PROPOSED
HOUSE OF REPRESENTATIVES AMENDMENTS TO S.B. 1068
(Reference to Senate engrossed bill)
Strike everything after the enacting clause and insert:
"Section 1. Section 36-2201, Arizona Revised Statutes, as amended by Laws 2014, chapter 215, section 141, is amended to read:
36-2201. Definitions
In this chapter, unless the context otherwise requires:
1. "Administrative medical direction" means supervision of emergency medical care technicians by a base hospital medical director, administrative medical director or basic life support medical director. For the purposes of this paragraph, "administrative medical director" means a physician who is licensed pursuant to title 32, chapter 13 or 17 and who provides direction within the emergency medical services and trauma system.
2. "Advanced emergency medical technician" means a person who has been trained in an advanced emergency medical technician program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.
3. "Advanced life support" means the level of assessment and care identified in the scope of practice approved by the director for the advanced emergency medical technician, emergency medical technician I-99 and paramedic.
4. "Advanced life support base hospital" means a health care institution that offers general medical and surgical services, that is certified by the director as an advanced life support base hospital and that is affiliated by written agreement with a licensed ambulance service, municipal rescue service, fire department, fire district or health services district for medical direction, evaluation and control of emergency medical care technicians.
5. "Ambulance" means any publicly or privately owned surface, water or air vehicle, including a helicopter, that contains a stretcher and necessary medical equipment and supplies pursuant to section 36-2202 and that is especially designed and constructed or modified and equipped to be used, maintained or operated primarily for the transportation of individuals who are sick, injured or wounded or who require medical monitoring or aid. Ambulance does not include a surface vehicle that is owned and operated by a private sole proprietor, partnership, private corporation or municipal corporation for the emergency transportation and in-transit care of its employees or a vehicle that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, care or treatment during transport and that is not advertised as having medical equipment and supplies or ambulance attendants.
6. "Ambulance attendant" means any of the following:
(a) An emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic whose primary responsibility is the care of patients in an ambulance and who meets the standards and criteria adopted pursuant to section 36-2204.
(b) An emergency medical responder who is employed by an ambulance service operating under section 36-2202 and whose primary responsibility is the driving of an ambulance.
(c) A physician who is licensed pursuant to title 32, chapter 13 or 17.
(d) A professional nurse who is licensed pursuant to title 32, chapter 15 and who meets the state board of nursing criteria to care for patients in the prehospital care system.
(e) A professional nurse who is licensed pursuant to title 32, chapter 15 and whose primary responsibility is the care of patients in an ambulance during an interfacility transport.
7. "Ambulance service" means a person who owns and operates one or more ambulances.
8. "Basic life support" means the level of assessment and care identified in the scope of practice approved by the director for the emergency medical responder and emergency medical technician.
9. "Bureau" means the bureau of emergency medical services and trauma system in the department.
10. "Centralized medical direction communications center" means a facility that is housed within a hospital, medical center or trauma center or a freestanding communication center that meets the following criteria:
(a) Has the ability to communicate with ambulance services and emergency medical services providers rendering patient care outside of the hospital setting via radio and telephone.
(b) Is staffed twenty-four hours a day seven days a week by at least a physician licensed pursuant to title 32, chapter 13 or 17.
11. "Certificate of necessity" means a certificate that is issued to an ambulance service by the department and that describes the following:
(a) Service area.
(b) Level of service.
(c) Type of service.
(d) Hours of operation.
(e) Effective date.
(f) Expiration date.
(g) Legal name and address of the ambulance service.
(h) Any limiting or special provisions the director prescribes.
12. "Council" means the emergency medical services council.
13. "Department" means the department of health services.
14. "Director" means the director of the department of health services.
15. "Emergency medical care technician" means an individual who has been certified by the department as an emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic.
16. "Emergency medical responder" as an ambulance attendant means a person who has been trained in an emergency medical responder program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.
17. "Emergency medical services" means those services required following an accident or an emergency medical situation:
(a) For on-site emergency medical care.
(b) For the transportation of the sick or injured by a licensed ground or air ambulance.
(c) In the use of emergency communications media.
(d) In the use of emergency receiving facilities.
