SENATE BILL No. 282

 

 

April 24, 2019, Introduced by Senator VANDERWALL and referred to the Committee on Health     Policy and Human Services.

 

 

 

     A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending section 20919 (MCL 333.20919), as amended by 2018 PA

 

383.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 20919. (1) A medical control authority shall establish

 

written protocols for the practice of life support agencies and

 

licensed emergency medical services personnel within its region.

 

The medical control authority shall develop and adopt the protocols

 

required under this section in accordance with procedures

 

established by the department and shall include all of the

 

following:

 

     (a) The acts, tasks, or functions that may be performed by

 

each type of emergency medical services personnel licensed under

 

this part.

     (b) Medical protocols to ensure the appropriate dispatching of

 

a life support agency based upon medical need and the capability of

 

the emergency medical services system.

 

     (c) Protocols for complying with the Michigan do-not-

 

resuscitate procedure act, 1996 PA 193, MCL 333.1051 to 333.1067.

 

     (d) Protocols defining the process, actions, and sanctions a

 

medical control authority may use in holding a life support agency

 

or emergency medical services personnel accountable.

 

     (e) Protocols to ensure that if the medical control authority

 

determines that an immediate threat to the public health, safety,

 

or welfare exists, appropriate action to remove medical control can

 

immediately be taken until the medical control authority has had

 

the opportunity to review the matter at a medical control authority

 

hearing. The protocols must require that the hearing is held within

 

3 business days after the medical control authority's

 

determination.

 

     (f) Protocols to ensure that if medical control has been

 

removed from a participant in an emergency medical services system,

 

the participant does not provide prehospital care until medical

 

control is reinstated and that the medical control authority that

 

removed the medical control notifies the department of the removal

 

within 1 business day.

 

     (g) Protocols to ensure that a quality improvement program is

 

in place within a medical control authority and provides data

 

protection as provided in 1967 PA 270, MCL 331.531 to 331.534.

 

     (h) Protocols to ensure that an appropriate appeals process is

 

in place.

     (i) Protocols to ensure that each life support agency that

 

provides basic life support, limited advanced life support, or

 

advanced life support is equipped with epinephrine or epinephrine

 

auto-injectors and that each emergency medical services personnel

 

authorized to provide those services is properly trained to

 

recognize an anaphylactic reaction, to administer the epinephrine,

 

and to dispose of the epinephrine auto-injector or vial.

 

     (j) Protocols to ensure that each life support vehicle that is

 

dispatched and responding to provide medical first response life

 

support, basic life support, or limited advanced life support is

 

equipped with an automated external defibrillator and that each

 

emergency medical services personnel is properly trained to utilize

 

the automated external defibrillator.

 

     (k) Except as otherwise provided in this subdivision, before

 

October 15, 2015, protocols to ensure that each life support

 

vehicle that is dispatched and responding to provide medical first

 

response life support, basic life support, or limited advanced life

 

support is equipped with opioid antagonists and that each emergency

 

medical services personnel is properly trained to administer opioid

 

antagonists. Beginning October 14, 2017, a medical control

 

authority, at its discretion, may rescind or continue the protocol

 

adopted under this subdivision.

 

     (k) (l) Protocols for complying with part 56B.

 

     (2) A medical control authority shall not establish a protocol

 

under this section that conflicts with the Michigan do-not-

 

resuscitate procedure act, 1996 PA 193, MCL 333.1051 to 333.1067,

 

or part 56B.

     (3) The department shall establish procedures for the

 

development and adoption of written protocols under this section.

 

The procedures must include at least all of the following

 

requirements:

 

     (a) At least 60 days before the adoption of a protocol, the

 

medical control authority shall circulate a written draft of the

 

proposed protocol to all significantly affected persons within the

 

emergency medical services system served by the medical control

 

authority and submit the written draft to the department for

 

approval.

 

     (b) The department shall review a proposed protocol for

 

consistency with other protocols concerning similar subject matter

 

that have already been established in this state and shall consider

 

any written comments received from interested persons in its

 

review.

 

     (c) Within 60 days after receiving a written draft of a

 

proposed protocol from a medical control authority, the department

 

shall provide a written recommendation to the medical control

 

authority with any comments or suggested changes on the proposed

 

protocol. If the department does not respond within 60 days after

 

receiving the written draft, the proposed protocol is considered to

 

be approved by the department.

 

     (d) After department approval of a proposed protocol, the

 

medical control authority may formally adopt and implement the

 

protocol.

 

     (e) A medical control authority may establish an emergency

 

protocol necessary to preserve the health or safety of individuals

within its region in response to a present medical emergency or

 

disaster without following the procedures established by the

 

department under this subsection for an ordinary protocol. An

 

emergency protocol established under this subdivision is effective

 

only for a limited period and does not take permanent effect unless

 

it is approved according to the procedures established by the

 

department under this subsection.

 

     (4) A medical control authority shall provide an opportunity

 

for an affected participant in an emergency medical services system

 

to appeal a decision of the medical control authority. Following

 

appeal, the medical control authority may affirm, suspend, or

 

revoke its original decision. After appeals to the medical control

 

authority have been exhausted, the affected participant in an

 

emergency medical services system may appeal the medical control

 

authority's decision to the state emergency medical services

 

coordination committee created in section 20915. The state

 

emergency medical services coordination committee shall issue an

 

opinion on whether the actions or decisions of the medical control

 

authority are in accordance with the department-approved protocols

 

of the medical control authority and state law. If the state

 

emergency medical services coordination committee determines in its

 

opinion that the actions or decisions of the medical control

 

authority are not in accordance with the medical control

 

authority's department-approved protocols or with state law, the

 

state emergency medical services coordination committee shall

 

recommend that the department take any enforcement action

 

authorized under this code.

     (5) If adopted in protocols approved by the department, a

 

medical control authority may require life support agencies within

 

its region to meet reasonable additional standards for equipment

 

and personnel, other than medical first responders, that may be

 

more stringent than are otherwise required under this part. If a

 

medical control authority proposes a protocol that establishes

 

additional standards for equipment and personnel, the medical

 

control authority and the department shall consider the medical and

 

economic impact on the local community, the need for communities to

 

do long-term planning, and the availability of personnel. If either

 

the medical control authority or the department determines that

 

negative medical or economic impacts outweigh the benefits of those

 

additional standards as they affect public health, safety, and

 

welfare, the medical control authority shall not adopt and the

 

department shall not approve protocols containing those additional

 

standards.

 

     (6) If adopted in protocols approved by the department, a

 

medical control authority may require medical first response

 

services and licensed medical first responders within its region to

 

meet additional standards for equipment and personnel to ensure

 

that each medical first response service is equipped with an

 

epinephrine auto-injector, and that each licensed medical first

 

responder is properly trained to recognize an anaphylactic reaction

 

and to administer and dispose of the epinephrine auto-injector, if

 

a life support agency that provides basic life support, limited

 

advanced life support, or advanced life support is not readily

 

available in that location.

     (7) If a decision of the medical control authority under

 

subsection (5) or (6) is appealed by an affected person, the

 

medical control authority shall make available, in writing, the

 

medical and economic information it considered in making its

 

decision. On appeal, the state emergency medical services

 

coordination committee created in section 20915 shall review this

 

information under subsection (4) and shall issue its findings in

 

writing.

 

     Enacting section 1. This amendatory act takes effect 90 days

 

after the date it is enacted into law.

 

     Enacting section 2. This amendatory act does not take effect

 

unless all of the following bills of the 100th Legislature are

 

enacted into law:

 

     (a) Senate Bill No. 200.

 

     (b) House Bill No. 4367.