Board of Selectmen
Information Packet
Town of Canton
4 Market Street, Collinsville, Connecticut 06022
Board of Selectmen
Town of Canton
Post Office Box 168
4 Market Street
Collinsville, Connecticut 06022
November 3, 2014
Respectfully,
________________________________________
Richard Hutchings MPA, RN EMT-P,
Chief Town of Canton Fire & EMS
________________________________________
John Bunnell, EMT-P, BA
Assistant Chief Town of Canton Fire & EMS
Town of Canton
Fire & EMS
Upgrade to Paramedic Level Service
Contents
Contents
Cover Letters
Overview
Section 1
Section 2
Start-Up Costs
Medications & Supplies
Medical Equipment
Paramedic Vehicle
Section 3
Financials
Section 4
Summary
o Operating Cost Models
o Reimbursement Rates/Call/Run Data
Section 5
Timeline/Schedule
Section 6
Section 7
Section 8
Reference Materials
Section 9
Town of Canton
Fire & EMS
Upgrade to Paramedic Level Service
Overview
Section 1
Overview
Brief History:
The Canton Memorial Ambulance was formed in 1950 by employees of the Collins Company.
The Canton Memorial Ambulance was established as living memorial to U.S. war veterans. The
ambulance operated as an independent organization from 1950 till 1963 when it merged with the
Collins Company Fire Department.
In 1987 Chief Hutchings spearheaded an effort to upgrade to service to the present AEMT Level
(formerly known as the Intermediate Level) of service. The AEMT Level of service essentially
provides three key skills, enhanced assessment, IV therapy to improve blood volume/pressure
and better airway management over the basic skills (though not to the gold standard of intubation
as provided by paramedics). In the last few years the service has added new protocols and
equipment to improve patient care (QuikClot, Lucas 2, Naloxone, CPAP). While these have all
been good improvements they fall short of the level of service provided by paramedics.
Our sponsor hospital is the University of Connecticut Health Center in Farmington. Notice has
been given that effective July 1, 2016 they (UConn) will no longer sponsor Canton at the AEMT
level. Canton is the last remaining AEMT level service operating in the region. (Please see area
map at the end of this Overview)
Additional Background Regarding Canton EMS:
In the third quarter of 2011 the Board of Selectmen appointed a Temporary Committee to make
recommendations for long range plans for providing Emergency Medical Services (EMS) for the
Town of Canton.
The Committee submitted a report to the Board of Selectmen dated September 7, 2012. The
report recommended upgraded to paramedic level of service within two years. The report is
included for reference in Section 8.
The Town of Canton Volunteer Fire and EMS is part of Region 3 of the Connecticut Regional
EMS Councils and as such is governed by the North Central CT EMS Council Regional
Guidelines. To better understand the various levels of service (EMR, EMT, AEMT, Paramedic)
in detail a copy of the Guidelines have been provided. As this is a 220 page document only a
single copy has been made a part of this submission. Additional copies are available on request
or may be viewed on line at:
http://www.ctemscouncils.org/downloads/NC_EMS_%20Guidelines.pdf
Current Status:
At present when a 911 call is received a Canton Police Officer is dispatched to the scene. That
responding officer is our Towns First Responder. Car 10 is dispatched, provided a full legal
crew is available, to the scene and assumes responsibility for the patient(s). If a higher level of
care is required paramedics are dispatched from UConn. Depending on the nature of the call
they either meet on scene or intercept during transport.
In the State of Connecticut there are four levels of Primary Service Area Responder levels:
First Responder
Basic Ambulance
Intermediate Ambulance
Paramedic
As currently certified by the Connecticut Department of Health our primary ambulance (Car 10)
must be staffed to provide the intermediate level service (AEMT + EMT) in order to respond to a
call. The second ambulance (Car 11) must provide basic level of service (1 EMT + 1 EMT) at a
minimum. The second car out may provide intermediate level service as long as an AEMT is on
board.
The service is staffed by a paid service provider 06:00 to 18:00 Monday through Friday with a
crew of an AEMT and an EMT.
From 18:00 to 06:00 every day and 06:00 to 18:00 on weekends a volunteer crew staffs the
ambulance.
If a full legal crew (AEMT + EMT) is not available, even if two EMTs are ready at the station
to respond, the dispatcher must request mutual aid from a surrounding town in order to satisfy
the requirements established for an AEMT level service.
Time:
At present UConn provides paramedic services to the Town of Canton. As noted in the EMS
Study Committee Report, the average response times for paramedics was 16.95 minutes with
90% of all calls arriving within 32 minutes. Ten percent of the response times for medics was
between 32 and 68 minutes. The NFPA 1710 standard is an 8 minute response time. At best
UConn is 13 minutes from Canton. Traffic and weather have a significant impact on response
times. Establishing a paramedic service in Town will mitigate the majority of risk of travel
distance.
Sample Scenario:
If the Town upgrades to paramedic level service Car 10 will be able to
respond to all calls with a Basic ambulance (R2) and the paramedic
will be able to respond via a separate fly car. If after evaluation the
patient may be transported at the BLS level, the paramedic will remain
in Town prepared for the next call. Assuming a second call is
activated while the first ambulance is out of Town, the medic and a
second basic level ambulance can respond. Taking it one step further,
a third call is activated while both ambulances are out of Town, the
medic can respond and a mutual aid call for a basic ambulance can go
out to our partner towns.
It is not that uncommon to have both Car 10 and Car 11 activated at
one time. In fact, we have had the rare occasion of multiple medical
calls that were responded to by Car 10, Car 11, Utility 8, Rescue 9 plus
personal owned vehicles (POVs).
By establishing a paramedic service in Town a higher level of care and maximization of current
resources can be developed.
What does Paramedic-level Service Mean?
Please see Section 5 for a Matrix Comparing EMR, EMT-Basic, AEMT and Paramedic Levels of
Service.
Timeline:
Please see attached Gantt chart for transitioning to paramedic level service.
High-level View of Next Steps:
Over the course of the next several months steps will need to be taken to either downgrade our
service to the Basic EMT level or implement a plan to provide the paramedic level of service in
Canton. Depending on meeting schedules, planning for Town vote (if required), verifying costs,
filing appropriate documents with the State the overall process may take 12 to 18 months. A
preliminary implementation timeline/schedule has been included in Section 6 of this information
packet.
Goals:
Provide the highest level or patient care in the Town of Canton
Procure the appropriate level and quality of medical equipment and/or support vehicle
Procure commercial qualified paramedic staffing company services
Maintain the current core of qualified EMTs and FF/EMTs
Further develop the management of the Canton EMS
Enhance cooperation with surrounding towns
Work towards self-sufficiency through run volume, collection ratio and rate structure
HARTLAND
CANTON
BRISTOL
BURLINGTON
Hartford
County
Text
GRANBY
SIMSBURY
AVON
AM
R
FARMINGTON
AM
R
PLAINVILLE
AM
R
SOUTHINGTON
AM
R
EAST
GRANBY
EAST
HARTFORD
WINDSOR
LOCKS
ROCKY
HILL
Aetn
a
Aetn
a
WETHERSFIELD
Aetna
/
AMR
HARTFORD
WINDSOR
SUFFIELD
BLOOMFIELD
AM
R
NEWINGTON
AM
R
WEST
HARTFORD
NEW
BRITAIN
BERLIN
ENFIELD
EAST
WINDSOR
SOUTH
WINDSOR
MANCHESTER
GLASTONBURY
MARLBOROUGH
Town of Canton
Fire & EMS
Upgrade to Paramedic Level Service
Options for
Emergency
Medical Services
Section 2
Options
for
Emergency Medical Service Levels
Recommended Options:
Outsource for Paramedic Staffing (maintain two EMTs add fly car)
Outsource for Paramedic Staffing (maintain one EMT 06:00 to 18:00 and add fly
car for nights and weekends)
Utilize a commercial emergency medical service company (Aetna, AMR, Campion, Hunters,
other) to provide all emergency medical services to the Town.
The primary effects of this change versus the current status are:
Pros:
Improves the response times of paramedics to provide highest level of emergency
medical care in the field and during transport.