(e) In administering initial care and preliminary treatment procedures by emergency medical care technicians.
18. "Emergency medical services provider" means any governmental entity, quasi-governmental entity or corporation whether public or private that renders emergency medical services in this state.
19. "Emergency medical technician" means a person who has been trained in an emergency medical technician program certified by the director or in an equivalent training program and who is certified by the director as qualified to render services pursuant to section 36-2205.
20. "Emergency receiving facility" means a licensed health care institution that offers emergency medical services, is staffed twenty-four hours a day and has a physician on call.
21. "Fit and proper" means that the director determines that an applicant for a certificate of necessity or a certificate holder has the expertise, integrity, fiscal competence and resources to provide ambulance service in the service area.
22. "Medical record" means any patient record, including clinical records, prehospital care records, medical reports, laboratory reports and statements, any file, film, record or report or oral statements relating to diagnostic findings, treatment or outcome of patients, whether written, electronic or recorded, and any information from which a patient or the patient's family might be identified.
23. "National certification organization" means a national organization that tests and certifies the ability of an emergency medical care technician and whose tests are based on national education standards.
24. "National education standards" means the emergency medical services education standards of the United States department of transportation or other similar emergency medical services education standards developed by that department or its successor agency.
25. "Paramedic" means a person who has been trained in a paramedic program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.
26. "Physician" means any person licensed pursuant to title 32, chapter 13 or 17.
27. "Police dog":
(a) Means a specially trained dog that is owned or used by a law enforcement department or agency of this state or any political subdivision of this state and that is used in the course of the department's or agency's official work.
(b) Includes a search and rescue dog, service dog, accelerant detection canine or other dog that is in use by the law enforcement agency for official duties.
27. 28. "Stretcher van" means a vehicle that contains a stretcher and that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, aid, care or treatment during transport.
28. 29. "Suboperation station" means a physical facility or location at which an ambulance service conducts operations for the dispatch of ambulances and personnel and that may be staffed twenty-four hours a day or less as determined by system use.
29. 30. "Trauma center" means any acute care hospital that provides in-house twenty-four hour daily dedicated trauma surgical services that is designated pursuant to section 36-2225.
30. 31. "Trauma registry" means data collected by the department on trauma patients and on the incidence, causes, severity, outcomes and operation of a trauma system and its components.
31. 32. "Trauma system" means an integrated and organized arrangement of health care resources having the specific capability to perform triage, transport and provide care.
32. 33. "Validated testing procedure" means a testing procedure that is inclusive of practical skills, or an attestation of practical skills proficiency on a form developed by the department by the educational training program, identified pursuant to section 36-2204, paragraph 2, that is certified as valid by an organization capable of determining testing procedure and testing content validity and that is recommended by the medical direction commission and the emergency medical services council before the director's approval.
33. 34. "Wheelchair van" means a vehicle that contains or that is designed and constructed or modified to contain a wheelchair and that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, aid, care or treatment during transport.
Sec. 2. Section 36-2201, Arizona Revised Statutes, as amended by Laws 2022, chapter 381, section 1, is amended to read:
36-2201. Definitions
In this chapter, unless the context otherwise requires:
1. "Administrative medical direction" means supervision of emergency medical care technicians by a base hospital medical director, administrative medical director or basic life support medical director. For the purposes of this paragraph, "administrative medical director" means a physician who is licensed pursuant to title 32, chapter 13 or 17 and who provides direction within the emergency medical services and trauma system.
2. "Advanced emergency medical technician" means a person who has been trained in an advanced emergency medical technician program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.
3. "Advanced life support" means the level of assessment and care identified in the scope of practice approved by the director for the advanced emergency medical technician, emergency medical technician I-99 and paramedic.
4. "Advanced life support base hospital" means a health care institution that offers general medical and surgical services, that is certified by the director as an advanced life support base hospital and that is affiliated by written agreement with a licensed ambulance service, municipal rescue service, fire department, fire district or health services district for medical direction, evaluation and control of emergency medical care technicians.
