THIRTY-FIRST LEGISLATURE, 2021
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO EMERGENCY MEDICAL SERVICES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that existing laws relating to the licensing or certification of emergency medical personnel address only emergency ambulance personnel, including licensed emergency medical technicians – basic, advanced emergency medical technicians, and mobile intensive care technicians or paramedics. There is no licensure category for emergency medical responders. The legislature further finds that emergency medical responders provide at-the-scene, life-saving care with minimal equipment to critical care patients and have the knowledge and skills necessary to provide immediate interventions while awaiting arrival of additional emergency medical services. Emergency medical responders are a vital part of a comprehensive emergency medical services system response, and include firefighters and ocean safety lifeguards who provide immediate life-saving interventions to patients but do not provide emergency ambulance services.
The purpose of this Act is to:
(1) Align Hawaii with national trends and mitigate the unintended consequences associated with the deregulation of Hawaii's emergency medical services system by:
(A) Enabling the Hawaii medical board to issue licenses for emergency medical responders and other emergency ambulance personnel, which shall be based on certain requirements; and
(B) Including emergency medical responders in the State's pre-hospital response; and
(2) Require the department of commerce and consumer affairs to examine a potential additional licensure category for emergency medical technicians who have received certain certification from the National Registry of Emergency Technicians but do not provide emergency ambulance services.
SECTION 2. Section 321-222, Hawaii Revised Statutes, is amended by amending the definition of "emergency medical services personnel" to read as follows:
medical services personnel" means any mobile intensive care technician or
emergency medical technician who is [
certified or] licensed by the
SECTION 3. Section 321-229, Hawaii Revised Statutes, is amended by amending subsections (a) to (c) to read as follows:
"(a) The University of Hawaii shall provide
training courses in basic, intermediate, and advanced life support for emergency
medical services personnel. The
curricula and syllabi of these courses shall be approved in advance by the
department of health. The curricula and
syllabi of courses for ambulance personnel shall be consistent with the scope
and level of the practice of emergency medical services associated with emergency
ambulance personnel [
certification] licensure defined by the Hawaii
medical board under part II of chapter 453.
(b) The University of Hawaii, or other accredited
community college, college, or university, or any professional organization
that is approved by the department of health to provide emergency medical
services training, shall consult with the department of health to determine the
number and type of emergency medical services courses necessary to support the
staffing requirements for emergency medical services. The basic life support and advanced life
support training programs shall be relevant to and consistent with the training
course required for [
certification] licensure under chapter 453.
(c) The department shall develop standards for emergency
medical services course instructors and standards for emergency medical
services training facilities for all basic life support personnel, advanced
life support personnel, users of the automatic external defibrillator, and
emergency medical dispatch personnel that shall be at least equivalent to or
exceed the standards necessary to meet the requirements, pursuant to part II
of chapter 453, for the [
certification] licensure of basic life
support personnel and advanced life support personnel."
SECTION 4. Section 453-2, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:
"(b) Nothing herein shall:
(1) Apply to so-called Christian Scientists; provided that the Christian Scientists practice the religious tenets of their church without pretending a knowledge of medicine or surgery;
(2) Prohibit service in the case of emergency or the domestic administration of family remedies;
(3) Apply to any commissioned medical officer in the United States armed forces or public health service engaged in the discharge of one's official duty, including a commissioned medical officer employed by the United States Department of Defense, while providing direct telehealth support or services to neighbor island beneficiaries within a Hawaii National Guard armory on the island of Kauai, Hawaii, Molokai, or Maui; provided that the commissioned medical officer employed by the United States Department of Defense is credentialed by Tripler Army Medical Center;
(4) Apply to any practitioner of medicine and surgery from another state when in actual consultation, including in-person, mail, electronic, telephonic, fiber-optic, or other telehealth consultation with a licensed physician or osteopathic physician of this State, if the physician or osteopathic physician from another state at the time of consultation is licensed to practice in the state in which the physician or osteopathic physician resides; provided that:
(A) The physician or osteopathic physician from another state shall not open an office, or appoint a place to meet patients in this State, or receive calls within the limits of the State for the provision of care for a patient who is located in this State;
(B) The licensed physician or osteopathic physician of this State retains control and remains responsible for the provision of care for the patient who is located in this State; and
(C) The laws and rules relating to contagious diseases are not violated;
services rendered by any person [
certified] licensed under part
II of this chapter to provide emergency medical services, or any physician
assistant, when the services are rendered under the direction and control of a
physician or osteopathic physician licensed in this State except for final
refraction resulting in a prescription for spectacles, contact lenses, or
visual training as performed by an oculist or optometrist duly licensed by the
State. The direction and control shall
not be construed in every case to require the personal presence of the
supervising and controlling physician or osteopathic physician. Any physician or osteopathic physician who
employs or directs a person [ certified] licensed under part II of
this chapter to provide emergency medical services, or a physician assistant,
shall retain full professional and personal responsibility for any act that
constitutes the practice of medicine when performed by the [ certified] licensed
person or physician assistant;
(6) Prohibit automated external defibrillation by:
(A) Any first responder personnel certified by the department of health to provide automated external defibrillation when it is rendered under the medical oversight of a physician or osteopathic physician licensed in this State; or
(B) Any person acting in accordance with section 663‑1.5(e); or
(7) Prohibit a radiologist duly licensed to practice medicine and provide radiology services in another state from using telehealth while located in this State to provide radiology services to a patient who is located in the state in which the radiologist is licensed. For the purposes of this paragraph:
"Distant site" means the location of the radiologist delivering services through telehealth at the time the services are provided.
"Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a radiologist through telehealth, including but not limited to a radiologist's or health care provider's office, hospital, health care facility, a patient's home, and other non-medical environments such as school-based health centers, university-based health centers, or the work location of a patient.
"Radiologist" means a doctor of medicine or a doctor of osteopathy certified in radiology by the American Board of Radiology or the American Board of Osteopathy.
"Telehealth" means the use of telecommunications, as that term is defined in section 269-1, to encompass four modalities: store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the radiologist is at a distant site. Standard telephone contacts, facsimile transmissions, or e-mail texts, in combination or by themselves, do not constitute a telehealth service for the purposes of this paragraph."
SECTION 5. Section 453-31, Hawaii Revised Statutes, is amended to read as follows:
"§453-31 Emergency ambulance service personnel. The practice of any emergency medical
services by any individual employed by an emergency ambulance service who is
not licensed under part I of this chapter or under chapter 457 shall be
subject to [
certification] licensure under this part. In the event of any conflict between this part
and any rules adopted under section 453-2, this part shall control with regard
to emergency ambulance service personnel.
The Hawaii medical board shall define the
scope of the practice of emergency medical services, different levels of the
practice, and degree of supervision required of a supervising physician or
osteopathic physician when a person [
certified] licensed under
this part provides services within the practice of medicine."
SECTION 6. Section 453-32, Hawaii Revised Statutes, is amended to read as follows:
Licensure of emergency ambulance personnel[ .]
and emergency medical responders. (a) The Hawaii medical board shall [ certify]
issue licenses to individuals [ as] qualified in emergency medical
services, upon application therefor[ ; provided that the], consistent
with the following levels of practice:
(1) Emergency medical responder;
(2) Emergency medical technician;
(3) Advanced emergency medical technician; or
(4) Mobile intensive care technician or paramedic.
(b) The applicant for [
Hold a current certificate from the National Registry of
Emergency Medical Technicians[ ,has] for the requisite level of practice,
have satisfactorily passed a course of training in emergency medical services
for emergency ambulance services personnel [ which] that shall be
based on and may exceed the national curriculum of the United States
Department of Transportation and approved by the board[ ,] if required
for the applicable level of practice, and [ meets] meet other
standards and qualifications, including passage of an examination, set by the Hawaii
medical board pertinent to the practice of emergency medical services in Hawaii;
Meet continuing education requirements [ which] that shall
be set by the Hawaii medical board; and
Meet other qualifications set by the Hawaii medical board.
(c) The board shall directly review the credentials
of applicants and administer examinations required. [
Certification] Licensure under
this section shall be a prerequisite to the practice of emergency medical
services as an emergency medical responder or as an employee of an
emergency ambulance service.
(d) The Hawaii medical board shall provide
standard application forms for the [
certification] licensure of
emergency ambulance personnel and emergency medical responders and shall
provide for the periodic renewal of such [ certification.] licenses. The Hawaii medical board shall assess a fee
for such application, [ certification,] licensure, and
renewal. The Hawaii medical board shall
provide for the revocation, suspension, or limitation of [ certification]
licensure in the event an individual once [ certified] licensed
under this section fails to maintain or meet requirements for continued [ certification,]
licensure or for good cause shown.
(e) Applicants for licensure as an emergency medical responder shall additionally demonstrate:
(1) Successful completion of a Hawaii medical board‑approved emergency medical responder course that meets or exceeds the National Emergency Medical Services Education Standards for the Emergency Medical Responder;
(2) A current cardiopulmonary resuscitation certification;
(3) Proficiency in Basic Life Support for Healthcare Providers or equivalent credential;
(4) Successful completion of the Hawaii medical board‑approved emergency medical responder cognitive (knowledge) examination and psychomotor (skills) examination; and
(5) Any other requirements determined by the Hawaii medical board.
Any emergency medical responder licensed under this part shall document care in a pre-hospital emergency medical records system compatible with the emergency medical services system's pre-hospital medical records system. Emergency medical responders shall practice under a physician or osteopathic physician.
