Legislature(1993 - 1994)
03/28/1994 01:00 PM House JUD
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 478 - AUTHORITY TO PRONOUNCE DEATH Number 022 REP. GENE THERRIAULT, representing House District 33, thanked Chairman Porter and read a brief sponsor statement. It read: HB 478 proposes to allow mobile intensive care paramedics and emergency medical technicians to determine and pronounce death under certain circumstances. Registered paramedics or certified EMT's who are active members of the certified emergency medical service, may make the determination in the pronouncement of death. If a physician is not immediately available upon determining that the person has suffered irreversible cessation of circulatory and respiratory functions. Currently, when a member of emergency medical service begins CPR, they are required to continue resuscitation until the person recovers, the EMT or paramedic is relieved by either a medical facility or a physician. The responding parties become physically exhausted and no longer able to continue. Their physical safety is seriously threatened, or a physician pronounces the person dead. Many times physicians in medical facilities are not immediately available, and emergency medical response members are required to continue unproductive resuscitation for several hours. HB 478 would allow an EMT or paramedic to declare death in situations where a physician is not available. This will help emergency response teams to better attend to the emergency medical needs of the State of Alaska. Number 072 CRAIG LEWIS, Fairbanks via teleconference strongly urged legislators to support this bill. He said the bill was long overdue for the EMT and paramedic community. As in some cases, administering CPR for six or seven hours is a traumatic and barbaric situation to put EMT's through, as well as the family of the people involved. This bill, quite simple, would resolve that situation. Number 100 RONNI SULLIVAN, Executive Director for Southern Region Emergency Medical Services in Anchorage. She is also a licensed paramedic who has been involved in emergency services for 17 years. She supported HB 478 fully. She believed the bill to be valuable to medical service providers, particularly to rural areas and to medivac services. There are hundreds of stories about needless prolonged transportation. These cases put a lot of stress of the EMS providers, on the patients' families, and they deny the patient the right to dignity after death. Long term resuscitative efforts do not work, we know. They cause EMS yet to continue, often with red lights and siren over very isolated, snowy, dangerous routes. She fears this endangers someone else's life, trying to continue resuscitation that everyone knows will not work. At the same time that resuscitation service continues, often medivac services have been called in at a great expense. This is a rare bill. It works for everyone. She urged support. Number 144 CHAIRMAN PORTER asked if was also concern about liability if they were not given authority to pronounce death. MS. SULLIVAN answered that they had not had a great deal of liability because they had not yet had the responsibility. Number 154 REP. JOE GREEN asked about a California law stating that you had no duty to render aid, but once you start to render aid, then you have a duty to continue. Maybe that is not a problem in Alaska, but with passing this law, it seems like it would help that individual who had gotten himself in and now is hung up for a long time. Number 171 MS. SULLIVAN answered that it absolutely would help, and the parameters in this bill are very specific for when you can stop resuscitation and when you can not. Number 178 MARK JOHNSON, Chief, Emergency Medical Services Section for the Alaska Department of Health and Social Services. He stated that they do support this bill. It starts with some definitions that everyone can agree on, such as a person who is decapitated is dead. But then the part of the bill that is most important for our EMT's is where it says, "CPR must continue for a normothermic patient up to 30 minutes, and then they can stop and declare the patient dead, or up to one hour for a hypothermic patient, because we have had some successful resuscitations after prolonged CPR for cold water near drowning, for example. We have had a lot of successes in our state but he believes the research is very clear. Any time you have to do CPR on somebody for that long a period of time, there is no hope, and I think this would be a good bill. Number 205 STEVE O'CONNOR, Assistant Chief of Emergency Services in Soldotna and also currently serves as the chair of the Alaska Council of Emergency Medical Services. He supported passing of the bill. It will go a long way in helping the paramedics through real difficult situations in rural areas. Number 220 THOMAS NAROW, Chief of Service for Interior Ambulance & Rescue Squad. They cover a large portion of the Northeast (inaudible) Borough as well as provide medivac to Interior Alaska ground ambulance (inaudible). He encouraged the support of this bill as they can get out quite remote, and as a provider, he felt this would serve as a great benefit to himself as well as to other members of his department, to be able to make that determination to provide a little dignity for the patient and their family, and put a little bit more ease in the mind of the medics who have had to work these (inaudible) for a long period of time. Number 254 CAROL MILLS, Nurse Practitioner and Clinical Coordinator for the Galena Health Center, testified offnet and supported the bill after seeing great problems for 13 years with medivac flights, which take about four hours to arrive in Galena. Number 282 YVONNE HOWARD testified offnet in support of the bill. She has been in charge of the Eagle Emergency Medical Service in Eagle for 10 years. She has worked in the emergency medical profession for 16 years. One time they tried to resuscitate a person for eight hours, rotating different people. Medivacs normally take one and one-half to two hours to arrive in Eagle. She encouraged passage of the bill. Number 316 PAUL FINCH, Fort Yukon Clinic Director for 7 years testified offnet and reconfirmed that the bill is a good idea. Number 345 BRENT URSEL, from McGrath testified offnet and felt the bill to be very important, especially for the Interior (inaudible) and small villages that don't have lighted runways, that don't have runways long enough to (inaudible). Number 376 REP. PETE KOTT motioned to move CSHB 478(HES) with individual recommendations and fiscal notes. Number 395 REP. GAIL PHILLIPS noted that the letter of intent requires additional training for EMT's, and the other requires extensive notification. On the first one requiring additional training for EMT's, she assumed this training had to be certified, yet did not see in the bill where that was stated. REP. KOTT said that it was the intent that this additional training be put into the EMT standardized training program, however, based on testimony, it is already included. He just wanted to insure that for those areas that, perhaps, did not have it, they would address the issue and also to bring it up during re-certification of annual training, however it comes about; to make sure that everybody is aware of it. Number 423 REP. JEANNETTE JAMES expressed faith in the EMT's, and she lacked concern about additional training. She understood the need for requiring extensive notification, but she wanted to know what the fiscal impact would involve. REP. KOTT answered there would be absolutely no fiscal impact. Number 440 REP. PHILLIPS asked what the technical process would be for how the notification would be put into place. One of the concerns for not having to continue resuscitation has come from the senior centers, therefore doing something with the senior centers or the people that respond in the senior arena. CHAIRMAN PORTER asked Mark Johnson if he could help with either one of those questions. Number 448 MR. JOHNSON replied that with the training, the course that provides for certification for EMT's, is a national standard curriculum, and what we would be doing here is letting people in our state know these very strictly-defined circumstances, EMT's are allowed to deviate from the typical standard practice where they do not discontinue resuscitation until they turn the patient over to a hospital, or physician, or whatnot. We can get that information out to our people and to the medical directors, all the state certified ambulance services in Alaska have to have medical directors, but not all of the EMT's are necessarily members of a state certified service, so we will get that information out if this bill passes and make sure the medical directors provide the instruction. Any additional training they get, can be applied to their re-certification hours. MR. JOHNSON also addressed the notification question. He thought the notification issue would actually be on the next bill to be heard. REP. GREEN still had a question about the duty of the average citizen, once having began CPR. He asked if passage if this bill would help in regards to the average good Samaritan? CHAIRMAN PORTER said it did not. CHAIRMAN PORTER assured Rep. Green that this bill only addresses people who are certified as EMT's and intensive care persons. There was a motion to move CSHB 478. CSHB 478(HES) was passed out of committee with individual recommendations.
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