5. "Ambulance":
(a) Means any publicly or privately owned surface, water or air vehicle, including a helicopter, that contains a stretcher and necessary medical equipment and supplies pursuant to section 36-2202 and that is especially designed and constructed or modified and equipped to be used, maintained or operated primarily to transport individuals who are sick, injured or wounded or who require medical monitoring or aid.
(b) Does not include a surface vehicle that is owned and operated by a private sole proprietor, partnership, private corporation or municipal corporation for the emergency transportation and in-transit care of its employees or a vehicle that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, care or treatment during transport and that is not advertised as having medical equipment and supplies or ambulance attendants.
6. "Ambulance attendant" means any of the following:
(a) An emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic whose primary responsibility is the care of patients in an ambulance and who meets the standards and criteria adopted pursuant to section 36-2204.
(b) An emergency medical responder who is employed by an ambulance service operating under section 36-2202 and whose primary responsibility is driving an ambulance.
(c) A physician who is licensed pursuant to title 32, chapter 13 or 17.
(d) A professional nurse who is licensed pursuant to title 32, chapter 15 and who meets the state board of nursing criteria to care for patients in the prehospital care system.
(e) A professional nurse who is licensed pursuant to title 32, chapter 15 and whose primary responsibility is the care of patients in an ambulance during an interfacility transport.
7. "Ambulance service" means a person who owns and operates one or more ambulances.
8. "Basic life support" means the level of assessment and care identified in the scope of practice approved by the director for the emergency medical responder and emergency medical technician.
9. "Bureau" means the bureau of emergency medical services and trauma system in the department.
10. "Centralized medical direction communications center" means a facility that is housed within a hospital, medical center or trauma center or a freestanding communication center that meets the following criteria:
(a) Has the ability to communicate with ambulance services and emergency medical services providers rendering patient care outside of the hospital setting via radio and telephone.
(b) Is staffed twenty-four hours a day seven days a week by at least a physician licensed pursuant to title 32, chapter 13 or 17.
11. "Certificate of necessity" means a certificate that is issued to an ambulance service by the department and that describes the following:
(a) The service area.
(b) The level of service.
(c) The type of service.
(d) The hours of operation.
(e) The effective date.
(f) The expiration date.
(g) The legal name and address of the ambulance service.
(h) The any limiting or special provisions the director prescribes.
12. "Council" means the emergency medical services council.
13. "Department" means the department of health services.
14. "Director" means the director of the department of health services.
15. "Emergency medical care technician" means an individual who has been certified by the department as an emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic.
16. "Emergency medical responder" as an ambulance attendant, whose primary responsibility is driving an ambulance, means a person who has successfully completed training in an emergency medical responder program that is certified by the director or in an equivalent training program or who is approved by the emergency medical services provider's administrative medical director on file with the department.
17. "Emergency medical responder program" means a program that includes at least the following:
(a) Emergency vehicle driver training.
(b) Cardiopulmonary resuscitation certification.
(c) Automated external defibrillator training.
(d) Training in the use of noninvasive diagnostic devices, including blood glucose monitors and pulse oximeters.
(e) Training on obtaining a patient's vital signs, including blood pressure, pulse and respiratory rate.
18. "Emergency medical services" means those services required following an accident or an emergency medical situation:
(a) For on-site emergency medical care.
(b) To transport the sick or injured by a licensed ground or air ambulance.
(c) In using emergency communications media.
(d) In using emergency receiving facilities.
(e) In administering initial care and preliminary treatment procedures by emergency medical care technicians.
19. "Emergency medical services provider" means any governmental entity, quasi-governmental entity or corporation whether public or private that renders emergency medical services in this state.
20. "Emergency medical technician" means a person who has been trained in an emergency medical technician program certified by the director or in an equivalent training program and who is certified by the director as qualified to render services pursuant to section 36-2205.
21. "Emergency receiving facility" means a licensed health care institution that offers emergency medical services, is staffed twenty-four hours a day and has a physician on call.
22. "Fit and proper" means that the director determines that an applicant for a certificate of necessity or a certificate holder has the expertise, integrity, fiscal competence and resources to provide ambulance service in the service area.
23. "Medical record" means any patient record, including clinical records, prehospital care records, medical reports, laboratory reports and statements, any file, film, record or report or oral statements relating to diagnostic findings, treatment or outcome of patients, whether written, electronic or recorded, and any information from which a patient or the patient's family might be identified.