Places burden of paying for training on the out-sourced company
Avoids long term employment benefit obligations for the Town
Eliminates the need to provide ambulance apparatus, medical supplies and training
Cons:
Town call volume may not attract multiple bidders for the scope of services requested in
an RFP
Eliminates any reimbursement income for calls
Shifts burden of some first aid consumables on Police and Fire (O2, masks, basic
supplies)
Likely eliminates volunteer Canton Memorial Ambulance
Cons:
Commits paramedic to Car 10 only
Town call volume may not attract multiple bidders for the scope of services requested in
an RFP
Added cost of providing medical equipment and medications to start up service
Cons:
Town call volume may not attract multiple bidders for the scope of services requested in
an RFP
Added cost of providing fly car to begin service
Outsource for Paramedic Staffing (maintain one EMT 06:00 to 18:00 and add fly car for
nights and weekends)
Utilize a commercial emergency medical staffing service (Aetna, AMR, Campion, Hunters,
Vintech, other) to provide an emergency medical paramedic to staff the existing ambulance
provided by the Town. This hybrid option would change the current EMT/AEMT team to one
EMT paid for by the Town (M-F/06:00 to 18:00) and add a paramedic for all shifts.
By having a medic on the schedule for all shifts the Town will avoid costs for outsourced
AEMTs that have been hired with greater frequency due to a lack of available volunteer
AEMTs. Further the paramedic in a fly car offers the ultimate in volunteer utilization,
flexibility for apparatus responding and maximized reimbursement rates.
The primary effects of this change versus the current status are:
Pros:
Improves the response times of paramedics to provide highest level of emergency
medical care in the field and during transport.
Places burden of paying for training on the out-sourced company
Avoids long term employment benefit obligations for the Town
Increases reimbursement rates (income) for calls responded to with the higher level of
service
Potential for reimbursement for paramedic service provided to mutual aid towns
Scalability, if call volume warrants, a second EMT can be added and the medic utilizes
the fly car.
Cons:
Added cost of providing fly car to begin service
Town of Canton
Fire & EMS
Upgrade to Paramedic Level Service
Start-up Costs
Section 3
- Acetaminophen (Tylenol)
- Adenosine 12mg, 4 ml vial
- Adenosine 6mg, 2 ml vial
- Albuterol
- Amiodarone
- Aspirin
- Atropine
- Benzocaine Spray
- Calcium Chloride
- Dextrose (D10)
- Dextrose (D50)
- Diltiazem
- Diphenhydramine
- Dopamine
- Epinephrine (1:1000)
- Epinephrine (1:10,000)
- Glucagon
- Haloperidol
- Ipratropium Bromide
- Lactated Ringers
- Lidocaine
- Magnesium Sulfate
- Metoclopramide Hydrochloride (Reglan)
MedicationCosts
UpgradetoParamedicLevelService
0
2
2
8
1
0
2
0
4
36
1
1
1
3
1
3
2
1
6
1
1
1
4
Qty.
each
each
bx/10
bx/10
pk/25
each
bx/25
cs/50
each
bx/10
bx/30
cs/24
bx/10
bx/10
each
bx/10
bx/10
bx/10
bx/25
pk/25
Unit
0.00
199.90
62.90
11.79
124.75
0.00
152.99
0.00
15.79
3.79
161.99
68.20
73.50
24.29
81.25
98.99
267.99
84.60
62.70
100.56
87.99
96.75
2.22
Unit
Cost
0.00
399.80
125.80
94.32
124.75
0.00
305.98
0.00
63.16
136.44
161.99
68.20
73.50
72.87
81.25
296.97
535.98
84.60
376.20
100.56
87.99
96.75
8.88
Totals
Sub Total
1
2
0
4
0
0
1
3
2
2
3
2
1
3
cs/100
bx/25
each
bx/10
each
each
pk/25
each
bx/25
bx/25
bx/10
224.75
56.80
0.00
21.29
0.00
0.00
228.00
58.99
2.73
112.99
17.09
41.59
166.50
70.69
UCONN will exchange our Narc kits, they provide this service at no cost the narc kits contain:
- Fentanyl Citrate
- Midazolam
- Morphine Sulfate
- Solu-Medrol
- Metoprolol
- Naloxone
- Nitrostat
- Normal Saline
- Olanzipine ( Zyprexa)
- Odansetron
- Procainamide
- Racemic Epinephrine
- Sodium Bicarbonate
- Tetracaine
- topex
- Vasopressin
- Zyprexa
224.75
113.60
0.00
85.16
0.00
0.00
228.00
176.97
5.46
225.98
51.27
83.18
166.50
212.07
4868.93
SubTotal
ConsumableEquipment
DurableEquipment
EquipmentCosts
UpgradetoParamedicLevelService
Unit
cs/20
bx/10
bx/10
cs/5
cs/5
each
each
each
bx/25
bx/100
bx/10
1
1
5
each
each
Unit
QTY
11
8
11
2
4
3
2
2
1
4
QTY
35,000.00
319.96
35,319.96
Cost
107.80 1,185.80
25.00 200.00
24.00 264.00
186.95 373.90
175.95 703.80
6.36 19.08
6.49 12.98
6.49 12.98
367.25 367.25
1,219.00 1,219.00
104.90 524.50
35000
79.99
Cost
Initial
Cost
TotalEquipmentCosts
SubTotal
- Intraosseous Drill
- Intraosseous Needles (Adult)
- Intraosseous Needles (pedi)
- Intraosseous Needles (bariatric)
- 1 ml syringes
- 5 ml syringes
- 10 ml syringes
- Safety Glide Syringe with Needle 1cc
- Safety Glide Syringe with Needle 3cc
- Safety Glide Syringe with Needle 5cc
- Safety Glide Syringe with Needle 10cc
- Hypodermic needles
- Electrodes (Adult, pedi)
- ECG paper
- Morgan Lens
- Nebulizer assemblies
- Nebulizer mask (adult, pedi)
- Twinpak Dual Cannula device
- Chest decompression needles (Adult,Pedi)
- Cricothyrotomy Kit
1
10
3
5
1
1
1
1
1
1
1
1
2
3
3
2
2
1
5
2
each
each
each
each
bx/100
bx/125
bx/100
cs/400
cs/400
cs/400
cs/400
bx/100
cs/1000
cs/18
each
cs/50
cs/50
bx/100
each
each
700.00
120.00
120.00
120.00
59.89
24.39
25.59
261.52
243.92
287.92
295.92
36.89
315.80
95.22
30.89
51.00
75.00
68.00
13.99
219.98
45,699.17
700.00
1,200.00
360.00
600.00
59.89
24.39
25.59
261.52
243.92
287.92
295.92
36.89
631.60
285.66
92.67
102.00
150.00
68.00
69.95
439.96
10,379.21
Fly-Car Vehicle
UpgradetoParamedicLevelService
33,000
3,000
7,000
1,500
1,000
4,000
49,500
Town of Canton
Fire & EMS
Upgrade to Paramedic Level Service
Financials
Section 4
11/17/2014
Year1
RecommendedOptions
Onemedic+oneEMT(noflycar)
Projections*
($297,047)
Onemedic+twoEMT'sw/Flycar
($387,837)
Onemedic+oneEMTw/Flycar(offhoursonly)
($341,737)
NotRecommended
DowngradetoBLS
($130,627)
OutsourceallEMStocommercialservice
(sometownspayinexcessof
$400,000duetolowcallvolume,
otherspayverylittle.)
$382,000
to
$20,000
Townemployeeparamedics
($580,487)
BasisofProjections:
FY11143YearAverages(rounded)
3YearAverageExpense
3YearAverageRevenue
3YearAverageAnnualShortfall
$424,000
$334,000
$(90,000)
*Projectionsarebasedoncurrentspendingandrevenues.Thatis,projectednumbersinclude
anticipatedoperatinglossesaspreviouslyexperienced.
