with the capability to stabilize and treat critical medical conditions. An emergency aeromedical system must assure timely transport of seriously ill and injured persons to definitive medical facilities based on national aeromedical standards meeting medical necessity criteria.

In particular, Maui county is in need of emergency aeromedical services provided by a helicopter aeromedical unit to complement emergency ground ambulance and fixed-wing transport services. Residents of the islands of Maui, Molokai, and Lanai are without an adequate emergency aeromedical system to meet the American College of Surgeons performance measure of four hours from the time a serious head injury patient arrives at the initial receiving facility until arrival at a facility capable of providing appropriate medical care. In addition, there is not an adequate measure of the delay from the time of the trauma or serious illness to arrival at a facility capable of providing appropriate and potentially life-saving care.

The purpose of this part is to establish for the islands of Maui county a helicopter critical care emergency aeromedical service which operates twenty-four hours a day, and is staffed by medical personnel to provide rapid transport to appropriate medical care facilities. Establishment of the emergency helicopter unit is intended to respond to intra-county emergencies; integrate ground, rotor, and fixed-wing transport with the 911 response system; augment aeromedical services that fixed-wing transport cannot provide; and enhance critical emergency rapid transport options for seriously, critically ill patients especially those from remote areas such as Lanai, Molokai, and Hana. It is not the intent of this part to supplant existing ground or fixed-wing transport, especially for routine or non-time sensitive inter-facility transportation. The emergency helicopter unit shall utilize triage protocols to ensure the medically appropriate dispatch of the unit. Helicopter utilization shall be based on national aeromedical triage and transport guidelines as established by the Association of Air Medical Services, the American College of Surgeons, and the National Association of Emergency Medical Services Physicians.

SECTION 6. There is appropriated out of the general revenues of the State of Hawaii the sum of $        , or so much thereof as may be necessary for fiscal year 2003-2004, for funding an emergency helicopter aeromedical service for the county of Maui; provided that no funds shall be made available under this part unless the county of Maui provides $         for the purpose for which this sum is appropriated; provided further that emergency helicopter aeromedical services shall use triage protocols and be based on national aeromedical, triage, and transport guidelines established by the Association of Air Medical Services, the American College of Surgeons, and the National Association of Emergency Medical Services Physicians. In establishing this service, the department of health is encouraged to partner with the county of Maui, health care providers, and the private sector to ensure that this necessary service is provided in the most cost efficient manner, utilizing all available resources.

The sum appropriated shall be expended by the department of health through its emergency medical service system for the purposes of this part.

PART III

SECTION 7. There is appropriated out of the general revenues of the State of Hawaii the sum of $          , or so much thereof as may be necessary for fiscal year 2003-2004, for emergency medical services at the Waianae Coast Comprehensive Health Center, including ambulance services; provided that no funds shall be made available under this part unless the city and county of Honolulu provides $         for the purpose for which this sum is appropriated.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART IV

SECTION 8. The legislature finds that the Kihei/Wailea region of Maui is a growing community and tourist center that includes only one twenty-four-hour, locally based advanced life support ambulance service for its visitors and residents. Thus, in emergency situations occurring when the single overburdened ambulance is already on call, the response time of ambulances from nearby communities increases by an additional twenty to thirty minutes, depending on the location of the ambulance. The legislature further finds that in many emergency medical situations, this prolonged response time can mean the difference between life and death for individuals visiting or living in this community.

The purpose of this part is to provide parity in emergency health care for residents and visitors of the Kihei/Wailea region of Maui by providing an additional twenty-four-hour advanced life support ambulance service.

SECTION 9. There is appropriated out of the general revenues of the State of Hawaii the sum of $        , or so much thereof as may be necessary for fiscal year 2003-2004, to provide sufficient twenty-four-hour advanced life support ambulance services for the Kihei/Wailea region of Maui; provided that no funds shall be made available under this part unless the county of Maui provides $         for the purpose for which this sum is appropriated.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART V

SECTION 10. The legislature finds that unacceptably long and potentially life-threatening delays in emergency ambulance service have occurred in the Hawaiian Ocean View Estates area of the island of Hawaii. These delays, which can last up to two hours, occur when the Ka'u ambulance--located in Naalehu--is already on call. Although emergency medical technicians with the fire department can provide basic life support until a back up advanced life support ambulance with mobile intensive care technicians arrives on scene, there is a vast difference between the level of care that each kind of technician is qualified to provide. Delays in the provision of appropriate emergency medical care because of geography are inhumane and unfair.

Consequently, the purpose of this part is to appropriate funds to the department of health to provide emergency advanced life support ambulance service to the residents of Hawaiian Ocean View Estates on the island of Hawaii.

SECTION 11. There is appropriated out of the general revenues of the State of Hawaii the sum of $          , or so much thereof as may be necessary for fiscal year 2003-2004, to provide emergency advanced life support ambulance service to the residents of Hawaiian Ocean View Estates on the island of Hawaii; provided that no funds shall be made available under this part unless the county of Hawaii provides $         for the purpose for which this sum is appropriated.

The sum appropriated shall be expended by the department of health for the purposes of this part; provided that any emergency advanced life support ambulance and its crews shall be based at the fire station constructed by the volunteer fire department in Hawaiian Ocean View Estates.

PART VI

SECTION 12. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 13. This Act shall take effect upon its approval, provided that sections 6, 7, 9, and 11 shall take effect on July 1, 2003.