24. "National certification organization" means a national organization that tests and certifies the ability of an emergency medical care technician and whose tests are based on national education standards.
25. "National education standards" means the emergency medical services education standards of the United States department of transportation or other similar emergency medical services education standards developed by that department or its successor agency.
26. "Paramedic" means a person who has been trained in a paramedic program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.
27. "Physician" means any person licensed pursuant to title 32, chapter 13 or 17.
28. "Police dog":
(a) Means a specially trained dog that is owned or used by a law enforcement department or agency of this state or any political subdivision of this state and that is used in the course of the department's or agency's official work.
(b) Includes a search and rescue dog, service dog, accelerant detection canine or other dog that is in use by the law enforcement agency for official duties.
28. 29. "Stretcher van" means a vehicle that contains a stretcher and that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, aid, care or treatment during transport.
29. 30. "Suboperation station" means a physical facility or location at which an ambulance service conducts operations for the dispatch of ambulances and personnel and that may be staffed twenty-four hours a day or less as determined by system use.
30. 31. "Trauma center" means any acute care hospital that provides in-house twenty-four-hour daily dedicated trauma surgical services that is designated pursuant to section 36-2225.
31. 32. "Trauma registry" means data collected by the department on trauma patients and on the incidence, causes, severity, outcomes and operation of a trauma system and its components.
32. 33. "Trauma system" means an integrated and organized arrangement of health care resources having the specific capability to perform triage, transport and provide care.
33. 34. "Validated testing procedure" means a testing procedure that includes practical skills, or attests practical skills proficiency on a form developed by the department by the educational training program, identified pursuant to section 36-2204, paragraph 2, that is certified as valid by an organization capable of determining testing procedure and testing content validity and that is recommended by the medical direction commission and the emergency medical services council before the director's approval.
34. 35. "Wheelchair van" means a vehicle that contains or that is designed and constructed or modified to contain a wheelchair and that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, aid, care or treatment during transport.
Sec. 3. Title 36, chapter 21.1, article 1, Arizona Revised Statutes, is amended by adding section 36-2230, to read:
36-2230. Ambulance services; police dogs; authorization; policies and procedures; immunity
A. Each ambulance service shall authorize its emergency medical care technicians to provide emergency treatment, if trained, to a police dog that is injured in the line of duty and to transport the police dog, along with a police officer or other police personnel who are medically trained, by ambulance or another emergency medical services vehicle to a veterinary clinic or veterinary hospital equipped to provide emergency treatment to dogs, if a person is not requiring emergency medical treatment or transport at that time.
B. Each ambulance service may develop written policies and procedures for all of the following:
1. Appropriate training of the ambulance service's emergency medical care technician personnel to provide police dogs with basic level first aid, cardiopulmonary resuscitation and life-saving interventions, including administering naloxone, that are developed in consultation with a veterinarian who is licensed in this state.
2. Safe handling procedures for injured police dogs, including the use of a box muzzle, and response coordination with a law enforcement agency member who is trained in handling police dogs, that are developed in consultation with a veterinarian who is licensed in this state and a law enforcement police dog handler or trainer.
3. Identification of local veterinary facilities that will provide emergency treatment of injured police dogs on short notice.
4. Proper and complete decontamination of stretchers, the patient compartment and all contaminated medical equipment after a police dog has been transported by an ambulance or other emergency medical services vehicle.
5. Sterilization of the interior of an ambulance or other emergency medical services vehicle, including complete sanitizing of all allergens and disinfection to a standard safe for human transport before the ambulance or other vehicle is returned to human service.
C. Emergency medical care technicians and any other personnel certified under this chapter who in the performance of their duties and in good faith render emergency first aid, cardiopulmonary resuscitation, transportation or other emergency medical services to an injured police dog pursuant to this section are not personally liable as a result of rendering such aid or services.
Sec. 4. Effective date
Section 36-2201, Arizona Revised Statutes, as amended by Laws 2022, chapter 381, section 1 and this act, is effective from and after December 31, 2023."
Amend title to conform