03/08/1993 02:20 PM Senate HES

  The next order  of business was  SSSB 71 (EMERGENCY  MEDICAL                 
  SERVICES SYSTEM), sponsored by Senator Leman.  SENATOR LEMAN                 
  said  after  seeing  the  assessment  of  Emergency  Medical                 
  Services in Alaska completed by the National Highway Traffic                 
  Safety Administration Technical Assistance Team he concluded                 
  that  there  were  some  good  recommendations  on  updating                 
                                                                               
                                                                               
  statutes.   He  said he  worked with  people  from Emergency                 
  Medical Services  as well as  the Departments of  Health and                 
  Social  Services and  Commerce and  Economic Development  in                 
  writing SSSB 71.  He  said Alaska is fortunate to  have over                 
  3,000  volunteers  and  paramedics who  provide  a  valuable                 
  service, in many cases, at a reduced cost.                                   
                                                                               
  MARK  JOHNSON, Chief,  Emergency  Medical Services  Section,                 
  Department  of  Health  and  Social  Services, testified  in                 
  support of  SSSB 71.   He  informed the  committee that  the                 
  legislation the Emergency Medical Services Section functions                 
  under  was initially passed  by the legislature  in 1977 and                 
  was amended in  1978.  It has  not been amended since.   The                 
  National Highway Traffic and Safety Administration started a                 
  program a  few years ago to  make it possible  for states to                 
  have  an outside comprehensive  evaluation of their systems.                 
  About  38 states have taken advantage  of that process which                 
  uses federal  funds.    He  said  in  September,  1992,  the                 
  National  Traffic  Highway Safety  Administration  brought a                 
  team  of experts to Alaska from around the U.S.  Mr. Johnson                 
  said he  has  been working  with  Senator Leman's  staff  to                 
  identify areas that need changes and to address the  various                 
  components  of a  comprehensive  emergency medical  services                 
  system.  Mr. Johnson continued  to review his position paper                 
  as to what the legislation would do.                                         
                                                                               
  This legislation would:                                                      
                                                                               
  (1)  Expand authority of the EMS Section, Department of                      
       Health  and Social Services  to set  standards for                      
       Mobile Intensive Care Paramedic training programs;                      
                                                                               
  (2)  Expand the  authority of the Department  of Health                      
       and Social  Services to  address statewide  trauma                      
       care system development and to establish standards                      
       for the certification of trauma centers;                                
                                                                               
  (3)  Require  the  Department  of  Health  and   Social                      
       Services   to  establish   an  EMS   patient  care                      
       information system and  require EMS  organizations                      
       and hospital to provide data;                                           
                                                                               
  Mr. Johnson noted that currently there is a statewide trauma                 
  registry  data  system  that every  acute  care  hospital in                 
  Alaska is participating in  on a voluntary basis.   The bill                 
  would put that system  in statute.  He noted  the department                 
  also does surveys of pre-hospital emergency medical services                 
  every  year.    Approximately 75  percent  of  the ambulance                 
  services are already providing data.                                         
                                                                               
  (4)  Change the name  of the State Advisory  Council on                      
       Emergency Medical Services  to the Alaska  Council                      
       on Emergency  Medical Services,  provide that  the                      
       Council advise  the governor and  the commissioner                      
                                                                               
                                                                               
       of Health and  Social Services on EMS  issues, and                      
       specify the types  of EMS  system providers to  be                      
       appointed by the governor;                                              
                                                                               
  (5)  Expand the  authority of  the department  to adopt                      
       regulations to  charge fees for  certification and                      
       licensing of organizations;                                             
                                                                               
  (6)  Provide  for  certification  of emergency  medical                      
       dispatchers;                                                            
                                                                               
  (7)  Provide  for  the  disclosure of  medical  records                      
       information  to  pre-hospital  EMS  providers  for                      
       quality of care review and education; and                               
                                                                               
  (8)  Include  state  certified EMT  instructors  in the                      
       immunity from  liability protection  listed in  AS                      
       18.08.086.   Other provisions of  this bill  would                      
       delete   references   to   the  Statewide   Health                      
       Coordinating Council and health  systems agencies,                      
       which  no  longer  exist,  and  delete  the  words                      
       "physician  trained"  in  statutory references  to                      
       mobile intensive care paramedics (MICP's), to more                      
       accurately reflect  that MICP's  are trained  by a                      
       combination  of  physicians,   nurses  and   other                      
       paramedics.                                                             
                                                                               
  Number 298                                                                   
                                                                               
  CHAIRMAN RIEGER questioned whether the department is already                 
  doing the patient information system.  Mr. Johnson said  the                 
  answer is "yes"  and it is being done under a federal grant.                 
  Chairman Rieger said the fiscal note  is $200 thousand.  Mr.                 
  Johnson explained that if the federal  money runs out, there                 
  is no  money currently to  replace it.   If the  bill passes                 
  along with the  fiscal note, that would give  the department                 
  the  money to  continue the system.   It started  as a pilot                 
  program in 1988 and it is a very good data system.                           
                                                                               
  Chairman  Rieger  asked what  benefits  are coming  from the                 
  system.  Mr. Johnson said the system has two major purposes.                 
  One purpose is  provide data for  quality of care review  so                 
  that  the  department can  give  reports back  to hospitals.                 
  Very soon  they will be  giving reports to  the pre-hospital                 
  ambulance  services on trauma patients.  Mr. Johnson said it                 
  is a very sophisticated piece of software that was developed                 
  by the former chairman of  the American College of Emergency                 
  Physicians, Committee on  Trauma.  Included in  the software                 
  are  some parameters  that  came  out  of the  Major  Trauma                 
  Outcome Study, which was  a nationwide study done by  trauma                 
  centers throughout the U.S. in the mid 1980s.                                
                                                                               
  Mr. Johnson referred  to the other  major piece of the  data                 
  the  department  gets information  on  which relates  to the                 
                                                                               
                                                                               
  causes  and severity  of the  injuries.   Injuries  are like                 
  diseases as  they tend to  show up in clusters.   When those                 
  clusters can be identified, you can begin to look at ways to                 
  prevent  those  injuries.   He  said they  are  beginning to                 
  review  the  data  and  isolate  those  circumstances  which                 
  resulted in injuries.                                                        
                                                                               
  TODD  HUTTENLOCHER,  Medical  Director,   Emergency  Medical                 
  Services Section, Department of Health and  Social Services,                 
  testified  in  support of  SSSB 71.    He said  the enabling                 
  legislation for the EMS Section is  15 years old.  Over that                 
  time  period, the department  has identified a  need for the                 
  designation of paramedic training programs and certification                 
  of those programs within the state.   They have identified a                 
  need   for   emergency   medical    dispatch   certification                 
  standardization.  Neither  of those currently exist  and the                 
  legislation will  allow  the  department  to do  that  in  a                 
  formulated, well thought out pre-planned system.                             
                                                                               
  Number 354                                                                   
                                                                               
  There being  no further  testimony on  the measure,  SENATOR                 
  LEMAN moved to pass SSSB 71 out of the Senate HESS Committee                 
  with  individual  recommendations  and  accompanying  fiscal                 
  notes.  There being no objection, the motion passed.