**DoesnotincludethevalueofliquidatingcurrentEMSequipmentandapparatus.
**
**
11/16/2014
UpgradetoParamedicLevelService
1FTMedic/1EMTFlyCar
FY's11 14
3Year
Average
EmergencyServicesFund
GeneralFund*
SubTotal Expenses
expenses
expenses
353,772
70,358
424,130
EmergencyServicesFund*
OperatingGain/(Loss)
revenue
334,303
(89,827)
Adjustments:
ALSinlieuofBLSclassifications
ALSAssessmentsOnly
MutualAidIntercepts
Staffing:
AddParamedic(commercial24/7@$31/hr)
Reduce1EMT(618MF)
ReducedAEMTstaffingtocovervolunteershifts
CostReductions
orAdded
Revenues
rate
$354
$356
$682
qty
100
50
25
31
0
8760
3120
CostIncreases
orReduced
Revenues
$ 35,400
$ 17,800
$ 17,050
$271,560
$
$ 30,000
Medications
Equipment
Vehicle
$ 14,000
$ 45,700
$ 49,500
Fuel
Maintenance/Tires
$ 4,000
$ 3,500
Equipment/ExpenseContingency
SubTotalIncreasesandReductions
TotalProjectedFirstYearCost
$10,000.0
$100,250.0 $398,260.0 $(298,010.0)
$(387,836.7)
11/16/2014
UpgradetoParamedicLevelService
1FTMedic/1EMTFlyCar(OffHoursOnly)
FY's11 14
3Year
Average
EmergencyServicesFund
GeneralFund*
SubTotal Expenses
expenses
expenses
353,772
70,358
424,130
EmergencyServicesFund*
OperatingGain/(Loss)
revenue
334,303
(89,827)
Adjustments:
ALSinlieuofBLSclassifications
ALSAssessmentsOnly
MutualAidIntercepts
Staffing:
AddParamedic(commercial24/7@$31/hr)
Reduce1EMT(618MF)
ReducedAEMTstaffingtocovervolunteershifts
CostReductions
orAdded
Revenues
rate
$354
$356
$682
qty
100
25
5
31
22
8760
3120
CostIncreases
orReduced
Revenues
$ 35,400
$ 8,900
$ 3,410
$271,560
$ 68,640
$ 30,000
Medications
Equipment
Vehicle
$ 14,000
$ 45,700
$ 49,500
Fuel
Maintenance/Tires
$ 4,000
$ 3,500
Equipment/ExpenseContingency
SubTotalIncreasesandReductions
TotalProjectedFirstYearCost
$10,000.0
$146,350.0 $398,260.0 $(251,910.0)
$(341,736.7)
11/16/2014
UpgradetoParamedicLevelService
1FTMedic/1EMTNoFlyCar
FY's11 14
3Year
Average
EmergencyServicesFund
GeneralFund*
SubTotal Expenses
expenses
expenses
353,772
70,358
424,130
EmergencyServicesFund*
OperatingGain/(Loss)
revenue
334,303
(89,827)
Adjustments:
ALSinlieuofBLSclassifications
ALSAssessmentsOnly
MutualAidIntercepts
Staffing:
AddParamedic(commercial24/7@$31/hr)
Reduce1EMT(618MF)
ReducedAEMTstaffingtocovervolunteershifts
CostReductions
orAdded
Revenues
rate
$354
$356
$682
qty
100
0
0
31
22
8760
3120
CostIncreases
orReduced
Revenues
$ 35,400
$
$
$271,560
$ 68,640
$ 30,000
Medications
Equipment
Vehicle
$ 14,000
$ 45,700
$
Fuel
Maintenance/Tires
$
$
Equipment/ExpenseContingency
SubTotalIncreasesandReductions
TotalProjectedFirstYearCost
$10,000.0
$134,040.0 $341,260.0 $(207,220.0)
$(297,046.7)
11/16/2014
UpgradetoParamedicLevelService
DowngradetoBLS
FY's11 14
3Year
Average
EmergencyServicesFund
GeneralFund*
SubTotal Expenses
expenses
expenses
353,772
70,358
424,130
EmergencyServicesFund*
OperatingGain/(Loss)
revenue
334,303
(89,827)
Adjustments:
ALSinlieuofBLSclassifications
ALSAssessmentsOnly
MutualAidIntercepts
Staffing:
AddParamedic(commercial24/7@$31/hr)
Reduce1EMT(618MF)
ReducedAEMTstaffingtocovervolunteershifts
CostReductions
orAdded
Revenues
rate
$354
$356
$682
qty
200
0
0
31
22
0
0
CostIncreases
orReduced
Revenues
$70,800
$
$
$
$
$30,000
Medications
Equipment
Vehicle
$
$
$
Fuel
Maintenance/Tires
$
$
Equipment/ExpenseContingency
SubTotalIncreasesandReductions
TotalProjectedFirstYearCost
$
$30,000.0 $70,800.0 $(40,800.0)
$(130,626.7)
11/16/2014
UpgradetoParamedicLevelService
1FTMedic/1EMTNoFlyCar
CreateTownEmployeePositions
FY's11 14
3Year
Average
EmergencyServicesFund
GeneralFund*
SubTotal Expenses
expenses
expenses
353,772
70,358
424,130
EmergencyServicesFund*
OperatingGain/(Loss)
revenue
334,303
(89,827)
Adjustments:
ALSinlieuofBLSclassifications
ALSAssessmentsOnly
MutualAidIntercepts
Staffing:
AddParamedic(5.5FTE's24/7@$100,000/yr)
Reduce1EMT(618MF)
ReducedAEMTstaffingtocovervolunteershifts
CostReductions
orAdded
Revenues
rate
$354
$356
$682
qty
100
0
0
31
22
8760
3120
CostIncreases
orReduced
Revenues
$35,400
$
$
$550,000
$68,640
$30,000
Medications
Equipment
Vehicle
OngoingTrainingCosts(estimated)
$14,000
$45,700
$
$5,000
Fuel
Maintenance/Tires
$
$
Equipment/ExpenseContingency
SubTotalIncreasesandReductions
TotalProjectedFirstYearCost
$10,000.0
$134,040.0
$624,700.0 $(490,660.0)
$(580,486.7)
CompareModels:
RecommendedOptions:
Commercialparamedicstaffing24hours/daywithflycar+2EMT's
Commercialparamedicstaffing24hours/day+1EMT(flycaroffhoursonly)
Commercialparamedicstaffing24hours/day+1EMT(noflycar)
NotRecommended:
DowngradetoBLS
CreateTownofCantonParamedicEmployeepositions
CompletelyOutsourceParamedicLevelService(includingbasicEMS)
Town of Canton
Fire & EMS
Upgrade to Paramedic Level Service
Tabular
Comparison of
Service Levels
Section 5
Oral airway
BVM
Sellicks Maneuver
Head-tilt chin lift
Jaw thrust
Modified chin lift
Obstructionmanual
Oxygen therapy
Nasal cannula
Non-rebreather face mask
Upper airway suctioning
Partial rebreathers
Venturi mask
CPAP
Oral airway
BVM
Sellicks Maneuver
Head-tilt chin lift
Jaw thrust
Modified chin lift
Obstructionmanual
Oxygen therapy
Nasal cannula
Non-rebreather face mask
Upper airway suctioning
AEMT
Partial rebreathers
Venturi mask
CPAP
EMT
EMR
Airway
Oral airway
BVM
Sellicks Maneuver
Head-tilt chin lift
Jaw thrust
Modified chin lift
Obstructionmanual
Oxygen therapy
Nasal cannula
Non-rebreather face mask
Upper airway suctioning
Paramedic
Oral airway
BVM
Sellicks Maneuver
Head-tilt chin lift
Jaw thrust
Modified chin lift
Obstructionmanual
Oxygen therapy
Nasal cannula
Non-rebreather face mask
Upper airway suctioning
Humidifiers
Partial rebreathers
Venturi mask
Manually Triggered
Ventilator (MTV)
Automatic Transport
Ventilator (ATV)
Oral and Nasal airways
Esophageal-Tracheal
Multi-Lumen Airways
BiPAP/CPAP
Needle chest
decompression
Chest tube monitoring
Percutaneous
cricothyrotomy2
ETCO2/Capnography
Assessment
Manual BP
EMR
EMR
Pharmacological Interventions
Unit dose auto-injectors
for self or peer care
EMT
Manual BP
Pulse oximetry
Manual and auto BP
Blood glucose monitor
AEMT
Paramedic
NG/OG tube
Nasal and oral
Endotracheal intubation
Airway obstruction
removal by direct
laryngoscopy
PEEP
Manual BP
Pulse oximetry
Manual and auto BP
Blood glucose monitor
Manual BP
Pulse oximetry
Manual and auto BP
Blood glucose monitor
EKG interpretation
Interpretive 12 Lead
Blood chemistry analysis
Paramedic
Unit dose auto-injectors
for self or peer care
Assisted Medications
Assisting a patient in
administering his/her
own prescribed
medications, including
auto-injection
Tech of Med
Administration
Buccal
Oral
Administered Meds
PHYSICIAN-approved
over-the-counter
medications (oral
glucose, ASA for chest
AEMT
Assisted Medications
Assisting a patient in
administering his/her
own prescribed
medications, including
auto-injection
Tech of Med
Administration
Buccal
Oral
Administered Meds
PHYSICIAN-approved
over-the-counter
medications (oral
glucose, ASA for chest
EMT
Assisted Medications
Assisting a patient in
administering his/her
own prescribed
medications, including
auto-injection
Tech of Med
Administration
Buccal
Oral
