Legislature(1993 - 1994)

03/28/1994 01:00 PM JUD

Audio Topic
* first hearing in first committee of referral
+ 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                      
  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                  
  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                       
  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                      
  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                       
  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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