Report Title:

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

Description:

Establishes a special fund for emergency medical services to be funded by an additional fee imposed on certificates of registration for motor vehicles. 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. (SD2)

HOUSE OF REPRESENTATIVES

H.B. NO.

1182

TWENTY-SECOND LEGISLATURE, 2003

H.D. 2

STATE OF HAWAII

S.D. 2


 

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. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to part XVIII to be appropriately designated and to read as follows:

"321- Emergency medical services special fund. (a) There is established within the state treasury a special fund to be known as the emergency medical services special fund to be administered and expended by the department of health.

(b) The moneys in the special fund shall used by the department of health for operating the state comprehensive emergency medical services system established under this part.

(c) Fees remitted pursuant to section 286-51(b), interest and investment earnings attributable to the moneys in the special fund, and grants, donations, and contributions from private or public sources for the purposes of the fund, shall be deposited into the special fund.

(d) The department of health shall submit an annual report to the legislature no later than twenty days prior to the convening of each regular session; providing an accounting of the receipts of, and expenditures from, the special fund."

SECTION 2. Section 286-51, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) This part shall be administered by the director of finance in conjunction with the requirements of sections 249-1 to 249-13 and shall entail no additional expense or charge to the person registering the ownership of a motor vehicle other than as provided by this section or by other laws; provided that for each new certificate of ownership issued by the director of finance under section 286-52, the director of finance may charge a fee which shall be deposited in the general fund. The fees charged to issue a new certificate of ownership shall be established by the county's legislative body.

Notwithstanding any other law to the contrary, an additional fee of not more than $1 for each certificate of registration for a U-drive motor vehicle and $2 for each certificate of registration for all other motor vehicles may be established by ordinance and collected annually by the director of finance of each county, to be used and administered by each county:

(1) For the purpose of beautification and other related activities of highways under the ownership, control, and jurisdiction of each county; and

(2) To defray the additional cost in the disposition and other related activities of abandoned or derelict vehicles as prescribed in chapter 290.

The $2 fee established pursuant to this subsection for certificates of registration for motor vehicles other than U-drive motor vehicles may be increased by ordinance up to a maximum of $5; provided that all amounts received from any fee increase over $2 shall be expended only for the purposes of paragraph (2). The moneys so assessed and collected shall be placed in a revolving fund entitled, "the highway beautification and disposal of abandoned or derelict vehicles revolving fund".

Notwithstanding any other law to the contrary, an additional fee of not more than $      for each certificate of registration for a U-drive motor vehicle and $      for each certificate of registration for all other motor vehicles shall be collected annually by the director of finance of each county.               of the amount of each fee shall be deposited into the emergency medical services special fund. The remainder shall be retained by the counties for their administrative costs in providing emergency aeromedical services."

SECTION 3. 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 4. 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 5. 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 6. 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."

SECTION 7. Section 321-232, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) The department of health shall establish reasonable fees for services rendered to the public by the department of health, any county, or private agency under this part; provided that all such revenues which shall be collected by the department of health and the respective counties shall be deposited into the state general fund, except such amounts necessary to provide for collection services for bad debt accounts. Fees required to be set by this section shall be established in accordance with chapter 91."

PART II

SECTION 8. 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 9. There is appropriated out of the emergency medical services special fund the sum of $        , or so much thereof as may be necessary for fiscal year 2004-2005, 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 10. There is appropriated out of the emergency medical services special fund the sum of $          , or so much thereof as may be necessary for fiscal year 2004-2005, for emergency medical services at the Waianae Coast Comprehensive Health Center, including ambulance services.

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

PART IV

SECTION 11. 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 12. There is appropriated out of the emergency medical services special fund the sum of $        , or so much thereof as may be necessary for fiscal year 2004-2005, to provide sufficient twenty-four-hour advanced life support ambulance services for the Kihei/Wailea region of Maui.

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

PART V

SECTION 13. 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 14. There is appropriated out of the emergency medical services special fund the sum of $          , or so much thereof as may be necessary for fiscal year 2004-2005, to provide emergency advanced life support ambulance service to the residents of Hawaiian Ocean View Estates on the island of Hawaii.

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

SECTION 16. This Act shall take effect upon its approval, provided that sections 9, 10, 12, and 14 shall take effect on July 1, 2003.