Administered Meds
PHYSICIAN-approved
over-the-counter
medications (oral
glucose, ASA for chest
Trauma Care
EMR
Manual cervical stabilization
Manual extremity stabilization
Eye irrigation
Direct pressure
Hemorrhage control
Emergency moves for endangered
patients
pain of suspected
ischemic origin)
Naloxone
EMT
Manual cervical stabilization
Manual extremity stabilization
Eye irrigation
Direct pressure
Hemorrhage control
Emergency moves for endangered
patients
Spinal immobilization
Seated spinal immobilization
Long board
Extremity splinting
pain of suspected
ischemic origin)
Peripheral IV insertion
IV fluid infusion
Naloxone
AEMT
Manual cervical stabilization
Manual extremity stabilization
Eye irrigation
Direct pressure
Hemorrhage control
Emergency moves for endangered
patients
Spinal immobilization
Seated spinal immobilization
Long board
Extremity splinting
pain of suspected
ischemic origin)
Peripheral IV insertion
IV fluid infusion
Central line monitoring
IO insertion
Venous blood sampling
Tech of Med
Administration
Endotracheal
IV (push and infusion)
NG
Rectal
IO
Topical
Accessing implanted
Central IV port
Administered Meds
PHYSICIAN-approved medications
Paramedic
Maintenance of blood
administration
Thrombolytics
initiation
Cardiac/Medical Care
EMR
CPR
AED
Assisted normal delivery
Traction splinting
Mechanical pt restraint
Tourniquet
MAST/PASG
Cervical collar
Rapid extrication
EMT
CPR
AED
Assisted normal delivery
Mechanical CPR
Assisted complicated delivery
Traction splinting
Mechanical pt restraint
Tourniquet
MAST/PASG
Cervical collar
Rapid extrication
AEMT
CPR
AED
Assisted normal delivery
Mechanical CPR
Assisted complicated delivery
Traction splinting
Mechanical pt restraint
Tourniquet
MAST/PASG
Cervical collar
Rapid extrication
Morgan lens
Paramedic
CPR
AED
Assisted normal delivery
Mechanical CPR
Assisted complicated delivery
Cardioversion
Carotid massage
Manual defibrillation
TC pacing
Town of Canton
Fire & EMS
Upgrade to Paramedic Level Service
Timeline/
Schedule
Section 6
ID
FollowupBOSMeeting(ifrequired)
FollowupBOSMeeting(ifrequired)
AwardContract
13
AwardContracts/PO's
18
24
23
22
21
20
NewServiceLevelIsActive(ALSorBLS)
SupportforAEMTends
ReviewBillingProtocols/Recovery
ReviewProposals
17
19
RequestforProposalsforEquipment
16
15
AcquireRequiredEquipment
ReviewProposals
12
14
RequestforProposalsforALSStaffing/Outsourcing
NotificationtoDPHOEMSforPSAR
11
10
BoardofFinance
PresenttoBoardofSelectmen
SubmitInformationtoBOS/CAO
TaskName
0days
0days
0days
20days
30days
1day
0days
30days
30days
0days
0days
0days
0days
Duration
Finish
Tue9/1/15
Thu8/20/15
Fri7/10/15
Page1
Fri7/1/16
Thu6/30/16
Fri7/1/16
Thu6/30/16
Tue12/15/15 Tue12/15/15
Tue11/17/15 Mon12/14/15
Wed10/7/15 Tue11/17/15
Wed10/7/15 Wed10/7/15
Tue9/1/15
Fri7/10/15
Mon6/1/15
Tue12/23/14 Tue12/23/14
Wed12/10/14 Wed12/10/14
Tue11/25/14 Tue11/25/14
Mon11/3/14 Mon11/3/14
Start
TownofCanton
ChangeinServicePlanningSchedule
2015
Q1
12/23
12/10
11/25
11/3
Q4
Q2
Q3
9/1
Q4
12/15
2016
Q1
Q2
7/1
6/30
Q3
Town of Canton
Fire & EMS
Upgrade to Paramedic Level Service
Scalability and
Exit Strategy
Section 7
If after operating the paramedic level service it is determined to be economically unfeasible then
the Town could elect to terminate the service agreement with the staffing company and liquidate
the equipment procured at start-up.
If it is determined that the paramedic level of service is working practically but receivables are
inconsistent with continuation the Town could elect to solicit proposals to completely outsource
the emergency medical services and liquidate all equipment and apparatus. This decision would
effectively disband the volunteer emergency medical service in Town.
Town of Canton
Fire & EMS
Upgrade to Paramedic Level Service
EMS Study
Committee
Report
Section 8
Town of Canton
Fire & EMS
Upgrade to Paramedic Level Service
Reference
Materials
Section 9
February
14
Final Report
Executive Summary
The regulation of Emergency Medical Services (EMS) at the state level is the
responsibility of the Department of Public Health. Services are delivered by way
of a variety of organizational structures at the local level: commercial, nonprofit,
volunteer, and sometimes combination organizations that are a hybrid of these
structures.
Given the short 6-month duration of the Task Force, as well as the complexities
of the EMS System, the Connecticut Emergency Medical Services Task Force
offers the following recommendations in response to the given charge:
Task Force Charge
1. The process for designating
changing a primary service area;
Table of Contents
Executive Summary
Table of Contents
Background
Recommendation #1:
Changes to the Local EMS Plan
Recommendation #2:
DPH Shall Review Local EMS Plans Every 5 Years
10
Recommendation #3
Sale or Transfer of a PSAR
11
Recommendation #4
Removal of a PSAR
12
14
Position Statement
Submitted by Opponents of Recommendation #5
15
Position Statement
Submitted by Proponents of Recommendation #5
17
Recommendation #5:
Alternative Provision of PSA Responsibilities
18
Conclusion
19
20
24
26
28
29
Background
The PSA Concept
The concept of Primary Service Areas (PSA) was introduced in Connecticut in
1974. A PSA is a specific geographic area that is served exclusively by an
emergency medical services (EMS) provider. The State of Connecticut
Department of Public Health (DPH) designates this provider. Only the Primary
Service Area Responder (PSAR) designated by the State may answer
emergency calls in the specified geographic area. These geographic areas may
include or be within the boundaries of a municipality, tax district, tribal entity or
other specifically identified areas. For the purposes of this report, they shall be
referred to as municipalities.
The statement of intent prefacing the 1974 regulations cited the stacking of
emergency calls, rotation lists, and a lack of accountability as some of the more
serious problems that were to be eliminated by the PSA System. It was the
States intent to provide a statewide system of emergency medical services and
a coordinated response to emergency calls.
The designation of PSARs assigned statutory and regulatory responsibilities to
individual providers. It also defined levels of accountability for the coordinated
emergency medical response and patient care in specific geographic areas, thus
promoting statewide stability.
Levels of Service
There are four PSAR levels of EMS recognized and regulated by the State. They
are First Responder, Basic Ambulance, Intermediate, and Paramedic. The levels
differ in the level of training and skills performed by personnel, as well as
equipment required. Each geographic area should have at least one PSAR
designated for each level of service.
The DPH is required to assign a PSAR for each level of service for every
municipality in the state. Public Health regulations establish the factors that are
to be considered when designating an EMS provider as a PSAR. A single PSAR
may be certified or licensed to provide one or more of these levels of service.