(f) For purposes of this section, "emergency ambulance personnel" means emergency medical technicians, advanced emergency medical technicians, mobile intensive care technicians, or paramedics."
SECTION 7. Section 453-32.1, Hawaii Revised Statutes, is amended to read as follows:
Renewal of [
licensure. (a) Every person holding a [ certificate] license
under this part shall renew the [ certificate] license with the
board no later than January 31 of each even-numbered year, pay a renewal fee,
and comply with the continuing education requirements set forth in the board's
(b) To determine compliance, the board may conduct a random audit. A person selected for audit shall be notified by the board. Within sixty days of notification, the person shall provide to the board documentation to verify compliance with the continuing education requirements.
(c) Failure to renew, pay the renewal fee, and,
in the case of audited persons, provide documentation of compliance shall
constitute a forfeiture of the [
certificate] license which may
only be restored upon the submission of written application, payment to the
board of a restoration fee, and in the case of audited persons, documentation
(d) A [
certificate] license that
has been forfeited for one renewal term shall be automatically terminated and
cannot be restored, and a new application for [ certification] licensure
shall be required."
SECTION 8. Section 453-32.5, Hawaii Revised Statutes, is amended to read as follows:
Temporary certification.] Provisional licensure. (a) The board shall approve [ temporary certification]
provisional licensure of an applicant under section 453-32 if the
applicant has graduated from a board approved training program within twelve
months of the date of application and has never taken the written and practical
examination of the National Registry of Emergency Medical Technicians for that
level of practice but otherwise meets the requirements of section 453-32, has filed
a complete application with the board, and has paid all required fees.
If the applicant fails to apply for, or
to take, the next succeeding examination or fails to pass the examination or
fails to receive a [
certificate,] license, all privileges under
this section shall automatically cease upon written notification sent to the
applicant by the board. A [ temporary
certificate] provisional license for each level of practice may be
issued only once to each person.
Prior to practicing under [
certification,] any provisional license, applicants shall notify the
board in writing of any and all employers under whom they will be performing
SECTION 9. Section 453-32.51, Hawaii Revised Statutes, is amended to read as follows:
"§453-32.51 Limited [
certification.] provisional licensure. (a) The Hawaii medical board
shall approve limited [ temporary certification] provisional licensure
of an applicant under this section if the applicant:
graduated from a board or state-approved training program as developed and
promulgated by the United States Department of Transportation[
;], if required
for the applicable level of practice;
(2) Has passed the written and practical examinations of the National Registry of Emergency Medical Technicians for that level of practice;
(3) Holds a current certificate from the National Registry of Emergency Medical Technicians for that level of practice;
(4) Has submitted a letter verifying acceptance into a period of peer review as an emergency medical technician or mobile intensive care technician;
(5) Has filed a completed application with the board; and
(6) Has paid all the required fees.
certification] licensure of any applicant shall be restricted to
a maximum of one year.
All privileges under this section shall automatically cease if the
applicant receives [
certification] licensure under section 453-32
or 453-32.1 or is no longer participating in a period of peer review."
SECTION 10. Section 453-32.6, Hawaii Revised Statutes, is amended to read as follows:
"§453-32.6 Delegation to committee of practicing emergency physicians or osteopathic physicians and emergency ambulance personnel. The Hawaii medical board shall establish a committee consisting of practicing emergency physicians or osteopathic physicians and emergency ambulance personnel to assist the board in the performance of duties under this part.
The board, by written order, may delegate
to the committee any of its powers and duties for administration of this part,
except that the board shall not delegate any authority to adopt, amend, or
repeal rules, take disciplinary action against a [
holder, or restore a [ certificate] license which has been
SECTION 11. The department of commerce and consumer affairs shall examine the possibility of the creation of an additional licensure category for emergency medical technicians who have received certification from the National Registry of Emergency Medical Technicians at a higher level of practice than emergency medical responders but who do not provide emergency ambulance services.
SECTION 12. There is appropriated out of the compliance resolution fund the sum of $ or so much thereof as may be necessary for fiscal year 2021-2022 and the same sum or so much thereof as may be necessary for fiscal year 2022-2023 for the Hawaii medical board to establish and hire full-time equivalent ( . FTE) permanent positions for the purposes of this Act.
The sums appropriated shall be expended by the department of commerce and consumer affairs for the purposes of this Act.
SECTION 13. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 14. This Act shall take effect on July 1, 2060.
Emergency Medical Responders; Emergency Ambulance Service Personnel; Licensure; Hawaii Medical Board; Appropriation; Compliance Resolution Fund
Enables the Hawaii medical board to license emergency ambulance service personnel and emergency medical responders. Requires the department of commerce and consumer affairs to examine the creation of an additional licensure category for emergency medical technicians who are certified at a higher practice level than emergency medical responders but do not provide ambulance services. Appropriates funds from the compliance resolution fund for positions. Effective 7/1/2060. (HD2)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.