Only five broad standards related to PSAs exist in the current Statutes and
Regulations.
Current Statutes and Regulations Related to PSAs
1. PSARs are required to respond to all emergency calls 24 hours a day, 7
days a week. There is no defined response time standard in the
Regulations of Connecticut State Agencies Sec. 19a-179-11. Availability
of response services
2. PSARs may lose their assignments if OEMS determines it is in the best
interests of patient care to do so; as prescribed in the Regulations of
Connecticut State Agencies Sec. 19a-179-4(d) as well as CGS Sec. 19a177(12) and CGS Sec. 19a-181c (c).
3. Municipalities may petition the commissioner to suspend a PSA holder if
the chief administrative officer can demonstrate that an emergency exists
and that the safety, health, and welfare of the citizens of the affected area
are jeopardized by the performance of the PSA responder. In accordance
with CGS Sec. 19a-181c (b) and the Regulations of Connecticut State
Agencies Sec. 19a-179-4(e).
The performance of the responder is unsatisfactory based on the Local
EMS Plan established by the municipality pursuant to CGS Sec. 19a-181c
(b) and associated agreements or contracts.
4. If any licensed or certified ambulance service fails to submit required EMS
information for a specified period of time, the Commissioner may take
action in accordance with CGS Sec. 19a-177-8(a)(c).
5. A municipality may petition the Commissioner, not more than once every
three years, for the removal of a PSAR on the grounds of unsatisfactory
performance in accordance with CGS Sec. 19a-181c (b).
Weaknesses
Municipalities have limited or no input in choosing or changing their PSAR
Municipalities and PSARs are not proficient with current State Statutes and
Regulations that pertain to the PSA System
Historically inconsistent application of current Statutes and Regulations
There have not been recent updates to State Statutes and Regulations
Opportunities
Establish a foundation for statewide performance standards that are
measurable, achievable and objective, which include review and enforcement
components
Streamline the process for municipalities to change providers based on nonperformance
Evaluate the status of Local EMS Plans
Use data to identify opportunities for additional education of all system
stakeholders
Establish periodic reviews for all Local EMS Plans
Threats
Increasing demand for services
Decrease in reimbursements
Erosion of trust between municipalities and PSAR holders due to a lack of
transparency and inclusion
Challenges created by oversight of 169 municipalities
Potential for deregionalization
EMS system fragmentation and isolation
The Task Force Members used the results of their collective SWOT Analysis as
the basis for the recommendations being offered in this report.
Recommendation #2: DPH Shall Review Local EMS Plans Every 5 Years
DPH shall conduct a review of the EMS delivery system in every municipality in
Connecticut a minimum of every five years.
Such review shall include, and independently evaluate, the following elements for
compliance with CGS 19a-181b and relevant OEMS Regulations:
1. The applicable Local EMS Plan
2. Performance of all levels of assigned PSARs
DPH shall assign a rating of Meeting Performance Standards, Exceeding
Performance Standards, or Failure to Comply with Performance Standards for
each PSA reviewed.
Failure to comply may result in a DPH approved improvement plan with periodic
follow-up reviews with a 6-month time frame, subject to the approval of both the
municipality and the PSAR. Further failure to comply may result in DPH removal
of PSA assignment.
It is the position of the Task Force that Appendix E, The Local EMS Plan
Template shall be the basis for all Local EMS Plans.
EMS Plans and no community has attempted to remove a PSAR under the
statutory mechanism provided. Supporters of a "for cause" removal process
respectfully suggest that municipalities utilize the existing tools provided by the
legislature before seeking a fundamental legislative change which will have major
negative consequences on a very good EMS system. Allowing municipalities to
seek removal of an EMS PSAR without cause and without consideration of the
impact on the entire statewide system is not in the best interest of the residents
of the Connecticut.
Indiscriminate removal of any PSARs would likely
compromise Connecticuts delicate statewide system and existing mutual aid
agreements by focusing solely on the individual municipality.
Conclusion
The Connecticut EMS PSA Task Force was made up of professionals who are
dedicated to the quality delivery of EMS to all people in the State of Connecticut.
The Task Force applied their cumulative years of experience and training to
complete its legislated charges.
Each member of the Task Force appreciates the dedication and time of their
counterparts. Task Force members also appreciate and thank the members of
the Connecticut Legislature, Connecticut Department of Public Health Staff, and
the public who attended meetings and offered insightful comments. Input from all
of these interested parties was seriously considered by the Task Force.
In conclusion, the Task Force recommends that the Connecticut Legislature
continue the effort to reform and adjust the EMS PSA system using this report as
an exceptional and enabling resource which supports needed changes to an
EMS system that is so critically vital to the citizens of the State of Connecticut.
subject of an investigation. The commissioner may petition the superior court for
the judicial district of Hartford to enforce such order or any action taken
pursuant to section 19a-17. The commissioner shall give notice and an
opportunity to be heard on any contemplated action under said section 19a-17.
Sec. 2. Section 19a-195a of the general statutes is repealed and the following is
substituted in lieu thereof (Effective October 1, 2013):
(a) The Commissioner of Public Health shall adopt regulations in accordance
with the provisions of chapter 54 to provide that emergency medical technicians
shall be recertified every three years. For the purpose of maintaining an
acceptable level of proficiency, each emergency medical technician who is
recertified for a three-year period shall complete thirty hours of refresher
training approved by the commissioner, or meet such other requirements as may
be prescribed by the commissioner.
(b) The commissioner shall adopt regulations, in accordance with the provisions
of chapter 54, to (1) provide for state-wide standardization of certification for
each class of (A) emergency medical technicians, including, but not limited to,
paramedics, (B) emergency medical services instructors, and (C) [medical
response technicians] emergency medical responders, (2) allow course work for
such certification to be taken state-wide, and (3) allow persons so certified to
perform within their scope of certification state-wide.
Sec. 3. (Effective from passage) (a) There is established, within the Department of
Public Health and within available appropriations, the Connecticut emergency
medical services primary service area task force. The task force shall review
topics, including, but not limited to, the following: (1) The current process for
designating and changing primary service areas; (2) local primary service area
contract and applicable subcontract language and emergency medical services
plans as such language and plans vary among municipalities and as such
contracts and plans pertain to performance and oversight measures; (3) methods
to designate emergency medical service providers that are used by other states
that have populations, geography and emergency medical services systems that
are similar to those of this state; and (4) the process by which municipalities may
petition for a change or removal of a primary service area responder.
(b) The task force shall consist of the following members:
(1) Five members appointed by the Commissioner of Public Health, one each of
whom shall be: (A) A representative of a municipal emergency medical services
provider; (B) a representative of a for-profit ambulance service; (C) a
representative of the Connecticut Hospital Association; (D) a representative of a
Final Report Approved February 7, 2014
(f) All appointments to the task force shall be made not later than thirty days
after the effective date of this section. The Commissioner of Public Health or the
commissioner's designee shall schedule the first meeting of the task force. A
majority of the task force members shall constitute a quorum. A majority vote of
a quorum shall be required for any official action of the task force.
(g) The administrative staff of the Department of Public Health shall serve as
administrative staff of the task force.
(h) Not later than February 15, 2014, the task force shall report, in accordance
with the provisions of section 11-4a of the general statutes, to the joint standing
committee of the General Assembly having cognizance of matters relating to
public health concerning its activities, as described in subsection (a) of this
section. Such report shall include, but need not be limited to, recommendations
concerning: (1) The process for designating and changing a primary service area;
(2) improvements to local primary service area contract and applicable
subcontract language and emergency medical services plans, including
provisions of such contracts and plans relating to performance measures and
oversight by municipalities of primary service area responders; (3) a process for
expanding or enhancing emergency medical services offered in local primary
service areas; (4) a mechanism for reporting adverse events to the Department of
Public Health and for said department to issue a response; and (5) an outreach
plan to educate municipalities on their rights and duties as holders of contracts
and subcontracts for primary service area responders.
(i) The task force shall submit its report on February 15, 2014. The task force shall
terminate on the date it submits its report.
Approved July 12, 2013
Appointing Authority
1.
A representative of a
municipal emergency
medical services provider
Commissioner of Public
Health, Jewel Mullen
Gary Wiemokly
Director of EMS
Town of Enfield
Appointee
2.
Commissioner of Public
Health, Jewel Mullen
3.
A representative of the
Connecticut Hospital
Association
Commissioner of Public
Health, Jewel Mullen
Carl Schiessl
Director of Regulatory Advocacy
Connecticut Hospital Association
4.
A representative of a
nonprofit emergency
medical services provider
Commissioner of Public
Health, Jewel Mullen
Joseph Danao
Deputy Chief
Gardner Lake Volunteer Fire
Company Salem
5.
A representative of the
emergency medical
services advisory board,
established pursuant to
section 19a-178a of the
general statute
Commissioner of Public
Health, Jewel Mullen
Charlee Tufts
Executive Director
Greenwich EMS
6.
Mary-Ellen Harper
Director of Fire & Rescue
Services
Town of Farmington
7.
A representative of a
municipal public safety
board, public safety
agency, or municipal
legislative body
8.
Matthew Galligan
Town Manager
South Windsor
9.
A representative of an
emergency medical
services provider that
primarily provides fire
services
Thomas G. Ronalter
Fire Chief
New Britain Fire Department
Brooklyn, Canterbury,
Killingly, Mansfield,
Putnam, Scotland,
Thompson & Windham
Appointing Authority
Bruce Baxter
Chief
New Britain EMS
Appointee
Seth Roberts
West Haven Fire Dept.
Vincent Landisio
Fire Chief
North Haven Fire Department
David Lowell
Executive Vice President/Chief
Operating Officer
Hunters Ambulance
Meriden, CT
Commissioner of Public
Health Jewel Mullen
Raphael M. Barishansky
Director
Office of Emergency Medical
Services
Task Force Co-Chair
It is incumbent upon both municipalities and the EMS agencies that service them
to avail themselves of all opportunities for communication on issues of mutual
concern.
The Office of Emergency Medical Services looks forward to working with both
EMS agencies and municipalities to strengthen the statewide EMS system.
________________________________________________________________________________________________
6. What EMD performance standards have you set for your PSAP?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
II.
______No
9. Identify the target percent of the total EMS first call requests to be answered by
the PSAR in a 12 month period:
_________________________________________________________________________________________________
10. Name of sponsor hospital providing medical direction and quality assurance
oversight:
_________________________________________________________________________________________________
11. Name of Medical Director:
_________________________________________________________________________________________________
B. SUPPLEMENTAL FIRST RESPONDER (if applicable)
_________________________________________________________________________________________________
1. Chief of Service __________________________________________________________________________
2. Address of Service
________________________________________________________________________________________________
3. Is this service the assigned primary service area responder? _______Yes _______No
If yes, list the geographical boundaries of the primary service area.
________________________________________________________________________________________________
4. Does the service provide AED as first responder? _______________Yes _____________No
5. Who provides mutual-aid coverage to the First Responder service?
_________________________________________________________________________________________________
6. Do you have a written mutual-aid agreement for First Responder service?
_________________________________________________________________________________________________
7. Does this service respond to other municipalities for mutual aid? ____Yes _______No
If yes, list municipalities: ___________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. Identify the desired response time* performance standards for the Supplemental
First Responder response in fractile format:
Under ____ Minutes ____ % of responses for light and siren emergency responses.
Under ____ Minutes ____ % of responses for non-light and siren emergency
responses.
9. Identify the target percent of the total EMS first call requests to be answered by
the PSAR in a 12-month period:
_____________________________________________________________________________________________
10. Name of sponsor hospital providing medical direction and quality assurance
oversight:
_________________________________________________________________________________________________
5. 11. Name of Medical Director:
_________________________________________________________________________________________________
C. BASIC AMBULANCE SERVICE
_________________________________________________________________________________________________
1. Chief of Service ___________________________________________________________________________
2. Address of Service
_________________________________________________________________________________________________
3. Is this service the assigned primary service area responder? _______Yes _______No
If yes, list the geographical boundaries of the primary service area.
_________________________________________________________________________________________________
4. Who provides mutual-aid coverage to the basic ambulance service?
_________________________________________________________________________________________________
5. Do you have a written mutual-aid agreement for basic ambulance service?
_________________________________________________________________________________________________
6. Does this service respond to other municipalities for mutual aid? _____Yes _____No
If yes, list municipalities: ____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Identify the desired response time* performance standards for the Basic
Ambulance response in fractile format:
Under ____ Minutes ____ % of responses for light and siren emergency
responses.
Under ____ Minutes ____ % of responses for non-light and siren emergency
responses.
8. Identify the target percent of the total EMS first call requests to be answered by
the PSAR in a 12 month period:
_________________________________________________________________________________________________
9. Name of sponsor hospital providing medical direction and quality assurance
oversight:
_________________________________________________________________________________________________
10. Name of Medical Director:
_________________________________________________________________________________________________
D. PARAMEDIC SERVICE
________________________________________________________________
1. Chief of Service __________________________________________________________________________
2. Address of Service
_________________________________________________________________________________________________
3. Is this service the assigned primary service area responder? ________Yes ______No
If yes, list the geographical boundaries of the primary service area.
_________________________________________________________________________________________________
4. Who provides mutual-aid coverage to the paramedic service?
_________________________________________________________________________________________________
5. Do you have a written mutual-aid agreement for paramedic service?
_________________________________________________________________________________________________
6. Does this service respond to other municipalities for mutual aid? ______Yes ____No
If yes, list municipalities: ____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Identify the desired response time* performance standards for the Paramedic
Service response in fractile format:
Under ____ Minutes ____ % of responses for light and siren emergency
responses.
Under ____ Minutes ____ % of responses for non-light and siren emergency
responses.
8. Identify the target percent of the total EMS first call requests to be answered by
the PSAR in a 12 month period:
_________________________________________________________________________________________________
9. Name of sponsor hospital providing medical direction and quality assurance
oversight:
_________________________________________________________________________________________________
10. Name of Medical Director:
_________________________________________________________________________________________________
____________No
2. Describe the process used for review, maintenance and improvement of the
quality of the delivery of medical care:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Is the Sponsor Hospital involved in this process? ______________Yes ________________No
3. Describe the methodology used to make EMS system improvements within the
municipality:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Describe the process used to document and report adverse events:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Is the Sponsor Hospital informed of adverse events affecting patient care?
_____Yes _____No
heartsafe-community org
http://www.ct.gov/dph/lib/dph/communications/hs_brochure.pdf
3. .Does the municipality offer other forms of public education and information
related to its EMS system on a regular and structured basis? _________ Yes _________No
Describe:______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
___ Yes
___ Yes
___ Yes
___ Yes
___No
___No
___No
___No
Describe:
________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
2. Is the municipality and/or provider involved with their Regional EMS Council?
Municipality Representative?
First Responder Representative?
Basic Ambulance Service Representative?
Paramedic Service Provider Representative?
___ Yes
___ Yes
___ Yes
___ Yes
___No
___No
___No
___No
Describe:
________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
3. Is the municipality and/or provider involved in statewide EMS committees,
organizations, activities, etc.?
Municipality Representative?
First Responder Representative?
Basic Ambulance Service Representative?
Paramedic Service Provider Representative?
___ Yes
___ Yes
___ Yes
___ Yes
___No
___No
___No
___No
Describe:
________________________________________________________________________
_________________________________________________________________________________________
Final Report Approved February 7, 2014
_________________________________________________________________________________________
_________________________________________________________________________________________
*For the standardized purpose of this plan, fractile response time at each level
should be based on time of dispatch of the responder to the arrival at scene of
the responder. Communities may measure other elements of response times as a
part of their systems review and planning.
VII. Attachments
All subcontracts, written agreements or mutual aid call agreements that emergency
medical services providers have with other entities to provide services identified in
the plan.
List the document type and date submitted
Document Type
Office
_________________________
_________________________
__________________________________
_________________________
__________________________________
_________________________
__________________________________
_________________________
__________________________________
_________________________
__________________________________
_________________________
__________________________________
Reviewer Name
________________
________________
________________
________________
________________
Comments
_________________________
_________________________
_________________________
_________________________
_________________________
MEMORANDUM
DATE:
November 1, 2013
TO:
FROM:
RE:
Please find enclosed, for your review a copy of the Department of Public Healths 2013 Legislative
Proposals.
My staff and I have carefully analyzed the enclosed proposals and feel that these initiatives, if
passed by the General Assembly, will allow the Department to better ensure the quality and delivery
of services to the public. The bills we are submitting in order of priority are:
1. An Act Concerning Various Revisions to the Public Health Statutes
2. An Act Amending the Sovereign Immunity Waiver Regarding the Department of Public
Health
3. An Act Enabling the Department of Public Health to Contract with Other States
4. An Act Concerning Online Applications and License Renewal
5. An Act Concerning Meningococcal Vaccines for College Students Residing on Campus
6. An Act Concerning The Inspection Of Ambulances
7. An Act Concerning Advanced Emergency Medical Technicians
8. An Act Concerning Streamlining the Takeover Proceedings and Certificates of Public
Convenience and Necessity
9. An Act Concerning Medical Orders for Life Sustaining Treatment
10. An Concerning Return of Unexpended Local Health Per-Capita Funds and Proration of
Local Health Per-Capita Funds When Towns Join Health Districts
11. An Act Concerning Nursing Facility Management Services
12. An Act Concerning On-Site Breastfeeding In Day Care Facilities
13. An Act Concerning Genealogists Access to Vital Records Vaults
14. An Act Concerning Reporting Requirements For Radon-Related Disciplines
15. An Act Concerning Electronic Physician Signatures
16. An Act Concerning Penalties for Failure To Comply With A Recall Of Shellfish.
17. An Act Concerning The Freedom of Information Act.
We have forwarded our legislative initiatives to the appropriate administrative agencies. Please let
me know if you have any questions or if I can provide you with additional information. I look
forward to working with you on this agenda.
TABLE OF CONTENTS
An Act Concerning Various Revisions to the Public Health Statutes...3
An Act Amending the Sovereign Immunity Waiver Regarding the
Department of Public Health.42
An Act Enabling the Department of Public Health to Contract with Other States...50
An Act Concerning Online Applications and License Renewal...53
An Act Concerning Meningococcal Vaccines for College Students Residing on Campus..56
An Act Concerning The Inspection Of Ambulances.60
An Act Concerning Advanced Emergency Medical Technicians.....64
An Act Concerning Streamlining the Takeover Proceedings and Certificates of Public
Convenience and Necessity...69
An Act Concerning Medical Orders for Life Sustaining Treatment..76
An Concerning Return of Unexpended Local Health Per-Capita Funds and Proration of Local
Health Per-Capita Funds When Towns Join Health Districts81
An Act Concerning Nursing Facility Management Services.84
An Act Concerning On-Site Breastfeeding In Day Care Facilities...87
An Act Concerning Genealogists Access to Vital Records Vaults..94
An Act Concerning Reporting Requirements For Radon-Related Disciplines.98
An Act Concerning Electronic Physician Signatures..102
An Act Concerning Penalties for Failure To Comply With A Recall Of Shellfish.105
An Act Concerning The Freedom Of Information Act...108
Origin of Proposal
___ New Proposal
If this is a resubmission, please share:
___ Resubmission
(1) What was the reason this proposal did not pass, or if applicable, was not included in the
Administrations package?
(2) Have there been negotiations/discussions during or after the previous legislative session to
improve this proposal?
(3) Who were the major stakeholders/advocates/legislators involved in the previous work on this
legislation?
(4) What was the last action taken during the past legislative session?
PROPOSAL IMPACT
Agencies Affected (please list for each affected agency)
Agency Name:
Agency Contact (name, title, phone):
Date Contacted:
Approve of Proposal
___ YES
___NO
___Talks Ongoing
62
___NO
Fiscal Impact (please include the proposal section that causes the fiscal impact and the
anticipated impact)
Municipal (please include any municipal mandate that can be found within legislation)
State
Federal
Additional notes on fiscal impact
Policy and Programmatic Impacts (Please specify the proposal section associated with the
impact)
Sec 1. Subdivision (23) of subsection (c) of section 19a-14 of the general statutes is repealed
and the following is substituted in lieu thereof:
(23) Emergency medical technician, [advanced emergency medical technician,] emergency medical
responder and emergency medical services instructor;
Sec 2. Section 19a-178a of the general statutes is repealed and the following is substituted in
lieu thereof:
63
(a) There is established within the Department of Public Health an Emergency Medical Services
Advisory Board.
(b) The advisory board shall consist of members appointed in accordance with the provisions of this
subsection and shall include the Commissioner of Public Health and the departments emergency
medical services medical director, or their designees. The Governor shall appoint the following
members: One person from each of the regional emergency medical services councils; one person
from the Connecticut Association of Directors of Health; three persons from the Connecticut
College of Emergency Physicians; one person from the Connecticut Committee on Trauma of the
American College of Surgeons; one person from the Connecticut Medical Advisory Committee; one
person from the Emergency Department Nurses Association; one person from the Connecticut
Association of Emergency Medical Services Instructors; one person from the Connecticut Hospital
Association; two persons representing commercial ambulance providers; one person from the
Connecticut Firefighters Association; one person from the Connecticut Fire Chiefs Association; one
person from the Connecticut Chiefs of Police Association; one person from the Connecticut State
Police; and one person from the Connecticut Commission on Fire Prevention and Control. An
additional eighteen members shall be appointed as follows: Three by the president pro tempore of
the Senate; three by the majority leader of the Senate; four by the minority leader of the Senate;
three by the speaker of the House of Representatives; two by the majority leader of the House of
Representatives and three by the minority leader of the House of Representatives. The appointees
shall include a person with experience in municipal ambulance services; a person with experience in
for-profit ambulance services; three persons with experience in volunteer ambulance services; a
paramedic; an emergency medical technician; [an advanced emergency medical technician;] three
consumers and four persons from state-wide organizations with interests in emergency medical
services as well as any other areas of expertise that may be deemed necessary for the proper
functioning of the advisory board.
Sec 3. Section 19a-179a of the general statutes is repealed and the following is substituted in
lieu thereof:
Notwithstanding any provision of the general statutes or any regulation adopted pursuant to this
chapter, the scope of practice of any person certified or licensed as an emergency medical
[technician] responder, [advanced] emergency medical technician or a paramedic under regulations
adopted pursuant to section 19a-179 may include treatment modalities not specified in the
regulations of Connecticut state agencies, provided such treatment modalities are (1) approved by
the Connecticut Emergency Medical Services Medical Advisory Committee established pursuant to
section 19a-178a and the Commissioner of Public Health, and (2) administered at the medical
oversight and direction of a sponsor hospital, as defined in section 28-8b.
Sec 4. Section 19a-179d of the general statutes is repealed and the following is substituted in
lieu thereof:
Notwithstanding the provisions of subdivision (1) of subsection (a) of section 19a-179 and section
19a-195b, the Commissioner of Public Health may implement policies and procedures concerning
training, recertification and reinstatement of certification or licensure of emergency medical
responders, emergency medical technicians[, advanced emergency medical technicians] and
paramedics, while in the process of adopting such policies and procedures in regulation form,
provided the commissioner prints notice of the intent to adopt regulations in the Connecticut Law
Journal not later than thirty days after the date of implementation of such policies and procedures.
64
Policies implemented pursuant to this section shall be valid until the time final regulations are
adopted.
Sec 5. Section 19a-195b of the general statutes is repealed and the following is substituted in
lieu thereof:
(a) Any person certified as an emergency medical technician, [advanced emergency medical
technician,] emergency medical responder or emergency medical services instructor pursuant to this
chapter and the regulations adopted pursuant to section 19a-179 whose certification has expired may
apply to the Department of Public Health for reinstatement of such certification as follows: (1) If
such certification expired one year or less from the date of application for reinstatement, such
person shall complete the requirements for recertification specified in regulations adopted pursuant
to section 19a-179, as such recertification regulations may be from time to time amended; (2) if
such certification expired more than one year but less than three years from the date of application
for reinstatement, such person shall complete the training required for recertification and the
examination required for initial certification specified in regulations adopted pursuant to section
19a-179, as such training and examination regulations may be from time to time amended; or (3) if
such certification expired three or more years from the date of application for reinstatement, such
person shall complete the requirements for initial certification specified in regulations adopted
pursuant to section 19a-179, as such initial certification regulations may be from time to time
amended.
(b) Any certificate issued pursuant to this chapter and the regulations adopted pursuant to section
19a-179 which expires on or after January 1, 2001, shall remain valid for ninety days after the
expiration date of such certificate. An such certificate shall become void upon the expiration of such
ninety-day period.
Sec 6. Section 19a-197a of the general statutes is repealed and the following is substituted in
lieu thereof:
[(a) As used in this section, emergency medical technician means (1) any class of emergency
medical technician certified under regulations adopted pursuant to section 19a-179, including, but
not limited to, any advanced emergency medical technician, and (2) any paramedic licensed
pursuant to section 20-206ll. (b)] Any emergency medical technician or paramedic who has been
trained, in accordance with national standards recognized by the Commissioner of Public Health, in
the administration of epinephrine using automatic prefilled cartridge injectors or similar automatic
injectable equipment and who functions in accordance with written protocols and the standing
orders of a licensed physician serving as an emergency department director may administer
epinephrine using such injectors or equipment. All emergency medical technicians and paramedics
shall receive such training. All licensed or certified ambulances shall be equipped with epinephrine
in such injectors or equipment which may be administered [in accordance with written protocols
and standing orders of a licensed physician serving as an emergency department director] under the
medical oversight and direction of a sponsor hospital, as defined in section 28-8b.
Sec 7. Section 20-206nn of the general statutes is repealed and the following is substituted in
lieu thereof:
65
The Commissioner of Public Health may take any disciplinary action set forth in section 19a-17
against a paramedic, emergency medical technician, emergency medical responder[, advanced
emergency medical technician] or emergency medical services instructor for any of the following
reasons: (1) Failure to conform to the accepted standards of the profession; (2) conviction of a
felony, in accordance with the provisions of section 46a-80; (3) fraud or deceit in obtaining or
seeking reinstatement of a license to practice paramedicine or a certificate to practice as an
emergency medical technician, emergency medical responder[, advanced emergency medical
technician] or emergency medical services instructor; (4) fraud or deceit in the practice of
paramedicine, the provision of emergency medical services or the provision of emergency medical
services education; (5) negligent, incompetent or wrongful conduct in professional activities; (6)
physical, mental or emotional illness or disorder resulting in an inability to conform to the accepted
standards of the profession; (7) alcohol or substance abuse; or (8) wilful falsification of entries in
any hospital, patient or other health record. The commissioner may take any such disciplinary
action against a paramedic for violation of any provision of section 20-206jj or any regulations
adopted pursuant to section 20-206oo. The commissioner may order a license or certificate holder to
submit to a reasonable physical or mental examination if his or her physical or mental capacity to
practice safely is the subject of an investigation. The commissioner may petition the superior court
for the judicial district of Hartford to enforce such order or any action taken pursuant to section 19a17. The commissioner shall give notice and an opportunity to be heard on any contemplated action
under said section 19a-17.
66
General
Assembly
February Session,
2014
*02058_______PH_*
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S
RECOMMENDATIONS REGARDING ADVANCED EMERGENCY
MEDICAL TECHNICIANS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-175 of the general statutes is repealed and the
following is substituted in lieu thereof (Effective January 1, 2017):
(24)Paramedic;
(25)Athletic trainer;
(26)Perfusionist;
(27)Master social worker subject to the provisions of section 20-195v;
(28)Radiologist assistant, subject to the provisions of section 20-74tt;
(29)Homeopathic physician;
(30)Certified water treatment plant operator, certified distribution system
operator, certified small water system operator, certified backflow
prevention device tester and certified cross connection survey inspector,
including certified limited operators, certified conditional operators and
certified operators in training; and
(31)Tattoo technician.
The department shall assume all powers and duties normally vested with
a board in administering regulatory jurisdiction over such professions.
The uniform provisions of this chapter and chapters 368v, 369 to 381a,
inclusive, 383 to 388, inclusive, 393a, 395, 398, 399, 400a and 400c,
including, but not limited to, standards for entry and renewal; grounds for
professional discipline; receiving and processing complaints; and
disciplinary sanctions, shall apply, except as otherwise provided by law,
to the professions listed in this subsection.
Sec. 3. Subsections (a) and (b) of section 19a-178a of the general statutes
are repealed and the following is substituted in lieu thereof (Effective
January 1, 2017):
(a) There is established within the Department of Public Health an
Emergency Medical Services Advisory Board.
(b)The advisory board shall consist of members appointed in accordance
with the provisions of this subsection and shall include the Commissioner
19a-175
Sec. 2
January 1, 2017
19a-14(c)
Sec. 3
January 1, 2017
Sec. 4
January 1, 2017
19a-179a
Sec. 5
January 1, 2017
19a-179d
Sec. 6
January 1, 2017
19a-195b
Sec. 7
January 1, 2017
19a-197a
Sec. 8
January 1, 2017
20-206nn
Sec. 9
January 1, 2017
19a-904(a)(5)
Statement of Purpose:
To implement the Department of Public Health's recommendations
concerning advanced emergency medical technicians.
[Proposed deletions are enclosed in brackets. Proposed additions are
indicated by underline, except that when the entire text of a bill or resolution or
a section of a bill or resolution is new, it is not underlined.]
Highlights-Led regional guidelines and policies development helping make North Central most
progressive and emulated regional guidelines in state; policies included DNR, lights and sirens,
interaction with law enforcement, pain control, STEMI Alert, spinal immobilization and chemical
restraint
Community
Organized and Led EMS Rally at State Capitol protesting dismantling of EMS agency, which eventually
led to reversal of Commissioners policies. May 19, 1997
Led successful effort to change state laws to enable paramedics to give controlled substances on
standing orders, Worked with regional, state, and federal officials to prepare case, testified before state
legislature. March 2, 2000.
Co-Chairman of American Heart Association Mission Lifeline STEMI Accelerator Project Paramedic
Training Committee. Helped organize and lectured at Paramedic STEMI Conference attended by over
100 regional paramedics, authored STEMI workbook given to all participants. September 2013
Humanitarian
Medical Missions to Dominican Republic with Saint Francis Hospital Surgical Team, functioned as
paramedic and translator. May 2005, May 2006
Hurricane Katrina - Deployed to Gulfport Mississippi in aftermath of Hurricane to assist with 911
operations. September 2005
Writing
Internationally published author and EMS commentator
Books
Paramedic on the Front Lines of Medicine (Fawcett 1998), picked by New York Public Library as one of
outstanding books of 1998, selection of Literary Guild. Translated into Japanese. Nonfiction memoir.
Rescue 471: A Paramedics Stories (Ballantine 2000). Nonfiction memoir.
Mortal Men: Paramedics on the Streets of Hartford (Dystel 2012), Novel.
Blogs
Street Watch: Notes of a Paramedic (www.medicscribe.com); 2006-2013; original member of JEMS
Fireemsblogs network, entries have been published in JEMS and EMS World, regular featured postings
on www.jems.com
Capnography for Paramedics (www.emscapnography.blogspot.com) Established in 2006, Number 1
reference site on capnography for paramedics .
Awards
CCEP - Connecticut Chapter Emergency Medical Physicians Non-Physician of the Year Award 1994 for
contributions to statewide EMS Development
Recognized by CORC Committee of Regional Chairpersons for contributions to EMS - 1994
EMS Champions Award- Saint Francis Hospital 2011 For outstanding care and EMS contributions as a
paramedic.
Speaking Engagements
Mission LifeLine Paramedic Conference, John Dempsey Case Presentation, Early Notification/STEMI
Alert, West Hartford , CT, September 2013
EMS Masters Series, Meriden, CT, Cardiac Resuscitation, April 2013
New Britain EMS Education and Leadership Symposium, October 2010
Presented multiple CMEs at Saint Francis Hospital, Hartford Hospital, New Britain EMS, Backus Hospital,
American Medical Response- West Hartford, Farmington Fire, East Hartford Fire, and Keene Medical
Center, New Hampshire and other locations on Pain Management, STEMI Care, and Capnography,
among other topics.
Monthly Presenter at John Dempsey Hospital CMEs 2008-2013
Presented at Ct EMS Conference in past years on Capnography and Writing in EMS